Crossing the Food Desert

It is possible to find good food in North America but it’s expensive, thin on the ground and crusted around the edge of the continent. You won’t find it on the interstates, where fast food chains reign. Here food is assembled rather than cooked, portion control is king and what flavor there is comes in single-serve sachets. When you travel across the USA, you are crossing a food desert.

The food deserts, areas where access to affordable, healthy food is restricted or nonexistent, are growing. Desertification is spreading in the heartland, and in expanding areas of poverty in the inner cities where residents cannot buy fresh fruits and vegetables because there are no grocery stores within convenient traveling distance (1, 2).

Some call the off-ramps ‘food swamps’, defined as areas where the only available foods are nutrient-poor and typically fast foods. Deserts and swamps are not identical but they overlap in terms of nutritional degradation, and are grouped together here for convenience.

They provide a wildly impoverished diet. In the Turkish village I currently inhabit, today’s breakfast and dinner included 32 vegetables, grains, seeds, nuts and fruits that I recognized and 7 herbs and sea plants I could not identify. In a typical US fast food menu I counted only 6; potatoes, GMO wheat and corn, with tomatoes, lettuce and onion on the side (3). Hold the pickle.

The deserts and swamps contribute to the USA’s appalling life expectancy data (4). Among the poorest Americans, men die 15 years and women 10 years earlier than the richest, and the gap is widening. During the 13-year period covered by this study, the differences in life expectancy increased by 3 years.

The next generation suffers too; food desert dwellers are more likely to have premature babies (5), who are more likely to suffer lower health and life expectancy (6), and reduced intelligence (7).

A subsequent Danish study (8) which showed a considerably smaller difference in life expectancy between rich and poor due to social mobility, is irrelevant; Denmark and the USA are entirely different cultures. Social mobility is being crushed in the USA and its western satrapies (9, 10), while Denmark has remained relatively unaffected. So far.

To make matters worse American poverty is rising at unprecedented rates, with child poverty rates doubling from 5.2% to 12.4% in the 12 months between 2021 and 2022 (11). 18% of children now live with food insecurity (12), a tragic situation closely linked to later life obesity (13) with all its attendant health problems.

Officials who claim that food inflation is under control are lying through their grillz, but it’s not just an economic issue. Interlocking financial and cultural factors affect supply, affordability and demand (14). Children weaned on fast and convenient foods are often reluctant to change their eating habits, even when more nutritious foods are available (15, but see also 16). This is more than a matter of preference; ultra-processed foods are designed to be addictive (17), and roughly 14% of adults and 12% of children appear to be dependent on them (18).

There is a new acronym in town: UPFA. It stands for Ultra-Processed Food Addiction, and there is evidence that it may respond to drugs which modify the neurology of addiction, including naltrexone, bupropion and the GLP-1 agonists (19, 20). The 64 thousand dollar question: will UPFA make the next version of DSM-5, or ICD-11, and become official?

The above factors ensure that the socioeconomic cancer of the food deserts and clinical cancer, along with malnutrition, obesity, the degenerative diseases in general – and therefore earlier death – remain demographically intertwined (21-27).

You see the inverse of this in groups that side-stepped the ultra-processed juggernaut. Among Amish who hold to the old ways, the incidence of cancer drops to around half of their 21^st century neighbors’ (28) – as do rates of diabetes, hypertension and obesity (28, 29). Their health and life expectancies are correspondingly higher (30, 231).

The authors of the last paper (31) seem puzzled that their subjects live longer despite lower hospital use rates. I’m pretty sure that staying out of the hospital contributes to their sustained good health! (32)

Although the ‘backward’ Amish show us the way forward, too many of English, as they call us, are addicted to bad food. So let them all eat cake, with a side of Ozempic (33). Big Pharma, of course, approves this statement, and in the United States (and captured New Zealand) broadcasts it daily and directly to the masses.

Among those academics who have slipped the traces of pharmaceutical indoctrination, however, a light is dawning. There is a growing realization that while drugs cannot keep the population healthy, a better diet will. Hence the proliferation of ‘food as medicine’ trials, with the variable results (34, 35) one would expect due to the very many confounders inherent in such studies.

For example, everyone starts from a different nutritional baseline. The UK-centered database FoodDB has identified 128,283 distinct food and drink products available in the major British supermarkets (36), containing up to 70, 926 different compounds with varying nutritional and calorific values, and epigenetic and metabolomic impacts (37).

Even within a group who all eat the same food, differences in genetic profiles, physical activity, emotional health, absorption from the gut and even the speed of eating contribute to subtle but potentially important microbiotal and metabolomic differences. We routinely see 6:3 ratios ranging from 6 to 20 or higher in the same family, eating a very similar diet, with omega-3 indexes showing a similar spread (38).

Then there are the growing numbers of children (and adults) with eating disorders (39, 40), who have additional and often very specific nutritional and therefore metabolic problems. Emerging evidence that some of the eating disorders may have a neuroinflammatory and dysbiotic origin (41, 42) indicates a vicious circularity in which diet affects behaviour which affects diet …

When all your human guinea pigs have different baseline nutritional and metabolic values, the results of intervention studies with food are always going to be noisy.

To make matters worse, can we really define a healthy dietary intervention? Over the last few decades opinions have shifted on fats and oils (saturated fats formerly bad, now not so much, omega-6 plant oils yielding to omega-3’s but this shift compromised by poorly formulated products), cholesterol (becoming irrelevant and being replaced by sugar), sodium (‘bad’, but perhaps good for some), alcohol (a lot vs a little vs none), meat (healthy vs unhealthy, and this profoundly affected by processing and cooking methods) …

Do we really need another vastly over-complicated – and inappropriate, in my view – Food Compass (43, 44)? Do we need another vastly expensive intervention study, another trawl through the biobanks?  When vestigials, mid-Victorians and Blue Zoners all show that a diet which prevents chronic inflammation, promotes eubiosis and innate immunity, and provides high nutrient and low calorie density, will reduce the burden of chronic degenerative disease by up to 90% (45-47)?

Full disclosure: recent research suggests that a significant amount of Blue Zone data is likely inaccurate (48). Furthermore, many of the zones are being obliterated by changing diets and lifestyles (ie 49). In the former Blue Zone of Okinawa, for example, the overweight USA military presence has polluted local culture with drugs, prostitution, crime, junk foods and military industrial toxins (50-52, all of which have contributed to rapidly declining public health).

It really isn’t that complicated. We can improve our abyssmal public health by reverting to traditional foods, or by developing a new generation of ultra-processed products which promote health by recapitulating the lower calorific density and higher nutrient density of traditional foods (53). In the meantime, there is the Health Protocol biohack.

Legislation bringing the food companies to heel would transform the health landscape, and put most doctors and life scientists (including me) out of work. And that would be a very good thing. It is unlikely to happen in the West, where corporate interests rule, so we must rely on nutritional allopatry. The Global South seems more likely to introduce us to a healthier future unless RFK Jr, against all odds, is able to defeat the Goliath of Big Food.

Next week: Mainly in vein.

References

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