Solving the problems we create

If we want to cut down on disease and achieve meaningful health care reform, we should make it a top nonpartisan priority to address our nation’s nutrition crisis.

Dariush Mozaffarian, Professor of Nutrition, Tufts University

There are so many hot-button issues on which I want to voice my opinion that I find myself in a quandary this morning over which to choose. Gun control obviously has had people all up in arms this week (pardon the pun). LGBTQ rights are an issue again, thanks to a change in presidential policy. Women’s reproductive rights are in the same boat and don’t even get me started on children’s healthcare. There is more than enough to talk about for days without ever reaching any kind of workable solution. We have, in the United States, done nothing but talk about these issues for so very long that even the most insignificant action seems dramatic, so we do nothing.

Then, I open my refrigerator, looking for something to mollify the munchies that are inherent to spending long hours in front of a computer, an am reminded that we are at the end of our monthly budget for food. The fridge is looking pretty sparse. There’s sugar-free jam, light margarine, some leftover curried chicken and noodles, and 1% milk. There’s ground beef and frozen veggies in the freezer, and I have a roast thawing for dinner, but come Monday we’re going to need to make a trip to the store. That means I have to start deciding now what we can afford.

, but come Monday we’re going to need to make a trip to the store. That means I have to start deciding now what we can afford.

Here I have a problem. Why? Because I recently came across this study indicating that food is the leading cause of poor health in America. If we’re going to talk about things that kill us and do us harm, before we look at guns, before we look at access to medicines, and before we start screaming about the cost of healthcare, we have to stop and look at the effects of what we’re putting in our mouths. Now, I’m diabetic, so I already know some of the dangers that come with being loose and free with one’s diet. However, diabetes isn’t even new the top of serious health problems whose core causality is rooted in food. Heart disease, stroke, chronic obstructive pulmonary disease, chronic kidney disease, and kidney cancer all rank higher and all of them have at least partial causality in the poor nutrition levels we perpetuate.

Argue, fuss, grouse and complain all you want, the bottom line comes down to the fact that the high cost of healthcare in the United States is significantly attributed to our lousy eating habits and unless we do something we’re going to soon a dramatic change in what had been an increasing life expectancy. We’ve already seen the numbers fall for Caucasian males, who are notoriously bad eaters. Without significant change, though, we could see ourselves dropping like flies over the next 20 or so years. Perhaps even worse, though, is that before we die we’re going to rack up impossibly high medical bills that come with frequent heart attacks, broken hips and things caused by falls due to a loss in bone density, and increased liver and kidney disease. Bad enough that we’re dying, we’re raising the cost of healthcare by dragging it out over 30 or so years.

I know, you don’t want to believe me. I don’t want to believe me, either. That’s why there’s peer-reviewed research to back up these allegations. Try this one on for size: approximately twice as many people die each year from eating hot dogs (processed meats) than in automobile accidents. We’re talking something in the neighborhood of 60,000 people a year. Who knew hot dogs were such vicious killers? And no, eating “light” or “low sodium” hot dogs doesn’t make enough difference to be worth the trouble. Processed meats, such as the pepperoni on that pizza, or the salami on that sandwich, are high in sodium, carbohydrates, fat, and processed sugars, all of which are bad for us when we over consume them, and we habitually over consume everything.

So, I need to make sure my family and I are eating healthy. That means we should load up on fruit, nuts, fish, vegetables, vegetable oil, whole grains, beans, low-fat yogurt  That also means we should absolutely stay away from refined grains, starches, sugars, processed meats, high-sodium foods, industrial trans fats. Anything that falls between those two lists is kind of a “meh” food that’s not going to kill you quite as quickly, but should probably be consumed in moderation.

Immediately, there are some problems here. Take refined grains for example. The most common “refined grain” that is in almost every cupboard is all-purpose flour. Almost any white-colored flour is bad for you. That whiteness comes from extreme processing methods that include bleaching. Over time, all that flour contributes most heavily to heart disease and diabetes and stroke. The better replacement to all-purpose flour is whole wheat flour but that comes with a couple of complications. Have you tried cooking with whole wheat flour? Cakes, cookies, bread, fried food batter, all the things that we most frequently cook with heavy amounts of all-purpose flour require some adjustments if we use whole wheat, and sometimes those adjustments aren’t enough. Have you ever tasted whole wheat chocolate chip cookies? No, really, just dump them in the trash.

Oh, and then, to add insult to injury, whole wheat, the stuff that’s actually easier to package, cost more. For example, my local Kroger (grocery store) has a five-pound bag of Gold Medal all-purpose flour for $2.99. However, the same sized bag of King Arthur Premium 100% Whole Wheat Flour is $5.69! Nearly twice as much! Now, there are store brand options that lower the price of both, but the nutritional differences between the store brand wheat flour and King Arthur is significant.  If we’re going to talk health here, we have to go with the good stuff and that means taking a bigger bite out of my limited budget.

Budget. For a first-world country, there are a lot of people in the United States who have insufficient food budgets to eat healthily. Research shows an incredible correlation between low incomes and dietary problems.  We don’t eat well, we get sick. We get sick, we can’t work. We can’t work, we can’t afford healthy food. We can’t afford healthy food … you see where this is going, right?

Let’s look at my specific situation as an example, since I know exactly what’s going on here.  I have approximately $400 a month with which to feed five people, three of which are adults. Of those three adults, though, the Young Woman of the house consumes the least. Her schedule is such that she ends up eating out more than the rest of us. The kids get breakfast and lunch at school five days a week, so that helps as well. The budget isn’t totally inflexible, either. If we get down to the end of the month and need milk and bread, we usually can afford to exceed our stated limit. We’re privileged, though.  Many people don’t have that option.

So, when we go grocery shopping, trying to keep in mind what is healthy versus what is not, our bill ends up looking something like this (I’m rounding to make the math easier):

Meat: $84
Fruit: $22
Veggies: $104
Dairy: $68
Grocery (whole wheat pasta, beans, etc): $136
Total $414

$414? Really? And I’ve not even gotten to sugar-free snacks, which are an absolute necessity. Are you beginning to see the problem?  Now, if I were to replace healthy food with frozen and pre-packaged things such as pizza, boxed mac & cheese, and breaded fish, I could make that budget stretch a lot further. Canned veggies are really inexpensive, for example, but they are also loaded with sodium, have the vitamins cooked out, and a surprising number come with added sugar!

There are a lot of people who have no choice but to get by on much less. I once met a family of seven whose monthly food budget was less than $200 and they were excited because they were better off than most of their neighbors. Everyone in their neighborhood was malnourished and the adults all had chronic health issues of some kind. Children were frequently ill and had to miss school, which meant one parent had to miss work as well. The situation was absolutely heartbreaking!

Here’s where we have to get real. As a society and as a government the United States has habitually made it easier to eat poorly than to eat healthily. Hold on, don’t give me any conspiracy theory crap about this being how “the man” keeps us down. That’s nonsense. To a large extent, we’ve brought this on ourselves. We created the demand for fast food. We are the ones who order the greasy stuff when there are healthy options on the menu. If grocery stores stop carrying healthy alternatives its because you and I wouldn’t buy them. Supply and demand is a significant factor in what’s available to eat and what we have been demanding for the last 60 years is not more vitamin-packed vegetables.

At the same time, however, farm-to-table costs have continued to rise to the point that the family of four with both parents working can only afford a monthly food budget around $200. That’s where government action comes in. An unreasonably low minimum wage and a lack of subsidies for farmers and food programs keeps costs higher than is reasonably affordable. Tack on the demographic fact that poverty conditions affect a disproportional number of non-white families and single women with children and it’s easy to see how the high cost of eating well directly contributes to increased healthcare costs.

The good news is that we can fix this problem and a lot of it can happen without any government involvement at all. That same economics law of supply and demand that helped get us into this situation can help get us out. How we spend the money in our food budget determines what’s available on store shelves and in restaurants. We cannot underestimate the degree to which you and I have control over our options. It starts with one less fast food visit per week. That’s it. It may not sound like much, but the average fast food bill hits right around ten dollars per person. That’s $40 for a family of four. $40 a week adds up to $120 a month that is now available to spend on real food. The impact is felt both directions. The combined loss to fast food forces them to re-consider their menus and pricing. When that money is spent on healthy choices at the grocery store, more healthy choices are added to the shelves. Increased demand both increases supply and, to a limited extent, decrease prices at the same time.

Solving the problems we create
photo credit: charles i. letbetter

Mind you, I’m not suggesting you cut your fast food habit cold turkey. We become addicted to fat and cholesterol more quickly and more severely than we do any regulated drug. We have to wean ourselves off that habit. Start with dropping one trip to McD’s or Taco Bell per week. Do that for a couple of months. Fight against the munchies you get in the middle of the night by using that money to buy healthy chips and low- or non-fat cheese. I buy a black bean chip that is significantly lower in fat, cholesterol, and carbohydrates than anything I can get from Lays® and the nachos I make actually taste better and do a wonderful job of killing those munchies. Backing off the fast food is one hundred percent possible if you decide that’s what you’re going to do.

The second step is learning to shop and prepare food that is more healthy. Everyone struggles here because we’ve all grown up on a steady diet of food cooked in fat. Have you ever wondered just how many tons of butter the cooks on the Food Network go through each month? They would probably save on production costs if they had their own dairy. We use butter in everything.  Consider, however, that one tablespoon of unsalted butter contains 100 calories and 17 grams of fat, 14 of which are saturated fat—the kind that is really bad for your heart. By comparison, a light margarine has only 35 calories per tablespoon and only 4 grams of fat, 2 of which are saturated.  Subtracting those 12 grams of fat makes a huge difference when it comes to the nation’s leading killers: heart disease, high blood pressure, and diabetes. That’s just one tiny little change in our shopping habits that has a tremendous impact on our health.

If we, as a nation, did those two things alone, the impact on national healthcare costs would be absolutely phenomenal. More importantly, not only would we be paying out less for healthcare, we would have more time with the people we love the most. How many of us have lost someone to heart disease or high blood pressure? We can reduce that, not eliminate it entirely, but reduce the frequency of fatal heart disease, high blood pressure, and diabetes simply by making relatively minor changes in our food choices.

Let me emphasize, again, that I’m not advocating anything severe. There are no legitimate scientific studies that support a massive overhaul of the nation’s diet. Neither can I advocate trendy weight loss gimmicks like the Keto diet that everyone is currently raving about. The Keto diet isn’t all that different from the Atkins diet my father tried in the 1970s. While both can result in short-term weight loss, neither are sustainable over the long term. The Atkins diet is especially problematic in that the absence of fiber and reliance on red meat increases by more than double one’s chances of colon, stomach, or esophageal cancer. That’s not helping us reduce healthcare costs, is it?

I also don’t want to give anyone the mistaken idea that eating healthily means completely eliminating all the foods we enjoy. My doctor was amazed that I reduced my A1C from 10.5 to 5.6 in six months. He was concerned that I was being too restrictive in my diet. Yet, during that six months, we took my son to our favorite Indian buffet and did not hold back. We took the little ones to a new pizza buffet that opened in our neighborhood (pizza sucked by the way). We took a road trip and paid almost no attention to diets while traveling (I did avoid things such as soda and candy). There were plenty of other instances where what showed up on our table played more to our taste buds than our health needs. Yet, there was plenty of improvement in both my blood pressure and my sugar levels during that time.

Improving our health and lowering our healthcare costs is within our reach without any involvement from the government.  Screw Congress and their inability to legislate their way out of a wet paper bag.  We can do this ourselves.

Solving the problems we create
photo credit: charles i. letbetter

Not that we couldn’t use some help, mind you. Were Congress to decide to get off its partisan ass and do something constructive, there are plenty of things that could help, especially when it comes to the poor, who, not surprisingly, has some of the highest healthcare cost. Dr. Dariush Mozaffarian at Tufts University has researched this whole topic of lowering healthcare cost by eating better and came up with some rather simple ways that government could help without busting the federal budget.

  • Subsidizing the cost of fruits and vegetables by 10% could save 150,000 lives over 15 years.
  • A 10% tax on soda could save 30,000 lives and help pay for the subsidies.
  • Reducing salt in packaged foods by just three grams per day could save between $10 to $24 billion in health care costs annually.
  • USDA limits on additives that include trans fats, sodium, and sugars could save over $12 billion in annual health care costs.
  •  Wellness programs that incentivize participation save $3.27 in lower medical costs and $2.73 in less absenteeism for every dollar spent.

Dr. Mozaffarian has plenty of other recommendations based on extensive research, but the emphasis remains the same: we can significantly lower our healthcare costs simply by putting more focus on what we’re eating and making the right foods more readily accessible.

One of my most frequent frustrations with Americans is that we are fat and lazy. We are, hands down, the most obese nation in the world and we yell and scream about health care and Congress gutting the Affordable Care Act while doing absolutely nothing to lower health care costs for ourselves. We hold a lot more power than we apparently realize.

The same applies to other issues beyond healthcare. We can address issues of racism and inequality directly, immediately, simply by being more aware of how we treat other people. Across the board, we are, as a society, woefully blind to how horrible we treat each other on a daily basis even while thinking that we’re “good” people. We, you and I, could solve the world’s refugee crisis if we put as much effort into that problem as we do into supporting billion-dollar sports franchises.  Gun and domestic violence numbers go down when we are more directly involved in our schools and communities. There is plenty of research behind all of this. Doctors and scientists have been telling us these things for decades There are workable solutions that are readily within our grasp.

Where we fail, my friends, is that we are lazy. We are too self-involved to even realize we’re not taking care of ourselves. Our focus on having the best experiences in life, on making the most money, on making sure our children have the things we didn’t have, while not bad in of themselves, give us such tunnel vision that we don’t see how simple it would be for us to solve the problems that plague us as a society. Instead, we repeatedly look to a government for solutions when they have repeatedly over the past twenty years proven themselves incapable of doing much more than wasting billions of taxpayer dollars. If the government can’t even handle something as simple as fixing the hundreds of bridges that are dangerously ready to collapse how can we expect them to be proficient in addressing social problems that we, ourselves, created in the first place?

We, not the government, cause the vast majority of problems our society faces. That means we, not the government, have the ability to solve them. Should government help where it is reasonable? Absolutely. There are things best done on a broad, nationwide basis and only government can be effective in implementing those programs. Still, make no mistake, the bulk of the responsibility has to be our own. Me. You. Starting with reducing our healthcare costs by changing our attitudes toward food just a little. We don’t have to go stark raving mad in order to see dramatic results.

Don’t complain about the state of the world, of your country, of your city, if you are doing nothing to be part of the solution. That’s how life works, dudes. Make adjustments as necessary.

Abide in Peace,
The Old Man

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Solving the problems we create
photo credit: charles i. letbetter

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