Introduction

After reviewing Can Fixing Dinner Fix the Planet by Dr. Fanzo in my last blog post, a friend replied with a post about “Sacred Cow”, a book and movie with a very different take on eating beef, basically saying that cattle can help save the planet. The argument was all very well researched and referenced. This left me in quite a quandary. Did I get it all wrong in saying that we should be eating less beef in that last post?

I have spent a lot of time tracking down a very complicated story. In fact, I think that I am going to have to start all my blogs from here on with the mantra, “It’s complicated.” Here is the complicated and intriguing version of what I found. Like so many things in our world these days, it is not black or white, and if we are not patient enough to listen to the full nuanced story, then we are not in a position to give meaningful relevant answers. I don’t say this to criticize one side or the other. Like almost everyone, I would really like short sound-bite sized answers. But that is not the world we live in. So here is a somewhat middle ground complex answer that I have come to that will probably not satisfy everyone but is the most honest answer that I can find at the moment.

First, I will explain some basics about protein nutrition with a summary of my last anti-beef post. Then a summary of the Sacred Cow pro-beef position with some pros and cons with some basics about ruminants and how they can benefit us. Then a dive into some of the complex issues surrounding the multiple uses of farmland, the conflicts with ethanol production from corn, the contribution of non-meat animal products like dairy and eggs, first world vs third world needs, and the contribution of fish to human protein nutrition. With all that in mind we will try to answer the question, should we eat less beef or meat?

Protein Basics

First, let’s start with a quick review of the basics of what humans need in terms of protein. The generally accepted wisdom among nutritionists is that adult humans require about 0.66 grams of mixed source protein per kg of body weight per day. When we convert that into the Recommended Dietary Allowance (RDA), we bump that up a bit to 0.80 g/kg to make sure that we cover everyone, even those with unusually high needs, and then we multiply it by an average body weight to give us the official RDA of 56 g/day for adult men and 46 g/day for women. We tend to bump that up some for pregnant women, for people who are aggressively weightlifting, for vegans, and for the elderly who are not metabolizing protein so well. But for most folks 19-70 years old, the RDA is just fine. How does that compare to what us Americans actually consume? On average, adult women in the US consume about 70 g/day and men consume about 100 g/day. So, when you hear that people are not consuming enough protein, please remember that we are already consuming about twice as much as we require.

Here are some finer details if you care to know. Proteins are made up of 21 amino acids, about half of which we require in our diets because our bodies do not synthesize them directly. Animal sources of food generally have all these required amino acids; not so much for the plant sources such as beans and other vegetables. But if you are a vegan and if you eat a varied diet with grains and beans and veggies and fruits, then you should be just fine, amino acid-wise. Your protein requirements are a bit higher than described above since the plant protein quality is a bit lower.

Low Beef Basics

In the previous article I agreed with the author of the book I reviewed in recommending that we all should eat less beef. I will quickly summarize from the previous review of Can Fixing Dinner Fix the Planet. I said then:

While ruminants (mostly cows) can be raised on pastureland, only about 1/3 worldwide are and almost none in the US are. Beef comes at an enormous environmental cost. It takes up to 30 pounds of grain to get a pound of beef. Other meats, including pork and poultry are more efficient. This is grain and land that could be used for human food directly. You may have heard about “cow farts” and how they contribute to greenhouse gases; a true fact, except that it is actually cow burps. About 40% of all greenhouse emissions related to the livestock industry come from this source.

Thinking more globally, Dr. Fanzo continues, “When health and sustainability align, choices become easier. If beef consumption in high-consuming countries declined to about 50 calories a day, it would nearly eliminate the need for additional agricultural expansion and associated deforestation.”

I am embarrassed to admit now that several facts that I have previously written are misleading and several are complicated and need some explanation that will follow. One misleading statement is that none of US cattle are raised on pasture. In fact, most are raised on forage and other ingredients most of their first year. Forage can be grass in the field or grassy type products that are cut and stored for later use. Most beef cattle are “finished” for the last few months of their lives in feed lots where they are fed a very nutritious diet that includes ground corn and other food concentrates. The other misleading fact is in the 30 pounds of grain per pound of beef. This is based on the assumption that cattle are fed only corn or other grains. As you will see below, this is wrong on several counts.

Sacred Cow Basics

I listened to an hour-long talk by Diana Rodgers, RD on YouTube that was very well presented and, in many places was well documented and well referenced. She favors grass-fed beef production, and she contends that ruminants will help save the planet and our health. While I do disagree with some of her points, I want to compliment her on her diligent research on the topic of meat and health. There is also a book and movie by the same title, Sacred Cow. From the website, she states, “Our hope is to create a new dialogue examining our cultural bias against cattle, pointing out the importance of red meat to our food system and how well managed grazing animals are one of our best solutions to repair the damages of our industrial agricultural system.”

Here are some issues I had with Ms. Rodgers’s presentation. She contends that adults in the US are only consuming about 2 oz of beef a day. I thought that was rather low. I found this fact was rather hard to pin down. The Big Ag folks contend it is about 3.6 oz per day while estimates from government intake data (NHANES) estimate about 2.4 oz per day. But even at 2 oz per day, that comes to 46 pounds a year.

Without a lot of supporting data, she recommends an animal protein intake of about 1.6 g/kg/day. This is twice the RDA and has very little support among other dietitians and nutritionists.

Ms. Rodgers contends that ruminants are the best caretakers of our native grasslands and are the true carbon recyclers of the planet. There are some truths here. The problem is that in the US not all cattle are raised and finished this way. She and I would probably agree that currently in the US, cattle are not a “…well managed grazing animal”, as she aspires from her website. I will also contend below that her solution for well managed grazing animals may be a better solution than she intended.

Two facts that she presents are verifiable and supported by other research and publications. Only 4% (give or take) of the greenhouse gas in the US is from methane from cow burps. However, in the larger picture, global greenhouse gas production from the entire cattle and cow (beef and dairy) industry is 14.5% of the total. In fact, per kg of animal protein produced it would appear that beef cattle are still the major contributors of greenhouse gases compared to other animals and animal products we consume.

But, as Ms. Rodgers contends, as much as 90% of what cattle eat is inedible by humans. This leads to my own confusion about consuming beef mentioned at the start. Why is eating beef such a problem? We often compare the efficiency of raising cattle to other meat sources, such as chickens and pigs. Only 9% of the corn crop in the US goes directly to cattle, while about the same goes to pork and chicken. These are all worth considering as we weigh the importance of eating less beef and less meat overall. A United Nation FAO report of livestock production yielded this graphic of food sources for livestock. Note that only 13% is Grains and 1% Other edible. That leaves 86% inedible. However, that 13% of animal food from grain is actually 32% of the overall global grain production.

Ruminant Properties

Ruminant animals include cattle, bison, sheep, goats, and deer. Their unique digestive system allows them to utilize cellulose from grasses and other sources. They derive nutrition from these foods that other animals, including pigs, chickens, and humans cannot benefit from. In the economy of agriculture, this is a great benefit to us humans. We can feed ruminants plants we can’t eat like grass and corn stalks and hay. They turn this into meat and milk, and we benefit. Note that in the graph above, 46% of livestock food around the world is grass and leaves. While I was not able to independently confirm the following calculation, the following quote makes sense from what we have seen so far. “For every 0.6 pounds of human edible protein cattle consume, there is a return of 1 pound of human edible protein in the form of beef.”

Multiple Use Complications

Ruminant nutrition is beneficial to humans. Material that is inedible to humans can be made into food that humans can benefit from. But let’s add another complication that I will not delve too deeply into here since it desires an entire episode. This is the “Fuel vs. Food” controversy. Some of what we feed to cattle is the by-product of the fermentation process of turning corn into ethanol for use as fuel for our cars. About 1/3 of the domestic US corn crop is currently being used for this purpose. So, the fuel and the cattle industries have this interesting synergism. One literally feeds the other.

Here is another way to look at the graph above. If there were no livestock industry and no ethanol industry to feed it, how could all this land and these products be turned to human benefit? The argument is often made truthfully that much of the grassland around the world is not usable for anything else except grazing cattle. But is this true everywhere, especially in the US? If less corn was going to ethanol, could more land be used for other things than corn and soya? I suspect so. Or could that corn and soya enter the global market and bring the price down for children in Kampala, Uganda?

Rich vs Poor Country Complications

There is a complication here on the protein needs of rich countries and poor countries. Rich countries such as the US consume more protein, especially animal protein, than needed. Poor countries are generally in need of protein. One size does not fit all. While many folks, including me, suggest that rich countries should reduce their animal protein intake, we need to consider ways to encourage protein intake in poorer countries, including livestock production especially on marginal land that is otherwise not useful for other agricultural purposes.

Land Use Complications

Generally speaking, grain crops go to one of three things, human dinner plates, fuel production either as ethanol or as biodiesel, and animal feed. At this point, about half of the grain production in the world is going to fuel and animals and half to humans. About a third goes to animals and this creates some interesting math that has been missed by some authors, including Dr. Fanzo, the author of Can Fixing Dinner Fix the Planet. Also misguided was the author of an influential academic article from 2013 that suggested ways to increase food production by reducing livestock. These authors, using data on the conversion of animal food protein into human food protein, found beef production to be incredibly inefficient at 5%. This 5% means that when 20 pounds of protein in grain is fed to animals, only 1 pound of animal protein is produced for the market. This is a common misperception and does not consider the ruminant advantages of cattle and the 86% non-human food sources of livestock production. The conclusions about beef in many of that academic source (cited by others almost 700 times) are erroneous for this reason.

But there is another side. National Geographic did a nice spread on the challenges of feeding 9 billion people in the future. One of their nice graphics illustrated the degree to which land was being used to support human food vs animal and fuel-based foods. They show that most of the agriculture in the US and Europe supports animals and fuels while in Africa and India most of the agricultural land is used for people. An FAO article from the UN states that “…26% of the Planet’s ice-free land is used for livestock grazing and 33% of croplands are used for livestock feed production. Globally, livestock provides 25 percent of protein intake and 15 percent of dietary energy.” So, over half of the usable land gives us only a quarter of our protein.

Fisheries

Just a quick bit of context here on the other major source of protein in the human diet, fish. Fish are an interesting “crop” since no one plants seed, fertilized, or patiently grows this “crop.” Frankly, we just go out and grab it, pretty much as fast as we can. Aquatic foods, including fish, comprise 7% of protein intake worldwide. And this has cost us dearly. We are depleting wild fish stocks rapidly. Presently, about half of the fish we consume are raised in aquaculture, closer to the usual model of normal agriculture.

Dairy and Eggs?

Dairy and eggs are an interesting source of animal protein that does not directly involve the slaughter of animals for food. In fact, they are much more efficient means of producing human consumable protein from feeding grain to animals. Together, eggs and dairy have a protein conversion rate of about 40%. This makes the vegetarian diet appealing from the environmental point of view. The healthiness of these food sources is still debated, but as protein sources in the diet, they rank as exceptionally high-
quality protein. Interestingly, both cultured fish and chickens can be raised with about the same protein efficiency. Pork, the other red meat, is closer to beef in protein conversion efficiency. The trouble with pork is that pigs are fed on mostly human-edible grains like corn and soy and do not have the ruminant advantage. This brings pork much more into the spotlight as a protein source we might consider reducing for environmental reasons. While pigs apparently do not have the methane burps of cattle or the ruminant advantages of cattle, they are still somewhat costly protein sources considering their food sources and land use. They also create quite a bit of waste that often creates environmental issues.

Is meat truly unhealthy?

This is very hotly debated. Many nutritionists, including me, have said for a long time that red meat, and processed meat in particular, is unhealthy. A recent set of articles in the Annals of Internal Medicine by a thoughtful group of international scientists, concluded that the recommendation to eat less red meat was unnecessary and that the science behind it was weak. For example, they surveyed the literature and found that avoiding red meat consumption would lead to about 4 fewer cardiovascular deaths about every 11 years per 1000 people. That means that there would be 4 fewer deaths per 1000 people who ate no meat every 11 years compared to 1000 people that regularly ate meat. Now, in fairness, lots of very smart scientists disagree strongly with these conclusions and it has descended into a deep argument into how best to do nutritional research.

I will spare you the waist deep arcane arguments here, but I come out somewhere in the middle. There are several reasons to believe that these results underestimate the size or truthfulness of this negative meat effect on our health. (A student of mine and I wrote a nice article connecting red meat with diabetes.) But if you have a choice between stopping smoking a pack a day and stopping eating a cheeseburger a day, I suggest you stop smoking. But, if it’s a choice between a cheeseburger and a Mountain Dew, I would drop the burger.

Grass-fed Beef

Diana Rodgers, in her movie and talk, makes a strong argument for raising beef steer on grass pastures. I agree. There are very modest differences in the healthiness of the final beef product for humans but a great benefit for the planet and the market. It avoids the problematic aspects of the current means of cattle production including the erosion problems, over fertilization leading to anoxic rivers and river outlets, noxious concentrated animal feeding operations (CAFOs), the synergism with the ethanol industry, the destruction of the Amazon rain forest, and the possible breeding of resistant bacterial strains. (These were all spelled out in the previous post.) There is simply not enough pasture to raise all the beef we are currently eating. Thus, the price of beef would probably go up by some huge amount, maybe triple. Hamburger might be $10 a pound. This would have enormous effects. Cattle would eat what they naturally like to eat-grass. Corn would be fed to people, not cattle that are being finished. There may be other effects that are a bit more difficult to predict. More marginal land would probably be turned into pasture. The demand for pork and chicken would increase and thus their prices would increase. We already consume twice as much protein as we require. We already are using far more land than we need for these products.

I suggest that we switch to grass-only and let beef compete with other commodities grown on the diminishing resource we call arable land. You might raise the very sensible question, is this even practical or possible? Probably not at present, but somebody must at least put it forward as the most sensible eventual solution. We can move that way in small increments.

Should we eat less beef?

This is the crux of the matter and why you have patiently read through all this so far. Diana Rodgers, the author behind Scared Cow and the Annals authors have assembled some powerful arguments against limiting beef. I respect their research and findings. Rodgers and her crew put together a very impressive film that I watched carefully in its entirety. It does not dwell much on the issues we have raised here. It addresses the question of how we can grow beef cattle sustainably. A compelling picture was painted of entirely pasture-raised animals. If this was the only beef that we raised and ate, then I would be in favor of including beef in the American (and European) diet. We would have a lot less of it and it would cost a whole lot more.

But remember that cattle, grass-fed or not, still contribute greenhouse gases into the environment. Depending on how you count it the beef cost, it is as much as one seventh of the current greenhouse
gas load.

So, I agree with Ms. Rodgers in her rather idealistic conclusion in favor of grass-only beef. I might go further and suggest that we encourage this on grassland that is not suitable for other purposes. Other countries with serious protein needs will need other protein solutions that will still require animal production, including ruminants. One size will not fit all.

Should we eat less meat?

Based on what we have seen here, maybe the even larger question is, should we be eating less of all types of meat? In my previous article based on Dr. Fanzo’s suggestions, I was suggesting less beef, but here I am going to widen that based on the research presented here. For the sake of our health (less than before, but still an issue) and the sake of the planet (think of land use, greenhouse gases, and energy use) and the needs of 8 billion neighbors, we Americans do not need all the animal protein we consume. We can easily fall back to eggs, dairy, and maybe a little chicken and cultured fish for our limited animal protein need, eschewing red meat (beef, pork, and lamb) and do everyone a favor.

Conclusion

We have come full circle. We started by doubting the conclusions from my previous review of Dr. Fanzo suggesting we eschew beef completely. We found some weaknesses in her and other’s arguments. We found our true requirement for protein, and we discovered the benefits of ruminants. We learned about the number of resources and amount of land that go into livestock. I have concluded that grass-fed beef does solve many of the problems raised previously. I am now concluding that the need is there to reduce all our red meat consumption for the same three reasons as we started with, our health, the planet’s health, and our 8 billion neighbors. Yes, it is indeed complicated.

A Review of Can Fixing Dinner Fix the Planet? by Jessica Fanzo, PhD (published 2021 by Johns Hopkins University Press)

(I started out to write this as a book review in which I would briefly touch on the book’s content and the author’s point of view and then critique the good and disappointing parts of the book and recommend who might most benefit from reading it.  I ended up writing more of a book commentary in which I incorporated some of my own ideas into a detailed description of this rather excellent book.  Then it got rather long.  So, my apologies to Dr. Fanzo, the author, for taking advantage of her text to express my own views.  It’s good we agree so much.)

An article I read recently recommended this book and since it fell in my sweet spot of professional interests. I thought I would review it and possibly recommend it to my blog friends. So, in short, I do recommend it and in short, we can help fix the planet by what we fix for dinner.

But before getting to that, I want to step back a bit and address a larger question that has been bothering me and really applies here.  The implication of this book is that we ought to change what we eat at our own dinner tables to help people halfway around the world.  Why should we do that?  What is this called, this idea that we somehow owe it to society to pitch in on these big social problems?  Well, I looked, and I have found a phrase for this; it is called Social Responsibility.  This is the idea that we somehow owe it to the larger society around us, however that gets defined, to pitch in and do our part for the whole.  We don’t get much back from this individually except a better functioning society to live in and a warm feeling that we have helped somewhat.  It sounds vaguely like an echo of that familiar saying, “Do unto others as you would have done unto you.”

Now based on your own political leanings or religious likings, you, my dear reader, may have a range of willingness to contribute to this Responsibility.  But interestingly, we are all already doing a considerable amount of this social contribution and may not realize it.  For example, do you recycle your plastics and glass; do you vote; do you donate to a charity; do you and your children get vaccinated; do you pay taxes, abide by the rules of your HOA?  Do you know anyone who has served in the armed forces?  All of these are forms of social responsibility.  You are often giving back to society more than you yourself are benefitting.

Now, we are about to talk about a book that is going to suggest a new form of social responsibility, that what we eat may have social consequences that we should consider.  Interestingly, we will see that what we choose to feed our families has three interlocking effects.  What’s on our dinner table affects our own family’s health, the health of the planet, and the availability of food for others.  And most encouragingly, for the most part, changing our diets in one direction can benefit all three at once.

And now to the book.

Can Fixing Dinner Fix the Planet? is by Dr. Jessica Fanzo, a professor at Johns Hopkins University and an expert in global nutrition.  She has vast experience in health and diet in many countries including the US.  She has done a masterful job of bringing a huge and complex set of interlocking problems to an understandable level for a lay audience.  The book has only five chapters in 188 pages.  The first chapter covers the scope of problems we face as a society. She states, 

“The foods we eat are much more than just a source of sustenance.  They have direct and substantial impacts on the nutrition and health of individuals and populations, the planet’s natural resources and climate change, and structural equity and social justice challenges of societies. Food connects us to the world.  It also dictates, to a degree most people don’t realize, the kind of world we live in today and the kind of world we will occupy in the future. —- Without drastically altering course, we’ll soon struggle to feed, shelter, and treat our growing human population, some of that behavior centers around our diets and what’s on our dinner plate.”

In the second chapter, Dr. Fanzo draws from her long experience in poorer countries to explain the causes and effects of malnutrition. She brings a wealth of important and pertinent facts and statistics to bear on food insecurity both at home and abroad.  She explains the complexity of the problem, “Poverty both causes and results in food insecurity. — Malnutrition harms a person’s ability to earn a living, creating a vicious cycle between poverty and malnutrition.”  This leads to a paradoxical “double burden” of both malnutrition and obesity in the same communities and even the same families.  “Empty calorie diets that either lack variety [think poorer countries] or rely on highly processed foods [think US] can cause weight gain without providing nourishment.”  Much of this can be blamed on the increased availability of ultra-processed foods in supermarkets.  In 1990 about 15% of folks in Latin America shopped in supermarkets; only 10 years later, with increased urbanization, that had risen to almost 60%, with a concurrent rise in obesity.

Malnutrition is compounded by poor access to clean water, contaminated foods, micronutrient deficiencies, and childhood diseases like diarrhea and pneumonia.  Dr. Fanzo concludes, “Without healthy humans, there can’t be a healthy planet, and with poor planet health there will be poor human health.”  All of this will be complicated by climate change, depletion of aquafers, depletion of fisheries, erosion of arable land, urbanization, increased resistance to pesticides, and increasing trade tariffs.

Do you think about the ethics of what is on your dinner table?  Until I read this book, I didn’t.  Many actions we take in life are a balance between the privilege of certain freedoms we have and the ethical responsibilities we bear.  I have the privilege to water my lawn all I want.  But in a drought, I might want to consider the responsibility I bear to my neighbors for the water I use that would not be available to them.  I may have the privilege of playing Death By Decibels all night long, but do I bear some responsibility to my neighbor’s children for my habit?  If I eat beef every dinner seven days a week since I can afford it, who bears the costs that I may not see, and do I owe anything to them?  That is essentially the question of Chapter 3 of the book. “We need to collectively grapple with and resolve these issues if we want to ensure that everyone has equitable access to healthy and sustainable diets. — On the global balance sheet, what do wealthy nations “owe” impoverished nations that struggle to grow food because of climate change caused largely by the actions of industrialized nations and multinational corporations?”

Serious food insecurity affects about a billion people worldwide.  This varies from year to year depending on trade and crops and weather.  These folks are spending about 50-80% of their entire income on food and very poor quality food at that.  They are faced with global trade forces they can’t control, and climate changes and local conflicts that make daily meals a constant worry.

And that brings us to meat, really a central ethical issue on our plates, dinner plates that is.  Dr. Fanzo reminds us that the average American consumes 40 times more meat than the average citizen of Bangladesh.  Meat consumption worldwide has quadrupled in the last 80 years and still growing rapidly, especially in middle income countries.  This is one of those privileges that we described above.  Unfortunately, meat comes with costs that we don’t see in the supermarket.  While ruminants (mostly cows) can be raised on pastureland, only about 1/3 worldwide are and almost none in the US.  Beef comes at an enormous environmental cost.  It takes up to 30 pounds of grain to get a pound of beef.  Other meats, including pork and poultry are more efficient.  This is grain and land that could be used for human food directly.  You may have heard about “cow farts” and how they contribute to greenhouse gases.  A true fact, except that it is actually cow burps.  About 40% of all greenhouse emissions related to the livestock industry come from this source.

One of the pleasures of this book is being introduced to new concepts and vocabulary.  In economic terms an externality is the cost of something that is not included in the price one pays.  Since much of the corn and soy that is grown in our midwest goes to raising our T-bones and sirloins, it does not go to the global market; thus, small households in Latin America are paying more for their tortillas and vegetable (soybean) oil.  We are also experiencing climate change at an alarming rate in part due to millions of cows and their burps.  Other foods that could be grown in those midwest fields are not being grown (think other grains and other healthier fruits and vegetables). So those costs are higher than they need to be.  Since corn and soy require so much fertilizer that runs into the Mississippi River, we have an anoxic zone, a dead zone, in the Gulf of Mexico where nothing lives that can be fished.  We also have enormous, concentrated animal feeding operations (CAFOs) that fatten up cattle for market.  These create clouds of stench and dust and probably resistant bacteria strains. None of this is on the price tag in the store but someone is paying for it, one way or another.

There is a solution.  It has been estimated that the world would only need to decrease animal consumption by 30% to meet global greenhouse goals.  This is a complex issue covered recently by a carefully researched article in The Atlantic that concluded that we don’t all have to become vegans.  A lot depends on big changes that can be made to the livestock industry.  However, what is very clear is that by eating less beef, we can embrace our social responsibility for a number of global problems at once: global warming, world hunger, ocean dead zone, and better health.

Gosh, I forgot to mention that part about better health.  Less red meat including beef is healthier.  So less red meat means that I can benefit while the world (climate, oceans, crops, poor countries) also benefits.  That’s called a win-win-win-win-win.  An interesting research article just came out in ATVB that found that meat consumption hurts us in a whole new way.  We all know that cholesterol and high blood pressure can kill you.  This article found that besides these, meat contributes a new chemical, synthesized in our gut from meat ingredients, that gets in our blood and contributes to heart disease and stroke.  Other research has previously shown how red meat also contributes to diabetes risk.

So, in answer to the title question, can fixing dinner fix the planet?  The first and most important answer is less red meat on the dinner menu, especially a lot less beef.

Chapters 4 and 5 address solutions.  Chapter 4 addresses policy solutions and chapter 5 solutions by individuals.  Admittedly, due to the nature of public policy, Chapter 4 is a bit of a dry read.  The complexities of effective public policies make this a difficult arena in which to work but also a place that many millions of folks can be affected at once.  Another new concept that Dr. Fanzo introduced to me in this book is the food system.  This is the enormous enterprise that brings us food.  It starts with the folks who create new seed varieties, then to all the supplier of other goods for farmers, then to agriculture itself, then to the processors, storers and movers of foods, then to the retailers of raw, processed, and cooked foods, then to us at home.  But don’t forget the advertisers, trade unions, packagers, and other groups involved.  And each of these groups has a firm on K Street in Washington pushing their own special interests.  Now throw in the rest of the world and their interconnecting food systems and we have a behemoth that is almost unmovable. Now try to control this with 230 different national and territorial governments and you see the scope of the problem.  And if we have a policy to control an aspect of foods for health purposes alone, will it be equitable to Manhattanites and also villagers in Botswana?  Will it have unforeseen environmental impacts in northern Pakistan?  Will it cross the religious sensitivities of Buddhists in Vietnam?  Will any of a hundred special interest groups complain?

An interesting example are the incentives placed by the US government to make ethanol for fuel from corn.  Due to these incentives, a thriving ethanol-from-corn industry has developed.  The US corn crop has grown by about a third and about a third of that crop now goes to ethanol.  As a fuel, this process is barely energy efficient, with about 1.5 units of energy generated for each unit of energy invested.  By comparison, for gasoline the ratio is 11.  The price of corn has also tripled and partially blamed for the spike in food prices in 2007-2008 and the continued rise since then.  Also, much land that was used for other crops or was environmentally sensitive is now growing corn.  So, one policy change for apparently good environmental reasons at the time has helped only marginally.  It is also negatively affecting food prices and the environment all at the expense of US taxpayers.

What policies then might be both healthy for people and the planet?  Another fine word in Dr. Fanzo’s vocabulary list is a “nudge.”  These are rather modest policy changes that move the behaviors of constituents to be healthier without them hardly noticing.  One nudge that has been used in some US cities is a tax on sugary beverages, just a few cents per bottle.  Will this prevent all obesity and diabetes?  No, but when combined with other nudges it will move things in the right direction.  One nudge that I would favor would be to fund the reclamation of the Gulf of Mexico dead zone with a fee on fertilizers.  This would be passed on the farmers and on the beef producers and on the beef buyers.  It would address an externality with a nudge into the food system.  There now, I have used all three of our new vocabulary words in one sentence. 

While I have agreed with most everything that Dr. Fanzo has written, one question kept coming up in this chapter in particular.  Dr. Fanzo has great reverence for the small family farmer, in the US and especially in poorer countries.  She championed policies that tended to protect this way of life.  While I admire this, I found myself asking why that was necessary.  Certainly, I would not favor violent or destructive means of forcibly ending family farming.  However, when I look over the span of human history, I see many people moving and changing jobs and locations in response to changes in technologies and policies.  Every single one of us Americans (I could also include Canadians, Australians, and New Zealanders) who are not First Nation natives, can attest to this trend.  Also, if we are asking livestock ranchers in the US to change jobs and grow less beef, then can we not expect improved technology in Uganda to displace family farmers?

One major problem to also consider is that healthy food is expensive.  The USDA puts out a wonderful guide on what a healthy diet should consist of.  One simple problem, the healthiest food aisle in the grocery store is the most expensive aisle, the produce aisle.  The cheapest and healthiest food in the store is a bag of dried beans on the bottom shelf of aisle 4.  The second healthiest is a big jar of peanut butter. (Well, that may not be exactly true, but it is nutrient dense, and I really like peanut butter.)  Also, we need to remember that not one size fits all especially in Zimbabwe.  We do rightfully recommend less red meat to Americans, but a little more meat, up from almost none, might be the best thing for parts of rural Zimbabwe.

Dr. Fanzo spends a lot of time in this chapter describing her work with the EAT-Lancet Commission Report on Food, Planet, and Health.  This group published a monumental report in Lancet in 2019 on just this very topic of how to create a diet that is healthy, provides food for everyone, and also saves the planet.  It is a highly controversial report with push back from almost every special interest group you can imagine.  However, it moved forward the very important conversation of how we feed a growing population and save the planet at the same time.  They even provided a graphic of a dinner plate for how individuals should eat.  As you might suspect, about half the plate was fruits and vegetables, a quarter was whole grains, and the rest was proteins from sources that were safe for the planet.  She acknowledged that “nearly 1.6 billion people don’t have the financial means to follow the Planetary Health Diet” and that it “does not account for cultural differences in diets around the world.”  But it is a good start.

So public policy is tough but an important part of changing the way we eat and prepare for the future.

Chapter 5 is where it comes to our own dinner tables. Dr. Fanzo starts by assuring us that there is no one single healthy diet.  Here are her three rules. “First, we need to reduce the over consumption of calories.  Second, we need to avoid unhealthy, highly processed foods.  Third, [Americans] need to reduce their consumption of animal source foods, beef in particular.”  One of my favorite and famous quotes from Michael Pollan sums this up more succinctly from his book In Defense of Food. “Eat [whole] foods, not too much, mostly from plants.”

Thinking more globally, Dr. Fanzo continues, “When health and sustainability align, choices become easier.  If beef consumption in high-consuming countries declined to about 50 calories a day, it would nearly eliminate the need for additional agricultural expansion and associated deforestation.”  So, what does 50 calories of beef look like?  Using 90% lean ground beef as an example, that would be about 1 ounce per day or one juicy half pound steak per week.  If we all shifted to a vegetarian diet, greenhouse gases would decrease by about a quarter.  The Mediterranean diet is also a good alternative.

When I taught Global Nutrition to college students, I would ask them in one class what they had for breakfast and then ask how much thought they put into those choices.  Of course, breakfast is the meal that we think least about.  We are often half asleep and on autopilot.  Of the three or four things we usually have, we pick one and go with it.  But if we back off a bit and consider what people eat for breakfast around the world, we will realize that we are severely bound by culture and habit and family traditions and cost and time and creativity to a very limited breakfast menu.

Our food consciousness (another new concept from the book) is very limited at breakfast time.  How much thought do we put into the food choices we make?  Our choices are partially limited by our food literacy, another new concept.  How broad is our actual knowledge of foods, where to get them and how to prepare them?  As we walk through the grocery store the usual questions that we ask ourselves are about the cost of foods, our preference for foods based on past experience, and the convenience of foods.  But what if we also asked about our health and the sustainability of foods?  What if we were willing to broaden our food literacy with a new brand or new food?  Could we just cast our eyes to the bottom shelves and see new things like bags of beans.  How about ground turkey instead of ground beef?  What if we worried more about food waste, especially with the fresh produce we buy?  Will I really use a whole 3 lb. bag of apples before they are too soft for my taste?

This is where Dr. Fanzo is taking us, to a more deliberate and thoughtful choice of foods, to a wider consideration of issues as we make our way through the grocery store and prepare dinner.  When you see that pound of ground beef, you should see the 30 pounds of grain that went into making it.  Then compare that to the 2-3 pounds of grain for the chicken breast in the same cooler. Also see the CAFO where the cattle were raised and the dead zone it created.  Yes, a pound of chickpeas takes longer to cook and is outside your experience. However, it has about the same amount of protein as the ground beef.  Chickpeas also goes a small way to lower the price of grain halfway around the world and also to lower carbon emissions and is also better for your health.  Here is where our social responsibility about our dinner plates starts.  We can win for our family’s health at the same time that we win for the planet and our global neighbors.

Back to the premise of the book:  What’s on our dinner table affects our own family’s health, the health of the planet, and the availability of food for others.  And most encouragingly, for the most part, changing our diets in one direction can benefit all three at once. Dr. Fanzo is suggesting that simply decreasing the amount of red meat we eat, we can increase our own health by decreasing heart and stroke risk, increase the health of the planet by decreasing greenhouse gases that contribute to global warming, and provide more food for others by decreasing the amount of feed and water necessary for animal growth. As socially responsible citizens of this planet, this can be an easy start.

Part 2

In the previous post of this series, I explained how apples, as a perennial member of the EWG Dirty Dozen, are not so dirty and are, in fact, surprisingly clean for a fruit that is in a constant battle with an array of natural pesty enemies.  We examined the Toxicology in that previous post.  Today we will look at the Analytical Chemistry and Nutrition of the issue.  We will again remember the famous quote from Paracelsus that “Only the dose makes the poison”.

Let’s return again to the 2016 USDA data on pesticides in apples samples.  It is again attached below.  Remember that 531 apple samples were tested for 201 possible pesticide residues.  Today we will focus on the LOD Range column.  This is the Limit of Detection or the lowest level at which that particular pesticide can be detected with the instrumentation the USDA is using.  It is usually measured in part per million or ppm.  Most of these are small numbers, usually three places to the right of the decimal.  An LOD of 0.003 ppm (as for 3-Hydroxycarbofuran, the second pesticide on the list) is actually 3 ppb or 3 parts per billion. What does this mean in real life?  Let’s take something simple like salt dissolved in water as a demonstration.  In the following table we will dissolve salt in water in decreasing amounts until we get to ppb.  We will start with a liter of water which is about 1 quart.

An Olympic sized swimming pool contains about 2.5 million liters of water.  If you put 2.5 grams of salt, about half a teaspoon, into an Olympic sized pool, that would be 1 part per billion.  The detection limit for 3-Hydroxycarbofuran is 3 times that or about one and a half teaspoons in an Olympic sized pool.  Just for an interesting comparison, the toxic dose of Botox is about 50 micrograms, very toxic.  Diluted in a swimming pool at 3 ppb, someone would have to drink 17 liters (about 4 gallons) to have a toxic dose.

The point that I want to make here is that the USDA methods are very very sensitive.  So, when the EWG says that the average apple sample contains four detectable pesticide residues, I want you to think of Paracelsus and of the Olympic sized pool.  What does it really mean that an exquisitely small amount of a pesticide has been found and that on average four barely traceable amounts of pesticides have been found?  This is an unfortunate twisting of the analytical chemistry of this situation that usually bypasses the lay consumer.  One would normally assume that if four pesticides are found in an apple then that must be meaningful in real life.  But if I told you that I had put a detectable level of botox in your swimming pool (assume an LOD of 0.003 ppm as for 3-Hydroxycarbofuran), you now know that unless you drank 4 gallons you would be fairly safe.  So, the key question, per Paracelsus, is what is the dose, and EWG does not tell us that.  In their Methodology, they indicate that they use six criteria to rank that year’s foods for inclusion in the list.  This might suggest a balanced approach based on a range of food characteristics.  But five of the six criteria depend entirely on the number of detectable pesticides in one way or another.  It is only the number and not the amount, or dose, that really is being considered.

To use just three quick examples, I looked down the list of pesticides in our apple list for the first 3 that had over 20% “defects” or positive readings.  They were Acetamiprid, Boscalid, and Chlorantraniliprole.  I found the average pesticide residue for the 531 samples and divided it by the EPA tolerance.  For the 3 pesticides the average was 0.58%.  That means that on average an American apple in 2016 had less than 1% of the maximum tolerated dose of each of those 3 pesticides.  It averaged about 9 ppb for each of these three high exposure chemicals.  That is an astonishingly low amount especially since over 20% of all those samples had detectable levels.  The EWG did not really consider how low the dose was in ppb or how low it was compared to the legal limit.  They only counted it as an exposure.  Paracelsus would have rolled over in his grave.

I am reminded again of the legal term “De minimis”.  In common usage this means, “The law does not concern itself with trifles”.  This came to my attention when it was used against the Delaney Clause in 1992.  The Delaney Clause seemed like a very sensible piece of law when it was enacted in 1958.  It said in effect that if a substance were found to cause cancer in man or animal, then it could not be used as a food additive.  As the science progressed and became more sensitive, it was found that almost everything caused cancer at some dose (remember Paracelsus) in test animals and the court cases became increasingly silly attempting to prohibit substances in our foods.  Finally in 1992, the EPA started rolling back some restrictions on some pesticides on the basis of de minimis.  I’m sure you can see where this is going.  We have real threats to our health out there (COVID, smoking, alcohol, opioids, etc) and there are certainly environmental chemicals of concern, but when a wonderfully healthy apple has less than 1% of the tolerated dose of a pesticide residue, I suggest you eat two apples instead of one and not worry about residues.

With that segue, let’s turn to nutrition here.  The EWG suggests that for the Dirty Dozen we find alternatives such as other healthy foods without residues, or find organic alternatives.  These may seem reasonable but are also generally unnecessary.  In this situation as in many similar ones, we need to consider the tradeoffs.  What do we gain and lose by taking or not taking an action?  As it happens, apples are cheap and nutritious.  They have lots of vitamin C, lots of fiber, and lots of potentially healthy phytochemicals that can act to prevent chronic diseases.  There is very little difference between traditional and organic apples except the price.  So, I suggest buying twice as many traditionally grown apples.  If you opt for trading for another fruit, will it be as nutritious or as cheap or as available?

There is one deep concern that I have about this type of food recommendation and others in my field share my concern.  It is fairly elitist.  Who can afford to make these dietary changes?  It is folks who read or listen to this sort of information and have the time, money, and access to easily make these changes.  Consider other folks from other backgrounds with limitations on access, time, and money.  This type of information seems classist, pointless, or simply induces some level of guilt that they cannot provide for their children properly.  Some poor soul may take a quick look at those 12 fruits and vegetables and decide that it would be safest to stop eating any fruits or veggies.  Is that our message?

An additional point I would like to make is how this sort of thing is covered in the press.  This is an example of how a quick sound bite that seems fairly healthy can find its way into numerous media outlets with little critical review.  CNN covered this year’s Dirty Dozen with a fairly positive review.  They get a quote from an EWG toxicologist and used a slick graphic supplied by EWG.  They followed up with several typical EWG talking points concerning specific pesticides.  Only one contrary voice was quoted and EWG was allowed to respond.  The usual advice is given to eat organic alternatives and choose local foods.  In fairness to CNN and other outlets, the Dirty Dozen has a high gloss PR image and is very smooth with its statements and supporting experts.  They make it very easy for publications to put together a seemingly objective piece with little extra work that meets the deadline.  Most of the other media posts that I can find online are from very like minded outlets supporting chemical-free foods, and organic, and vegetarian groups.  Not surprisingly, they gave rather favorable reviews.  WebMD did a much nicer job.  In addition to the EWG toxicologist, they got perspective from an industry group and from a dietitian and professor.  She raised several points similar to mine and stressed eating a lot of fruits and vegetables.

My point here is that this is a hard area to report objectively in.  As an editor, you receive a nice glossy press release that supports good health and points to the usual bad guys such as agricultural chemicals.  How deep do you need to dig on that?  And readers love it and with some quick quotes from “both sides” and you are good to go with pretty pictures and graphics supplied by the press release.  And you meet your deadline.  Editors have my entire sympathy.

But this leads me to my final point and why I bothered to bring this rather minor issue to the attention of my (few) faithful readers.  In our time when it is so easy to create and distribute this sort of misinformation, what is happening to things that we thought we held dear?  Does a balanced view really matter compared to a glossy PR piece?  Does true expertise in a field hold any sway at all in a public discussion?  Is science just a thing to be twisted politically so that “Trust the science” is now held in derision?  Does the loudest voice always win?  Will we actually believe the small voice from the back of the room that says, “But, mother, the emperor has no clothes?”

In this one small area in which I have some expertise, I declare that the Dirty Dozen is largely BS and should be considered de minimis.   Stick to the big issues, truth, mercy, and justice, and eat your fruits and vegetables, all of them, lots of them, without guilt.

(I don’t want to bore you with my credentials, so if you want to see why I think I am qualified to criticize this website scroll to the bottom of this article.)

I recently came upon the 2022 version of the Environmental Working Group’s Dirty Dozen.  This is a yearly posting from this group that alerts the public to the dozen fruits or vegetables that the EWG considers most highly contaminated with pesticides and for which the public should consider avoiding or considering organic alternatives.  I have had several concerns about this list for a number of years and would now like to explain those concerns.  In a word, there is a misconception of the analytical chemistry, the toxicology, and the nutrition of these 12 healthy foods.  If you bear with me then I will explain some of the problems I see with this posting and why eating as many fruits and veggies as you can get your hands on is good for you.

Let me start with a famous maxim from Paracelsus, a sixteenth century quack, polymath, and “father of toxicology”.  “Sola dosis facit venenum” or famously “Only the dose makes the poison”.  As we review the Dirty Dozen and the data that supports them, it will be important to remember that anything can be a poison if the dose is high enough and anything can be relatively safe if the dose is low enough.

First though, let me start with an overview of what the Dirty Dozen are and who the EWG is.  In a word, the EWG is about pesticides and other chemicals in our environment and protecting us from them by direct communication with consumers and by shining “a spotlight on outdated legislation, harmful agricultural practices and industry loopholes that pose a risk to our health and the health of our environment.”  They have been publishing the Dirty Dozen since 2004.  Each year the list varies a little and each year major news organizations cover the new list and suggest ways to avoid these foods.  As you can well imagine, certain industry groups are not happy about this list and put out their own statements downplaying the dire warning of the EWG. 

The Dirty Dozen report contains several positive aspects that I would be remiss in not mentioning.  First, they use good clean government data from the USDA and the FDA in their computation and assessment.  They are not so far on the fringe as to concoct myths from whole cloth.  Second, in their report, which regrettably few people will read, they do tell their readers, “A critical part of a healthy diet includes a combination of fruits and vegetables, regardless of how they are grown.”  While I will take issue with some of their other statements in a minute, we can both agree on this.  More fruits and veggies are good for you, regardless of how they are grown.

So now let’s get into the weeds, looking at the numbers and the toxicology. (Analytical Chemistry and Nutrition next week.)  The USDA does not assess every commodity every year so I went to a fruit that I was familiar with and that is near to the top of the Dirty Dozen every year, apples.  Any citizen can find these data.  Go to the Pesticide Data Program of the USDA.  On the left you will find the PDP Database Search.  For Apples, you will click on Apples, “Click All Pesticides” and “2016” from the Year column.  From the Output Preference pull down menu and select “Summary of Findings” and “Search”.  Wait a minute for the search and you should have 201 pesticides listed that were tested in 531 apple samples tested in 2016.  Amazing.  I have attached that spreadsheet below, so you don’t have to download it.  The USDA samples the way that a consumer would.  They go to stores and growers, obtain random samples of apples from all over the country, rinse them off the way a consumer should and prepare them the way a consumer would.  In some cases that would involve peeling.  On the table, notice how many samples had “defects”, meaning they tested positive for a pesticide.  I counted 47 different positive pesticide defects.  EWG generously only counts those with 2 or more positives.  That lowers our count to 39.  Of course, not every pesticide was found in every apple.  On average there were about 4 “defects” per apple sample.

Let’s look at the details.  There are some interesting stories here.  In the EPA Tolerance column notice the “NT” values.  These are “No Tolerance” pesticides, meaning that the EPA does not want to see any of these chemicals.  These are basically outdated bad chemicals that have been banned or regulated.  So how did our American farmers do with the nasties?  Notice that there is not a single “defect” for an NT chemical in the list.  American apple farmers are completely clean at the undetectable level for the baddest of baddies.  It is a bit sad that the EWG did not brag about this.  But no, apples are on the Dirty Dozen.

Now let’s compare the EPA Tolerance level with the Max detect column.  This compares the highest level of each pesticide found and compares it with the highest level that the EPA allows.  If the Max is higher than the EPA Tolerance, then someone has broken the rules.  Since we have so many to compare, I created another column that takes the ratio of the two: max/Tolerance.  If it is >1.0 then there is a violation.  But the highest value in that column is 0.66 for the fungicide Thiabendazole.  I call that “not bad” for 201 pesticide residues in 531 apples from all across the US.  In fairness, the EWG will argue that some of those tolerances should be lower, but across the board, things look pretty safe.  In fact, the average ratio of max to tolerance is 10%, meaning that of the residues found, the most extreme value of each is on average about an order of magnitude below the tolerated amount.  Again, pretty safe.

Let’s go to the other extreme and look at the chemicals that show up in a large number of samples, over 20%.  Most of them are fungicides: Thiabendazole, Pyrimethanil, Pyraclostrobin, Fludioxonil, and Boscalid. Two are insecticides: Chlorantraniliprole and Acetamiprid (a neonicotinoid insecticide). One is a post-harvest preservative that acts as an antioxidant and fungicide, Diphenylamine.  So, what about these common chemicals?  Here is what I know about growing apples.  Humans love to eat apples.  We each eat about 10 pounds a year.  But do you know what loves to eat apples even more?  Fungus and insects!  It is an absolute war out there.  Apple growers must spray something, usually a fungicide of one kind or another or an insecticide every two weeks all season long on their orchards.  If it is a wet season, it is even worse.  Then there is the pruning and the mowing and raking and then praying for no early frost and no late rains.  Wikipedia lists 43 fungal diseases of apples.  Then there are the rusts, nematodes, viral diseases, and insects.  These farmers need all the weapons they can get to hope to win this war year after year.

Oddly, the biggest cause of these problems is us consumers.  We like to eat crisp shiny blemish-free apples in March long after the growing season.  If we had suggested that to early apple growers like Thomas Jefferson or George Washington, they would have had a great laugh at our expense, and then taken another long draught of their hard apple cider.  American consumers are very picky and these farmers can’t allow a single blemish from some fungus or an insect bite.

But let’s take more seriously two serious criticisms EWG makes of the USDA and the permitted use of these pesticides in the US.  They are critical of the use of Diphenylamine in the post-harvest treatment of apples.  They cite evidence that the amine group in the Diphenylamine may be converted to a carcinogen in the acidic conditions of the stomach and that its essentially cosmetic post-harvest use is not worth the risk.  There is theoretical data for this but very little actual data on this possible effect.  The Europeans with the Precautionary Principle have created a temporary threshold about 100-fold less than our EPA tolerance of 10 ppm.  Based on the very picky esthetics of American consumers, I fully sympathize with growers who are trying to avoid every blemish as they hold fruit for the March and April markets.  While the data show that 80% of samples had measurable levels, 20% had undetectable levels.  I strongly suspect that even if the US dropped its tolerance to 1 ppm our growers would have little trouble meeting it.  There is also the legal standard of De minimis.  That is, does this issue really reach the bar of minimum legal threat?  The highest single apple had a level of 3.8 ppm.  If a person ate 10 lbs of apples with that level of Diphenylamine in a year and if a tenth of that converted to nitrosamine, that would be approximately 2 mg of carcinogen over a year, compared to all the healthy stuff that person got in those apples.  I would hope that any reasonable judge would pronounce, “De minimis” and please spend my time with really important things like second-hand smoke in children.

The other concerning issue is the neonicotinoid insecticide Acetamiprid.  These have indeed been of concern and may, just may, be one cause of the colony collapse disorder among honeybees.  Insecticides are difficult to create and apply because they generally are broad spectrum and kill all kinds of bugs, including bees, which are one of our best valued insects.  Acetamiprid is among the best of the neonicotinoids having about a tenth of the toxicity among bees as other classes of neonicotinoids.  It also has a rather short half life once sprayed of about half an hour, compared to 2 hours for other neonicotinoids.  The EPA tolerance is quite low at 1 ppm (about 0.2 mg in an average apple) and the insect war on apples is quite high.  We need to allow these farmers some effective tools if we want apples at a reasonable price in our markets.  There are alternative insecticides, but they are generally older, have known resistant species, and other known toxicities and side effects.

So, we have looked in some detail at the same data that EWG used for their assessment that apples perennially belong on the Dirty Dozen.  Based on what we have seen, we seem to have remarkable safe apples grown by remarkably responsible growers.  While there are always outliers and always more to learn about the chemicals we use, I think we can confidently say, “An apple a day (of almost any kind) keeps…”  If all the other members of the Dirty Dozen are this dirty, then I declare them a Not Very Dirty Dozen and Paracelsus would agree.

In our next post we will come back to this.  I will address the topics of analytical chemistry and the nutrition of the Dirty Dozen more fully next time.

My Credentials

I have recently become more conscious of the fact that we have too many printed opinions out there.  One thing that we should do is limit our own printings to areas in which we are relative experts or in which we are relatively well read.  To that end, here is why I feel qualified to address the deficiencies of the Dirty Dozen.  This article is about pesticide residues in foods.  I hold a BS in Biochemistry with several courses in Organic Chemistry.  In fact, I am a member in good standing in the American Chemical Society.  I have a MS in Environmental Toxicology with a course in Insecticide Toxicology.  I have a PhD in Nutrition and my minor area was Analytical Chemistry.  I also worked at a lab bench full time doing research for about 22 years.  All that academic and research work was at Cornell University.  I have since taught Nutrition courses at Appalachian State University from the introductory level (for which I am also the coauthor of a textbook) to the graduate level, including a graduate course in Statistics.  I have also been doing research in epidemiology and also laboratory research on the phytochemical in apples. I have 30 peer-reviewed publications.

Last week we discussed our rising obesity epidemic, why it is important to all of us to consider, what are some of its causes and what are some of its effects.  This week we will pick up the discussion with a broader consideration of the social context of the issue.

So where are we socially as Americans in our relation to food?  We have largely forgotten how to cook or eat together.  We snack all day long, especially at work and from vending machines.  We use the drive-thru regularly for meals with their increasingly large portion sizes.  We quench our thirst with quarts of sugary or alcoholic beverages.  We rely increasingly on the freezer case at the supermarket for complete meals. Regular mealtimes are a thing of the past.

Researchers have found some interesting demographic trends that are perpetuating our epidemic.  Basically, obesity begets obesity.  Americans are having kids at an older age.  Kids of older moms tend to be larger at birth and stay larger through life.  Moms who are obese tend to have larger babies.  Older babies tend to be heavier moms.  Obese moms tend to have more children than thinner moms.  An interesting effect in dating and marriage.  Obese folks tend to attract each other.  Children of obese parents tend to become obese.  If one parent is obese there is a 50% chance a child will become obese, 80% if both parents are obese.  All of this increases obesity and the obesity genes in our population.

Basically, obesity in America perpetuates obesity.  We are coming to understand the biology of this effect.  Folks who are obese become insulin resistant.  This means that glucose levels in the blood build up.  This glucose is taken in by the liver and turned to fat.  Obesity also leads to leptin resistance.  Leptin is the hormone our fat cells secrete to tell the brain that we have plenty of fat and we should stop eating.  But at a certain point, the brain basically goes deaf to those messages and no longer hears the “stop eating” message.  Endocrine disruptors are also disrupting these messages.  We are also fundamentally changing the flora of bacteria in our large intestines with these changes in diet over time.  We are now learning the important nutritional effects these are having that tend to push the fat building mechanisms of the body.

So back to our question.  Is there blame to be placed?  It is easy to blame McDonalds and school lunch programs.  It is easy to blame the box of Krispy Kreme on the counter at work or vending machines full of snacks or social media.  Schools don’t have gym classes anymore or my town doesn’t have a playground for my kids.  TV shows have too many ads.  All those drink companies put too much sugar in their drinks, and nobody gets enough sleep.  We can blame farm subsidies to corn farmers.  And don’t get me started on processed foods with all those preservatives and chemicals.  Believe it or not, we are actually living in great times in relation to food availability.  In the 1950s about 25% of family income went to food.  Today it is just over 10% and half of that is now getting spent outside the home at restaurants and the like.

This is clearly larger than one obese person.  It is hard to blame Mary or Beth or Joe or Frank for their obesity when we look at all these forces at work around us.  We need to work very hard not to stigmatize folks caught in these cyclical conditions.  The causes are clearly larger and seem embedded in our culture and our environment.  Heck, almost 40% of adults are obese and another 30% are overweight.  That means that normal weight folks are the minority. Be careful who you insult.

We are surrounded by these cultural and environmental influences that are so pervasive as to be almost invisible.  But they have this huge impact on us.  So, I want to slow down a bit and think about what we mean when we talk about culture and a cultural influence.

I did a lazy thing.  I looked up “culture” online.  Here is a nice definition that I found. 

Culture (/ˈkʌltʃər/) is an umbrella term which encompasses the social behavior and norms found in human societies, as well as the knowledge, beliefs, arts, laws, customs, capabilities, and habits of the individuals in these groups.

Culture is really hard to think about in the abstract.  It is like looking in the mirror and asking is this how I look to other people?  Is this really how others see me?  If we want to talk about our American culture, it is almost too big to grasp.  Americans are so different.  Ages, ethnicities, parts of the country, urban, rural, recent immigrants, different religions.  That said, what if we asked how Americans are different from Europeans or South Americans?  In comparison with other groups, we might have a way to draw some generalizations about what we Americans have in common.

So, we have this American culture that we can barely define, but we observe that those who live in that culture have been getting progressively more overweight over the last 60-70 years or so.  This has occurred across the whole range of Americans from the Arctic Circle in Alaska to Key West in Florida.  So, what do we have that makes our American culture, those social behaviors and norms, so prone to obesity?  Back to our definition. Culture is the knowledge, beliefs, arts, laws, customs, capabilities, and habits of the individuals in these groups.  So, culture is the accumulation of all us individuals.  We are each part of and saturated with our American culture.  Think about a concert.  You pay to go to see and hear a great band.  You contribute, literally contribute, money to an expression of American culture in the concert.  But then you walk out grooving on the great music with your friends, having absorbed and been saturated with some specific aspect of American culture.  So, is this culture something that we inherit or something that we create?  Clearly, we absorb it as we grow up.  Clearly, we like parts and dislike other parts.  Obviously, it is some of both inherited and created, but we don’t have to pass on the culture we inherited.

Blame

So, we have an obesity-prone culture.  Where is the blame if any for our obesity prone culture?  We inherited this culture.  We enjoy this culture.  We fight with parts of this culture.  How do we participate in this culture?  With all of us in thousands of micro decisions we make every day.  Who bought the 2-liter soda for the apartment?  Who knows that lady at the Wendy’s drive thru on a first name basis?  Who doesn’t even own a frying pan or a whisk or know how to make mac and cheese from scratch?  Who doesn’t have a single fruit in the house, but always carries 3 granola bars in their backpack?  Who took the bus instead of walking that 1-mile commute, or binged on some stupid show all weekend instead of getting outdoors?

There are hundreds of small ways to change our personal cultures.  A bag of apples instead of a box of Krispy Kremes.  Speaking out when the next Farm Bill comes up in Congress.  Do we really need to go to the all-you-can-eat buffet tonight?  How about lingering a little longer in the produce aisle next time you are in the grocery store and less in the frozen dinner section?  Get a rice cooker.  Make brown rice.  It is amazingly easy.  Why are you really staying up to midnight, or 1 or 2 or 3, binging on some show?

The marketplace responds to our vote with our dollars.  How can we blame big companies when we eat their food and drive through their drive-thru windows?  They are only doing what we want.  I’m sure there would be helpful public policies and regulations that would be helpful, but what drives the companies to develop the products they do?  Our insatiable appetite does.  General Mills would love nothing more than to keep making the same old Corn Chex cereal for the next century and take in a comfortable profit on a low sugar breakfast cereal.  But us fickle consumers keep changing our demands and forcing them to change flavors and take out high fructose corn sugar (for no reason, but that’s another story) and make it gluten-free.  We play this rather odd game of make-me-happy but then we blame them when they add more sugar or salt or lower the fiber or add flavor enhancers with fancy names.  Now don’t get me wrong, there is plenty of blame to go around, but we as consumers should own our share.

So, who is to blame for our 60-year climb into obesity?  Our culture, yes.  But remember that we are all our culture and we all can change that culture.  We have met the enemy, it is fat and it is us, all of us.

So, what can we do about our problem?  Well, one thing we shouldn’t do is go on a diet in the usual sense.  Dieting in America is one of the hardest things imaginable.  All the forces, cultural and physiological, are arrayed against you.  What is needed is a healthier and more long-term perspective. 

Here are some lifestyle suggestions that can change our individual cultures and may contribute to a change in our American culture.  I am partially drawing from two interesting sources.  A Psychology Today article from 10 years ago nicely diagnosed our social causes of obesity with some suggestions for change.  The NY Time just completed a January series called the Eat Well Challenge.

• Am I really hungry?  We are regularly assaulted by food messages telling us to consume.  If you ate less than 2 hours ago, you are probably not actually hungry, even as you are looking hard at that doughnut right now.  If we stick closer to actual mealtimes for eating, this gets easier.
• How long have I been on my phone?  Was it really necessary?  Phone and screen time does two things.  It makes us eat mindlessly and it keeps us from being active.
• How about a smaller plate?  Portion sizes have increased over the last 50 years.  We can reverse this if we choose, by simply choosing a smaller plate or bowl or glass or by ordering one size smaller than usual at the drive-thru.
• Does it have to be that sweet?  Our drinks are all sweet now, and some are astonishingly sugary.  It is easy to recommend just water, but even just looking at the label for something with half the sugar of your usual would be a great step in the right direction.
• Did I enjoy every bite? Slow it down, put down the fork between bites.  Why the hurry?  Is eating a chore or a charm?  Mindful eating is a wonderful habit to cultivate.
• Can I cook that?  One of the things we have lost is kitchen literacy.  But cooked food is family food. It is food we talk about and share.  Start simple with a few recipes.  Get the basic tools needed.  Also, as suggested above, get a rice cooker.  
• How about another veggie?  Instead of removing some no-no food, just add another veggie to the table.  
• But my diet?  Is the point being healthy or losing weight?  Obviously the two are connected but being healthy will lead to weight loss that stays.
• Am I a hungry shopper?  You will be in a hurry and will tend to buy more snack food and less fruit.
• Fruit and veggie check.  Do you have more fruits and vegetables in the refrigerator or more snack food on the counters?
• Am I sleep cheating?  Anything less than 7 hours is cheating yourself.  What screen time should you give up?

Conclusion

The United States, and in fact most of the world, has an obesity problem that is increasing.  It is costing us a lot in terms of disability, disease, deaths, and dollars.  It is too simple and actually rather misinformed and wrong to point to overweight people as the ones to blame.  It turns out that we are all to blame because it is deeply embedded in our culture and our economy that we ended up this way.  We all actually really really like this obesity-prone culture with its low-cost drive-thrus and tasty snacks and sugary drinks.  The miracle is that all of us aren’t obese.  The good news is that since we are our culture, then we all have a vote.  We can buy apples instead of fruit roll ups and we can stay home and learn how to cook a real stew instead of another evening at the all-you-can-eat buffet.  This would be a win for healthy kids, healthy culture, and maybe even a few lost pounds.  So, buy a whisk and google “homemade mac and cheese” and change the world.