Image Credit: Kristina DeMuth. This image has been modified.

From Adequate Nutrition to Optimum Nutrition

Research in human nutrition over the past four decades has led to many discoveries as well as a comprehensive understanding of the exact mechanisms behind how food nutrients affect our bodies. As I discuss in my video Reductionism and the Deficiency Mentality, however, the “prevalence of epidemics of diet-related chronic diseases, especially obesity, type 2 diabetes, osteoporosis, cardiovascular diseases, and cancers, dramatically increases worldwide each year.” Why hasn’t all this intricate knowledge translated into improvements in public health? Perhaps it has to do with our entire philosophy of nutrition called reductionism, where everything is broken down into its constituent parts; food is reduced to a collection of single compounds with supposed single effects. “The reductionist approach has traditionally been and continues today as the dominant approach in nutrition research.” For example, did you know that mechanistically, there’s a chemical in ginger root that down-regulates phorbol myristate acetate-induced phosphorylation of ERK1/2 and JNK MAP kinases? That’s actually pretty cool, but not while millions of people continue to die of diet-related disease.

We already know that three quarters of chronic disease risk––diabetes, heart attacks, stroke, and cancer—can be eliminated if everyone followed four simple practices: not smoking, not being obese, getting a half hour of exercise a day, and eating a healthier diet, defined as more fruits, veggies, and whole grains, and less meat. Think what that could mean in terms of the human costs. We already know enough to save millions of lives. So, shouldn’t our efforts be spent implementing these changes before another dollar is spent on research such as figuring out whether there is some grape skin extract that can lower cholesterol in zebra fish or even trying to find out whether there are whole foods that can do the same? Why spend taxpayer dollars clogging the arteries of striped minnows by feeding them a high cholesterol diet to see whether hawthorn leaves and flowers have the potential to help? Even if they did and even if it worked in people, too, wouldn’t it be better to simply not clog our arteries in the first place? This dramatic drop in risk and increase in healthy life years through preventive nutrition need not involve superfoods or herbal extracts or fancy nutritional supplements—just healthier eating. When Hippocrates supposedly said, “Let food be your medicine and medicine be your food,” he “did not mean that foods are drugs, but rather, that the best way to remain in good health is to maintain a healthy diet.” (Note: Hippocrates probably never actually said that—but it’s a great sentiment anyways!)

The historical attitude of the field of nutrition, however, may be best summed up by the phrase, “Eat what you want after you eat what you should.” In other words, eat whatever you want as long as you get your vitamins and minerals. This mindset is epitomized by breakfast cereals, which often provide double-digit vitamins and minerals. But the road to health is not paved with Coke plus vitamins and minerals. This reductionistic attitude “is good for the food industry but not actually good for human health.” Why not? Well, if food is good only for a few nutrients, then you can get away with selling vitamin-fortified Twinkies.

We need to shift from the concept of merely getting adequate nutrition to getting optimal nutrition. That is, we shouldn’t just aim to avoid scurvy, but we should promote health and minimize our risk of developing degenerative diseases.

Bringing things down to their molecular components works for drug development, for example, discovering all the vitamins and curing deficiency diseases. In the field of nutrition, “[h]owever, the reductionist approach is beginning to reach its limits.” We discovered all the vitamins more than a half-century ago. When is the last time you heard of someone coming down with scurvy, pellagra, or kwashiorkor, the classic deficiency syndromes? What about the diseases of dietary excess: heart disease, diabetes, obesity, and hypertension? Ever heard of anyone with any of those? Of course we have. Yet we continue to have this deficiency mindset when it comes to nutrition.

When someone tries to reduce their consumption of meat, why is “where are you going to get your protein?” the first question they get asked, rather than “if you start eating like that, where are you going to get your heart disease?” The same deficiency mindset led to the emergence of a multibillion-dollar supplement industry. What about a daily multivitamin just “as ‘insurance’ against nutrient deficiency?” Better insurance would be just to eat healthy food.


Professor Emeritus T. Colin Campbell wrote a Whole book about this issue, and I’m looking forward to doing many more videos on the topic.

So, where do plant-eaters get protein? Check out Do Vegetarians Get Enough Protein? to learn more.

The concept of optimal, rather than merely adequate, nutrition is illustrated well in this video about fiber: Lose Two Pounds in One Sitting: Taking the Mioscenic Route.

Other videos on reductionism include

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Discuss

Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.


48 responses to “From Adequate Nutrition to Optimum Nutrition

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  1. Reductionism vs Wholeism

    “To understand the Universe, one needs both a telescope and a microscope,

    and the brains to interpret what one sees in each” :-)

    —- WFPB-Hal, circa 2016

    1. To understand the universe and this world you just have to be aware.
      Everything is upside down , heart and vascular disease comes from animal products. Everything about your health is the food we eat. We are made for plant based diet, animal products clog up the arteries. Diabetes 2 is caused by animal products who are clogging up receptors so they do not see the signal to let glucose into the cells. 6 weeks plant bases diet and gone is diabetes 2 , body restores itself. Doctors get 7 hours in nutrition in their career. What a coincidence ?! $$ Brainwashed we all are ..All vegetarian animals have seminal vesicles , man have them. Keep it simple and learn everything is upside down, besides people in Australie are not standing upside down.

      Based on male anatomy, real men should be vegans (no animal foods). Human males have seminal vesicles: no other meat-eating animal has these important collecting pouches as part of their reproductive anatomy.

      https://www.drmcdougall.com/misc/2012nl/dec/fav5.htm

      1. Your heart is in the right place but let’s stick to the facts. There are many so-called vegan diets that lead to heart and vascular disease. “Vegans’ can get also diabetes. Highly processed plant foods can be just as dangerous and perhaps even more dangerous than animal food diets. Whole food plant based diets are the way to go.
        https://www.youtube.com/watch?v=q7KeRwdIH04

        There are non-meating mammals that don’t have seminal vesicles too like kangaroos.

        1. I would be happy to try hawthorne leaves and flowers to lower my cholesterol if the research was solid. Nothing I tried worked…

          My recent test results show my ldl to be 6% above normal and total cholesterol is 4% above normal.

          As of last June I am WFPB SOS-free, (i.e. no salt, no oil, no sugar while eating whole food with little or no processing : veggies, legumes (1.5 cups daily), whole grains (1.5 cups daily), fruits (fresh and a small quantity of died ones including a few dates daily)). Following the ‘daily dozen’ app advice quite closely.

          Also following specific suggestions found here on NutritionFacts: added milled flax seeds (1-2 Tbs daily with steel cut oatmeal), 1 apple a day, blueberry powered tea (1tsp daily), amla powder prepared as tea (1-2 tsp daily). Reduced saturated fat next to nothing, cutting out chocolate. No avocado. Limiting nuts to ~ 1-2 Tbs a day.

          Why is it not working ? What might I try that could work better ? Or perhaps the claims about the benifits of WFPB are inflated!

      2. Interesting, but are egg whites ok, as far as diabetes, because dr. G does not seem to clarify if it is the protein inn egg whites or the cholesterol that is associated with increased diabetes rates. Any idea what the clear science says?

  2. You make it so clear that our overall thinking about food and nutrition is out of whack. Things could be so much simpler and less expensive if we kept it simple with those 4 points. But as a society we do the opposite! It’s sad. But thanks for keeping it hopeful. And humorous!

  3. Why spend taxpayer dollars clogging the arteries of striped minnows by feeding them a high cholesterol diet to see whether hawthorn leaves and flowers have the potential to help?
    —————————————————————————————-
    WAIT! Hawthorne leaves and flowers could have saved the Minnow? If only Gilligan and the Skipper had known this. I put the blame squarely on the Professor.

  4. Our bodies are made entirely of food. In Eastern thought, physicality is often referred to as the Food Body. I heard that 20 years ago and it changed my thinking of my health completely.

    It took twenty years for me to better understand that concept and am so grateful to have NutritionFacts.org for helping me fine tune my eating with amazing precision.

    At 65, I am so much more healthy and fit, physically and emotionally, than I was at 45.

    Because another wonderful side effect of healthy eating is getting in touch with one’s complete self. The body is made of food but is also greatly affected by emotions and trauma.

    An acquaintance had a heart transplant at Johns Hopkins and was told that they now understand that emotional memories are often held in the body and the heart recipient may become aware of the donor’s emotional life and preferences.

    Perhaps difficult emotions and trauma are playing out as illness in many people, with all the cheap, bad food causing the actual damage. A difficult trap to escape.

    You have to really want it, you have to want to get better, to understand your body’s needs and patterns. I was so sick and unhappy but I was determined to find another way.

    If I can, then anyone can create a new, healthier body, with right-food, thoughtful awareness and movement.

    1. Susan Guthrie, I totally agree. Your comments echo my sentiments/experience, and I’m sure those of many NF readers as well. You raised a few points, but I would like to emphasize one, and it’s something I have not seen discussed on NF boards before.

      You mention “cheap, bad food causing the damage”, and I know we all agree. I have spent hours reading labels on canned goods (that I don’t even buy) only to be horrified at how bad food manufacturing/processes have become. I see these same poor quality products in the bags we distribute at the food banks and shelters. Do canned beans really need HFCS and 2 other sources of sugars ? We are giving full consent to the “damage” with our dollars spent on poor quality products. I dont know how others feel about it, but it seems to me that we really need an awakening at so many levels.

      1. I thought vegetarian baked beans were good for me until I finally woke up and saw that half the can was filled with HFCS. Out of the hundreds of cereals sold at WalMart only two don’t have sugar listed as the first or second ingredient; grape nuts and shredded wheat. It’s disgusting. Virtually all processed foods are loaded with sugar.

        1. Blair, it’s so frustrating! I am totally disgusted as well. There are canned vegetables that are frankly, a waste of a can. Our food companies should be ashamed. Food buyers should be ashamed. It’s garbage, and we are paying for it with the highest obesity rates in the world.

      2. Yes it is sad that food banks, shelters get all the cheap foods. Also how can a homeless person or low income person afford good healthy food and feel good enough to better themselves, they live in an impossible trap, we need to line the streets, parks and empty allotments with garden produce. Fresh fruit and veggies should be cheap or free.

    1. Unfortunately, the liberal left only goes after the energy companies and the pesticide companies when making an argument. They are still afraid of speaking out or declaring war on sugar, meat, and the junk food industries because of what happened to Oprah 20 years ago. They certainly have the voice for this type of thing and they can force these corporations by staging boycotts and demanding healthier food. They are also afraid of big Pharma with regard to demanding that natural supplements to be on an even plane instead of the meds with all the side-effects. What happened to the war on cancer? Cancer is big business in this country. If the liberals could take a solid stand on these issues first, and let the positive results become apparent, then they would have a much easier time with changing how we use fossil fuels in this country. Liberals are much more energetic when it comes to making a stand than conservatives. I’m independent. I lean right on financial issues and left on social issues. Just my humble opinion here.

  5. I’m so glad you finally called out this issue, and mentioned T. C. Campbell’s excellent book “Whole”. Sadly, it is probably inevitable that NutritionFacts.org will always have a strong bias toward bogus single-element issues, since that’s where most of the research studies happen, due to funding biases which you have often called out.

    1. Bruce, I think you have brought up an important point.

      Maybe you didn’t mean it the way I take it, but it reminds me that I can’t just become aware of something and accept that as best for me. Dr. Greger’s message is in fact a “one-size-fits-all” approach to better health.

      Impossible to do otherwise without seeing each individual separately. That suggests to those of us willing to put in the work, we take the framework and “experiment” with combinations or single purpose additions to our consumption.

      Modern medicine is seeking ways to monitor individuals via tech which will make what I do by trial and error, accessible to everyone and a better way for everyone to get to a better solution, faster.

      1. Lonie, i couldn’t agree more. People just want formulas, but it’s not that simple. You have to find out what your body requires. I found out from a German pediatrician that one of my children needs more B vitamins than most people. (American doctors had no idea what was wrong.)
        Another of my kids needs more omega 3’s or he has gut issues. Was told to try that by a Dutch nurse. I’ve found that to feel good I need to eat at least 100 grams of greens a day, and that I cannot make vitamin A from betacarotene. We are all different. The studies just get us started. But we can all eat more vegetables, and most of us more fruit for better health.

      2. Lonie

        I am a bit cautious about this line of reasoning.

        The problem with the personal trial and error approach is that you don’t know if you have been getting it right or wrong until you drop dead or suffer some adverse event or other. Or which variables that you adjusted, are the ones that helped and which are the ones that hindered. A prime example is low carb diets which are also calorie restricted. How many people do we see reporting improved lipids etc which they attribute to their diet but which may in fact have been due to weight loss or reduced consumption of trans fats and/or refined carbs? Or increased activity levels?

        Unless you have good reasons to think that you are not ‘average’ in some respect or other, this approach can degenerate into I’ll eat and do what I want because we are all different.

        Yes, Dr Greger’s approach is a one-size fits all approach. So are all dietary and physical activity guidelines for that matter. Because those are the approaches that have been demonstrated to benefit most people. Self experimentation without strong evidence, expert guidance and/or specialist knowledge could be risky.

        And we are all vulnerable to the Dunning-Kruger Effect. Look at all those geniuses who use a ‘ketogeic’ diet to treat their diabetes. Sure it masks certain symptoms just as opioids mask the pain of cancer.but they still have diabetes just as the pain free/controlled cancer patients still have cancer. How do we know that we aren’t tripping down that same garden path?

        1. The problem with the personal trial and error approach is that you don’t know if you have been getting it right or wrong until you drop dead or suffer some adverse event or other.
          —————————————————-
          Tom, some of us are more attuned to our bodies. That is, we can tell if we are not up to snuff and can then begin figuring out why. That, plus if we have lab work done regularly (semi annual for me) we can see the unseeable from observation or feel alone.
          ________________________________________
          Unless you have good reasons to think that you are not ‘average’ in some respect or other…
          ——————————————————————-
          average?… AVERAGE!… if dueling were still allowed my second would be calling on you!

          Average… pfffttt.

          1. Lonie

            There’s nothing wrong with being average to my mind. By ‘average’, I mean normal or not having an unusual physical/genetic etc abnormality.

            I suppose I could turn it round and say that ‘unless you have good reason to think that you are freakish in some respect or other ……’

            :)

    2. I could not agree more, Mr. Hamilton.

      As you suggest, the problem is one of concentrating so hard on the “single elements” that we can’t see the whole. Whenever somebody demands a “citation” for a statement they disagree with, I answer with eight or nine books rather than a URL.

      I am purchasing Dr. Campbell’s “Whole” on your suggestion. His “The China Study” is the most persuasive work relating diet to health available. There ain’t no arguing with demographic studies!

      1. ‘There ain’t no arguing with demographic studies!’

        That attitude is why advocates of saturated fat, dairy and meat consumption like to conduct and promote ‘appropriately designed’ demographic studies. Think PURE, Siri-Tarino and Chowdhury for example. Ditto for the cholesterol sceptics like Ranskov and Kendrick.

        Multiple supporting layers of evidence from demographic/observational, experimetal and mechaisms of action studies are needed for us to be confident that our analyses and conclusions are likely to be correct.

        The GRADE approach to assessing evidence has been adopted in the medical sphere and has been adopted for use in the the nutritional sphere wher the methodology first employed by the World Cancer Research Fund has been influential.

        Most modern diet/nutritional guidelines articulate the way that they grade and use evidence.

  6. Hippocrates may not have said diet is better than drugs but the Rambam from the 12th century Egypt did say something very similar and guaranteed that if you followed his advice you would stay healthy. If we could only get doctors to clean up their act.

  7. “For example, did you know that mechanistically, there’s a chemical in ginger root that down-regulates phorbol myristate acetate-induced phosphorylation of ERK1/2 and JNK MAP kinases?”

    I have no idea what this means! I’m guessing that’s a good thing?

    1. Yeah Mary S, That caught my eye too and left me hanging… Since it is found in ginger root I’m going to assume it is a good thing.

    2. Same here, not a clue what it might mean. But that’s the great thing about all encounters with Dr. Gregor, each one requires some followup homework to some degree or another.

    3. Hi Mary S – Thanks for your question! Phorbol myristate acetate is a tumor promoter. There is a MAPK/ERK pathway, which is a chain of proteins in cells that communicate signals to the DNA in a cell. When these proteins become mutated, it can lead to the development of cancer. So the chemical in ginger root that is being referred to has the ability to down-regulate the activity of the tumor promoter on these proteins, thus leading to cancer prevention!

      I hope this helps!
      Janelle RD – Registered Dietitian & NutritionFacts.org Health Support Volunteer

  8. I’m a contributor to your cause, Dr Greger. But this one just doesn’t quite stand up:

    What about a daily multivitamin just “as ‘insurance’ against nutrient deficiency?” Better insurance would be just to eat healthy food.

    Where do you acquire that magical ‘healthy food’ you talk of? In a world with depleted soils. Not everyone can grow their own.

    Even you suggest people supplement with Vitamin B. What’s wrong with a multivitamin for insurance? Nothing.

    I recently found out my arthritis was due to a boron deficiency. Since I’ve started supplementing I feel much, much better.

    We need some supplements in today’s world. To say otherwise is to side with the troubled doctor industry that consistently trades in old and dis-proven information.

    Thanks for everything that you do!

    1. As you note, Dr Greger does recommend that people take some supplements

      https://nutritionfacts.org/2011/09/12/dr-gregers-2011-optimum-nutrition-recommendations/

      As for multivitamins, there is no evidence that they benefit anyone. Some studies have even shown increased mortality with multivitamin use. Dr Greger is simply going with the evidence when he does not recommend them – after all, this is a site about what the science shows. Type multivitamin in the search box above or for something more recent, see this
      https://www.sciencedirect.com/science/article/pii/S0735109718345601

      I should disclose though that I take a multivitamin – it’s a convenient way to take daily B12, D and iodine which Dr Greger does recommend.

  9. One of the things I hate hearing is “everything in moderation”, to me there is no such thing, optimum nutrition does give you the best chance of being healthy no matter what else is in your life.

  10. I believe the majority of people who eat the WAD understand that they’re not eating healthy. But who is willing to change a lifetime habit? Most people lack the desire and self discipline to start eating better, much less stay the course.

  11. Dr. λ, Creator of Variables, Binder of Variables, Applicator of Terms, Checker of Types, β-Reducer of β-Redexes Dr. λ, Creator of Variables, Binder of Variables, Applicator of Terms, Checker of Types, β-Reducer of β-Redexes says:

    Personally I think health is nowadays more about what you do not eat then it is about what you eat. People keep worrying about deficiencies but they never worry about all the junk that is clogging up their body and giving them horrible health problems.

    That is like filling the fuel tank of your car with dirt and then throwing some fuel on top and wondering why your car does not work properly even though you added enough fuel to drive the distance that you wanted.

    The body is a miracle machine but even the body has it’s limits to how much junk it can take. And most people nowadays go way over those limits.

  12. For so many out there who perhaps emotionally need comfort food, the problem goes back to the food they grew up on. In my early childhood we ate meat but it was healthier meat… we had vegetables year ’round due to canning. We had fruit the same way. We would maybe get a hamburger once a week or maybe every two weeks. We had nuts and oranges or a coconut when Dad brought some home from town… a candy bar once or twice a week.

    Just think how those “comfort foods” have changed today. Hard to blame the young mothers of today as they usually are part of the household breadwinners, if not the sole breadwinner.

    Still, this is where poor health begins.

  13. 3 weeks into following the Daily Dozen nutrition guidelines…..which is a complete 180 from my past “diet”. Initially, huge boost in energy and well being. Now, 5-7 pounds weight GAIN and daily headaches. Has anyone else experienced this? Is this some kind of adjustment my body is making? I can’t afford to gain weight, even if it is a healthy way to eat.

    1. FS, My regimen has helped me maintain the weight I’m most comfortable with. And that includes drinking tea throughout the day if it is convenient, plus eating a ginger snap, oatmeal, or coconut macaroon cookie with the tea. Doing this throughout the day keeps me from being hungry and causes me to eat less when eating my one meal.

      Not sure about the headaches but possibly due to my daily supplementation of White Willow Bark (aspirin mimetic) is the reason I never experience them.

    2. @FeistySpice, for what it’s worth here’s my experience:

      I went DailyDozen 14 months ago. First couple of weeks were a bit rough, I think mostly due to my gut flora making the shift to accommodate a plant-based diet. Next 7 weeks went well, steadily losing about one pound per week. Blood work at that point (9 weeks in) was very encouraging. Total cholesterol (formerly 225-ish) went down to 150 (LDL 97). I was feeling pretty chuffed at that point and definitely committed to staying with it.

      Then things got rough again. Over the next 8 weeks, I had two infections (tooth abcess and prostate infection) that required two different nasty antibiotics to wipe out (plus a root canal for the tooth). I kept with the Daily Dozen but added servings locally made unpasteurized sauerkraut with each meal to replace the gut bugs lost to the antibiotics.

      Pretty smooth sailing since then and I remain committed to the DD as a way of life. I’ve dropped 20 lbs that had been hanging around my middle for decades (BMI went from 23.5 to 21) and I feel generally excellent.

      I never had any weight gain, so it’s hard to guess what could be causing that in your case (assuming you were not underweight to begin with). When I first started DD, I used the cronometer.com website to estimate my metabolic requirements and to calculate the calories in a typical day’s eating. The numbers were consistent with the one pound per week weight loss I mentioned earlier. My metabolic requirement is about 1800 kcal and the DD foods came to about 1300. That’s a 500 kcal daily deficit and it tracks perfectly with the weight loss rate since one pound of fat equals 3500 kcal. I now consume some extra nuts and grains to maintain my present weight.

      The headaches might be a B12 issue. I do recall now that I had some headache and lack of mental focus about 4 weeks in. I thought the nutritional yeast I was using was B12 fortified, but that was not the case. The headaches went away within a week of starting a daily B12 supplement.

      Hope this is of some use.

    3. I’m glad you are following the DD guidelines, esp because it sounds like you were not getting many (any?) of those healthy foods in before. How are you doing with your weight now? If you still are not losing or even gaining, I’d look at if you are eating other items besides the DD, esp. oils or many nuts and seeds. Those really pack on the calories and can contribute to weight gain even if the nuts and seeds are nutritious. It’s cumbersome but you might want to add up calories just to see how many you are taking in (This isn’t something you usually have to do with a WFPB diet, but it might help clarify for you exactly what might be causing a gain in weight now.) You’ve seen other suggestion regarding headaches which I hope are subsiding. If not keep a headache diary and consult a doctor because this may not be related to your new food intake.

  14. Oh man, that quinoa salad is making my mouth water! I know this is weird, well, maybe not to this group, but if I go more than 4 or 5 days without, I start craving salads.

  15. Dr Greger,
    Has anyone reported that this lifestyle has made their large, bulging, zigzagging varicose veins go away? Thanks for all you do for us.

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