“Food Intelligence”: Make Healthy the Default — In Public Spaces and Private Kitchens

While “nutrition science” often seems to cry out for air quotes around “science,” we are fortunate now to have a new book on the topic written by one of the most thoughtful and deliberate nutrition researchers of the modern age: Kevin Hall.

Hall has consistently steered a course of thoughtful rigor, leading a succession of highly impactful studies at the NIH before departing earlier this year, citing concerns about censorship from the Robert F. Kennedy Jr regime.

In September, Hall, together with journalist Julia Belluz, published Food Intelligence, a much-anticipated, highly engaging book reviewing the current state of nutrition science, including Hall’s critical contributions to our current understanding.

Key takeaways include:

• For those confused by nutrition science, there’s a good reason, the authors suggest: “Nutrition isn’t rocket science; it’s harder.” There are many variables (and physiological processes) involved, and definitive experiments seem to be as challenging as they as are rare.
• Despite the many strongly-held views on both sides of the debate, there’s little evidence to suggest either “low carb” or “low fat” diets are better or worse than the other; some have enjoyed considerable success with each of these approaches.  Moreover, the authors argue that this impassioned debate largely represents a distraction from more important considerations.
• The real enemy, in the view of the authors: “hyperpalatable,” “calorie-dense” foods, which they view as a clear and present danger that overwhelms our ability to resist them. Consequently, much of the book emphasizes broad structural changes — inspired by our approach to tobacco — to shift the defaults in our environment.
• Hall and Belluz’s bottom line advice for individuals:

“The evidence on optimal nutrition has been clear and consistent over decades; it’s boring by this point: Eat more vegetables, along with fiber, legumes, whole grains, and fruits.  Limit sodium, sugar, saturated fat, and junk foods.”

“Imprecision Nutrition”

The authors are deeply skeptical of platforms offering “cutting-edge” putatively precise approaches to healthy eating, and suggest the term “imprecision nutrition” might be more apt.  In particular, they report:

• There’s scant solid evidence supporting “precision nutrition” approaches, beyond standard guidance: more plants and whole foods, fewer ultraprocessed items.
• While consumer-grade continuous glucose monitors (CGMs) may be the flavor of the moment, Hall and Beluz write that the data they produce is remarkably noisy and inconsistent, noting that the “lack of reliable responses to the same repeated meal suggest[s] a good deal biological variability and technical imprecision.”
• The authors observe that the microbiome is the “new frontier in health science, but assert that, like CGMs for precision nutrition, it’s “not quite ready for primetime.” They note that while we’ve gathered considerable associational data around the microbiome, the idea we know how to manipulate it to improve health is “massively overhyped.”

Beyond their robust summary of nutritional science, Hall and Belluz offer recommendations that are mostly focused on broad, structural changes to alter the way we encounter food in our environment. 

As Hall explained to me,

“…we did not want to write a book filled with diet advice for individuals… Rather, we wanted to focus on explaining the fascinating world of nutrition & metabolism science, including how food intake is biologically controlled and the influence of our food environment in likely driving the increased prevalence of diet-related chronic disease.”

Their emphasis on the impact of environmental factors that influence health aging reminded me of the work of UK researcher Michael Kelly, in particular the paper “Why Is Changing Health-Related Behavior So Difficult,” as I’ve discussed with TR readers. 

A key conclusion Kelly and Baker reach is the importance of deeply understanding the specific context in which behaviors occur; abstract away these pesky details, they write, and you miss critical insights.

Improve Eating By Focusing on Individuals or our Food Environment?

When pursuing change – including health-promoting behavior change, such as reducing smoking or improving how we eat — there’s an enduring tension between whether to focus on individuals (bottom up) or on structural obstacles (top down).

While Hall and Beluz acknowledge that there’s some individual responsibility in healthy eating, they predominantly direct their attention to what they see as powerful external dynamics that have rendered resistance to unhealthy deliciousness virtually futile. 

A useful discussion of exactly this type of tension can be found in the latest episode of the (always worthwhile) “Excellence, Actually” podcast – in particular the insights offered by co-host Brad Stulberg

Stulberg cites a September “Excellence, Actually” episode featuring sports psychologist George Mumford, who has famously helped athletes such as Michael Jordan and Kobe Bryant stay mentally fit and resilient.

On the September podcast, Mumford poignantly described examples of racial discrimination he endured earlier in his career, but to Stulberg’s surprise, Mumford emphasized the importance of focusing on individual agency.

In the latest episode, Stulberg describes what happened when he pressed Mumford on the point:

“And he’s like, damn right there are structural issues, but you got agency and you can’t control the structure. What you can control is your agency. And if you want to sit and complain about the structure, see how that’s working for you. What’s that getting you? And you can’t go fix a broken world if you yourself are broken, if you, yourself aren’t working on self-improvement.”

Stulberg adds that if you “actually look at people who have reason to … complain about structures, they’re the ones that are like, ‘I need agency. Because if I don’t have agency, I got no one there to help me.’”

That said, Stulberg also emphasizes that in deciding whether to focus your energy on changing individuals or structures, it should be “both/and” rather than “either/or”:   

“If you want to be a badass performer and a badass person in the world, you need to realize that you have agency and you have responsibility and you need to get your sh-t together and you want to commit to getting better and taking on big goals and striving for them… You also want to make sure that you’re checking in on your neighbors and your community and you don’t want to bury your head in your sand and turn a blind eye to structural problems.”

Hall and Belluz, explicitly inspired by the long, difficult, and ultimately successful effort to depopularize smoking in the United States through top-down changes (Sid Mukherjee’s discussion of this effort in Emperor of All Maladies is a great read on the topic), believe a similar approach will be required to improve our eating.

I would have appreciated a deeper look at what individuals might do, particularly enabled by technology. Such approaches, if widely adopted, can also drive broader change, from the bottom up; the Yuka app, as I’ve highlighted for TR readers, may represent an example of how technology can help drive broader change by integrating the voices of many individuals.

Of course, the same bottom-up approach can also lead to scientifically questionable outcomes, such as the stigmatization of GMOs (to say nothing of essential childhood vaccines).

I appreciate – deeply, viscerally appreciate – the challenges of healthy eating, and the difficulty of resisting temptation in a world where you are constantly surrounded by meticulously engineered, hyperpalatable, calorie-dense highly processed deliciousness. 

It’s a constant struggle at so many levels, from the social to the subcellular – a complex challenge Hall and Belluz help us more completely understand.