The Evolution of Nutrition Frameworks in Recent Years
Dr. David Wiss
February 21, 2021
There are many conceptual frameworks by which people understand the ever-evolving field of nutrition. In this article, we cover the major nutrition models in use today, highlighting some of the recent developments. Before diving in, there are two important considerations: first, nutrition research is difficult to conduct. One reason is that the impact of nutrition on humans as a species is generally quite slow, therefore it is difficult to control for other lifestyle factors (e.g., exercise, sleep, etc.) in food studies that often span over years. Thus, nutritional epidemiology has a reputation for producing conflicting findings, breeding much skepticism among scientists (and the general public).
Second, there are a wide range of different nutritional approaches that can prove to be successful for people. Since all people eat food, most people have developed some form of an opinion about it. Not surprisingly, there are many conflicting views on dietary matters. In fact, people (including professionals) seem to form “tribes” based on their nutritional identity. We call this “nutritional tribalism,” which helps to understand why groups of people may favor one conceptual framework over another. Thus, individual nutritional psychology informs our food choices more than most people are aware of. We recommend learning more about someone’s framework before accepting nutritional advice.
The Calorie Model
The most established framework for approaching nutrition is the calorie model. Calories represent units of energy. More specifically, a kilocalorie (which we refer to as a calorie) is the amount of heat needed to raise the temperature in one kilogram of water by one degree Celsius. The First Law of Thermodynamics states that energy cannot be created or destroyed. Thus, the concept of “energy balance” through calorie mathematics has robust scientific support. Early research mapped out the calorie content of foods and such databases are updated regularly with new foods and used to estimate calorie counts for consumers interested in this information. Large chain restaurants are even required by law to provide calorie counts for items on their menus. Because many people use nutrition frameworks in the context of weight management, and calories are perhaps the simplest method for determining predictions of homeostasis, calories remain at the forefront. Meanwhile, there is much more to nutrition than weight management!
At Wise Mind Nutrition, we believe the calorie model is incomplete and therefore misleading because people often assume that all calories are created equal, which is certainly untrue for mental health purposes. One example is food additives, which the calorie model entirely ignores.
The Macronutrient Model
The second framework is the macronutrient model. This framework goes beyond the overall calorie count and focuses on the distribution of carbohydrates, protein, and fat. This is more detailed than the calorie model because it allows for manipulation of macronutrient distribution within the same level of calories. The most well-known manipulation of macronutrient intake is “low-carb” dieting, which is also generally used in the context of weight management. These approaches are common among fitness circles focused on altering body composition. Many fitness apps track both calories and macronutrients (“macros”). A major shortcoming of this model is the assumption that foods within each macronutrient category are equal. This model does have application for physical as well as mental health, but more specifics are needed for individuals interested in using nutrition to improve mental health. This model might overlook one’s fiber intake.
The Micronutrient Model
The third framework is the micronutrient model. This takes nutrition one step further and examines the presence of vitamins and minerals in food, which do not provide calories, but are involved/required in a wide range of physiological processes. Many of the fitness apps that track calories and macros also provide estimations of micronutrients to ensure that diets are balanced with respect to non-caloric nutrition. A shortcoming of this model is the shift toward an emphasis on dietary supplements rather than food. In other words, this framework creates the assumption that if people consume all their vitamins and minerals in supplement form, they can make food choices based on calories, macronutrients, or simply preference. However, with respect to mental health, micronutrients in dietary supplements do not compare to those found in food. The main difference is that plant foods also have fiber and other polyphenolic compounds that create a synergistic nutritional effect (“food synergy”), far above and beyond what occurs when these nutrients are consumed in isolation.
The Food Group Model
The fourth framework is the “food group” model. This model has a well-known history with the United States Department of Agriculture’s Food Pyramid and, more recently, MyPlate. The main benefit of this system is its simplicity. It provides an alternative to computational, overly scientific approaches which are less accessible to the average person. With some basic nutrition education, most people can implement a food group approach toward balanced eating. A recommendation of this model is to make 50% of the plate fruits and/or vegetables, or to eat from each food group twice per day. The assumption in this system is that each food in a group has nutritional similarities with other foods in their category. One problem with this approach is that people can use it to look for what food groups to cut out (e.g., grains, dairy, animal protein), rather than focusing on ways to include or introduce a food group. Of course, some people may benefit from excluding certain food groups for various reasons, but the majority of people do best by eating from all food groups on a daily basis. In the US, most people don’t eat enough fruits and vegetables.
The Anti-Inflammatory Model
The fifth framework is the anti-inflammatory eating model, which takes into account the immune system. This conceptual framework is not new but continues to gain popularity as science demonstrates links between inflammation and health, including mental health. Population data has been used to develop the Dietary Inflammatory Index, which can be useful in getting a general idea about eating to reduce inflammation. However, population-level data cannot be applied to all individuals. It is important to acknowledge that individuals may be highly reactive to foods (e.g., in the case of a particular food sensitivity) that are considered anti-inflammatory at the population level. Functional lab testing is the only way to determine which foods may produce or reduce inflammation in an individual. Sidenote: of all diets investigated for their health benefits, the Mediterranean Diet reigns supreme in terms of reducing inflammation, and is therefore the most evidence-based approach to anti-inflammatory eating.
The Gut Health Model
The sixth framework is the gut health model, which is related to the anti-inflammatory eating approach. While this model is not new, recent advances in the study of the microbiome (the collective genome of microorganisms living inside of us) have brought this model to the forefront. This approach focuses on the presence of microorganisms through the gastrointestinal tract. There are now ways to extract microbial genetic material from human stool and get a snapshot of what is going on inside the intestines. One popular intervention for improving gut health is with probiotics, but more recently research is showing that prebiotics are extremely important. Prebiotics are dietary fibers that are the preferred fuel for gut microbes. It is very important to eat fiber for gut health. Recently the term “postbiotics” has entered the scene, which describes the byproducts of microbial degradation of prebiotics, as well as amino acids that come from protein. A strength of this framework is that goes way beyond calories, however the science here is very new and there is a lack of consensus on how to best improve gut health. For example, some practitioners focus on elimination of foods, and others favor strategic reintroduction. Elimination diets are not without controversy, as they have been associated with disordered eating.
The Personalized Nutrition Model
The seventh framework is what we refer to as personalized nutrition, also known as precision nutrition (stemming from the broader field of precision medicine). The terms “functional nutrition” and “functional medicine” are essentially implying the same thing. This approach can draw from all the previous models but has a much more individualized approach. Instead of relying on population-level data to guide treatment, personalized nutrition models focus on collecting specific individual-level data through testing. For example, an individual’s HgA1C (the marker of long-term blood glucose) may be used to inform macronutrient distribution. A food sensitivity test may inform foods to emphasize more in the diet. Micronutrient testing in conjunction with genetic analysis may be used to inform supplement protocols. One shortcoming with this approach is that most testing is not covered by insurance and can be prohibitively expensive. Therefore, disadvantaged groups typically do not benefit from these emerging technologies, which can thereby increase health disparities.
The Nutrition for Mental Health Model
The eighth and final framework is the Nutrition for Mental Health model. The burgeoning field of nutritional psychiatry has gained much attention in the medical arena. There is also growing interest in nutritional psychology, which focuses on how individuals think about food, which is often connected to a person’s experience in their body. This model challenges the calorie model. For example, a calorie model might assume that lower calories imply a better choice. Using a regular soda versus diet soda example, the Nutrition for Mental Health model may suggest that the diet soda is a worse choice, in the case of known gut issues or possible neurotoxicity in an individual. This model considers biopsychosocial mechanisms drawing from the anti-inflammatory model, the gut health model, the personalized nutrition model, and more. Furthermore, the Nutrition for Mental Health model goes beyond even the biological mechanisms by considering the sociocultural factors related to food choices.
At Wise Mind Nutrition, we are helping shape the future of Nutrition for Mental Health by bringing together knowledge from multiple disciplines to bridge the gap between physical and mental health. We have witnessed transformational experiences directly connected to an increased nutritional awareness and it is our mission to bring this heightened consciousness to all who seek it. Join us!