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What is healthy, sustainable and ethical preventive diet?

An alarming finding!

By definition, preventive nutrition is at the service of humans in order to enable them to live a long but above all in good health so that “life expectancy in good health” (61.8 years for men and 63.5 years for women in 2010) is close to “theoretical life expectancy” (78.3 years for men and 85.3 years for women in 2010) (Figure 1). In short, the average French person lives in good health until retirement age and then is ill until death (16.5 years for men and 21.8 years for women). And the space between the two « life expectancies » tends to increase. A gloomy situation on the human, social and economic levels! Yet we know that a good diet combined with regular (even moderate) physical exercise can save many healthy years, probably at least ten. In addition, a poor diet is now the leading cause of death in France, directly or indirectly, namely around one in three deaths (mainly cardiovascular disease, type 2 diabetes [1] and certain cancers).

Figure 1. Espérance de vie théorique et en bonne santé

The essential question is therefore: « How can we stop the ever growing ‘epidemic’ of chronic diseases linked to an unbalanced lifestyle? « .

Preventive nutrition is a powerful lever, which can be taught from an early age. The reasons for this medical disaster are actually quite simple: there is of course the nutritional transition from a traditional diet based on plant products and minimally processed foods to a diet rich in animal products and ultra-processed; the concomitant decrease in physical activity and energy expenditure; a lack of nutrition education in school from an early age; and finally, the most essential reason of all because it corresponds to the deep roots of the current situation, reductionist thought.

The latter is typically Western and has its source in the thought of Descartes: indeed, reductionism splits reality into isolated entities to better study them considering that 2 = 1 + 1 on the basis of a linear cause and effect relationship. This reductionism applied to human nutrition has led to the deconstruction of foods into isolated nutrients and to recombine them in endless combinations under the guise of innovation. These are ultra-processed foods that can no longer be found in natural origin, pure man-made products and most often very high in calories and poor in protective micronutrients (scientists then speak of « empty calories »).

However, it turns out that the populations that adhere the most to these products (≥ 50% of daily calorie intake on average) are the most affected by chronic diseases. It is therefore not surprising that the development of chronic diseases linked to poor diet is concomitant with the hyper-industrialization of diet. It is enough to see the rates of type 2 diabetes in populations that have remained pastoral or traditional (nomads, Papuan, Inuit): less than 1-2% of the prevalence of type 2 diabetes against 8-10% in our Western countries, or even more in some countries such as Saudi Arabia (14-20%) or Mexico (10-14%); and the natives emigrating to our so-called industrialized countries and adopting our western-style diet very quickly end up presenting rates of type 2 diabetes similar to ours. In addition, forecasts for the prevalence of type 2 diabetes by 2030 are worrying at the global level. For example in France new cases of diabetes increased from 20 to over 70% depending on the region between 2003 and 2011.

What « remedies »?

In order to remedy this state of affairs, in addition to introducing nutrition education from primary school (from 3 years old) and increasing physical activity, we must relearn how to eat « well » in order to remain healthy. For this, as not everyone can be a specialist in nutrition, it is necessary to look for generic food rules which are acceptable, scientific and easily understandable by all, whatever their origin, their country, their age, etc. But these rules should not flow from reductionist thinking as is the case today, namely an approach according to the composition of the food in nutrients or in calories. Because indeed a calorie of a food A is absolutely not equal to a calorie of a food B according to the matrix of the food, our level of physical activity or if we eat alone in front of the TV or in group! The nutrient or composition approach is therefore obsolete today and has definitely found its limits, what the Anglo-Saxons call « Nutritionism ».

I therefore recommend returning to a more holistic approach to diet and food considering that the whole is greater than the sum of the parts (so that 2> 1 + 1 = mechanism of synergy [2] according to a law of multicausal nonlinear effect) and that food must preserve the three fundamental dimensions of life: health, animal welfare and the environment (Figure 2). A holistic approach to food is to consider the food in its complexity and also to consider that it has a health effect greater than the sum of the health effects of each of the nutrients taken separately, which science moreover demonstrates very good. On these holistic and scientific bases I propose to define what I call the three Golden Rules of sustainable and healthy food:

1) Favor plant products over animal products in a caloric ratio of around 85/15%, or no more than one in six calories of animal origin. However, today the French consume almost one in three calories of animal origin and 60% of the proteins consumed are of animal origin, which is too much, both for health, to preserve animal welfare and environment (Figure 2); To achieve this sustainability, we would therefore need to reduce our animal calories by 50% and replace these 50% with calories from grains and seeds such as whole grains (wheat, rice, oats, corn, etc.), pseudo-cereals ( amaranth, quinoa and buckwheat), legumes (beans, soya, broad beans, lentils, etc.) and nuts (such as walnuts, hazelnuts, etc.), which are all under-consumed in France (<15 g / day whatever either the type of seeds). In addition, overall we consume too much protein: 0.83 g of protein/kg of body weight/day is sufficient in adulthood [3] (ANC, Recommended Nutritional Intakes), or 58 g of protein for an adult of 70 kg; but overall we are closer to 1 g/kg, or even more. So meat should become a side dish and plant products the main course, and not the other way around as is the case today. In addition, by consuming less meat, for the same price, we can turn to better quality meat from extensive sectors generally more respectful of animal welfare.

Figure 2. L’alimentation et les 3 dimensions de la vie sur terre

2) Within plant and animal products, favor foods un-, minimally- or normally processed (that is to say foods which are not a recombination of ingredients already isolated from complex natural foods by fractionation or » cracking”) in a ratio of 85/15%, ie no more than one in six calories from ultra-processed foods. To recognize an ultra-processed food, nothing could be simpler: read the list of ingredients on the packaging; if there are more than 5, you have a good chance of being in front of an ultra-processed food. Also, if you can no longer recognize the original food, this is not a very good sign either. Let’s take two simple examples: a whole apple is un-/minimally-processed (depending on storage conditions), an applesauce is normally processed (apples plus sugar in general), and an apple juice reconstituted from a dehydrated powder with various additives is an ultra-processed product – to be avoided. Indeed in the latter case impossible to recognize the original apple. Another example, take a grilled whole fish (minimally processed), canned in oil (normally processed) and crushed/fractionated then reintroduced into fish nuggets (ultra-processed). And we can decline the exercise for almost all staple foods, even legumes (boiled seeds versus legume soup versus legume milk enriched with sugar, flavorings, etc.). Note also that the more the food is processed, the more it loses the structure of its initial matrix (deconstruction of the food). Today it is therefore time to classify foods according to their degree of processing and no longer according to botanical plant groups or animal species such as fruits, vegetables, cereals, legumes, white meats, red meats, fish, eggs, dairy products. , etc. It is the degree of transformation that makes sense from a nutritional point of view, not the food group as such. Finally, less processed foods are more satiating and lower the level of sugars in the blood compared to ultra-processed foods.

3) Within foods un-, minimally- or normally processed diversify by favoring organic, seasonal and local foods as far as possible. In fact, by diversifying, you have a greater chance of consuming a greater diversity of protective micronutrients (vitamins, minerals, trace elements, polyphenols, carotenoids, etc.) which have multiple and synergistic actions in the human body: antioxidants, anti-inflammatories , anti-carcinogenic, anti-hypertensive, hypocholesterolemic, hypoglycemic, lipotropic [4]… Diversifying ultra-processed foods does not make sense because they are generally refined, rich in energy and poor in protective micronutrients: therefore consume 5 chocolate bars different types found in vending machines have the same nutritional effect as consuming the same chocolate bar 5 times.

These three golden rules are generic enough to be applied almost everywhere in the world according to cultures and traditions, even climatic and environmental conditions. This allows science and culture to be combined without the two opposing each other.

Get out of « dogmatic » healthy diets for better prevention

A diet should be healthy but also sustainable and try to respond to the different challenges and dimensions of sustainability (Figure 3). The stakes are high. Research to date has focused on defining what a healthy diet might be. She has studied extensively Mediterranean, vegetarian, vegan, DASH (Dietary Approaches to Stop Hypertension) diets and other diets known for their health benefits such as the Okinawa diet. These diets are generally all characterized by a high proportion of minimally processed plant products, and therefore generally meet the 3 golden rules, more or less. In addition, many countries around the world have proposed nutritional recommendations at the national level, generally based on the results of epidemiological nutritional studies and illustrated by food pyramids; and even more and more countries are looking at the virtues of their national regime, for example the Nordic Scandinavian regime.

Figure 3. L’alimentation et les différentes dimensions de la durabilité

However, reality shows that it is difficult to get these diets adopted by the majority. There is indeed still a lot of resistance. Some want to continue to consume animal products, others want to keep their culinary traditions, and still others have a lifestyle that is difficult to reconcile with regular adherence to these diets or recommendations. In addition, are these healthy diets sustainable, i.e. do they fulfill the other dimensions of sustainability of environmental, animal welfare, sociocultural and/or religious aspects? Not necessarily. For example, if everyone starts consuming more fruits, vegetables or fish, is this compatible with protecting the environment or animal welfare? For fish, not in view of the plundering of ocean stocks and the programmed disappearance of certain species. For fruits and vegetables, we also know that their carbon cost is higher than that of grains and seeds (or starchy foods) and that they are generally very water demanding. And for dairy products, is consuming 2 to 3 servings per day compatible with animal welfare when we know how dairy cows are treated in intensive breeding in some countries? Finally, do the Scandinavians want to adopt, for example, the Mediterranean diet?

A question then arises: is it really reasonable to want to generalize these healthy diets to the whole planet? Probably not. Why ? I will try to answer it:

Towards a regionalization of healthy diets

First of all, each region of the world is part of its own culinary tradition, religious beliefs, environment and climate, and specific socioeconomic realities. Why not taking it into account? Take the example of France: while the populations of the south can adhere to the Mediterranean diet, the culinary traditions are very different in the north, west and east. In the north, traditionally a lot of potatoes are eaten, in the west more seafood and in mountainous regions more cheese, etc. As for the climatic and agronomic conditions, they are obviously very different, whether it is for the rainfall, the average temperature and the quality of the soil.

The concept of a “regionalized healthy and sustainable diet” involves developing diets in line with all dimensions of sustainability, based on a healthy diet. For example, Auvergne, where I live, ranks first nationally for beef production. Auvergne also has a large number of ewes. As for crop production, they occupy a fifth of the useful agricultural surface, wheat being the most cultivated cereal. The region is also known for its cheeses and lentil production. Can we define a sustainable healthy diet based on these characteristics? Certainly yes. For that, of course, this means favoring local productions and short circuits and rather eating seasonal plant products. It can also mean reducing the production of beef in favor of more plant production, such as legumes or fruits and vegetables compatible with the Auvergne climate.

However, there is one category of food that is grown almost everywhere on the planet and quite easily meets all the criteria for sustainability. These are grains and seeds, more particularly protein crops (legumes), and to a lesser extent cereals (whole) and oilseeds (nuts). Yet they are produced almost everywhere on the planet, are generally inexpensive, easy to store over long periods of time and have great health benefits. Each of these groups is characterized by their richness in complex carbohydrates, proteins and lipids, respectively, as well as by a content of numerous protective bioactive compounds. They are also generally a source of slowly assimilable sugars, dietary fiber and provide a feeling of prolonged satiety. So we can imagine that grains and seeds can form the basis of healthy regionalized diets whatever the region of the globe. Furthermore, all epidemiological studies highlight the protective nature of these foods against the risk of the main chronic diseases such as obesity, type 2 diabetes, cardiovascular diseases and certain cancers. The cereal-legume combination is already widely used, especially on the South American (corn-beans), Asian (rice-soybean) and North African (durum wheat-chickpea) continents, among others. It is probably no coincidence that the Sixty-eighth General Assembly of the United Nations proclaimed 2016 « International Year of Pulses (IIL) » (A/RES/68/231). Remember that legumes do not need nitrogen fertilizers to grow.

Then, on the basis of grains and seeds, everyone can then diversify their diet taking into account their preferences, traditions, beliefs, economic conditions, positioning in relation to animal welfare, and local cultures; while trying to adhere as much as possible to the 3 golden rules, thus combining scientific results and regional realities.

To conclude, preventive nutrition (I prefer « preventive diet » because the food dimension is more significant) must now be based on a holistic and more ethical approach putting people at the center and not financial interests. We have entered a new food or nutritional transition, so we need to move towards less processed foods and more plant products. Buying food from a merchant is an essential act for everyone because we are all interconnected: so if I buy an ultra-processed food of animal origin containing ingredients from the four corners of the planet I may be contributing to the impoverishment of peasants in developing countries, I contribute to animal abuse and deforestation in certain parts of the world. The choice is ours, we are responsible and today it is possible to have access to nutritional information. Only then can we get « things » right, for us, the animals and the planet as a whole.

Author : Dr Anthony Fardet

BIO: Trained as an agro-food engineer from AgroParisTech and a doctorate in Human Nutrition from the University of Aix-Marseille, I worked for 12 years on the health potential of cereal products using experimental approaches (in vitro studies, in animals and humans), including in particular metabolomic studies. I carried out this laboratory research at INRAE (10 years), at IRD (ex-ORSTOM: 1 year of scientific cooperation) and at Danone-LU (1 year of post-doc) on the various cereal products commonly consumed, i.e., pasta, biscuits, weaning porridge, bread and breakfast cereals, and on important grain compounds such as antioxidants, fiber, polyphenols and lipotropes.

Since 2010, my work has mainly consisted of analyzes of food data using an empirico-inductive (from reality to theory) and holistic (search for links between the parts of complex systems that are food and diets) approach: collection, analysis, synthesis and dissemination of new concepts, theories and/or paradigms for preventive and sustainable diets through qualitative (narrative and systematic reviews), quantitative (data exploration) and quantitative/qualitative (‘mixed research synthesis studies’); as well as concept, opinion and foresight articles. Data mining (machine learning and multivariate analyzes) constitutes my main quantitative methodology. My work has generated new holistic concepts such as the 3V rule, HCM (‘Healthy Core Metabolism’) or the new link between loss of « matrix » effect of foods and chronic diseases.

My research activities also include many expert activities: I notably held a 3-year mandate with ANSES in the CES Nutrition from 2012 to 2015. Today, my expertise includes both the public and private sector.[1] « Type 2 diabetes » or « non-insulin-dependent diabetes » (NIDDM) (also called « insulin-resistant diabetes » or « middle-aged diabetes », sometimes « acquired diabetes »), is a metabolic disease affecting glycoregulation eventually causing diabetes mellitus.

[2] Synergy is a type of phenomenon whereby several factors acting in common together create a global effect; a synergistic effect distinct from anything that could have happened if they had operated in isolation, whether each on their own or all together but working independently. So there is the idea of creative cooperation.

[3] 1 g/kg/day in the elderly

[4] Food compounds that prevent excess fat in the liver.

Gabriela Ana

Holistic Health Coach

+34 604 398 948


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