Britt Robinson

FST 100B
15 March 2016
J.B. German
Food Properties: The Interview

A few years in the not-too-distant future, a young college graduate enters a warm
room, opposite three professionals in the field of nutrition. This graduate is seeking
employment in the field, and is eager to relay how invested she is in this journey to the
individuals whom she hopes will be her employers. After a brief introduction, she sits in
the chair at the table in front of the interviewers, enthusiasm evident on her face. The
interviewers exchange looks among themselves, then look to the recent graduate, who
beams.

Graduate:
Hello! Im so pleased to meet all of you, and so excited to talk to you about the
developing landscape of food, and how individuals such as myself will play an integral
part in shaping the future of our multi-faceted food system.

The interviewers nod amongst themselves. The first, sitting to the graduates left,
speaks.

Interviewer #1:
Multi-faceted system. I like that. There is the larger context, of course; people
intersect with food systems as animals and as consumers, and of course their are
always the ties of culture to food as well. And of course, if all of that werent complicated
enough, there is the global impact to consider.

Graduate:
Yes, I agree one hundred percent! The interconnectedness of people and food
and culture is astoundingly complicated, but then to top it all off, there is the growing
concern - literally! - of a rising population. While this hasnt been a concern for too
terribly long - for example since the industrial revolution and its transformation of our
own society from an agricultural to industrial model of food supply in the 20 th century -
the demands of the increasing amount of eaters in the world has shifted the
perspectives of many people from food as a mundane part of life to a commodity to be
bought and sold. Of course, with this economic viewpoint also comes the - to borrow a
term, diabolical - reduction of food to its component parts; that is to say, food is no
longer seen as mundane, but rather as a collection of vitamins, minerals, toxins, and of
course, calories, not only by those producing food and food products, but by consumers
as well.

Interviewer #1:
How do you think this shift in focus has impacted the public in general?

Graduate:
Well there are a couple of different stances that one can take on that particular
issue, and I find myself straddling the fence. On one hand, one of the fantastic
successes of the 20th centurys chemically reductionist point of view has been the
identification of essential nutrients and subsequent fortification of foods with these
compounds, which has made diseases of nutritional deficiency like goiter or rickets a
thing of the past in developed countries. Of course, on the other hand, there are
consequences to approaching problems from a reductionist point of view; for example,
by reductive thinking, it is a logical step to say that an excess of calories in the diet
leads to excess body weight, and here in the USA we see that excess body weight is
occurring even in children. The next logical step is to say that children who are
overweight should limit their caloric intake, which is a disastrous conclusion! Children
should not be limiting the food that they eat, they are growing and developing, and have
a high amount of needs - to say that children need to eat less in order to weigh less
without even addressing the issue of free-form exercise is ridiculous. So essentially, the
reductive chemistry approach to food has been both a wonderful boone and a terrible
burden, and which side of the fence I reside on ultimately depends on the topic at
hand.

Interviewer #3:
It is an interesting dichotomy indeed. And specifically in the case of mothers, this
is a very interesting conundrum; how does one justify depriving a child of nutrition after
carrying, birthing, and then investing ones own body and energy to nourishing an infant
with milk?

Interviewer #2:
 And whats more, how do those types of decisions factor into the industry of food
itself?

Graduate:
Well in truth, similar to the way that a diet is made up of more than its
component parts, these decisions and many more that are just as complicated go into
creating the web that is the food system, and in particular, what we value about foods
themselves is what is creating that web. Simply, what we value about foods and food
products is reliable safety, stability, and nourishment, and more recently with the advent
of industrialism the increasingly important traits of affordability and foods ability to
delight. And perhaps most recently - and quickly becoming most relevant - is the pillar
upholding all of these values, sustainability.

The Interviewers again nod collectively at what the Graduate can only assume
they find to be a brilliant assessment of food decision-making, and she mentally
prepares herself to be dismissed. Her hopes are dashed, however, when the
Interviewer to her left speaks.

Interviewer #1:
While this has been an interesting philosophical discourse, Im personally more
interested in your depth of knowledge. What can you tell me about food as it relates to
the patients that you hope to work with?

The graduate pauses for a moment, collecting her thoughts. After briefly
considering her options, she decides to discuss the role of sensations in food decision-
making.

Graduate:
What I recognize about my future patients - without even having to meet them -
is that they have basic drivers for what is getting their appetites attention. Humans as
animals have developed senses that are designed to seek out the maximum benefit for
themselves out of their environment. From an evolutionary perspective, weve adapted
fantastic mechanisms for extracting what we need from surrounding organisms and
environs, as well as warning systems that help us to avoid toxicants. Of course,
evolution has worked in much more than just our favor; many of the organisms that we
eat have had evolution on their side to help them develop ways to avoid predation.
Animals have honed behavior patterns like herding or physical adaptations such as
speed or flight to help avoid being eaten - although domestication of livestock has
greatly impeded any sort of advantage they have - and even plants have developed
ways to deter animals from preying on them, by such means as toxic secondary
metabolites. Considering both sides of this dichotomy - extracting nutrients and avoiding
toxins - the senses that modern animals have developed are amazingly adept, if
completely taken for granted.

Interviewer #1:
Explain what you mean by taken for granted.

Graduate:
In the simplest terms - and using humans as my example - we are all aware of
our five basic senses: sight, hearing, touch, taste, and smell. We learn about these
senses as children, in grade school, but rarely do we discuss them at length, especially
in regards to evolution. In truth, I wish that I had discussed more of the evolutionary
basis for these senses, in as much as how they were able to develop from early
evolution as single celled, simple organisms. Further discussion on this topic would
have lent to greater appreciation for the elegance of the systems that developed, but I
digress.
Getting back to the senses, lets consider vision. Our sight is our primary method
of interpreting the world around us, and its so intrinsic in all that most of us do that we
often dont stop to think of how amazing these clusters of cells and nerve tissue are.
Our sight is able to detect within a very narrow range of the electromagnetic spectrum,
and yet that narrow range is constantly supplying us with information, a fact which
surrounding plant - really, food - materials have exploited. Although food is largely
thought of as something belonging to the taste modality of the senses, sight plays a
major role in our food decisions as well. For instance, plants synthesize pigments, which
are simply highly conjugated molecules (many of which turn out to be quite beneficial for
us as vitamins and antioxidants) existing in the storage vesicles of plant cells. The fact
that plants - especially flowering plants - synthesize these molecules is no mystery;
frequently pigments can act as methods of energy capture for the plant, or as
antioxidants for protection. The great beauty of plant pigments and our reliance on
vision as a primary indicator of plant maturity and nutrients is that this combination of
traits smacks of coevolution, which drives home the point that people - like other
animals - are inextricably tied to world in which they live, much as we tend to separate
ourselves from it.
Of course, one can hardly mention this relationship without recalling that food
industries in the past and continuing today take advantage of our reliance on things like
plant pigments, by changing foods to make them appear as we think they should. A
prime example of this is nitrite which is used in processed meats today - nitrite interacts
with myoglobin in muscle tissue to create nitrosomyoglobin, which imparts a very red
(therefore seemingly fresh) color to the meats.

Interviewer #1:
Thats quite a bit of consideration for vision and food. However, In terms of the
general population, thats likely not the main sense that comes to mind when discussing
food.

Graduate:
And while I agree that that is not what people think of when considering food, I
do not believe that the sight of a particular food item should be dismissed for its power
in choice. Other senses, perhaps, have more of a relationship with gustatory delights,
but still others are considered even less important than sight. As an example, hearing is
generally not associated with food, except perhaps in the sensation of crunchy versus
soft foods. The ear is fantastic as a sensory apparatus, but certainly not as relevant to
our discussion.
At first glance, the sense of touch also appears to be somewhat irrelevant, but
when considering the tongue and its amazing ability to determine texture, this sense
becomes very impressive in food perception. The tactile sensation of pressure is
sensed by pacinian corpuscles, which are specialized cells occurring all over the body.
They are especially numerous on the tongue, which, thanks to their presence, can
sense tactile activity in the micron range! The tongue has amazing tactile function, and
is able to distinguish textures that are creamy, or powdery, or gritty, which are otherwise
undetected by sight. Many people claim sensitivity to texture in foods, and state texture
as a reason for avoiding some things - as an example, my fiance and his avoidance of
ice cream with nuts and other large pieces due to the interruption of the smooth
creaminess of the ice cream. The sensitivity with which some people approach texture
means that textural components of foods must absolutely be considered, otherwise one
runs the risk of not meeting the needs of some clients and patients.
 Of course, nothing can be said about consumer preference that doesnt include
flavor, which is the combination of taste and olfaction. Taste, like vision, is an elegant
system, designed to help nourish and protect us. Most are familiar with the five tastes -
salty, sour, sweet bitter, and umami - however they are rarely examined for their
function, but rather for their enjoyment as an aspect of food. Generally speaking, the
flavors of salty, sweet, and umami are seen to have very low taste thresholds, down to
0.0007M; however, compared to sour and bitter, this number is unimpressive. The
flavors that are associated with toxins, bitter specifically, can be detected at levels as
low as 0.000008 M, which is a testament to the selective pressure of evolution. Flavors
are detected via taste buds, which are in various structures of the tongue, consisting of
receptor cells, basal, and support cells. Mammalian receptors have been studied
extensively and characterized by Dr. Charles Zuker of UCSD, whose focus was on the
genetics of taste. He discovered three major classes of receptors which exhibit different
affinities for various flavor compounds, and what is most striking about his research is
the large amount of variability that exists among the bitter receptors - about thirty
receptors are expressed, while the sweet and savory receptors have only one type of
receptor. Again, selective advantage favors the animals that stay away from toxins, and
so its no wonder that sensitivity to bitter compounds developed so specifically.
Granted, among individuals there are variations; in populations there are
individuals who have more or less than the average amount of taste receptors, known
as supertasters and nontasters, respectively, who will also have very different palates to
consider when attempting to design diet plans.
Our sense of smell is also very important in flavor perception. At the top of the
nasopharynx - the chamber between the nose and mouth - is the olfactory epithelium: a
collection of cells whose nerves extend directly through the bone of the skull, into the
brain.Odorants bind to the receptors of these cells based on properties such as
volatility, solubility, stereochemistry, chirality, et cetera. The various types of receptors
bind to odorants, and depending on the variety of odorants and their combinations, odor
mosaics are formed, creating unique odor - and flavor - profiles.
The combination of taste and olfaction work together to create flavor, which is by
far the biggest factor in food choice - flavor, and of course, preference. As babies, when
exposed to the five basic flavors, we react in much the same ways; however as we
mature, preferences develop based on factors like meal frequency, positive associations
due to celebrations and the like, and as one would expect, culture.
 The Interviewers have all been listening, and making notes here and there,
murmuring to each other and themselves. As they come to the end of their notes and
the room quiets, the graduate smiles. She hasnt been ejected from the interview, and
as the interviewers look up from their notes to her, she prepares herself once more to
conduct goodbyes.
Again, however, this hope is dashed, as Interviewer #2 speaks.

Interviewer #2:
We cant argue that humans as animals do have very specific drivers for
keeping appetites fed. However, the food system is much bigger than the individual
eaters, bigger than most realize. What can you tell us about the larger system?

For a moment, the graduate pauses to ponder the question. The Food System
is something that she has always considered to be inclusive of the biology of humans,
but that didnt seem to be what this Interviewer was looking for.

Graduate:
Well the larger food system, the industry of food, has a lot of moving parts.
Chiefly, I would say that the aim of the industry is to profit. Many in my cohort fondly
refer to the food industry as Big Agra, and many instructors in my past have talked at
length about the industry as a conniving organization that is generally most concerned
with protecting their money in the form of their biggest assets: brand names. I myself do
think that most large businesses in the food industry are hyper-concerned about image,
however when presented during my years of classes the feeling that I always came
away with was that these companies were evil, in a sense. Now, I dont think thats true,
and to be honest I think that it also contributes to an us vs. them mentality that you see
so often in college students, but thats beside the point.
As I was saying before, there are a lot of moving parts in the industry, and in
terms of overarching themes that are ever-present, food safety is chief among them.
Not to put too fine a point on it, but food safety is the crux of consumerism, balancing
nourishment and protection. As ever, evolution plays a role here as it does in every
other aspect of life!
Evolution for us - especially in this context - describes where we fit in the food
chain, and what we eat. As I mentioned earlier, although in a different context, evolution
is driving organisms to get the most from their environment while simultaneously
protecting them from harm. This constant conflict has many different sources, and
targets, as well as varying methods of protection. In general, we must recognize the key
players in safety - which is simply the freedom from hazard and injury. THe discussion
of safety includes toxicants (increased levels of which produce harm), nutrients (wherein
deficiency is harmful), and other threats (namely biological hazards such as pathogens).
Considering all of this, there are also varying perspectives about the types of
potential hazards. In terms of threats that exist in the world - which me must be aware of
as clinicians - there are acute and chronic hazards, endogenous and exogenous toxins,
and an altogether lack of nutrients. All of these threats must be considered when
examining large industries like the food industry, which is central to keeping the
population alive and (hopefully) thriving. While these are many aspects of threats to
keep in mind, the industry as a whole, thanks to its component company parts, is very
invested in keeping the public safe. As I have mentioned, large companies that create
food products for consumers are very concerned about public safety, because they
have a lot at stake: their brands. The food system, like it or not, is a competitive
capitalist marketplace, and as such it is entirely built around consumer loyalty. If, say, an
exogenous contamination occurs by a pathogen like E. coli, consumers can panic and
abandon a brand for one that they see as less of a threat. It is this brand value that
gives large companies the greatest incentive to keep their consumers safe.

Interviewer #2:
In this field, working with patients of many different backgrounds, what can you
tell us about the types of food hazards you would expect? After all, in the nutrition field,
you would also be considered a part of the larger food industry, as a go-between for
food products and consumers.

Graduate:
I agree, although perhaps that has never been explicitly said to me before. As I
mentioned before, there are many types of hazards to be aware of: endogenous threats
like plant toxins and allergens; exogenous toxins like molds or pathogenic strains of
bacteria; and nutrient deficiencies relating to things like food choice and bioavailability of
nutrients. In all of these things there are also the acute versus chronic levels of hazard
to consider. For example, an exogenous threat like botulism toxin is certainly an acute
hazard, but another exogenous threat like consistent low doses of aflatoxin in peanut
butter1 is considered by some to be chronic. In cases like these it is important to realize

1 Remarks made in Aflatoxin, or Another Reason to Avoid Peanuts at MarksDailyApple.com

http://www.marksdailyapple.com/aflatoxins-or-another-reason-to-shun-peanuts/#axzz42co9IxFi
that dose is paramount, though I imagine that the more chronic type of threat that I will
be working with will surround issues of nutrient deficiency due to unbalanced diets, and
of course overall lack of nutrition education in the general population.

Interviewer #2:
Youve hit the nail on the head with that remark. Regarding consumer education, there
is very little widespread nutrition education in this country. Continuing to examine the
safety of foods, however, do you think that this is a problem? Considering things like
safety regulations, and fortification of essential nutrients, is nutrition education so
important?

Graduate:
I absolutely, one hundred percent believe that consumer education in nutrition is
of paramount importance. It may sound a little intense, I know, but considering how out
of touch consumers are with the processes meant to keep them safe, and how
concerned they are with more trivial matters of food production, I am completely
committed to consumer education. Just to give you an idea of where safety regulation
and consumers diverge, let me give you an example of the primary issues on the minds
of regulatory agencies: microbial threats, nutritional deficiency, environmental hazards,
toxins, pesticides and additives are the most important issues, in that order. Food
legislation in this country has been developing very aggressively for over one hundred
years, and yet, in spite of outlawing adulteration of foods, testing additives rigorously,
prohibiting carcinogens, and limiting unavoidable adulterants like pesticides, consumers
in general seem to be most concerned about additives and pesticides, and largely are
unconcerned about the deadly threats of microbes and nutritional deficiency.
Functionally, consumers are worried about food safety exactly opposite to regulatory
agencies, even though those agencies are doing everything in their power to keep
consumers alive and well. This disconnect is huge, and I believe is contributing to
consumer trends like switching from pasteurized to raw milk - which, considering
possible hazards from microbial sources, is astounding.

Interviewer #2:
Why do you think this disconnect exists?

Graduate:
 I think the disconnect stems from the idea that the food industry is an industry,
and the belief that that means the only reason for existence is profit. Even that idea is
shortsighted, however, because even if the only piece to the industry that existed was
the bottom line, it wouldnt serve the industry to completely disregard the safety of their
consumers - after all, they need consumers returning to stay viable! Beyond the distrust
of a capitalist system, however, I think that one of the big pieces of information that is
missing for consumers is what exactly regulatory agencies - like the FDA, USDA, and
EPA, and even quality control within businesses - are doing to mitigate threats. The
larger governmental agencies play a role in passing laws, but internally, companies also
use and develop Hazard Analysis Critical Control Points. These processes are
proactive, and are used to determine critical control points (where things can go wrong),
establish monitoring procedures around these, put in place corrective actions, verify that
these are performed, and keep records to ensure all control points are satisfactorily
dealt with. What that means is that things like prepared foods are considered from farm
to table, and any point in time that is deemed a possible place where something can go
wrong and harm the consumer is dealt with before it becomes a problem; its because of
this proactive approach that packaged foods come with explicit directions on how to
prepare items (like a frozen product containing meat or dairy), and because of these
points that other food-handling certifications like ServSafe 2 exist.

Interviewer #2:
Maybe if the general public had more information as to how these Critical
Control Points were dealt with, they would feel more confident in the measures taken for
their benefit. Imagine for just a moment, however, that you were a more suspicious
consumer, maybe like one of your anti-Big Agra cohorts. Do you think that if one of
these individuals - or even a lay person - had a decent understanding of food industry
regulations, that they would welcome that information? Or do you think its possible that
considering the regulations would breed more suspicion?

Graduate:
If Im following you correctly, it sounds like youre asking, what if knowing more about
regulation will make consumers think theres something worse out there than the
salmonella and E. coli outbreaks that occur every so often. It seems silly, to be honest,
2 ServSafe - National Restaurant Association certifies food handlers after instructing them how to
prepare/handle food properly, mostly to avoid pathogenic contamination. http://www.servsafe.com/home?
gclid=CjwKEAiA9om3BRDpzvihsdGnhTwSJAAkSewLmF8ZpxNAcJRqmfjCzCVexaQPQDah9EfV7X0PX-
cQERoCHk7w_wcB
that even something like protection has the potential to become a part of a conspiracy
theory. Ill grant you, its possible that knowing more about these preventative measures
could breed more suspicion, but in this case I think the bigger issue is actually making
people more aware of the true dangers of food-borne illnesses. Even with everything
that the food industry does to prevent harm, the CDC still estimates that 1 of every 6
Americans will contract a foodborne illness every year 3, and that approximately 3,000 of
those individuals will die4. That is a very small fraction of the countrys population, so I
can understand why most people dismiss these types of outbreaks - theres a mentality
of itll never be me, which is dangerous. When people start to separate themselves
from illnesses like food-borne illness, they can act carelessly and open themselves up
more to the possibility of illness themselves. So, getting back to the original question, I
think its entirely possible that awareness may breed suspicion in a small percentage of
consumers, but to that end, I think it is crucial to educate consumers about why these
protocols are in place, and elucidate real and present danger of exogenous pathogens
that these Critical Control Points are working to eliminate.
Realistically, i dont think it would be practical to educate the entire population of the
methods used in this type of quality control. While these methods are more a part of my
every-day discussion, the details of various spectrometries - mass, emission, absorption
- and different assays tend to make people without a background in science go glassy-
eyed5. That said, I do think that if the rigorous tests that are used in tandem to detect
potential hazards should at least be explained in simple terms so that the public has
some appreciation for what food regulation systems are doing to prevent disease.

Interviewer #2:
Do you think that the public would have enough confidence in that explanation?

Graduate:
Perhaps, but I imagine there would still be plenty of people who will always have
doubts. And really, doubt is a useful tool, especially when talking about health. Even
within the field, there is doubt. With all of these tools that the industry uses to detect
toxins and other hazards, there is doubt that also exists in the methods of testing. After
all, we are talking about examining materials on an atomic scale, and we are looking for

3 And in spite of my own education and warnings on the topic, I made myself sick this quarter by making
a poor food choice!
4 Estimates provided by the CDC http://www.cdc.gov/foodborneburden/index.html
5 My fiance is known for this, literally every time I talk about anything Im doing in school.
materials in the extremely complex matrices that are food materials. In all this, we have
to remember that we dont have a magical magnifying class that will definitively identify
a toxin; so we have to rely on using multiple techniques and lots of interpretation to be
confident in our judgements.
In order to quantify the amounts of toxic materials in food, there are basic levels
of quantitation that must be met to ensure that we have found whatever the materials is
were looking for. We have to be able to eliminate noise, by setting up a limit of
detection of the analyte in question, and we need to be confident of our results, by
setting a limit of linearity, which is the maximum amount of analyte detected while still
being confident of our results. In order to quantify our analyte in a meaningful way, we
have to examine it in the dynamic range, that is, between the limit of detection and the
limit of linearity.
Quantification of analytes doesnt stop there, however, because the amounts of
analytes measured is absolutely meaningless unless we take into account what that
means in the context of the food itself. Of the amount of the analyte (toxin or nutrient),
how much are we actually ingesting? To know what it is were taking in, we have to
know about serving information - how big is a serving size, and therefore the amount of
injested analyte?
We have to be sure that our samples of analyte are representative of a
population, and remain stable during storage and analysis; and in terms of quantitation
of analytes we have to be accurate and able to reproduce experiments, while
eliminating matrix interference and also being integrative of other forms of our analyte
(for example melamine, and another form, the stereoisomer cyaluronic acid; both of
these compounds need to be analyzed together because separately they are nontoxic,
but in the body they co-crystallize in the kidney and cause severe damage).

Interviewer #3:
It sounds like you have a decent idea about hazard avoidance, but these some
of these methods can likely be used for nutrient analysis as well.

Graduate:
Oh yes! Chemical analysis is a double-edged sword in that way: it can be used
for good or evil. As with hazard analysis, nutrient analysis aims to find levels of a
nutrient per a serving of food material. What comes from those analyses are nutrient
guidelines that aim to inform consumers how much should be consumed in a serving, or
in a day, but that is the tricky thing about consumers: guidelines are often disregarded
as mere suggestions, which we can see quite clearly with the Dietary Guidelines for
Americans and its many platforms - compare the quick fix for weight loss that was the
Atkins diet, which showed huge success with 60% of Americans adopting the diet,
versus less than 10% of Americans following the Dietary Guidelines, as presented by
guides like the Food Pyramid, MyPyramid, and its current iteration, MyPlate. Essentially,
quantitative analysis is absolutely critical in both the toxic and nutritive aspects of food
safety, but more than just that, these analyses have to be communicated well, so that
consumers can utilize that information to help make dietary decisions.
I find that communication is the greatest problem existing when it comes to all
issues relating to food safety, in both the nutrient and toxin sense of safety. There is a
wealth of data about pathogens and other hazards, and on nutrient needs for every
stage of life in people, and yet the public has no real intuitive sense on how to integrate
this data to create a diet. Something that I wish had come up more in my learning is
better communication methods. In my education, I recall seeing many ways that
communication failed, however there were no alternatives provided. Perhaps instead of
focusing on the failures of communication in this country, we could have seen
successes elsewhere, or even pulled from other schools of thought - like Psychology -
to decide better courses of action in terms of creating better communication platforms.

At the end of her discussion, the graduate smiles, finding her explanation of the
problems in communicating food safety to consumers to be a wonderful explanation of
the biggest problem in the industry. When the final Interviewer raises her eyes from her
most recent notes and focuses intently on the graduate, she sits up a little straighter in
her seat, sensing that a new question is forthcoming.

Interviewer #3:
Communication is certainly key, however in this field you may find that your
communication will involve more than just scare tactics. You will be required to counsel
individuals in order to better help them achieve their goals, which will require a wide
breadth of knowledge of what nourishes humans. As a former nutrition student, I would
imagine that this knowledge base is very broad.

The Graduate nods, happy that the interview has turned to what she considers to
be her strongest topic.
 Graduate:
Currently, communications stand at a combination of values, which to the
average consumer really just look like alphabet soup: DRI, EAR, RDA, AI, and UL.
Together, all of these recommendations for dietary intake describe many different
aspects of amounts of nutrients to consume, but at a glance they are somewhat
meaningless. In my field, I believe that my first point of adequate communication would
be breaking down these values to their component parts and making their meanings
digestible to clients and patients. These are the individuals who are seeking change in
their life, and they deserve to have the appropriate tools at their disposal to implement
that change.
The relationships among Estimated Average Requirement, Recommended
Dietary Allowance, Adequate Intake and Tolerable Upper Intake Limit need to be
synthesized in such a way as to educate consumers about ideals when it comes to
micronutrients specifically. Until I learned about these different values in detail, I was
also very unclear as to how and why these values were different, and so as a
professional, I recognize the need for explanation.
Really, these values are all related: the Estimated Average Requirement is the
average intake of a nutrient estimated to meet the requirements of half of healthy
individuals in a cohort, and the Recommended Dietary Allowance is simply that value
plus an additional two standard deviations (so 97-98% of healthy individuals in a
cohort). In general, this means that most individuals are getting more than they need of
a nutrient to avoid deficiency. In some cases, however, individuals are taking in enough
to the point of toxicity, which is described by the Tolerable Upper Intake Level, which is
simply the highest average amount of a nutrient that can be taken in while causing no
adverse health effects. The wide range between the RDA (where most individuals are
getting more than what they need) and the UI (representing the limit where there are no
adverse effects observed) is the Adequate Intake amount of that nutrient. Armed with
just that knowledge alone, consumers can make many decisions about food choices,
and especially supplement use!
Something to note, I said before that the components of Dietary Reference
Intakes examine micronutrients specifically, and that is because there is another
measure for macronutrients: Acceptable Macronutrient Distribution Range (AMDR). For
my purposes, I dont find this to be a very helpful measure, because even in the US,
there are a wide variety of dietary patterns, and among those, energy acquisition is not
as big an issue as micronutrient levels. Additionally, humans can survive with many
different macronutrient range compositions, many of which harken back to various
indigenous styles of eating, so these ranges are less useful than the micronutrient
ranges mentioned before.
Currently, essential nutrients and their AIs have been established, and so the
challenge now is communicating (and often times convincing) consumers to eat a diet
that ensures theyre meeting their needs. Every five years, the Dietary Guidelines in the
US aims to communicate to consumers the types of foods that they should be eating
more of and avoiding excesses of. The problem with these Guidelines is that they are
largely dismissed, as consumers eat what they want based on what tastes good to them
- flavor preferences gained over a lifetime of reinforcement by culture and society.

Interviewer #3:
Can you think of things now that you would like to be able to communicate
effectively? For instance, if I came to you as a consumer seeking better general health,
what would you tell me?

Graduate:
As a practitioner, I would stress the importance of balance, not only in the diet,
but in life as a whole: that is to say I would emphasize the need for balancing food,
sleep, stress, et cetera.
In the diet, however, I would be more specific in mentioning nutrients that need to
be balanced in order to live a healthful life. Much of this is going to stress the
importance of some specific micronutrients, especially those that have been quite
problematic in the past in terms of catastrophic diseases of deficiency.
The first of these that comes to mind is folic acid, which is well known now for its
role in the prevention of neural tube defects in newborns. Another critical nutrient with
devastating health effects due to deficiency is vitamin C, which, if deficient, is known to
cause tissue damage resulting in hemorrhaging and scurvy. A third very obvious
essential nutrient to discuss is iodine, which, in the event of deficiency, results in a very
noticeable swelling of the thyroid gland, producing the throat lump of goiter. In all, the
goal in discussing a few of the essential nutrients is not to scare consumers, but rather
to illustrate the point that the role of essential nutrients - vitamins and minerals in this
case - is absolutely vital, and that in order to achieve adequate intakes of these
nutrients, the diet must exhibit diversity. Additionally, this discussion also serves as a
reminder that many diseases of deficiency have been addressed via fortification and
enrichment, which acts as a stepping stone to communicate the effectiveness of the
food industry and regulatory powers that have contributed to overall public health.
Other discussions that I would have would revolve around the multifunctionality
of nutrients. For instance, the fat soluble vitamins A and E are not only crucial for our
own health, but also are important for functions like pigmentation (in the case of A), and
interesting in terms of bioavailability (as in vitamin E). Vitamin A has important roles in
maintaining eye health, is made of plant pigment precursors, and acts as a protector for
other nutrients, much like vitamin E and other antioxidants. Vitamin E is an antioxidant
that is implicated in skin health, but in terms of bioavailability - that is, what is usable by
our bodies - there is only one form of the vitamin that is usable; our cellular mechanisms
recognize the molecule by its stereospecificity, rendering other forms useless as
vitamins, but still wonderful as antioxidants in food materials!
The big take-home message from all of these essential nutrients, their impacts,
and their multifunctional nature is that food is very complex, and variety is key in order
to maintain overall health.
Taking a step back and looking at a larger issue that Im noticing more and more
as protein becomes a more visible issue is the idea of protein balancing. For individuals
who consume meat products, consuming the complete array of amino acids is not a
problem. However, for individuals who do not consume animal foods and rely on plant
materials as their protein sources, being conscious of protein quality is a very important
concept to keep in mind. Amino acids must be consumed in order for our bodies to
create our own proteins, and to do this we have to have the right amounts of building
blocks. There are twenty amino acids that we form into proteins, and if there are some
that are conspicuously low in the diet, those are termed limiting amino acids. Limiting
amino acids need to be communicated to consumers because these are what dictate
when our own protein synthesis stops.
In this country, generally speaking, our tastes are largely based on hedonism -
we eat what we like. Some people dont enjoy meat products or dont eat animal
products for other reasons, and because of a wide variety of other available foods, they
are able to be calorically satisfied. If these people eat only what they enjoy without
ensuring that their protein needs are being met by combining complementary protein
foods (that is, combining plant foods with different amino acid profiles to create meals
with the full range of amino acids), they will be in trouble. Similarly, if food products are
eaten for flavor, but a low variety of foods are eaten, consumers can run the risk of
nutrient deficiency. Even if foods are fortified or enriched, vitamins that are abundant in
other foods that consumers dont enjoy, but are lacking in fortified foods, may be lacking
in the diet.
Education on the topic of protein complementation will become more important
moving forward due to the unsustainability of growing animals for food and an
increasing amount of people entering the middle class (and therefore able to afford
meat products). I will communicate various ways to incorporate complementary proteins
into the diet, including the exploration of ethnic foods like combinations of cereal grains
and legumes in Mexican and Middle Eastern Cuisine.

Interviewer #3:
With the way that you want to approach diet with patients, do you think that
ethnic diets will play a role for all patients, or will this only be a consideration for people
of specific backgrounds?

Graduate:
I dont think that the discussion of ethnic foods should be limited to those of only
specific cultural groups; rather, ethnic foods should be discussed and celebrated for
their strengths with people of many different backgrounds.
The development of ethnic foods grew from eons of trial and error, of early
humans in various environments trying to take advantage of their surroundings. In fact,
it was through very early trial and error that cooking was hypothesized to occur 6, as
discussed by Dr. Richard Wrangham in his multiple works on the subject of cooking and
human evolution. The success of cooking and its subsequent enhancement of
bioavailability of nutrients have allowed humans brains to grow and allowed humans to
develop into a globally dominant species spanning the far reaches of colonizable land.
Environments of all types have been exploited, and even where some nutrients are
sparse, this trial and error has resulted in diets with foods that provide a complete array
of nutrients, as well as complementary proteins.
For these reasons, I think it is especially important to bring ethnic foods to the table in
discussion, to prove the effectiveness of their nutrient delivery, and to expose what
could be an uneducated palate to other delightful foods that may otherwise not be
considered.

Interviewer #3:

6 See works by Richard Wrangham, most notably Catching Fire: How Cooking Made Us Human
 That seems like a good start to a conversation with a patient, well-rounded in
terms of both detail and big picture points of view. What type of advice would you
provide to consumers in a marketplace, and how to navigate their way to better health
on their own?

Graduate:
Sending a consumer out into the marketplace - with all its competitive marketing
- would mean arming them with the tools to interpret advertising. The marketplace is rife
with splashes of color and loud lettering to attract attention, and products are tagged
with claims about nutrient status; terms like high fiber, less sugar, low sodium
appear around every corner and draw in consumers who are looking to find their
favorite foods - only healthier. I believe that the best way to begin the conversation
with consumers about making good choices for themselves is to inform them about
nutrition labels versus nutrient and health claims.
Nutrient claims are placed very conspicuously on the front of boxes, often
supported with other health claims. Only a few health claims are federally approved:
calcium content and the risk of osteoporosis, sodium and the risk for high blood
pressure, and fiber and the risk for heart disease are a few claims that are well-
recognized by consumers. Additional implied health claims also find their way onto
boxes, which make these products stand out even more to consumers because of the
association between frequently marketed words and the health claims that usually
accompany them - a clear example of this is cereal products that claim to be high fiber
and low fat and sodium, and also boast the use of whole grain. In the eyes of
consumers, these words function like buzzwords that soothe the desire to feel like
healthy choices have been made while taste preferences have been satisfied.
My goal with consumers is to help them recognize the inconsistencies of health
claims, and to learn to navigate nutrition labels instead. Granted, nutrition labels use %
Daily Value, which is based on a 2,000 calorie diet in the US, and an adjustment of
Average Intake to reflect percentages of micronutrients. In general, I believe that this
will be the best approach to introduce healthful decision-making. After this introduction, I
plan to have more far-reaching discussions with patients involving the specific nutrient
intake recommendations of RDA, AI, and UL, especially since those values will be more
valuable when approaching diet from a whole-foods perspective, rather than focusing so
much on food products.

Interviewer #2:
 So your goal is to eventually steer your patients away from food products and
the industry that creates these products?

Graduate:
In a sense, yes. What I want to do is help re-connect patients to their food
supply. I feel that food products, although safe in terms of not being explicitly harmful
due to regulatory agencies and brand protection, are products, and the competitive
marketplace in which they exist dont treat consumers as individuals in need of nutrition,
but instead approach them as ways to achieve profit.

Interviewer #3:
Well, its clear that your breadth and depth of knowledge is certainly satisfactory
for the work that will be required of you in the future. If you had to sum up your learning
with one idea, or one sentiment, what would it be?

Graduate:
Ive learned a lot in my years of studying nutrition 7, but the biggest, most
encouraging message that Ive taken with me in all that time is the idea of the extreme
elasticity of humans genes. A person is not doomed from the very beginning of their life
based on genetics, nor will they be forced to circle the health drain their entire life based
on a few years of bad decisions. The human genome is remarkably malleable; it
changes over time based on what we do to ourselves, what exposures we have and
what environments we interact with, and these changes can reach through generations
and affect more than just the here-and-now self. By realizing our own power to affect
our health and the health of our children, grandchildren and so on, I am confident that
consumers will want to harness that power and affect real, lasting change.
I realize that moving forward, the disease-based model of healthcare must be amended,
that clinicians such as myself must be proactive and not simply reactionary as the
disease model is. In practice, this means that I must think about health not as simply the
freedom from suffering from disease, but the freedom to live the life that one chooses
because the body can, and I must impart these values in my patients.
People have the power to guide their health and their familys health away from
disease and towards a life of joy, play, and fulfilment, and not necessarily a future that is
immobile and full of pain. As a practitioner, I will use my knowledge as a tool to help

7 Most notably: Get a helmet!

guide patients and consumers towards a healthful life, because they can and should
have it.

The graduate stops speaking, feeling the emotional attachment to this conviction
beginning to strain her voice. She looks to the Interviewers, who are looking at one
another, and she prepares herself for more questioning. One by one they smile, and the
first Interviewer, to her left, speaks.

Interviewer #1:
That is a wonderful stance to take when beginning in the clinical field of nutrition.
Thank you very much for coming in, and we look forward to working with you in the
future. Well be in touch.

The graduate beams, and nods deeply with appreciation, too overwhelmed by
the simple words to speak. In her mind, she revisits educators from her past, and
recalls one who was, in essence, the touchstone who provided the foundation of her
knowledge for this interview. If she could go back and do it all again, she would, but for
now, she mentally thanks him, and makes a mental note to email Dr. German and thank
him for the wonderful teaching and incredible inspiration he provided, which served to
reinforce her love of the interconnectedness of the field of nutrition.