What does healthy even mean?

What does healthy even mean?

By Sherry Coleman Collins, MS, RDN, LD

With the new year comes a fresh routine, and for many, a renewed desire to commit to eating healthy foods. But what does it mean for a food to be “healthy”? Did you know the FDA actually has a definition for the term? Set way back in 1994, the existing definition of healthy limits fats and focuses on specific nutrients, reflecting the attitude and understanding of nutrition at the time. But things have changed so much, and we understand more about what really constitutes a healthy diet. After years of contemplation, FDA has released their proposed update to the 1994 definition of healthy. But defining healthy isn’t as straightforward as you might initially think. Let’s explore this a bit more.

To start, the term “healthy” is almost as misunderstood as the term “wellness” in today’s lexicon. It’s used in ways that lead to confusion for consumers which is why the FDA seeks to provide a framework for how food brands are allowed – and not allowed – to use it. At a time when there’s so much misinformation (and information in general) available it can be incredibly confusing for consumers to know what they should eat for better health. The FDA should be applauded for the effort and for including some solid recommendations to help cut through the clutter. In particular, I appreciate and align with the recommendations that promote fruits, vegetables, and whole grains, as well as fish, beans, legumes, and nuts and seeds without getting bogged down in unnecessary focuses on saturated fat and cholesterol, as this appropriately follows the most current nutrition science. Of note, the new proposed rule also excludes naturally occurring sources of saturated fat from nuts and seeds from any saturated fat limitations. This is incredibly helpful and highlights the significant role nuts and seeds play in a nutritious diet.

On the other hand, there are some parts of the proposed rule that have the potential to be misunderstood and that may not be helpful. A healthy diet is one that includes variety and balance of all nutrients, while fitting into an individual’s lifestyle, culture and preferences. Single ingredients and individual nutrients do not reflect the totality of one’s diet and may devalue the importance of a nutritionally complete eating pattern. In fact according to the Academy of Nutrition and Dietetics’ Total Diet Approach to Healthy Eating, “the total diet or overall pattern of food eaten is the most important focus of healthy eating. All foods can fit within this pattern if consumed in moderation with appropriate portion size and combined with physical activity.”[S(1]? The position paper elaborates, explaining, “Focusing on variety, moderation, and proportionality in the context of a healthy lifestyle, rather than targeting specific nutrients or foods, can help reduce consumer confusion and prevent unnecessary reliance on supplements.” As an example, this guidance document states, “[i]t is reasonable to consume high-calorie foods in small quantities in order to enjoy nutritious foods, such as a sprinkle of sugar on a grapefruit.”

The proposed standard prohibiting added sugar from proteins to be considered healthy may result in missed nutrients from familiar and enjoyable foods. On the surface, this approach seems reasonable, but it may also be limiting for some health supporting protein foods, particularly those that are shelf-stable and highly accessible sources of protein. Peanut butter is one protein food that may not be considered healthy because of a small amount of added sugar added to some brands – typically around 2 grams per serving – a very small amount when considering common sources of added sugar. As an affordable, accessible, and highly versatile protein source for many families, excluding peanut butter from “healthy” labeling may contribute to unnecessary avoidance and missed nutrient benefits. Importantly, research studies that demonstrate the contribution that peanut butter can make to good health, including reducing the risk of type 2 diabetes[S(2]?, maintaining a healthy weight [S(3]?and better overall health[S(4]? were all conducted with the inclusion of conventional peanut butter brands. In other words, research shows eating peanut butter has a variety of benefits and the potential to improve health, regardless of the type someone chooses. To add confusion, the new proposed rule – according to FDA’s website – allows for added sugar in similar amounts in protein-rich dairy foods, such as Greek yogurt. Why is added sugar acceptable in this food, but not in peanut butter?

Health experts believe that Americans eat too much sugar and salt, yet research shows a healthy diet does not need to be completely void of sugar or salt. The truth is that salt and sugar all contribute to the enjoyment of food and they can make certain foods taste delicious to some people who may otherwise find them unpalatable. One great example is brussels sprouts – a favorite vegetable of mine, but one that many people reject because of its natural bitter and sulfurous flavor. A pinch of sugar along with the caramelization of roasting or searing transforms this vegetable into something completely irresistible. Are these nutrient-rich gems now unhealthy because they have a small amount of added sugar? I would argue they are still nutrient-dense and the added enjoyment may also mean a more frequent intake of said nutrients. Similarly, salt can improve the flavor of lean chicken breast when it is otherwise bland and boring.

If the goal is to encourage Americans to eat nutrient-rich foods with benefits, it’s important to build on what they already love to eat.?Again, from the Academy’s Total Diet Approach, “A growing body of evidence supports recommendations to design behavior-oriented food and nutrition programs that are sustainable because they fit individual preferences. Almost two thirds (62%) of American adults report being “more interested in hearing about what to eat, rather than what not to eat.”” Simple and delicious foods that are healthy sometimes include reasonable amounts of salt and sugar and need not be overly restrictive. Food that is healthy and also delicious is more likely to result in sustainable eating patterns aligned with the latest recommendations for better health outcomes.

https://www.jandonline.org/action/showPdf?pii=S2212-2672%2812%2901993-4?[S(1]

https://academic.oup.com/ajcn/article/113/4/960/6104798?[S(2]

https://academic.oup.com/jn/article/138/9/1741S/4750849?[S(3]

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/73C2B58F9AE6CC08786078548018E30D/S000711450600359Xa.pdf/div-class-title-health-benefits-of-nuts-potential-role-of-antioxidants-div.pdf?[S(4]