What information do you consider when you read a food label? My bet is that for those who do take the time to read the fine print, it’s typically the calorie count, the fat and sodium content, and perhaps even the recommended daily allowance of vitamins and nutrients that take center stage, especially for people who have an eye toward losing weight or making healthier choices. But what about the ingredient list? The ingredients in particular, including the ones with names that sound like compounds best discussed in a chemistry class, are often ignored. And I’m sure we all know people who don’t give any part of nutrition labels even a passing glance. I’ve actually heard friends admit, “I don’t want to know what’s in my food; I just want to enjoy it.” There’s no doubt there’s a very strong emotional connection to foods that we love…but we owe it to ourselves to take a much closer look at exactly what we put into our bodies.
 
It’s well established that our food choices play a significant role in our overall health and our risk of developing or worsening chronic diseases. Much has changed in relation to the science of healthy eating and disease prevention since many of us studied nutrition in nursing school. Have you kept up with the latest evidence to inform your own food choices or those of your family and patients, or do you place your trust in popular media and advertising claims about diet and nutrition? How do you knowingly separate the healthy food facts from the hype? Unfortunately, the hype comes from advertising dollars that, in a large part, serve to drown out the evidence from legitimate food science research.
 
I’ve always tried to eat “healthy,” but in retrospect, my diet left a lot to be desired. There’s nothing like a health scare to motivate new learning. My sentinel moment occurred the day I discovered that I had developed a major food allergy to carrageenan. To my great surprise, consuming my favorite brands of coffee creamer, yogurt, ice cream, and sorbet started to reliably induce progressively worsening wheezing, facial flushing, and tachycardia. The reaction that captured my full attention came very close to sending me to the emergency department for treatment. Being a stubborn ED nurse, I self-treated with over-the-counter antihistamines and fully committed to figure out exactly what caused me to react. Through the process of elimination, I found that the common denominator in all four foods was carrageenan. Eating even a small amount of it reproduced my symptoms quite predictably. Switching to brands of products that didn't contain the offending ingredient and carefully scrutinizing all food labels made eating much less eventful and far more enjoyable.  
 
When I researched carrageenan, I learned that it’s made from red seaweed and is added to food as a non-nutritive thickening agent. Although it's a natural product found in many "healthy" foods, it’s a potent inflammatory mediator that’s been linked to inflammatory bowel disease and colon cancer.¹ Carrageenan is actually used as an inflammatory agent to test the efficacy of anti-inflammatory drugs.¹ Knowing the risk it creates, even for people who don’t have an allergy to carrageenan, I had to wonder why it’s even placed in the products we buy and why it’s so pervasive? 
 
Sadly, I learned that there are many other chemical additives commonly found in our food supply that are suspects in causing a myriad of human health issues. Take artificial sweeteners, for example: a prospective study just published from the Framingham Heart Study Offspring Cohort group revealed that individuals with the highest consumption of artificial sweeteners had a statistically significant higher risk of stroke and dementia, even after other possible contributing factors were adjusted.²

So, my personal mission began to learn as much as possible from legitimate, high quality, evidence-based health literature about nutrition and food safety. The information I found inspired me to make a personal commitment to eat “clean”— that is to avoid food with chemical additives — and completely change my diet to consume foods derived primarily from whole, plant-based sources. The fewer the ingredients, the better. I’ve learned that plant-based, nutrient-dense foods are the very best to fuel our bodies and prevent disease.  Yes, these foods can be prepared in very delicious and healthy ways. Eating like this feels different because most of us were not raised on a clean, plant-based diet. We were raised on high sugar diets with artificial colors, preservatives, and chemical additives because that’s what was advertised on television and we came to believe that these “foods” were somehow good for us.
 
Changing the way we eat is a very heavy lift. It clashes with the typical societal food norms, family customs, and available choices on many restaurant menus. It’s especially tough to be discriminating with food choices when eating out. Few people really understand how to feed someone on a plant-based diet. For example, I was served only a plate of plain lettuce at one recent function that I attended by those who knew my plant-based preferences. Keep in mind that all manner of fruits, vegetables, seeds, nuts, legumes, grains, and healthy, plant-based oils are part of the repertoire of possibilities. 

Eating a clean, plant-based diet is a journey. I’ve found that the more I learn, the easier it is to make good choices. A very broad base of scientific evidence exists to support that dietary choices are firmly connected to personal health. As nurses, we need to expand our knowledge base on this subject and incorporate teaching about the impact of food choices on health into our teaching with patients. Simple steps like choosing to bring fruits, vegetables, nuts, and healthy grains into work for snacks in the break room can make a positive difference (as opposed to the usual tempting fare found on most nursing units). For those of you interested in learning more, I’ve included a reading list of resources that were most helpful to me in shaping my own perspectives. One of my favorite websites, https://nutritionfacts.org, provides reviews on the latest high quality, peer reviewed, evidence-based research on food, nutrition, and overall health. The information contained on this website has enabled me to better make healthy lifestyle decisions. 
 
As we celebrate Nurses’ Week and beyond, I encourage you to take stock of your own dietary habits and make informed choices that promote optimal health!
 
Bon appetit!
Linda
 

References:
1.  Borthakur A, Bhattacharyya S, Anbazhagan AN, Kumar A, Dudeja PK, Tobacman JK.
Prolongation of carrageenan-induced inflammation in human colonic epithelial cells by activation of an NFκB-BCL10 loop. Biochem Biophys Acta, 2012;1822:1300-1307. Retrieved at:  http://ac.els-cdn.com/S0925443912001032/1-s2.0-S0925443912001032-main.pdf?_tid=0b956676-2db2-11e7-8d56-00000aacb360&acdnat=1493563018_03f88014c2f300c3ba560bb71255bd30.

2.  Pase MP, Himali JJ, Beiser AS, Aparicio HJ, Satizabal CL, Vasan RS, Seshadri S, Jacques PF.  Sugar- and Artificially Sweetened Beverages and the Risks of Incident Stroke and Dementia:  A Prospective Cohort Study. Stroke. 2017;48:1139-1146.  Retrieved April 24, 2017: https://doi.org/10.1161/STROKEAHA.116.016027.

 

• Campbell, T. C., & Campbell, T. M.  (2006). The China Study:  The Most Comprehensive Study of Nutrition Ever Conducted.  Dallas:  Benbella Books.
• Fuhrman, J.  (2011). Eat to Live.  New York:  Little, Brown and Company.
• Greger, M., Stone, G. (2015). How Not to Die.  New York: Flatiron Books.
• Greger, M. https://nutritionfacts.org  Accessed April 30, 2017.
• Robinson, J. (2013).  Eating on the Wild Side.  New York:  Little, Brown and Company.

 
 Linda Laskowski-Jones, MS, APRN, ACNS-BC, CEN, FAWM, FAAN
Editor-in-Chief, Nursing2017
Vice President: Emergency & Trauma Services
Christiana Care Health System – Wilmington, Delaware