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Nutritional Anxieties: From the Fear of Bad Nutrients to the Scarcity of Health-Enhancing Nutrients

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Over half of Americans, one third of British, and a quarter of Australians take one or more nutritional supplements each day, typically in the form of multivitamin and mineral tablets. And if not popping supplements, then they and many more people may be consuming reduced-fat or reduced-calorie foods and drinks, or foods fortified with the latest wonder nutrients, such as omega-3 fats.

Three studies just published in the journal Annals of Internal Medicine have reported that nutrient and multivitamin supplements are ineffective in reducing the risk of chronic diseases or improving cognitive functions, and that may even cause harm. Such conclusions are nothing new. Since the discovery of vitamins in the early 20th century, many nutrition experts have been urging us to source our nutrients from foods rather than from nutritional supplements. (1)

Yet nutrition scientists have also fueled our nutritional fears and anxieties that we're not consuming enough of the "good" nutrients we require for "optimal" health. Many experts continue to endorse the use of vitamin and mineral supplements as a form of "nutrition insurance," to cover you just in case you're not eating right and missing out on some essential component. For example, Walter Willet, a leading American nutritional epidemiologist from the Harvard Medical School, justifies multivitamin consumption as a "cheap and effective genuine 'life insurance' policy."

Nutritional fears and anxieties are now one of the defining features of our relationship to food, and seem to be driving this consumption of nutritionally modified foods and nutritional supplements. Many people -- including those who otherwise seem healthy and are eating plenty of (if not too much) good quality foods -- are concerned that they're just not getting enough of these nutrients out of everyday foods, and feel compelled to seek these nutrients from fortified foods or nutritional supplements.

The food and supplement industries have been very skillful at exploiting and exacerbating these anxieties, but they did not invent them. The public's concerns with the nutritional adequacy of their diets and the nutritional requirements of their bodies is in the first instance a product of the dominant focus on nutrients within nutrition science and dietary advice.

I refer to this dominant and reductive focus on nutrients as the ideology of nutritionism. This ideology now also frames and shapes the way in which individuals think about and engage with food and their bodies in terms of their nutrient components and requirements.

While the number of nutritional anxieties and fears that grip the public continue to increase, the nature of these anxieties has taken three distinct forms over the past century -- from the obsession with getting an adequate dose of essential nutrients, to the fear of too many bad nutrients, to anxieties over the scarcity of health-enhancing nutrients. These three forms of nutritional anxieties can be situated within three historical eras of nutritionism: the quantifying era, the good-and-bad era and the functional era.

Vitamania and Calorie-Counting
Beginning in the late 19th century, the primary aim of nutrition science was to identify the types and quantities of nutrients that were required to promote bodily growth and prevent deficiency diseases. In this quantifying era of nutrition, protein was fetishized for its growth-promoting properties, and it was on this basis that meat, and later dairy products, were heavily promoted. (2-3)

In the late 19th century, the calorie emerged as the primary concept for measuring the "energy" value of food and the energy needs of the body. Calories in, calories out. By the early 20th century, calorie counting for the purposes of weight loss was already starting to become an obsession of middle-class Americans, and therefore also a source of anxiety. (4-5)

But it was the discovery of vitamins that really sparked the public's nutritional obsessions. Many people were willing to believe the exaggerated claims regarding the health-promoting properties of these vitamins promoted by vitamin manufacturers and alternative health movements -- claims that went well beyond the more cautious pronouncements of most nutrition scientists. These vitamins were also perceived to be scarce in everyday industrially grown and processed foods, thus fueling the first nutrient rush to vitamin-fortified foods and vitamin supplements.

What I call the perception of nutrient scarcity refers to the anxieties and often exaggerated concerns that not only highly processed foods, but even fresh, whole foods, no longer contain the quantities of nutrient we require for good or "optimal" health. Government run nutrient-fortification programs targeting the nutritional deficiencies of subgroups of the population also reinforced the idea that everyday foods and dietary patterns were nutritionally deficient, and that they could be addressed through supplementation. (6)

Bad Nutrients: From the Fear of Fat to Carbophobia
Beginning in the 1960s, the idea that there are not just good and bad foods, but good and bad nutrients, was conceived and promoted by nutrition experts to the public. Fat, saturated fat and cholesterol were the vilified nutrients the public was told to avoid, and chronic diseases were linked to the overconsumption of these bad nutrients and of the foods in which they were contained. (7)

Nutritional anxieties thereby shifted to the consumption of these bad nutrients -- although the concern with getting an adequate quantity of essential nutrients also persisted. In this good-and-bad era of nutrition science, negative nutritional messages dominated dietary guidelines, with exhortations to "avoid," "reduce" and "eat less" of these harmful nutrients.

But this distinction between good and bad fats presented an extremely simplified, exaggerated and black-and-white view of the role of these naturally occurring nutrients that -- arguably -- wasn't adequately supported by the scientific evidence. It also led to some distorted dietary advice and dietary choices, with eggs and butter being vilified, while margarine and fat-reduced foods were presented as healthier choices.

This fear of bad nutrients was eventually embraced by food companies as a strategy for promoting their products, in the form of reduced fat, reduced calorie and cholesterol-free offerings.

The low-carb movement led by Dr. Atkins also emerged in the 1970s, and turned the distinction between good and bad nutrients on its head. (8) To low-carb proponents, it is carbs -- and "refined carbs" in particular -- rather than fats that are the bad nutrients. Carbophobia and fat-phobia proceeded to battle it out in the ensuing decades during the macronutrient diet wars.

Functional Nutrients: Optimal and Enhanced Health
Since around the mid 1990s, there has been a shift to a new era of functional nutritionism, in which the focus is on the more positive and health-enhancing potential of a novel range of nutrients and food components, such as omega-3 fats, antioxidants, plant sterols, probiotics and vitamin D.

These "functional" nutrients and food components are supposed to target and enhance the performance of particular bodily functions and processes, and to optimize our health, when consumed in high or "optimal" doses. This includes eating protein for satiety, probiotics for gut health, omega-3 for brain functioning, and low-GI (glycemic index) foods for blood-glucose management.

At the same time experts suggest that the suboptimal intake of these nutrients may increase our risk of chronic diseases. (9) In this functional era, we are made to worry that we may not be getting enough of these functional food components in everyday foods and diets, thereby exacerbating the public's nutritional anxieties. These new fears and anxieties are being added to -- rather than simply replacing -- the older fears of eating too many bad nutrients, or not consuming an adequate intake of essential nutrients.

The food and supplement industries have been very willing to promote the fear of scarcity of these functional nutrients, in order to construct consumer demand for their fortified foods and nutritional supplements, such as cholesterol-lowering margarine fortified with plant sterols, omega-3 enriched orange juice and probiotic yogurts.

Food and drink manufacturers also continue to produce old staples such as low-fat, low-calorie and vitamin-enriched products. Yet such modifications do not necessarily produce a better quality or less processed food. Soft drink manufacturers, for example, have produced low-calorie beverages by simply replacing some of the sucrose with artificial or other highly refined and intense sweeteners, such as stevia.

Guided by the same nutritional logic, some whole foods are now celebrated as nutrient-dense "superfoods" if they contain high concentrations of these functional nutrients, thereby exaggerating the health benefits of these foods.

While there certainly are many people who may suffer nutrient deficiencies due to very poor quality diets -- and which is typically an outcome of socioeconomic disadvantage -- focusing on changing the type and improving the overall quality of the foods being consumed is arguably a better option than focusing on the presence or absence of particular nutrients.

For most people, the alternative to both supplements and to nutritionism is to not only refocus on foods, but also to make space for other ways of understanding food and the body. Food production and processing quality should be a primary indicator of the healthfulness of foods, and in particular how different types of processing may be enhancing, reducing or degrading the quality of a food. In this respect we need to become more food quality literate, rather than just nutritionally literate.

But we can also learn from other cultural and traditional knowledge of what makes an overall healthful diet, as well as trusting in the sensual and practical knowledge and experience we develop from growing, preparing and consuming our food. The Slow Food movement, for example, has championed this approach to food. (10) Perhaps this is a recipe for freeing us of the anxieties over whether we're getting enough, too much, or the "optimal" amount of particular nutrients in our diets.

References:
1. Apple, R. (1996). Vitamania: Vitamins in American Culture. New Brunswick, Rutgers University Press.

2. Cannon, G. (2003). The Fate of Nations: Food and Nutrition Policy in the New World. St Austell, Caroline Walker Trust.
Apple, R. (2010). What's for dinner? Science and the ideology of meat in twentieth-century US culture. Meat, Medicine and Human Health in the Twentieth Centiry. D. Cantor and e. al.: 127-235.

3. Wiley, A. S. (2011). Re-Imagining Milk, Routledge.

4. Carpenter, K. (2003). "A short history of nutritional science: Part 1 (1785-1885)." The Journal of Nutrition 133(3): 638-645.

5. Schwartz, H. (1986). Never Satisfied: A Cultural History of Diets, Fantasies and Fat. New York, Doubleday.

6. Apple, R. (1996). Vitamania: Vitamins in American Culture. New Brunswick, Rutgers University Press.

7. Scrinis, G. (2013). Nutritionism: The Science and Politics of Dietary Advice. New York, Columbia University Press. Chapter 4.

8. Atkins, R. C. (1973). Dr. Atkins Diet Revolution. New York, Bantam.

9. Heaney, R. (2008). "Nutrients, endpoints and the problem of proof." The Journal of Nutrition 138(9): 1591-1595.

10. Petrini, C. (2001). Slow Food: The Case for Taste. New York, Columbia University Press.

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