Chapter 14: Vegetables and Fruit

If I ever write a diet book that contains a chapter on vegetables and fruit, here is the sentence that would make up the entirety of that chapter:

“Fruits and vegetables: eat them.”

Most of you don’t eat enough of them. Try to eat more. Please and thank you.

Now I’ll turn it over to the Hartwig’s to see if they feel the same way that I do.

Whole30

“…a diet rich in vegetables can actually help you battle our old arch nemesis, systemic inflammation, and reduce your risk for lifestyle-related disorders—stroke [1], coronary heart disease [2], and certain types of cancer [3].”

I have a good feeling about this. Let’s take them one by one.

Stroke [1] – meta-analysis of prospective cohort studies shows that those who eat more fruits and vegetables have fewer strokes. The more fruit and veg you ate the more your risk decreased. Recent meta-analyses have echoed these same findings of the health preserving effects of eating fruit and veg [4].

Coronary Heart Disease [2] – this source is a 2002 review of “metabolic, epidemiologic, and clinical trial evidence regarding diet and CHD prevention”. Here were their main findings:

Swap out some saturated and trans-fats for unsaturated fats
Increase consumption of omega-3 fatty acids
Consume a diet high in fruits, vegetables, nuts, and whole grains and low in refined grain products.

Aside from the irony that the researchers encourage people to eat whole grains, a food group entirely banned from the Whole30, the cited paper does support their assertion that “a diet rich in vegetables can…reduce our risk for…coronary heart disease”. More recent publications also support this [4].

Certain Types of Cancer [3] – here we have a paper discussing chronic inflammation and cancer. In it, they state “Eating a diet rich in fruits and vegetables is thought to be the best and safest means of preventing cancer. Epidemiologic studies suggest that diets high in fruits and vegetables are strongly associated with a lower incidence of different forms of cancer”.

So far so good!

Whole30

“…vegetables provide the richest source of antioxidants, which prevent or reverse damage caused by excess free radicals. Compounds from meat also add antioxidants to our arsenal and supply building blocks for our body’s own antioxidant production. See? Meat does more than just provide protein! [5]”

True again! There are peptides that have antioxidant properties such as amino acids like cysteine, methionine, and glutathione that can help prevent oxidative damage [7,8]. I’d add the caveat that these protein-based antioxidants can come from sources other than meat with soy also being a great plant source of a complete protein.

Whole30

“Other [free radicals] can be created from our food, particularly when we consume certain types of fats—remember the seed oils chapter? [9]”

They cite a paper that looks at how some oils are more susceptible to oxidation than others when heated, but I’m going hold off on discussing this topic till I’m able to dig into chapter 9 (Seed Oils) and chapter 15 (The Right Fats). Stay tuned kids.

Whole30

“Free radicals are also normal metabolic byproducts: They’re produced…during strenuous exercise. [10]”

Also true, as this study eloquently notes [11] “A balance between free radicals and antioxidants is necessary for proper physiological function. If free radicals overwhelm the body's ability to regulate them, a condition known as oxidative stress ensues. Free radicals thus adversely alter lipids, proteins, and DNA and trigger a number of human diseases.” Exercising can actually enhance your body’s ability to handle free radicals [12,13].

Whole30

“Vegetables and fruits have the highest natural concentration of antioxidants—things we bet you’ve heard of, like vitamin C, vitamin E, and beta-carotene—so it makes sense that a diet rich in these noble martyrs would help us fight free radicals and reduce systemic inflammation. [14]”

The cited article is a review paper that discusses the impacts of genetic and environmental factors on C-reactive protein (CRP) concentrations. CRP is a protein that plays a role in the bodies systemic response to inflammation. Elevated CRP is a potential risk factor for heart disease. The review describes how those with higher intakes of “fruits and vegetables were associated with a lower risk of [metabolic syndrome] and lower…CRP concentrations…The anti-inflammatory effect appears to be mainly attributable to the antioxidant components of fruits and vegetables”. I would like point out that the review also noted that intakes of legumes (beans) and whole grains, foods on the Whole30’s no-no list, were associated with lower CRP levels as well.

WARNING. RANT AHEAD!

Ok, so eating healthy is really not terribly complex. I know that it may seem that way because of the mixed media messages, nutrition gurus, and general misinformation that gets spread around the internet. But when you peel back all the marketing and hype and get down to brass tacks a healthy diet for most people is going to consist primarily (but not entirely) of minimally processed whole foods. Diets gurus often like to add in layers of complexity that are excessive, confusing, and largely unnecessary. For example, in this chapter the Hartwig’s give you a list of their “go to” veggies. All fine and well. But then they complicate things by saying:

You can’t have corn because it's technically a grain, not a vegetable.
Oh and you can’t have green peas or lima beans because those are legumes (yes, with a straight face they are telling you not to eat peas. Toddlers the world over are rejoicing.)
But you can have green beans, snow peas, and sugar snap peas cuz those are mostly the plants pod and not really a fully formed legume so those are OK.

My advice? If you have no special medical/dietary conditions eat your vegetables. All of them.

Now wasn’t that simple? Rant over.

Whole30

“…diets rich in fruit and compounds found in fruit (like vitamin C) have been associated with a reduced risk of systemic inflammation and related conditions and diseases. [15]”

Correct again [4]! We’re on a factual accuracy roll here in this chapter. But my Spidey sense is tingling. Me thinks their truthiness streak may not hold up for long…

Whole30

“While fruits are certainly nutrient-dense and yummy, they are not as nutritious as vegetables.”

Citation please! What research are they basing this off of?

Whole30

“We don’t know of a single micronutrient found in fruit that you can’t also find in vegetables. (Translation: Veggies are mandatory; fruit is optional)”

Again, no citation is provided but, in theory, the opposite could also be true. That is to say, I’m not aware of a single micronutrient found in vegetables that you can’t also find in fruit.

Whole30

“Certified organic vegetables and fruits are produced without the use of synthetic pesticides, herbicides, and chemical fertilizers, do not contain genetically modified organisms (GMOs), and are not processed using irradiation, industrial solvents, or artificial food additives. They are generally regarded as more nutrient-dense and environmentally safe than their non-organic counterparts. [16]”

This paragraph is a doozy. Let’s break it down.

Whole30

“Certified organic vegetables and fruits are produced without the use of synthetic pesticides, herbicides, and chemical fertilizers…”

False [17]. Please direct your attention to the USDA’s National Organic Program's National List of Allowed and Prohibited Substances (USDA-NOP-NLAPS). In particular, the section entitled “Synthetic substances allowed for use in organic crop production” (7 CFR 205.601).

It seems there are quite a few synthetic pesticides allowed in organic agriculture. In total there are about 40 odd pesticides allowed in organic production and a few synthetic fertilizers (7 CFR 205.601(j)).

Whole30

“Certified organic vegetables and fruits…do not contain genetically modified organisms (GMOs), and are not processed using irradiation...”

GMO’s and ionizing radiation are indeed not allowed in the production of organic foods [22]. But as we talked about in my inaugural post about why I’m reviewing this book, the consumption of GMO’s is a bit of a non-issue when it comes to food safety or personal health. Ionizing radiation may be a new concept for some of you. It does sound scary but also falls into the “non-issue” category. This technique is used to prevent foodborne illnesses like E. coli from spreading, helps with food preservation, can control insects on imported foods, and can sterilize foods so they can be stored for years [23]. This process does not make your foods radioactive or compromise its nutritional quality. All NASA astronauts eat meats that have been “sterilized by irradiation to avoid getting foodborne illnesses when they fly in space” [23]. The Food and Drug Administration (FDA), The World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), the U.S. Department of Agriculture (USDA), the European Food Safety Authority (EFSA), and the Environmental Protection Agency (EPA) have all reviewed and endorsed the safety of irradiating foods [23-27,68].

Whole30

“Certified organic vegetables and fruits…are not processed using…industrial solvents or artificial food additives.”

Unlike GMO’s and irradiation, artificial/synthetic food additives and some industrial solvents are allowed in organic food production but there is a strict list of which ones are permitted in organic agriculture and food processing [22].

Whole30

“Certified organic vegetables and fruits…are generally regarded as more nutrient-dense and environmentally safe than their non-organic counterparts.”

False again. Four meta-analyses have looked at hundreds of studies and found that organic foods were no more nutritious than conventionally grown foods [18-21]. And to say that organic foods are “generally regarded as safer for the environment” and not provide any citations is a little perplexing. The idea that organic foods are better for the environment is a very broad question with many factors to be considered. For example, organic agriculture yields about 20% produce less produce per acre than conventional farms [28-30,67]. To shift all farms over to organic would require a lot more land be plowed for farming; something I don’t think would be seen as environmentally friendly. There are many facets to be considered before we summarily declare organic as more “environmentally friendly”.

And now for a tangent on the Environmental Working Groups 2015 Shopper's Guide to Pesticides in Produce (AKA the EWG’s “Dirty Dozen” list).

The Hartwig’s recommend that you consult the EWG’s list of “the “12 dirtiest” (most contaminated with pesticide residue) and “15 cleanest” (least contaminated) [conventional] produce items”. They say you should spend your money buying organic versions of the “dirtiest” produce to avoid those nasty pesticides. Here are three reasons why you should ignore this list.

They don’t take tolerance levels into account, or what the EPA has determined a safe level of exposure would be. For example, EWG states that 99% of apple samples tested positive for at least one pesticide residue. They do not factor in that this residue could be astronomically small. Was there 1 gram of residue or 0.000000000000000001 grams? It absolutely makes a difference. If you were looking to take some Tylenol for your fever would you take 500 mg (2 caplets) or 0.00000000000000001 mg? Dosage matters y’all. The 2013 data from the USDA’s Pesticide Data Program showed that only 0.27% of all produce tested exceeded tolerance levels and 40.5% had no pesticide traces whatsoever [31].
The USDA does not test for residues of organic-approved pesticides on organic produce. So when the EWG is recommending that you buy certain produce as organic they are doing so without having any idea how much or little pesticide is on said produce. The USDA just completed a pilot study to test organic produce for non-organic approved pesticides [32]. This data was not factored into the EWG’s analysis [33]. In short, the EWG is saying “Go buy organic for these 12 food items because reasons!”
A study published on the EWG’s methodology for their shopper’s guide list concluded that “[Our] findings suggest that the potential consumer risks from exposure to the most frequently detected pesticides on the “Dirty Dozen” list of foods are negligible and cast doubts as to how consumers avoiding conventional forms of such produce items are improving their health status…The methodology used to create the “Dirty Dozen” list does not appear to follow any established scientific procedures [34].”

Remember what I said earlier about making diets unnecessarily confusing? Things like “eat your fruits vegetables, but you should buy organic versions of these 12 (Oh and remember, no peas!)” fall squarely into the category of “unnecessarily confusing”.

Whole30

“Fructose is different from other simple sugars in the way it’s processed in the body…fructose is sent straight to the liver, where it is metabolized and either stored as energy (liver glycogen) or converted into triglycerides (fat) and dumped into the bloodstream.”

Not quite. The vast majority of fructose is converted into either glucose, lactate, or stored as glycogen in the liver. The glucose and lactate will mostly be oxidized when you are in energy balance. Only about 1-3% may be used to form new fatty acids such as triglycerides [35,36].

Whole30

“The effects of a diet too high in fructose are decidedly not good… [37,38]”

So here they cite a blog post and an interview with Dr. Richard Johnson by Dr. Joe Mercola. I’m gonna pause right here to point out that Dr. Mercola is hands down one of the biggest health frauds on the internet. He consistently makes grandiose and unsubstantiated claims about food ingredients he claims are dangerous but then sells products that contain these “dangerous” ingredients. A snake oil salesman if I ever saw one.

Now Dr. Richard Johnson is another story. Dr. Johnson seems to be a well-meaning scientist who believes that fructose may be at the center of a lot of our health ills. We shall see…

Whole30

“The effects of a diet too high in fructose…may include liver damage, inflammation, atherosclerosis, free-radical damage, and an increased risk of diabetes, high blood pressure, kidney disease, and obesity [39].”

Dr. Johnson was the lead author of the paper cited for the above paragraph. Published in 2007, Dr. Johnson laid out his hypothesis of why fructose is the dietary devil. To bolster his argument, Dr. Johnson gives a review of the literature which includes human trials, animal trials, and cohort studies. Luckily for us, veritable mountains of research have been done in humans since he put forth his hypothesis. Let’s take a look at each of the above claims and see how they hold up. Remember, the claim being made is that fructose has the unique ability to cause the above-mentioned diseases to a greater degree than other types of carbs, fats, or proteins.

Whole30

“Fructose may cause liver inflammation.”

Two meta-analyses found that fructose did not induce liver inflammation (called NASH or NAFLD) under isocaloric conditions (weight maintaining diets) [41,42]. Overfeeding fructose (hypercaloric – weight gaining diets) did impair some liver health markers, but concrete conclusions cannot be drawn because excess energy intake was a confounder.

Whole30

“Fructose may cause atherosclerosis.”

A meta-analysis examining 16 trials found that consuming large amounts of fructose under isocaloric conditions did not increase post-meal triglycerides but did under hypercaloric conditions [43]. Excess calories was a confounder. A more recent meta-analysis pooled data from 59 trials and found no difference in HDL, LDL, Apo B, triglycerides, or Non-HDL-C when fructose was added to the diet under isocaloric conditions [44]. Increases in triglycerides and apo b were seen under fructose-induced hypercaloric conditions, but excess calories were a confounder again.

Whole30

“Fructose may increase the risk of diabetes.”

While there have been many observational cohort studies showing an association between increased sugar intake and type 2 diabetes, the role of fructose playing a causal role in this is far from clear [45]. Interestingly enough, a meta-analysis of 18 trials of those with T2D looked at what happens when fructose replaced other carbs in the diet under isocaloric conditions [46]. Either metabolic improvements or no effect was seen in glycated blood proteins, fasting glucose or fasting insulin.

Whole30

“Fructose may increase the risk of high blood pressure.”

A meta-analysis of 15 trials found that “fructose intake in isocaloric exchange for other carbohydrates significantly decreased diastolic and mean arterial pressure. There was no significant effect of fructose on systolic blood pressure. The hypercaloric fructose feeding trials found no significant overall mean arterial blood pressure effect of fructose in comparison with other carbohydrates [47].”

Whole30

“Fructose may increase the risk of obesity.”

Two meta-analyses have been published in this area. Both found that fructose ingested under isocaloric conditions did not possess the unique ability to induce weight gain. The hypercaloric fructose groups did experience weight gain [48,49].

While the authors of all the cited meta-analyses called for more research to be done in each of these areas, the current body of evidence implies that fructose does not appear to be the dietary supervillain it’s been made out to be. That is to say, if fructose had the unique ability to wreak havoc on our metabolism we should have seen deleterious effects in both the isocaloric trials as well as the hypercaloric trials. Alas, no negative outcomes were seen in the isocaloric trials. This gives credence to the idea that it is the excess calories themselves and not necessarily the added fructose that caused the negative outcomes in the hypercaloric trials.

It should also be noted that many trials were feeding their participants unrealistically high doses of fructose. We’re talking 150 grams a day or more of pure fructose in some cases. These ultra-high doses should have been more than enough to elicit some negative reaction in the isocaloric trials if indeed fructose were a dietary villain.

Whole30

“In fact, many studies show that diets high in fructose play a key role in metabolic syndrome [40].”

Dr. Richard Johnson was again the lead author of the cited paper here. He discusses the “causal role for uric acid in fructose-induced metabolic syndrome”. Uric acid is a chemical created when the body breaks down purines, which can be found in some foods and drinks. High levels of uric acid can lead to gout (a type of arthritis) or kidney disease [50]. A 2012 meta-analysis found that “Isocaloric exchange of fructose for other carbohydrate did not affect serum uric acid in diabetic and nondiabetic participants…Hypercaloric supplementation of control diets with fructose (+35% excess energy) at extreme doses (213–219 g/day) significantly increased serum uric acid compared with the control diets alone in nondiabetic participants…Confounding from excess energy cannot be ruled out in the hypercaloric trials [51].”

The authors also noted that “The effect of the interaction of energy and fructose remains unclear. Larger, well-designed trials of fructose feeding at "real world" doses are needed”.

Whole30

“Most fructose in the American diet doesn’t come from fresh fruit but from the high-fructose corn syrup (HFCS) or sucrose… [52]”

True.

Whole30

“…a twenty-ounce soda contains about thirty-six grams of fructose [53].”

True. There is a range of fructose that various sodas can contain and 36 grams is within that range [54-56].

Whole30

“…some studies do show that consuming HFCS leads to significantly more weight gain and higher triglycerides than consuming table sugar [59].”

They forgot to mention that this study was done in rats, not humans. Rats process carbohydrates in a different manner than we humans do so you cannot make a 1 to 1 comparison. When looking at trials performed on humans we see no difference in weight gain or changes in triglycerides [57,58]. Furthermore, in the meta-analyses looking at the effects of high fructose consumption on body weight and lipids (in an isoenergetic state) we saw no negative health outcomes [43,44,48,49].

And yes, many of these studies were available before the book was published. I guess they just missed them…

Whole30

“…even the U.S. Food and Drug Administration says that HFCS is not a “natural sugar [61].”

Not quite. As I have noted in previous blog posts the USDA regulates the term “natural” on any meat, poultry, or egg product. The FDA has jurisdiction over everything else. But the FDA has "not developed a definition for use of the term natural or its derivatives. However, the agency has not objected to the use of the term if the food does not contain added color, artificial flavors, or synthetic substances" [62].

So the source they cite is a blog post from the site FoodNavigator-USA.com that covers news about the food and beverage markets [63]. The blog post is entitled “HFCS is not ‘natural’, says FDA” that was published in April of 2008. The post notes the following: “However, in response to an inquiry from FoodNavigatorUSA.com, the regulatory agency examined the composition of HFCS, which it said is produced using synthetic fixing agents. "Consequently, we would object to the use of the term 'natural' on a product containing HFCS," the [FDA] agency's Geraldine June said in an email to FoodNavigatorUSA.com, “The use of synthetic fixing agents in the enzyme preparation, which is then used to produce HFCS, would not be consistent with our (…) policy regarding the use of the term 'natural' [63].”

Three months later in July of 2008 on the same website was an article by this title, “HFCS is natural, says FDA in a letter [64].” The article updates the previous April article by noting that “Geraldine June from the FDA’s product evaluation team, said the agency would “not object to the use of the term ‘natural’ on a product containing HFCS” provided synthetic fixing agents do not come in contact with it during manufacturing, or if the acids used to obtain the starch hydrolysate meet certain criteria [65].”

Further attempts to get the FDA to declare HFCS as natural or synthetic have been rebuffed by the agency [65].

Again, all this info was available before the book was published. I’m sensing a theme here.

Whole30

“…liquid calories aren’t as satiating as real food [60]”

Jump in your time machines kids because the cited paper for this claim was published in 1969! Now, research in this area has progressed a bit in the past 40+ years but the primary findings are very similar to those of this 1969 paper. This review sums it up nicely, “There is a strong literature comprised of epidemiological, appetitive, and controlled feeding trials indicating that, compared to solid food forms, energy-yielding beverages are more likely to lead to positive energy balance and weight gain [66].”

Closing thought - I gotta say, on the whole, the blatant lack of fact checking that is pervasive throughout this book is utterly baffling.

The Scienciness Scale

Of the claims made in this chapter, here is how they stack up on the Scienciness Scale.

Scienciness Categories

True (4 Points) – true statements
Mostly True (3 Points) – where the bulk of the claim is factually accurate
Misleading (2 Points) – where statements are presented out of context
Mostly False (1 Point) – where the bulk of the claim is factually inaccurate
False (0 Points) – false statements

Results

21 Statements Evaluated
49 Out of 84 Possible Points Earned
58.33% Overall Factual Accuracy

Statement Categorization

True

“…a diet rich in vegetables can actually help you battle our old arch nemesis, systemic inflammation, and reduce your risk for lifestyle-related disorders—stroke [1], coronary heart disease [2], and certain types of cancer [3].”

“…vegetables provide the richest source of antioxidants, which prevent or reverse damage caused by excess free radicals. Compounds from meat also add antioxidants to our arsenal and supply building blocks for our body’s own antioxidant production. See? Meat does more than just provide protein! [5]”

“Free radicals are also normal metabolic byproducts: They’re produced…during strenuous exercise. [10]”

“Vegetables and fruits have the highest natural concentration of antioxidants—things we bet you’ve heard of, like vitamin C, vitamin E, and beta-carotene—so it makes sense that a diet rich in these noble martyrs would help us fight free radicals and reduce systemic inflammation. [14]”

“…diets rich in fruit and compounds found in fruit (like vitamin C) have been associated with a reduced risk of systemic inflammation and related conditions and diseases. [15]”

“Certified organic vegetables and fruits…do not contain genetically modified organisms (GMOs), and are not processed using irradiation”

“Most fructose in the American diet doesn’t come from fresh fruit but from the high-fructose corn syrup (HFCS) or sucrose… [52]”

“…a twenty-ounce soda contains about thirty-six grams of fructose [53].”

“…liquid calories aren’t as satiating as real food [60]”

Mostly True

“The effects of a diet too high in fructose are decidedly not good… [37,38]”

Misleading

“We don’t know of a single micronutrient found in fruit that you can’t also find in vegetables. (Translation: Veggies are mandatory; fruit is optional)”

“Certified organic vegetables and fruits…are generally regarded as more…environmentally safe than their non-organic counterparts.”

“In fact, many studies show that diets high in fructose play a key role in metabolic syndrome [40].”

Mostly False

“While fruits are certainly nutrient-dense and yummy, they are not as nutritious as vegetables.”

“Fructose is different from other simple sugars in the way it’s processed in the body…fructose is sent straight to the liver, where it is metabolized and either stored as energy (liver glycogen) or converted into triglycerides (fat) and dumped into the bloodstream.”

“The effects of a diet too high in fructose…may include liver damage, inflammation, atherosclerosis, free-radical damage, and an increased risk of diabetes, high blood pressure, kidney disease, and obesity [39].”

“…even the U.S. Food and Drug Administration says that HFCS is not a “natural sugar [61].”

False

“Certified organic vegetables and fruits are produced without the use of synthetic pesticides, herbicides, and chemical fertilizers…”

“Certified organic vegetables and fruits…are not processed using industrial solvents, or artificial food additives.”

“Certified organic vegetables and fruits…are generally regarded as more nutrient-dense

“…some studies do show that consuming HFCS leads to significantly more weight gain and higher triglycerides than consuming table sugar [59].”

Nutrition As I Know It

Chapter 14: Vegetables and Fruit

WARNING. RANT AHEAD!

The Scienciness Scale

Statement Categorization

Sources