Updated: Jul 14
Once, a patient tried to convince me that Red Bulls were healthy since they contained added vitamins. On another occasion, a poorly controlled diabetic told me that he avoided fruits since they were full of sugar. Then another one mentioned he wasn't worried about his diet since he always remembered to take his daily multivitamin.
Did you know that beta-carotene (found in carrots ) supplements were found to increase breast cancer in one study, but carrots are protective against cancer. Did you know that vitamin E supplements often contain only one of the 8 sub-types and that taking high doses of one could impede the absorption of the other 7, with negative consequences down the road?
What you don't know could hurt you and with all of the conflicting misinformation out there put forth by those selling you these foods or supplements, no wonder we're all confused. Do antioxidant supplements work? The answer is no. Studies show that taken individually, antioxidant extracts confer almost no benefit, whereas antioxidants taken through food have many. Antioxidants can't be viewed as distinct or individual molecules, since in nature, they exist interlinked, surrounded and trapped in a web, or matrix of fiber, phytochemicals and other chemical compounds. To have any beneficial or measurable effect, these antioxidants must be consumed with the complex matrix in which they exist. Isolating or extracting antioxidants and concentrating them in pill form often makes them lose their magic. The food-processing phenomenon can be viewed as part of a spectrum, where basically a small or large part of the matrix is destroyed. The amount of alteration of the food's matrix will ultimately determine the loss of valuable micronutrients, which are then re-added to the food in question. Re-adding them through fortification without the complex food matrix they originally contained is not the same as the way it was packaged by Mother Nature. Processing can be defined as the amount of alteration that goes into the food matrix, as well as the amount of additives that are added to the end product to maintain shelf-life, taste, texture, etc.
These are all examples of nutritional reductionism, or nutritionism, the concept that we can reduce whole foods and their impacts on the human body based on the effects of their individual nutrients.
In other words, nutritionism assumes we can determine the health effects of a particular food based purely on the micronutrients it contains, regardless of its food matrix. It's the complete opposite of whole-ism, where a holistic and zoomed out approach at food is prioritized. I'll give you an example. Let's say you're looking for a healthy breakfast cereal for your child. You try to read the food label and you're suddenly impressed by the fact that the cereal seems to contain an adequate amount of vitamins and minerals. Now, what you might not notice is that this cereal is highly processed, meaning the original matrix of the whole grains it contained has been completely destroyed, along with the health promoting compounds it contained. The cereal is then re-fortified with additional micronutrients and this makes the food label look like a champion. Additives and other industrial chemicals are added for taste, spoilage prevention and color. You think this is a relatively healthy cereal. What no one talks about is that these micronutrients that were added to the cereal behave in a different way when these nutrients aren't consumed within the original food matrix they came with in nature. A similar cereal made with whole or minimally processed grains will offer a lot more bang for your health buck. That being said, certain micronutrients are actually better absorbed after fortification, and I'm not bashing fortification, which has the best of intentions. I'm simply pointing out that for the most part, and for most nutrients, except outliers like iodine, folate, vitamin B12 and vitamin D, fortification isn't necessary if you're eating more whole foods.
Step Into The Food Matrix
The health benefits of nutrients, like vitamins, minerals and antioxidants are often studied and researched in labs after being isolated from the food matrix they came with, so reductionism is necessary in order to study micronutrients in a lab, but we can't automatically assume that what happens in a test tube will happen in our complex bodies.
Let me give you a few simple examples of how a food matrix can effect nutrient absorption. If you eat whole nuts, like cashews or almonds for example, their absorption will go like this. The digestion starts in your mouth through chewing and salivary enzymes. Then on to the stomach where the acids start denaturing certain proteins. Then on to the first portion of your small intestine, called the duodenum, where fats get broken down by bile acid and pancreatic enzymes. The microscopic and macroscopic pieces of nuts move down the small intestine where some of the nutrients get absorbed. Believe it or not, bigger pieces of unchewed nuts will have escaped the digestive forces of the previous organs and some pieces will make it to your colon. Here, they provide a feast for your gut flora. They will ferment and break down the remaining nut particles and release potent chemicals in return. These chemicals derived from gut bacteria will get reabsporbed in your blood flow, and circulate everywhere in your body, offering many benefits in the process. Up to 10-15% of the nut particles will never be absorbed, finding themselves excreted in your stools. Now imagine the same amount of nuts, but ingested in powder form, or in nut-butter form. Since the food matrix is altered, the absorption and ensuing health effects of the exact same food will be drastically different. Almost none of the nut particles will even make it to the colon, since the powdered forms were all absorbed in your small intestine. None of the calories will get excreted in your stools. This scenario illustrated with nuts is the same with pretty much all foods.
Sugars in whole fruit are not absorbed in the same way as sugar in fruit juices, and even more different than in sugar from froot loops. Whole legumes, like chickpeas, do not have the same metabolic effects as chickpea flours do. The calories, vitamins and minerals absorbed will be much different in a whole food when compared to a minimally processed food, like its powdered form. If absorption can be drastically modified with minimal processing techniques, like powdering, one can safely assume that ultra-processing will change its absorption and health effects even more. In ultra-processing, the food matrix is so altered that it's unrecognizable. The health effects of the nutrients that are added back in aren't zero, but can be inferior to the health effects of the same nutrients that were there all along before processing removed them. When nutrients get absorbed in whole foods, they get absorbed concurrently with the fiber and phytochemicals that surround them.
Are There Benefits To Nutritionism?
Nutritionism has given us improved versions of nutrient-poor processed foods. It has given us fortified foods, like orange juice with added calcium, milk with vitamin D, or breakfast cereals like Lucky Charms fortified with folate. If you're gonna eat these foods, I much rather you eat the fortified version, but never assume that these foods are healthy to start with. Fortification of processed foods through nutritionism has shifted our attention away from the fact that most of these foods aren't healthy to start with. Micronutrients added to processed foods do not always behave the same way in our bodies than the same nutrients absorbed along with their unprocessed food matrix.
The Downfalls Of Our Reductionist View
Nutritionism had led us to believe that the healthfulness of a specific food can be described purely based on the individual micronutrients it contains. Science has proven this to be not true. Extracting and consuming individual nutrients from an apple is not even close to eating an actual apple. The food matrix is made out of fiber and other phytonutrients that intimately surround the micronutrients and have significant effects on how these are absorbed and metabolized in our bodies. The simplistic views of nutritionism have encouraged food corporations to market many of their fortified foods as new and improved versions of the previous generation of products.
One of the major drawbacks of nutritionism is that it has shifted our perspective away from eating real food. No one ever argued whether broccoli was better than oatmeal, or if apples were healthier than oranges. Nutritional reductionism has created a polarized view of food, where some are labelled as good and others as bad. People now think beans contain too many carbs, or avocados and nuts contains too much fat. Diabetics avoid fruit thinking they contain too much sugar. If people focused on whole foods instead of individual nutrients, none of this would happen.
The dualistic thinking brought upon us by nutritionism has led us to believe that if there are “good” nutrients, there must be ”bad” ones too. This is demonstrated by our society’s fear of fat, or how we put protein on a pedestal. We fear carbs when the longest living populations on earth eat a mostly carb heavy diet. Nutritionism leads to food fads, where certain foods are demonized, like in to paleo diet where it is recommended to avoid legumes and whole grains. On the other hand, science clearly shows that these 2 food groups are the most associated with longevity and reduced risk of cancer and other chronic diseases. Nutritional reductionism makes us fear these foods because of the individual nutrients they contain, instead of seeing them holistically.
Adding vitamin B12 to Red Bulls or fortifying Lucky Charms cereal doesn't make them healthy. It might prevent deficiencies in certain vital nutrients, but ignores the fact that the food matrix present in whole foods seems to be the main predictor of a food's healthfulness, not the individual micronutrients. To simplify things, eat more real foods, like the ones that grow in the ground, or from a tree. We evolved eating a variety of these, without stressing over whether apples were healthier than oranges.