Future of Foods: Harmonization of Eastern and Western Food Systems
CHANG Y. LEE¹, CHERL-HO LEE² and TAI-WAN KWON³
1) Department of Food Science & Technology, Cornell University Geneva, New York 14456 USA
2) Graduate School of Biotechnology, Korea University Seoul, Korea
3) Institute of Food Science, Inje University Kimhae, Kyungnam, Korea

An advanced food/nutrition system is the cornerstone upon which modern societies and economies have been built. A proper food supply frees a nation and its people to pursue goals that improve the human condition. The former Under Secretary of United State Department of Agiculture, Eileen Kennedy, who made introductory remarks for the book American’s Eating Habits, stated that "A nation whose basic nutritional needs are met is healthier, more productive, and can focus its energies on educational attainment, improved housing, enhanced medical care, and the provision of goods and services associated with a highly developed society" (Kennedy et al., 2000). On a related subject, Nobel Laureate Dr. Robert W. Fogel, introduced a new term "technophysio evolution" in the preface of the same book (Fogel, 2000). He stated that "The studies of the nineteenth and twentieth centuries point to the existence of a synergism between technological and physiological improvements that has produced a form of human evolution that is biological but not genetic. . . "

Unlike the genetic theory of evolution, the theory of technophysio evolution rests on the proposition that during the past century, human beings have gained an unprecedented degree of control over their environment. He pointed out that this new degree of control enabled Homo sapiens to increase its average body size by more than 50%, increase its average longevity by more than 100%, and improve greatly the robustness and capacity of vital organ systems. Fogel also stated that the most important aspect of technophysio evolution is the continuing conquest of chronic malnutrition due mainly to a severe deficiency in dietary energy.

Today, no country in the world has a more bountiful food supply than the United States. However, in modern America, the past problems of low caloric intakes and inadequate consumption of vitamins and minerals have been supplanted by poor diets of a different scale and with different implications. Mean while, in some of the Eastern countries, where the traditional food system was based mainly on plant sources, GNPs are rising rapidly, populations are becoming more urban, and societies are entering different stages of what has been called the nutrition transition from diets high in complex carbohydrates and fiber to more animal-based diets with a higher proportion of fats, especially saturated fats, and sugars. The resulting adverse health effects and the growing Westernization of eating habits are known to be responsible for the rising rates of obesity and associated chronic diseases in Eastern countries.

Throughout history, human societies have developed varieties of food systems that fit specific individual regions and countries and are based on available plant and animal foods that successfully supported growth and reproduction. Therefore, there has been a large difference in food systems between Western and Eastern countries. The diversity of the global population and the existence of a complex and technologically and traditionally sophisticated food system allow for a wide variety of eating patterns throughout the world.

As economies changed from scarcity to abundance in the U.S. and other Western countries, principal diet-related diseases have shifted from nutrient deficiencies to chronic diseases related to dietary excesses. This shift has led to the increasing recent scientific consensus that eating more plant foods and less animal foods would best promote health. This consensus is based on research relating dietary factors to chronic disease risks, and to observations of exceptionally low chronic disease rates among people consuming traditional Asian and Mediterranean diets. It has been known that some Asian countries, as well as Mediterranean, lead the world in several important indices of health–low rates of coronary heart disease and certain cancers. However, with increasing Westernization, this traditional pattern has been changing in recent years, and some unhealthy signs are starting to show in the statistics. This article will discuss the differences in food systems between East and West and to identify the mix of Western foods of animal sources and Eastern foods of plant sources, so that future global foods prevent nutrient deficiencies as well as chronic diseases and improve the worldwide human condition.

While the relationship between food and health has been known in Asia for a long time as a traditional culture, Western scientists started to recognize in the mid-1960’s that chronic diseases (coronary heart disease, certain cancers, stroke, and diabetes) had replaced deficiency conditions as the principal diet-related health problems in Europe and the US. In the US, dietary guidelines were established in 1977, recommending that Americans reduce intake of energy, fat, saturated fat, cholesterol, sugar, salt, and alcohol and increase intake of foods containing complex carbohydrates and fiber (U.S. Senate, 1977; USDA/HHS, 1980). Much information about food and health was derived from comprehensive studies of the 1950’s-60’s, such as “The Framingham Study” (Kannel et al., 1961) and “The Seven Countries Study” (Key, 1970). The studies reported that traditional Mediterranean diets were associated with great longevity and exceptionally low rates of heart disease and other chronic diseases (James, 1988; Nestle, 1995). In the early 1960s, for example, the overall life expectancy among Greeks (32.5 years) at age 45 years exceeded that of any other known population, including the US (30.8 years) and the UK (30.9 years). Mortality statistics for 1960-90 from the World Health Organization database showed that death rates in the Mediterranean region (Greece and Spain) were also generally lower compared to the more economically developed countries. Several studies identified that Mediterranean people consume high amounts of vegetables, fruits, legumes, and grains, moderate amounts of dairy products, and low amounts of meat products (Trichopoulou and Lagiou, 1997). Some studies have reported plant foods to provide more than 60% of the total energy consumed, and animal foods less than 10% (Allbaugh, 1953). However, socioeconomic changes in this region over the past few decades have been associated with change in both lifestyle and dietary patterns in the populations. Recently, risk factors for chronic diseases have been increasing unfavorably among Mediterranean populations, as a result of undesirable changes in dietary practices (Kafatos et al., 1997).

Another comprehensive study on food and health in the East was the 1983 Project of Cornell University-Oxford University-Chinese Academy of Preventive Medicine under the sponsorship of the National Science Foundation (Junshi et al., 1990; Campbell and Junshi, 1994). This China project identified the diseases of affluence and the diseases of poverty in the same country. The rich disease grouping includes the cancers and heart disease that were associated with high blood level of cholesterol due to high intake of animal protein and fats. This study showed that chronic degenerative diseases can be prevented by an aggregate effect of nutrients and nutrient-intake amounts that are commonly supplied by foods of plant origin and that even small intakes of foods of animal origin are associated with significant increases in plasma cholesterol concentrations, which are associated, in turn, with significant increases in chronic degenerative disease mortality rates.

THE WESTERN DIET

American farmers are not only remarkably productive, but the surpluses are an important part of the supply of food to the rest of the world. In 1900, one American farmer produced enough food to feed seven Americans, but in 1988 one American farmer produced enough to feed 92 Americans and 22 foreigners. American agricultural surpluses have been a major factor in U. S. exports, going back more than a century. Since then, the U.S. has not only had a higher caloric consumption per capita, but a large proportion of calories has originated from meat and dairy products. Still, today more than ever, Americans are a nation of meat eaters. In 1997, based on balance sheet data, total meat consumption (red meat, poultry, and fish) amounted to 190 pounds per person (Putnam and Gerrior, 2000). As recommended, Americans now consume more cereal products and fruits and vegetables than they did in the 1970’s. However, contrary to the recommendation, they are consuming record high amounts of high-fat dairy products and near-record amounts of added fats and sweeteners (Table 1). Overall, it appears that today’s Americans are eating too much.

On the statistics of death rates in the U.S. (Table 2), coronary heart disease, cancer, and stroke are the three leading causes of death in the U.S. and were responsible for more than half of all deaths in 1994 (Frazao, 2000). It has been suggested that diet also played a major role in the development of diabetes, hypertension, and overweight. These six health conditions incur considerable medical expenses, lost work, disability, and premature deaths. The most recent Dietary Guidelines for Americans published in May 2000 includes ten guidelines under the three basic messages: Aim for Fitness; Build a Healthy Base; and Choose Sensibly. It emphasizes measuring and evaluating body mass index (BMI), looking at risk factors for chronic disease, and managing weight. The recommendation for managing weight includes information about portion sizes, noting that many foods are sold in double-portion size.

THE EASTERN DIET

In general, as incomes rise, national food availability and the purchasing power of the people increase, and populations become more urban. These changes consequently influence the food and nutrition system; e.g., diets high in complex carbohydrates and fiber give way to more varied diets with a high proportion of fats, saturated fats, and sugar. Eastern countries, where traditional diets are based mainly on plant foods, have been in a transitional state for the past several decades. During the past 50 years, with rapid economic growth and increasing per capita income, the Japanese people are eating more foods from a wide range of varieties. The traditional Japanese diet–heavily reliant on rice and other food grains, fish, shellfish, and seaweeds has become somewhat Westernized. Meals now include more red meats, poultry, milk and other dairy products, eggs, fruit, and vegetables, as well as processed food, such as pasta, ham, bacon, catsup, and fruit beverages. Consumption of cereals declined from 338 to 256 g/capita/day between 1975 and 1998 (Table 3). Although rice is the staple of the Japanese diet, consumption of rice decreased from 248 g/capita/day in 1975 to 165 in 1998. Rice alone provided almost half of the population’s total calories in 1955 but declined to 29% in 1998. Cereals supplied about 50% of the population’s total daily caloric intake in 1975, but only 40% in 1998. Consumption of fruits and vegetables decreased from 441 g/capita/day in 1975 to 389 in 1998. In the 1980s, French fries became popular in Japan, contributing to rising oil and potato consumption. However, the Japanese taste for meat (meat, meat products, and fish and shellfish) has continuously risen rapidly, from 158 g/capita/day in 1975 to 173 in 1998. Consumption of red meat alone has increased about 10 fold since 1955. Japanese consumption of milk and dairy products increased several fold since 1955– from less than 35 g/capita to more than 130 in 1998. The actual average daily Japanese food intake decreased from 2,226 kcal/capta in 1975 to 1,979 in 1998. The carbohydrate contribution to total calories decreased substantially (63% to 58%), whereas the proportion of energy from fat also increased from 22% to 26% (Table 4).

As a result of this rapid Westernization of the Japanese diet, the population of overweight (expressed as BMI > 25) from 1979-1998 increased substantially in all age groups, as shown in Fig. 1 (JMHLW, 2000A). A significant increase of 15% was noticed in the 30-39 age group. The death rate due to diseases related to diet has been increasing rapidly during the past 30 years. The number of deaths due to cancer increased from 116.3/100,000 persons in 1970 to 226.7 in 1997 and that due to heart disease from 86.7 to 114.3 (JMHLW, 2000B). This increase might be due in part to the increased proportion of aged population, but the changing diet system in Japan during the past 50 years may also have caused it. The current changing conditions provide an opportunity to examine more closely some important health conditions associated with the changed lifestyle and concentrations of dietary total fat and saturated fatty acid in the diet. Therefore, the Japanese scientific community strongly suggested that the traditional Japanese diet, which includes mainly rice, soybean, and fish, must be restored (Lands et al., 1990; Drewnowski and Popkin, 1997).

Korea achieved a more impressive rate of economic growth during the past three decades than Japan did. Per capita GNP increased dramatically from the early 1960s to the mid-1990s, with the rate of increase accelerating in the late 1980s (Fig. 2). The per capita GNP increased more than 100 times between 1962 and 1996 from U.S. $87 to 11,380. This rapid change has also affected food system and consumption patterns. Importation of wheat from the U.S. to make up for food shortages in the 1960s provided opportunities to produce many processed foods made from wheat flour, such as breads and noodles. New food processing technologies were introduced widely, and there was a noticeable food processing industry expansion during the 1980s. In addition, Western fast-food restaurants appeared during the same period. Today in Korea we can see all kinds of U.S. national chain fast-food restaurants, including McDonald’s, Burger King, Kentucky Fried Chicken, Dunkin Donuts, Subway, TGIF, Starbucks, Baskin-Robbins, and others (Fig. 3). Therefore, there has been some concern as to whether these by-products of economic growth, such as social, lifestyle, and diet changes may bring about an excess consumption of energy, animal fats, and sugars that are held to be responsible for the global rates of obesity and associated chronic diseases.

A recent Korean household food intake survey (KHIDI, 2000) showed that the total amount of food intake per capita per day fluctuated around 1000 g, with a moderate increase in 1998 to 1290 g (Table 5). Plant food represented more then 90% of the total food consumption up to the 1980s, then decreased slowly to 81% in 1998. On the other hand, the percentage of animal food intake increased from 8% of the total food consumption in the 1970s to nearly 19% during the same period. The relative proportion of the plant source (81%) in 1998 is noteworthy because it is significantly higher than for most other nations at the same economic levels.

With respect to individual food groups (Table 6), cereal consumption decreased from 517 g in 1970 to 348 g in 1998, but there was a significant increase in consumption of fruits, meat, and dairy product. The increase in meat from 64 g in 1970 to 135 g in 1998 was mainly due to increased consumption of red meat and poultry products. Compared to Japanese, Koreans consume more cereals but much less meat, eggs, dairy products, and added fat. Consumption of added oils in Korea increased insignificantly between the 1970s and the 1990s (KHIDI, 1999). The 1998 data show that Koreans consumed less than 5.7 g/capita/day of vegetable oil and less than 2.1 g/capita/day of animal fats and oil. The consumption of added oil in Korea is lower than that in most other Asian countries, including Japan and China.

Total calorie intake showed a slow decrease from 2150 kcal to 1985 during the past 30 years due to rapid industrialization and mechanization (Table 7). Carbohydrates contributed 78% of total calories in 1971 and 66% in 1998. Contribution of protein has been relatively constant throughout the period in the range of 13-17%. However, contribution of fat to the total calorie increased from 9% in 1971 to 19% in 1998 but is much in many other Asian countries and even lower than in most Western countries. This is the most noticeable feature of the Korean nutrition transition: the dietary shift was not linked with an increase of fat intake commensurate with the country’s increase in income. On the basis of recent report on the relation between per capita GNP and dietary fat intake among 121 countries (Drewnowski and Popkin, 1997; Kim et al., 2000), it was expected that the percentage of energy from fat in Korea would be 35.5% in 1996, however, the actual percentage of energy from fat was 18.8% that is 16.7 percentage points lower than the expected level.

The prevalence of adult obesity in Korea has been very low. The recent national health and nutrition survey in Korea (KHIDI, 2000) showed the range of overweight (BMI=25-30)at 20-27% and the obesity (BMI $ 30) at only 2-3% among $20 years old. Among Asian countries, Koreans showed a low prevalence of overweight and obesity compared to similar or much lower incomes. Uniquely Koreans’ low fat intake might be part of the reason for the lower prevalence of obesity in Korea than in many other Asian countries (Kim et al., 2000; Popkin and Doak, 1998). However, recent statistics on the younger generation (KEDI, 2000) showed that there has been a moderate increase (3.7%) in BMI during the past 10 years among 17-year old boys and a significant increase (11-12%) among 10-year old children. These increases may portend future increase in BMI and a careful monitoring system is needed.

Recently, circulatory diseases and cancers have been two leading causes of death in Korea (Table 8). The disease classification system presented here does not distinguish individual diseases, but the number of deaths per 100,000 persons in 1998 due to circulatory diseases and cancers was 123.7 and 110.8, respectively. Deaths due to diabetes, the third disease related to diet were only 21.1 per 100,000 persons. Trends in the past 10 years showed that death rates due to circulatory diseases and stomach cancer have been decreasing while death rates due to diabetes, breast cancer, and colon cancer have been increasing (KNSO, 1999). Demographic changes may have made the increasing trend in chronic disease apparent.

EAST VS WEST

When we compared Korean and the U.S. diets, the actual average food energy intake of both countries (based on intake surveys) is close to each other at around 2,000 kcal (Table 9). However, there is a big difference in carbohydrate and fat consumption between East and West. The contribution of carbohydrate to the total calories in Korea is much higher (66%) than in America (52%), whereas the contribution of fat to the total calorie in the West (33%) is much higher than in the East (19%). This difference can be clearly seen by examining the intake of major nutrients (Table 10). Koreans consume more grains, fruits, and vegetables, whereas Americans consume more meat and meat products. Americans also consume much more dairy products (more than 3 times) than Koreans.

To make a direct comparison between Korea and the U.S. in death rates due to individual diseases, the recent WHO statistics (WHO, 1999) are presented in Table 11. The data show that overall the death rate in Korea is lower than that of America (Table 11). The death rate in Korea due to cancers was about one half of that in America. The Korean death rate of stomach cancer is much higher than in America. It was suggested that high proportions of fermented foods and higher salt in the diets might be related to a high incidence of stomach cancer. The death rates among Koreans due to colon, breast (female), and prostate (male) cancer were much lower than in America. Especially noteworthy are the lowest death rates of breast cancer among Korean women and males’ colon and prostate cancer. The death rate from diabetes in Korea was lower than in America, but there has been an increasing death rate due to diabetes in recent years. Death rates due to circulatory diseases in Korea were again significantly lower than those of America. There was a significantly higher death rate in Korean males due to chronic liver disease. It may due to a higher alcohol consumption by Korean males.

Many reports suggested that Koreans’ low fat intake and high plant food intake might be part of the reason for the lower prevalence of obesity, lower death rates due to CHD, high blood pressure and the lowest rate of breast cancer and prostate and colon cancers than in many other Asian and Western countries. Considering the current concerns about the worldwide increase in fat intake and diet-related diseases, the low fat intake in Korea is noteworthy. There are several possible explanations for the high intake of plant foods and low fat intake in Korea.

One may relate to the relatively high carbohydrate intake (381 g/capita/day in Korea vs 255 in the U.S.). Typically, as incomes rise and populations become more urban, diets high in complex carbohydrates and fiber give way to more varied diets with a higher proportion of fats, saturated fats, and sugars. However, Korea is an exception, possibly because rice has been the primary element of the diet. Of the total calories of 1,985 kcal/capita/day during 1998, 834 kcal (or 42%) came from rice. This predominance of rice as a staple food may have helped keep the fat intake relatively low.

The other factor that helped keep the fat intake low is kimchi, the second largest food item in the Korean diet after rice. Koreans consume about 122 g/capita/day, almost 10% of the total food intake (1,290g/capita/day). Kimchi is one of the major sources of fiber, calcium, iron, vitamins A, B₁, B₂, C, and niacin. It is low in calories, with less than 20 kcal/100 g compared to 116 kcal/100 g for Western salad with dressing. In addition, there have been many recent reports that kimchi has additional important nutraceutical functions, such as antioxidant and anticancer activities.

The third reason for the lack of effect of increases in GNP on fat intake is also explained partly by the style of cooking. While Western-style cooking uses plenty of oil or butter, Korean cooking uses a small amount of sesame-seed or soybean oil. Most vegetable dishes are prepared by adding small amounts of sesame-seed oil after boiling or steaming. Even on Western-style salads consumed in Korea, Koreans are using so called “Koreanized dressings” that are made of mainly low-calorie soy sauce, vinegar, and small a quantity of sesame-seed oil and spices.

The fourth reason appears to be due to the fact that there are strong movements in Korea to retain the traditional diet through mass media campaigns, such as television programs and consumer movements that promote traditional local foods by emphasizing their local characters and higher quality in terms of nutritional and functional benefits. Daily morning shows on several TV stations introduce famous local and unique traditional foods of villages and promote their consumption. Those foods are practically all plant-based or fish/shellfish products.

A more plausible explanation appears to be a Korean tradition that is specially related to food. In Asia, there has always been a strong, albeit undocumented, belief that food is closely related to medicine, the elixir of youth and health. The notion that “food and medicine” are of the same origin was established in the old times. Therefore, the concept of an intimate interrelationship between food and health has been deeply rooted in Asian life for many years, and Koreans have been practicing it in their daily lives. Koreans believe the old traditional concept of “food is medicine.” Therefore, herbs or fruit ingredients such as ginger, cinnamon, adlay, mugwort, pomegranate, citron, mushroom, ginseng, etc., were used in cooking, and also used for their therapeutic effects. This traditional concept originated from the old Chinese theories of man-universe unity, “yin and yang,” the Five Phases Principles, and other fundamental principles of medical treatment (Lee, 2001). Yin represents material entities such as nutrients, while yang represents functions, such as energy. Therefore, the Korean traditional diet is based on the harmonization of properties and taste on the yin and yang, the Five Phases Principles. Therefore, “balance” or “harmonization” is the basic principle of old Eastern medicine/food.

These principles have been applied from the beginning of raw material selection to the mixing and final preparation of dishes. Considering food to be medicine, the traditional medicine practitioners in Asia studied each food ingredient for its property, taste, and medicinal effects and food preparation is considered to be “prescribing medicine” for the individuals in a household. Some of the well-known food supplementary ingredients today in the U.S., such as ginger, garlic, dates, chestnuts, gingko, soybeans, and others, have been used as spices in traditional Korean dishes for generations. Therefore, today’s Western term “functional foods” is the same as the traditional Eastern term “therapeutic foods” or “health foods” that have been commonly used in Korea for many years.

The reliability of these yin-yang, Five Phases theories and tradition in terms of Western scientific basis is not clear yet, but it provides an example of how to select the foods that are desirable for an individual body. This kind of thinking forms the basis of the therapeutic food concepts of the East.

Therefore, we can conclude that overall the dietary shifts in Korea, such as increased animal food intake, are not necessarily total Westernization. Koreans especially like traditionally prepared dishes, and those traditional foods will continue to represent a major component of the future Korean diet. East and West should learn from each other for a better future food-nutrition-health system.

REFERENCES