Some years back, the chef and writer Michael Ruhlman asked to meet with me to discuss my thoughts on supermarkets and ultra-processing. He took copious notes, and published several essays about my observations about the extent to which words are employed to influence and – yes – manipulate consumer behavior.
He enjoyed hearing about my patients who regularly purchased “fat-free half-n-half” without questioning its meaning and were then stunned to discover it consisted of equal parts skim milk and corn syrup.
Ruhlman liked my take on the word “healthy.” I talked about how crazy it is to describe food as healthy. It’s not the food that’s healthy, I said. It’s us. Nourishing food improves our health. And kale isn’t healthy, it’s nutritious, though not, obviously, if that’s all you eat.
Ruhlman described me as self-taught, an autodidact. Even at one of the most visionary medical schools in the country, I received essentially no nutrition education. That constituted a huge opportunity, and still does, with total hours of nutrition education now having risen to around 15 hours.
The best way for doctors to guide patients’ choices is to begin making those changes themselves. Patients don’t care what we say nearly as much as they care what we do. If those don’t match up, then it’s what you do that prevails. If you really want to make a difference, you’ve got to walk the walk, that is if you aren’t already.
Ruhlman gave a big shout-out to an important concept, the term “refined.” To refine is to remove coarse impurities. If you want to increase sales of white flour, then sure, call it refined. But if you want consumers to know that whole-grain flour is more nourishing, then white flour should be called “stripped,” which is exactly what it is. What are the consequences of stripping? To increase shelf life and profitability. Stripping is not a small thing.
Stripping removes the nourishing germ (oil) and bran (fiber), as well as many micronutrients, the absence of which results in several significant nutritional deficiencies. In the early 1900s, therefore, Congress passed legislation requiring the food industry to “enrich” bread with iron and vitamins B1, B2 and B3, and, decades later, to “fortify” it with folate (vitamin B9). What about more subtle nutritional deficiencies? I saw those in my exam rooms every day.
Here’s the overarching point: it’s OK to eat whatever you want. It’s your choice, after all. However, it’s a serious problem when you can’t figure out what your choices and their consequences are in the first place. When industry capitalizes on consumer ignorance, and that drives up health care costs, then it’s time to look at the words. That’s where I come in, and so here is my straight talk: Eat nourishing food. Be healthy.
Ruhlman said, “Words matter. … And until we have better information and clearer shared language defining our food, smart choices will be ever harder to make.”
I couldn’t have said it better.
Dr. Roxanne Sukol writes about adult health, preventative medicine and wellness for the Cleveland Jewish News. She is a retired internal medicine physician from Cleveland Clinic.