Five More Steps Needed To Make Real Progress
By Jim Prevor, Editor-in-Chief, Produce Business
The produce industry, with its Fruits & Veggies – More Matters campaign and the, now superseded, 5 A Day program, has relied heavily on a general message of a pathway to healthiness by boosting produce consumption. This is an effort that has not succeeded.
There is, however, the hope that if we could identify more specific health benefits to be derived from consuming specific items, higher consumption might be achieved. It is not 100 percent clear if that theory is true. Research identifying benefits in the consumption of pomegranates and pomegranate juice — when backed by skilled marketers — certainly moved the needle on pomegranate-related consumption. It is not clear that this led to overall increases in produce consumption.
This is hopeful research, and if eating pistachios can help prevent the progression of prediabetes to full-blown diabetes, this would bode well as a major advance in public health.
Alas, as is always the case, this type of research is — to paraphrase Churchill — not the end; it is not even the beginning of the end; it is not even the end of the beginning. Before we can really begin to attribute such powers to pistachios or to any other food, at least five steps must be completed:
1) The research has to be repeated multiple times, by different researchers, at different institutions, and with larger groups. This study included only 54 prediabetic adults — 29 men and 25 women. That is a start — but just a start.
2) The research has to be extended to actually note disease outcomes. They did not study people long enough to determine if, in fact, people who sustain the diet enhanced with pistachios actually are less likely to develop full-on diabetes.
3) Research needs to be conducted with various alternative diets. In this case, they had two choices: The control diet or the diet in which pistachios were added and other things reduced. As author Mary Jo Feeney explains: “In the CD, 55 percent of the calories came from carbohydrates and 30 percent from fat. In the PD, 50 percent of the consumed calories came from carbohydrates and 35 percent from fat.”
Even if the pistachio diet is better, this research doesn’t establish that it is pistachios, uniquely, that make it better. Perhaps it is the shift from carbohydrates that makes it better. After all, avoiding carbohydrates is a standard recommendation given to pre-diabetics. Maybe almonds would have the same effect?
A study based on a series of different diets of similar composition would be necessary before we can attribute unique health-inducing properties to a particular food.
4) Real world applicability also needs to be tested. This analyst confesses both to loving pistachios and to never once eating only 2 ounces of them at a sitting. Do typical prediabetic consumers, not operating under short-term research constraints, actually constrain their pistachio consumption to 2 ounces? If not, what is the dietary impact of consuming the typical amount consumed? Are the beneficial effects of the product outweighed by increased obesity due to increased calorie consumption? Or is the pistachio such a source of healthfulness that the more one consumes, the better off we are. Or are pistachios so inducing of satiety that people self-correct and consume fewer calories of other sources when they consume more pistachios?
5) Finally, of course, we need to study more people at different stages of healthfulness. For example, does this approach actually help people who have diabetes? Does it help people to not progress to a prediabetes state?
Of course, none of this is indicative of any flaw in the research. It is just an acknowledgment that as Laotzi, the founder of Taoism, taught us: “A journey of a thousand miles begins with a single step.”
And for the produce industry, it is a reminder of how high the barrier is if we wish to use science to persuade consumers of particular benefits of particular produce items. It means sustained investment in research. This particular study was done in Spain and partially supported by the American Pistachio Growers. They deserve commendation for undertaking the effort.
Because the industry has limited resources, we need to advance research to the point where the National Institutes of Health and major health insurance companies see enough potential to invest in larger studies at Johns Hopkins and Harvard.
Even then, even if we can show convincingly that pistachios or other items have important health benefits, the challenge will still be to find a path to not merely create a one-item boom — as with kale — but to choose information to change diet patterns in such a way that overall consumption of produce begins to rise.