TheEuropeanScientist: In your book Coup de pied dans le plat (“Putting the boot into nutrition”), you define what a healthy diet consists of. Can you tell us more?
Professor Philippe Legrand: It is essential to have a good understanding of what a healthy diet is. A simplistic answer could be: “Avoiding illness, obesity etc…. “. But before you become obsessed with disease, you have to eat just to be able to grow up, live and grow old in good health. Food provides nutrients first, not medicine.
- First of all, it is essential to ensure the dietary diversity required by humans, who are after all omnivores, and no foods should be excluded, except of course where it is a matter of allergies.
- Then you need to take care that the amount of energy (portion) is appropriate and not excessive… which means taking the individual’s needs into account but also the nature of the food.
- Finally, there is one aspect that is often overlooked: the pleasure of eating and social interaction. This factor is an integral part of our diet and is, unfortunately, too often forgotten by experts, yet it is an essential part of health.
TES: You attach a great deal of importance to individual responsibility and education in the composition of a menu.
Prof. PL: It just makes sense. Because once we have defined what a healthy diet is, we can develop our first rule: there are no bad foods, even if they are all (even the most natural) unbalanced to a greater or less extent. For example, oils are 100% fat; fish or chicken muscle is almost entirely protein; pasta is almost 100% glucose in the form of starch, etc. It is up to the consumer to create a balanced menu by selecting appropriate amounts from all these more or less unbalanced foods, using common sense and some dietary knowledge.
So it is the consumer who is ultimately responsible, and who needs to be educated. Of course, an organism can adapt and regulate to a certain extent, but not when it comes to the total amount of energy ingested, which is not simply expelled if it is more than is required for energy expenditure. That leads to enormous responsibility and power for the consumer, but when you think about it, that is a good thing: he or she can take charge and/or get help from professionals (dieticians) rather than blaming “glands, hormones, genes and the food industry”, letting himself off the hook and abdicating responsibility all too often when faced with the “extra kilos”. Aside from where it is a matter of illness, in nutrition and primary prevention, the first requirement is education about quantity and then putting emphasis on the power of individual responsibility, empowerment, and common sense.
This is why food education is crucial. It is essential to know how to build a menu that is quantitatively and qualitatively balanced, based on a diverse range of foods (from the most natural to the most highly processed, including the most practical…) over several days or around a week. Anything can go on the menu, but with sensible portions and common-sense quantities appropriate to our needs, based on our lifestyles. A good grounding in food education guarantees that you will be competent enough to build your own menu. Rather than wringing our hands about food, let’s educate, with the central premise of avoiding the two main pitfalls: over-consumption of energy and lack of essential nutrients as a result of exclusions which are not necessary as we are naturally omnivorous.
TES: What do you think of labelling systems in general and Nutriscore in particular?
Prof PL: While food education is necessary, labels are not the most efficient part of the process. Of course, all labelling is a positive step towards access to information. But not all labelling systems are equally valuable. You mention Nutriscore, and I’m sorry to say that it doesn’t do much to improve individual consumers’ food education.
In fact, it does not provide information on the composition of the food but gives an overall verdict on the food. It is no more and no less than an opinion or a judgment. As a source of scientific information, it falls short. In addition, the opinion in question may be biased or ill-judged because it is based on an algorithm that is not visible to the consumer. Most importantly, the bases and tenets of this algorithm are debatable and, indeed, much debated. As a French lipid specialist, having presided over the development of the ANC fat levels (the English equivalent is the RDA or Recommended Dietary Allowances) from ANSES (the French food, environment and occupational safety department) over many years of my working life, I can confirm that the fat section of the Nutriscore algorithm is wrong (because it is out of date) and in total contradiction with the ANC from ANSES.
I’ll go into a little more detail. In lipid nutrition, the recommended intake (RDA) indicates a percentage of fat between 35 and 40% of the energy intake in the diet, and consumption in France is 37%, which is perfect. So why do we see this violent anti-fat bias in the Nutriscore algorithm? It is outdated and has no basis, even though at the individual level, many people consume too much carbohydrate and lipid energy in relation to their energy expenditure. In fact, the problems of obesity and excess weight primarily relate to the quantity consumed by the individual, not the percentage of fat in the food.
The fat element is also wrong for other reasons: combatting saturated fatty acids (SFAs) is totally outdated, as all recent meta-analyses show, and because of the lack of distinction (in the Nutriscore algorithms) between the different “saturates”, which nevertheless have important functions and very varied effects. Finally, no account is taken of the fact that the saturated fatty acids in our bodies come largely from excess sugar and alcohol intake. It’s hard to get away from fifty years of fundamental anti-fat hatred! Fundamental, because yes, our fat stomachs and other bulgy bits are indeed made up of lipids, but of mixed origin: carbohydrates, alcohol and fats, the result of a total excess of calorific intake but not specifically fats. It’s now well known… except for in the Nutriscore!
For example: in the Nutriscore, all oils are classified between C and E and most of them between D and E. Why do they incur this punishment when they should range from A to E, according to their levels of essential fatty acids, omega-6, omega-3, and saturated fatty acids? Their original sin is unforgivable, “they’re fat”. It’s still a bit of a shock to learn that even diet sodas were ranked higher than fruit juices and olive oil by the Nutriscore.
So, this goes to show that the designers of the Nutriscore algorithm literally sat on the ANSES reports for lipids. This highlights the fact that on the matter of lipids, the Nutriscore mainly reflects a dogmatic opinion, a sweeping judgement of food and not really an educational tool.
Another critical point: the Nutriscore, in its understandable desire to drive progress in the food industry, should have been limited to processed and manufactured foods, without including basic natural foods (oil, dairy products, bread, sugar, fish…). This would have enhanced its credibility and reduced the counterproductive effects cited below.
One last point: using the Nutriscore penalises foods which may be widely consumed in moderation without adverse effects (e.g. chocolate, rated E). This kind of penalty can have the harmful consequence of enabling orthorexic and restrictive approaches in vulnerable consumers. However, do people who eat loads of chocolate need Nutriscore to know when they are going too far?
TES: on a philosophical level, you are also critical of this system.
Prof PL: I totally share the impression of the Nutriscore that “intention justifies action in the absence of demonstration” (JP Laplace). Indeed, there has never been any demonstration of the health benefits of this system, because all that has been demonstrated is that it has changed the composition of the shopping basket. Fine, but what has the trend been, for which consumers and with what effects on health? An improvement of objective health criteria or a deterioration tending to imbalance for certain groups? Orthorexic behaviour? To be continued
And then, Nutriscore encourages a kind of prohibition that creates fears and exacerbates certain behaviours (such as the orthorexia we were talking about earlier).
Moreover, the simplistic use of a few coloured letters will not encourage nutritional education for consumers. A fellow researcher even said of Nutriscore, albeit with a touch of humour: “It’s not far off training laboratory rats”
All of this refocuses us too exclusively and negatively on the evils of nutrition and posits the fundamental question: “Who should we blame for our troubles, who is guilty: the eater or the food?” From my point of view, it is obvious that the guilt is shared, but the eater remains the foremost “responsible-but-not-guilty”, being the one filling the plate and bringing the fork to his or her mouth. With the Nutriscore it’s quite the opposite: we condemn food a priori rather than trying to educate the eater, although the eater has plenty of common sense and can be trusted once he or she has had a minimum of food education. Blaming food too much is at best useless, at worst counterproductive … but it is so popular and ideological … because it allows us while we are at it to blame our cells, our hormones, our genes and therefore our parents, and the bad guys in the food industry, etc… With regard to the food industry if we want to offer constructive criticism, it would be better to set up a debate/campaign about portion sizes, in order to encourage manufacturers to offer smaller portions, because when we have purchased something it is difficult not to consume it, even if it’s just because we don’t want it to go to waste…
I would like to formulate a final question/criticism from an economic point of view: it has been shown that “red” scored products will probably be consumed less, so their prices will go down, so will it end up with only the poorest consumers purchasing them?
TES: You are talking about an ideological confrontation over the effectiveness of Nutriscore at government level.
Prof PL: Absolutely! In 2017 ANSES published a paper that highlighted an “insufficient level of evidence to demonstrate the relevance of these labels to public health issues”. However, the Nutriscore creators did not take this consideration into account and the Haut Comité de Santé Publique (HCSP) (High-Level Committee on Public Health), although unable to justify its choice, implemented Nutriscore. Yes, there certainly is an ideological and methodological conflict: ANSES publishes on and outlines the latest science on the basis of long, rigorous and effective collective expertise, while Nutriscore is imposing itself by dint of invasive “citizen” petitions and dogmatic and debatable opinions.
TES: In your opinion, what would have been the right solution in terms of labelling?
Prof PL: There were other, more educational solutions that focused on portions and quantities and made the consumer more responsible with information on the weight and/or calorific quantity (in portions) of the 5 major nutritional groups: carbohydrates, fats, proteins, vitamins, minerals. This how, for example, the Nutri-colour system, or SAIN, work. The relative contribution of the portion to the daily requirement could also be added. A lot of scientists and nutritionists thought that these systems would be more useful and educational, although they are well aware that education is the most important thing, starts from childhood, and is the responsibility of parents, teachers, trainers, and health professionals, but that is another story….