Food and Nutrition

Why Holistic Nutrition is the Best Approach

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by David Katz, MD, via The Huffington Post,

If you are like most people, you may well subscribe to the ONAAT fallacy. I am more confident, however, that you don’t know what it is. That’s because I just made up the name, although not the concept.

The ‘ONAAT’ fallacy stands for ‘one nutrient at a time.’ It’s the false, but insidiously persistent notion, that the nutritional quality of a food, or the relevant nutrition guidance for a given patient, can in fact be gauged just that way, one nutrient at a time.

Having devoted years of effort to the development of a nutrition guidance system that can function as ‘GPS for the food supply,’ providing summative information about overall nutritional quality — I find the proliferation of so-called “attribute systems” (e.g., this one, this one, and this one and others like them) that call out one or more attributes of a food a potential threat to progress in this area.

My physician colleagues are, with all due respect to our clan, a major reason the ONAAT fallacy was set in motion, and propagated. Because of relative neglect of nutrition in medical education, physicians tend to ignore the topic, or when addressing it at all, to offer limited and discrete advice directly related to their field.

Rather than providing advice about food, let alone the whole diet, cardiologists may be prone to advise against an excess of saturated and trans fat, and dietary cholesterol. Endocrinologists may emphasize avoidance of sugar and refined starches. Gastroenterologists may focus on fiber. Nephrologists and others treating high blood pressure may focus on sodium. And so on. There are exceptions, of course, but the rule prevails.

In my own primary care practice over the years, I have encountered many patients who were trying to follow exactly that kind of dietary advice, imparted by some medical specialist focusing on some particular condition or risk factor. The trouble with “one nutrient at a time” guidance is of the classic missing the forest for the trees variety, or of the even worse “mistaking the part for the elephant” variety. The nutritional properties of a food cannot reliably be captured in any given nutrient level or attribute.

A food may be a source of whole grain, but also a concentrated source of sugar and salt. A food may be low in sugar, but high in salt—or vice versa. A food may be low in sugar, but a delivery vehicle for trans fat. It may be trans fat free, because it is comprised entirely of sugar and food dyes. Such a food—gummy bears, for instance—may be organic, without that signifying anything commendable about its nutritional profile.

Food cannot be judged one component at a time any better than elephants can. What about health?

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