Quantity Trumps Quality in Public Nutrition Education
Katka Novakova, MD, ND
In the last 15 years, Americans have become increasingly conscious of the link between diet and chronic disease. The Surgeon General noted that an increase in consumption of fruits and vegetables together with an increase in physical activity could prevent the deaths of more than 300,000 Americans each year from cancer, heart disease, stroke and diabetes. Both the American Cancer Society and the American Heart Association have actively tried to educate children and adults about the importance of eating 5 – 9 servings of fruits and vegetables each day. As a result, most of our patients understand that a healthy diet is one of the pillars of naturopathic medicine and that eating more fruits and vegetables will be an important component of any dietary changes they will make.
While the quantity of fruits and vegetables in a patient’s diet is undeniably important (the more fruits and vegetables of almost any kind the patient eats, the better), as naturopaths we are also interested in the quality and the nutritional value of the foods that our patients consume. Pigment rich dark greens such as spirulina, chlorella and young grass juices are among the most nutrient dense foods provided by nature, closely followed by fruits such as blueberries and black currant and green leafy vegetables like kale and chard.
Unfortunately, the significance of these phytonutrient rich fruits and vegetables is largely missing from public nutrition education. It is not surprising that our patients are not finding advertisements for these nutrient dense fruits and vegetables on television or learning about them from their primary care doctor. But even the most widely accessed and advertised government websites aimed at improving nutrition emphasize quantity without providing accurate information about the quality of fruits and vegetables people should consume.
Perhaps the most widely publicized information has been the “Five-a-Day” campaign. The www.5aday.gov website is extremely colorful, well-organized and has the potential to be a wonderful resource, however, there are some disturbing gaps in the information provided. For example, every picture depicts either refined or starchy fruits and vegetables such as juice, bananas, dried fruit, baby carrots, and peas. There is no discussion of the quality of these vegetables and when a picture of dark leafy greens is finally shown, it is with the caption “Eat your greens – just watch the fat.” Although this probably refers to methods of preparation, not the nutritional content of greens, this is likely unclear to many visitors.
Another website, www.mypyramid.gov, has a picture gallery that lists 55 different kinds of vegetables to meet the 5-9 daily requirement. While it acts as a quick and easy reference, it includes legumes such as beans, soy and even tofu as qualifying vegetables. Of those 55, only 17 had links to a picture with nutritional information and those were limited to vegetables with lower phytonutrient content such as corn, carrots, beans, iceberg lettuce, tomato juice, potatoes and peas. Of the 32 different kinds of fruits listed, only 12 had links to more information, most of which had an especially high glycemic index such as bananas, oranges, fruit juices, grapes and raisins.
After exploring these websites, it is not surprising that according to the US General Accounting Office, in 1999 white potatoes, iceberg lettuce, and canned tomatoes accounted for 53 percent of total vegetable servings and citrus (fresh and juice), apples (fresh and juice) and bananas accounted for 52 percent of total fruit servings. This means that more than half of the total daily fruit and vegetable consumption for Americans comes from only these six sources.
This only underscores how important it is that our patients understand not only “the amount per day” concept, but also the difference in nutrient and antioxidant content and glycemic index between five servings of fruits and vegetables that consist of corn, orange juice, potatoes, carrots and raisins versus five servings of chard, blueberries, avocado, broccoli and beets. As the information presented to the general public is not always complete, I am reminded of the Naturopathic principle Docere – “physician as teacher.” It is vital that we take an active role in filling those gaps by providing information on nutrient rich fruits and vegetables, emphasizing variety, and encouraging patients to find new and creative ways to achieve optimal health through nutrition. Fast-paced lifestyles prevent us from “doing the right thing” but, fortunately, the marketplace has provided phytonutrient-dense superfood beverages that help to bridge the gap. While there is never a substitute for good eating habits, these serve as a convenient way to support good health.
Dr. Katka Novakova received her Medical Doctorate from the First Medical Faculty of Charles University in Prague, Czech Republic and her Naturopathic Doctorate from Southwest College of Naturopathic Medicine in Tempe, AZ. Dr. Novakova has a practice in Scottsdale, AZ.