Is nat­u­ral al­ways best?

Look­ing again at how we choose the things we eat

The Irish Times - Tuesday - Health - - Front Page - Jamie Ball

An­thrax, as­bestos, arsenic, mer­cury, cyanide, formalde­hyde: what are the two things they all have in com­mon? Yes, they’re all in­deed very dan­ger­ous, if not lethal, for us, but they’re also nat­u­ral prod­ucts. And there are many more. Any­one for hem­lock?

So, how is it so many ed­u­cated adults as­sume that “nat­u­ral” au­to­mat­i­cally equates to all things good for you? The fact that the UN Food and Agri­cul­ture Or­ga­ni­za­tion’s Codex Ali­men­ta­r­ius – the or­gan­i­sa­tion’s uni­ver­sal com­pen­dium of recog­nised stan­dards, codes of prac­tice and food guide­lines – does not recog­nise the term “nat­u­ral”, hasn’t stopped it be­ing splashed across food prod­ucts.

But what is a “nat­u­ral” food any­way? It’s gen­er­ally taken to be free of any food ad­di­tives or ar­ti­fi­cial in­gre­di­ents (eg sweet­en­ers, flavour­ings, an­tibi­otics, food colours, etc), but some take it to mean those foods which are ei­ther un­pro­cessed or min­i­mally pro­cessed. But de­fine “pro­cessed”?

“A pro­cessed food is sim­ply a food that has gone through a process, or change, from its nor­mal, nat­u­ral state,” says di­eti­cian Sarah Keogh of Eatwell clinic in Dublin 2. “A packet of chopped car­rots, for ex­am­ple, has been pro­cessed sim­ply be­cause they have been chopped. Like any­thing, there are some very good and not so good pro­cessed foods. Whether we like it or not, pro­cessed foods are a part of mod­ern life.”

Keogh says rather than make peo­ple feel wrong or guilty for con­sum­ing pro­cessed foods, we should be talk­ing about the in­gre­di­ents to look out for on the back, and don’t be swayed by the word “nat­u­ral” on the front. And sub­scrib­ing to the “but it’s nat­u­ral” school of crash slim­ming can be equally con­found­ing, with the likes of the lemon juice, grape juice or cu­cum­ber diet all vy­ing for our wal­let.

“The hu­man body needs a re­ally wide range of nu­tri­tion and nu­tri­ents, ide­ally ev­ery day,” says Keogh. “If you’re fol­low­ing such di­ets for weeks on end, you’re go­ing to miss out on cer­tain nu­tri­ents, which will im­pact the body. But we know that the more crash di­ets you have, the heav­ier you will ul­ti­mately get: although you will lose weight, the re­bound weight is greater. Also, you’re more likely to de­velop Type 2 di­a­betes if you’re bounc­ing your weight up and down, rather than stay at a steady weight.

“I’ve had peo­ple only eat­ing fruit and veg­eta­bles who come into me be­cause their hair is fall­ing out, and you try to ex­plain to them that although fruit and veg­eta­bles are in­cred­i­ble im­por­tant, on their own they do not rep­re­sent a bal­anced diet. You know, there’s a rea­son we have a food pyra­mid.”

Keogh says aside from the likes of coeliac dis­ease or Type 2 di­a­betes, which can be man­aged ex­tremely well by a diet set out by a qual­i­fied and ex­pe­ri­enced di­eti­cian, nu­tri­tion should never be used as the sole or prin­ci­ple means in over­com­ing chronic ill­ness.

High-fi­bre diet

“The most im­por­tant ar­eas where diet can make a real difference in so­ci­eties such as ours, is in the preven­tion and treat­ment of di­ver­ti­c­uli­tis. A high-fi­bre diet is def­i­nitely very help­ful in pre­vent­ing that, and im­por­tant in manag­ing it once it has es­tab­lished it­self,” says New­bridge-based GP Dr Bren­dan O’Shea, who is also di­rec­tor of the post­grad­u­ate re­source cen­tre at the Ir­ish Col­lege of Gen­eral Prac­tion­ers.

“Oth­er­wise in our so­ci­ety, it’s rare that a par­tic­u­lar diet is go­ing to make a huge im­pact on the range of ill­nesses we see and treat in large num­bers, such as car­dio-vas­cu­lar dis­eases and can­cer. But most of us should be eat­ing more fi­bre than we do, and, in most in­stances, con­sum­ing fewer calo­ries.”

A packet of chopped car­rots has been pro­cessed sim­ply be­cause they have been chopped. There are some very good and not so good pro­cessed foods

Not to be un­der­played in the #bu­tit­snat­u­ral rea­son­ing is the role of highly re­fined ad­ver­tis­ing meth­ods of the food and agri-food sec­tor.

“I do think the com­mer­cial food in­dus­try is very adroit in its mar­ket­ing, and the big­ger the com­pany the more so­phis­ti­cated the mar­ket­ing tech­niques. I think it would be help­ful if peo­ple were more en­er­getic, rig­or­ous and per­cep­tive about what the mar­keters are try­ing to achieve,” says O’Shea, who adds that rais­ing the ad­ver­tis­ing stan­dards bar for food prod­ucts, in the face of ever grow­ing and trou­bling obe­sity statis­tics, would help take “steps against un­tram­melled com­mer­cial­ism at the ex­pense of the health of the cit­i­zens”.

Atyp­i­cal ex­pe­ri­ences

Googling con­di­tions is not a good idea, O’Shea says, as very of­ten the traf­fic driven to such sites is be­ing gen­er­ated by a mi­nor­ity of peo­ple who have had atyp­i­cal ex­pe­ri­ences, thereby not pro­vid­ing re­li­able in­for­ma­tion or ef­fec­tive re­as­sur­ance. That said, some ac­cred­ited health web­sites can be very re­li­able re­source for all, says O’Shea, such as pa­ or safe­

But the GP is quick to point out the im­pact peo­ple’s com­plex­i­ties have in this de­bate. “When you get peo­ple com­ing from the more af­flu­ent end of the so­cial spec­trum, they are ar­guably more sus­cep­ti­ble to the sug­ges­tion that they’re bloated or tired or feel­ing dread­ful, or their im­mune sys­tem is down. These are se­duc­tive mes­sages that we con­stantly see, such as im­ages of women at bus stops rub­bing their tummy, with a yo­ghurt be­ing waved in the back­ground.

“Most peo­ple who have back­ground con­cerns or wor­ries im­me­di­ately be­gin to feel bet­ter as soon as they be­gin tak­ing action, al­most ir­re­spec­tive of whether the ac­tions are of proven sci­en­tific ef­fi­cacy or not. So, peo­ple and their com­plex­i­ties play a huge role in this,” says O’Shea.

“Cer­tainly, in prac­tice, we see cer­tain peo­ple con­sis­tently com­ing in who be­lieve them­selves to have med­i­cal con­di­tions for which there is no real ev­i­dence. It doesn’t hap­pen an aw­ful lot but I do think it prob­a­bly hap­pens more if your gen­eral prac­tice is lo­cated in an af­flu­ent area, and it hap­pens an aw­ful lot less if you’re in a de­prived area.”

One case in point, O’Shea is keen to raise, is the num­ber of peo­ple who are con­vinced they have coeliac dis­ease, when there’s no clin­i­cal ev­i­dence for it. But, over­all, he sees the pur­suit of nat­u­ral reme­dies and treat­ments by pa­tients as not some­thing most GPs, him­self in­cluded, are highly con­cerned about.

The hu­man body needs a re­ally wide range of nu­tri­tion, ide­ally ev­ery day

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