MANILA, Philippines—I was going to leave my column’s topic last Wednesday on “nutritionism” had it not been for Dr. Cecilia Florencio, professor emeritus at the University of the Philippines and the country’s most eminent nutritionist, who texted me to say she agreed that we need to get our priorities right: people, food and nutrients in that order.

We are captives of nutritionism with its focus on individual nutrients that are touted like magic bullets to solve our health problems. Yesterday the newspapers featured the President boasting about the government’s support of new “kalabasa-fortified noodles.” Presumably, the noodles are more nutritious than other commercial products because it has “kalabasa,” or squash, which is rich in vitamin A.

But other commercial instant noodles—now, it seems, the national dish of the Philippines—are also “fortified” with vitamin A and iron, complete with the Department of Health logo signifying its endorsement of the products. We’re left with questions about who actually benefits from these products. Will malnourished children be better off taking these “fortified” noodles? Or will this rake in more sales for the instant noodle manufacturers, as mothers begin to believe that these products are nutritious and good for their children?

Pork leg

I’d like to get back to the best-selling book “In Defense of Food” by Michael Pollan, which deals at great length with nutritionism. He points out that studies on the benefits of particular nutrients often show only correlation. I thought of an ongoing craze among the Chinese of eating pork leg because some research report ended up in the mass media with claims that pork leg brought down heart disease rates. Absurd as it may sound, such a correlation could exist, but all that correlation is telling us is this: among the people who participated in the research, those who ate pork leg had low heart disease rates.

We don’t know what else the research participants were eating. Neither do we know what the lifestyles of the participants were: If the study had been conducted in Hong Kong among the working class, I wouldn’t have been surprised to find lower heart disease rates because Hong Kong residents walk a lot. (The shopaholics among my Filipina friends complain, too, about getting large clothing sizes in Hong Kong because Hong Kong women all seem so slim.)

Many studies have shown that taking multivitamins is correlated with better health, but a good nutritionist will point out that this doesn’t mean the multivitamins alone will bring about good health. People who take multivitamins are probably more health conscious and might be more careful with what they eat, how much sleep and exercise they get. Conversely, people who take multivitamins but have low health literacy, as we do in the Philippines, might look at these vitamins as a cure-all to substitute for lifestyle changes, so I wouldn’t be surprised if we found such multivitamin consumers to be less healthy than those who are not taking any supplements.

I’ll give another example here to explain why the focus on nutrients can give us false leads. Some time in the 1980s, when I was working with a health NGO, I got word from some health professionals that there were villages in the Cordillera with relatively low goiter incidence. That was exciting news because goiter, an iodine deficiency disorder, is widespread in the region and can lead to other problems.

Lowlanders suffer less from goiter because of the iodine available mainly from seafood. The Cordillera villages with low goiter incidence also had limited seafood, but the villagers themselves speculated that a weed called “burburtak” was saving them from goiter. There was much excitement among the health agencies working in the Cordillera, who were hoping that by promoting “burburtak” the goiter problem could be solved. But it all turned out to be a false lead. The iodine content of “burburtak” varied from one village to another, and seemed to be a function of the soil’s own chemical composition.

The lesson is simple: When researchers talk about a particular vegetable or fruit having high levels of “anti-oxidants,” it doesn’t mean that by taking that magic food you’ll be saved from cancer. The anti-oxidant level will vary like “burburtak” did with iodine.

Goiter is a straightforward disease, clearly associated with a deficiency in one nutrient. Other diseases are more complicated. Heart disease, for example, emerges from a convoluted interaction of genetics and a host of lifestyle factors (smoking, diet, exercise, to name a few). Health activists like me will go a step further and point out “macro” factors, such as the government’s investment in preventive health education, the affordability of medicines like anti-hypertensives, even workplace conditions and the levels of stress induced.

Simple advice

Pollan is not a food faddist (whom he calls “orthorexics,” or people with an unhealthy obsession about healthy eating). Instead, he offers three simple pieces of advice for healthier nutrition: eat food, not too much, mostly plants.

The eat food advice is particularly intriguing, “food” used here in contrast to the junk that’s pushed on us in advertisements. He suggests that when we go to the supermarket, we should shop more at the sides, where fresh produce are stocked, rather than in the stacks in between where you have all the “food-like substances,” each trying to catch your attention with exorbitant health claims.

He suggests reading the packaging as well—and avoiding products that have long lists of ingredients. The more ingredients you can’t figure out, the healthier it will be to simply avoid the product. Don’t be deceived either by the use of the term “natural”—the food manufacturers are aware that people want to go back to natural foods, and so they’ll find ways to make their foodlike substances as natural as they can, including the use of “natural” flavors which are as “natural” as air freshener scents.

I can tell you I’m not one of those health freaks. Some processed foods are fine with me; after all, picked vegetables and tofu (“sosyal” term for “tokwa”) are processed too and I marvel at these simple but innovative cultural innovations.

Neither am I a gourmand insisting on fine foods. My tastes are simple, but I do want to eat food. As an anthropologist, I agree with Pollan when he observes that animals feed, but only humans eat food.

Food eating is social and cultural, especially when it comes to taste. We grow up believing very salty and very sweet foods are “good”; yet, when you think about it, large amounts of salt and sugar end up masking the real taste of food. Reduce the salt and sugar and you’ll find that foods taste much better, to the point where you might actually find sweetness and saltiness to be repulsive. With less salt and sugar, foods become so much richer and varied in tastes so that you might end up eating less, savoring more. That’s good nutrition.

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Email: mtan@inquirer.com.ph