Optimizing Metabolism

by Ingrid Kohlstadt, MD, MPH

Food Safety vs. Nutrition

December 10 marks the 116th army vs. navy football game and it will take place in my hometown of Baltimore, Maryland. In this December Townsend Letter on men’s health, I describe another longstanding competition: food safety vs. nutrition. My goal is to draw awareness to the inherent competition between the food safety and nutrition. Foods prepared to be free of infection are those most likely to be highly processed and the least nutritious. That creates a dilemma which this column addresses, football style.

Play Strategies

Both food safety and nutrition have the same broad mandate to keep people healthy. Therefore, at first glance it would seem that the two work in tandem. However, practically speaking, they are often at cross-purposes. I’ll elaborate.

Food safety prevents food from spreading infectious organisms and toxic byproducts. Food safety’s winning “plays” include: ultrapasteurize, freeze-dry, irradiate, enrich, microwave, deep-fry, disinfect, and transesterify.

Nutrition’s strategy is to keep people healthy by nourishing the body and its microbiome to resist infectious organisms. Nutrition’s “plays” include: fresh, fermented, organic, unprocessed and all natural.

Think of the coach who tells the quarterback to run the ball up the center when he’d rather throw a touchdown. That’s analogous to ultrapasteurization. While it protects against the serious concern of pathogenic E. coli bacteria, it prevents the healthful bacteria in the human gut from fully digesting the milk. You can’t even make yogurt from ultrapasteurized milk. I’d rather prevent E. coli by regulation of the dairy industry and thereby still have nourishing milk. There are many “plays” in modern food production wherein shortcuts increase infection and “more processing” is permitted at cost to the food’s nutritional value.

The Short Playing Season

Food safety vs. nutrition deserves public dialogue. The obvious “referees” would be the federal government. But largely due to those formidable linebackers called corporate interests, food safety vs. nutrition decisions languish without leadership. The government has kept food safety and nutrition in separate playing fields. I’ll elaborate.

At state and local health departments, restaurant inspections and outbreak investigations are conducted by the environmental health team, and nutrition by dieticians and the Women Infants Children (WIC) program.

At the Centers for Disease Control and Prevention, foodborne outbreaks and obesity prevention (through integrative medicine including nutrition) are funded by different mechanisms and conducted in different centers, leaving little opportunity for collaboration.

The FDA houses the Center for Food Safety and Applied Nutrition (CFSAN), which suggests as it should that the two work together. Unfortunately, the funding was allocated in the order in which the names are listed: According to the FDA’s own task force, which presented its findings in 2010, the money consistently ran out before it got to the “Applied Nutrition” half. Therefore CFSAN isn’t the venue that it was intended to be, since its nutrition obligations are accomplished primarily through interagency collaboration.

The NIH’s PubMed is a tremendous resource, but much of the best nutrition information, anything from bioavailability of certain foods to clinical trials in animals (who, unlike humans, really stick to their diets!), is part of another database called Agricola.

Who’s Engaged in the Game?

The organizations engaged in nutrition vs. food safety are those with real-life challenges to solve – the army and navy, for example! Take the British Navy of the 1700s. They dubbed the unassuming American white haricot bean navy bean. On long return voyages, these beans were both food safe and nutritious, which the British Navy acknowledged as essential to their historic military prowess.

Today NASA and the US Antarctic Program have also effectively engaged in the challenge. NASA’s technology has been applied to making food safer and nutritious. The health of those on the receiving end of the world’s longest supply chains is carefully researched. Public schools have engaged because nutritious foods improve academic test scores of students. VA hospitals have engaged because cost-containment studies consistently identify value in nourishing foods.

America’s Favorite Playing Field:

The Refrigerator

Each of us should be engaged. As referees of our own nutrition, we can inform ourselves how to make good calls during critical plays. Here are examples of how your home refrigerator is a playing field for food safety vs. nutrition.

When to raise the penalty flag against food safety:

• If milk doesn’t spoil in the refrigerator after 2 weeks, then your gut bacteria won’t “eat” it either.

• Packaged brussels sprouts labeled “do not freeze” are probably gassed. Freezing would force gas preservatives into the vegetables themselves.

• Bread that’s “enriched” means that the alpha, beta, gamma, and delta forms of vitamin E were stripped from the grain and then enough of one antioxidant, usually alpha-tocopherol, is “enriched” back so that it can sit in your refrigerator for longer. That’s not the protection against gluten sensitivity that most of us need

When to raise the penalty flag against nutrition:

• If you diet and stuff your fridge with good intentions, the risk of foodborne illness goes up. However appliance manufacturers already know about you and have a solution – a new refrigerator. They designed new refrigerators with engineering controls to better chill and separate those “freshies” while waiting for those good intentions to be fulfilled.

• Some people diet with sweeteners (natural and artificial) known to cause gas and bloating. These symptoms are often mistakenly thought to be food poisoning.

• Efforts to eat more nutritiously have led some people to eat foods that change medication levels. Adverse drug effects are shockingly underdiagnosed and can resemble foodborne illness.

The Game-Winning Handoff

Each year, food becomes more processed to protect against infection, but at the cost of food quality and nutrition. Would-be leaders are constrained in many ways. They consequently tend to focus on food safety due to the unwanted press from outbreaks. The focus of elected officials on food/water safety over nutrition was illustrated in the tragic handling of the Flint, Michigan, water supply – free of infection but high in toxic lead. The void in leadership doesn’t have to stop us from having both food safety and nutrition. By being proactive in our own food choices we can receive that game-winning hand-off.

Ingrid Kohlstadt, MD, MPH, FACPM, FACN

Faculty Associate, Johns Hopkins Bloomberg School of Public Health

Executive Director, NutriBee National Nutrition Competition Inc.

Editor, Advancing Medicine with Food and Nutrients (CRC Press; 2013)