What is a Balanced Diet?

Posted on by Kaoru Kashima in Newsletter

Some of you have probably been advised by a doctor or nurse to take nutritional supplements such as Ensure or Boost when you are unable to eat as you would like due to illness or injury. Ensure and Boost are products manufactured by pharmaceutical companies (Ensure by Abbott, Boost by Nestle HealthScience) and are designed to provide a balanced intake of the necessary calories, protein, vitamins and minerals. Whilst it cannot be said that all studies demonstrating the efficacy of these products are biased, as many are funded by or involve the pharmaceutical companies that manufacture them, it is worth pausing to reflect before jumping to the conclusion that ‘everything is fine because the balance is right’. Behind the term ‘nutritional balance’, there may in fact be a perspective that is often overlooked.

In fact, recent nutritional research has increasingly shown that ‘even if the recommended intake levels for the same nutrients are met, the way in which they are consumed can significantly affect their impact on the body’. Here, we present some of the key studies in this field.

In February this year, a research team from Harvard University published a large-scale study in JACC, the journal of the American College of Cardiology, in which they followed approximately 200,000 Americans for up to 32 years. The study showed that even when following the same ‘low-carbohydrate’ or ‘low-fat’ diets, the risk of heart disease varies significantly depending on the quality of the foods chosen. A ‘low-quality’ low-carbohydrate, low-fat diet consisting of white rice, white bread and processed foods high in sugar was associated with an increased risk of coronary heart disease. Conversely, in the ‘high-quality’ version of the diet, which is centered on vegetables, fruit, whole grains (such as brown rice and whole wheat flour) and high-quality oils, the risk of coronary heart disease was significantly reduced. A reduction in triglycerides, an increase in ‘good’ (HDL) cholesterol and a reduction in systemic inflammation were also confirmed by detailed metabolite analysis (metabolomics analysis). In other words, simply meeting the targets of ‘X g of carbohydrates and X g of fat’ was not enough; it was ‘the types of food from which those amounts were obtained’ that had a significant impact on heart health.

Furthermore, large-scale trials conducted by the US National Cancer Institute and the Finnish government (the ATBC and CARET trials) sought to confirm the association identified in previous epidemiological studies, namely that ‘the higher the intake of beta-carotene from food sources such as vegetables, the lower the risk of lung cancer’. However, when smokers were given a supplement containing isolated β-carotene, the results were exactly the opposite. In the ATBC trial, the incidence of lung cancer rose by 18 percent and the overall mortality rate by 8 percent.  In the CARET trial, lung cancer rates rose by 28 percent and the overall mortality rate by 17 percent; both trials were halted early due to safety concerns. Nutrients that are supposed to be beneficial to the body when consumed as part of a diet can, in fact, be harmful when taken in isolation. This is one of the key lessons in nutrition. A similar phenomenon has also been reported with calcium. A meta-analysis published in the BMJ by a research team at the University of Auckland in New Zealand found that people who took calcium supplements (500 mg or more per day) had an approximately 30 percent higher risk of myocardial infarction than those who did not. Conversely, no association was found between calcium intake from diet and the risk of cardiovascular disease.

This trend was also evident in ‘multivitamin supplements’, which provide a combination of nutrients in tablet form. Large-scale, independent studies have shown that combinations of synthetic multivitamins and antioxidant supplements do not demonstrate any clear preventive effect on mortality or cardiovascular disease. (Please note these studies are done with over the counter supplements) On the contrary, there have even been reports of adverse effects. Meanwhile, the PREDIMED trial conducted in Spain confirmed a very significant benefit, with a 28–31 per cent reduction in major cardiovascular events among the group that followed the Mediterranean ‘dietary pattern’ itself, which is rich in olive oil and nuts. When viewed in this way, it becomes clear that the notion that ‘as long as the required nutrient levels are met, the effects are the same regardless of how they are consumed’ lacks scientific backing.

Of course, for some people—such as those with impaired swallowing function, those who are largely bedridden and unable to cook for themselves with no one nearby to prepare meals for them, or those whose immune systems have been significantly weakened by medical treatment and who need to take particular care regarding the hygiene of raw foods, products such as Ensure and Boost might be better options that support their daily lives. It is by no means the case that you ‘must absolutely stop’ even in such circumstances. However, if that is not the case, why not try prioritizing the consumption of fresh vegetables, fruit, and high-quality proteins and fats, preferably in their ‘whole food’ form, as a first step? If you find it difficult to chew, try experimenting with dishes that are easier to eat, such as smoothies packed with fresh ingredients or rice porridge made with plenty of vegetables, meat and fish. That alone might just change the way you approach your health. Nutrition cannot be measured by numbers alone. The various studies presented here quietly yet powerfully illustrate this point.

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Published by Kaoru Kashima

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