NYTimes
March 29, 2007
It’s Not You, It’s Your Apartment
By JOYCE WADLER
DATING is fraught with disappointments, so you can imagine how delighted a single woman might be to find someone like Albert Podell — particularly after she Googles him and learns how rich he is. Last year, Mr. Podell, a 70-year-old lawyer, gave N.Y.U. Law School $2.9 million. He goes out four nights a week, to the opera, symphony or theater. He is well read. He says he has traveled to 162 countries.
Then comes that magic evening when the woman is ready to go back to his place.
“It’s totally unchanged, like it was when I went to law school in 1973, a time warp,” Mr. Podell says of his small one-bedroom in SoHo, a description that seems plausible, given the hot pink living room with the futon seating and the fraying contact paper on the kitchen cabinets.
The place is also dimly lighted, which, once you examine the kitchen nook in daylight, is probably not such a bad thing. The cabinets hold nothing but a six-month supply of powdered milk for Mr. Podell’s cereal, so that he can keep his trips to the supermarket to a minimum; the Formica countertop is peeling; the stove has been disconnected from the gas feed. (Mr. Podell, who usually eats out, sees no reason to waste fuel.)
All these things have proved detriments to love, but none so effectively as his sheets. Mr. Podell likes the ones from the ’60s and ’70s that tell a story: sheets with intergalactic battles or pink hippopotami or the Beatles. Since these are no longer available in adult-bed sizes, Mr. Podell’s sheets are now 30 to 40 years old. The fading is such that a person who saw one in a Salvation Army bin, having lost everything she owned in a fire, would remind herself that there was no reason to be desperate. The fading, however, was apparently not the reason that the sheets became a deal breaker.
“I was dating this very nice woman, I thought,” says Mr. Podell. “I was ready and she was ready to do the big deed. I take her to my apartment, go into the bedroom, and fling back the sheets, and she said, ‘My husband had these sheets and he was a mean-hearted son of a bitch and you must be like him and I’m leaving.’ ”
Spring is here and the restaurants will soon be filled with anxious and hopeful couples, ordering wine, dusting off their most luminous lies, thinking they might finally have found love. Then they will see their dates’ homes for the first time. And suddenly some of them will realize that they cannot be with this person a moment longer — or at the very latest, because that wine was not cheap, beyond the next morning. A few whose homes have been romantic deal breakers may, like Mr. Podell, know what went wrong and choose to ignore it, seeing their apartments as a reflection of their brave refusal to bow to conventional taste.
“There have been at least 40 women who’ve said, why do you live here?” he says.
Make that 41. Why does he live here?
“Ever hear the words ‘rent stabilized’?” says Mr. Podell, who’s paying $702 for a one bedroom in SoHo. “What do I need a fancy place for? A lot of people want to show off their wealth. It ain’t me, baby.”
Then there is Bob Strauss, 46, who writes dating advice for match.com and has a real stuffed baby seal in his apartment. He didn’t whack the seal on its silky little head, it’s a family piece inherited from a rich aunt and uncle in Miami.
It is displayed along with Mr. Strauss’s South Park and Sonic the Hedgehog figurines and Lego collection.
“It’s provocative,” he adds. “I like going out with tough, smart, aggressive, challenging type people. It’s fine with me if they want to argue about it; I don’t want to blandify my apartment to make myself generically acceptable.”
Most people, however, will never know how their homes sabotaged their romance. They operate under the assumption that if the garbage has been discarded and the dog hair removed, the house is romance-ready. They are unaware that such seemingly insignificant details as a Klimt poster or harsh overhead lighting are proof to some that they are not dateworthy. For these poor innocents, a guide.
No Stuffed Animals, Even If You Are Dying
Alison Forbes, a founder of The Art of Everyday Living consulting service in Los Angeles, is often called upon to help make homes relationship-ready. It was her sorry duty to inform us that the stuffed animal pandemic continues. She believes it may show a reluctance to grow up — or, in cases where the stuffed animals cover the bed, a reluctance to make space for another person.
Jason Bunin, the 36-year-old bad-boy chef at the Knickerbocker Bar and Grill in Greenwich Village, echoed her disapproval.
“You see it more in younger girls, like between 21 and 25,” Mr. Bunin says. “Pink, purple, teddy bears, unicorns, all over the bed. I’d just whack ’em off with my arm.”
Why do men dislike stuffed animals?
“Too cutesy and immature.” Also, Mr. Bunin says, if you were to get involved with someone like that, you’d have that garbage in your house.
Mr. Bunin, by the way, is on the dating scene no more. He married Caron Newman earlier this month in an Elvis-themed wedding in Las Vegas. You can check out the video at cupidswedding.com. Mr. Bunin is the one in the black sequined tuxedo.
There Is a Reason Nice Buildings Are Not Named for Norman Bates
Sure, you can save money by moving into your mother’s house, but as always in matters of romance, you must first ask yourself: Would James Bond do it?
If you are still thinking about the answer, consider the experience of Adria Armbrister, a 30-year-old program coordinator at Columbia University’s School of Public Health. Ms. Armbrister met a man online through Yahoo and after a month and a half of e-mailing they had dinner. It went well: The man, who was 29, owned a business, he did not ask Ms. Armbrister to pay for her own meal or try to borrow money. On the second date, they stopped by his house to pick up an umbrella. The house had belonged to his mother, who had died five years earlier. The plastic-covered gold sofas and the heavy gold tasseled lamps suggested to Ms. Armbrister that her date had not redecorated — never a sign of an enterprising personality. But the deal breaker came when she saw his room.
“We walked up three flights of stars to the attic,” she says. “It looked like a teenager’s room. The computer was up there and the twin bed, his clothes were all over the floor. I was like, uuuuuh-huuuuh. He didn’t even seem sorry that he lived in a 12-year-old boy’s room, this was like normal behavior. It said to me, this person is not grown up yet. It was frightening. He’s lived his whole life in the attic.”
What did her date do for a living?
“He was in the real estate business.”
The Word “Ex” May Be Substituted for the Word “Mother”
It is also a detriment to romance when one’s date shares a roof with a former spouse.
“I met him at a function,” says a woman who is a lawyer in Manhattan and has been divorced for several years. She would speak only on condition of anonymity. “It was like” — and here she sings — “across a crowded room. He was very upfront about his living arrangement. He said he and his wife had one of those huge Upper West Side apartments with four bedrooms. She lived in one, another couple lived in another one, whoever was in need of a home is in the third one. Every morning, they go to the kitchen and have coffee together. I couldn’t picture myself in that scenario. It was like Frasier and Niles with that father and Daphne. He was very cute, but then I realized he was totally unsuccessful.”
Although the Stasi Were Said to Love It
“I can’t sit in a room with overhead lighting,” says Michele Slung, a freelance book editor in Woodstock, N.Y. “It makes me feel like I’m in a police interrogation room. I believe in lamps that are casting warm glows, and anyone that doesn’t understand that, I can’t be in their house, men or women. It’s a matter of warmth; it makes people happy.”
Ms. Slung insists on pink light bulbs, her preferred shade being Dawn Pink. She also uses amber lampshades.
“I don’t think I could ever like somebody who got their lighting wrong,” she says. “What this probably means is that I’m not in the market for a guy. If I ever found a guy with a beautifully lit house I would propose — although probably his wife would have done the lighting.”
In the Afterglow of Love, Nobody Ever Reaches for a Hammer
Michael Longacre is a New York graphic designer. He believes that design people are aesthetically demanding, but in the case of one brief affair, the problem was a more basic sort. “This was a great looking guy, who worked on Wall Street,” Mr. Longacre says. “He wore like $2,000 suits, but his great pride was really, really expensive shoes. He told me he had 50 or 60 pairs of these Italian shoes that are $750 a pair. I go to his apartment, there was no framing on the doors, there were like test colors on the walls. He’d started work on it several years earlier. I said, ‘You’ve spent $30,000 on shoes, but you’re gonna renovate your own apartment when you get around to it?’ He also showed me his waterless bong. Having high-tech marijuana equipment is another deal breaker for me.”
We Aren’t Kidding About the Klimt
Adam Handler, who is 35, lives in Atlanta where he does grass-roots organizing for CARE. He is now married. But five or six years ago, when he was single and living in Washington, D.C., a nascent relationship was destroyed when a woman he’d been dating invited him back to her apartment.
“On her walls she had my two most despised pieces of art,” Mr. Handler says. One was “The Kiss” by Gustav Klimt. “I happen to hate Klimt, but ‘The Kiss’ is the most trite and overdone and what made it worse, it was in her bedroom. Then there was the Robert Doisneau photograph of this couple kissing.”
That black and white photo taken on a Paris street in the ’50s? That’s kind of romantic.
“It’s romantic when you’re 16,” Mr. Handler says. “At some point you need to outgrow it.”
The romance, while it did not end that evening, ended soon after.
“She was attractive, she was smart, she was all the things I thought I would have liked in a woman, but I decided I didn’t trust her judgment,” Mr. Handler says.
What was his wife’s place like when they met?
It was a studio in Manhattan, Mr. Handler says, with a few really nice antiques. She also had a very impressive set of Le Creuset cookware. He had just about the same amount of All-Clad. It worked.
A Touch of Raffia Might Have Helped. But We Doubt It
Evan Lobel knows how to put together a welcoming apartment — in addition to being the owner of Lobel Modern, a vintage furniture store in lower Manhattan, he’s a designer. But even that doesn’t guarantee success.
“I was dating somebody very seriously,” says Mr. Lobel, who is 42. “He went away for a year to work in the Peace Corps. The two of us were in love. I said, I’m gonna wait, I’m not gonna be with anyone else, and I lived up to that. When he came back, we were supposed to live together. I thought, wouldn’t it be a nice surprise, after a year of living in huts, to live in a nice big, beautiful apartment.”
While his boyfriend was posted in Swaziland, Mr. Lobel sold his 1,200-square-foot Chelsea apartment and bought a 2,500-square-foot loft, with a fireplace and stone bathrooms. It was a frightening financial leap. While his old apartment sold for $1.5 million, the new one cost almost $2.4 million. He brought in beautiful pieces: a cabinet by the midcentury designer Tommi Parzinger; a Karl Springer chandelier with an estimated value of $25,000.
Then his boyfriend returned.
“He said, ‘What is this? I can’t live in a place like this, I was just around people who were hungry and dying,’” Mr. Lobel says. “In the end we were breaking up. For a while I regretted even buying that apartment.”
It’s Not My Place, It’s You
Matt Heindl, who is 34 and does Internet marketing, remembers two terrible dating experiences. The first involved a woman who was a nail biter — he discovered this in the cold light of morning when he found bits of her nails on the bedside stand. He also has a vivid memory of the mildewed towel she offered when he took a shower.
“It kind of smelled like dog,” he says, with a tone of disgust. “I can smell it now.”
The second experience involved an artist who lived in an East Village tenement. As he entered her apartment, a free-flying parrot relieved itself on his head. Then a large rabbit darted out from somewhere and licked his feet. A baby gate separated a second rabbit from the first — there had been a nasty penis-biting episode, his date explained. Also, the kitchen wall was covered with antique egg beaters, which looked to Mr. Heindl like weird tools.
Mr. Heindl and his date, Breck Hostetter, have now been married two years, and have a 9-month-old daughter, Greta. She operates Sesame Letterpress out of their home in Carroll Gardens. It is named, Ms. Hostetter says, after a parakeet who passed away at age 12.
Can Mr. Heindl explain how a deal breaker turned into marriage?
“I seriously thought, ‘Shall I run? No, I like her, I like her, I’ll check it out,’ ” he says. “I thought about it, I asked myself, ‘Why are you doing this?’ and I decided it showed she can really nurture, because one was like a really old rabbit, a geriatric rabbit. And she baked, obviously.”
So there it is — if your date doesn’t get your rabbit or your seal or your light bulb, he or she is not the person for you. Mr. Handler, the Klimt hater, now believes he was probably looking for a reason to break up with the woman he was seeing because she wasn’t right for him.
Mr. Podell, of the cartoon animal sheets, proudly fills a page with the household complaints of his dates. They include the size of his apartment, the lack of a coffeepot, the nonexistent stove connection, the lack of closet space. His love life, however, is great. He has a 22-year-old Russian girlfriend, whom he met in Malta. They have taken vacations to Asia, Europe and India, with Mr. Podell footing the bill.
Mr. Podell’s girlfriend lives in Moscow.
She has never seen his apartment.
Thursday, March 29, 2007
Sunday, March 18, 2007
Huntington's Disease -- Knowing and Future Planning
NYTimes
March 18, 2007
Facing Life With a Lethal Gene
By AMY HARMON
The test, the counselor said, had come back positive.
Katharine Moser inhaled sharply. She thought she was as ready as anyone could be to face her genetic destiny. She had attended a genetic counseling session and visited a psychiatrist, as required by the clinic. She had undergone the recommended neurological exam. And yet, she realized in that moment, she had never expected to hear those words.
“What do I do now?” Ms. Moser asked.
“What do you want to do?” the counselor replied.
“Cry,” she said quietly.
Her best friend, Colleen Elio, seated next to her, had already begun.
Ms. Moser was 23. It had taken her months to convince the clinic at NewYork-Presbyterian Hospital/Columbia University Medical Center in Manhattan that she wanted, at such a young age, to find out whether she carried the gene for Huntington’s disease.
Huntington’s, the incurable brain disorder that possessed her grandfather’s body and ravaged his mind for three decades, typically strikes in middle age. But most young adults who know the disease runs in their family have avoided the DNA test that can tell whether they will get it, preferring the torture — and hope — of not knowing.
Ms. Moser is part of a vanguard of people at risk for Huntington’s who are choosing to learn early what their future holds. Facing their genetic heritage, they say, will help them decide how to live their lives.
Yet even as a raft of new DNA tests are revealing predispositions to all kinds of conditions, including breast cancer, depression and dementia, little is known about what it is like to live with such knowledge.
“What runs in your own family, and would you want to know?” said Nancy Wexler, a neuropsychologist at Columbia and the president of the Hereditary Disease Foundation, which has pioneered Huntington’s research. “Soon everyone is going to have an option like this. You make the decision to test, you have to live with the consequences.”
On that drizzly spring morning two years ago, Ms. Moser was feeling her way, with perhaps the most definitive and disturbing verdict genetic testing has to offer. Anyone who carries the gene will inevitably develop Huntington’s.
She fought her tears. She tried for humor.
Don’t let yourself get too thin, said the clinic’s social worker. Not a problem, Ms. Moser responded, gesturing to her curvy frame. No more than two drinks at a time. Perhaps, Ms. Moser suggested to Ms. Elio, she meant one in each hand.
Then came anger.
“Why me?” she remembers thinking, in a refrain she found hard to shake in the coming months. “I’m the good one. It’s not like I’m sick because I have emphysema from smoking or I did something dangerous.”
The gene that will kill Ms. Moser sits on the short arm of everyone’s fourth chromosome, where the letters of the genetic alphabet normally repeat C-A-G as many as 35 times in a row. In people who develop Huntington’s, however, there are more than 35 repeats.
No one quite knows why this DNA hiccup causes cell death in the brain, leading Huntington’s patients to jerk and twitch uncontrollably and rendering them progressively unable to walk, talk, think and swallow. But the greater the number of repeats, the earlier symptoms tend to appear and the faster they progress.
Ms. Moser’s “CAG number” was 45, the counselor said. She had more repeats than her grandfather, whose first symptoms — loss of short-term memory, mood swings and a constant ticking noise he made with his mouth — surfaced when he turned 50. But it was another year before Ms. Moser would realize that she could have less than 12 years until she showed symptoms.
Immediately after getting her results, Ms. Moser was too busy making plans.
“I’m going to become super-strong and super-balanced,” she vowed over lunch with Ms. Elio, her straight brown hair pulled into a determined bun. “So when I start to lose it I’ll be a little closer to normal.”
In the tumultuous months that followed, Ms. Moser often found herself unable to remember what normal had once been. She forced herself to renounce the crush she had long nursed on a certain firefighter, sure that marriage was no longer an option for her. She threw herself into fund-raising in the hopes that someone would find a cure. Sometimes, she raged.
She never, she said, regretted being tested. But at night, crying herself to sleep in the dark of her lavender bedroom, she would go over and over it. She was the same, but she was also different. And there was nothing she could do.
A Lesson in Stigma
Ms. Moser grew up in Connecticut, part of a large Irish Catholic family. Like many families affected by Huntington’s, Ms. Moser’s regarded the disease as a curse, not to be mentioned even as it dominated their lives in the form of her grandfather’s writhing body and unpredictable rages.
Once, staying in Ms. Moser’s room on a visit, he broke her trundle bed with his violent, involuntary jerking. Another time, he came into the kitchen naked, his underpants on his head. When the children giggled, Ms. Moser’s mother defended her father: “If you don’t like it, get out of my house and go.”
But no one explained what had happened to their grandfather, Thomas Dowd, a former New York City police officer who once had dreams of retiring to Florida.
In 1990, Mr. Dowd’s older brother, living in a veteran’s hospital in an advanced stage of the disease, was strangled in his own restraints. But a year or so later, when Ms. Moser wanted to do her sixth-grade science project on Huntington’s, her mother recoiled.
“Why,” she demanded, “would you want to do it on this disease that is killing your grandfather?”
Ms. Moser was left to confirm for herself, through library books and a CD-ROM encyclopedia, that she and her brothers, her mother, her aunts, an uncle and cousins could all face the same fate.
Any child who has a parent with Huntington’s has a 50 percent chance of having inherited the gene that causes it, Ms. Moser learned.
Her mother, who asked not to be identified by name for fear of discrimination, had not always been so guarded. At one point, she drove around with a “Cure HD” sign in the window of her van. She told people that her father had “Woody Guthrie’s disease,” invoking the folk icon who died of Huntington’s in 1967.
But her efforts to raise awareness soon foundered. Huntington’s is a rare genetic disease, affecting about 30,000 people in the United States, with about 250,000 more at risk. Few people know what it is. Strangers assumed her father’s unsteady walk, a frequent early symptom, meant he was drunk.
“Nobody has compassion,” Ms. Moser’s mother concluded. “People look at you like you’re strange, and ‘What’s wrong with you?’ ”
Shortly after a simple DNA test became available for Huntington’s in 1993, one of Ms. Moser’s aunts tested positive. Another, driven to find out if her own medical problems were related to Huntington’s, tested negative. But when Ms. Moser announced as a teenager that she wanted to get tested one day, her mother insisted that she should not. If her daughter carried the gene, that meant she did, too. And she did not want to know.
“You don’t want to know stuff like that,” Ms. Moser’s mother said in an interview. “You want to enjoy life.”
Ms. Moser’s father, who met and married his wife six years before Ms. Moser’s grandfather received his Huntington’s diagnosis, said he had managed not to think much about her at-risk status.
“So she was at risk,” he said. “Everyone’s at risk for everything.”
The test, Ms. Moser remembers her mother suggesting, would cost thousands of dollars. Still, in college, Ms. Moser often trolled the Web for information about it. Mostly, she imagined how sweet it would be to know she did not have the gene. But increasingly she was haunted, too, by the suspicion that her mother did.
As awful as it was, she admitted to Ms. Elio, her freshman-year neighbor at Elizabethtown College in Pennsylvania, she almost hoped it was true. It would explain her mother’s strokes of meanness, her unpredictable flashes of anger.
Ms. Moser’s mother said she had never considered the conflicts with her daughter out of the ordinary. “All my friends who had daughters said that was all normal, and when she’s 25 she’ll be your best friend,” she said. “I was waiting for that to happen, but I guess it’s not happening.”
When Ms. Moser graduated in 2003 with a degree in occupational therapy, their relationship, never peaceful, was getting worse. She moved to Queens without giving her mother her new address.
Wanting to Know
Out of school, Ms. Moser soon spotted a listing for a job at Terence Cardinal Cooke Health Care Center, a nursing home on the Upper East Side of Manhattan. She knew it was meant for her.
Her grandfather had died there in 2002 after living for a decade at the home, one of only a handful in the country with a unit devoted entirely to Huntington’s.
“I hated visiting him growing up,” Ms. Moser said. “It was scary.”
Now, though, she was drawn to see the disease up close.
On breaks from her duties elsewhere, she visited her cousin James Dowd, the son of her grandfather’s brother who had come to live in the Huntington’s unit several years earlier. It was there, in a conversation with another staff member, that she learned she could be tested for only a few hundred dollars at the Columbia clinic across town. She scheduled an appointment for the next week.
The staff at Columbia urged Ms. Moser to consider the downside of genetic testing. Some people battle depression after they test positive. And the information, she was cautioned, could make it harder for her to get a job or health insurance.
But Ms. Moser bristled at the idea that she should have to remain ignorant about her genetic status to avoid discrimination. “I didn’t do anything wrong,” she said. “It’s not like telling people I’m a drug addict.”
She also recalls rejecting a counselor’s suggestion that she might have asked to be tested as a way of crying for help.
“I’m like, ‘No,’ ” Ms. Moser recalls replying. “ ‘I’ve come to be tested because I want to know.’ ”
No one routinely collects demographic information about who gets tested for Huntington’s. At the Huntington’s Disease Center at Columbia, staff members say they have seen few young people taking the test.
Ms. Moser is still part of a distinct minority. But some researchers say her attitude is increasingly common among young people who know they may develop Huntington’s.
More informed about the genetics of the disease than any previous generation, they are convinced that they would rather know how many healthy years they have left than wake up one day to find the illness upon them. They are confident that new reproductive technologies can allow them to have children without transmitting the disease and are eager to be first in line should a treatment become available.
“We’re seeing a shift,” said Dr. Michael Hayden, a professor of human genetics at the University of British Columbia in Vancouver who has been providing various tests for Huntington’s for 20 years. “Younger people are coming for testing now, people in their 20s and early 30s; before, that was very rare. I’ve counseled some of them. They feel it is part of their heritage and that it is possible to lead a life that’s not defined by this gene.”
Before the test, Ms. Moser made two lists of life goals. Under “if negative,” she wrote married, children and Ireland. Under “if positive” was exercise, vitamins and ballroom dancing. Balance, in that case, would be important. Opening a bed-and-breakfast, a goal since childhood, made both lists.
In the weeks before getting the test results, Ms. Moser gave Ms. Elio explicit instructions about acceptable responses. If she was negative, flowers were O.K. If positive, they were not. In either case, drinking was acceptable. Crying was not.
But it was Ms. Elio’s husband, Chris Elio, who first broached the subject of taking care of Ms. Moser, whom their young children called “my Katie,” as in “this is my mom, this is my dad, this is my Katie.” They should address it before the results were in, Mr. Elio told his wife, so that she would not feel, later, that they had done it out of a sense of obligation.
The next day, in an e-mail note that was unusually formal for friends who sent text messages constantly and watched “Desperate Housewives” while on the phone together, Ms. Elio told Ms. Moser that she and her husband wanted her to move in with them if she got sick. Ms. Moser set the note aside. She did not expect to need it.
‘It’s Too Hard to Look’
The results had come a week early, and Ms. Moser assured her friends that the “Sex and the City” trivia party she had planned for that night was still on. After all, she was not sick, not dying. And she had already made the dips.
“I’m the same person I’ve always been,” she insisted that night as her guests gamely dipped strawberries in her chocolate fountain. “It’s been in me from the beginning.”
But when she went to work the next day, she lingered outside the door of the occupational therapy gym, not wanting to face her colleagues. She avoided the Huntington’s floor entirely, choosing to attend to patients ailing of just about anything else. “It’s too hard to look at them,” she told her friends.
In those first months, Ms. Moser summoned all her strength to pretend that nothing cataclysmic had happened. At times, it seemed easy enough. In the mirror, the same green eyes looked back at her. She was still tall, a devoted Julia Roberts fan, a prolific baker.
She dropped the news of her genetic status into some conversations like small talk, but kept it from her family. She made light of her newfound fate, though often friends were not sure how to take the jokes.
“That’s my Huntington’s kicking in,” she told Rachel Markan, a co-worker, after knocking a patient’s folder on the floor.
Other times, Ms. Moser abruptly dropped any pretense of routine banter. On a trip to Florida, she and Ms. Elio saw a man in a wheelchair being tube-fed, a method often used to keep Huntington’s patients alive for years after they can no longer swallow.
“I don’t want a feeding tube,” she announced flatly.
In those early days, she calculated that she had at least until 50 before symptoms set in. That was enough time to open a bed-and-breakfast, if she acted fast. Enough time to repay $70,000 in student loans under her 30-year term.
Doing the math on the loans, though, could send her into a tailspin.
“I’ll be repaying them and then I’ll start getting sick,” she said. “I mean, there’s no time in there.”
Finding New Purpose
At the end of the summer, as the weather grew colder, Ms. Moser forced herself to return to the Huntington’s unit.
In each patient, she saw her future: the biophysicist slumped in his wheelchair, the refrigerator repairman inert in his bed, the onetime professional tennis player who floated through the common room, arms undulating in the startlingly graceful movements that had earned the disease its original name, “Huntington’s chorea,” from the Greek “to dance.”
Then there was her cousin Jimmy, who had wrapped papers for The New York Post for 19 years until suddenly he could no longer tie the knots. When she greeted him, his bright blue eyes darted to her face, then away. If he knew her, it was impossible to tell.
She did what she could for them. She customized their wheelchairs with padding to fit each one’s unique tics. She doled out special silverware, oversized or bent in just the right angles to prolong their ability to feed themselves.
Fending off despair, Ms. Moser was also filled with new purpose. Someone, somewhere, she told friends, had to find a cure.
It has been over a century since the disease was identified by George Huntington, a doctor in Amagansett, N.Y., and over a decade since researchers first found the gene responsible for it.
To raise money for research, Ms. Moser volunteered for walks and dinners and golf outings sponsored by the Huntington’s Disease Society of America. She organized a Hula-Hoop-a-thon on the roof of Cardinal Cooke, then a bowl-a-thon at the Port Authority. But at many of the events, attendance was sparse.
It is hard to get people to turn out for Huntington’s benefits, she learned from the society’s professional fund-raisers. Even families affected by the disease, the most obvious constituents, often will not help publicize events.
“They don’t want people to know they’re connected to Huntington’s,” Ms. Moser said, with a mix of anger and recognition. “It’s like in my family — it’s not a good thing.”
Her first session with a therapist brought a chilling glimpse of how the disorder is viewed even by some who know plenty about it. “She told me it was my moral and ethical obligation not to have children,” Ms. Moser told Ms. Elio by cellphone as soon as she left the office, her voice breaking.
In lulls between fund-raisers, Ms. Moser raced to educate her own world about Huntington’s. She added links about the disease to her MySpace page. She plastered her desk at work with “Cure HD” stickers and starred in a video about the Huntington’s unit for her union’s Web site.
Ms. Moser gave blood for one study and spoke into a microphone for researchers trying to detect subtle speech differences in people who have extra CAG repeats before more noticeable disease symptoms emerge.
When researchers found a way to cure mice bred to replicate features of the disease in humans, Ms. Moser sent the news to friends and acquaintances.
But it was hard to celebrate. “Thank God,” the joke went around on the Huntington’s National Youth Alliance e-mail list Ms. Moser subscribed to, “at least there won’t be any more poor mice wandering around with Huntington’s disease.”
In October, one of Ms. Moser’s aunts lost her balance while walking and broke her nose. It was the latest in a series of falls. “The cure needs to be soon for me,” Ms. Moser said. “Sooner for everybody else.”
A Confrontation in Court
In the waiting room of the Dutchess County family courthouse on a crisp morning in the fall of 2005, Ms. Moser approached her mother, who turned away.
“I need to tell her something important,” Ms. Moser told a family member who had accompanied her mother to the hearing.
He conveyed the message and brought one in return: Unless she was dying, her mother did not have anything to say to her.
That Ms. Moser had tested positive meant that her mother would develop Huntington’s, if she had not already. A year earlier, Ms. Moser’s mother had convinced a judge that her sister, Nora Maldonado, was neglecting her daughter. She was given guardianship of the daughter, 4-year-old Jillian.
Ms. Moser had been skeptical of her mother’s accusations that Ms. Maldonado was not feeding or bathing Jillian properly, and she wondered whether her effort to claim Jillian had been induced by the psychological symptoms of the disease.
Her testimony about her mother’s genetic status, Ms. Moser knew, could help persuade the judge to return Jillian. Ms. Maldonado had found out years earlier that she did not have the Huntington’s gene.
Ms. Moser did not believe that someone in the early stages of Huntington’s should automatically be disqualified from taking care of a child. But her own rocky childhood had convinced her that Jillian would be better off with Ms. Maldonado.
She told her aunt’s lawyer about her test results and agreed to testify.
In the courtroom, Ms. Moser took the witness stand. Her mother’s lawyer jumped up as soon as the topic of Huntington’s arose. It was irrelevant, he said. But by the time the judge had sustained his objections, Ms. Moser’s mother, stricken, had understood.
The next day, in the bathroom, Ms. Maldonado approached Ms. Moser’s mother.
“I’m sorry,” she said. Ms. Moser’s mother said nothing.
The court has continued to let Ms. Moser’s mother retain guardianship of Jillian. But she has not spoken to her daughter again.
“It’s a horrible illness,” Ms. Moser’s mother said, months later, gesturing to her husband. “Now he has a wife who has it. Did she think of him? Did she think of me? Who’s going to marry her?”
Facing the Future
Before the test, it was as if Ms. Moser had been balanced between parallel universes, one in which she would never get the disease and one in which she would. The test had made her whole.
She began to prepare the Elio children and Jillian for her illness, determined that they would not be scared, as she had been with her grandfather. When Jillian wanted to know how people got Huntington’s disease “in their pants,” Ms. Moser wrote the text of a children’s book that explained what these other kinds of “genes” were and why they would make her sick.
But over the winter, Ms. Elio complained gently that her friend had become “Ms. H.D.” And an impromptu note that arrived for the children in the early spring convinced her that Ms. Moser was dwelling too much on her own death.
“You all make me so happy, and I am so proud of who you are and who you will be,” read the note, on rainbow scratch-and-write paper. “I will always remember the fun things we do together.”
Taking matters into her own hands, Ms. Elio created a profile for Ms. Moser on an online dating service. Ms. Moser was skeptical but supplied a picture. Dating, she said, was the worst thing about knowing she had the Huntington’s gene. It was hard to imagine someone falling enough in love with her to take on Huntington’s knowingly, or asking it of someone she loved. At the same time, she said, knowing her status could help her find the right person, if he was out there.
“Either way, I was going to get sick,” she said. “And I’d want someone who could handle it. If, by some twist of fate, I do get married and have children, at least we know what we’re getting into.”
After much debate, the friends settled on the third date as the right time to mention Huntington’s. But when the first date came, Ms. Moser wished she could just blurt it out.
“It kind of just lingers there,” she said. “I really just want to be able to tell people, ‘Someday, I’m going to have Huntington’s disease.’ ”
‘A Part of My Life’
Last May 6, a year to the day after she had received her test results, the subject line “CAG Count” caught Ms. Moser’s attention as she was scrolling through the online discussion forums of the Huntington’s Disease Advocacy Center. She knew she had 45 CAG repeats, but she had never investigated it further.
She clicked on the message.
“My mother’s CAG was 43,” it read. “She started forgetting the punch line to jokes at 39/40.” Another woman whose husband’s CAG count was 47 had just sold his car. “He’s 39 years old,” she wrote. “It was time for him to quit driving.”
Quickly, Ms. Moser scanned a chart that accompanied the messages for her number, 45. The median age of onset to which it corresponded was 37.
Ms. Elio got drunk with her husband the night Ms. Moser finally told her.
“That’s 12 years away,” Ms. Moser said.
The statistic, they knew, meant that half of those with her CAG number started showing symptoms after age 37. But it also meant that the other half started showing symptoms earlier.
Ms. Moser, meanwhile, flew to the annual convention of the Huntington’s Disease Society, which she had decided at the last minute to attend.
“Mother or father?” one woman, 23, from Chicago, asked a few minutes after meeting Ms. Moser in the elevator of the Milwaukee Hilton. “Have you tested? What’s your CAG?”
She was close to getting herself tested, the woman confided. How did it feel to know?
“It’s hard to think the other way anymore of not knowing,” Ms. Moser replied. “It’s become a part of my life.”
After years of trying to wring conversation from her family about Huntington’s, Ms. Moser suddenly found herself bathing in it. But for the first time in a long time, her mind was on other things. At a youth support group meeting in the hotel hallway, she took her place in the misshapen circle. Later, on the dance floor, the spasms of the symptomatic seemed as natural as the gyrations of the normal.
“I’m not alone in this,” Ms. Moser remembers thinking. “This affects other people, too, and we all just have to live our lives.”
Seizing the Day
July 15, the day of Ms. Moser’s 25th birthday party, was sunny, with a hint of moisture in the air. At her aunt’s house in Long Beach, N.Y., Ms. Moser wore a dress with pictures of cocktails on it. It was, she and Ms. Elio told anyone who would listen, her “cocktail dress.” They drew the quotation marks in the air.
A bowl of “Cure HD” pins sat on the table. Over burgers from the barbecue, Ms. Moser mentioned to family members from her father’s side that she had tested positive for the Huntington’s gene.
“What’s that?” one cousin asked.
“It will affect my ability to walk, talk and think,” Ms. Moser said. “Sometime before I’m 50.”
“That’s soon,” an uncle said matter-of-factly.
“So do you have to take medication?” her cousin asked.
“There’s nothing really to take,” Ms. Moser said.
She and the Elios put on bathing suits, loaded the children in a wagon and walked to the beach.
More than anything now, Ms. Moser said, she is filled with a sense of urgency.
“I have a lot to do,” she said. “And I don’t have a lot of time.”
Over the next months, Ms. Moser took tennis lessons every Sunday morning and went to church in the evening.
When a planned vacation with the Elio family fell through at the last minute, she went anyway, packing Disney World, Universal Studios, Wet ’n Wild and Sea World into 36 hours with a high school friend who lives in Orlando. She was honored at a dinner by the New York chapter of the Huntington’s society for her outreach efforts and managed a brief thank-you speech despite her discomfort with public speaking.
Having made a New Year’s resolution to learn to ride a unicycle, she bought a used one. “My legs are tired, my arms are tired, and I definitely need protection,” she reported to Ms. Elio. On Super Bowl Sunday, she waded into the freezing Atlantic Ocean for a Polar Bear swim to raise money for the Make-a-Wish Foundation.
Ms. Elio complained that she hardly got to see her friend. But one recent weekend, they packed up the Elio children and drove to the house the Elios were renovating in eastern Pennsylvania. The kitchen floor needed grouting, and, rejecting the home improvement gospel that calls for a special tool designed for the purpose, Ms. Moser and Ms. Elio had decided to use pastry bags.
As they turned into the driveway, Ms. Moser studied the semi-attached house next door. Maybe she would move in one day, as the Elios had proposed. Then, when she could no longer care for herself, they could put in a door.
First, though, she wanted to travel. She had heard of a job that would place her in different occupational therapy positions across the country every few months and was planning to apply.
“I’m thinking Hawaii first,” she said.
Then they donned gloves, mixed grout in a large bucket of water and began the job.
March 18, 2007
Facing Life With a Lethal Gene
By AMY HARMON
The test, the counselor said, had come back positive.
Katharine Moser inhaled sharply. She thought she was as ready as anyone could be to face her genetic destiny. She had attended a genetic counseling session and visited a psychiatrist, as required by the clinic. She had undergone the recommended neurological exam. And yet, she realized in that moment, she had never expected to hear those words.
“What do I do now?” Ms. Moser asked.
“What do you want to do?” the counselor replied.
“Cry,” she said quietly.
Her best friend, Colleen Elio, seated next to her, had already begun.
Ms. Moser was 23. It had taken her months to convince the clinic at NewYork-Presbyterian Hospital/Columbia University Medical Center in Manhattan that she wanted, at such a young age, to find out whether she carried the gene for Huntington’s disease.
Huntington’s, the incurable brain disorder that possessed her grandfather’s body and ravaged his mind for three decades, typically strikes in middle age. But most young adults who know the disease runs in their family have avoided the DNA test that can tell whether they will get it, preferring the torture — and hope — of not knowing.
Ms. Moser is part of a vanguard of people at risk for Huntington’s who are choosing to learn early what their future holds. Facing their genetic heritage, they say, will help them decide how to live their lives.
Yet even as a raft of new DNA tests are revealing predispositions to all kinds of conditions, including breast cancer, depression and dementia, little is known about what it is like to live with such knowledge.
“What runs in your own family, and would you want to know?” said Nancy Wexler, a neuropsychologist at Columbia and the president of the Hereditary Disease Foundation, which has pioneered Huntington’s research. “Soon everyone is going to have an option like this. You make the decision to test, you have to live with the consequences.”
On that drizzly spring morning two years ago, Ms. Moser was feeling her way, with perhaps the most definitive and disturbing verdict genetic testing has to offer. Anyone who carries the gene will inevitably develop Huntington’s.
She fought her tears. She tried for humor.
Don’t let yourself get too thin, said the clinic’s social worker. Not a problem, Ms. Moser responded, gesturing to her curvy frame. No more than two drinks at a time. Perhaps, Ms. Moser suggested to Ms. Elio, she meant one in each hand.
Then came anger.
“Why me?” she remembers thinking, in a refrain she found hard to shake in the coming months. “I’m the good one. It’s not like I’m sick because I have emphysema from smoking or I did something dangerous.”
The gene that will kill Ms. Moser sits on the short arm of everyone’s fourth chromosome, where the letters of the genetic alphabet normally repeat C-A-G as many as 35 times in a row. In people who develop Huntington’s, however, there are more than 35 repeats.
No one quite knows why this DNA hiccup causes cell death in the brain, leading Huntington’s patients to jerk and twitch uncontrollably and rendering them progressively unable to walk, talk, think and swallow. But the greater the number of repeats, the earlier symptoms tend to appear and the faster they progress.
Ms. Moser’s “CAG number” was 45, the counselor said. She had more repeats than her grandfather, whose first symptoms — loss of short-term memory, mood swings and a constant ticking noise he made with his mouth — surfaced when he turned 50. But it was another year before Ms. Moser would realize that she could have less than 12 years until she showed symptoms.
Immediately after getting her results, Ms. Moser was too busy making plans.
“I’m going to become super-strong and super-balanced,” she vowed over lunch with Ms. Elio, her straight brown hair pulled into a determined bun. “So when I start to lose it I’ll be a little closer to normal.”
In the tumultuous months that followed, Ms. Moser often found herself unable to remember what normal had once been. She forced herself to renounce the crush she had long nursed on a certain firefighter, sure that marriage was no longer an option for her. She threw herself into fund-raising in the hopes that someone would find a cure. Sometimes, she raged.
She never, she said, regretted being tested. But at night, crying herself to sleep in the dark of her lavender bedroom, she would go over and over it. She was the same, but she was also different. And there was nothing she could do.
A Lesson in Stigma
Ms. Moser grew up in Connecticut, part of a large Irish Catholic family. Like many families affected by Huntington’s, Ms. Moser’s regarded the disease as a curse, not to be mentioned even as it dominated their lives in the form of her grandfather’s writhing body and unpredictable rages.
Once, staying in Ms. Moser’s room on a visit, he broke her trundle bed with his violent, involuntary jerking. Another time, he came into the kitchen naked, his underpants on his head. When the children giggled, Ms. Moser’s mother defended her father: “If you don’t like it, get out of my house and go.”
But no one explained what had happened to their grandfather, Thomas Dowd, a former New York City police officer who once had dreams of retiring to Florida.
In 1990, Mr. Dowd’s older brother, living in a veteran’s hospital in an advanced stage of the disease, was strangled in his own restraints. But a year or so later, when Ms. Moser wanted to do her sixth-grade science project on Huntington’s, her mother recoiled.
“Why,” she demanded, “would you want to do it on this disease that is killing your grandfather?”
Ms. Moser was left to confirm for herself, through library books and a CD-ROM encyclopedia, that she and her brothers, her mother, her aunts, an uncle and cousins could all face the same fate.
Any child who has a parent with Huntington’s has a 50 percent chance of having inherited the gene that causes it, Ms. Moser learned.
Her mother, who asked not to be identified by name for fear of discrimination, had not always been so guarded. At one point, she drove around with a “Cure HD” sign in the window of her van. She told people that her father had “Woody Guthrie’s disease,” invoking the folk icon who died of Huntington’s in 1967.
But her efforts to raise awareness soon foundered. Huntington’s is a rare genetic disease, affecting about 30,000 people in the United States, with about 250,000 more at risk. Few people know what it is. Strangers assumed her father’s unsteady walk, a frequent early symptom, meant he was drunk.
“Nobody has compassion,” Ms. Moser’s mother concluded. “People look at you like you’re strange, and ‘What’s wrong with you?’ ”
Shortly after a simple DNA test became available for Huntington’s in 1993, one of Ms. Moser’s aunts tested positive. Another, driven to find out if her own medical problems were related to Huntington’s, tested negative. But when Ms. Moser announced as a teenager that she wanted to get tested one day, her mother insisted that she should not. If her daughter carried the gene, that meant she did, too. And she did not want to know.
“You don’t want to know stuff like that,” Ms. Moser’s mother said in an interview. “You want to enjoy life.”
Ms. Moser’s father, who met and married his wife six years before Ms. Moser’s grandfather received his Huntington’s diagnosis, said he had managed not to think much about her at-risk status.
“So she was at risk,” he said. “Everyone’s at risk for everything.”
The test, Ms. Moser remembers her mother suggesting, would cost thousands of dollars. Still, in college, Ms. Moser often trolled the Web for information about it. Mostly, she imagined how sweet it would be to know she did not have the gene. But increasingly she was haunted, too, by the suspicion that her mother did.
As awful as it was, she admitted to Ms. Elio, her freshman-year neighbor at Elizabethtown College in Pennsylvania, she almost hoped it was true. It would explain her mother’s strokes of meanness, her unpredictable flashes of anger.
Ms. Moser’s mother said she had never considered the conflicts with her daughter out of the ordinary. “All my friends who had daughters said that was all normal, and when she’s 25 she’ll be your best friend,” she said. “I was waiting for that to happen, but I guess it’s not happening.”
When Ms. Moser graduated in 2003 with a degree in occupational therapy, their relationship, never peaceful, was getting worse. She moved to Queens without giving her mother her new address.
Wanting to Know
Out of school, Ms. Moser soon spotted a listing for a job at Terence Cardinal Cooke Health Care Center, a nursing home on the Upper East Side of Manhattan. She knew it was meant for her.
Her grandfather had died there in 2002 after living for a decade at the home, one of only a handful in the country with a unit devoted entirely to Huntington’s.
“I hated visiting him growing up,” Ms. Moser said. “It was scary.”
Now, though, she was drawn to see the disease up close.
On breaks from her duties elsewhere, she visited her cousin James Dowd, the son of her grandfather’s brother who had come to live in the Huntington’s unit several years earlier. It was there, in a conversation with another staff member, that she learned she could be tested for only a few hundred dollars at the Columbia clinic across town. She scheduled an appointment for the next week.
The staff at Columbia urged Ms. Moser to consider the downside of genetic testing. Some people battle depression after they test positive. And the information, she was cautioned, could make it harder for her to get a job or health insurance.
But Ms. Moser bristled at the idea that she should have to remain ignorant about her genetic status to avoid discrimination. “I didn’t do anything wrong,” she said. “It’s not like telling people I’m a drug addict.”
She also recalls rejecting a counselor’s suggestion that she might have asked to be tested as a way of crying for help.
“I’m like, ‘No,’ ” Ms. Moser recalls replying. “ ‘I’ve come to be tested because I want to know.’ ”
No one routinely collects demographic information about who gets tested for Huntington’s. At the Huntington’s Disease Center at Columbia, staff members say they have seen few young people taking the test.
Ms. Moser is still part of a distinct minority. But some researchers say her attitude is increasingly common among young people who know they may develop Huntington’s.
More informed about the genetics of the disease than any previous generation, they are convinced that they would rather know how many healthy years they have left than wake up one day to find the illness upon them. They are confident that new reproductive technologies can allow them to have children without transmitting the disease and are eager to be first in line should a treatment become available.
“We’re seeing a shift,” said Dr. Michael Hayden, a professor of human genetics at the University of British Columbia in Vancouver who has been providing various tests for Huntington’s for 20 years. “Younger people are coming for testing now, people in their 20s and early 30s; before, that was very rare. I’ve counseled some of them. They feel it is part of their heritage and that it is possible to lead a life that’s not defined by this gene.”
Before the test, Ms. Moser made two lists of life goals. Under “if negative,” she wrote married, children and Ireland. Under “if positive” was exercise, vitamins and ballroom dancing. Balance, in that case, would be important. Opening a bed-and-breakfast, a goal since childhood, made both lists.
In the weeks before getting the test results, Ms. Moser gave Ms. Elio explicit instructions about acceptable responses. If she was negative, flowers were O.K. If positive, they were not. In either case, drinking was acceptable. Crying was not.
But it was Ms. Elio’s husband, Chris Elio, who first broached the subject of taking care of Ms. Moser, whom their young children called “my Katie,” as in “this is my mom, this is my dad, this is my Katie.” They should address it before the results were in, Mr. Elio told his wife, so that she would not feel, later, that they had done it out of a sense of obligation.
The next day, in an e-mail note that was unusually formal for friends who sent text messages constantly and watched “Desperate Housewives” while on the phone together, Ms. Elio told Ms. Moser that she and her husband wanted her to move in with them if she got sick. Ms. Moser set the note aside. She did not expect to need it.
‘It’s Too Hard to Look’
The results had come a week early, and Ms. Moser assured her friends that the “Sex and the City” trivia party she had planned for that night was still on. After all, she was not sick, not dying. And she had already made the dips.
“I’m the same person I’ve always been,” she insisted that night as her guests gamely dipped strawberries in her chocolate fountain. “It’s been in me from the beginning.”
But when she went to work the next day, she lingered outside the door of the occupational therapy gym, not wanting to face her colleagues. She avoided the Huntington’s floor entirely, choosing to attend to patients ailing of just about anything else. “It’s too hard to look at them,” she told her friends.
In those first months, Ms. Moser summoned all her strength to pretend that nothing cataclysmic had happened. At times, it seemed easy enough. In the mirror, the same green eyes looked back at her. She was still tall, a devoted Julia Roberts fan, a prolific baker.
She dropped the news of her genetic status into some conversations like small talk, but kept it from her family. She made light of her newfound fate, though often friends were not sure how to take the jokes.
“That’s my Huntington’s kicking in,” she told Rachel Markan, a co-worker, after knocking a patient’s folder on the floor.
Other times, Ms. Moser abruptly dropped any pretense of routine banter. On a trip to Florida, she and Ms. Elio saw a man in a wheelchair being tube-fed, a method often used to keep Huntington’s patients alive for years after they can no longer swallow.
“I don’t want a feeding tube,” she announced flatly.
In those early days, she calculated that she had at least until 50 before symptoms set in. That was enough time to open a bed-and-breakfast, if she acted fast. Enough time to repay $70,000 in student loans under her 30-year term.
Doing the math on the loans, though, could send her into a tailspin.
“I’ll be repaying them and then I’ll start getting sick,” she said. “I mean, there’s no time in there.”
Finding New Purpose
At the end of the summer, as the weather grew colder, Ms. Moser forced herself to return to the Huntington’s unit.
In each patient, she saw her future: the biophysicist slumped in his wheelchair, the refrigerator repairman inert in his bed, the onetime professional tennis player who floated through the common room, arms undulating in the startlingly graceful movements that had earned the disease its original name, “Huntington’s chorea,” from the Greek “to dance.”
Then there was her cousin Jimmy, who had wrapped papers for The New York Post for 19 years until suddenly he could no longer tie the knots. When she greeted him, his bright blue eyes darted to her face, then away. If he knew her, it was impossible to tell.
She did what she could for them. She customized their wheelchairs with padding to fit each one’s unique tics. She doled out special silverware, oversized or bent in just the right angles to prolong their ability to feed themselves.
Fending off despair, Ms. Moser was also filled with new purpose. Someone, somewhere, she told friends, had to find a cure.
It has been over a century since the disease was identified by George Huntington, a doctor in Amagansett, N.Y., and over a decade since researchers first found the gene responsible for it.
To raise money for research, Ms. Moser volunteered for walks and dinners and golf outings sponsored by the Huntington’s Disease Society of America. She organized a Hula-Hoop-a-thon on the roof of Cardinal Cooke, then a bowl-a-thon at the Port Authority. But at many of the events, attendance was sparse.
It is hard to get people to turn out for Huntington’s benefits, she learned from the society’s professional fund-raisers. Even families affected by the disease, the most obvious constituents, often will not help publicize events.
“They don’t want people to know they’re connected to Huntington’s,” Ms. Moser said, with a mix of anger and recognition. “It’s like in my family — it’s not a good thing.”
Her first session with a therapist brought a chilling glimpse of how the disorder is viewed even by some who know plenty about it. “She told me it was my moral and ethical obligation not to have children,” Ms. Moser told Ms. Elio by cellphone as soon as she left the office, her voice breaking.
In lulls between fund-raisers, Ms. Moser raced to educate her own world about Huntington’s. She added links about the disease to her MySpace page. She plastered her desk at work with “Cure HD” stickers and starred in a video about the Huntington’s unit for her union’s Web site.
Ms. Moser gave blood for one study and spoke into a microphone for researchers trying to detect subtle speech differences in people who have extra CAG repeats before more noticeable disease symptoms emerge.
When researchers found a way to cure mice bred to replicate features of the disease in humans, Ms. Moser sent the news to friends and acquaintances.
But it was hard to celebrate. “Thank God,” the joke went around on the Huntington’s National Youth Alliance e-mail list Ms. Moser subscribed to, “at least there won’t be any more poor mice wandering around with Huntington’s disease.”
In October, one of Ms. Moser’s aunts lost her balance while walking and broke her nose. It was the latest in a series of falls. “The cure needs to be soon for me,” Ms. Moser said. “Sooner for everybody else.”
A Confrontation in Court
In the waiting room of the Dutchess County family courthouse on a crisp morning in the fall of 2005, Ms. Moser approached her mother, who turned away.
“I need to tell her something important,” Ms. Moser told a family member who had accompanied her mother to the hearing.
He conveyed the message and brought one in return: Unless she was dying, her mother did not have anything to say to her.
That Ms. Moser had tested positive meant that her mother would develop Huntington’s, if she had not already. A year earlier, Ms. Moser’s mother had convinced a judge that her sister, Nora Maldonado, was neglecting her daughter. She was given guardianship of the daughter, 4-year-old Jillian.
Ms. Moser had been skeptical of her mother’s accusations that Ms. Maldonado was not feeding or bathing Jillian properly, and she wondered whether her effort to claim Jillian had been induced by the psychological symptoms of the disease.
Her testimony about her mother’s genetic status, Ms. Moser knew, could help persuade the judge to return Jillian. Ms. Maldonado had found out years earlier that she did not have the Huntington’s gene.
Ms. Moser did not believe that someone in the early stages of Huntington’s should automatically be disqualified from taking care of a child. But her own rocky childhood had convinced her that Jillian would be better off with Ms. Maldonado.
She told her aunt’s lawyer about her test results and agreed to testify.
In the courtroom, Ms. Moser took the witness stand. Her mother’s lawyer jumped up as soon as the topic of Huntington’s arose. It was irrelevant, he said. But by the time the judge had sustained his objections, Ms. Moser’s mother, stricken, had understood.
The next day, in the bathroom, Ms. Maldonado approached Ms. Moser’s mother.
“I’m sorry,” she said. Ms. Moser’s mother said nothing.
The court has continued to let Ms. Moser’s mother retain guardianship of Jillian. But she has not spoken to her daughter again.
“It’s a horrible illness,” Ms. Moser’s mother said, months later, gesturing to her husband. “Now he has a wife who has it. Did she think of him? Did she think of me? Who’s going to marry her?”
Facing the Future
Before the test, it was as if Ms. Moser had been balanced between parallel universes, one in which she would never get the disease and one in which she would. The test had made her whole.
She began to prepare the Elio children and Jillian for her illness, determined that they would not be scared, as she had been with her grandfather. When Jillian wanted to know how people got Huntington’s disease “in their pants,” Ms. Moser wrote the text of a children’s book that explained what these other kinds of “genes” were and why they would make her sick.
But over the winter, Ms. Elio complained gently that her friend had become “Ms. H.D.” And an impromptu note that arrived for the children in the early spring convinced her that Ms. Moser was dwelling too much on her own death.
“You all make me so happy, and I am so proud of who you are and who you will be,” read the note, on rainbow scratch-and-write paper. “I will always remember the fun things we do together.”
Taking matters into her own hands, Ms. Elio created a profile for Ms. Moser on an online dating service. Ms. Moser was skeptical but supplied a picture. Dating, she said, was the worst thing about knowing she had the Huntington’s gene. It was hard to imagine someone falling enough in love with her to take on Huntington’s knowingly, or asking it of someone she loved. At the same time, she said, knowing her status could help her find the right person, if he was out there.
“Either way, I was going to get sick,” she said. “And I’d want someone who could handle it. If, by some twist of fate, I do get married and have children, at least we know what we’re getting into.”
After much debate, the friends settled on the third date as the right time to mention Huntington’s. But when the first date came, Ms. Moser wished she could just blurt it out.
“It kind of just lingers there,” she said. “I really just want to be able to tell people, ‘Someday, I’m going to have Huntington’s disease.’ ”
‘A Part of My Life’
Last May 6, a year to the day after she had received her test results, the subject line “CAG Count” caught Ms. Moser’s attention as she was scrolling through the online discussion forums of the Huntington’s Disease Advocacy Center. She knew she had 45 CAG repeats, but she had never investigated it further.
She clicked on the message.
“My mother’s CAG was 43,” it read. “She started forgetting the punch line to jokes at 39/40.” Another woman whose husband’s CAG count was 47 had just sold his car. “He’s 39 years old,” she wrote. “It was time for him to quit driving.”
Quickly, Ms. Moser scanned a chart that accompanied the messages for her number, 45. The median age of onset to which it corresponded was 37.
Ms. Elio got drunk with her husband the night Ms. Moser finally told her.
“That’s 12 years away,” Ms. Moser said.
The statistic, they knew, meant that half of those with her CAG number started showing symptoms after age 37. But it also meant that the other half started showing symptoms earlier.
Ms. Moser, meanwhile, flew to the annual convention of the Huntington’s Disease Society, which she had decided at the last minute to attend.
“Mother or father?” one woman, 23, from Chicago, asked a few minutes after meeting Ms. Moser in the elevator of the Milwaukee Hilton. “Have you tested? What’s your CAG?”
She was close to getting herself tested, the woman confided. How did it feel to know?
“It’s hard to think the other way anymore of not knowing,” Ms. Moser replied. “It’s become a part of my life.”
After years of trying to wring conversation from her family about Huntington’s, Ms. Moser suddenly found herself bathing in it. But for the first time in a long time, her mind was on other things. At a youth support group meeting in the hotel hallway, she took her place in the misshapen circle. Later, on the dance floor, the spasms of the symptomatic seemed as natural as the gyrations of the normal.
“I’m not alone in this,” Ms. Moser remembers thinking. “This affects other people, too, and we all just have to live our lives.”
Seizing the Day
July 15, the day of Ms. Moser’s 25th birthday party, was sunny, with a hint of moisture in the air. At her aunt’s house in Long Beach, N.Y., Ms. Moser wore a dress with pictures of cocktails on it. It was, she and Ms. Elio told anyone who would listen, her “cocktail dress.” They drew the quotation marks in the air.
A bowl of “Cure HD” pins sat on the table. Over burgers from the barbecue, Ms. Moser mentioned to family members from her father’s side that she had tested positive for the Huntington’s gene.
“What’s that?” one cousin asked.
“It will affect my ability to walk, talk and think,” Ms. Moser said. “Sometime before I’m 50.”
“That’s soon,” an uncle said matter-of-factly.
“So do you have to take medication?” her cousin asked.
“There’s nothing really to take,” Ms. Moser said.
She and the Elios put on bathing suits, loaded the children in a wagon and walked to the beach.
More than anything now, Ms. Moser said, she is filled with a sense of urgency.
“I have a lot to do,” she said. “And I don’t have a lot of time.”
Over the next months, Ms. Moser took tennis lessons every Sunday morning and went to church in the evening.
When a planned vacation with the Elio family fell through at the last minute, she went anyway, packing Disney World, Universal Studios, Wet ’n Wild and Sea World into 36 hours with a high school friend who lives in Orlando. She was honored at a dinner by the New York chapter of the Huntington’s society for her outreach efforts and managed a brief thank-you speech despite her discomfort with public speaking.
Having made a New Year’s resolution to learn to ride a unicycle, she bought a used one. “My legs are tired, my arms are tired, and I definitely need protection,” she reported to Ms. Elio. On Super Bowl Sunday, she waded into the freezing Atlantic Ocean for a Polar Bear swim to raise money for the Make-a-Wish Foundation.
Ms. Elio complained that she hardly got to see her friend. But one recent weekend, they packed up the Elio children and drove to the house the Elios were renovating in eastern Pennsylvania. The kitchen floor needed grouting, and, rejecting the home improvement gospel that calls for a special tool designed for the purpose, Ms. Moser and Ms. Elio had decided to use pastry bags.
As they turned into the driveway, Ms. Moser studied the semi-attached house next door. Maybe she would move in one day, as the Elios had proposed. Then, when she could no longer care for herself, they could put in a door.
First, though, she wanted to travel. She had heard of a job that would place her in different occupational therapy positions across the country every few months and was planning to apply.
“I’m thinking Hawaii first,” she said.
Then they donned gloves, mixed grout in a large bucket of water and began the job.
Sunday, February 11, 2007
Max Brenner chocolate
NYMag
Few legal substances exert as strong a pull as chocolate, which might explain the slightly dazed and practically drooling crowds streaming in and out of Max Brenner: Chocolate by the Bald Man, the glitzy new Union Square emporium that’s part retail sweetshop, part café, and all slickly packaged cocoa-scented theme park. With its vats of swirling molten chocolate, its ceiling pipes painted to resemble Oompa-Loompa–esque cocoa conduits, and the goofy chocolate-centric slogans scribbled everywhere, it’s hard to separate the place from the superslick marketing plan. For the chocolate-obsessed New Yorker, intimately familiar with the single-origin oeuvre of everyone from Jacques Torres to La Maison du Chocolat’s Robert Linxe, one question is even more pressing than whether to sample the chocolate bagel or the chocolate pizza: Who is this Max Brenner, and how come I’ve never heard of him?
The answer is bittersweet. Just as there is no Johnny Rocket and, sadly, no Chuck E. Cheese, there is no living, breathing Max Brenner—well, not really. The name is actually a composite of two Israeli marketing geniuses, Max Fichtman and Oded Brenner, who launched the business ten years ago in Ra’anana and sold it to Strauss-Elite (Israel’s version of Kraft), which now operates outposts and franchises from Melbourne to Makati City. Somewhere over the course of spreading the chocolate gospel, the European-trained (and sufficiently bald) chocolatier Oded Brenner has adopted the Wonka-like persona of “Max Brenner.” These days, he can generally be found at his newest location, expediting orders, munching chocolate-covered toast, and ensuring that the venture continues to position itself as the joyful antithesis of the intimidating realm that, his press materials assert, haute chocolate inhabits. Trouble is, Brenner’s self-proclaimed “new worldwide chocolate culture” comes off as just the sort of tourist-targeting spectacle you’d expect to find in Times Square, animated with loud Euro-accented house music and an abundance of overwrought, often overly sweet concoctions.
Like ChikaLicious and Room 4 Dessert, Max Brenner strives to be a dessert destination, and the minuscule café tables tend to be taken by groups of diet-be-damned girlfriends yapping away like overstimulated mynah birds, gurgling tots, and sheepish young couples on dates. The fact that the liquor license hasn’t arrived hasn’t hurt business one bit; most evenings, there’s a bottleneck at the hostess stand. Service, by the way, is friendly and well meaning, although the wait for food can be long. That wait means there’s plenty of time to study the room, done up in the usual cocoa-themed color palette of browns, caramel, orange, and cream, and to read the suggestive writing on the walls: VERY MUCH CHOCOLATE. YUMMY … STOP IT MAX, THIS IS ALREADY TOO MUCH. That’s a sentiment you can’t argue with after flipping through the somewhat disorienting menu, filled as it is with descriptors like “popping candies,” “chocolate licks,” and “crunchy bits,” and arranged into a dozen or so categories like “Max Iscream” (ice cream), Sweet Icons (fondues, soups, s’mores), and Desserts (cakes, meringues, truffles), many of them available grouped together on one plate like a BBQ combination platter.
The best way to order may be to resort to the same method some people use for finding a plumber in the Yellow Pages: Close your eyes, open up the book, and go with whatever your index finger happens to land on. If you’re lucky, you’ll end up with one of the fondues, like the Popsicle version—vanilla ice cream on a stick that comes on an embarrassing cartoon baby tray of sorts with little bowls of delicious melted chocolate, “crunchy chocolate waffle balls” that taste like Kit Kats, and the ever-popular “crunchy bits,” which seem like crushed praline. You dip the ice-creamsicle into the chocolate and then roll it around in the crunchy things like a recalcitrant 5-year-old who plays with his food. If you’re unlucky, you’ll end up with the cloyingly sweet chocolate-topped and crunchy-bitted pizza, or, worse, the Melting Chocolate Heart Cake, which your server will recommend and dutifully describe to you as never having elicited anything but squeals of joy but is really just a not-so-molten chocolate cake—more dormant volcano than hot lava flow.
Special attention is paid to drinks, perhaps because their custom-made vessels are sold in the shop. Of the various hot chocolates, all of them good, the best is the rich “Italian” version. It’s as thick as maple syrup, with a nicely balanced, dark-chocolate complexity. You can order this invigorating libation to go at the takeout bar or in the dining room, where it’s delivered to the table in what your server will describe to you as a “hug mug,” a ceramic cup tapered at one end in such a way as to encourage the drinker to grasp it reverently with both hands the way a frostbitten Swede cuddles his goblet of glogg. It’s much more user-friendly than the “suckao,” a bizarre apparatus in which you melt chocolate into milk over a candle flame and sip the resulting brew through a metal straw.
Because man (be he bald-headed or well coiffed) cannot live by chocolate alone, Max Brenner also offers a hodgepodge of savory dishes, from “giant” omelettes to “giant” kielbasa, presumably to fortify its customers for the impending sugar onslaught and to lower their risk of going into diabetic shock. As is often the case with menus that reach beyond their areas of expertise, none of this stuff goes over well. Just as you would not go to Il Mulino for a white-chocolate-Oreo-cookie frappé, you shouldn’t come to Max Brenner: Chocolate by the Bald Man for its lasagne Bolognese. That dish is a college-cafeteria-level rendition served, unfathomably, with a little bowl of what your server informs you is crème fraîche. Likewise, a croque madame that substitutes a waffle for bread is a dish more to be pitied than censured. And then there is Max’s pastrami sandwich: One way you can tell that it’s different from the one at Katz’s is that it’s served between two slices of French toast. On a more positive note, that giant kielbasa sandwich, served with sauerkraut, grainy mustard, and chile mayonnaise, isn’t half bad, and just try ordering a dish like that at La Maison du Chocolat.
No Stars
Max Brenner: Chocolate by the Bald Man
841 Broadway, nr. 13th St.; 212-388-0030
Few legal substances exert as strong a pull as chocolate, which might explain the slightly dazed and practically drooling crowds streaming in and out of Max Brenner: Chocolate by the Bald Man, the glitzy new Union Square emporium that’s part retail sweetshop, part café, and all slickly packaged cocoa-scented theme park. With its vats of swirling molten chocolate, its ceiling pipes painted to resemble Oompa-Loompa–esque cocoa conduits, and the goofy chocolate-centric slogans scribbled everywhere, it’s hard to separate the place from the superslick marketing plan. For the chocolate-obsessed New Yorker, intimately familiar with the single-origin oeuvre of everyone from Jacques Torres to La Maison du Chocolat’s Robert Linxe, one question is even more pressing than whether to sample the chocolate bagel or the chocolate pizza: Who is this Max Brenner, and how come I’ve never heard of him?
The answer is bittersweet. Just as there is no Johnny Rocket and, sadly, no Chuck E. Cheese, there is no living, breathing Max Brenner—well, not really. The name is actually a composite of two Israeli marketing geniuses, Max Fichtman and Oded Brenner, who launched the business ten years ago in Ra’anana and sold it to Strauss-Elite (Israel’s version of Kraft), which now operates outposts and franchises from Melbourne to Makati City. Somewhere over the course of spreading the chocolate gospel, the European-trained (and sufficiently bald) chocolatier Oded Brenner has adopted the Wonka-like persona of “Max Brenner.” These days, he can generally be found at his newest location, expediting orders, munching chocolate-covered toast, and ensuring that the venture continues to position itself as the joyful antithesis of the intimidating realm that, his press materials assert, haute chocolate inhabits. Trouble is, Brenner’s self-proclaimed “new worldwide chocolate culture” comes off as just the sort of tourist-targeting spectacle you’d expect to find in Times Square, animated with loud Euro-accented house music and an abundance of overwrought, often overly sweet concoctions.
Like ChikaLicious and Room 4 Dessert, Max Brenner strives to be a dessert destination, and the minuscule café tables tend to be taken by groups of diet-be-damned girlfriends yapping away like overstimulated mynah birds, gurgling tots, and sheepish young couples on dates. The fact that the liquor license hasn’t arrived hasn’t hurt business one bit; most evenings, there’s a bottleneck at the hostess stand. Service, by the way, is friendly and well meaning, although the wait for food can be long. That wait means there’s plenty of time to study the room, done up in the usual cocoa-themed color palette of browns, caramel, orange, and cream, and to read the suggestive writing on the walls: VERY MUCH CHOCOLATE. YUMMY … STOP IT MAX, THIS IS ALREADY TOO MUCH. That’s a sentiment you can’t argue with after flipping through the somewhat disorienting menu, filled as it is with descriptors like “popping candies,” “chocolate licks,” and “crunchy bits,” and arranged into a dozen or so categories like “Max Iscream” (ice cream), Sweet Icons (fondues, soups, s’mores), and Desserts (cakes, meringues, truffles), many of them available grouped together on one plate like a BBQ combination platter.
The best way to order may be to resort to the same method some people use for finding a plumber in the Yellow Pages: Close your eyes, open up the book, and go with whatever your index finger happens to land on. If you’re lucky, you’ll end up with one of the fondues, like the Popsicle version—vanilla ice cream on a stick that comes on an embarrassing cartoon baby tray of sorts with little bowls of delicious melted chocolate, “crunchy chocolate waffle balls” that taste like Kit Kats, and the ever-popular “crunchy bits,” which seem like crushed praline. You dip the ice-creamsicle into the chocolate and then roll it around in the crunchy things like a recalcitrant 5-year-old who plays with his food. If you’re unlucky, you’ll end up with the cloyingly sweet chocolate-topped and crunchy-bitted pizza, or, worse, the Melting Chocolate Heart Cake, which your server will recommend and dutifully describe to you as never having elicited anything but squeals of joy but is really just a not-so-molten chocolate cake—more dormant volcano than hot lava flow.
Special attention is paid to drinks, perhaps because their custom-made vessels are sold in the shop. Of the various hot chocolates, all of them good, the best is the rich “Italian” version. It’s as thick as maple syrup, with a nicely balanced, dark-chocolate complexity. You can order this invigorating libation to go at the takeout bar or in the dining room, where it’s delivered to the table in what your server will describe to you as a “hug mug,” a ceramic cup tapered at one end in such a way as to encourage the drinker to grasp it reverently with both hands the way a frostbitten Swede cuddles his goblet of glogg. It’s much more user-friendly than the “suckao,” a bizarre apparatus in which you melt chocolate into milk over a candle flame and sip the resulting brew through a metal straw.
Because man (be he bald-headed or well coiffed) cannot live by chocolate alone, Max Brenner also offers a hodgepodge of savory dishes, from “giant” omelettes to “giant” kielbasa, presumably to fortify its customers for the impending sugar onslaught and to lower their risk of going into diabetic shock. As is often the case with menus that reach beyond their areas of expertise, none of this stuff goes over well. Just as you would not go to Il Mulino for a white-chocolate-Oreo-cookie frappé, you shouldn’t come to Max Brenner: Chocolate by the Bald Man for its lasagne Bolognese. That dish is a college-cafeteria-level rendition served, unfathomably, with a little bowl of what your server informs you is crème fraîche. Likewise, a croque madame that substitutes a waffle for bread is a dish more to be pitied than censured. And then there is Max’s pastrami sandwich: One way you can tell that it’s different from the one at Katz’s is that it’s served between two slices of French toast. On a more positive note, that giant kielbasa sandwich, served with sauerkraut, grainy mustard, and chile mayonnaise, isn’t half bad, and just try ordering a dish like that at La Maison du Chocolat.
No Stars
Max Brenner: Chocolate by the Bald Man
841 Broadway, nr. 13th St.; 212-388-0030
Korean fried chicken
NYTimes
February 7, 2007
Koreans Share Their Secret for Chicken With a Crunch
By JULIA MOSKIN
WHEN Joe McPherson moved to Seoul in 2002, he thought he was leaving fried chicken behind. “I grew up watching Popeyes training videos,” Mr. McPherson said. His father managed a Popeyes franchise near Atlanta and fried chicken was a constant presence in his life.
“Living in the South, you think you know fried chicken,” he said. But in Seoul, he said, “there is a mom-and-pop chicken place literally on every corner.” Many Asian cooking traditions include deep-fried chicken, but the popular cult of crunchy, spicy, perfectly nongreasy chicken — the apotheosis of the Korean style — is a recent development.
In the New York area, Korean-style fried chicken places have just begun to appear, reproducing the delicate crust, addictive seasoning and moist meat Koreans are devoted to.
“Food in Korea is very trendy,” said Myung J. Chung, an owner of the Manhattan franchise of Bon Chon Chicken, a karaoke-and-chicken lounge that opened in December. “Other trends last two or three years, but fried chicken has lasted for 20 years,” he said.
Platters of fried chicken are a hugely popular bar food in South Korea — like chicken wings in the United States, they are downed with beer or soju, after work or after dinner, rarely eaten as a meal.
“Some places have a very thin, crisp skin; some places have more garlicky, sticky sauces; some advertise that they are healthy because they fry in 100 percent olive oil,” said Mr. McPherson, an English teacher, who writes a food blog called zenkimchi.com/FoodJournal.
“Suddenly there will be a long line outside one chicken place, for no apparent reason, and then the next week, it’s somewhere else.”
Even Korea’s corner bars and fast-food chicken chains are preoccupied with the quality, freshness and integrity of their product.
With Korean-style chicken outlets opening recently in New York, New Jersey and California, fried chicken has begun to complete its round-trip flight from the States to Seoul.
“I really think we make it better than the original,” said Young Jin, who opened a friendly little chicken joint called Unidentified Flying Chickens in Jackson Heights last month. “We use fresh, not frozen, chicken, always fried to order, no trans fats, no heat lamps.”
In Korea, chickens are much smaller, so the whole chicken is fried and served, hacked up into bite-size pieces. But the large breasts and thighs of American chickens are a challenge to cook evenly.
According to Mr. Jin and others, that’s why the Korean-style chicken places here serve mostly wings (true connoisseurs can specify either the upper “arm” or the “wing”) and small drumsticks. The chicken is typically seasoned only after it is fried, with either a sweetish garlic-soy glaze or a hotter red-pepper sauce that brings the dish into Buffalo wing territory.
But do not look for blue cheese and celery sticks, or even biscuits and gravy. The typical accompaniment to Korean fried chicken is cubes of pickled radish and plenty of beer or soju; the combination produces an irresistible repetition of salt and spice, cold and hot, briny and sweet, crunchy and tender.
“People — even Americans — say the combination is really addictive,” said Ryan Jhun, Mr. Chung’s brother-in-law and business partner. Mr. Jhun spent a month training with the founder of Bon Chon to master the chain’s frying method, which produces characteristically light and crunchy pieces. Bon Chon, Bon Bon and Unidentified Flying Chickens all base their technique on the one developed by Kyochon, one of the most popular Korean chains. Although none of the chicken fryers interviewed would describe the method in its entirety, its outline is clear. (Warning: partisans of Southern-fried chicken will find much that is blasphemous in the following.)
For crunch, American-style fried chicken relies on a thick, well-seasoned crust, often made even thicker by soaking the chicken pieces beforehand in buttermilk. When that crust is nubbly and evenly browned, and the chicken meat is cooked through, the chicken is sublime. But too often, the flesh is still raw when the crust is cooked, or the skin never cooks all the way through, leaving a flabby layer of skin between the meat and the crust.
Korean-style fried chicken is radically different, reflecting an Asian frying technique that renders out the fat in the skin, transforming it into a thin, crackly and almost transparent crust. (Chinese cooks call this “paper fried chicken.”) The chicken is unseasoned, barely dredged in very fine flour and then dipped into a thin batter before going into the fryer. The oil temperature is a relatively low 350 degrees, and the chicken is cooked in two separate stages.
After 10 minutes, the chicken is removed from the oil, shaken vigorously in a wire strainer and allowed to cool for two minutes. This slows the cooking process, preventing the crust from getting too brown before the meat cooks through. It also shaves off all those crusty nubs and crags that American cooks strive for.
After 10 more minutes in the fryer, the chicken is smooth, compact, golden-brown, and done. Then, it’s served plain (with a small dish of salt and pepper for seasoning) or lightly painted with sauce. When it’s done correctly, the sauce is absorbed into the crust, adding savor without making it soggy.
Last week, I tasted chicken from four different Korean-style spots, and arrived at a rule of thumb that the best chicken had the least sauce (although chicken with no sauce at all was weirdly bland). The chain Cheogajip was more heavy-handed with the sauce than the others, making their chicken too sticky and sweet. But all the other chicken was at least tasty and even delicious, remaining crisp through the day and when reheated the next morning. The sauces at Unidentified Flying Chickens, which Mr. Jin makes from scratch and is still developing, had the most rounded flavors.
Mr. Jin sees his new store, located in a neighborhood that is more Latino than Asian, as the cradle of a multicultural empire devoted to one thing: perfect fried chicken.
“You wouldn’t go to a soft tofu store and expect to find great kalbi,” he said, referring to the grilled, sweet-and-salty short ribs that are another Korean favorite. “When you make only one thing, and you make people wait for 20 minutes to get it, it had better be good.”
A Sampler
Here are places to try Korean-style fried chicken in New York City. Seating is often limited. All chicken is fried to order, so for takeout or delivery, call at least 30 minutes ahead.
BON CHON CHICKEN 314 Fifth Avenue (32nd Street), second floor, (212) 221-2222; and 157-18 Northern Boulevard (58th Street), Queens, (718) 321-3818.
BON BON CHICKEN 98 Chambers Street (Church Street), (212) 227-2375, opening in March.
UNIDENTIFIED FLYING CHICKENS 71-22 Roosevelt Avenue (71st Street), Queens, (718) 205-6662.
February 7, 2007
Koreans Share Their Secret for Chicken With a Crunch
By JULIA MOSKIN
WHEN Joe McPherson moved to Seoul in 2002, he thought he was leaving fried chicken behind. “I grew up watching Popeyes training videos,” Mr. McPherson said. His father managed a Popeyes franchise near Atlanta and fried chicken was a constant presence in his life.
“Living in the South, you think you know fried chicken,” he said. But in Seoul, he said, “there is a mom-and-pop chicken place literally on every corner.” Many Asian cooking traditions include deep-fried chicken, but the popular cult of crunchy, spicy, perfectly nongreasy chicken — the apotheosis of the Korean style — is a recent development.
In the New York area, Korean-style fried chicken places have just begun to appear, reproducing the delicate crust, addictive seasoning and moist meat Koreans are devoted to.
“Food in Korea is very trendy,” said Myung J. Chung, an owner of the Manhattan franchise of Bon Chon Chicken, a karaoke-and-chicken lounge that opened in December. “Other trends last two or three years, but fried chicken has lasted for 20 years,” he said.
Platters of fried chicken are a hugely popular bar food in South Korea — like chicken wings in the United States, they are downed with beer or soju, after work or after dinner, rarely eaten as a meal.
“Some places have a very thin, crisp skin; some places have more garlicky, sticky sauces; some advertise that they are healthy because they fry in 100 percent olive oil,” said Mr. McPherson, an English teacher, who writes a food blog called zenkimchi.com/FoodJournal.
“Suddenly there will be a long line outside one chicken place, for no apparent reason, and then the next week, it’s somewhere else.”
Even Korea’s corner bars and fast-food chicken chains are preoccupied with the quality, freshness and integrity of their product.
With Korean-style chicken outlets opening recently in New York, New Jersey and California, fried chicken has begun to complete its round-trip flight from the States to Seoul.
“I really think we make it better than the original,” said Young Jin, who opened a friendly little chicken joint called Unidentified Flying Chickens in Jackson Heights last month. “We use fresh, not frozen, chicken, always fried to order, no trans fats, no heat lamps.”
In Korea, chickens are much smaller, so the whole chicken is fried and served, hacked up into bite-size pieces. But the large breasts and thighs of American chickens are a challenge to cook evenly.
According to Mr. Jin and others, that’s why the Korean-style chicken places here serve mostly wings (true connoisseurs can specify either the upper “arm” or the “wing”) and small drumsticks. The chicken is typically seasoned only after it is fried, with either a sweetish garlic-soy glaze or a hotter red-pepper sauce that brings the dish into Buffalo wing territory.
But do not look for blue cheese and celery sticks, or even biscuits and gravy. The typical accompaniment to Korean fried chicken is cubes of pickled radish and plenty of beer or soju; the combination produces an irresistible repetition of salt and spice, cold and hot, briny and sweet, crunchy and tender.
“People — even Americans — say the combination is really addictive,” said Ryan Jhun, Mr. Chung’s brother-in-law and business partner. Mr. Jhun spent a month training with the founder of Bon Chon to master the chain’s frying method, which produces characteristically light and crunchy pieces. Bon Chon, Bon Bon and Unidentified Flying Chickens all base their technique on the one developed by Kyochon, one of the most popular Korean chains. Although none of the chicken fryers interviewed would describe the method in its entirety, its outline is clear. (Warning: partisans of Southern-fried chicken will find much that is blasphemous in the following.)
For crunch, American-style fried chicken relies on a thick, well-seasoned crust, often made even thicker by soaking the chicken pieces beforehand in buttermilk. When that crust is nubbly and evenly browned, and the chicken meat is cooked through, the chicken is sublime. But too often, the flesh is still raw when the crust is cooked, or the skin never cooks all the way through, leaving a flabby layer of skin between the meat and the crust.
Korean-style fried chicken is radically different, reflecting an Asian frying technique that renders out the fat in the skin, transforming it into a thin, crackly and almost transparent crust. (Chinese cooks call this “paper fried chicken.”) The chicken is unseasoned, barely dredged in very fine flour and then dipped into a thin batter before going into the fryer. The oil temperature is a relatively low 350 degrees, and the chicken is cooked in two separate stages.
After 10 minutes, the chicken is removed from the oil, shaken vigorously in a wire strainer and allowed to cool for two minutes. This slows the cooking process, preventing the crust from getting too brown before the meat cooks through. It also shaves off all those crusty nubs and crags that American cooks strive for.
After 10 more minutes in the fryer, the chicken is smooth, compact, golden-brown, and done. Then, it’s served plain (with a small dish of salt and pepper for seasoning) or lightly painted with sauce. When it’s done correctly, the sauce is absorbed into the crust, adding savor without making it soggy.
Last week, I tasted chicken from four different Korean-style spots, and arrived at a rule of thumb that the best chicken had the least sauce (although chicken with no sauce at all was weirdly bland). The chain Cheogajip was more heavy-handed with the sauce than the others, making their chicken too sticky and sweet. But all the other chicken was at least tasty and even delicious, remaining crisp through the day and when reheated the next morning. The sauces at Unidentified Flying Chickens, which Mr. Jin makes from scratch and is still developing, had the most rounded flavors.
Mr. Jin sees his new store, located in a neighborhood that is more Latino than Asian, as the cradle of a multicultural empire devoted to one thing: perfect fried chicken.
“You wouldn’t go to a soft tofu store and expect to find great kalbi,” he said, referring to the grilled, sweet-and-salty short ribs that are another Korean favorite. “When you make only one thing, and you make people wait for 20 minutes to get it, it had better be good.”
A Sampler
Here are places to try Korean-style fried chicken in New York City. Seating is often limited. All chicken is fried to order, so for takeout or delivery, call at least 30 minutes ahead.
BON CHON CHICKEN 314 Fifth Avenue (32nd Street), second floor, (212) 221-2222; and 157-18 Northern Boulevard (58th Street), Queens, (718) 321-3818.
BON BON CHICKEN 98 Chambers Street (Church Street), (212) 227-2375, opening in March.
UNIDENTIFIED FLYING CHICKENS 71-22 Roosevelt Avenue (71st Street), Queens, (718) 205-6662.
Sunday, January 28, 2007
Nutrition/dietary article
NYTimes
January 28, 2007
Unhappy Meals
By MICHAEL POLLAN
Eat food. Not too much. Mostly plants.
That, more or less, is the short answer to the supposedly incredibly complicated and confusing question of what we humans should eat in order to be maximally healthy. I hate to give away the game right here at the beginning of a long essay, and I confess that I’m tempted to complicate matters in the interest of keeping things going for a few thousand more words. I’ll try to resist but will go ahead and add a couple more details to flesh out the advice. Like: A little meat won’t kill you, though it’s better approached as a side dish than as a main. And you’re much better off eating whole fresh foods than processed food products. That’s what I mean by the recommendation to eat “food.” Once, food was all you could eat, but today there are lots of other edible foodlike substances in the supermarket. These novel products of food science often come in packages festooned with health claims, which brings me to a related rule of thumb: if you’re concerned about your health, you should probably avoid food products that make health claims. Why? Because a health claim on a food product is a good indication that it’s not really food, and food is what you want to eat.
Uh-oh. Things are suddenly sounding a little more complicated, aren’t they? Sorry. But that’s how it goes as soon as you try to get to the bottom of the whole vexing question of food and health. Before long, a dense cloud bank of confusion moves in. Sooner or later, everything solid you thought you knew about the links between diet and health gets blown away in the gust of the latest study.
Last winter came the news that a low-fat diet, long believed to protect against breast cancer, may do no such thing — this from the monumental, federally financed Women’s Health Initiative, which has also found no link between a low-fat diet and rates of coronary disease. The year before we learned that dietary fiber might not, as we had been confidently told, help prevent colon cancer. Just last fall two prestigious studies on omega-3 fats published at the same time presented us with strikingly different conclusions. While the Institute of Medicine stated that “it is uncertain how much these omega-3s contribute to improving health” (and they might do the opposite if you get them from mercury-contaminated fish), a Harvard study declared that simply by eating a couple of servings of fish each week (or by downing enough fish oil), you could cut your risk of dying from a heart attack by more than a third — a stunningly hopeful piece of news. It’s no wonder that omega-3 fatty acids are poised to become the oat bran of 2007, as food scientists micro-encapsulate fish oil and algae oil and blast them into such formerly all-terrestrial foods as bread and tortillas, milk and yogurt and cheese, all of which will soon, you can be sure, sprout fishy new health claims. (Remember the rule?)
By now you’re probably registering the cognitive dissonance of the supermarket shopper or science-section reader, as well as some nostalgia for the simplicity and solidity of the first few sentences of this essay. Which I’m still prepared to defend against the shifting winds of nutritional science and food-industry marketing. But before I do that, it might be useful to figure out how we arrived at our present state of nutritional confusion and anxiety.
The story of how the most basic questions about what to eat ever got so complicated reveals a great deal about the institutional imperatives of the food industry, nutritional science and — ahem — journalism, three parties that stand to gain much from widespread confusion surrounding what is, after all, the most elemental question an omnivore confronts. Humans deciding what to eat without expert help — something they have been doing with notable success since coming down out of the trees — is seriously unprofitable if you’re a food company, distinctly risky if you’re a nutritionist and just plain boring if you’re a newspaper editor or journalist. (Or, for that matter, an eater. Who wants to hear, yet again, “Eat more fruits and vegetables”?) And so, like a large gray fog, a great Conspiracy of Confusion has gathered around the simplest questions of nutrition — much to the advantage of everybody involved. Except perhaps the ostensible beneficiary of all this nutritional expertise and advice: us, and our health and happiness as eaters.
FROM FOODS TO NUTRIENTS
It was in the 1980s that food began disappearing from the American supermarket, gradually to be replaced by “nutrients,” which are not the same thing. Where once the familiar names of recognizable comestibles — things like eggs or breakfast cereal or cookies — claimed pride of place on the brightly colored packages crowding the aisles, now new terms like “fiber” and “cholesterol” and “saturated fat” rose to large-type prominence. More important than mere foods, the presence or absence of these invisible substances was now generally believed to confer health benefits on their eaters. Foods by comparison were coarse, old-fashioned and decidedly unscientific things — who could say what was in them, really? But nutrients — those chemical compounds and minerals in foods that nutritionists have deemed important to health — gleamed with the promise of scientific certainty; eat more of the right ones, fewer of the wrong, and you would live longer and avoid chronic diseases.
Nutrients themselves had been around, as a concept, since the early 19th century, when the English doctor and chemist William Prout identified what came to be called the “macronutrients”: protein, fat and carbohydrates. It was thought that that was pretty much all there was going on in food, until doctors noticed that an adequate supply of the big three did not necessarily keep people nourished. At the end of the 19th century, British doctors were puzzled by the fact that Chinese laborers in the Malay states were dying of a disease called beriberi, which didn’t seem to afflict Tamils or native Malays. The mystery was solved when someone pointed out that the Chinese ate “polished,” or white, rice, while the others ate rice that hadn’t been mechanically milled. A few years later, Casimir Funk, a Polish chemist, discovered the “essential nutrient” in rice husks that protected against beriberi and called it a “vitamine,” the first micronutrient. Vitamins brought a kind of glamour to the science of nutrition, and though certain sectors of the population began to eat by its expert lights, it really wasn’t until late in the 20th century that nutrients managed to push food aside in the popular imagination of what it means to eat.
No single event marked the shift from eating food to eating nutrients, though in retrospect a little-noticed political dust-up in Washington in 1977 seems to have helped propel American food culture down this dimly lighted path. Responding to an alarming increase in chronic diseases linked to diet — including heart disease, cancer and diabetes — a Senate Select Committee on Nutrition, headed by George McGovern, held hearings on the problem and prepared what by all rights should have been an uncontroversial document called “Dietary Goals for the United States.” The committee learned that while rates of coronary heart disease had soared in America since World War II, other cultures that consumed traditional diets based largely on plants had strikingly low rates of chronic disease. Epidemiologists also had observed that in America during the war years, when meat and dairy products were strictly rationed, the rate of heart disease temporarily plummeted.
Naïvely putting two and two together, the committee drafted a straightforward set of dietary guidelines calling on Americans to cut down on red meat and dairy products. Within weeks a firestorm, emanating from the red-meat and dairy industries, engulfed the committee, and Senator McGovern (who had a great many cattle ranchers among his South Dakota constituents) was forced to beat a retreat. The committee’s recommendations were hastily rewritten. Plain talk about food — the committee had advised Americans to actually “reduce consumption of meat” — was replaced by artful compromise: “Choose meats, poultry and fish that will reduce saturated-fat intake.”
A subtle change in emphasis, you might say, but a world of difference just the same. First, the stark message to “eat less” of a particular food has been deep-sixed; don’t look for it ever again in any official U.S. dietary pronouncement. Second, notice how distinctions between entities as different as fish and beef and chicken have collapsed; those three venerable foods, each representing an entirely different taxonomic class, are now lumped together as delivery systems for a single nutrient. Notice too how the new language exonerates the foods themselves; now the culprit is an obscure, invisible, tasteless — and politically unconnected — substance that may or may not lurk in them called “saturated fat.”
The linguistic capitulation did nothing to rescue McGovern from his blunder; the very next election, in 1980, the beef lobby helped rusticate the three-term senator, sending an unmistakable warning to anyone who would challenge the American diet, and in particular the big chunk of animal protein sitting in the middle of its plate. Henceforth, government dietary guidelines would shun plain talk about whole foods, each of which has its trade association on Capitol Hill, and would instead arrive clothed in scientific euphemism and speaking of nutrients, entities that few Americans really understood but that lack powerful lobbies in Washington. This was precisely the tack taken by the National Academy of Sciences when it issued its landmark report on diet and cancer in 1982. Organized nutrient by nutrient in a way guaranteed to offend no food group, it codified the official new dietary language. Industry and media followed suit, and terms like polyunsaturated, cholesterol, monounsaturated, carbohydrate, fiber, polyphenols, amino acids and carotenes soon colonized much of the cultural space previously occupied by the tangible substance formerly known as food. The Age of Nutritionism had arrived.
THE RISE OF NUTRITIONISM
The first thing to understand about nutritionism — I first encountered the term in the work of an Australian sociologist of science named Gyorgy Scrinis — is that it is not quite the same as nutrition. As the “ism” suggests, it is not a scientific subject but an ideology. Ideologies are ways of organizing large swaths of life and experience under a set of shared but unexamined assumptions. This quality makes an ideology particularly hard to see, at least while it’s exerting its hold on your culture. A reigning ideology is a little like the weather, all pervasive and virtually inescapable. Still, we can try.
In the case of nutritionism, the widely shared but unexamined assumption is that the key to understanding food is indeed the nutrient. From this basic premise flow several others. Since nutrients, as compared with foods, are invisible and therefore slightly mysterious, it falls to the scientists (and to the journalists through whom the scientists speak) to explain the hidden reality of foods to us. To enter a world in which you dine on unseen nutrients, you need lots of expert help.
But expert help to do what, exactly? This brings us to another unexamined assumption: that the whole point of eating is to maintain and promote bodily health. Hippocrates’s famous injunction to “let food be thy medicine” is ritually invoked to support this notion. I’ll leave the premise alone for now, except to point out that it is not shared by all cultures and that the experience of these other cultures suggests that, paradoxically, viewing food as being about things other than bodily health — like pleasure, say, or socializing — makes people no less healthy; indeed, there’s some reason to believe that it may make them more healthy. This is what we usually have in mind when we speak of the “French paradox” — the fact that a population that eats all sorts of unhealthful nutrients is in many ways healthier than we Americans are. So there is at least a question as to whether nutritionism is actually any good for you.
Another potentially serious weakness of nutritionist ideology is that it has trouble discerning qualitative distinctions between foods. So fish, beef and chicken through the nutritionists’ lens become mere delivery systems for varying quantities of fats and proteins and whatever other nutrients are on their scope. Similarly, any qualitative distinctions between processed foods and whole foods disappear when your focus is on quantifying the nutrients they contain (or, more precisely, the known nutrients).
This is a great boon for manufacturers of processed food, and it helps explain why they have been so happy to get with the nutritionism program. In the years following McGovern’s capitulation and the 1982 National Academy report, the food industry set about re-engineering thousands of popular food products to contain more of the nutrients that science and government had deemed the good ones and less of the bad, and by the late ’80s a golden era of food science was upon us. The Year of Eating Oat Bran — also known as 1988 — served as a kind of coming-out party for the food scientists, who succeeded in getting the material into nearly every processed food sold in America. Oat bran’s moment on the dietary stage didn’t last long, but the pattern had been established, and every few years since then a new oat bran has taken its turn under the marketing lights. (Here comes omega-3!)
By comparison, the typical real food has more trouble competing under the rules of nutritionism, if only because something like a banana or an avocado can’t easily change its nutritional stripes (though rest assured the genetic engineers are hard at work on the problem). So far, at least, you can’t put oat bran in a banana. So depending on the reigning nutritional orthodoxy, the avocado might be either a high-fat food to be avoided (Old Think) or a food high in monounsaturated fat to be embraced (New Think). The fate of each whole food rises and falls with every change in the nutritional weather, while the processed foods are simply reformulated. That’s why when the Atkins mania hit the food industry, bread and pasta were given a quick redesign (dialing back the carbs; boosting the protein), while the poor unreconstructed potatoes and carrots were left out in the cold.
Of course it’s also a lot easier to slap a health claim on a box of sugary cereal than on a potato or carrot, with the perverse result that the most healthful foods in the supermarket sit there quietly in the produce section, silent as stroke victims, while a few aisles over, the Cocoa Puffs and Lucky Charms are screaming about their newfound whole-grain goodness.
EAT RIGHT, GET FATTER
So nutritionism is good for business. But is it good for us? You might think that a national fixation on nutrients would lead to measurable improvements in the public health. But for that to happen, the underlying nutritional science, as well as the policy recommendations (and the journalism) based on that science, would have to be sound. This has seldom been the case.
Consider what happened immediately after the 1977 “Dietary Goals” — McGovern’s masterpiece of politico-nutritionist compromise. In the wake of the panel’s recommendation that we cut down on saturated fat, a recommendation seconded by the 1982 National Academy report on cancer, Americans did indeed change their diets, endeavoring for a quarter-century to do what they had been told. Well, kind of. The industrial food supply was promptly reformulated to reflect the official advice, giving us low-fat pork, low-fat Snackwell’s and all the low-fat pasta and high-fructose (yet low-fat!) corn syrup we could consume. Which turned out to be quite a lot. Oddly, America got really fat on its new low-fat diet — indeed, many date the current obesity and diabetes epidemic to the late 1970s, when Americans began binging on carbohydrates, ostensibly as a way to avoid the evils of fat.
This story has been told before, notably in these pages (“What if It’s All Been a Big Fat Lie?” by Gary Taubes, July 7, 2002), but it’s a little more complicated than the official version suggests. In that version, which inspired the most recent Atkins craze, we were told that America got fat when, responding to bad scientific advice, it shifted its diet from fats to carbs, suggesting that a re-evaluation of the two nutrients is in order: fat doesn’t make you fat; carbs do. (Why this should have come as news is a mystery: as long as people have been raising animals for food, they have fattened them on carbs.)
But there are a couple of problems with this revisionist picture. First, while it is true that Americans post-1977 did begin binging on carbs, and that fat as a percentage of total calories in the American diet declined, we never did in fact cut down on our consumption of fat. Meat consumption actually climbed. We just heaped a bunch more carbs onto our plates, obscuring perhaps, but not replacing, the expanding chunk of animal protein squatting in the center.
How did that happen? I would submit that the ideology of nutritionism deserves as much of the blame as the carbohydrates themselves do — that and human nature. By framing dietary advice in terms of good and bad nutrients, and by burying the recommendation that we should eat less of any particular food, it was easy for the take-home message of the 1977 and 1982 dietary guidelines to be simplified as follows: Eat more low-fat foods. And that is what we did. We’re always happy to receive a dispensation to eat more of something (with the possible exception of oat bran), and one of the things nutritionism reliably gives us is some such dispensation: low-fat cookies then, low-carb beer now. It’s hard to imagine the low-fat craze taking off as it did if McGovern’s original food-based recommendations had stood: eat fewer meat and dairy products. For how do you get from that stark counsel to the idea that another case of Snackwell’s is just what the doctor ordered?
BAD SCIENCE
But if nutritionism leads to a kind of false consciousness in the mind of the eater, the ideology can just as easily mislead the scientist. Most nutritional science involves studying one nutrient at a time, an approach that even nutritionists who do it will tell you is deeply flawed. “The problem with nutrient-by-nutrient nutrition science,” points out Marion Nestle, the New York University nutritionist, “is that it takes the nutrient out of the context of food, the food out of the context of diet and the diet out of the context of lifestyle.”
If nutritional scientists know this, why do they do it anyway? Because a nutrient bias is built into the way science is done: scientists need individual variables they can isolate. Yet even the simplest food is a hopelessly complex thing to study, a virtual wilderness of chemical compounds, many of which exist in complex and dynamic relation to one another, and all of which together are in the process of changing from one state to another. So if you’re a nutritional scientist, you do the only thing you can do, given the tools at your disposal: break the thing down into its component parts and study those one by one, even if that means ignoring complex interactions and contexts, as well as the fact that the whole may be more than, or just different from, the sum of its parts. This is what we mean by reductionist science.
Scientific reductionism is an undeniably powerful tool, but it can mislead us too, especially when applied to something as complex as, on the one side, a food, and on the other, a human eater. It encourages us to take a mechanistic view of that transaction: put in this nutrient; get out that physiological result. Yet people differ in important ways. Some populations can metabolize sugars better than others; depending on your evolutionary heritage, you may or may not be able to digest the lactose in milk. The specific ecology of your intestines helps determine how efficiently you digest what you eat, so that the same input of 100 calories may yield more or less energy depending on the proportion of Firmicutes and Bacteroidetes living in your gut. There is nothing very machinelike about the human eater, and so to think of food as simply fuel is wrong.
Also, people don’t eat nutrients, they eat foods, and foods can behave very differently than the nutrients they contain. Researchers have long believed, based on epidemiological comparisons of different populations, that a diet high in fruits and vegetables confers some protection against cancer. So naturally they ask, What nutrients in those plant foods are responsible for that effect? One hypothesis is that the antioxidants in fresh produce — compounds like beta carotene, lycopene, vitamin E, etc. — are the X factor. It makes good sense: these molecules (which plants produce to protect themselves from the highly reactive oxygen atoms produced in photosynthesis) vanquish the free radicals in our bodies, which can damage DNA and initiate cancers. At least that’s how it seems to work in the test tube. Yet as soon as you remove these useful molecules from the context of the whole foods they’re found in, as we’ve done in creating antioxidant supplements, they don’t work at all. Indeed, in the case of beta carotene ingested as a supplement, scientists have discovered that it actually increases the risk of certain cancers. Big oops.
What’s going on here? We don’t know. It could be the vagaries of human digestion. Maybe the fiber (or some other component) in a carrot protects the antioxidant molecules from destruction by stomach acids early in the digestive process. Or it could be that we isolated the wrong antioxidant. Beta is just one of a whole slew of carotenes found in common vegetables; maybe we focused on the wrong one. Or maybe beta carotene works as an antioxidant only in concert with some other plant chemical or process; under other circumstances, it may behave as a pro-oxidant.
Indeed, to look at the chemical composition of any common food plant is to realize just how much complexity lurks within it. Here’s a list of just the antioxidants that have been identified in garden-variety thyme:
4-Terpineol, alanine, anethole, apigenin, ascorbic acid, beta carotene, caffeic acid, camphene, carvacrol, chlorogenic acid, chrysoeriol, eriodictyol, eugenol, ferulic acid, gallic acid, gamma-terpinene isochlorogenic acid, isoeugenol, isothymonin, kaempferol, labiatic acid, lauric acid, linalyl acetate, luteolin, methionine, myrcene, myristic acid, naringenin, oleanolic acid, p-coumoric acid, p-hydroxy-benzoic acid, palmitic acid, rosmarinic acid, selenium, tannin, thymol, tryptophan, ursolic acid, vanillic acid.
This is what you’re ingesting when you eat food flavored with thyme. Some of these chemicals are broken down by your digestion, but others are going on to do undetermined things to your body: turning some gene’s expression on or off, perhaps, or heading off a free radical before it disturbs a strand of DNA deep in some cell. It would be great to know how this all works, but in the meantime we can enjoy thyme in the knowledge that it probably doesn’t do any harm (since people have been eating it forever) and that it may actually do some good (since people have been eating it forever) and that even if it does nothing, we like the way it tastes.
It’s also important to remind ourselves that what reductive science can manage to perceive well enough to isolate and study is subject to change, and that we have a tendency to assume that what we can see is all there is to see. When William Prout isolated the big three macronutrients, scientists figured they now understood food and what the body needs from it; when the vitamins were isolated a few decades later, scientists thought, O.K., now we really understand food and what the body needs to be healthy; today it’s the polyphenols and carotenoids that seem all-important. But who knows what the hell else is going on deep in the soul of a carrot?
The good news is that, to the carrot eater, it doesn’t matter. That’s the great thing about eating food as compared with nutrients: you don’t need to fathom a carrot’s complexity to reap its benefits.
The case of the antioxidants points up the dangers in taking a nutrient out of the context of food; as Nestle suggests, scientists make a second, related error when they study the food out of the context of the diet. We don’t eat just one thing, and when we are eating any one thing, we’re not eating another. We also eat foods in combinations and in orders that can affect how they’re absorbed. Drink coffee with your steak, and your body won’t be able to fully absorb the iron in the meat. The trace of limestone in the corn tortilla unlocks essential amino acids in the corn that would otherwise remain unavailable. Some of those compounds in that sprig of thyme may well affect my digestion of the dish I add it to, helping to break down one compound or possibly stimulate production of an enzyme to detoxify another. We have barely begun to understand the relationships among foods in a cuisine.
But we do understand some of the simplest relationships, like the zero-sum relationship: that if you eat a lot of meat you’re probably not eating a lot of vegetables. This simple fact may explain why populations that eat diets high in meat have higher rates of coronary heart disease and cancer than those that don’t. Yet nutritionism encourages us to look elsewhere for the explanation: deep within the meat itself, to the culpable nutrient, which scientists have long assumed to be the saturated fat. So they are baffled when large-population studies, like the Women’s Health Initiative, fail to find that reducing fat intake significantly reduces the incidence of heart disease or cancer.
Of course thanks to the low-fat fad (inspired by the very same reductionist fat hypothesis), it is entirely possible to reduce your intake of saturated fat without significantly reducing your consumption of animal protein: just drink the low-fat milk and order the skinless chicken breast or the turkey bacon. So maybe the culprit nutrient in meat and dairy is the animal protein itself, as some researchers now hypothesize. (The Cornell nutritionist T. Colin Campbell argues as much in his recent book, “The China Study.”) Or, as the Harvard epidemiologist Walter C. Willett suggests, it could be the steroid hormones typically present in the milk and meat; these hormones (which occur naturally in meat and milk but are often augmented in industrial production) are known to promote certain cancers.
But people worried about their health needn’t wait for scientists to settle this question before deciding that it might be wise to eat more plants and less meat. This is of course precisely what the McGovern committee was trying to tell us.
Nestle also cautions against taking the diet out of the context of the lifestyle. The Mediterranean diet is widely believed to be one of the most healthful ways to eat, yet much of what we know about it is based on studies of people living on the island of Crete in the 1950s, who in many respects lived lives very different from our own. Yes, they ate lots of olive oil and little meat. But they also did more physical labor. They fasted regularly. They ate a lot of wild greens — weeds. And, perhaps most important, they consumed far fewer total calories than we do. Similarly, much of what we know about the health benefits of a vegetarian diet is based on studies of Seventh Day Adventists, who muddy the nutritional picture by drinking absolutely no alcohol and never smoking. These extraneous but unavoidable factors are called, aptly, “confounders.” One last example: People who take supplements are healthier than the population at large, but their health probably has nothing whatsoever to do with the supplements they take — which recent studies have suggested are worthless. Supplement-takers are better-educated, more-affluent people who, almost by definition, take a greater-than-normal interest in personal health — confounding factors that probably account for their superior health.
But if confounding factors of lifestyle bedevil comparative studies of different populations, the supposedly more rigorous “prospective” studies of large American populations suffer from their own arguably even more disabling flaws. In these studies — of which the Women’s Health Initiative is the best known — a large population is divided into two groups. The intervention group changes its diet in some prescribed manner, while the control group does not. The two groups are then tracked over many years to learn whether the intervention affects relative rates of chronic disease.
When it comes to studying nutrition, this sort of extensive, long-term clinical trial is supposed to be the gold standard. It certainly sounds sound. In the case of the Women’s Health Initiative, sponsored by the National Institutes of Health, the eating habits and health outcomes of nearly 49,000 women (ages 50 to 79 at the beginning of the study) were tracked for eight years. One group of the women were told to reduce their consumption of fat to 20 percent of total calories. The results were announced early last year, producing front-page headlines of which the one in this newspaper was typical: “Low-Fat Diet Does Not Cut Health Risks, Study Finds.” And the cloud of nutritional confusion over the country darkened.
But even a cursory analysis of the study’s methods makes you wonder why anyone would take such a finding seriously, let alone order a Quarter Pounder With Cheese to celebrate it, as many newspaper readers no doubt promptly went out and did. Even the beginner student of nutritionism will immediately spot several flaws: the focus was on “fat,” rather than on any particular food, like meat or dairy. So women could comply simply by switching to lower-fat animal products. Also, no distinctions were made between types of fat: women getting their allowable portion of fat from olive oil or fish were lumped together with woman getting their fat from low-fat cheese or chicken breasts or margarine. Why? Because when the study was designed 16 years ago, the whole notion of “good fats” was not yet on the scientific scope. Scientists study what scientists can see.
But perhaps the biggest flaw in this study, and other studies like it, is that we have no idea what these women were really eating because, like most people when asked about their diet, they lied about it. How do we know this? Deduction. Consider: When the study began, the average participant weighed in at 170 pounds and claimed to be eating 1,800 calories a day. It would take an unusual metabolism to maintain that weight on so little food. And it would take an even freakier metabolism to drop only one or two pounds after getting down to a diet of 1,400 to 1,500 calories a day — as the women on the “low-fat” regimen claimed to have done. Sorry, ladies, but I just don’t buy it.
In fact, nobody buys it. Even the scientists who conduct this sort of research conduct it in the knowledge that people lie about their food intake all the time. They even have scientific figures for the magnitude of the lie. Dietary trials like the Women’s Health Initiative rely on “food-frequency questionnaires,” and studies suggest that people on average eat between a fifth and a third more than they claim to on the questionnaires. How do the researchers know that? By comparing what people report on questionnaires with interviews about their dietary intake over the previous 24 hours, thought to be somewhat more reliable. In fact, the magnitude of the lie could be much greater, judging by the huge disparity between the total number of food calories produced every day for each American (3,900 calories) and the average number of those calories Americans own up to chomping: 2,000. (Waste accounts for some of the disparity, but nowhere near all of it.) All we really know about how much people actually eat is that the real number lies somewhere between those two figures.
To try to fill out the food-frequency questionnaire used by the Women’s Health Initiative, as I recently did, is to realize just how shaky the data on which such trials rely really are. The survey, which took about 45 minutes to complete, started off with some relatively easy questions: “Did you eat chicken or turkey during the last three months?” Having answered yes, I was then asked, “When you ate chicken or turkey, how often did you eat the skin?” But the survey soon became harder, as when it asked me to think back over the past three months to recall whether when I ate okra, squash or yams, they were fried, and if so, were they fried in stick margarine, tub margarine, butter, “shortening” (in which category they inexplicably lump together hydrogenated vegetable oil and lard), olive or canola oil or nonstick spray? I honestly didn’t remember, and in the case of any okra eaten in a restaurant, even a hypnotist could not get out of me what sort of fat it was fried in. In the meat section, the portion sizes specified haven’t been seen in America since the Hoover administration. If a four-ounce portion of steak is considered “medium,” was I really going to admit that the steak I enjoyed on an unrecallable number of occasions during the past three months was probably the equivalent of two or three (or, in the case of a steakhouse steak, no less than four) of these portions? I think not. In fact, most of the “medium serving sizes” to which I was asked to compare my own consumption made me feel piggish enough to want to shave a few ounces here, a few there. (I mean, I wasn’t under oath or anything, was I?)
This is the sort of data on which the largest questions of diet and health are being decided in America today.
THE ELEPHANT IN THE ROOM
In the end, the biggest, most ambitious and widely reported studies of diet and health leave more or less undisturbed the main features of the Western diet: lots of meat and processed foods, lots of added fat and sugar, lots of everything — except fruits, vegetables and whole grains. In keeping with the nutritionism paradigm and the limits of reductionist science, the researchers fiddle with single nutrients as best they can, but the populations they recruit and study are typical American eaters doing what typical American eaters do: trying to eat a little less of this nutrient, a little more of that, depending on the latest thinking. (One problem with the control groups in these studies is that they too are exposed to nutritional fads in the culture, so over time their eating habits come to more closely resemble the habits of the intervention group.) It should not surprise us that the findings of such research would be so equivocal and confusing.
But what about the elephant in the room — the Western diet? It might be useful, in the midst of our deepening confusion about nutrition, to review what we do know about diet and health. What we know is that people who eat the way we do in America today suffer much higher rates of cancer, heart disease, diabetes and obesity than people eating more traditional diets. (Four of the 10 leading killers in America are linked to diet.) Further, we know that simply by moving to America, people from nations with low rates of these “diseases of affluence” will quickly acquire them. Nutritionism by and large takes the Western diet as a given, seeking to moderate its most deleterious effects by isolating the bad nutrients in it — things like fat, sugar, salt — and encouraging the public and the food industry to limit them. But after several decades of nutrient-based health advice, rates of cancer and heart disease in the U.S. have declined only slightly (mortality from heart disease is down since the ’50s, but this is mainly because of improved treatment), and rates of obesity and diabetes have soared.
No one likes to admit that his or her best efforts at understanding and solving a problem have actually made the problem worse, but that’s exactly what has happened in the case of nutritionism. Scientists operating with the best of intentions, using the best tools at their disposal, have taught us to look at food in a way that has diminished our pleasure in eating it while doing little or nothing to improve our health. Perhaps what we need now is a broader, less reductive view of what food is, one that is at once more ecological and cultural. What would happen, for example, if we were to start thinking about food as less of a thing and more of a relationship?
In nature, that is of course precisely what eating has always been: relationships among species in what we call food chains, or webs, that reach all the way down to the soil. Species co-evolve with the other species they eat, and very often a relationship of interdependence develops: I’ll feed you if you spread around my genes. A gradual process of mutual adaptation transforms something like an apple or a squash into a nutritious and tasty food for a hungry animal. Over time and through trial and error, the plant becomes tastier (and often more conspicuous) in order to gratify the animal’s needs and desires, while the animal gradually acquires whatever digestive tools (enzymes, etc.) are needed to make optimal use of the plant. Similarly, cow’s milk did not start out as a nutritious food for humans; in fact, it made them sick until humans who lived around cows evolved the ability to digest lactose as adults. This development proved much to the advantage of both the milk drinkers and the cows.
“Health” is, among other things, the byproduct of being involved in these sorts of relationships in a food chain — involved in a great many of them, in the case of an omnivorous creature like us. Further, when the health of one link of the food chain is disturbed, it can affect all the creatures in it. When the soil is sick or in some way deficient, so will be the grasses that grow in that soil and the cattle that eat the grasses and the people who drink the milk. Or, as the English agronomist Sir Albert Howard put it in 1945 in “The Soil and Health” (a founding text of organic agriculture), we would do well to regard “the whole problem of health in soil, plant, animal and man as one great subject.” Our personal health is inextricably bound up with the health of the entire food web.
In many cases, long familiarity between foods and their eaters leads to elaborate systems of communications up and down the food chain, so that a creature’s senses come to recognize foods as suitable by taste and smell and color, and our bodies learn what to do with these foods after they pass the test of the senses, producing in anticipation the chemicals necessary to break them down. Health depends on knowing how to read these biological signals: this smells spoiled; this looks ripe; that’s one good-looking cow. This is easier to do when a creature has long experience of a food, and much harder when a food has been designed expressly to deceive its senses — with artificial flavors, say, or synthetic sweeteners.
Note that these ecological relationships are between eaters and whole foods, not nutrients. Even though the foods in question eventually get broken down in our bodies into simple nutrients, as corn is reduced to simple sugars, the qualities of the whole food are not unimportant — they govern such things as the speed at which the sugars will be released and absorbed, which we’re coming to see as critical to insulin metabolism. Put another way, our bodies have a longstanding and sustainable relationship to corn that we do not have to high-fructose corn syrup. Such a relationship with corn syrup might develop someday (as people evolve superhuman insulin systems to cope with regular floods of fructose and glucose), but for now the relationship leads to ill health because our bodies don’t know how to handle these biological novelties. In much the same way, human bodies that can cope with chewing coca leaves — a longstanding relationship between native people and the coca plant in South America — cannot cope with cocaine or crack, even though the same “active ingredients” are present in all three. Reductionism as a way of understanding food or drugs may be harmless, even necessary, but reductionism in practice can lead to problems.
Looking at eating through this ecological lens opens a whole new perspective on exactly what the Western diet is: a radical and rapid change not just in our foodstuffs over the course of the 20th century but also in our food relationships, all the way from the soil to the meal. The ideology of nutritionism is itself part of that change. To get a firmer grip on the nature of those changes is to begin to know how we might make our relationships to food healthier. These changes have been numerous and far-reaching, but consider as a start these four large-scale ones:
From Whole Foods to Refined. The case of corn points up one of the key features of the modern diet: a shift toward increasingly refined foods, especially carbohydrates. Call it applied reductionism. Humans have been refining grains since at least the Industrial Revolution, favoring white flour (and white rice) even at the price of lost nutrients. Refining grains extends their shelf life (precisely because it renders them less nutritious to pests) and makes them easier to digest, by removing the fiber that ordinarily slows the release of their sugars. Much industrial food production involves an extension and intensification of this practice, as food processors find ways to deliver glucose — the brain’s preferred fuel — ever more swiftly and efficiently. Sometimes this is precisely the point, as when corn is refined into corn syrup; other times it is an unfortunate byproduct of food processing, as when freezing food destroys the fiber that would slow sugar absorption.
So fast food is fast in this other sense too: it is to a considerable extent predigested, in effect, and therefore more readily absorbed by the body. But while the widespread acceleration of the Western diet offers us the instant gratification of sugar, in many people (and especially those newly exposed to it) the “speediness” of this food overwhelms the insulin response and leads to Type II diabetes. As one nutrition expert put it to me, we’re in the middle of “a national experiment in mainlining glucose.” To encounter such a diet for the first time, as when people accustomed to a more traditional diet come to America, or when fast food comes to their countries, delivers a shock to the system. Public-health experts call it “the nutrition transition,” and it can be deadly.
From Complexity to Simplicity. If there is one word that covers nearly all the changes industrialization has made to the food chain, it would be simplification. Chemical fertilizers simplify the chemistry of the soil, which in turn appears to simplify the chemistry of the food grown in that soil. Since the widespread adoption of synthetic nitrogen fertilizers in the 1950s, the nutritional quality of produce in America has, according to U.S.D.A. figures, declined significantly. Some researchers blame the quality of the soil for the decline; others cite the tendency of modern plant breeding to select for industrial qualities like yield rather than nutritional quality. Whichever it is, the trend toward simplification of our food continues on up the chain. Processing foods depletes them of many nutrients, a few of which are then added back in through “fortification”: folic acid in refined flour, vitamins and minerals in breakfast cereal. But food scientists can add back only the nutrients food scientists recognize as important. What are they overlooking?
Simplification has occurred at the level of species diversity, too. The astounding variety of foods on offer in the modern supermarket obscures the fact that the actual number of species in the modern diet is shrinking. For reasons of economics, the food industry prefers to tease its myriad processed offerings from a tiny group of plant species, corn and soybeans chief among them. Today, a mere four crops account for two-thirds of the calories humans eat. When you consider that humankind has historically consumed some 80,000 edible species, and that 3,000 of these have been in widespread use, this represents a radical simplification of the food web. Why should this matter? Because humans are omnivores, requiring somewhere between 50 and 100 different chemical compounds and elements to be healthy. It’s hard to believe that we can get everything we need from a diet consisting largely of processed corn, soybeans, wheat and rice.
From Leaves to Seeds. It’s no coincidence that most of the plants we have come to rely on are grains; these crops are exceptionally efficient at transforming sunlight into macronutrients — carbs, fats and proteins. These macronutrients in turn can be profitably transformed into animal protein (by feeding them to animals) and processed foods of every description. Also, the fact that grains are durable seeds that can be stored for long periods means they can function as commodities as well as food, making these plants particularly well suited to the needs of industrial capitalism.
The needs of the human eater are another matter. An oversupply of macronutrients, as we now have, itself represents a serious threat to our health, as evidenced by soaring rates of obesity and diabetes. But the undersupply of micronutrients may constitute a threat just as serious. Put in the simplest terms, we’re eating a lot more seeds and a lot fewer leaves, a tectonic dietary shift the full implications of which we are just beginning to glimpse. If I may borrow the nutritionist’s reductionist vocabulary for a moment, there are a host of critical micronutrients that are harder to get from a diet of refined seeds than from a diet of leaves. There are the antioxidants and all the other newly discovered phytochemicals (remember that sprig of thyme?); there is the fiber, and then there are the healthy omega-3 fats found in leafy green plants, which may turn out to be most important benefit of all.
Most people associate omega-3 fatty acids with fish, but fish get them from green plants (specifically algae), which is where they all originate. Plant leaves produce these essential fatty acids (“essential” because our bodies can’t produce them on their own) as part of photosynthesis. Seeds contain more of another essential fatty acid: omega-6. Without delving too deeply into the biochemistry, the two fats perform very different functions, in the plant as well as the plant eater. Omega-3s appear to play an important role in neurological development and processing, the permeability of cell walls, the metabolism of glucose and the calming of inflammation. Omega-6s are involved in fat storage (which is what they do for the plant), the rigidity of cell walls, clotting and the inflammation response. (Think of omega-3s as fleet and flexible, omega-6s as sturdy and slow.) Since the two lipids compete with each other for the attention of important enzymes, the ratio between omega-3s and omega-6s may matter more than the absolute quantity of either fat. Thus too much omega-6 may be just as much a problem as too little omega-3.
And that might well be a problem for people eating a Western diet. As we’ve shifted from leaves to seeds, the ratio of omega-6s to omega-3s in our bodies has shifted, too. At the same time, modern food-production practices have further diminished the omega-3s in our diet. Omega-3s, being less stable than omega-6s, spoil more readily, so we have selected for plants that produce fewer of them; further, when we partly hydrogenate oils to render them more stable, omega-3s are eliminated. Industrial meat, raised on seeds rather than leaves, has fewer omega-3s and more omega-6s than preindustrial meat used to have. And official dietary advice since the 1970s has promoted the consumption of polyunsaturated vegetable oils, most of which are high in omega-6s (corn and soy, especially). Thus, without realizing what we were doing, we significantly altered the ratio of these two essential fats in our diets and bodies, with the result that the ratio of omega-6 to omega-3 in the typical American today stands at more than 10 to 1; before the widespread introduction of seed oils at the turn of the last century, it was closer to 1 to 1.
The role of these lipids is not completely understood, but many researchers say that these historically low levels of omega-3 (or, conversely, high levels of omega-6) bear responsibility for many of the chronic diseases associated with the Western diet, especially heart disease and diabetes. (Some researchers implicate omega-3 deficiency in rising rates of depression and learning disabilities as well.) To remedy this deficiency, nutritionism classically argues for taking omega-3 supplements or fortifying food products, but because of the complex, competitive relationship between omega-3 and omega-6, adding more omega-3s to the diet may not do much good unless you also reduce your intake of omega-6.
From Food Culture to Food Science. The last important change wrought by the Western diet is not, strictly speaking, ecological. But the industrialization of our food that we call the Western diet is systematically destroying traditional food cultures. Before the modern food era — and before nutritionism — people relied for guidance about what to eat on their national or ethnic or regional cultures. We think of culture as a set of beliefs and practices to help mediate our relationship to other people, but of course culture (at least before the rise of science) has also played a critical role in helping mediate people’s relationship to nature. Eating being a big part of that relationship, cultures have had a great deal to say about what and how and why and when and how much we should eat. Of course when it comes to food, culture is really just a fancy word for Mom, the figure who typically passes on the food ways of the group — food ways that, although they were never “designed” to optimize health (we have many reasons to eat the way we do), would not have endured if they did not keep eaters alive and well.
The sheer novelty and glamour of the Western diet, with its 17,000 new food products introduced every year, and the marketing muscle used to sell these products, has overwhelmed the force of tradition and left us where we now find ourselves: relying on science and journalism and marketing to help us decide questions about what to eat. Nutritionism, which arose to help us better deal with the problems of the Western diet, has largely been co-opted by it, used by the industry to sell more food and to undermine the authority of traditional ways of eating. You would not have read this far into this article if your food culture were intact and healthy; you would simply eat the way your parents and grandparents and great-grandparents taught you to eat. The question is, Are we better off with these new authorities than we were with the traditional authorities they supplanted? The answer by now should be clear.
It might be argued that, at this point in history, we should simply accept that fast food is our food culture. Over time, people will get used to eating this way and our health will improve. But for natural selection to help populations adapt to the Western diet, we’d have to be prepared to let those whom it sickens die. That’s not what we’re doing. Rather, we’re turning to the health-care industry to help us “adapt.” Medicine is learning how to keep alive the people whom the Western diet is making sick. It’s gotten good at extending the lives of people with heart disease, and now it’s working on obesity and diabetes. Capitalism is itself marvelously adaptive, able to turn the problems it creates into lucrative business opportunities: diet pills, heart-bypass operations, insulin pumps, bariatric surgery. But while fast food may be good business for the health-care industry, surely the cost to society — estimated at more than $200 billion a year in diet-related health-care costs — is unsustainable.
BEYOND NUTRITIONISM
To medicalize the diet problem is of course perfectly consistent with nutritionism. So what might a more ecological or cultural approach to the problem recommend? How might we plot our escape from nutritionism and, in turn, from the deleterious effects of the modern diet? In theory nothing could be simpler — stop thinking and eating that way — but this is somewhat harder to do in practice, given the food environment we now inhabit and the loss of sharp cultural tools to guide us through it. Still, I do think escape is possible, to which end I can now revisit — and elaborate on, but just a little — the simple principles of healthy eating I proposed at the beginning of this essay, several thousand words ago. So try these few (flagrantly unscientific) rules of thumb, collected in the course of my nutritional odyssey, and see if they don’t at least point us in the right direction.
1. Eat food. Though in our current state of confusion, this is much easier said than done. So try this: Don’t eat anything your great-great-grandmother wouldn’t recognize as food. (Sorry, but at this point Moms are as confused as the rest of us, which is why we have to go back a couple of generations, to a time before the advent of modern food products.) There are a great many foodlike items in the supermarket your ancestors wouldn’t recognize as food (Go-Gurt? Breakfast-cereal bars? Nondairy creamer?); stay away from these.
2. Avoid even those food products that come bearing health claims. They’re apt to be heavily processed, and the claims are often dubious at best. Don’t forget that margarine, one of the first industrial foods to claim that it was more healthful than the traditional food it replaced, turned out to give people heart attacks. When Kellogg’s can boast about its Healthy Heart Strawberry Vanilla cereal bars, health claims have become hopelessly compromised. (The American Heart Association charges food makers for their endorsement.) Don’t take the silence of the yams as a sign that they have nothing valuable to say about health.
3. Especially avoid food products containing ingredients that are a) unfamiliar, b) unpronounceable c) more than five in number — or that contain high-fructose corn syrup.None of these characteristics are necessarily harmful in and of themselves, but all of them are reliable markers for foods that have been highly processed.
4. Get out of the supermarket whenever possible. You won’t find any high-fructose corn syrup at the farmer’s market; you also won’t find food harvested long ago and far away. What you will find are fresh whole foods picked at the peak of nutritional quality. Precisely the kind of food your great-great-grandmother would have recognized as food.
5. Pay more, eat less. The American food system has for a century devoted its energies and policies to increasing quantity and reducing price, not to improving quality. There’s no escaping the fact that better food — measured by taste or nutritional quality (which often correspond) — costs more, because it has been grown or raised less intensively and with more care. Not everyone can afford to eat well in America, which is shameful, but most of us can: Americans spend, on average, less than 10 percent of their income on food, down from 24 percent in 1947, and less than the citizens of any other nation. And those of us who can afford to eat well should. Paying more for food well grown in good soils — whether certified organic or not — will contribute not only to your health (by reducing exposure to pesticides) but also to the health of others who might not themselves be able to afford that sort of food: the people who grow it and the people who live downstream, and downwind, of the farms where it is grown.
“Eat less” is the most unwelcome advice of all, but in fact the scientific case for eating a lot less than we currently do is compelling. “Calorie restriction” has repeatedly been shown to slow aging in animals, and many researchers (including Walter Willett, the Harvard epidemiologist) believe it offers the single strongest link between diet and cancer prevention. Food abundance is a problem, but culture has helped here, too, by promoting the idea of moderation. Once one of the longest-lived people on earth, the Okinawans practiced a principle they called “Hara Hachi Bu”: eat until you are 80 percent full. To make the “eat less” message a bit more palatable, consider that quality may have a bearing on quantity: I don’t know about you, but the better the quality of the food I eat, the less of it I need to feel satisfied. All tomatoes are not created equal.
6. Eat mostly plants, especially leaves. Scientists may disagree on what’s so good about plants — the antioxidants? Fiber? Omega-3s? — but they do agree that they’re probably really good for you and certainly can’t hurt. Also, by eating a plant-based diet, you’ll be consuming far fewer calories, since plant foods (except seeds) are typically less “energy dense” than the other things you might eat. Vegetarians are healthier than carnivores, but near vegetarians (“flexitarians”) are as healthy as vegetarians. Thomas Jefferson was on to something when he advised treating meat more as a flavoring than a food.
7. Eat more like the French. Or the Japanese. Or the Italians. Or the Greeks. Confounding factors aside, people who eat according to the rules of a traditional food culture are generally healthier than we are. Any traditional diet will do: if it weren’t a healthy diet, the people who follow it wouldn’t still be around. True, food cultures are embedded in societies and economies and ecologies, and some of them travel better than others: Inuit not so well as Italian. In borrowing from a food culture, pay attention to how a culture eats, as well as to what it eats. In the case of the French paradox, it may not be the dietary nutrients that keep the French healthy (lots of saturated fat and alcohol?!) so much as the dietary habits: small portions, no seconds or snacking, communal meals — and the serious pleasure taken in eating. (Worrying about diet can’t possibly be good for you.) Let culture be your guide, not science.
8. Cook. And if you can, plant a garden. To take part in the intricate and endlessly interesting processes of providing for our sustenance is the surest way to escape the culture of fast food and the values implicit in it: that food should be cheap and easy; that food is fuel and not communion. The culture of the kitchen, as embodied in those enduring traditions we call cuisines, contains more wisdom about diet and health than you are apt to find in any nutrition journal or journalism. Plus, the food you grow yourself contributes to your health long before you sit down to eat it. So you might want to think about putting down this article now and picking up a spatula or hoe.
9. Eat like an omnivore. Try to add new species, not just new foods, to your diet. The greater the diversity of species you eat, the more likely you are to cover all your nutritional bases. That of course is an argument from nutritionism, but there is a better one, one that takes a broader view of “health.” Biodiversity in the diet means less monoculture in the fields. What does that have to do with your health? Everything. The vast monocultures that now feed us require tremendous amounts of chemical fertilizers and pesticides to keep from collapsing. Diversifying those fields will mean fewer chemicals, healthier soils, healthier plants and animals and, in turn, healthier people. It’s all connected, which is another way of saying that your health isn’t bordered by your body and that what’s good for the soil is probably good for you, too.
Michael Pollan, a contributing writer, is the Knight professor of journalism at the University of California, Berkeley. His most recent book, “The Omnivore’s Dilemma,” was chosen by the editors of The New York Times Book Review as one of the 10 best books of 2006.
January 28, 2007
Unhappy Meals
By MICHAEL POLLAN
Eat food. Not too much. Mostly plants.
That, more or less, is the short answer to the supposedly incredibly complicated and confusing question of what we humans should eat in order to be maximally healthy. I hate to give away the game right here at the beginning of a long essay, and I confess that I’m tempted to complicate matters in the interest of keeping things going for a few thousand more words. I’ll try to resist but will go ahead and add a couple more details to flesh out the advice. Like: A little meat won’t kill you, though it’s better approached as a side dish than as a main. And you’re much better off eating whole fresh foods than processed food products. That’s what I mean by the recommendation to eat “food.” Once, food was all you could eat, but today there are lots of other edible foodlike substances in the supermarket. These novel products of food science often come in packages festooned with health claims, which brings me to a related rule of thumb: if you’re concerned about your health, you should probably avoid food products that make health claims. Why? Because a health claim on a food product is a good indication that it’s not really food, and food is what you want to eat.
Uh-oh. Things are suddenly sounding a little more complicated, aren’t they? Sorry. But that’s how it goes as soon as you try to get to the bottom of the whole vexing question of food and health. Before long, a dense cloud bank of confusion moves in. Sooner or later, everything solid you thought you knew about the links between diet and health gets blown away in the gust of the latest study.
Last winter came the news that a low-fat diet, long believed to protect against breast cancer, may do no such thing — this from the monumental, federally financed Women’s Health Initiative, which has also found no link between a low-fat diet and rates of coronary disease. The year before we learned that dietary fiber might not, as we had been confidently told, help prevent colon cancer. Just last fall two prestigious studies on omega-3 fats published at the same time presented us with strikingly different conclusions. While the Institute of Medicine stated that “it is uncertain how much these omega-3s contribute to improving health” (and they might do the opposite if you get them from mercury-contaminated fish), a Harvard study declared that simply by eating a couple of servings of fish each week (or by downing enough fish oil), you could cut your risk of dying from a heart attack by more than a third — a stunningly hopeful piece of news. It’s no wonder that omega-3 fatty acids are poised to become the oat bran of 2007, as food scientists micro-encapsulate fish oil and algae oil and blast them into such formerly all-terrestrial foods as bread and tortillas, milk and yogurt and cheese, all of which will soon, you can be sure, sprout fishy new health claims. (Remember the rule?)
By now you’re probably registering the cognitive dissonance of the supermarket shopper or science-section reader, as well as some nostalgia for the simplicity and solidity of the first few sentences of this essay. Which I’m still prepared to defend against the shifting winds of nutritional science and food-industry marketing. But before I do that, it might be useful to figure out how we arrived at our present state of nutritional confusion and anxiety.
The story of how the most basic questions about what to eat ever got so complicated reveals a great deal about the institutional imperatives of the food industry, nutritional science and — ahem — journalism, three parties that stand to gain much from widespread confusion surrounding what is, after all, the most elemental question an omnivore confronts. Humans deciding what to eat without expert help — something they have been doing with notable success since coming down out of the trees — is seriously unprofitable if you’re a food company, distinctly risky if you’re a nutritionist and just plain boring if you’re a newspaper editor or journalist. (Or, for that matter, an eater. Who wants to hear, yet again, “Eat more fruits and vegetables”?) And so, like a large gray fog, a great Conspiracy of Confusion has gathered around the simplest questions of nutrition — much to the advantage of everybody involved. Except perhaps the ostensible beneficiary of all this nutritional expertise and advice: us, and our health and happiness as eaters.
FROM FOODS TO NUTRIENTS
It was in the 1980s that food began disappearing from the American supermarket, gradually to be replaced by “nutrients,” which are not the same thing. Where once the familiar names of recognizable comestibles — things like eggs or breakfast cereal or cookies — claimed pride of place on the brightly colored packages crowding the aisles, now new terms like “fiber” and “cholesterol” and “saturated fat” rose to large-type prominence. More important than mere foods, the presence or absence of these invisible substances was now generally believed to confer health benefits on their eaters. Foods by comparison were coarse, old-fashioned and decidedly unscientific things — who could say what was in them, really? But nutrients — those chemical compounds and minerals in foods that nutritionists have deemed important to health — gleamed with the promise of scientific certainty; eat more of the right ones, fewer of the wrong, and you would live longer and avoid chronic diseases.
Nutrients themselves had been around, as a concept, since the early 19th century, when the English doctor and chemist William Prout identified what came to be called the “macronutrients”: protein, fat and carbohydrates. It was thought that that was pretty much all there was going on in food, until doctors noticed that an adequate supply of the big three did not necessarily keep people nourished. At the end of the 19th century, British doctors were puzzled by the fact that Chinese laborers in the Malay states were dying of a disease called beriberi, which didn’t seem to afflict Tamils or native Malays. The mystery was solved when someone pointed out that the Chinese ate “polished,” or white, rice, while the others ate rice that hadn’t been mechanically milled. A few years later, Casimir Funk, a Polish chemist, discovered the “essential nutrient” in rice husks that protected against beriberi and called it a “vitamine,” the first micronutrient. Vitamins brought a kind of glamour to the science of nutrition, and though certain sectors of the population began to eat by its expert lights, it really wasn’t until late in the 20th century that nutrients managed to push food aside in the popular imagination of what it means to eat.
No single event marked the shift from eating food to eating nutrients, though in retrospect a little-noticed political dust-up in Washington in 1977 seems to have helped propel American food culture down this dimly lighted path. Responding to an alarming increase in chronic diseases linked to diet — including heart disease, cancer and diabetes — a Senate Select Committee on Nutrition, headed by George McGovern, held hearings on the problem and prepared what by all rights should have been an uncontroversial document called “Dietary Goals for the United States.” The committee learned that while rates of coronary heart disease had soared in America since World War II, other cultures that consumed traditional diets based largely on plants had strikingly low rates of chronic disease. Epidemiologists also had observed that in America during the war years, when meat and dairy products were strictly rationed, the rate of heart disease temporarily plummeted.
Naïvely putting two and two together, the committee drafted a straightforward set of dietary guidelines calling on Americans to cut down on red meat and dairy products. Within weeks a firestorm, emanating from the red-meat and dairy industries, engulfed the committee, and Senator McGovern (who had a great many cattle ranchers among his South Dakota constituents) was forced to beat a retreat. The committee’s recommendations were hastily rewritten. Plain talk about food — the committee had advised Americans to actually “reduce consumption of meat” — was replaced by artful compromise: “Choose meats, poultry and fish that will reduce saturated-fat intake.”
A subtle change in emphasis, you might say, but a world of difference just the same. First, the stark message to “eat less” of a particular food has been deep-sixed; don’t look for it ever again in any official U.S. dietary pronouncement. Second, notice how distinctions between entities as different as fish and beef and chicken have collapsed; those three venerable foods, each representing an entirely different taxonomic class, are now lumped together as delivery systems for a single nutrient. Notice too how the new language exonerates the foods themselves; now the culprit is an obscure, invisible, tasteless — and politically unconnected — substance that may or may not lurk in them called “saturated fat.”
The linguistic capitulation did nothing to rescue McGovern from his blunder; the very next election, in 1980, the beef lobby helped rusticate the three-term senator, sending an unmistakable warning to anyone who would challenge the American diet, and in particular the big chunk of animal protein sitting in the middle of its plate. Henceforth, government dietary guidelines would shun plain talk about whole foods, each of which has its trade association on Capitol Hill, and would instead arrive clothed in scientific euphemism and speaking of nutrients, entities that few Americans really understood but that lack powerful lobbies in Washington. This was precisely the tack taken by the National Academy of Sciences when it issued its landmark report on diet and cancer in 1982. Organized nutrient by nutrient in a way guaranteed to offend no food group, it codified the official new dietary language. Industry and media followed suit, and terms like polyunsaturated, cholesterol, monounsaturated, carbohydrate, fiber, polyphenols, amino acids and carotenes soon colonized much of the cultural space previously occupied by the tangible substance formerly known as food. The Age of Nutritionism had arrived.
THE RISE OF NUTRITIONISM
The first thing to understand about nutritionism — I first encountered the term in the work of an Australian sociologist of science named Gyorgy Scrinis — is that it is not quite the same as nutrition. As the “ism” suggests, it is not a scientific subject but an ideology. Ideologies are ways of organizing large swaths of life and experience under a set of shared but unexamined assumptions. This quality makes an ideology particularly hard to see, at least while it’s exerting its hold on your culture. A reigning ideology is a little like the weather, all pervasive and virtually inescapable. Still, we can try.
In the case of nutritionism, the widely shared but unexamined assumption is that the key to understanding food is indeed the nutrient. From this basic premise flow several others. Since nutrients, as compared with foods, are invisible and therefore slightly mysterious, it falls to the scientists (and to the journalists through whom the scientists speak) to explain the hidden reality of foods to us. To enter a world in which you dine on unseen nutrients, you need lots of expert help.
But expert help to do what, exactly? This brings us to another unexamined assumption: that the whole point of eating is to maintain and promote bodily health. Hippocrates’s famous injunction to “let food be thy medicine” is ritually invoked to support this notion. I’ll leave the premise alone for now, except to point out that it is not shared by all cultures and that the experience of these other cultures suggests that, paradoxically, viewing food as being about things other than bodily health — like pleasure, say, or socializing — makes people no less healthy; indeed, there’s some reason to believe that it may make them more healthy. This is what we usually have in mind when we speak of the “French paradox” — the fact that a population that eats all sorts of unhealthful nutrients is in many ways healthier than we Americans are. So there is at least a question as to whether nutritionism is actually any good for you.
Another potentially serious weakness of nutritionist ideology is that it has trouble discerning qualitative distinctions between foods. So fish, beef and chicken through the nutritionists’ lens become mere delivery systems for varying quantities of fats and proteins and whatever other nutrients are on their scope. Similarly, any qualitative distinctions between processed foods and whole foods disappear when your focus is on quantifying the nutrients they contain (or, more precisely, the known nutrients).
This is a great boon for manufacturers of processed food, and it helps explain why they have been so happy to get with the nutritionism program. In the years following McGovern’s capitulation and the 1982 National Academy report, the food industry set about re-engineering thousands of popular food products to contain more of the nutrients that science and government had deemed the good ones and less of the bad, and by the late ’80s a golden era of food science was upon us. The Year of Eating Oat Bran — also known as 1988 — served as a kind of coming-out party for the food scientists, who succeeded in getting the material into nearly every processed food sold in America. Oat bran’s moment on the dietary stage didn’t last long, but the pattern had been established, and every few years since then a new oat bran has taken its turn under the marketing lights. (Here comes omega-3!)
By comparison, the typical real food has more trouble competing under the rules of nutritionism, if only because something like a banana or an avocado can’t easily change its nutritional stripes (though rest assured the genetic engineers are hard at work on the problem). So far, at least, you can’t put oat bran in a banana. So depending on the reigning nutritional orthodoxy, the avocado might be either a high-fat food to be avoided (Old Think) or a food high in monounsaturated fat to be embraced (New Think). The fate of each whole food rises and falls with every change in the nutritional weather, while the processed foods are simply reformulated. That’s why when the Atkins mania hit the food industry, bread and pasta were given a quick redesign (dialing back the carbs; boosting the protein), while the poor unreconstructed potatoes and carrots were left out in the cold.
Of course it’s also a lot easier to slap a health claim on a box of sugary cereal than on a potato or carrot, with the perverse result that the most healthful foods in the supermarket sit there quietly in the produce section, silent as stroke victims, while a few aisles over, the Cocoa Puffs and Lucky Charms are screaming about their newfound whole-grain goodness.
EAT RIGHT, GET FATTER
So nutritionism is good for business. But is it good for us? You might think that a national fixation on nutrients would lead to measurable improvements in the public health. But for that to happen, the underlying nutritional science, as well as the policy recommendations (and the journalism) based on that science, would have to be sound. This has seldom been the case.
Consider what happened immediately after the 1977 “Dietary Goals” — McGovern’s masterpiece of politico-nutritionist compromise. In the wake of the panel’s recommendation that we cut down on saturated fat, a recommendation seconded by the 1982 National Academy report on cancer, Americans did indeed change their diets, endeavoring for a quarter-century to do what they had been told. Well, kind of. The industrial food supply was promptly reformulated to reflect the official advice, giving us low-fat pork, low-fat Snackwell’s and all the low-fat pasta and high-fructose (yet low-fat!) corn syrup we could consume. Which turned out to be quite a lot. Oddly, America got really fat on its new low-fat diet — indeed, many date the current obesity and diabetes epidemic to the late 1970s, when Americans began binging on carbohydrates, ostensibly as a way to avoid the evils of fat.
This story has been told before, notably in these pages (“What if It’s All Been a Big Fat Lie?” by Gary Taubes, July 7, 2002), but it’s a little more complicated than the official version suggests. In that version, which inspired the most recent Atkins craze, we were told that America got fat when, responding to bad scientific advice, it shifted its diet from fats to carbs, suggesting that a re-evaluation of the two nutrients is in order: fat doesn’t make you fat; carbs do. (Why this should have come as news is a mystery: as long as people have been raising animals for food, they have fattened them on carbs.)
But there are a couple of problems with this revisionist picture. First, while it is true that Americans post-1977 did begin binging on carbs, and that fat as a percentage of total calories in the American diet declined, we never did in fact cut down on our consumption of fat. Meat consumption actually climbed. We just heaped a bunch more carbs onto our plates, obscuring perhaps, but not replacing, the expanding chunk of animal protein squatting in the center.
How did that happen? I would submit that the ideology of nutritionism deserves as much of the blame as the carbohydrates themselves do — that and human nature. By framing dietary advice in terms of good and bad nutrients, and by burying the recommendation that we should eat less of any particular food, it was easy for the take-home message of the 1977 and 1982 dietary guidelines to be simplified as follows: Eat more low-fat foods. And that is what we did. We’re always happy to receive a dispensation to eat more of something (with the possible exception of oat bran), and one of the things nutritionism reliably gives us is some such dispensation: low-fat cookies then, low-carb beer now. It’s hard to imagine the low-fat craze taking off as it did if McGovern’s original food-based recommendations had stood: eat fewer meat and dairy products. For how do you get from that stark counsel to the idea that another case of Snackwell’s is just what the doctor ordered?
BAD SCIENCE
But if nutritionism leads to a kind of false consciousness in the mind of the eater, the ideology can just as easily mislead the scientist. Most nutritional science involves studying one nutrient at a time, an approach that even nutritionists who do it will tell you is deeply flawed. “The problem with nutrient-by-nutrient nutrition science,” points out Marion Nestle, the New York University nutritionist, “is that it takes the nutrient out of the context of food, the food out of the context of diet and the diet out of the context of lifestyle.”
If nutritional scientists know this, why do they do it anyway? Because a nutrient bias is built into the way science is done: scientists need individual variables they can isolate. Yet even the simplest food is a hopelessly complex thing to study, a virtual wilderness of chemical compounds, many of which exist in complex and dynamic relation to one another, and all of which together are in the process of changing from one state to another. So if you’re a nutritional scientist, you do the only thing you can do, given the tools at your disposal: break the thing down into its component parts and study those one by one, even if that means ignoring complex interactions and contexts, as well as the fact that the whole may be more than, or just different from, the sum of its parts. This is what we mean by reductionist science.
Scientific reductionism is an undeniably powerful tool, but it can mislead us too, especially when applied to something as complex as, on the one side, a food, and on the other, a human eater. It encourages us to take a mechanistic view of that transaction: put in this nutrient; get out that physiological result. Yet people differ in important ways. Some populations can metabolize sugars better than others; depending on your evolutionary heritage, you may or may not be able to digest the lactose in milk. The specific ecology of your intestines helps determine how efficiently you digest what you eat, so that the same input of 100 calories may yield more or less energy depending on the proportion of Firmicutes and Bacteroidetes living in your gut. There is nothing very machinelike about the human eater, and so to think of food as simply fuel is wrong.
Also, people don’t eat nutrients, they eat foods, and foods can behave very differently than the nutrients they contain. Researchers have long believed, based on epidemiological comparisons of different populations, that a diet high in fruits and vegetables confers some protection against cancer. So naturally they ask, What nutrients in those plant foods are responsible for that effect? One hypothesis is that the antioxidants in fresh produce — compounds like beta carotene, lycopene, vitamin E, etc. — are the X factor. It makes good sense: these molecules (which plants produce to protect themselves from the highly reactive oxygen atoms produced in photosynthesis) vanquish the free radicals in our bodies, which can damage DNA and initiate cancers. At least that’s how it seems to work in the test tube. Yet as soon as you remove these useful molecules from the context of the whole foods they’re found in, as we’ve done in creating antioxidant supplements, they don’t work at all. Indeed, in the case of beta carotene ingested as a supplement, scientists have discovered that it actually increases the risk of certain cancers. Big oops.
What’s going on here? We don’t know. It could be the vagaries of human digestion. Maybe the fiber (or some other component) in a carrot protects the antioxidant molecules from destruction by stomach acids early in the digestive process. Or it could be that we isolated the wrong antioxidant. Beta is just one of a whole slew of carotenes found in common vegetables; maybe we focused on the wrong one. Or maybe beta carotene works as an antioxidant only in concert with some other plant chemical or process; under other circumstances, it may behave as a pro-oxidant.
Indeed, to look at the chemical composition of any common food plant is to realize just how much complexity lurks within it. Here’s a list of just the antioxidants that have been identified in garden-variety thyme:
4-Terpineol, alanine, anethole, apigenin, ascorbic acid, beta carotene, caffeic acid, camphene, carvacrol, chlorogenic acid, chrysoeriol, eriodictyol, eugenol, ferulic acid, gallic acid, gamma-terpinene isochlorogenic acid, isoeugenol, isothymonin, kaempferol, labiatic acid, lauric acid, linalyl acetate, luteolin, methionine, myrcene, myristic acid, naringenin, oleanolic acid, p-coumoric acid, p-hydroxy-benzoic acid, palmitic acid, rosmarinic acid, selenium, tannin, thymol, tryptophan, ursolic acid, vanillic acid.
This is what you’re ingesting when you eat food flavored with thyme. Some of these chemicals are broken down by your digestion, but others are going on to do undetermined things to your body: turning some gene’s expression on or off, perhaps, or heading off a free radical before it disturbs a strand of DNA deep in some cell. It would be great to know how this all works, but in the meantime we can enjoy thyme in the knowledge that it probably doesn’t do any harm (since people have been eating it forever) and that it may actually do some good (since people have been eating it forever) and that even if it does nothing, we like the way it tastes.
It’s also important to remind ourselves that what reductive science can manage to perceive well enough to isolate and study is subject to change, and that we have a tendency to assume that what we can see is all there is to see. When William Prout isolated the big three macronutrients, scientists figured they now understood food and what the body needs from it; when the vitamins were isolated a few decades later, scientists thought, O.K., now we really understand food and what the body needs to be healthy; today it’s the polyphenols and carotenoids that seem all-important. But who knows what the hell else is going on deep in the soul of a carrot?
The good news is that, to the carrot eater, it doesn’t matter. That’s the great thing about eating food as compared with nutrients: you don’t need to fathom a carrot’s complexity to reap its benefits.
The case of the antioxidants points up the dangers in taking a nutrient out of the context of food; as Nestle suggests, scientists make a second, related error when they study the food out of the context of the diet. We don’t eat just one thing, and when we are eating any one thing, we’re not eating another. We also eat foods in combinations and in orders that can affect how they’re absorbed. Drink coffee with your steak, and your body won’t be able to fully absorb the iron in the meat. The trace of limestone in the corn tortilla unlocks essential amino acids in the corn that would otherwise remain unavailable. Some of those compounds in that sprig of thyme may well affect my digestion of the dish I add it to, helping to break down one compound or possibly stimulate production of an enzyme to detoxify another. We have barely begun to understand the relationships among foods in a cuisine.
But we do understand some of the simplest relationships, like the zero-sum relationship: that if you eat a lot of meat you’re probably not eating a lot of vegetables. This simple fact may explain why populations that eat diets high in meat have higher rates of coronary heart disease and cancer than those that don’t. Yet nutritionism encourages us to look elsewhere for the explanation: deep within the meat itself, to the culpable nutrient, which scientists have long assumed to be the saturated fat. So they are baffled when large-population studies, like the Women’s Health Initiative, fail to find that reducing fat intake significantly reduces the incidence of heart disease or cancer.
Of course thanks to the low-fat fad (inspired by the very same reductionist fat hypothesis), it is entirely possible to reduce your intake of saturated fat without significantly reducing your consumption of animal protein: just drink the low-fat milk and order the skinless chicken breast or the turkey bacon. So maybe the culprit nutrient in meat and dairy is the animal protein itself, as some researchers now hypothesize. (The Cornell nutritionist T. Colin Campbell argues as much in his recent book, “The China Study.”) Or, as the Harvard epidemiologist Walter C. Willett suggests, it could be the steroid hormones typically present in the milk and meat; these hormones (which occur naturally in meat and milk but are often augmented in industrial production) are known to promote certain cancers.
But people worried about their health needn’t wait for scientists to settle this question before deciding that it might be wise to eat more plants and less meat. This is of course precisely what the McGovern committee was trying to tell us.
Nestle also cautions against taking the diet out of the context of the lifestyle. The Mediterranean diet is widely believed to be one of the most healthful ways to eat, yet much of what we know about it is based on studies of people living on the island of Crete in the 1950s, who in many respects lived lives very different from our own. Yes, they ate lots of olive oil and little meat. But they also did more physical labor. They fasted regularly. They ate a lot of wild greens — weeds. And, perhaps most important, they consumed far fewer total calories than we do. Similarly, much of what we know about the health benefits of a vegetarian diet is based on studies of Seventh Day Adventists, who muddy the nutritional picture by drinking absolutely no alcohol and never smoking. These extraneous but unavoidable factors are called, aptly, “confounders.” One last example: People who take supplements are healthier than the population at large, but their health probably has nothing whatsoever to do with the supplements they take — which recent studies have suggested are worthless. Supplement-takers are better-educated, more-affluent people who, almost by definition, take a greater-than-normal interest in personal health — confounding factors that probably account for their superior health.
But if confounding factors of lifestyle bedevil comparative studies of different populations, the supposedly more rigorous “prospective” studies of large American populations suffer from their own arguably even more disabling flaws. In these studies — of which the Women’s Health Initiative is the best known — a large population is divided into two groups. The intervention group changes its diet in some prescribed manner, while the control group does not. The two groups are then tracked over many years to learn whether the intervention affects relative rates of chronic disease.
When it comes to studying nutrition, this sort of extensive, long-term clinical trial is supposed to be the gold standard. It certainly sounds sound. In the case of the Women’s Health Initiative, sponsored by the National Institutes of Health, the eating habits and health outcomes of nearly 49,000 women (ages 50 to 79 at the beginning of the study) were tracked for eight years. One group of the women were told to reduce their consumption of fat to 20 percent of total calories. The results were announced early last year, producing front-page headlines of which the one in this newspaper was typical: “Low-Fat Diet Does Not Cut Health Risks, Study Finds.” And the cloud of nutritional confusion over the country darkened.
But even a cursory analysis of the study’s methods makes you wonder why anyone would take such a finding seriously, let alone order a Quarter Pounder With Cheese to celebrate it, as many newspaper readers no doubt promptly went out and did. Even the beginner student of nutritionism will immediately spot several flaws: the focus was on “fat,” rather than on any particular food, like meat or dairy. So women could comply simply by switching to lower-fat animal products. Also, no distinctions were made between types of fat: women getting their allowable portion of fat from olive oil or fish were lumped together with woman getting their fat from low-fat cheese or chicken breasts or margarine. Why? Because when the study was designed 16 years ago, the whole notion of “good fats” was not yet on the scientific scope. Scientists study what scientists can see.
But perhaps the biggest flaw in this study, and other studies like it, is that we have no idea what these women were really eating because, like most people when asked about their diet, they lied about it. How do we know this? Deduction. Consider: When the study began, the average participant weighed in at 170 pounds and claimed to be eating 1,800 calories a day. It would take an unusual metabolism to maintain that weight on so little food. And it would take an even freakier metabolism to drop only one or two pounds after getting down to a diet of 1,400 to 1,500 calories a day — as the women on the “low-fat” regimen claimed to have done. Sorry, ladies, but I just don’t buy it.
In fact, nobody buys it. Even the scientists who conduct this sort of research conduct it in the knowledge that people lie about their food intake all the time. They even have scientific figures for the magnitude of the lie. Dietary trials like the Women’s Health Initiative rely on “food-frequency questionnaires,” and studies suggest that people on average eat between a fifth and a third more than they claim to on the questionnaires. How do the researchers know that? By comparing what people report on questionnaires with interviews about their dietary intake over the previous 24 hours, thought to be somewhat more reliable. In fact, the magnitude of the lie could be much greater, judging by the huge disparity between the total number of food calories produced every day for each American (3,900 calories) and the average number of those calories Americans own up to chomping: 2,000. (Waste accounts for some of the disparity, but nowhere near all of it.) All we really know about how much people actually eat is that the real number lies somewhere between those two figures.
To try to fill out the food-frequency questionnaire used by the Women’s Health Initiative, as I recently did, is to realize just how shaky the data on which such trials rely really are. The survey, which took about 45 minutes to complete, started off with some relatively easy questions: “Did you eat chicken or turkey during the last three months?” Having answered yes, I was then asked, “When you ate chicken or turkey, how often did you eat the skin?” But the survey soon became harder, as when it asked me to think back over the past three months to recall whether when I ate okra, squash or yams, they were fried, and if so, were they fried in stick margarine, tub margarine, butter, “shortening” (in which category they inexplicably lump together hydrogenated vegetable oil and lard), olive or canola oil or nonstick spray? I honestly didn’t remember, and in the case of any okra eaten in a restaurant, even a hypnotist could not get out of me what sort of fat it was fried in. In the meat section, the portion sizes specified haven’t been seen in America since the Hoover administration. If a four-ounce portion of steak is considered “medium,” was I really going to admit that the steak I enjoyed on an unrecallable number of occasions during the past three months was probably the equivalent of two or three (or, in the case of a steakhouse steak, no less than four) of these portions? I think not. In fact, most of the “medium serving sizes” to which I was asked to compare my own consumption made me feel piggish enough to want to shave a few ounces here, a few there. (I mean, I wasn’t under oath or anything, was I?)
This is the sort of data on which the largest questions of diet and health are being decided in America today.
THE ELEPHANT IN THE ROOM
In the end, the biggest, most ambitious and widely reported studies of diet and health leave more or less undisturbed the main features of the Western diet: lots of meat and processed foods, lots of added fat and sugar, lots of everything — except fruits, vegetables and whole grains. In keeping with the nutritionism paradigm and the limits of reductionist science, the researchers fiddle with single nutrients as best they can, but the populations they recruit and study are typical American eaters doing what typical American eaters do: trying to eat a little less of this nutrient, a little more of that, depending on the latest thinking. (One problem with the control groups in these studies is that they too are exposed to nutritional fads in the culture, so over time their eating habits come to more closely resemble the habits of the intervention group.) It should not surprise us that the findings of such research would be so equivocal and confusing.
But what about the elephant in the room — the Western diet? It might be useful, in the midst of our deepening confusion about nutrition, to review what we do know about diet and health. What we know is that people who eat the way we do in America today suffer much higher rates of cancer, heart disease, diabetes and obesity than people eating more traditional diets. (Four of the 10 leading killers in America are linked to diet.) Further, we know that simply by moving to America, people from nations with low rates of these “diseases of affluence” will quickly acquire them. Nutritionism by and large takes the Western diet as a given, seeking to moderate its most deleterious effects by isolating the bad nutrients in it — things like fat, sugar, salt — and encouraging the public and the food industry to limit them. But after several decades of nutrient-based health advice, rates of cancer and heart disease in the U.S. have declined only slightly (mortality from heart disease is down since the ’50s, but this is mainly because of improved treatment), and rates of obesity and diabetes have soared.
No one likes to admit that his or her best efforts at understanding and solving a problem have actually made the problem worse, but that’s exactly what has happened in the case of nutritionism. Scientists operating with the best of intentions, using the best tools at their disposal, have taught us to look at food in a way that has diminished our pleasure in eating it while doing little or nothing to improve our health. Perhaps what we need now is a broader, less reductive view of what food is, one that is at once more ecological and cultural. What would happen, for example, if we were to start thinking about food as less of a thing and more of a relationship?
In nature, that is of course precisely what eating has always been: relationships among species in what we call food chains, or webs, that reach all the way down to the soil. Species co-evolve with the other species they eat, and very often a relationship of interdependence develops: I’ll feed you if you spread around my genes. A gradual process of mutual adaptation transforms something like an apple or a squash into a nutritious and tasty food for a hungry animal. Over time and through trial and error, the plant becomes tastier (and often more conspicuous) in order to gratify the animal’s needs and desires, while the animal gradually acquires whatever digestive tools (enzymes, etc.) are needed to make optimal use of the plant. Similarly, cow’s milk did not start out as a nutritious food for humans; in fact, it made them sick until humans who lived around cows evolved the ability to digest lactose as adults. This development proved much to the advantage of both the milk drinkers and the cows.
“Health” is, among other things, the byproduct of being involved in these sorts of relationships in a food chain — involved in a great many of them, in the case of an omnivorous creature like us. Further, when the health of one link of the food chain is disturbed, it can affect all the creatures in it. When the soil is sick or in some way deficient, so will be the grasses that grow in that soil and the cattle that eat the grasses and the people who drink the milk. Or, as the English agronomist Sir Albert Howard put it in 1945 in “The Soil and Health” (a founding text of organic agriculture), we would do well to regard “the whole problem of health in soil, plant, animal and man as one great subject.” Our personal health is inextricably bound up with the health of the entire food web.
In many cases, long familiarity between foods and their eaters leads to elaborate systems of communications up and down the food chain, so that a creature’s senses come to recognize foods as suitable by taste and smell and color, and our bodies learn what to do with these foods after they pass the test of the senses, producing in anticipation the chemicals necessary to break them down. Health depends on knowing how to read these biological signals: this smells spoiled; this looks ripe; that’s one good-looking cow. This is easier to do when a creature has long experience of a food, and much harder when a food has been designed expressly to deceive its senses — with artificial flavors, say, or synthetic sweeteners.
Note that these ecological relationships are between eaters and whole foods, not nutrients. Even though the foods in question eventually get broken down in our bodies into simple nutrients, as corn is reduced to simple sugars, the qualities of the whole food are not unimportant — they govern such things as the speed at which the sugars will be released and absorbed, which we’re coming to see as critical to insulin metabolism. Put another way, our bodies have a longstanding and sustainable relationship to corn that we do not have to high-fructose corn syrup. Such a relationship with corn syrup might develop someday (as people evolve superhuman insulin systems to cope with regular floods of fructose and glucose), but for now the relationship leads to ill health because our bodies don’t know how to handle these biological novelties. In much the same way, human bodies that can cope with chewing coca leaves — a longstanding relationship between native people and the coca plant in South America — cannot cope with cocaine or crack, even though the same “active ingredients” are present in all three. Reductionism as a way of understanding food or drugs may be harmless, even necessary, but reductionism in practice can lead to problems.
Looking at eating through this ecological lens opens a whole new perspective on exactly what the Western diet is: a radical and rapid change not just in our foodstuffs over the course of the 20th century but also in our food relationships, all the way from the soil to the meal. The ideology of nutritionism is itself part of that change. To get a firmer grip on the nature of those changes is to begin to know how we might make our relationships to food healthier. These changes have been numerous and far-reaching, but consider as a start these four large-scale ones:
From Whole Foods to Refined. The case of corn points up one of the key features of the modern diet: a shift toward increasingly refined foods, especially carbohydrates. Call it applied reductionism. Humans have been refining grains since at least the Industrial Revolution, favoring white flour (and white rice) even at the price of lost nutrients. Refining grains extends their shelf life (precisely because it renders them less nutritious to pests) and makes them easier to digest, by removing the fiber that ordinarily slows the release of their sugars. Much industrial food production involves an extension and intensification of this practice, as food processors find ways to deliver glucose — the brain’s preferred fuel — ever more swiftly and efficiently. Sometimes this is precisely the point, as when corn is refined into corn syrup; other times it is an unfortunate byproduct of food processing, as when freezing food destroys the fiber that would slow sugar absorption.
So fast food is fast in this other sense too: it is to a considerable extent predigested, in effect, and therefore more readily absorbed by the body. But while the widespread acceleration of the Western diet offers us the instant gratification of sugar, in many people (and especially those newly exposed to it) the “speediness” of this food overwhelms the insulin response and leads to Type II diabetes. As one nutrition expert put it to me, we’re in the middle of “a national experiment in mainlining glucose.” To encounter such a diet for the first time, as when people accustomed to a more traditional diet come to America, or when fast food comes to their countries, delivers a shock to the system. Public-health experts call it “the nutrition transition,” and it can be deadly.
From Complexity to Simplicity. If there is one word that covers nearly all the changes industrialization has made to the food chain, it would be simplification. Chemical fertilizers simplify the chemistry of the soil, which in turn appears to simplify the chemistry of the food grown in that soil. Since the widespread adoption of synthetic nitrogen fertilizers in the 1950s, the nutritional quality of produce in America has, according to U.S.D.A. figures, declined significantly. Some researchers blame the quality of the soil for the decline; others cite the tendency of modern plant breeding to select for industrial qualities like yield rather than nutritional quality. Whichever it is, the trend toward simplification of our food continues on up the chain. Processing foods depletes them of many nutrients, a few of which are then added back in through “fortification”: folic acid in refined flour, vitamins and minerals in breakfast cereal. But food scientists can add back only the nutrients food scientists recognize as important. What are they overlooking?
Simplification has occurred at the level of species diversity, too. The astounding variety of foods on offer in the modern supermarket obscures the fact that the actual number of species in the modern diet is shrinking. For reasons of economics, the food industry prefers to tease its myriad processed offerings from a tiny group of plant species, corn and soybeans chief among them. Today, a mere four crops account for two-thirds of the calories humans eat. When you consider that humankind has historically consumed some 80,000 edible species, and that 3,000 of these have been in widespread use, this represents a radical simplification of the food web. Why should this matter? Because humans are omnivores, requiring somewhere between 50 and 100 different chemical compounds and elements to be healthy. It’s hard to believe that we can get everything we need from a diet consisting largely of processed corn, soybeans, wheat and rice.
From Leaves to Seeds. It’s no coincidence that most of the plants we have come to rely on are grains; these crops are exceptionally efficient at transforming sunlight into macronutrients — carbs, fats and proteins. These macronutrients in turn can be profitably transformed into animal protein (by feeding them to animals) and processed foods of every description. Also, the fact that grains are durable seeds that can be stored for long periods means they can function as commodities as well as food, making these plants particularly well suited to the needs of industrial capitalism.
The needs of the human eater are another matter. An oversupply of macronutrients, as we now have, itself represents a serious threat to our health, as evidenced by soaring rates of obesity and diabetes. But the undersupply of micronutrients may constitute a threat just as serious. Put in the simplest terms, we’re eating a lot more seeds and a lot fewer leaves, a tectonic dietary shift the full implications of which we are just beginning to glimpse. If I may borrow the nutritionist’s reductionist vocabulary for a moment, there are a host of critical micronutrients that are harder to get from a diet of refined seeds than from a diet of leaves. There are the antioxidants and all the other newly discovered phytochemicals (remember that sprig of thyme?); there is the fiber, and then there are the healthy omega-3 fats found in leafy green plants, which may turn out to be most important benefit of all.
Most people associate omega-3 fatty acids with fish, but fish get them from green plants (specifically algae), which is where they all originate. Plant leaves produce these essential fatty acids (“essential” because our bodies can’t produce them on their own) as part of photosynthesis. Seeds contain more of another essential fatty acid: omega-6. Without delving too deeply into the biochemistry, the two fats perform very different functions, in the plant as well as the plant eater. Omega-3s appear to play an important role in neurological development and processing, the permeability of cell walls, the metabolism of glucose and the calming of inflammation. Omega-6s are involved in fat storage (which is what they do for the plant), the rigidity of cell walls, clotting and the inflammation response. (Think of omega-3s as fleet and flexible, omega-6s as sturdy and slow.) Since the two lipids compete with each other for the attention of important enzymes, the ratio between omega-3s and omega-6s may matter more than the absolute quantity of either fat. Thus too much omega-6 may be just as much a problem as too little omega-3.
And that might well be a problem for people eating a Western diet. As we’ve shifted from leaves to seeds, the ratio of omega-6s to omega-3s in our bodies has shifted, too. At the same time, modern food-production practices have further diminished the omega-3s in our diet. Omega-3s, being less stable than omega-6s, spoil more readily, so we have selected for plants that produce fewer of them; further, when we partly hydrogenate oils to render them more stable, omega-3s are eliminated. Industrial meat, raised on seeds rather than leaves, has fewer omega-3s and more omega-6s than preindustrial meat used to have. And official dietary advice since the 1970s has promoted the consumption of polyunsaturated vegetable oils, most of which are high in omega-6s (corn and soy, especially). Thus, without realizing what we were doing, we significantly altered the ratio of these two essential fats in our diets and bodies, with the result that the ratio of omega-6 to omega-3 in the typical American today stands at more than 10 to 1; before the widespread introduction of seed oils at the turn of the last century, it was closer to 1 to 1.
The role of these lipids is not completely understood, but many researchers say that these historically low levels of omega-3 (or, conversely, high levels of omega-6) bear responsibility for many of the chronic diseases associated with the Western diet, especially heart disease and diabetes. (Some researchers implicate omega-3 deficiency in rising rates of depression and learning disabilities as well.) To remedy this deficiency, nutritionism classically argues for taking omega-3 supplements or fortifying food products, but because of the complex, competitive relationship between omega-3 and omega-6, adding more omega-3s to the diet may not do much good unless you also reduce your intake of omega-6.
From Food Culture to Food Science. The last important change wrought by the Western diet is not, strictly speaking, ecological. But the industrialization of our food that we call the Western diet is systematically destroying traditional food cultures. Before the modern food era — and before nutritionism — people relied for guidance about what to eat on their national or ethnic or regional cultures. We think of culture as a set of beliefs and practices to help mediate our relationship to other people, but of course culture (at least before the rise of science) has also played a critical role in helping mediate people’s relationship to nature. Eating being a big part of that relationship, cultures have had a great deal to say about what and how and why and when and how much we should eat. Of course when it comes to food, culture is really just a fancy word for Mom, the figure who typically passes on the food ways of the group — food ways that, although they were never “designed” to optimize health (we have many reasons to eat the way we do), would not have endured if they did not keep eaters alive and well.
The sheer novelty and glamour of the Western diet, with its 17,000 new food products introduced every year, and the marketing muscle used to sell these products, has overwhelmed the force of tradition and left us where we now find ourselves: relying on science and journalism and marketing to help us decide questions about what to eat. Nutritionism, which arose to help us better deal with the problems of the Western diet, has largely been co-opted by it, used by the industry to sell more food and to undermine the authority of traditional ways of eating. You would not have read this far into this article if your food culture were intact and healthy; you would simply eat the way your parents and grandparents and great-grandparents taught you to eat. The question is, Are we better off with these new authorities than we were with the traditional authorities they supplanted? The answer by now should be clear.
It might be argued that, at this point in history, we should simply accept that fast food is our food culture. Over time, people will get used to eating this way and our health will improve. But for natural selection to help populations adapt to the Western diet, we’d have to be prepared to let those whom it sickens die. That’s not what we’re doing. Rather, we’re turning to the health-care industry to help us “adapt.” Medicine is learning how to keep alive the people whom the Western diet is making sick. It’s gotten good at extending the lives of people with heart disease, and now it’s working on obesity and diabetes. Capitalism is itself marvelously adaptive, able to turn the problems it creates into lucrative business opportunities: diet pills, heart-bypass operations, insulin pumps, bariatric surgery. But while fast food may be good business for the health-care industry, surely the cost to society — estimated at more than $200 billion a year in diet-related health-care costs — is unsustainable.
BEYOND NUTRITIONISM
To medicalize the diet problem is of course perfectly consistent with nutritionism. So what might a more ecological or cultural approach to the problem recommend? How might we plot our escape from nutritionism and, in turn, from the deleterious effects of the modern diet? In theory nothing could be simpler — stop thinking and eating that way — but this is somewhat harder to do in practice, given the food environment we now inhabit and the loss of sharp cultural tools to guide us through it. Still, I do think escape is possible, to which end I can now revisit — and elaborate on, but just a little — the simple principles of healthy eating I proposed at the beginning of this essay, several thousand words ago. So try these few (flagrantly unscientific) rules of thumb, collected in the course of my nutritional odyssey, and see if they don’t at least point us in the right direction.
1. Eat food. Though in our current state of confusion, this is much easier said than done. So try this: Don’t eat anything your great-great-grandmother wouldn’t recognize as food. (Sorry, but at this point Moms are as confused as the rest of us, which is why we have to go back a couple of generations, to a time before the advent of modern food products.) There are a great many foodlike items in the supermarket your ancestors wouldn’t recognize as food (Go-Gurt? Breakfast-cereal bars? Nondairy creamer?); stay away from these.
2. Avoid even those food products that come bearing health claims. They’re apt to be heavily processed, and the claims are often dubious at best. Don’t forget that margarine, one of the first industrial foods to claim that it was more healthful than the traditional food it replaced, turned out to give people heart attacks. When Kellogg’s can boast about its Healthy Heart Strawberry Vanilla cereal bars, health claims have become hopelessly compromised. (The American Heart Association charges food makers for their endorsement.) Don’t take the silence of the yams as a sign that they have nothing valuable to say about health.
3. Especially avoid food products containing ingredients that are a) unfamiliar, b) unpronounceable c) more than five in number — or that contain high-fructose corn syrup.None of these characteristics are necessarily harmful in and of themselves, but all of them are reliable markers for foods that have been highly processed.
4. Get out of the supermarket whenever possible. You won’t find any high-fructose corn syrup at the farmer’s market; you also won’t find food harvested long ago and far away. What you will find are fresh whole foods picked at the peak of nutritional quality. Precisely the kind of food your great-great-grandmother would have recognized as food.
5. Pay more, eat less. The American food system has for a century devoted its energies and policies to increasing quantity and reducing price, not to improving quality. There’s no escaping the fact that better food — measured by taste or nutritional quality (which often correspond) — costs more, because it has been grown or raised less intensively and with more care. Not everyone can afford to eat well in America, which is shameful, but most of us can: Americans spend, on average, less than 10 percent of their income on food, down from 24 percent in 1947, and less than the citizens of any other nation. And those of us who can afford to eat well should. Paying more for food well grown in good soils — whether certified organic or not — will contribute not only to your health (by reducing exposure to pesticides) but also to the health of others who might not themselves be able to afford that sort of food: the people who grow it and the people who live downstream, and downwind, of the farms where it is grown.
“Eat less” is the most unwelcome advice of all, but in fact the scientific case for eating a lot less than we currently do is compelling. “Calorie restriction” has repeatedly been shown to slow aging in animals, and many researchers (including Walter Willett, the Harvard epidemiologist) believe it offers the single strongest link between diet and cancer prevention. Food abundance is a problem, but culture has helped here, too, by promoting the idea of moderation. Once one of the longest-lived people on earth, the Okinawans practiced a principle they called “Hara Hachi Bu”: eat until you are 80 percent full. To make the “eat less” message a bit more palatable, consider that quality may have a bearing on quantity: I don’t know about you, but the better the quality of the food I eat, the less of it I need to feel satisfied. All tomatoes are not created equal.
6. Eat mostly plants, especially leaves. Scientists may disagree on what’s so good about plants — the antioxidants? Fiber? Omega-3s? — but they do agree that they’re probably really good for you and certainly can’t hurt. Also, by eating a plant-based diet, you’ll be consuming far fewer calories, since plant foods (except seeds) are typically less “energy dense” than the other things you might eat. Vegetarians are healthier than carnivores, but near vegetarians (“flexitarians”) are as healthy as vegetarians. Thomas Jefferson was on to something when he advised treating meat more as a flavoring than a food.
7. Eat more like the French. Or the Japanese. Or the Italians. Or the Greeks. Confounding factors aside, people who eat according to the rules of a traditional food culture are generally healthier than we are. Any traditional diet will do: if it weren’t a healthy diet, the people who follow it wouldn’t still be around. True, food cultures are embedded in societies and economies and ecologies, and some of them travel better than others: Inuit not so well as Italian. In borrowing from a food culture, pay attention to how a culture eats, as well as to what it eats. In the case of the French paradox, it may not be the dietary nutrients that keep the French healthy (lots of saturated fat and alcohol?!) so much as the dietary habits: small portions, no seconds or snacking, communal meals — and the serious pleasure taken in eating. (Worrying about diet can’t possibly be good for you.) Let culture be your guide, not science.
8. Cook. And if you can, plant a garden. To take part in the intricate and endlessly interesting processes of providing for our sustenance is the surest way to escape the culture of fast food and the values implicit in it: that food should be cheap and easy; that food is fuel and not communion. The culture of the kitchen, as embodied in those enduring traditions we call cuisines, contains more wisdom about diet and health than you are apt to find in any nutrition journal or journalism. Plus, the food you grow yourself contributes to your health long before you sit down to eat it. So you might want to think about putting down this article now and picking up a spatula or hoe.
9. Eat like an omnivore. Try to add new species, not just new foods, to your diet. The greater the diversity of species you eat, the more likely you are to cover all your nutritional bases. That of course is an argument from nutritionism, but there is a better one, one that takes a broader view of “health.” Biodiversity in the diet means less monoculture in the fields. What does that have to do with your health? Everything. The vast monocultures that now feed us require tremendous amounts of chemical fertilizers and pesticides to keep from collapsing. Diversifying those fields will mean fewer chemicals, healthier soils, healthier plants and animals and, in turn, healthier people. It’s all connected, which is another way of saying that your health isn’t bordered by your body and that what’s good for the soil is probably good for you, too.
Michael Pollan, a contributing writer, is the Knight professor of journalism at the University of California, Berkeley. His most recent book, “The Omnivore’s Dilemma,” was chosen by the editors of The New York Times Book Review as one of the 10 best books of 2006.
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