Nutrition: What is a balanced food today?

Haro on red meat, salt, sugar, and fat! At a time when food condemnations are raining down, what is left of nutritional balance?

"Let your food be your medicine". This formula attributed to Hippocrates, a tutelary figure of medicine, has been applied to all sauces, including those of the most absurd diets. But its success is not denied because it reaffirms a popular conviction: you have to eat well to be in shape. And it is not the repeated nutritional surveys of the last few decades that will contradict this impression.

In 2017, in the third edition of the vast Inca study (national individual study of food consumption), the National Agency for Food Safety (Anses) concluded that "the role of diet in the increase or prevention of certain diseases such as cancer, obesity or cardiovascular disease is now scientifically established".

Junk food kills

Too much salt, sugar and fat; too much highly processed food; not enough fiber, fruits and vegetables... The diagnosis is made: in our countries, it is no longer undernourishment, but dietary imbalance that kills. It is not enough to eat, we must eat everything. Last April, an international study published in The Lancet quantified the number of deaths worldwide due to poor diet at 11 million. That's one in five premature deaths... more than tobacco, which causes 8 million deaths every year.

Eating a balanced diet is not necessarily a self-evident notion. Is a balanced diet the same for Chinese and Italians? For the teenager and the old man? For the sportsman and the diabetic? The cardiologist advises you to balance your diet with more fatty fish. The gastroenterologist reminds us of the importance of fiber, and the pediatrician of dairy products. Finally, the geriatrician checks that the elderly person is consuming enough protein... However, there are no contradictions between these specialists because, in the end, the personalized advice of each doctor to his patient fits into a general nutritional plan that sets the conditions for a balanced diet in terms of public health.

Halting the progression of obesity

In fact, the National Nutrition and Health Program (PNNS) was able to make people smile in 2001 with its invitations to eat five fruits and vegetables, but it did have a positive effect. "In 2016, the Esteban study showed that, over ten years, the progression of obesity and overweight in both adults and children in France had been halted. Public health campaigns were part of it," notes Dr. Chantal Julia, a physician and teacher-researcher at the AP-HP and the University of Paris-XIII.

In January 2019, in order to take into account the advances in research, the French Public Health Agency has therefore changed the recommendations of the "Eat-Bouger" program with a few new features:

 - Eat more legumes, such as chickpeas or lentils;
-  Increase the share of whole grain starchy foods, such as whole grain-bread or rice;
- Add nuts, almonds, walnuts, hazelnuts, rich in omega 3 and beneficial to the cardiovascular system;
- Limit the consumption of cold cuts and meats.

Various fruits and vegetables remain among the recommendations of the PNNS 2019 (French National Nutrition and Health Program), as well as the call to further reduce the quantities of sugar or salt.

Don't calculate everything

"Nutritional balance should not be viewed strictly in terms of a balance between input and output, nutrient intake and expenditure, but as a comprehensive health-promoting nutrition project," explains Dr. Julia. A functional vision of diet, limited to calculations of nutrient or vitamin intakes, cannot be permanently integrated into daily life, and on the other hand, it risks promoting orthorexia, an obsession with food control, the perverse effects of which are well known...".

It is for this reason that NSP boards should understand each other weekly rather than on a day-to-day basis, let alone meal by meal basis. And they also insist on the importance of exercise to combat sedentary lifestyles.

Eating a balanced diet does not mean filling out a balance sheet, but neither does it mean demonizing certain foods and banishing them forever. Rather, it's about valuing good products and encouraging variety. This is the objective of the Nutri-Score, the nutritional label launched by Santé Publique France in 2016. Its logos, which indicate the nutritional value of a food product based on a classification from A to E on a band colored from green to red, are intended to guide consumer choice. The ultra-processed products labeled E is not prohibited, but they are brought to the attention of the customer, who can thus limit their consumption.

"Besides, not all processed products in the same category, such as pizzas or industrial cookies, for example, all have the same E on a red background," notes Anne-Juliette Serry, head of the nutrition and physical activity unit at Santé Publique France. "Cookies with less fat, for example, or less hidden salts have a C rather than an E". And the consumer can find their way around immediately without having to consult the nutritional information, which is always written in lower case. "Indirectly, the Nutri-Score is also designed to encourage manufacturers to improve their recipes and take their products out of the red", confirms Anne-Juliette Serry.

Finally, eating well-balanced is now also eating ethically, since the environment and health are indissolubly linked. The public health researchers who are developing the PNNS are therefore assuming that they now also want to influence the improvement of foodstuffs by recommending short circuits, seasonal or even organic products, and by limiting pesticides.

Thank's you for reading this article.