07 September 2005

The Changing American diet.

Perennial favorite Science News has called attention to the virtues of the Mediterranean diet and particularly research that shows that extra-virgin olive oil may act as an anti-inflammatory, much like ibuprofin. The Denver Post is also on the story in its food section: "Once exotic, Mediterranean ingredients are now standard in our kitchens: olive oil, garlic, fresh herbs", the paper proclaims. Science is telling us what is healthy, with solid empircal evidence to back it up, and we are listening to the sometimes confusing message.

I am personally not an olive oil fan. Consumption of large amounts of it does not agree with my digestive system. But, there is no doubt that the American diet is changing. The United States has gotten the message about removing saturated and transfats from our diets. Lard is no longer found in every other recipe. I may not consume Mediterranean quantities of olive oil, but I do buy products that lack fats and trans-fats, do drink skim milk, have largely removed butter and margarine and lard from my diet, and do cook with other relatively healthy liquid vegetable oils that agree better with my system. I'm not the only one taking these steps.

According to the Economic Research Service of the U.S. Department of Agriculture, since 1970, per capita U.S. consumption of whole milk has dropped about 70%, while low-fat and skim milk consumption up almost three fold (total milk consumption per capita is down by about a third). Per capita butter consumption is down about 75% since 1940. Margarine consumption replaced most butter consupmtion initally, but has now fallen off has the public has become aware of the dangers of trans-fats.

The average American consumes less red meat per capita than in either 1910 or 1940. Red meat consumption is down more than 10% since 1970, although we do consume 33% more fish per capita than we did in 1970, and twice as much poultry.

This isn't to say that Americans have mastered the diet and exercise puzzle. Obesity levels remain at record highs. But, it isn't for want of trying to take, at least, easy steps to address it.

We are also seeing a shift in how we view asprin. A decade or two ago, we thought of it as primarily a headache and flu medicine. Now, as studies have shown that an asprin regime can cheaply and dramatically reduce cardio-vascular disease incidence, we are increasingly seeing asprin not as a medicine, but as a vitamin.

Ditto alcohol. Less than a century ago, our nation was convinced that prohibition was the solution. Now, epidemiology has taught us that regular moderate alcohol consumption is comparable in importance to heart health to cutting down on butter.

I'm optimistic. U.S. society has very rapidly become less active. People drive to get around and do sedentary work, something that was far less common half a century ago. Modern appliances like washing and drying machines, which are now ubiquitous, have even reduced the amount of physical labor associated with housework. Meanwhile, food has gotten a lot less expensive. In the Depression, the political slogan was a chicken in every pot. People were worried about simply getting enough food to eat on the table. Getting enough to eat is now rarely the biggest problem even for the very poor- although nutritional quality is often still lacking. Of course, it is goint to take time for our society to adjust to such a dramatic change, and while we are adjusting our habits, obesity is a natural consequence. But, the change is taking place.

Today's largely a middle class health craze is well on its way to become the standard American diet. All of us are slowly learning that if we do sententary work that we need to put exercise into our daily and weekly routines. This are hard lifestyle changes to make, and the people on the front lines of telling us what we need to do to be healthy, primary care physicians, are ill suited for changing lifestyles as opposed to treating infectious and accute conditions. They didn't sign up to be cultural innovators. But, despite a profusion of scientific idiots, a sufficient critical mass of Americans does care enough about their health to try to sort through the evidence and over time a consensus culture of food which is far more healthy is emerging.

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