Drop Dead Healthy

The Stomach, Revisited

The Quest for the Perfect Meal

A FEW DAYS AGO, I stumbled across what sounded like an interesting perspective: a Colorado-based doctor named Steven Bratman who has discovered what he calls a new eating disorder: “orthorexia nervosa.” He defines “orthorexia” as an unhealthy obsession with healthy foods.

The idea is that if you are unduly fixated on eating healthfully, you’ll stress yourself out—so much so that the damage from the stress outweighs any potential benefits of the good food. It’s an intriguing idea, so I e-mail Bratman to request an interview.

He agrees, responding that he has “a number of salty comments.”

Salty. Interesting choice. He even uses unhealthy foods as adjectives.

When I talk to him, Dr. Bratman is as full of sodium as promised. He says the obsession with healthy food is “stupid.” Its practitioners are filled with “hot air.” In the end, too much emphasis on your diet is harmful because “you don’t have balance in your life.”

Once upon a time, Bratman himself had a fetish for healthy food. Back in the seventies, he was an organic farmer and chef at a commune in upstate New York. He spent his days steaming tomatoes and arguing about whether aluminum pots were poisonous. He reached a breaking point when, he says, “a particularly enthusiastic visitor tried to convince me that slicing a vegetable would destroy its energy field.” In frustration, Bratman chased the guy away with a flat Chinese cleaver.

After his fall from health food grace, he coined the term “orthorexia.” The “ortho” part derives from the Greek for “correct,” and the “rexia” is from the word for “appetite.” Hence orthorexia, the mania for the correct diet. The condition hasn’t yet made it into The Diagnostic and Statistical Manual of Mental Disorders, the bible of psychological illnesses. But it’s gained some fans among therapists and researchers. Bratman wrote a book about the condition called Health Food Junkies.

The symptoms include:

• When you stray from healthy food, you’re filled with guilt and self-loathing.

• You become socially isolated because it’s hard to eat at the same table as less conscientious friends.

• Healthy eating has become your replacement religion, making you feel virtuous. You regard omnivores with disgust.

In Bratman’s words, “a day filled with wheatgrass juice, tofu and quinoa biscuits may come to feel as holy as one spent serving the destitute and homeless.”

So according to Bratman, health food fetishism will hurt me. Perhaps. But even if it’s true, I need some basic instructions on what to eat to be the healthiest person alive. What does he recommend?

“Don’t get fat and get your vitamins.”

That’s it? That’s his health advice? I press him for more.

Bratman resists. The problem is, everyone wants secrets: Selenium will prevent bladder cancer, so eat Brazil nuts! Flavonoids prevent heart disease, so eat pineapple! But the science just isn’t there yet. He tells me all health advice can be boiled down to a single paragraph:

“Eating fruits and vegetables is vaguely logical. Get sleep. Don’t live in the most polluted parts of the world. Don’t smoke. Don’t do unsafe things like skiing and hang gliding, which are inconceivably more dangerous than eating ‘unhealthy’ foods. Exercise is pretty likely good for you. Don’t drink too much alcohol—one or two drinks a day. And that’s about it.”

In Bratman’s view, all the hype about antioxidants and glycemic indices is unproven. Nutrition science is barely more evidence-based than phrenology. Or as Bratman puts it, “hardly better than college bullshitting.”

This stance has not made him friends in the health food community. His website has a section devoted to reader hate mail. One of the milder samples: “Dr. Bratman, you are a moron. Please go to Mickey Dee’s and chow down on a few Big Macs and don’t call me in the morning. I guess Monsanto’s GMO products, high-fructose corn syrup, aspartame, processed sugar and flour are great for us . . . Have a great day and don’t forget to supersize, you idiot.”

I don’t think Bratman is an idiot. Mind you, I don’t agree with him. His conclusions are far too radical for me. But I believe he provides an important cautionary voice. Because the more I learn, the more I realize we know a lot less about nutrition than the newspaper headlines would have you believe. Food is frustratingly complicated. It resists reductionism. Often, we’ll identify what we think is a secret healthy ingredient—carrots have beta carotene, which is why they prevent cancer. So we’ll give people beta-carotene supplements, only to find out it’s not so simple. Beta-carotene supplements increased the instances of lung cancer among smokers in a large study in Finland.

Your everyday carrot is filled with so many micronutrients, we don’t yet know how they interact with one another. Michael Pollan, author of The Omnivore’s Dilemma, likes to say, “Nutrition science, in my view, is sort of where surgery was in the year 1650. It’s interesting. . . . But would you really want them operating on you yet?” The best we can do, to paraphrase Pollan, is to eat whole foods, mostly plants, and not too much.

Ben Goldacre—a British doctor, skeptic, and author of the book Bad Science—is even harsher. He talks about nutritionists’ lack of “intellectual horsepower” and their “crimes” against sensible dietary advice.

The problem is, it’s hard to conduct randomized placebo-controlled studies on humans and their diets. If you could lock ten thousand people in identical rooms for eighty years and feed half of them nothing but vegan food and feed the other half nothing but steak and eggs, and keep everything else the same, you could have some real data. But unless a Bond villain decides to pursue a doctorate in nutrition, that’s not going to happen.

Instead, much of our nutrition knowledge comes from two sources. First, animal studies. Which can be enlightening but don’t always translate to humans.

And second, epidemiological studies. I’m vastly oversimplifying here, but an epidemiological study is when scientists analyze statistics in a population to determine the cause of a disease. It’s a hugely useful tool. Epidemiology helped link tobacco and lung cancer, and cholera and dirty water. But it’s also got limitations, especially when it comes to something as complicated as food and drink. There are hundreds of confounding factors that can throw off the results.

Consider alcohol. The data show that drinking is healthy because moderate drinkers live longer than teetotalers. But what if it’s not the drinking but the social interaction that goes along with drinking? What if parties and sporting events are healthy, not vodka?

The science journalist Gary Taubes wrote a great New York Times Magazine story on the problem, and sums it up this way: We often confuse correlation and causation. To cite a famous example: Diabetes rates are much lower in areas where people own passports. Therefore, you might conclude that owning a passport prevents diabetes. Right? Wrong. It’s more likely that passport owners are wealthier, and wealthier people can afford healthier food.

These complexities make me feel both better and worse. Better because I now understand why nutrition headlines contradict each other every week. (Soy is the secret! Soy is poison!) It’s not always out of stupidity or conspiracy. Sometimes it’s just because it’s so darn complicated.

But it’s also dispiriting, because at least for now, there are no black-and-white answers.

The Battle for the Plate

That said, I can’t give up. I still want to figure out some basic guidelines on what to eat.

First, let me start with what almost everyone agrees on, not counting Bratman. Study after study suggests we should be eating more whole foods, not processed foods—broccoli instead of french fries. We’ve got way too much sugar in our diet. And to a lesser extent, too much salt. And, as I mentioned before, we eat too much damn food.

In other words, almost everyone agrees our nation’s typical fried and sugar-laden daily intake is a disaster. My aunt Marti calls it by the delightfully descriptive acronym SAD—Standard American Diet.

So there’s a lot we all agree on. But there’s also a lot of room for dispute. And man, is there dispute. The nutrition field resembles Congress. There are two warring tribes, and most everyone falls somewhere along the spectrum.

On the far left side, many advocate for the plant-based diet. On the far right, others argue for the low-carb, high-protein diet.

Currently, the advocates of the mostly plant diet have the majority. The holy text of radical plant fans is the bestselling 2005 book The China Study by T. Colin Campbell, a nutritional biochemistry professor at Cornell. It’s an impressive book based on a huge twenty-year study of 880 million people in China. The conclusion? Eating animal products causes a large number of health problems, including heart disease, diabetes, breast cancer, macular degeneration, bowel cancer, osteoporosis, and others. The healthiest diet is one with no animal products at all, no beef, no poultry, no eggs, no fish, and no milk. Campbell doesn’t like to call the diet “vegan,” since that carries political tones. But essentially, it’s vegan. So that’s one side.

The other side is best represented by the aforementioned Gary Taubes, a brilliant journalist who wrote the books Good Calories, Bad Calories and Why We Get Fat. One of his big theses is that the low-fat diet is a sham. It’s based on faulty science. In fact, America adopted the low-fat diet in the 1970s. That’s the exact same era when the obesity epidemic began. The low-fat diet, he argues, has been a giant belly flop.

The real culprit isn’t fat. It’s carbohydrates—especially refined carbs. Here’s Taubes: “Insulin puts fat in fat cells. That’s what it does. And our insulin levels, for the most part, are determined by the carb-content of our diet—the quantity and quality of the carbohydrates consumed.” The more concentrated the sugar in our carbs, the more dangerous they are.

Taubes and his camp recommend restricting carbs as much as possible, especially processed carbs, high-glycemic carbs (like bananas), and starchy carbs (like potatoes). Instead, they recommend eating more protein and good fats. They eat a lot of lean beef, eggs, fish, and all sorts of vegetables (spinach and broccoli, for instance). But little grain.

I’ll tell you where I’ve stood for the last decade or so: On the spectrum, I’ve leaned more toward The China Study side. I’m not vegan. I still eat eggs and salmon. But I don’t eat beef, pork, or lamb. I used to call myself a quasi-vegetarian. Now I prefer the trendier term “flexitarian.”

There are two reasons I lean this way.

The first is because I’m biased. My lovable, eccentric aunt Marti has been drilling antimeat information into my brain since I was a kid. She’s showed me videos of the horrors of slaughterhouses. She’s told me about each and every carcinogen allegedly found in meat. She’ll make animal products as unappetizing as possible. If I’m eating ice cream, she’ll say, “Are you enjoying your mucus? Because that’s what ice cream is, essentially. Congealed mucus.” If I’m eating honey, she’ll ask, “How’s the bee vomit?”

Her passion is hard to forget. I still remember one dinner at my grandfather’s house. The whole extended family was there, and Marti, at the time, refused to eat at the same table where flesh was being served. Half the family was fine with that. But the other half wanted chicken. The solution? We had to set up two separate tables in the dining room—a meat table and a nonmeat table. My diplomatic grandparents didn’t want to take sides, so they sat at a third table in the middle, a dietary DMZ.

The second reason I opt for the plant-based diet is that, in technical matters, I tend to accept the beliefs of most scientists.

This semiblind acceptance is an unfortunate result of the arcanization of scientific knowledge. If I lived in the nineteenth century, I could judge for myself whether I thought Mendel’s study on peas made sense. But can I judge whether C-reactive protein is a better predictor of heart disease than LDL levels? Not without devoting several months of my life to that single question. It’s why I believe in global warming. If a survey by the National Academy of Sciences finds that 97 percent of climate scientists believe in man-made climate change, I feel it’s wise to accept their view.

This stance has its downsides. Science isn’t perfect, and suffers from biases, fads, and fraud. But the upsides outweigh the dangers.

And right now the majority of scientists advocate a diet with lots of plants and reduced animal-based fats and protein. Even the USDA’s 2011 dietary guidelines inch toward the plant-based side. In the past, some nutritionists slammed the USDA Food Pyramid for being too heavily influenced by the pro-meat agriculture lobby. But the latest version took the step of recommending minimal animal protein. You can see it in the 2011 MyPlate, in which protein makes up just 20 percent of the ideal meal, with beans strongly recommended.

But I don’t ignore Taubes’s advice. He makes a persuasive case against simple carbs, one that has altered what I put in my mouth. I’m now loath to put anything white in my mouth, not counting cauliflower and straws (the latter of which may help cut down on corrosion to the teeth, especially if they are placed in the back of the tongue).

Shopping the Perimeters

To help me figure out the healthiest diet, I decide I need a guided tour of the grocery. I called Marion Nestle, a professor at New York University, author of What to Eat, and a highly respected thinker in all things nutritional. She met me at Whole Foods in midtown New York.

I chose Whole Foods not just because it’s got lots of healthy food. But also because it’s got lots of unhealthy food disguised as healthy food. Sugar and fat in antioxidant clothing. And I’m a sucker for faux health food.

It’s been a significant portion of my diet for the past decade. I eat sweetened granola bars and organic cereal that tastes like off-brand versions of Frosted Flakes. An embarrassing confession: I used to drink VitaminWater. Look at that, I said to myself, it’s got green tea extract! If I’d been around in the nineteenth century, I’d be the first to say, Yes, Mr. Barnum, I would like to see the egress. Sounds fascinating.

I’m aware on some level VitaminWater is gussied-up sugar water—a bottle contains 32.5 grams of sugar, nearly as much as a can of Coca-Cola Classic’s 39 grams. But I still like eating and drinking this ersatz health food. It gives me a virtuous feeling, even if that virtue is unfounded. At least I’m doing something, you know? And it says “Healthy” right there on the package.

I meet Nestle—whose name, incidentally, is pronounced NESS-el, not like the Toll House cookie makers—at the bottom of the escalator. She’s with her boyfriend, Mal Nesheim, a well-respected (and farm-raised) Cornell University nutrition professor.

Nestle wants to make it clear she’s pro–Whole Foods, despite its flaws. She regrets mentioning its nickname, “Whole Paycheck,” in her book. “That was trite,” she says. Yes, it can gobble up your bank account, but the fact that healthy food costs more than artery-clogging food shouldn’t be dismissed with a glib phrase. It’s a complicated issue. (For one thing, Americans spend much less of their paycheck on food than Europeans—an estimated 10 percent to 30 percent. We might have to adjust our priorities.)

I ask her to show me the least healthy food in Whole Foods. “Oh, let’s go look at the breakfast cereals,” she says. “They’re always the most fun.”

We walk to aisle one. And there, we find box after box of cereal with pictures of farmhouses and grain fields. She picks up a carton. She slides her glasses from atop her curly gray hair to her nose, and lasers in on the nutrition label. Nestle has spent more time reading nutrition labels than most Americans have spent reading novels (which, I suppose, isn’t saying much). And she knows how to unlock their secrets.

“Evaporated cane juice,” she reads aloud. “Translation: sugar.”

Really? It sounds so natural.

“Organic molasses,” she keeps reading. “Translation: sugar.”

It’s not better?

“It’s got a few nutrients. But not enough to make a difference. Sugar is sugar.”

What about agave nectar? That’s the healthy sugar, right?

“No.”

Some sugars are slightly better than others, but only slightly. If you eat too much, they all end up as fat and can lead to metabolic syndrome and diabetes and all sorts of other horrible maladies.

A little farther down the aisle are all the faux-healthy protein bars. “Oh, look, it’s organic!” says Nestle, with more than a bit of sarcasm. “There’s now research that shows that when people see the word ‘organic,’ they think it has fewer calories.”

So if high-cane-juice cereals are the least healthy, what foods are the healthiest? Nestle leads me to the produce section.

“Here. Anything in here.”

“Blueberries?” I say. “They’re a superfood.”

“Yes, they’re healthy,” says Nestle. “But I don’t believe in superfoods.”

Hold on now. What’s this?

Nestle thinks that we have an outsize obsession with ranking our fruits and vegetables. Her argument is, in a way, similar to Bratman’s. Our reasoning is too reductive. We figure: Fruits and vegetables are good for you. Fruits and vegetables have antioxidants. Therefore it’s the antioxidants in the fruits and vegetables that are good for you.

This type of thinking leads us to believe the idea that the fruit with the most antioxidants is the best. It makes us overlook all the nonsuperfoods—what one writer called “Clark Kent” foods—such as apples and oranges, which are perfectly healthy. Antioxidants are just one of dozens of good chemicals in food.

Nestle says that the blueberry obsession can be traced, in part, to the clever marketing efforts of the Maine wild blueberry growers. A decade ago, the Maine blueberry industry was in trouble. In years past, blueberry promoters had tried several strategies: They attempted to market blueberries as candy. Even odder, they ran a campaign suggesting blueberries as a condiment to put on hamburgers. Nothing worked. But when a Tufts study said that wild blueberries had a high antioxidant rating, they ran with it, and blueberries have become the prototypical health food.

We finished our Whole Foods adventure and went to lunch at a nearby café. I order the Bibb lettuce salad, dressing on the side.

The waitress looked at Nestle and Nesheim. “Are the profiteroles good?” asks Nestle.

“So good,” says the waitress.

“I’ll have that.”

Huh. I’m here with quite possibly the most knowledgeable nutritionist in the world, and she’s having a plateful of sugar and fat.

“You’ve got to enjoy food,” says Nestle, noticing my raised eyebrows. “It’s one of the great things in life.” She assures me that she eats plenty of fruits and veggies as well.

I’m not a doctor, but I can say with certainty: Marion Nestle does not have orthorexia.

Checkup: Month 6

Weight: 160

Average number of errands sprinted per day: 3

Waist size: 34 (down from 35)

Pounds lifted on squat machine: 90 (improvement!)

Sleep per night: 6.4 hours

Half-ounce Purell bottles used this month: 14

Overall state: I’m feeling okay, though a little stressed out about how much of my book advance I’m spending on fitness equipment. My closets are filling up with a bizarre collection of weights, gadgets, and clothes. It’s as if I were given access to a SkyMall catalog, a cell phone, and a jug of whiskey.

I am now the proud owner of a yoga mat and a Swiss exercise ball. I also have a compression suit from Under Armour. This skintight silver outfit is supposed to help your muscles recover more quickly postworkout by reducing swelling. I wore it to the gym one day, and got plenty of feedback from the gym staff. “Hey, Superman!” “Nanu, nanu!” And so on. But there’s something comforting and womblike about its snugness.

I own a custom-fitted mouthpiece that is supposedly similar to the one worn by Derek Jeter. A modern spin on my eighth-grade retainer, the mouthpiece is designed to open your airways, and relax you by unclenching your jaw. It does make running easier—though I can get the same effect for free by jutting my jaw forward a half inch while running.

Of all the gadgets that clutter my closet, the most successful has been one of the simplest: a twenty-dollar pedometer. Actually, I have two, since Julie agreed to join me in my pedometer experiment.

Studies show that the more you pay attention to your body’s statistics, the greater the chance you’ll adopt a healthy lifestyle. This idea underpins the Quantified Self movement, in which adherents track everything from caloric output to selenium levels.

The mere act of weighing yourself daily makes it more likely you’ll shed pounds, according to a University of Minnesota study. Keeping a food journal makes you eat fewer fatty foods, according to another study. And pedometers make you walk more.

Julie and I wear our silver bubble-shaped pedometers clipped to our pants. Our stated goal is to rack up ten thousand steps per day—an amount that the President’s Council on Physical Fitness and Sports considers a “reasonable goal.”

The pedometer doesn’t just spur us to move, though it certainly does that. It changes the way we think about movement. What was once a chore becomes a game. The other day, I spent half an hour looking for Lucas’s missing stuffed elephant. Normally, that would be half an hour of frustration and snarling. Instead, I focused on the fact that I notched five hundred steps. Give me more missing stuffed animals! You got any keys I can search for? I’ll take anything on.

My treadmill desk gets me past the ten-thousand mark most days. But Julie doesn’t go down without a fight. She marches in place while making coffee or talking on the phone.

We were walking to the park the other day, and I noticed that she was taking quick, tiny, ballerina-size steps. “I’ve got shorter legs than you,” she said. “I’ve got to play to my strengths.”

She’s enjoying the competition. We’re getting along so well, I figure I’ll devote the next month to another joint activity.