He says of himself that he does not mince words. And you can see it. The great expert on the Mediterranean diet, Miguel Ángel Martínez-González, returns with a denouncing and defiant book and says what no one dares to say about the dark interests of the health industry. After Health for sure, the director of the Department of Preventive Medicine and Public Health at the University of Navarra and visiting professor at Harvard University, as well as an advisor to the former first lady of the United States, Michelle Obama, has just published together with the journalist Marisol Guisasola What are you eating? Science and conscience to resist (Planet).
As an expert in Public Health, how do you imagine this Christmas?
Wrong. All international Public Health observers place the management that has been made in Spain of the pandemic among the worst and once the fire has spread, they are all bad consequences. The fire should have been stopped at the beginning, but health workers were not tested, they were not provided with protective equipment, they did not act correctly in homes for the elderly, the demonstrations did not stop and so on in early March….
And inside the houses, what familiar scenes do you imagine?
I would recommend to the population that they do not travel. We all want to see the family but this Christmas has to be special and see ourselves through the screens. In these family gatherings of 8 or 10 people eat – without a mask – and no one eats six feet away from another person. The triple M – mask, meters and hands – is forgotten, a message that has to be repeated ad nauseam. People don’t live it. Why have we had so many sprouts? Because people went to bars and took off their masks as soon as they sat down, even if they hadn’t brought their coffee. We are going to see each other on screens mainly because the situation is serious and in every family there are elderly people, or those with obesity, diabetes, hypertension … which are very strong risk factors. Obesity increases the risk of dying by almost 50% if you catch Covid. If we want them, we cannot expose them because none of us know if we are in the presymptomatic phase or if we are asymptomatic. Prudence must be extremely extreme because 30-40% of our society is highly vulnerable.
What diet would you recommend following during a possible new confinement?
The main thing is to avoid ultra-processed foods, that is, packaged foods, which are loaded with sugar, fast-absorbing carbohydrates, and additives. You have to consume products that are recognized for what they are: fruit, vegetables, fish, eggs, poultry…. but not nuggets. What are nuggets? Chemistry works wonders and there is an outlet for what could not be sold in its natural state. I recommend following the Mediterranean diet, with a lot of salad, lots of legumes, extra virgin olive oil, nuts, legumes … And also to expose yourself to the sun for 20 minutes a day, your face and forearms.
“The situation is serious and in every family there are elderly people, or with obesity, diabetes, hypertension … which are very strong risk factors (for Covid)”
Has the pandemic made us eat healthier? More legumes, less processed?
We do not have very controversial data but there are many suggestions that it has been the other way around. Confinement produces a lot of psychological disorder and all people with a certain inclination to anxiety or depression have gotten worse, in those situations they really crave sweets and people are gaining weight. Also, you get less exercise. In the book ‘What do you eat?’ I put exercises and routines to do gymnastics at home and be active in times of confinement.
Is vitamin D reducing the risk of infection explained because it means spending more time outdoors?
No, it is a biological effect. Vitamin D is an immunomodulator that strengthens our immune system. We have a natural immunity that defends us from many infections to which we are continuously exposed. There are rigorous studies from the precovid era in which vitamin D has been administered to patients with low vitamin D levels and they developed significantly fewer infections from viruses very similar to the coronavirus. And now, in a pandemic, the levels of vitamin D in the stored blood of patients have been analyzed before becoming infected with Covid and it has been seen that those with low vitamin D were those who had the highest risk of becoming infected and who later became infected more proportion.
Will obesity be the next pandemic or is it already a silent pandemic?
It is already a pandemic. Before the Covid arrived, we already said that it was the pandemic of the s. XXI. The current obesity rates, never before recorded, are something very humiliating for Public Health. In the US, 43% of the adult population is obese, in Spain we are well above 60% adding obesity and overweight. We are in a situation where the rare thing is to be at a healthy weight. That the weird is what should be normal had never happened. A body mass index of 25 militates overweight, and 30, obesity. In the US they are approaching 10% of the adult population with morbid obesity. There is no health system that can handle it because morbid obesity is very expensive, annoying, and technically difficult. I think that in a year and a half or two years the Covid pandemic will disappear, we are clearly going to have a bad time until then, but the one that does not seem to disappear is obesity because we have been growing for 30 years, everywhere, and behind comes diabetes, kidney failure, cardiovascular diseases, cancers, osteoarthritis … which is determined by obesity.
“I think that in a year and a half or two years the Covid pandemic will disappear, we will clearly have a bad time until then, but the one that does not seem to disappear is obesity”
In the book you talk about the tricks of the industry to confuse, can you give me an example that has more outraged you?
It cannot be generalized to the entire food industry and very few scientists do. But there is a small group of scientists who, instead of creating their own science, what they do is that before anything that comes out that may be bad for the interests of the industry, they begin to do ‘agnogenesis’, which is to intentionally generate skepticism and confusion, behind which there are a few food industries that fund these few scientists. They are doing a lot of damage because they have managed to make the population perceive that in nutrition nothing is known for sure, that Castilla is wide and that you can eat everything ‘with variety and moderation’. Well no, the WHO already demonstrated in 2015 that processed meats are carcinogenic, there is no doubt that sugary drinks produce overweight.
You advocate a sugar regulation like alcohol, how would you do it?
You have to tax ultra-processed foods that are saturated with added sugar. You have to distinguish the natural sugar that a raisin or any fruit has, which is natural and healthy, from the sugar that is added to mustard or ketchup. All these products should become more expensive, as it seems they are going to do now with sugary drinks, but this cannot be the result of the Government having a collection incontinence and taking advantage of any excuse to collect. I will believe that they do it for Public Health as long as the proceeds are used to lower the price of extra virgin olive oil, nuts, fruit, vegetables and legumes, healthy foods and that are expensive especially for the most disadvantaged sectors .
“I will believe that sugary drinks are taxed by Public Health when the proceeds are dedicated to making healthy foods cheaper and that they are expensive for the most disadvantaged sectors”
What other products would you tax?
The ultra-processed, which may have more content than under normal conditions would have been waste. Strong alcoholic beverages are already taxed and are also ultra-processed. But not everything is regulation, you have to give the population education and reliable information. Not everything is the ‘Nanny State’. What is conspicuous by its absence are subsidies, it is a scandal that the poorest people cannot follow a healthy diet and have to eat hamburgers and the cheapest for lack of means. The eating pattern strongly influences the risks of suffering from diseases.
How much would the health system save on taxing sugary drinks?
It is very difficult to quantify because an isolated measure does not solve the problem. The tobacco problem, which has not been completely solved but has greatly reduced — in the 70s, 90% of people smoked and medical school professors taught smoking classes — was overcome by many actions: fiscal policies, regulations, actions on families and in educational centers, doctors have to be trained, dietitians have to be put in health centers, conflicts of interest of researchers have to be controlled, lobbies they do have to be avoided food companies in Brussels … If all this is done, effectively, the reduction in public spending on Health will be brutal. As if tobacco were eliminated, if this happened, the number of lung cancers and heart attacks that would be avoided would be impressive. But you have to act on many levels, there is no single magic measure.
Why are there no advertisements for fresh products, for real food, in the media?
They would have to advertise more, but they do not have that strength that multinational ultra-processed companies have, which, since they sell very cheaply, make a large margin -because the raw material is very cheap- and they sell a lot, they can dedicate most of their income to advertise. They need to do that advertising, which is often misleading with labels.
Excuse me, but it squeaked me to give a green traffic light to moderate wine consumption in the Mediterranean diet… it’s alcohol!
Red wine is included in all definitions of the Mediterranean diet. It is included because they are cardiovascular prevention studies and always refer to people over 45 years of age and with some cardiovascular risk. The consumption of a glass a day of red wine with meals – up to two in men – has been shown to reduce the risk of heart attack. But to those who are not at risk of heart attack, there is no point in recommending it, not even to abstainers.
“You have to go to the integral version of bread, pasta and rice and you have to reduce the consumption of potatoes”
Why can white bread be your worst enemy?
Everything that is not integral, and potatoes also come in there, has a very high starch content, which is a polysaccharide – like a chain in which each link is a glucose molecule. We quickly break that starch into glucose molecules and it is as if we are consuming sugar. This is what happens with foods rich in refined flours or starch (potatoes). You have to go to the integral version of bread, pasta and rice and you have to reduce the consumption of potatoes.
And finally, tell me how to distinguish between science and pseudoscience.
The best antidote to pseudoscience are epidemiological studies, that is, those that have at least 5,000 people studied for at least five years, but do not stay with studies that show intermediate markers. You have to look at the long term. The best antidote to pseudoscience is epidemiology. If one ‘Googles’ – as they say nowadays – one finds a multitude of hoaxes, but evidence-based medicine requires seeing if a certain eating pattern is associated or not with the future risk of suffering from a disease and that is what we do. nutrition epidemiologists.