Exploring the sense and nonsense of food and health

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The Obesity Epidemic: Why?

Diet and Health: With key to the calories. Lulu Hunt Peters, 1918

By Sally J. Feltner, PhD, RDN

In 2013, the American Medical Association House of Delegates approved a resolution classifying obesity as “a disease state with multiple pathophysiological aspects requiring a range of interventions.” We now accept the fact that obesity can lead to diabetes, heart disease, and cancer risks.

Today, 2.1 billion people – nearly 30% of the world’s population – are either obese or overweight, according to new data from 188 countries. The U.S. Centers for Disease Control and Prevention analysis said, “About 38 percent of U.S. adults aged 20 and older are obese as are more than 17 percent of children aged 6 to 11, federal data shows.”

“The global problem affects all countries, income levels, age groups and accounts for over 3-4 million deaths a year with estimated health costs of over $2 trillion a year.” (International Journal of Obesity).

There is no one cause. Many people still continue to blame the obese person’s lack of willpower and insist that if they just ate less and moved more, their weight would not be a problem. This may explain some cases of obesity, but how could more than 2 billion people worldwide begin to make poor choices about their food intake and allow themselves to become fat. Moreover, this upward trend earnestly began in the late 1980’s and has continued to the present. Obesity rates were just 13.4% in 1980 but reached 34.3% by 2008. So what happened to cause this sharp rise? – More than likely a lot of things.

In 2016, an article by Bruce Y. Lee, Associate Professor of International Health at Johns Hopkins Bloomberg School of Public Health succinctly describes his opinions on what factors changed to help create this epidemic. He states that obesity is a result of the breakdown of three major systems that include biological, social, and environmental factors.

Biological Systems

Our metabolic systems have been affected to some extent by non-stop dieting. A plethora of fad diets and exercise gimmicks grew into a huge obesity industry. Diet books topped Amazon and best seller lists while the supplement industry went berserk over worthless and sometimes dangerous weight loss aids. Americans responded and when surveyed, a large majority of respondents said they were “on a diet.”

Even TV reality shows (The Biggest Loser) resulted in weight loss that lowered the metabolism of almost all participants gained back their hard-fought  loss. As each weight loss attempt occurs, the cycle of weight loss/regain occurs over and over again. The body is threatened by a perceived starvation state and attempts to prevent it by putting forth metabolic and hormonal mechanisms to alleviate the threat. Obesity research has shown that nearly 95% of dieters regain their weight loss in a few years.

Social Systems

Social media, friends and family, cultural beliefs, TV advertising, and personal responsibility are all important in shaping our behaviors about eating, appearance, and body image.

Advertisements in the media have promoted the obesity epidemic by making claims that their products will magically transform your body into a svelte image and allow you to finally wear that bikini you bought years ago and that weight loss is easy. Most weight loss diets promise success by showing us before and after pictures of supposedly successful weight losers. What they do not say but disclaim in the small print that you usually can’t read is that results don’t always occur as presented. Most weight loss programs do not include an exercise component nor do they offer any behavioral counseling. Almost all have no disclosure about their success rates of weight loss and maintenance.

Environmental Systems

Determining what a healthy diet consists of is difficult enough – opinions abound and debates continue. This results in confusion and misinformation for the average consumer. They tend to give up on just what exactly is the best way to eat.

So many individuals are exposed to reliance on cheap foods found in the fast food industry. They may live in food deserts defined as parts of the country usually found in impoverished areas devoid of easy access to fresh fruit, vegetables, and other healthful whole foods. This is largely due to a lack of grocery stores, farmers’ markets, and other healthy food choices.

The food industry has been instrumental in developing ultra-processed foods that hardly resemble “real” foods. Snacking has become a national pastime and is dominating several of the inner aisles of the supermarkets. Snacks are abundant in every gas station, convenient store, or vending machine that tempt you to increase their profits.

Additionally, the food industry promotes the intake of sugar, fat and salt by attempting to reach what they call “the bliss point,” defined by the precise amount of sweetness that makes food and drink most enjoyable. You can find the results in the sugary cereals and sweetened beverage aisles in the supermarkets.

People do not cook anymore leading to procuring your meals outside the home. Restaurant portions have become gigantic compared to what they were in past decades. For example, a typical serving of theater popcorn was 270 calories (5 cups) in 1970 compared to now that is typically 630 calories (one tub). Some restaurant meals contain as many calories as we need in an entire day. The average U.S. intake increased 455 kcal/day, a 20% increase from 1970 to 2009. (Dr. Stephen Guyenet, The American Diet, 2012). From research studies we have found that the more food that is put in front of people, the more they eat. We now are familiar with the term “supersize” and the concept of “all you can eat buffets.”

The complexities of the obesity epidemic/pandemic are impossible to fully comprehend as well as their need to be “fixed” to reverse or at least slow down the trend. There are some solutions to accomplish this but they will require much cooperation between politics, community, medicine, research, government, and the public.

If America’s obesity trend continues at its current pace, all 50 states could have obesity rates above 44 percent by 2030, according to a new report from Trust for America’s Health and the Robert Wood Johnson Foundation. Although important, we need to stop just focusing on what we eat, but equally important on how we eat to fix what contributed to the epidemic in the first place.

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Will the Real Paleo Diet Stand Up?

The following article from Scientific American, April, 2017 by Peter Ungar gives us a sensible approach to the recent popularity of the so-called Paleolithic Diet. The premise of this diet is based on “the idea that modern humans evolved to  eat the way hunter-gatherers did during the Paleolithic period.” It turns out that this is not a simple matter,


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The Blue Zone Solution

Strawberries provide lots of good nutrition and can be cancer fighters.

Strawberries provide lots of good nutrition and can be cancer fighters.

This is a great book. It is so much more than just a diet book. The people of these five global areas generally are some of the longest-living and healthiest seniors on the planet. The book, The Blue Zone Solution: Eating and Living Like the World’s Healthiest People by Dan Buettner has four parts:


  1. Discovering the Blue Zones
  2. Making an American Blue Zone
  3. Building Your Own Blue Zone
  4. Blue Zone Recipes


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The Evolution of The Standard American Diet


I recently found this excellent video by Mark Bittman, an American food journalist, author and former columnist at the New York Times.  He is currently a fellow at the Union of Concerned Scientists.

He succinctly describes the origin and evolution of the Standard American Diet (SAD) in a provocative and entertaining manner. If you eat, you should listen to his 20 minute description of the heart of what we eat and why. The video was filmed in 2007, but still remains true today.


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Mr. America?

Bernarr Macfadden

Bernarr Macfadden (Photo credit: Wikipedia)

By Sally J. Feltner, PhD, RD

Every once in a while, it is fun to go back into history and rediscover the fads that were popular then – the story of Bernaar MacFadden is one of them. He was however, very successful and in my opinion, a very fascinating human being.

“In 1913, twenty year old Mary Wlliamson, a runner and muscular swimmer was crowned “Great Britain’s Perfect Woman and as part of her prize was a job offer from fitness guru, forty-four year old, Bernarr MacFadden. The job involved a traveling physical fitness show billed as “The World’s Healthiest Man and Woman.” They performed feats of physical prowess with the big finale featuring Mary’s nightly jump from a seven-foot platform onto MacFadden’s stomach. Another “prize” was becoming Bernarr’s third wife. He proposed one day when the pair was halfway through a ten-mile run and when she accepted, she recalled: “He stood on his head on me for one minute and four seconds.” Who was this man?


Bernarr MacFadden was a man that brought physical culture to America and Europe. “He stood five foot six inches tall and built a fortune from often, but not totally, misinforming the public about nutrition and health.. He was born in 1868 on a farm near Mill Springs, Missouri where his father died when he was four from chronic alcohol consumption.

Bernarr, a sickly boy, was raised by a TB-ill mother who send him away to a cheap boarding school. He later referred to this school as the “starvation school” Bernarr remembered often having peanuts as his only source of nourishment. His mother died from tuberculosis when he was eleven and Bernard, (he changed his name later to Bernaar) was sent to a northern Illinois farm to work for two years where his heath improved. He was then shipped off to St. Louis where his waiting relatives welcomed him, namely Uncle Harvey.

When walking in downtown St. Louis with his uncle one day, he discovered the Missouri Gymnasium and was impressed by the posters of musclemen displayed there. “The sickly young Barnard swore an oath: I’m going to be like them. I’m going to look like them.”

Bernarr obtained a copy of How to Get Strong and Stay So,  a bestseller in 1879 written by William Blaikie, a strongman and endurance athlete. He was further inspired to follow his dream; therefore, in the spring of 1891, Bernarr hung a shingle out that read:



He declared himself a “teacher of physical culture” to become the nation’s first personal trainer. He made up the term, kinisitherapist. No one knew what he meant.


MacFadden’s core belief mimicked the philosophy of Sylvester Graham that blamed toxins, improper diet and exercise habits, lack of sunshine and the use of tobacco and alcohol to be the reasons for most diseases. Bernard despised white flour and called it “dead food” and said: “ I saw that white bread was frequently condemned and I whenever available, secured whole wheat or Graham bread.” He did not, however, carry on the sexual restrictions of Graham.

He began a lecture series on physical culture and put up posters and small ads in the local newspapers. Each lecture started with Macfadden dressed only in a loincloth posing artistically in front of a cabinet lined with black velvet and lit from below to make him appear larger than he was.  His lectures became popular in both the U.S. and Europe.

He taught his nation-wide audiences that fresh fruits, vegetables, and whole grains were vital to good health. Today we know that his teachings about diet were relatively accurate in an era when nutrition knowledge was meager. He was not a true vegan, but used meat sparingly. His favorite food was carrots and he dutifully avoided sugar foods such as candy, cakes, pies and ice cream. He advocated eating only two meals a day and preached moderation while fasting once a week. There are some advocates that now suggest the same regimen.  He did not believe in pasteurization or homogenization of milk. He said that milk could cure many diseases. He avoided alcohol, tobacco. Of course, he advocated brisk walking, lifting weights, and prescribed calisthenics. Today’s body builders consider him the “father of physical culture.”

MacFadden published a culture magazine called Physical Culture. In 1901, he wrote: “Every disease in the human body is simply an endeavor on the part of the body to correct an abnormal condition…. It is the presence of impurities in the blood that make the production of a cold possible…Disease germs consume these poisons, or render them harmless.” By 1910, he ruled over a physical fitness empire. The empire included spas called “healthatoriums”, Physical Culture City and then Physical Culture University. He continued by promoting raw foods and salads every day and used fresh fruits to keep the intestines “antiseptic” to avoid autointoxication. He continued to avoid processed white sugar and flour.


His empire began to crumble. Research led to more knowledge about food components such as vitamins and minerals in the nutrition field. People began to lose interest in MacFadden’s ideas and his popularity declined.

In the final decade of his life, his previous wealth dwindled. He did not give up, however. He jumped out of a plane on his 83rd birthday; he did the same stunt the next year. In 1955, he was 87 and was experiencing liver and urinary tract problems. He fasted to treat his condition, but ironically died three days later due to complications from jaundice and dehydration.


Bernaar MacFadden was one of the most flamboyant and bizarre personalities in American culture; yet many people have forgotten him or have never heard of him today. He was the first food crusader to be known internationally and single-handed created the health and fitness awareness for millions of people. He continued to support detoxing and fasting that carried on the principles of Sylvester Graham. Even though some considered him a “quack,” he fought against medical quackery that began in the early 20th century. At the same time, he supported the medical practices of chiropractic and osteopathic treatments. In many aspects of his career like publishing and advertising, he was truly a genius.


The Strange Tale of a World-Changing Fitness and Sleaze Titan, Bruce Watson, 2013,

Ronald M. Deutsch, The New Nuts Among the Berries, Bull Publishing, 1977

Mark Adams, Mr. America, Harper Collins, 2009

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Pellagra: A Story from Medical History

Have you ever wondered why they add B vitamins (niacin, riboflavin, and thiamine) to flour, refined bread and pastas? We can recall the story of pellagra to answer this question.

In the early 1900’s, mental hospitals in the Southeastern U.S. treated many patients with dementia caused by a disease named pellagra. At that time, it was thought that an infectious agent or toxin caused the disease. Symptoms of a deficiency included skin rash, weakness, and mouth sores. When not treated, pellagra can lead to the 4 D’s: dementia, dermatitis, depression and death.

The disease was first noticed in Europe around 1720 and coincidentally during that time, corn or maize was beginning to be imported from the Americas to Europe where it was grown in many areas. Some physicians from Spain noticed that the disease may be associated with corn-based diets; others stuck to to the toxin theory and spent many years searching for its origin with no success.

It was not until 1907 that a major epidemic occurred in the Southeast U.S. that prompted the government to begin a series of pellagra studies. By 1928, the epidemic peaked with the number of cases reaching 7,000 deaths. One of the investigators was Dr. Joseph Goldberger who believed that diet played a role.

To show that the disease was not caused by a toxin, Goldberger and 15 others including his wife, voluntarily drank or injected themselves with blood, urine, feces and skin cells from pellagra patients and no illness occurred. They later put these materials in capsules.

It was observed that the disease struck people who ate diets  mainly of corn meal, salt pork, lard and molasses. When given meat, eggs and milk, the disease abated. Goldberger did just that in an experiment with volunteer prisoners. When most of the prisoners suffered from pellagra on the deficient diet, Goldberger concluded that the diet was the culprit and could be cured by what he called a “P-P factor.” More than 30 years later, an American biochemist, Conrad Elvehjem finally proved that the P-P factor was nicotinic acid, commonly known as the B vitamin,  Bniacin.

Not until 1936, did the Council on Foods and Nutrition of the American Medical Association recommended the fortification of food. This led to the voluntary enrichment of flour with thiamin, riboflavin, niacin and iron. This resulted in a decrease in deaths from pellagra of over 3,000 in 1938 to only about 1500 in 1943. Then mandatory enrichment in most states further decreased the death rate to nearly zero by1954.

How quickly we forget how severe a nutritional deficiency disease can become. Other deficiency diseases from B vitamins alone in the early days of refining flour included beriberi from a thiamine deficit and ariboflavinosis from a lack of riboflavin.  Refinement  stripped these nutrients  found in whole grains  resulting in a poor diet.

To this day, we still have severe problems in developing countries of death and blindness from a deficiency of vitamin A. It is estimated that 250,000 to 500,000 children go blind annually.   To alleviate the problem, food fortification and supplementation has been relatively successful in curbing the deficiency. For example, fortification of sugar in Guatemala maintains vitamin A status and in Africa and South-East Asia, growing fruits and  vegetables in home gardens complements dietary fortification. The story of pellagra was a lesson learned.