Food provides us with energy to run and materials needed to maintain the ongoing process of repair and regeneration.  How well those processes occur is highly related to food quality.  Quite simply, we have undergone a dramatic change in our food quality over the past 100 years and that change is a major factor in our declining health.  For example, 3% of the population had type two diabetes when I began practice over 40 years ago.  Currently, 14% or about 1 in 7 adults have the disease.

The population with “pre-diabetes” is thought to equal or exceed those with full diabetes.(1)  The majority of those patients will progress to full diabetes over time.  Personally, I think the term pre-diabetes is misleading.  We don’t call the first trimester of pregnancy “pre-pregnancy”, it is early pregnancy.  Diabetes is defined by an inability to normalize blood glucose measured by fasting glucose, or HA1C.  Prediabetes is diagnosed as the same but just less severe.  

Getting back to the food, it is the primary driver of diabetes as well as the other common chronic diseases including heart disease, stroke, many cancers, many digestive disorders and on and on.  Given this relationship it is important to understand how our food has changed so that individuals can implement their own solution.

 The answer to how our food has changed is somewhat complex involving changed trends in individual food selection, industry driven changes in food composition, and in the environment.  I listened to a fascinating discussion of these changes by Michael Ash, DO, ND at the Institute for Functional Medicine.  I was struck by the changes in food nutrient content between 1960 and 2022 that have resulted from increased atmospheric CO₂ increases.

As CO₂ has increased over that period, the balance of sugars and protein has changed in most of our major food staples.  Some of those changes include:

• The protein in potatoes, wheat and rice decreased 10-15%
• Fructose in vegetables increased 14%
• Carotenoids in vegetables decreased 15%
• Bitter uniformly decreased in all plants

These changes are significant in light of disease risk.  Lower protein intake is associated with declining bone and muscle regeneration seen in osteoporosis and physical decline.  Fructose is the sugar most associated with fatty liver disease and impaired blood sugar management.  Carotenoids are an important class of dietary antioxidants.

The decrease in bitters has broad implications.  Bitters induces the release of GLP-1 in the small intestine.  GLP-1 bonds to receptors in the gut that signal fullness and reduce consumption.  This is the basis of popular weight loss drugs Wegovy and Ozempic.  These drugs are also used for diabetes and have been shown to decrease fatty liver disease.

Some of these problems have been magnified by growing practices.  Most of the 25,000 known phytonutrients in plants are produced to protect the plant from fungus, bacteria and other stressors.  When soil is treated with antifungals and other chemicals, plants make fewer phytonutrients.  These phytonutrients such as flavonoids and phenolics provide broad antioxidant and anti-inflammatory benefits to us when we consume them.

The vitamin and mineral content of plants is dependent on the bacteria and other microorganisms in the soil for production and transfer to the plant.  This takes time and rich soil.  In dense commercial farming, plants are pushed with synthetic fertilizer and the micronutrient content has been shown to be importantly lower.

While climate change and growing practices have negatively affected our food content, a third factor, food selection has had the most impact.  While there are 300,000 plants usable for human consumption and when foods were only seasonally available, diet involved eating a broad selection of plants.  The standard American diet may only include 1 or 2 dozen plants limiting our exposure to the approximately known 18,000 phytonutrients which are spread across the edible plants.

Fixing the diet induced disease problem will only result from personal action.  Rules and mandates regarding food quality and selection are a meaningless exercise.  The strength of the food industry/lobby makes meaningful changes unlikely.  Most “guidelines” are gutted during approval by strong lobbying by those for whom change would not be in their best financial interests.

Perhaps the bigger issue fixing the diet disease problem is that guidelines have a poor record of changing human behavior.  A great example of this is smoking.  The immense amount of scientific evidence about the health effects of smoking has created some toothless guidelines which have had no effect on human behavior.

CDC analyzed the 2019–2022 National Health Interview Survey (NHIS) regarding smoking behavior.  Although tobacco product use remains the leading cause of preventable disease and death in the United States,in 2022, 49.2 million (19.8%)—or nearly 1 in 5—U.S. adults reported current tobacco product use.  In reality, food kills more people over time than does tobacco.

So, what is the message of all of this about food and disease?  Becoming an informed consumer of food is step 1.  For example, food quality is related to our climate quality.  Step 2 is recognizing that government/agencies/industry will not fix the problem.  Step 3 is taking personal control of what we eat and controlling our own health outcomes.  Food is unquestionably just like tobacco, “processed food remains a leading cause of preventable disease and death in the United States.In 2022, the majority of adults consumed predominantly processed food.”  It is our choice – make good ones.

Echouffo-Tcheugui JB, Selvin E. PRE-DIABETES AND WHAT IS MEANS: THE EPIDEMIOLOGICAL EVIDENCE.  Annu Rev Public Health. 2021 Apr 1; 42: 59–77.