Food habits are a complex aspect of human behavior, determined by multiple motives and directed and controlled by multiple stimuli. What foods people accept is another complex reaction influenced by biochemical, physiological, psychological, social, and educational factors. And the metabolic conditions of an individual, such as age, sex, and mental factors, will play a part in an individuals response to food.
Food consumption can be as much about culture as any of the above conditions. And food culture, which refers to many of the practices, attitudes, and beliefs around food and can be as much about ethnic cultural heritage and environmental culture as the complex conditions of individual eating. Food culture can include the preferences and eating habits that shape the things a person eats, as well as how a person eats, what a person eats, when a person eats, where a person gets their food, and how a person prepares their food. And what is considered healthy food choices and habits can vary between and within cultures.
The different food cultures around the world are influenced by many factors, with the most arguably important factor being the way cultures utilize specific ingredients and spices to develop flavor profiles. But all food cultures encompass a few key components:
- They involve sharing food with community and family
- They value the needs of the land over the convenience-driven desires of people
- They use food to celebrate religious and community events
- They focus on local and seasonal ingredients and use them to create unique and distinguished flavors
- They value their food experience
- Food is not something to be manipulated, but is meant to be shared and celebrated
Despite culture, the key driver for eating is hunger, and what a person chooses to eat is not determined by physiological or nutritional needs. Some of the factors that influence food choice include the following:
- Biological determinants, such as hunger, appetite, and taste
- Economic determinants, such as cost, income, and availability
- Physical determinants, such as access, education, skills, and time
- Social determinants, such as culture, family, peers, and meal patterns
- Psychological determinants, such as mood, stress, and guilt
- Attitudes, beliefs, and knowledge about food
The complexity of food choice, as explained above, also varies according to life stage. As well, the power of any factor of the above conditions will weigh differently from one individual and one group to the next. Therefore, in the case of an intervention in food culture, either for increased health or depleted ecology, or any other reason, will have to modify the intervention with consideration to the complex factors influencing both individual and group food choice.
Meanwhile, as more populations in the world are slowly concentrated in metropolitan centers, where multiple different cultures and ethnicities can intermingle to create diverse societies, the cultures around food become increasingly muddled. Ethnicity, in this case, refers to a social group that shares distinctive features, such as language, culture, physical appearance, religion, values, and customs. Ethnicity can be mutable to an extent, but can also be considered immutable, while culture refers to how people do and view things in a group. Such as a shared set of values, assumptions, perceptions, or conventions, which is often developed from a shared history and language.
From this culture emerges food culture. But in metropolitan centers, where many different cultures are able to collide and mingle, the food cultures can be shared, allowing people to share the food they eat, and resulting in a wide variety of food selections and individual or a group is able to make in the classes of food they eat. This can result in changes in human health based on diet.
There are two impacts on nutrition and food culture. The first is the culture of food in a given area, or the dietary habits among specific ethnic groups. The other is the impact on culture on the promotion of healthier eating habits, or culture's impact on diet and nutrition. In this case, nutrition can be defined as the micro- (vitamins and minerals) and macro- (carbohydrates, protein, and fat) nutrients as they relate to the body's dietary needs, and diet refers to the specific foods consumed.
There has been, especially in western cultures, an increased support for and encouragement of healthier eating and healthier eating habits. One of the important factors of health promotion that research has found has been in impact of culture, which is in addition to the range of personal, psychological, information, and environmental factors that impact what a person eats, and what a person considers to be healthy. For example, research contrasting the United States and Japan found that cultural contexts were imperative to promote normatively appropriate ways to think, feel, and act.
For example, in the mainstream United States, independence can be considered a foundational schema for thought and behavior. Institutions prioritize and promote independence, and agency derives from free choice and expression of personal preferences, intentions, and goals. Which suggests that, in the United States, arguably good outcomes will come from being associated with being independent. Meanwhile, in mainstream Japan, interdependence is the foundational schema for thought and behavior. Which means being a "good" government official, teacher, student, priest, parent, or person requires recognizing one's fundamental interdependence. People strive to maintain harmonious relationships, meet obligations, and adjust their behavior to accommodate others' needs and perspectives. Due to this association, good outcomes in terms of nutrition and diet can be associated with being interdependent.
In both cultural contexts, eating behavior is bound with culturally normative ways of being. There is evidence in both countries and cultures of healthy eating being viewed as the "right" and "good" way to behave. Whereas research suggests many Americans struggle to eat a healthy diet. While in Japan, the traditional diet is healthy, and the country has increasingly focused on maintaining and promoting healthy eating amid rising concerns about western dietary influences.
Part of this has been explained by the use of mealtimes in the United States as a time for the cultivation of independence, for taking control, making choices, and expressing personal preferences. while in Japan, the association between healthy food and realizing the interdependence of the self is culturally shaped and grounded in ideas and practices that reflect and foster this link. For example, the U.S. Department of Agriculture offers guidelines to encourage people to eat healthy by making certain choices while parents of "picky eaters" are advised to avoid a "battle of wills" in order to foster a child's independence. But the Japanese Farm Ministry's site offers guidelines that advise people to eat healthier by "cherishing a close family atmosphere" while preparing and eating meals. The Japanese guidelines further emphasize other facets of interdependence, such as balance and self-improvement.
While culture can impact how an individual, as part of a group, approaches their individual dietary needs, there is a further impact of the group selection on diet, with issues relating to ethnicity and culture impacting what foods are considered edible, and what foods can and should be consumed at different parts of the day. This shared set of values, assumptions, perceptions, and conventions, based often on shared history and language, is often what defines a cultural group. And this group will influence an individual's accepting and sampling different types of foods and adjusting their diet, which will result in changes in health.
An example of the exploration of the relationship between diet and culture has been undertaken in the United Kingdom, where ethnic minority groups and their changing dietary habits were studied. The study, by Gibbons et al (2000) found relatively high proportions of their Indian sample continued to consume what was considered a traditional Indian diet; similar results occurred in studies of a Pakistani group. In both groups, fizzy drinks were not consumed, although researchers noted a rise in the consumption of sandwiches. And there was a noted increase in sugar intake linked to changing dietary habits as people from these ethnic groups entered the United Kingdom. A Chinese group were found to follow the same patterns, with sugar less often consumed, and a belief in the minority group that water was good for oral health.
Much of the focus of the study was on sugar consumption, seen as a hallmark of the United Kingdom diet, and not consumed as often in the diets of the ethnic minority groups. And what the study found was that, in each group, sugar intake between meals occurred most in hot drinks or snack foods. "Traditional" diets were followed, by each group, at main meals, but breakfast and meals taken away from the home demonstrated greater "westernization."
Further, the study found respondents in each group were aware of positive and negative aspects of both western and non-western diets (with positive and negative definitions based on cultural values); but all groups saw diet as a cultural identifier of ethnicity. Meanwhile, for native United Kingdom people, in the study referred to as white people, diet was not seen as an index of culture or ethnicity; and the "indigenous" diet was seen as unhealthy.
Diet and nutrition are significant influencers of oral health, and can affect the development and progression of oral diseases and conditions such as caries, periodontal disease, and erosion, among others. The relationship between diet and nutrition with oral health is bidirectional, as the oral cavity's integrity can influence an individual's functional ability to eat. A variety of dietary factors are hypothesized to influence the oral cavity, including macro- and micro-nutrients, vitamins, pH properties, and behaviors associated with consumption. Further, factors such as stage of development, specific medical conditions, and socioeconomic status may change particular diet and nutritional considerations. For example, older patients may experience tooth loss, reduced masticatory ability, and decreased appetite, which can influence their nutritional state.
And then there is the observed role of diet and dietary culture on oral health. For example, according to the World Dental Federation, countries with the lowest rates of dental decay include the United States, Canada, Mexico, Germany, Spain, Italy, Norway, Sweden, Finland, and China. And some countries in Africa also have low rates of dental decay. On the other end of the spectrum, countries with high rates of dental decay, or low rates of oral health, include India, Saudi Arabia, Singapore, and some countries in South America and Asia.
The World Health Organization suggests some cultural factors that can increase the risk of poor oral health, including inadequate fluoride exposure, living in a poor or disadvantaged country, insufficient access to proper dental care, unhealthy diets, poor oral hygiene, tobacco use, and excessive alcohol use. However, not all developing countries experience high rates of poor oral health. Several countries in Africa have low oral health problem rates despite poor dental care access and low socioeconomic status. This is largely explained by the low incidence of processed sugar in the diets of residents of these countries.
Following this, the best dental diets appear to be those lowest in processed sugar in rich in whole foods. For example, foods found in the Mediterranean diet gave stronger, healthier teeth, according to the University Dental Group. The Cleveland Clinic and the American Dental Association say foods that promote a healthy mouth include fruits, vegetables, whole grains, legumes, tea (2 cups daily), calcium-rich foods, fish, and Xylitol-containing sugar-free gum. And diets low in processed sugar appear to be most protective against oral health problems.
As metropolis centers increasingly combine multiple different food cultures, and as traditional cultures give way to diet trends considered to be healthier, the possible oral health impacts of these trends have also been studied. This has included diet trends such as the ketogenic diet, the paleo diet, intermittent fasting, and the vegetarian/vegan diet.
A more recent dietary trend, the ketogenic diet is a high-fat, moderate-protein, low-carbohydrate diet. By reducing carbohydrates to 50 grams or less per day, the body goes into metabolic physiological ketosis; this is different from the pathological ketosis affecting individuals with uncontrolled diabetes. Ketogenesis initiates the breaking down of fats into ketones, which the body uses as an energy source. When the body burns ketones, it produces acetone, acetoacetate, and beta-hydroxybutyrate. The body in turn flushes the ketones through exhalation and urination, which can lead to the fruity smelling or acetone scented "keto" breath and xerostomia. The breakdown of protein in the body also produces ammonia, which can contribute to oral malodor as well.
Further, the restriction of carbohydrates, including fruits and vegetables, can lead to a reduction of important micro-nutrients. Vitamin A, Vitamin C, and Folate are all deficient in this diet, with each having an important function in oral health. The lack of these, and antioxidants, from the diet has been associated with an increased risk of oropharyngeal cancer.
While this eating pattern is compared with the keto diet, there are significant differences. Where the keto diet is focused on fat intake, the Paleo diet is primarily a plant-based diet. The diet focuses on eating nutrient-dense foods such as vegetables, lean meats, and seafood while eliminating inflammatory foods such as grains, dairy, refined sugars, refined oils, and processed foods. Those following a paleo diet have shown improvements in blood pressure and glucose tolerance, a decrease in insulin secretion and an increase in insulin sensitivity, with an improvement in lipid profiles. However, the diet removes grains and dairy, with a reduction in intake of fiber, protein, and calcium, all important nutrients for oral health. But, with an increased consumption of green leafy vegetables and lean animal meats, deficiencies are unlikely.
Another common dietary practice, intermittent fasting is more concerned with the pattern of eating, rather than what is consumed. This is a common practice in many ethnic cultures and religions. A common pattern in the diet is 16:8; in which a person eats during a designated 8-hour time frame and fasts for the remaining 16 hours, although there are a variety of fasting patterns. This pattern often follows a circadian cycle, and has been shown to increase weight-controlling hormones, such as human growth hormone and ghrelin.
Overnight fasting has also shown an increase in gluconeogenesis, which converts noncarbohydrate sources into energy, including fat. Limiting the eating phase can decrease the length of time the saliva pH drops to an acidic level. And hydration is encouraged in this kind of diet, which eliminates xerostomia and helps with normal saliva product. However, decreased mastication can lead to reduced saliva production, increased risk of xerostomia and caries, and gingival inflammation.
There are many variations on the vegetarian diet, with individuals often choosing one based on personal or religious beliefs. For example, some vegetarians will eat dairy such as eggs and cheese, while others will eat cheese but eliminate eggs. While a vegan diet eliminates all animal products entirely. The Academy of General Dentistry notes that patients following a vegan or vegetarian diet may have deficiencies in vitamin D, calcium, vitamin B12, and riboflavin. The lack of calcium and vitamin D can result in tooth and bone loss, and prevent remineralization of susceptible tooth surfaces.
And while vitamin D can be obtained through sunlight and a deficiency rate is rare, it can occur in people who do not consume milk or fish and avoid or limit sun exposure. A vitamin B12 deficiency can also lead to glossitis, angular cheilitis, recurrent ulcers, and oral candidiasis. Vegetarian diets have also been found to negatively impact saliva, with studies showing long-term followers of a vegetarian diet losing the ability for their saliva to act as a barrier to free radicals and bacterial contaminants in food. Another study found a diet high in fruits and vegetables offering positive impacts, including protection from oxidative damage, and altering the inflammatory response in periodontitis. However, the same diet showed subjects were more susceptible to tooth erosion.
Vegetarians and vegans are also at risk for protein deficiency due to the elimination of certain complete protein sources from their diet. Complete proteins contain all nine essential amino acids needed by the body. Protein has also been shown to be critical to the structural integrity and support structures of the dentition and for resistance of oral pathogens. This protein deficiency can be prevented through the consumption of whole grains, seeds, nuts, and soy, but the main sources of complete proteins include meat, cheese, dairy, and eggs.
2.9 Food Choices, Cultural Influences and Nutrition Transition - A Japanese Perspective
Culture and Healthy Eating: The Role of Independence and Interdependence in the U.S. and Japan
Culture and its Influence on Nutrition and Oral Health
Diet and Oral Health: Does Culture Play a Role?
Exploring issues related to oral health and attitudes to diet among second-generation ethnic groups