Food Anxiety: Our Struggle with Food

What's behind out diet struggles?

What to eat?  Many of us suffer from “food anxiety”—worries about what to eat and what not to eat in an environment full of contaminated foods and conflicting dietary guidelines.  Michael Pollan describes this food crisis in his book, The Omnivore’s Dilemma.  We no longer know what is safe or not safe to eat.  Just as our ancestors over the last several millennia had to figure out which berries and mushrooms were edible, so we too are beginning to evolve new instincts- although slowly- for assessing what is food and what is a food-like substance that might kill us. Despite pretty packaging and reassuring nutrition claims, processed foods may be undermining our health.  In the midst of shifting nutritional recommendations, one has to eat something, so it is going to be the Atkins diet or the Mediterranean diet, low-fat or low-carb, eggs or egg whites, casein-free or gluten-free?

Navigating through the changing nutritional recommendations and rapidly evolving research poses challenges for clinicians and patients.  Which nutritional recommendations do we trust?  The vacuum of authority and clarity on the topic of nutrition makes adopting any given set of nutritional recommendations difficult.  Giving patients a list of ten nutritional guidelines will only work if they actually believe in the benefit of those recommendations and the authority of their source. In addition, we all need motivation to make any change.

The Standard American Diet (SAD)

Despite all the attention to food and nutrition in recent years, the Standard American Diet (SAD) continues to undermine health of millions of individuals, we are overfed and undernourished as a nation.  While we are overfed in macronutrients, such as fats, carbohydrates, and proteins, we are undernourished in micronutrients, such as vitamins and minerals.  While a carrot, tomato, or potato may appear bigger and shinier than it did fifty years ago, it may contain fewer micronutrients (Thomas, 2003).  The nutrient content of many foods declined because of changes in agricultural practices and soil quality.  Because of these changes it is more difficult to get all the nutrients we need from the same quantity of food now than it was half a century ago.   According to U.S. Department of Agriculture (USDA) research, two thirds of the population fails to get the dietary recommendation for one or more nutrient.  For example, more than half of us get less than the recommended daily allowance of magnesium.

Many of the problems with food are quite hidden.  We eat and drink a lot of sugar, much of it in foods that do not appear to contain sugar, for example one 6 oz container of Yoplait Original Strawberry Yogurt contains 26 grams of sugar and one 20 oz Power C Vitamin Water contains a whopping 31 grams.

We consume trans fats hidden in processed foods, and even small amounts of trans fat can have a negative effect on health.  On average Americans consume 55 pounds of high fructose corn syrup per year, more than any other nation, and this may be linked to the rising rates of diabetes .  We consume all kinds of chemicals mixed into processed food or sprayed on produce without fully understanding the impact of these chemicals on our health.  Read more about the effects of pesticides on health on the Environmental Working Group website.  We are consuming too many omega-6 fats, which drive inflammation and other health problems, and not enough enough omega-3 fats, which are necessary for optimal brain function.  In the environment of nutritional abundance our brains are hungry and exposed to many toxins, and we suffering as a result.  The good news is that by informing yourself about the effects of food on the brain and making certain changes to how you eat you can improve your instincts for detecting what is food and what is not.  I am not a proponent of any extreme diet, as any fixed restrictions are likely to cause one to think more about the forbidden foods, and increase the risk for binge eating.

Americans are participating in large-scale experiments with various diets, nutritional supplements, and food additives—usually without informed consent.  Of course, these “experiments” are not really research studies, but rather popular fads, trends and poorly understood food contaminants.  Michael Pollan (2006) argues in The Omnivore’s Dilemma that Americans are particularly vulnerable to shifting nutritional recommendations.  A number of other cultures appear to consume diets that do not fit the current nutritional recommendations, and yet appear no worse for it.  One example is the “French paradox,” the relatively low incidence of coronary artery disease (CAD) in the French despite high levels of consumption of saturated fat.  While French cuisine hardly conforms to American nutritional recommendations of low saturated fat intake, the French enjoy better health, lower obesity rates, and less cardiovascular disease than Americans.  The “French paradox” concept has been criticized.  The poor eating habits may catch up with the French hearts in the coming decades, and the French already have one of the highest rates of cancer in the world (World Cancer Research Fund cancer statistics by country).

Panic In Aisle 6: Food Anxiety Today

Food anxiety is further fueled by suspicions that the interests of the national economy, processed food industries, and various agricultural lobbies might have something to do with the claims on food packaging and government guidelines such as the USDA ChooseMyPlate.

A number of widely disseminated and government backed nutritional recommendations appear to have no scientific basis and might actually be harmful, raising suspicion as to the reliability and accuracy of any broad nutritional recommendations.  For example the United States Department of Agriculture (USDA) recommendations for a low-fat diet, purported to improve cardiovascular health and aid weight loss, had no research backing when it was popularized.  Despite much effort and money spent on research, there is still no evidence that the low-fat diet helps with weight loss or heart health.  The Women’s Health Initiative, a large study of postmenopausal women conducted in the 1990s, studied the impact of the low-fat diet on a variety of health outcomes.  Nearly 20,000 women ate a low fat diet and were compared to nearly 30,000 women in the control group.  Women in the low fat diet group consumed about 10% less fat than women in the control group.  After eight years on the low fat diet, the weight loss in the low fat group was 0.1 kg, and the average waist circumference increased by 0.3 cm. While the women eating the low fat diet had some reductions in blood lipids and diastolic blood pressure, they had no significant decrease in the risk of cardiovascular disease, stroke, or cancer.  The results of this study shed doubt not only on the utility of the low-fat diet, but also on the scientific basis of USDA nutritional recommendations.

We are flooded with nutrition information through TV ads, news reports, food packaging, books, documentary films, advice from experts and friends, family, and I’m sure you can add to this list.  The buzz about food is fueled by alarms about our health.  We are witnessing high rates of mental illness; mind-body disorders, such as fibromyalgia, chronic fatigue, and irritable bowel syndrome; and lifestyle-related chronic diseases, such as diabetes, cardiovascular disease and obesity-related problems.  Keep reading the blog for exploration of how chronic diseases are diet related.  Many brain diseases are also linked to our diet.  See the book Grain Brain written by neurologist, David Perlmutter, for an exploration of the effects of food on neurological condition.  To learn more read articles on this blog and visit blogs such as Dr. PerlmutterDr. Brogan, Dr., and

Ideally all food would be healthy and we could feel safe eating any food available to us.  Until that day, we either throw up our arms, eat whatever, and see what happens, or we engage in the process of sorting out which foods increase our health and which foods decrease our health.  Every food we put in our bodies will either increase or decrease our wellbeing and knowledge is the key to decreasing our food anxiety.  Since we are all biochemically individual and need a somewhat different mix of nutrients, we need our instincts and intuition, tools such as elimination diet, and at times specialized medical assessments and laboratory testing, to figure out what is food and what is not food for our bodies.

Additional writing for this article by L. Smith