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From LaCroix To Protein Chips, A Trusted Source Answers 21 Burning Questions On What To Eat

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(California Walnut Commission/AP)

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I think of it as the anti-Goop.

While Gwyneth Paltrow's Goop catches flak for profiting off dubious health claims, the Center for Science in the Public Interest is a consumer advocacy nonprofit that stands for straight talk on food. The center, known as "America's Food Watchdog," has spearheaded initiatives ranging from getting soft drinks out of schools to getting calorie counts onto menus.

This week, the group's vice president for nutrition, Margo Wootan, was in Boston to help collect a major new award from the Friedman School of Nutrition Science and Policy at Tufts for that work. She also sat down at WBUR to face a barrage of questions of the "just tell me what to eat" variety. Below, edited, are 21 of our most burning queries about food, from protein chips to LaCroix flavoring.

1. So many of us struggle with eating. Why is it so hard?

There are two main reasons why it's so hard to eat well in America today. One is confusion: People think that the advice about nutrition keeps changing all the time. But actually, if I look back to my nutrition textbook from more years ago than I'd like to admit, that nutrition advice has basically stayed pretty constant. If you look at the Dietary Guidelines for Americans since back to 1980, it's still: 'Eat a lot of fruits and vegetables and whole grains, and cut back on sugar, salt and saturated fat.'

The reason why there's so much confusion is partly because of the food industry, because they want to sell what they want to sell, and so they pour a lot more money into providing information to the public than nutrition educators can. And the science around nutrition plays out in a very public way that you don't see in physics or chemistry. So one study can come out that doesn't find an effect of salt on blood pressure and then suddenly there are headlines saying, 'Don't worry about salt. You can eat all the salt you want.'

The other problem is that the food environment, the food system, really is broken. It makes it so hard for people to eat well. Portion sizes are gigantic. You're served a 300-calorie soda with free refills. The children's menu in restaurants is loaded with cheeseburgers with a side of fries and soda. Everywhere we go, we can eat. And all too often it's the wrong kind of food.

2. So given all the flip-flops in food studies, what's left that we can eat without a shred of doubt? Some research even suggests that spinach can interfere with calcium absorption ...

Don't ever worry about eating too many fruits and vegetables. Those are the core of a healthy diet. When you look at your plate, half your plate should be full of fruits and vegetables. And then complement that with some whole grains, and then some lean protein — beans, nuts, chicken, fish are all good choices.

I know it feels like nutrition advice keeps changing, but oftentimes that's around the edges: Should I take a vitamin E supplement? Is coconut oil good for me? A lot of that is pushed by diet book authors trying to sell more books, who want to have some snazzy new diet. If you just give the same old basic boring nutrition advice — eat more fruits and vegetables — you don't sell a lot of diet books.

Healthy eating in America today is so hard. It's like trudging through deep snow. It's not that you can't do it. It's just so, so hard.

Also, it's very easy for studies to be designed in a way where you come out with a null result, you come out with no effect: Your study is too small. It's not long enough. And then that study, which really is not well done, makes it sound to the public like salt doesn't matter, saturated fat doesn't matter, I don't need to cut back on butter. But those are not nutritionists who have changed their minds. That's one study that just wasn't well-designed.

3. Most of us know we should eat less sugar, eat more vegetables. But what stops us from acting on things we know we should do?

Healthy eating in America today is so hard. It's like trudging through deep snow. It's not that you can't do it. It's just so, so hard. What the Center for Science in the Public Interest tries to do is clear a path for people, to make it easier to eat well, by trying to change the food system, the food supply around you, to facilitate healthy eating.

So instead of wagging our finger at people and saying, 'Eat less trans fat,' we worked to get trans fat out of the food supply, to reduce the risk of heart disease. We just need to make it easier — actually, not even just easier — we need to make it possible for people to act on their good intentions and to eat well, and stop letting companies interfere so much with healthy eating.

Most people think about their food decisions as solely a matter of personal choice, but there are all these influences around us, and unfortunately, those drive us to eat more of the wrong kinds of foods. You go out to run a bunch of errands that have nothing to do with food, but after going to the hardware store, the bed-and-bath store, the office supplies store, you've just seen wall after wall, rack after rack of candy, chips and soda, and before you know it, you can't help but reach for that Snickers candy bar and eat it.

It's not that you wanted it. And in fact, 75 percent of people regret having bought that candy. They didn't want it. But marketing is designed to push us to eat, and to eat more often and the wrong kinds of food.

4. And this is one of your campaigns right now, to clean up the checkout counters, right?

We have a 'healthy retail project' to try to rethink retail, starting with the checkout. We think it's just downright unethical for candy companies and supermarkets to be pushing extra calories on people that they don't even really want. To get them at the end of the shop, when their kids are in tow and they're tugging at their pant leg, they're tired after work, and to manipulate them in an ever-so-subtle way to buy 250 extra calories full of sugar and fat, that contribute to obesity and diabetes and other health problems.

5. How important is the food environment in our own homes? Is it better just not to have less-healthy food in the house, or is it more about having willpower? 

This is probably a bit of an overstatement, but willpower is a myth when it comes to food — unless you're really well-rested, you're not distracted, you don't have a lot going on. When you're really focused, you can stand up to it. But we are hard-wired as human beings to eat.

So what we need is for food companies, restaurants, supermarkets to work with us instead of working against us, and instead of trying to undermine our best intentions, to set things up in ways that set us up for success — instead of what they do now, which is that they set us up for failure.

6. So at the most basic level, how can I know if my diet sucks?

I like the bluntness of the question. One key measure of a healthy diet is just to look at your plate and use common sense. So often, marketing is trying to make us question ourselves. But the basics of healthy eating really are very constant. So:

• Is half your plate full of fruits and vegetables?

• Are your grains whole grains?

• Are you choosing healthy proteins? Are the proteins you're choosing beans and chicken and fish as opposed to red or processed meat, which increase your risk of cancer?

For most of us, we are still at Nutrition 101 level. So people are worrying about small nuances around nutrition when they haven't even gotten the basics, which are fruits, vegetables and whole grains. It's not as if we used to say that fruits and vegetables were bad for you and now they're good. Or we used to say that you should eat a ton of salt and sugar, and now we're saying cut back. The core nutrition advice has stayed the same.

To people who are throwing up their hands and saying, 'Nutrition is just too confusing, I might as well eat whatever I want,'  I would say, 'Then the food industry has won.' The food industry wants you to be confused.

The controversy is around the edges. And things like coconut oil — that's not really a controversy among nutrition professionals. We've been saying at the Center for Science in the Public Interest that coconut oil is highly saturated and it raises blood cholesterol and contributes to heart disease. We've never said that that's a healthy oil. If you want to put a little bit of coconut oil in your food as a flavor, it's like butter. You shouldn't go overboard. But coconut oil has never been a healthy fat from nutritionists' viewpoint. It's the marketers and a few different fringe purveyors of wellness that have pushed coconut oil.

7. So what would you say to the people who say there have been so many diet flip-flops that I just don't think it even matters what I eat?

To people who are throwing up their hands and saying, 'Nutrition is just too confusing, I might as well eat whatever I want,'  I would say, 'Then the food industry has won.' The food industry wants you to be confused. They want to make it seem controversial: saturated fat, good or bad? Butter, good or bad? Coconut oil, good or bad? Salt, good or bad? But really, that is their strategy toward continuing to sell the same old food that they've always sold. Why should you switch to healthier options? Why should you give up their products if it's confusing?

Look at soda. The soft drink industry is raising questions about whether soda is bad for you. Come on. Who doesn't know that soda isn't a health food? And that you need to cut back on it to watch your weight, to cut back on sugar? Not that you can never have a soda. But they want you to think that this whole thing is overblown, it's all really about physical activity, so that you just say, 'What the heck, I'm just going to keep drinking soda.'

8. So what about artificially sweetened soda?

There is a continuum of risk. It's very clear that too much soda — regular, sugar- sweetened beverages — are contributing to obesity, diabetes and heart disease, and that we need to cut back on them. The best choice is to switch to seltzer or water or some other no-calorie healthy beverage.

I would say diet soda is the lesser of two evils. There are some concerns about risk, but that risk is really very, very small. And if I were a regular soda drinker and I wasn't ready to switch to water, I would switch to diet soda first, try to get used to that and maybe work my way toward flavored seltzer. But if you're just weighing risk, the risk of regular sugar-sweetened soda is worse than diet soda. It's still kind of an emerging area of science.

9. What about flavored seltzers, concerns about tooth enamel and the 'essences' in LaCroix products?

There are some emerging questions about seltzer and whether it can erode enamel. I would say, generally, drink seltzer with your meal, and then it's not going to increase your risk. If you're sipping on seltzer water all day long, maybe there might be a little concern. But again, we know that soda not only contributes to diabetes and heart disease but also affects dental health. So if you're trying to decide between a LaCroix and a soda, no question what a better choice is.

As for the recent lawsuit about LaCroix ingredients, one challenge with 'natural flavors' is you never really know what's in there. Most of the time, it's probably fine. And the question is: Is 'unnatural' always bad? Is 'natural' always good? It can seem confusing, but I think a little hint of flavor in the LaCroix  is very low on my list of concerns about the American diet.

More broadly, though, we think that the food additive approval system in this country is completely broken and needs to be fixed. To add an ingredient to food, companies need to either file an additive petition, which is a lot of work and many of them try to avoid it, or they just self declare that the ingredient is generally recognized as safe. That basically means that maybe some food company scientists or consultants sat in a back room somewhere and just self declared that an additive is safe for use in a product.

We think it's a gigantic loophole that needs to be fixed. We need to be able to trust that the ingredients in our food are safe, so that we don't have to memorize all these different terms and know what they mean. We just know if they're in our food that they're safe. That's what CSPI is really working hard on.

10. How about eating for the health of the planet? Special foods to avoid? 

The best place to start is with red meat: cows and pigs in particular, cows at the top. Eating less red meat is good for your health, because red meat is associated with cancer, and it's good for the planet because it uses a lot of water, and leads to a lot of waste and greenhouse gases.

Oftentimes, people are worried about the waste that comes from produce, but I think it's because it's waste that they see. If you get a box or bag or package of processed food, you don't know what waste went into producing it. The only waste you end up having is the little plastic bag. But when you eat a banana, you know that you are throwing away that whole peel. But there's waste throughout the food supply, and ways that we could address it. The food manufacturers need to focus more on reducing waste, not just us as individuals. They're throwing away a lot more than we are.

11. What's the healthiest, fastest breakfast?

I find breakfast to be the easiest meal to eat healthily. Oftentimes, when we start out the day, our intentions are really good, our willpower is really high. I usually eat breakfast at home, so it's easy. Whole grain cereal is a good choice. Eat it with low-fat or fat-free milk, and definitely put a lot of fruit on it. Rather than two cups of cereal, just have a cup of cereal and then throw a banana or strawberries or berries on it. I do eat eggs. I think they are a good choice with some whole grain toast. I would also recommend plain yogurt and then add your own sweetener to it.

But make sure at breakfast that you always have fruit. It shouldn't even feel like breakfast if you don't have some fruit.

12. How about fat? What fatty foods can be good for us (in moderation)?

Certain types of fat are essential nutrients. The problem with fat in the American diet is that we eat too much of it — too many deep-fried foods at restaurants, chips and snack foods, sweet baked goods. And the kind of fat that we eat is oftentimes the kind that raises blood cholesterol levels and increases our risk of heart disease: We eat too much saturated fat. So if you are thinking about drizzling some olive oil on your salad, terrific. If you're thinking about eating deep-fat fried potato chips and french fries, not so good.

Good sources of healthy fats: mayonnaise,  avocados, nuts. But you also have to be careful not to eat too much. Nuts are terrific, very good for you, but pair them with a fruit rather than just opening a giant can of peanuts and eating the whole thing.

13. There's a war against sugar under way, but how much is really too much? And how about natural and artificial sweeteners, and the sugar alcohols in some ice creams or protein bars?

Lots of people are trying to cut back on sugar, which is great. We've known that Americans are eating too much sugar for quite a long time. If you're thinking about sugar, the first thing to do is look at what you drink: half of the added sugars that are in the American food supply come from soda, sweetened iced teas, energy drinks, sports drinks, sugary drinks. So the first thing to do is to not look at the tiny amounts of sugar in your ketchup or peanut butter. That is really not the problem. It's what you drink.

After that comes sweet baked goods — doughnuts, pastries, snack cakes, cookies. That's a big source of sugar. And next comes ice cream. Counting grams of sugar is really difficult and very impractical. I would think about these big categories of food: sugary drinks, sweet baked goods and ice cream, and try to cut back on the amount of those foods that you eat.

There are a number of different safe added sweeteners, substitutes for sugar. One of them is sugar alcohols. They are safe. They don't increase risk of disease. But if you eat too much of them they can cause some digestive disturbances that people aren't that thrilled with, especially gas. So don't go overboard, but they are safe.

Stevia also seems to be a good option, and safe. For some people, it has a weird aftertaste, so it's really just a matter of preference. And what to avoid? On some of the artificial sweeteners, there's just not enough evidence. Others are known to be unsafe. So stay away from aspartame and acesulfame K. Sucralose — maybe, that's in a questionable area. Some people will say, 'Just avoid any additives. They're all bad.' But sometimes you can't tell. If you see something that says alpha tocopherol on your label, it sounds bad. That's actually Vitamin E. Ascorbic acid — acid sounds bad, but that's Vitamin C. So it can be hard to tell which additives are OK and which ones aren't.

We want the FDA to regulate additives better, so that people can trust that the additives that are in their food are safe. Until they do that, we have this Chemical Cuisine guide which can give you a sense of which additives are definitely unsafe, which are safe, and which we don't quite know, so it depends on how cautious you want to be. You could limit your intake or avoid them altogether.

14. Is there a way to trick your body into feeling like it got its sugar fix, without sugar?

Physiologically, we know that our taste for salt depends on how much salt we usually eat. So if you're used to eating a really salty, diet then you need your food to be more salty to taste good. But as you gradually eat less and less salt, you get used to it. With sugar, the science isn't as good, but I find the same thing. If I'm eating a lot of sugar, I need more and more sugar in order to feel like it's a treat.

I would say with the sweets, try fruit. Fruit is really delicious. There are so many different kinds; find the kind that you like and that you'll find satisfying. Maybe it won't work for you on a night when you've had a bad day at work, but it might work for you after lunch. And then save your treats for that occasional splurge.

And just try to watch your portion size. Have something you really love — like if you know that you really love ice cream, save that for a time where it's a treat — or split the brownie with a friend. Try to enjoy it in moderation, a little less often.

15. There are so many certifications on packaging. Which ones can we really trust?

Ideally, the Food and Drug Administration and the U.S. Department of Agriculture would have regulations that we can trust, so that we know when a claim is made on a product that it's something you can believe. But right now the agencies aren't there. One of the things that CSPI is really working hard to do is to have 'truth in food,' so you can believe what you read. Right now it is a little bit of the Wild West out there.

Each of those certification programs that different organizations have are based on different amounts of data, different ways that they determine it. And so unless you know about a specific certification program and how they are assessing a company, it's hard to know if you can believe those or not. We have some charts about meat, as well as what organic and labels mean.

But it's a shame that we have to turn to nonprofit and for-profit organizations to certify our products, and we can't just trust that what the companies are saying is true. There's a big initiative underway with the Food and Drug Administration called the Nutrition Innovation Strategy, and Commissioner [Scott] Gottlieb is looking at labeling issues. We're pushing very hard through that effort to try to get more truth in food, so that the claims that are made are actually based in truth, and are not so misleading to people — and confusing.

Just keep in mind that junk food is junk food, whether it's 'natural' or not, whether it has a little Vitamin C or not.

16. There's a lot of misleading marketing to health-conscious people. How can we watch out for that?

One strategy that food companies use regularly is to put a health halo around their products. So to put claims like 'gluten free' because they know that's hot right now. Or 'natural,' or  'contains 100 percent of your Vitamin C.' But just keep in mind that junk food is junk food, whether it's 'natural' or not, whether it has a little Vitamin C or not. And if the claim seems too good to believe it's probably not true.

One of the most confusing areas of claims is around whole grains. As people are trying to eat more whole grains, there are claims that 'it's made with whole wheat' or 'multigrain' or 'contains nine grains.' There are a lot of claims that are used that imply that something is whole grain, but it isn't. And so that's one of the areas we've asked for the FDA to take a stand, and to regulate those claims, to have clear definitions of what can be used and what can't be. In the meantime what you can do for grains is go to the ingredients list and look at the first ingredient: if it doesn't say 'whole wheat' or 'whole corn,' know that it's probably a refined grain product and made with whole grain.

One of the foods that really irks me are 'fruit snacks.' They are basically gummy bears with a sprinkling of fruit juice or vitamin C, marketed to parents as an alternative to fruit. But fruit snacks have much more in common with candy than they do with fruit.

17. How about all the 'healthier' alternatives to potato chips? Protein chips? Veggie chips? Plantain chips? 

You're not going to find anything healthy in the chip aisle. Just know, as soon as you head down the chip aisle, no matter whether you're deep-fat-frying apples, potatoes, sweet potatoes, or plantains, they're all basically nutritionally equal. It's not that they're terribly unhealthy, but they're calorically dense. They're easy to overeat. So just know that once you head down that aisle, it's all a treat. It's something that you eat just occasionally, not an everyday food. And no matter what you're deep-fat frying, you still need to eat it in moderation.

As for baked chips, they have fewer calories than deep fat fried chips, but oftentimes not by that much. So they can be an alternative, but it's not a health food.

A lot of this is just nutritionally modified, sophisticatedly marketed crap.

The  food industry has done a terrific job at marketing 'natural' or 'better for you' junk food as good for you. And partly it's because they put 33 billion dollars' worth of marketing behind their products, and they have a lot more marketing power and money to convince people that these are good foods.

But also, we want to believe it, right? You want to believe that somehow, a sweet potato chip is better for you than a regular potato chip. And so, in those moments when we want something for a treat, we think that's better for us. But a lot of this is just nutritionally modified, sophisticatedly marketed crap.

In all, the food industry spends about $33 billion a year on advertising and public relations, but they spend another $50 billion a year on in-store marketing, on secret deals and contracts that the food manufacturers pay to the supermarkets to put their food in your face. To put it in freestanding displays, on the end of aisle display, at the checkout.

So a person who's trying to cut back on candy, say, or chips, might purposely choose not to go down the candy aisle, but yet on the end-of-aisle displays, at the Valentine's Day display, at the checkout, they're being poked and prodded and repeatedly urged to eat candy. And you know, by the eighth time you've seen it in the supermarket, you're like, 'Oh my God, just give me a candy bar.'

18. How about protein? 

There is a lot of hype about protein these days — that it makes you fuller, that it helps you lose weight, that it can help build muscle, that you need it for strength training. There aren't that many Americans today who are protein-deficient. Sometimes seniors need to make sure they get enough protein. Protein is an important part of the diet. But it is not magical. It's not going to help you build muscle if you don't also exercise. Eating a lot of protein along with your usual junk food is not going to help you feel more satiated.

And if a junk food says it has a lot of protein in it — if it's a brownie with a lot of protein, if it's a bar with a lot of protein — it's probably just junk food. Again, the industry has been really terrific at taking whatever is the hot nutrient of the day and adding it to a lot of junk food as a way to get us to think that it's better for us. It's called 'permission marketing.'

Permission marketing is when the industry changes the product a little bit, adds the hot nutrient of the day, adds a vitamin, a mineral, and makes it sound better enough that it lets our guard down and gives us an excuse to eat something that we otherwise wouldn't. Like maybe you wouldn't usually have a brownie for breakfast, but a protein brownie somehow sounds like it might be a good food. Or a 'breakfast cookie.'

19. And meanwhile, McDonald's can still come out with a new 1,000-calorie burger? 

Companies have found that 'value marketing' is a good way to get people in the door, to make them feel like they got a good deal. So instead of just getting a 300-calorie hamburger, you can get a 1000-calorie hamburger and look, you've gotten so much value for your money!

It's really profitable for restaurants, because the actual price that they pay for the food to the farmer is only about 10 cents out of the dollar that you pay as a restaurant customer. So if they upgrade you from quarter-pounder to a double-quarter-pounder to a gigantic burger, it costs them only a little bit more money but they can charge you more. And they make more profit.

So big portions are profitable, and that's a problem because they're marketing them very aggressively, and making us think that bigger is better. You know, back when McDonald's first opened, what was a normal-sized hamburger, fries and a soda is now what we consider a children's meal. The portions have just gotten bigger and bigger, because if you want to attract new customers, you have to somehow distinguish yourself. And one of the ways they do that is by offering you more.

So even while you see McDonald's taking additives out of their bun, and reducing sodium, and talking about how much more natural and healthy their food is, they're still putting these gigantic burgers on the menu to attract certain people to come into the door.

20. Fad diets: Keto, paleo, carnivore, a new one every week. How do you make healthy eating last instead of just a phase?

If I were to sell a diet book with the real nutrition advice that's based on science — like eat a lot of fruits and vegetables, eat whole grains, and choose fish and beans and chicken as your protein — nobody is going to buy that boring, boring book. I've got to come up with some new fad, based in your hair color or your zip code. Everybody who wants to sell a diet book has to come up with some new gimmick.

A lot of diets work at first, but eventually they're just not the kind of diet that people can stick with. One of the other reasons why diets don't work is because our food environment just makes it so hard to follow. So even if you have a lot of willpower, you're really motivated, you're just bombarded all the time with a lot of messages to eat, with food in your face all the time — it's like people are shoving candy bars and giant 500-calorie coffees and scones and muffins and hamburgers and french fries at us all day --  and eventually you get tired.

It's like swimming upstream. If you're a good swimmer, you're really dedicated, you've been training, you can swim upstream for a while, but eventually you're going to get tired, stressed, distracted, and you're going to start going with the flow. And going with the flow in our current food environment means eating too much of the wrong kind of food.

We need to change the default. We need to make healthy eating the norm, so that those people who want to eat well can. It's like our work on the kids menu and soda. It's not that a parent can't actively choose to get a soda for their kids if they want. But the norm will be milk and water, so that if you're going in, nobody's asking you, 'Do you want soda with that?' They're just asking, 'Do you want milk or water?' And most people will stick with that, and they'll be healthier.

21. So if there were one change any of us could start making today to eat healthier forever, what would it be?

I probably sound like a broken record, but the most important change that most of us can make is to make half your plate fruits and vegetables, just at every single meal: At breakfast, to eat fruit; at lunch, to have a vegetable; at dinner, to have vegetables. Fruits and vegetables are good for us, they're chock full of vitamins and minerals, they're low in calories, and I have to say they taste delicious. But we need to learn how to cook them, prepare them, how to serve them at restaurants, in a way that is as appealing as they can be.

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Carey Goldberg Twitter Editor, CommonHealth
Carey Goldberg is the editor of WBUR's CommonHealth blog.

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