Almost universally, every artificially created sugar substitute is significantly healthier than sugar. People aren't often presented with the data on negative health outcomes of sugar when papers...
Almost universally, every artificially created sugar substitute is significantly healthier than sugar. People aren't often presented with the data on negative health outcomes of sugar when papers are published showing negative health outcomes of substitutes. The WHO has a fantastic meta-analysis and review breaking out a comparison of sugars to substitutes across a variety of health measures.
Is this not akin to saying something like, powder cocaine is healthier than crack? I think there’s a case to be made that any amount of refined sugar is unhealthy, and similarly so sugar...
Is this not akin to saying something like, powder cocaine is healthier than crack? I think there’s a case to be made that any amount of refined sugar is unhealthy, and similarly so sugar substitutes. (Don’t take th8s to mean I don’t eat all kinds of pastries and what not. I’m pretty addicted, which is part of my point).
Said another way, sugar substitutes are not healthy alternatives sugar, just like dipping is not a healthy alternative to smoking, even though in a technical sense they may be less harmful.
One issue is that there are many artificial sweeteners and they often behave differently from one another in multiple ways: safety profile, affect on blood sugar, gastrointestinal side effects,...
One issue is that there are many artificial sweeteners and they often behave differently from one another in multiple ways: safety profile, affect on blood sugar, gastrointestinal side effects, etc.
So claiming all artificial sweeteners are "not healthy alternatives to sugar" seems to be a stretch, IMHO. Even "less harmful but still bad" / smoking analogy seems a bit too harsh to me. There may be facets of this I agree with though- I'm not sure if studies have shown this at scale- but anecdotally I believe that at least some artificial sweeteners still cause food cravings like sugar does- so while the ingredients themselves may eventually prove "safe"- their biological / psychological side effects may counteract their inherent safety by externalizing it, basically
Certainly in terms of impact on blood sugar and calorie intake, there are quite a few substitutes/alternatives that are incomparable to real sugar, some have no affect at all on blood sugar- which to me makes them significantly healthier. I do believe that we need more thorough studies on all sugar substitutes, because while we shouldn't assume they're all just as unhealthy as sugar we shouldn't assume they're 100% perfect/safe either.
I am quite certain it would be beneficial for more people to reduce sugar in their diets, even if that means substituting something else in its place.
I'm not sure how you got to this conclusion. The article discussed in the CNN article found a hazard ratio of 1.8 (1.18-2.27) and 2.21 (1.2-4.07) for 4th and 1st quartile respectively (p=.007 and...
Is this not akin to saying something like, powder cocaine is healthier than crack?
I'm not sure how you got to this conclusion. The article discussed in the CNN article found a hazard ratio of 1.8 (1.18-2.27) and 2.21 (1.2-4.07) for 4th and 1st quartile respectively (p=.007 and p=.010). Of note, supplementary tables 13 and 14 both look at relative hazard ratios of the controlled factors including age, smoking status, diabetes, gfr, blood pressure, etc. The hazard ratio of erythritol is around 20-30% (1/5-1/4) as much as that of smoking status (any vs. never; similar p<.05 ratios).
Given that the total size of the population was relatively small in this study, that it included mostly older males who exclusively had a cardiac event, and it looked at very few confounding variables to control for (of particular note, nothing on SES), used a rather large dose of erythritol (30g) and has findings which are less significant than other well studied and known contributors such as smoking status, I'm not sure you can support almost any statement other than "this warrants more research".
Sick and tired of dietary studies where authors assume correlation is causation. This absolutely warrants further research and is potentially a reason to limit maximum amounts of erythritol in...
Exemplary
Sick and tired of dietary studies where authors assume correlation is causation. This absolutely warrants further research and is potentially a reason to limit maximum amounts of erythritol in food products, but the population we're looking at are people who had a cardiovascular event. This reminds me of a lot of studies I've seen on the risk of dietary salt when looking at people with high blood pressure - this may be a subset of the population and by drawing conclusions we're falling prey to selection bias, not to mention ignoring human variability (differing pathways for metabolization, not to mention genetic expression/variability).
I'm also struggling to find animal models which support the conclusion reached in this article (here's two models which do not). Did anyone have any better luck finding the animal models they allude to in the article? The only animal model cited in the paper is the following which says nothing about blood clotting risk and deals with a very specific subset of diseased rats.
Just as a side-note, practically all "stevia" sweeteners on the market are effectively pure erythritol. The ratio is generally right around 99.75% erythritol, and 0.25% stevia. Some FDA labelling...
Just as a side-note, practically all "stevia" sweeteners on the market are effectively pure erythritol. The ratio is generally right around 99.75% erythritol, and 0.25% stevia. Some FDA labelling loophole allows companies to market this ratio as stevia.
There are true, pure stevia products out there (generally liquid form with eyedropper lids), but they are very uncommon and hard to find.
If you think you use stevia, check your labels, closely.
Do you know if this is true for “stevia leaf extract”? I have found that I can detect stevia at very low thresholds, and I absolutely hate the flavor. Now I am wondering if I am tasting...
Do you know if this is true for “stevia leaf extract”? I have found that I can detect stevia at very low thresholds, and I absolutely hate the flavor. Now I am wondering if I am tasting erythrithol and not stevia.
IDK w/o seeing a product label. Stevia has a distinct taste, kinda like licorice. Many people don't like it. Erythritol is more bland, more like plain sugar. You can buy each separately, to figure...
IDK w/o seeing a product label. Stevia has a distinct taste, kinda like licorice. Many people don't like it. Erythritol is more bland, more like plain sugar.
You can buy each separately, to figure out which one you don't like, but it's probably the stevia.
Ah yes, keto ice cream, a quintessential part of the American diet that we are all familiar with. It would have been better if they just said it was equivalent to roughly n teaspoons, or at least...
Just how much is 30 grams of erythritol? The equivalent of eating a pint of keto ice cream, Hazen said.
Ah yes, keto ice cream, a quintessential part of the American diet that we are all familiar with.
It would have been better if they just said it was equivalent to roughly n teaspoons, or at least give me a product that I'm likely to actually be familliar with.
As someone who reads nutrition labels religiously I haven't seen erythritol in too many products. Rather worryingly I'm pretty sure it's in the Stevia sweetener for baking that I use, but the only other product I have seen it in is a very overpriced soda that I found in a health food store. That being said, I'm not sure if I've ever seen "sugar alcohols" without the actual ingredients following it in parentheses.
In spite of my complaints I'd actually say that this is perhaps one of the better examples of health study news coverage that I've seen, so avoiding this sweetener might be wise.
In the past few years, brands like Halo Top have exploded onto the ice cream market, filling the niche of "a pint of ice cream that you don't feel guilty about eating in one sitting," and knowing...
In the past few years, brands like Halo Top have exploded onto the ice cream market, filling the niche of "a pint of ice cream that you don't feel guilty about eating in one sitting," and knowing the rate that both diagnosed diabetics and healthy people I know who'll plow through them, I wouldn't mock their choice of example. Among health-conscious people of all ages and sorts, those keto ice creams are incredibly popular.
"Light" and calorie-reduced ice creams, yes, but not keto. Halo Top makes a line of keto ice creams, but the majority of ice cream they make is not keto-friendly.
"Light" and calorie-reduced ice creams, yes, but not keto. Halo Top makes a line of keto ice creams, but the majority of ice cream they make is not keto-friendly.
And those non-keto options still have 15+ g of erythritol per pint, and the zeitgeist says "sugar is evil, sugar alcohols are healthy". I don't know about how much volume of each line they move,...
And those non-keto options still have 15+ g of erythritol per pint, and the zeitgeist says "sugar is evil, sugar alcohols are healthy". I don't know about how much volume of each line they move, but I'm hesitant to expect that, despite the narrower set of flavour options in the keto line, they don't sell comparably. Certainly, I see each taking up about the same amount of space at my local grocery store, and I hardly live in the city with the most health-conscious people.
I actually don't bake with it. I mainly use it to sweeten my morning oatmeal. I don't really trust monkfruit right now since it basically just exploded from obscurity into popularity. I literally...
I actually don't bake with it. I mainly use it to sweeten my morning oatmeal.
I don't really trust monkfruit right now since it basically just exploded from obscurity into popularity. I literally just heard about it two weeks ago, and when I looked it up it appears that there's almost zero research done on how it affects the human body.
The irony is that I'm actually pretty OK with the flavor of aspartame, I just don't use it because I can't find it packaged in anything than tiny paper sachets.
You also have to be careful with monk fruit, as some brands mix in — you guessed it — erithrytol! EDIT: Unsweetened egg on my face! This is literally in the first sentence of the article: 🤦♂️I...
You also have to be careful with monk fruit, as some brands mix in — you guessed it — erithrytol!
EDIT: Unsweetened egg on my face! This is literally in the first sentence of the article:
A sugar replacement called erythritol – used to add bulk or sweeten stevia, monkfruit and keto reduced-sugar products – has been linked to blood clotting, stroke, heart attack and death, according to a new study.
🤦♂️I should get better about reading before diving into the comments.
Definitely warrants more research but I still view this as unnecessarily alarmist reporting. Typical science-watered-down-for-public-consumption nonsense, enough so that the article's title is...
Definitely warrants more research but I still view this as unnecessarily alarmist reporting. Typical science-watered-down-for-public-consumption nonsense, enough so that the article's title is incredibly misleading.
Shoot, I just bought a bunch of granulated erithynol/monk fruit for baking. I didn't really like it that much though (weird aftertaste + cooling effect), so I guess this is a good excuse to go...
Shoot, I just bought a bunch of granulated erithynol/monk fruit for baking. I didn't really like it that much though (weird aftertaste + cooling effect), so I guess this is a good excuse to go back to using sugar.
I use it in place of sugar. Mostly juices. I drink a lot of juice. Sucralose is the only artificial sweetener that does not cause any lingering bitterness for my palate. I don't tolerate...
I use it in place of sugar. Mostly juices. I drink a lot of juice. Sucralose is the only artificial sweetener that does not cause any lingering bitterness for my palate.
I don't tolerate artificial sweeteners in other things, such as cocoa or anything with milk. So those are strictly desert.
Ever tried stevia in your juices? I used to be a saccharin guy, then swapped to sucralose, then to stevia. It doesn't work well in tea, but in things with a stronger flavor like coffee, where I...
Ever tried stevia in your juices?
I used to be a saccharin guy, then swapped to sucralose, then to stevia. It doesn't work well in tea, but in things with a stronger flavor like coffee, where I exclusively use it as my sweetener of choice, it's great.
I tried them all. Before sucralose, I thought I would never be able to replace sugar in my diet. Everything else tastes horrible to me. I don't drink coffee or strong chocolate, as I have the...
I tried them all. Before sucralose, I thought I would never be able to replace sugar in my diet. Everything else tastes horrible to me.
I don't drink coffee or strong chocolate, as I have the tolerance to bitterness of a 4-year-old.
Nevertheless, I have my tea unsweetened and without milk, always had. So to me that is the natural way, and tea with other stuff feels weird to me. Maybe because in my culture tea is viewed more as medicine than a regular everyday beverage.
I agree. Sucralose is the best one I've yet tried. I definitely get more sugar than I need but I'm not at the point where I need to seek replacements for it.
I agree. Sucralose is the best one I've yet tried. I definitely get more sugar than I need but I'm not at the point where I need to seek replacements for it.
The fundamental problem is that there is no cure for overeating other than willpower and knowledge. Our brains short circuit with sweet stuff. It hits a deep biological nerve that screams 'THIS...
The fundamental problem is that there is no cure for overeating other than willpower and knowledge.
Our brains short circuit with sweet stuff. It hits a deep biological nerve that screams 'THIS NUTRIENT IS RARE GET LOTS OF IT,' which was somewhat true before slavery-induced sugar production. And definitely true pre-agriculture (the majority of human existence), when almost all sugars came from raw fruits with a short shelf life.
Even if it's (eventually) proven or disproven that artificial sweeteners are 100% safe, they still feed into the cycle that eating sweet things increases your desire for sweet things. And even if the sweetener itself is safe...what about all the other stuff you're consuming along with it?
Simple experiment is soda: If you cut it out from your life for 6 months (and don't substitute something equally as sweet like fruit juice or cookies), it'll seem almost digustingly sweet.
The only answer is to eat relative to your lifestyle and limit sugarbombs. No amount of refined processing is going to 'fix' that.
Here's a meta-analysis on the effect of attention and overeating, here's a meta-analysis on the effect of chewing an overeating, a meta-analysis on intuitive eating, a meta-analysis on stress and...
The fundamental problem is that there is no cure for overeating other than willpower and knowledge.
Here's a meta-analysis on the effect of attention and overeating, here's a meta-analysis on the effect of chewing an overeating, a meta-analysis on intuitive eating, a meta-analysis on stress and eating patterns, a meta-analysis on music an food intake, a meta-analysis on protein intake and body composition, and a meta-analysis on setting weight goals and food intake. This is not an exhaustive review of how much literature exists in studying food intake, but the idea that "willpower and knowledge" are all that's necessary is not supported by the wealth of science out there. While I am glad that you have found messages that happen to resonate with you and how you manage your own eating, it can be harmful to people struggling with weight to repeat messages like this which are not supported by science.
Some of the other statements you made about sweetness and the role of sugars and sugar substitutes are simply not supported by the literature we have either- if you are interested in learning more about modern dietary science I would highly suggest looking for dietary science books or gaining skills in reading and interpreting medical literature before drawing and spreading any strong conclusions. This particular field of science is incredibly polluted by capitalistic incentives (every food company wants to promote their own food as healthy and substitutes of their food as unhealthy) and frankly extremely complicated (dietary needs and preferences are as diverse as humans are in a way that concepts like blood pressure are not, especially since our guts host a bunch of organisms which are incredibly diverse among human populations).
I don't think this is true. The cure for overeating is a well selected meal. If your meal is high in fiber and avoids adding too much of those addictive flavorings - sugars and fats - then you...
The fundamental problem is that there is no cure for overeating other than willpower and knowledge.
I don't think this is true. The cure for overeating is a well selected meal. If your meal is high in fiber and avoids adding too much of those addictive flavorings - sugars and fats - then you will eat fewer calories than if you were to do the same with a meal rich with them. 2000 calories of broccoli is going to last multiple meals, while 2000 calories of milkshake might not even make you full for as long as a normal meal would.
(Though I guess this might be what you meant by "knowledge" - the knowledge to choose foods that are better for you.)
And willpower. It takes will to choose a good meal over an unhealthy one. It's easy to phone out for takeout. It's relatively hard to commit to cooking a healthy meal for yourself.
And willpower. It takes will to choose a good meal over an unhealthy one.
It's easy to phone out for takeout. It's relatively hard to commit to cooking a healthy meal for yourself.
I hate that they use such a vague headline as it gives power to baseless attacks on any artificial sweeteners. Sugar is still bad for ya, folks.
Almost universally, every artificially created sugar substitute is significantly healthier than sugar. People aren't often presented with the data on negative health outcomes of sugar when papers are published showing negative health outcomes of substitutes. The WHO has a fantastic meta-analysis and review breaking out a comparison of sugars to substitutes across a variety of health measures.
Is this not akin to saying something like, powder cocaine is healthier than crack? I think there’s a case to be made that any amount of refined sugar is unhealthy, and similarly so sugar substitutes. (Don’t take th8s to mean I don’t eat all kinds of pastries and what not. I’m pretty addicted, which is part of my point).
Said another way, sugar substitutes are not healthy alternatives sugar, just like dipping is not a healthy alternative to smoking, even though in a technical sense they may be less harmful.
One issue is that there are many artificial sweeteners and they often behave differently from one another in multiple ways: safety profile, affect on blood sugar, gastrointestinal side effects, etc.
So claiming all artificial sweeteners are "not healthy alternatives to sugar" seems to be a stretch, IMHO. Even "less harmful but still bad" / smoking analogy seems a bit too harsh to me. There may be facets of this I agree with though- I'm not sure if studies have shown this at scale- but anecdotally I believe that at least some artificial sweeteners still cause food cravings like sugar does- so while the ingredients themselves may eventually prove "safe"- their biological / psychological side effects may counteract their inherent safety by externalizing it, basically
Certainly in terms of impact on blood sugar and calorie intake, there are quite a few substitutes/alternatives that are incomparable to real sugar, some have no affect at all on blood sugar- which to me makes them significantly healthier. I do believe that we need more thorough studies on all sugar substitutes, because while we shouldn't assume they're all just as unhealthy as sugar we shouldn't assume they're 100% perfect/safe either.
I am quite certain it would be beneficial for more people to reduce sugar in their diets, even if that means substituting something else in its place.
I'm not sure how you got to this conclusion. The article discussed in the CNN article found a hazard ratio of 1.8 (1.18-2.27) and 2.21 (1.2-4.07) for 4th and 1st quartile respectively (p=.007 and p=.010). Of note, supplementary tables 13 and 14 both look at relative hazard ratios of the controlled factors including age, smoking status, diabetes, gfr, blood pressure, etc. The hazard ratio of erythritol is around 20-30% (1/5-1/4) as much as that of smoking status (any vs. never; similar p<.05 ratios).
Given that the total size of the population was relatively small in this study, that it included mostly older males who exclusively had a cardiac event, and it looked at very few confounding variables to control for (of particular note, nothing on SES), used a rather large dose of erythritol (30g) and has findings which are less significant than other well studied and known contributors such as smoking status, I'm not sure you can support almost any statement other than "this warrants more research".
Sick and tired of dietary studies where authors assume correlation is causation. This absolutely warrants further research and is potentially a reason to limit maximum amounts of erythritol in food products, but the population we're looking at are people who had a cardiovascular event. This reminds me of a lot of studies I've seen on the risk of dietary salt when looking at people with high blood pressure - this may be a subset of the population and by drawing conclusions we're falling prey to selection bias, not to mention ignoring human variability (differing pathways for metabolization, not to mention genetic expression/variability).
I'm also struggling to find animal models which support the conclusion reached in this article (here's two models which do not). Did anyone have any better luck finding the animal models they allude to in the article? The only animal model cited in the paper is the following which says nothing about blood clotting risk and deals with a very specific subset of diseased rats.
Just as a side-note, practically all "stevia" sweeteners on the market are effectively pure erythritol. The ratio is generally right around 99.75% erythritol, and 0.25% stevia. Some FDA labelling loophole allows companies to market this ratio as stevia.
There are true, pure stevia products out there (generally liquid form with eyedropper lids), but they are very uncommon and hard to find.
If you think you use stevia, check your labels, closely.
Do you know if this is true for “stevia leaf extract”? I have found that I can detect stevia at very low thresholds, and I absolutely hate the flavor. Now I am wondering if I am tasting erythrithol and not stevia.
IDK w/o seeing a product label. Stevia has a distinct taste, kinda like licorice. Many people don't like it. Erythritol is more bland, more like plain sugar.
You can buy each separately, to figure out which one you don't like, but it's probably the stevia.
Ah yes, keto ice cream, a quintessential part of the American diet that we are all familiar with.
It would have been better if they just said it was equivalent to roughly n teaspoons, or at least give me a product that I'm likely to actually be familliar with.
As someone who reads nutrition labels religiously I haven't seen erythritol in too many products. Rather worryingly I'm pretty sure it's in the Stevia sweetener for baking that I use, but the only other product I have seen it in is a very overpriced soda that I found in a health food store. That being said, I'm not sure if I've ever seen "sugar alcohols" without the actual ingredients following it in parentheses.
In spite of my complaints I'd actually say that this is perhaps one of the better examples of health study news coverage that I've seen, so avoiding this sweetener might be wise.
In the past few years, brands like Halo Top have exploded onto the ice cream market, filling the niche of "a pint of ice cream that you don't feel guilty about eating in one sitting," and knowing the rate that both diagnosed diabetics and healthy people I know who'll plow through them, I wouldn't mock their choice of example. Among health-conscious people of all ages and sorts, those keto ice creams are incredibly popular.
"Light" and calorie-reduced ice creams, yes, but not keto. Halo Top makes a line of keto ice creams, but the majority of ice cream they make is not keto-friendly.
And those non-keto options still have 15+ g of erythritol per pint, and the zeitgeist says "sugar is evil, sugar alcohols are healthy". I don't know about how much volume of each line they move, but I'm hesitant to expect that, despite the narrower set of flavour options in the keto line, they don't sell comparably. Certainly, I see each taking up about the same amount of space at my local grocery store, and I hardly live in the city with the most health-conscious people.
I actually don't bake with it. I mainly use it to sweeten my morning oatmeal.
I don't really trust monkfruit right now since it basically just exploded from obscurity into popularity. I literally just heard about it two weeks ago, and when I looked it up it appears that there's almost zero research done on how it affects the human body.
The irony is that I'm actually pretty OK with the flavor of aspartame, I just don't use it because I can't find it packaged in anything than tiny paper sachets.
You also have to be careful with monk fruit, as some brands mix in — you guessed it — erithrytol!
EDIT: Unsweetened egg on my face! This is literally in the first sentence of the article:
🤦♂️I should get better about reading before diving into the comments.
Definitely warrants more research but I still view this as unnecessarily alarmist reporting. Typical science-watered-down-for-public-consumption nonsense, enough so that the article's title is incredibly misleading.
Shoot, I just bought a bunch of granulated erithynol/monk fruit for baking. I didn't really like it that much though (weird aftertaste + cooling effect), so I guess this is a good excuse to go back to using sugar.
Sheesh, I’ve been using a lot of this ever since I did keto. Gotta find something else I guess.
Thank God it's not sucralose. I can't live without it.
What do you use it for?
I use it in place of sugar. Mostly juices. I drink a lot of juice. Sucralose is the only artificial sweetener that does not cause any lingering bitterness for my palate.
I don't tolerate artificial sweeteners in other things, such as cocoa or anything with milk. So those are strictly desert.
Ever tried stevia in your juices?
I used to be a saccharin guy, then swapped to sucralose, then to stevia. It doesn't work well in tea, but in things with a stronger flavor like coffee, where I exclusively use it as my sweetener of choice, it's great.
I tried them all. Before sucralose, I thought I would never be able to replace sugar in my diet. Everything else tastes horrible to me.
I don't drink coffee or strong chocolate, as I have the tolerance to bitterness of a 4-year-old.
Nevertheless, I have my tea unsweetened and without milk, always had. So to me that is the natural way, and tea with other stuff feels weird to me. Maybe because in my culture tea is viewed more as medicine than a regular everyday beverage.
I agree. Sucralose is the best one I've yet tried. I definitely get more sugar than I need but I'm not at the point where I need to seek replacements for it.
The fundamental problem is that there is no cure for overeating other than willpower and knowledge.
Our brains short circuit with sweet stuff. It hits a deep biological nerve that screams 'THIS NUTRIENT IS RARE GET LOTS OF IT,' which was somewhat true before slavery-induced sugar production. And definitely true pre-agriculture (the majority of human existence), when almost all sugars came from raw fruits with a short shelf life.
Even if it's (eventually) proven or disproven that artificial sweeteners are 100% safe, they still feed into the cycle that eating sweet things increases your desire for sweet things. And even if the sweetener itself is safe...what about all the other stuff you're consuming along with it?
Simple experiment is soda: If you cut it out from your life for 6 months (and don't substitute something equally as sweet like fruit juice or cookies), it'll seem almost digustingly sweet.
The only answer is to eat relative to your lifestyle and limit sugarbombs. No amount of refined processing is going to 'fix' that.
Here's a meta-analysis on the effect of attention and overeating, here's a meta-analysis on the effect of chewing an overeating, a meta-analysis on intuitive eating, a meta-analysis on stress and eating patterns, a meta-analysis on music an food intake, a meta-analysis on protein intake and body composition, and a meta-analysis on setting weight goals and food intake. This is not an exhaustive review of how much literature exists in studying food intake, but the idea that "willpower and knowledge" are all that's necessary is not supported by the wealth of science out there. While I am glad that you have found messages that happen to resonate with you and how you manage your own eating, it can be harmful to people struggling with weight to repeat messages like this which are not supported by science.
Some of the other statements you made about sweetness and the role of sugars and sugar substitutes are simply not supported by the literature we have either- if you are interested in learning more about modern dietary science I would highly suggest looking for dietary science books or gaining skills in reading and interpreting medical literature before drawing and spreading any strong conclusions. This particular field of science is incredibly polluted by capitalistic incentives (every food company wants to promote their own food as healthy and substitutes of their food as unhealthy) and frankly extremely complicated (dietary needs and preferences are as diverse as humans are in a way that concepts like blood pressure are not, especially since our guts host a bunch of organisms which are incredibly diverse among human populations).
I don't think this is true. The cure for overeating is a well selected meal. If your meal is high in fiber and avoids adding too much of those addictive flavorings - sugars and fats - then you will eat fewer calories than if you were to do the same with a meal rich with them. 2000 calories of broccoli is going to last multiple meals, while 2000 calories of milkshake might not even make you full for as long as a normal meal would.
(Though I guess this might be what you meant by "knowledge" - the knowledge to choose foods that are better for you.)
And willpower. It takes will to choose a good meal over an unhealthy one.
It's easy to phone out for takeout. It's relatively hard to commit to cooking a healthy meal for yourself.