Keeping it Simply Stupid: Marion Nestle’s “Rogue Guidelines”

One of the things I do to irritate myself into a state of incoherence is read the comments section on interwebz articles that propose to address our national concerns about food and health. A constantly recurring theme about eating a “healthy diet”–100% guaranteed to appear in any comment section–is “It’s so simple. Just [do this thing].”*

I blame the Dietary Guidelines (but then I blame the Dietary Guidelines for everything–when my car won’t start, it’s those damn  Guidelines again).  They began the long proud tradition of over-simplifying nutrition guidance to the point of uselessness, a tradition that Michael Pollan, and now Marion Nestle, has taken to new levels of banality. This oversimplification not only displays an unholy disregard for any sort of cultural, economic, or metabolic differences between humans, but–when you get down to the details (the main ingredients of which are always devilish)–it “simply” doesn’t say much of anything.

Marion Nestle and Tamar Haspel wrote a whole long article about the “6 easy steps” to eating better, reproduced in the boxes below.  Ranting in regular type?  That’s me.

Go through the fine print of the omnibus spending bill just passed by Congress, and you’ll see that the 2015 Dietary Guidelines, scheduled for release in — you guessed it — 2015, have been pushed out to 2016. You wouldn’t think that the government’s efforts, every five years, to help Americans eat more healthfully would turn into a political football. But when its appointed scientists reviewed the literature on meat and health, for example, they did something quite radical. They said what they meant with no equivocations: Americans should eat less meat.

In order to keep things simple, it’s best if you ignore any historical facts that might add nuance–or reality–to your story.  Like the fact that this 38-year-old “radical” idea to “eat less meat” arrived in the first edition of the 1977 Dietary Goals.  Yes, this statement was changed in the 2nd edition of the 1977 Goals, but not–as Marion Nestle and Michael Pollan would have it–due to the fact that Evil Meat ran roughshod over the science. Of course the meat folks were upset; this call to “eat less meat” had about as much science behind it as similar suggestions at the time that vegetable oil could cause health problems, which is to say, not enough to justify public health policy. Yet, due to reasons more social, political, and economic than scientific, the prohibitions about meat are still with us, while concerns about vegetable oil have faded out of mainstream nutrition

Numerous physicians and scientists represented in the 1977 Dietary Goals for the United States: Supplemental Views, point out that (as McGovern himself and one of his primary supporters, Dr. Mark Hegsted, admit) the case against meat had never been proven. They go on to argue that suggesting that Americans remove/reduce an important source of nutrition in their diet (meat) may have unforeseen negative consequences. Norton Spritz (NYU School of Medicine) states: “… there are serious nutritional problems that affect many Americans that are clearly related to dietary inadequacies particularly of high quality protein …” George M. Briggs (Professor of Nutrition at UC-Berkeley) states: “There is good evidence that those who consume meat at the average level or more have as good health records and freedom from chronic disease as those who do not.”

The switch in language in the 2nd edition of the 1977 Goals to decreasing “saturated fat” intake rather than “meat” in general was not because there was more conclusive science to support that approach, but because it was politically more tenable.  Meat producers could try to–and did–breed animals with a reduced amount of the ostensible evil food component, saturated fat, in their product. But saturated fat wasn’t really the problem now, was it?

F.A. Kummerow (Director, The Burnsides Research Laboratory, University of Illinois, Urbana-Champaign) points out: “Your data indicates that animal fat consumption has decreased 24 pounds and vegetable fat consumption has increased 34 pounds/capita from 1940 to 1974. Yet, coronary disease has increased during a time period that this change took place. Why blame animal fats?” (See Nina Teicholz’s neato graph for a visual of the trend.) Well, because they come from animals, and there are all sorts of social and cultural reasons that some people are opposed to eating animals, that’s why. Why these people got to make the rules for the rest of us is a story for a different day.

Scientists voiced a number of valid concerns about the wisdom of telling Americans to eat less meat in 1977, many of which are still valid today:  over 40% of Americans, mostly females,  have inadequate protein intake.  But that complicates the narrative, doesn’t it?

As if that were not radical enough — previous committees had pussyfooted with such euphemisms as “choose lean meats to reduce saturated fat” — this committee insisted on an additional reason beyond health: environmental considerations.

 The result? Uproar.

Why have an uproar about a group of nutrition scientists (for the rigors of nutrition science, see below) making declarations about environmental issues? Perhaps next year, we can have the EPA make dietary recommendations.

Arguments like the ones over the Dietary Guidelines, fueled by lobbyists, politicians and agenda-driven groups, make diet advice seem maddeningly inconsistent, but the fundamentals haven’t changed much at all.

Sigh.  “Fundamentals”? Really?  Which fundamentals would you be talking about now?  The “fundamentals” of 1955 when more than half of our calories came from meat, eggs, milk, cream, fats and oils? Oh, and adult diabetes was virtually unheard of.

eat like your grandmother

 

It’s time to take back the process, so we’re going rogue and issuing our own Dietary Guidelines, untainted by industry lobbying, unrestricted by partisan politics. Here, in six easy steps, is our advice for the new year: what we think dietary guidelines ought to say.

Really?  Untainted by industry lobbying? Because wheat and vegetable oil interests never lobby–only Evil Meat.  That’s why the bottom of Marion Nestle’s beloved Food Pyramid ended up being ALL MEAT. Wait?  No?  Nevermind.

1. Eat more plants. You heard it from your grandmother. You heard it from Michael Pollan. Now you hear it from us: Eat your vegetables. Add fruits, beans and whole grains, and the wide-ranging plant category should make up most of your diet. Variety is the key. Plants offer us such an astonishing range of roots, stems, leaves, flowers, buds and seeds that there is bound to be something even the most jaded vegetable skeptic can love.

It’s just so simple.  Eat more plants. The biggest increase in calories during the rise in obesity and diabetes in America came from flour, cereal, and vegetable oils.  That’s right.  Plants.

Food supply changes calories

As for your grandmother (or great-grandmother), she ate at least 10% of her calories from vegetables and fruit, and so should you (see above).

2.  Don’t eat more calories than you need. Although on any given day it’s hard to tell whether you’re doing that, over the long term, your scale is a sure-fire indicator. If the pounds are going up, eat less.

It’s just so simple.  Don’t eat more calories than you need, whatever that means.  You can’t really tell when you’ve overeaten–until after the fact–at which point you should eat less.  If you’re hungry when you “eat less,” tough luck.  Suck it up, you wuss, you’ve already had more calories than you “need.”

Let’s pause here for the good news. If you follow our first two guidelines, you can stop worrying. Everything else is fine-tuning, and you have plenty of leeway.

That was the “good news”?

3. Eat less junk. “And what’s junk?” we hear you asking. We have faith that you know exactly what junk is. It’s foods with lots of calories, plenty of sugar and salt, and not nearly enough nutritional value. It’s soda and sugary drinks. It’s highly processed, packaged foods designed to be irresistible. It’s fast food. You know it when you see it. When you do, don’t eat too much of it.

It’s just so simple.  Eat less “junk.”  And since we know that it’s really mostly minorities and poor people who eat all the “junk” food, we should start by eliminating all the  poor people by giving them more money so they don’t go around being poor.  After that we should encourage a massive influx of people of color into the U.S. so minorities won’t be minorities anymore and will therefore stop eating junk food.  Problem solved.

4.  Eat a variety of foods you enjoy. There is research on the health implications of just about any food you can think of. Some — such as fish — may be good for you. You should eat others — such as meat and refined grains — in smaller amounts. The evidence for most foods is so inconsistent that you should never force yourself to eat them if you don’t want to, or deny yourself if you do. If you love junk foods, you get to eat them, too (in moderation, of course). You have bought yourself that wiggle room by making sure the bulk of your diet is plants and by not eating more than you need.

It’s just so simple.  And by plants you mean flour, cereal, and vegetable oil, right?  And by “not eating more than you need” you mean, well, you don’t know what you mean and neither do we.

This is an appropriate place to talk about a phrase that has been thrown around a lot in the Dietary Guidelines brouhaha: “science-based.”

As a journalist (Tamar) and a scientist (Marion), we’re very much in favor of science. But in this situation, the food industry’s frequent calls for “science-based” guidelines really mean, “We don’t like what you said.”

So, let me see if I understand this?  When the food industry calls for “science-based” guidelines, that’s a bad thing?  But if a bunch of (mostly) scientists call for “science-based” guidelines** that’s a good thing? This is getting a little confusing.

Arriving at truths about human nutrition isn’t easy.

But wait, you said these are “6 easy steps”?  Ooooooh.  Light bulb moment.  You’re not actually planning on telling us any “truths about human nutrition,” are you?  Ah, this is all beginning to make sense.

We can’t keep research subjects captive and feed them controlled diets for the decades it takes many health problems to play out. Nor can we feed them something until it kills them. We have to rely on animal research, short-term trials and population data, all of which have serious limitations and require interpretation — and intelligent people can come to quite different opinions about what those studies mean.

Which is why “eat some if you like it” isn’t a wishy-washy cop-out. It acknowledges science’s limitations. We do know that plants are good, and we do know that junk foods aren’t, but in between is an awful lot of uncertainty. So, eat more plants, eat less junk, and eat that in-between stuff moderately. That is exactly the advice science demands.

“We do know that plants are good.”  Which plants are you talking about? Corn, wheat, soy = plants, right?  And how do we know these plants (whichever plants you mean) are “good”?  Surely not through the vagaries of nutrition science, with all of its “serious limitations.”  You’ve just made the case that nutrition science is a poorly disciplined loudmouth whose “demands” we might very well ignore.  Oh wait. Right.  This is the part about not exactly telling us any “truths about human nutrition.”

What we eat and how we eat go hand in hand. We’ve all been there, sitting in front of a screen and finding that, all of a sudden, that bag, box or sleeve of something crunchy and tasty is all gone.

We’re so focused on what to eat that how to eat gets short shrift. So: 

5.  Find the joy in food. Eat mindfully and convivially. One of life’s great gifts is the need to eat, so don’t squander it with mindless, joyless consumption. Try to find pleasure in every meal, and share it with friends, relatives, even strangers.

Just remember that your mindful, joyful consumption should be Mostly Plants.  Thank goodness flour, cereal, and vegetable oils are Mostly Plants, so that I may mindfully and joyfully eat those Strawberry PopTarts.  It’s just so simple.

Poptarts are Mostly Plants

 

Learn to cook. The better you cook, the better you eat. There are days when cooking feels like a chore, but there are also days when you find profound satisfaction in feeding wholesome homemade food to people you love.

“Learn to cook.”  It’s just so simple.

  1. First, use your copious spare time to chillax with some Ina Garten YouTube videos.
  2. Once you “know” how to cook, assemble some easy-to-prepare menu ideas that will meld seamlessly with your work schedule, your workout schedule, your partner’s work schedule, your partner’s workout schedule, and your kids’ soccer/ trombone/tap dancing schedule.  Or maybe your two-jobs and day-care and public transportation schedule. Or any variation on the above in your oh-so-simple life.
  3. Then go shopping and buy all the stuff you need (this step requires money, just FYI). Don’t forget to take your reusable hippie bags.
  4. Carry all the stuff home in the back of your Prius, or on the bus, or if the scale is telling you that you’ve had more calories than you “need,” you can just hoof it home, fatso.
  5. Put all of your groceries away. Try to find a place where the food won’t spoil, and your kids/partner/roommate won’t eat it before it becomes dinner. Recycle your plastic bags since your forgot to use your hippie ones.
  6. At the appointed hour, begin. Chop. Stir. Sauté. All the things.
  7. Call those “people you love” to the table.
  8. Search your soul for that “profound satisfaction” you’ve been promised when the “people you love” use this opportunity to gripe about flavor, color, consistency, and smell of the lovingly prepared food that sucked up hours of your life, which they then proceed to snarf down in 7 minutes flat before bolting from the table in order to escape your nonstop bitching about what a thankless task cooking is.

[Snarky aside:  This advice about cooking?  It just applies to poor slobs like you and me.  As for Marion Nestle herself, she’d prefer not to:  “I eat out a lot and don’t cook much for myself.” ]

And foods you make at home are worlds apart from foods that manufacturers make in factories. No home kitchen ever turned out a Lunchable.

In her “home kitchen,” my mom used to make us bologna and processed cheese food sandwiches on Wonder Bread.  As a special treat, she would sometimes leave the red plastic strip on the bologna.  Extra fiber.  But, most assuredly, not a Lunchable.

If you go out in the world armed only with these guidelines, you’ll do great. Sure, there’s much more to know, if you want to know it. We’ve forged careers writing about food and nutrition, and either one of us could talk micronutrients until your eyes glaze over. But these few basics are all you need to make good food decisions. Choose foods you like — heavy on the plants, light on the junk — cook them and enjoy them.

 It really is that simple.

Simple. Simply useless.  And not exactly “rogue” either.  The 2010 Dietary Guidelines include some form of every single one of these “rogue” guidelines–including the directive to cook and eat at home, preferably with your family, whether you like them or not–even if the 2015 ones don’t.

The only truly “rogue” statement Haspel and Nestle make is in the headline, and it is one with which I concur:

Forget government guidelines.

Simple.

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*Nowadays, when I see an online nutrition article with a comment section, I get out my FATSO card & see how many comments it takes for me to score a FATSO.  FATSO is like BINGO, only renamed in honor of America’s moral panic over body size.

**But not too science-based. According to the two letters sponsored by Center for Science in the Public Interest (motto: “Transfattingforming the American diet”), the members of the Dietary Guidelines Advisory Committee and a number of other nutrition-related organizations both opposed the notion that “Any new recommendations or changes to the 2010 Guidelines must be based on conclusions rated “Grade 1: Strong” by the Nutrition Evidence Library (NEL) rubric.”  In other words, the scientists–not the food industry–would like to have Guidelines based on weak conclusions from a scientific field whose methodology is already pretty weak.  Nice one, scientists.

The slick “new” Dietary Guidelines

Because never changing the recommendations means never having to say you’re sorry for 35 years of crappy advice, the 2015 (really 2016, but whose counting?) Dietary Guidelines repeat the same old-same old “whole grains, fruitsandvegetables, low-fat/fat-free dairy, fish, nuts, and (if you must) lean meat” guidance from years past. Only difference: The new Guidelines are now oozing with vegetable oil.

In the list of recommended foods to include in “a healthy eating pattern,” “oils” now have their own category.
Oil its own food group
For the most part, we are talking Big Oil: canola, corn, peanut, safflower, soybean, and sunflower. Oils that have been chemically extracted, de-gummed, bleached, and deodorized (y’know, stuff you do to dirty diapers). And good luck finding them at your local farmers market.

Big Oil is big business for the U.S. agricultural economy and for the nutrition science academic industry. Alice Lichtenstein, of the 2015 Dietary Guidelines Advisory Committee, has found more creative ways to feed all kinds of oil to hamsters, rats, and people than probably anybody on earth. Corn, canola, soybean, safflower, sunflower, margarine and shortening, even rice bran oil–you name the oily food substance and Alice Slicktenstein has built her career on getting funding for studying it. Most of her work is done at–and funded through–the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts, which is supported by money from, you guessed it, the USDA.  Her research is also supported by numerous grants from the NIH branch of HHS. However, this has nothing to do with the shiny new prominence of oily stuff in the USDA’s and HHS’s new Dietary Guidelines.

To be sure, oil oil everywhere is not the only thing slick about the new Guidelines. The language is pretty slippery too. There’s been a lot of cheering from the press about the “new” direction of the Guidelines, and indeed, some of the things being reported are actually in the Guidelines: The Guidelines have gotten rid of the ridiculous (and possibly dangerous) “1/2 teaspoon of salt a day” limits on sodium for some subpopulations–although the no-more-than 2300 mg (yes, a Whole Teaspoon!) limit should still be–wait for it–taken with a grain of salt.

Despite all arguments otherwise, nutrition–the politics and the science of it–is complicated. In a number of cases, trying to make the ugly stepsister foot of a “consistent public health message” squeeze into the glass slipper of inadequate and contradictory science has the Guidelines talking out of both sides of its oleaginous mouth. Here’s a closer look at what is going on:

1. Limits on cholesterol are gone.
Eh. Sorta kinda not really. It would appropriate to say “numerical” limits on cholesterol are gone, but the language of the DGA is still pretty limiting. As in:

“individuals should eat as little dietary cholesterol as possible”

What’s fun about this is that the Vegamanics are celebrating this as “cholesterol still sucks” while the SatFat Redeemers are all about “Eat them eggs, y’all.” They’re both right.  Or wrong.  Hey, this is nutrition! You don’t really expect a straight answer now, do you?

2. Red meat gets a pass.

It’s true that [lean] meat has not disappeared altogether, and that language about a “sustainable diet” (whatever that means) is not in the Guidelines. At the same time, the Guidelines recommend “lower intakes of meats, including processed meats,” lumping them in the same category as sugar-sweetened food and refined grains. So like the cholesterol issue above, this is getting played as “Evil meat lobby wins” on one side of the debate, and “Meat justice prevails” on the other.

The meat industry is happy to proclaim its support the Guidelines–as long as its product is still in them. If I were the meat folks though, I’d be working to shut the whole process down. If meat is still in the Guidelines, it is not for lack of 35 years of trying to get it out.

3. Limits on fat are gone.
Nope. Limits on “fat” are still there. If you’ve been hearing rumors that we are at the end of the “low-fat” era, and you thought that meant that the Guidelines were going to give the green light to fats–natural fats, fats that you could find at your local farmers market–you would be sadly, profoundly mistaken.

Just like all squares are rectangles, but only some rectangles are squares, all oils are fats, but only some fats are oils. The new Guidelines have been credited with saying, “Hey we’re okay with rectangles” but they are only okay with those rectangles that are squares.  You can eat fat, but only if it’s oil.

Evil fats

So: Fat–as in “saturated fat”– is still evil. But lower limits on “oil” are eased–with the exception of a few oils that the DGA folks still don’t like because their fatty acids are mostly saturated. Lower limits on oils in the diet have shifted from no less than 20% of calories to no less than 25%. But make no mistake: The upper limit on dietary “oil” as a macronutrient remains at 35% of calories, as it has been since 2005. Only by keeping limits on “oil” low can we manage to cram in the Guidelines’ requisite 45%-65% of calories of carbohydrate into our diets and still have room for protein.

In other words, the USDA hasn’t discarded the “low-fat” diet. They’ve discarded the “low oil” diet and actually, not even that. Now you are allowed a whopping 27 grams (about 5 teaspoons) of highly processed and refined, probably not local or within your foodshed, oily oil. Cheers!crisco oil
4. The DGA limits sugar intake.
Nope. It limits “added sugar” intake. That means that a bottle of orange juice, which “naturally” has as much sugar as a bottle of soda, is “good,” while soda is “bad.” Yeah yeah yeah. I hear you out there: “But but but. Orange juice has Vitamin C.” So add some Vitamin C to soda–same difference. Puh-leeze. Sugar is sugar. (I’ll save my “starch is sugar too” rant for another day.)

And all this talk about how Americans “typically exceed” recommendations for added sugar intake? Go look through the past 35 years of Dietary Guidelines. This is the first time ever that there has been an official numerical limit on sugar in any form–added or otherwise. I’m not sure how we could “exceed” something that wasn’t defined in the first place. However, the “Americans don’t follow the Guidelines” story is the best way to avoid confronting the fact that the Guidelines have not worked as intended. USDA/HHS can pretend that all would have been well if those fat stupid Americans had just done the stuff they were (actually not) told to do! Secretary Burwell suggested at the hearings in October that without the Guidelines the rapid rise in obesity rates might have been even rapider …

“We are on the wrong trajectory, but would the trajectory have been worse?”

… though it is hard to see how.  Fat lazy Americans can only cram so many Double Whoppers with Cheese down their gullets at a time, and besides Netflix wasn’t even invented until, like, 1997.

For a bit of perspective, although the 10% cap on “added sugars” is being hailed as some nutrition revolution, the USDA says Americans typically consume 13% of their calories from “added sugars” now. The radical new cap on “added sugars” heralds a (potential) whopping 3% decline in their consumption.  To be replaced by “naturally occurring sugars”? Or possibly more artificial sweeteners? Maybe, beer?

One thing is true about the Guidelines, though. Pretty much everyone hates them. Doesn’t matter where on the nutrition dogma spectrum you look–Marion Nestle or Nina Teicholz–everyone’s complaining.

I don’t like them either, but for reasons I don’t hear about in the press:

“All segments of society—individuals, families, communities, businesses and industries, organizations, governments, and others—can and should “align with the Dietary Guidelines.”

What this means:  The Guidelines have not worked as intended in the past and haven’t changed significantly in this edition, but this isn’t because the whole idea of having a single dietary prescription that will reduce risk of virtually every chronic disease in all Americans no matter their race, gender, age, genetics, lifestyle, etc. etc. etc. is patently ludicrous.  The Guidelines haven’t worked because we haven’t “aligned with” them.

As some snarky person once said, this is all about enforcing your right to eat what the folks behind the Guidelines have determined is good for you. 

“Aligning with the Dietary Guidelines by taking these actions is powerful because it can help change social norms and values and ultimately support a new prevention and healthy lifestyle paradigm that will benefit the U.S. population today as well as future generations.”

What this means:  Making certain behaviors the “norm” through public health dictum is a tried-and-true way for privileged classes to impose their values on the less-privileged.  “Aligning with” the Guidelines will help make eating (and exercising) like rich white people the morally superior choice for everyone.

To paraphrase how one brainless “expert” on public consumption put it many years ago, “Let them eat kale!”

For the rest of us, well, Marion Nestle is right when she says that the Guidelines are a “win” for the processed food industries.  She should know.  She was managing editor of the 1988 Surgeon General’s  Report on Nutrition and Health, which said that processed food created to fit the prevailing definition of “healthy” is exactly what the public needs:

“Food manufacturers can contribute to improving the availability of palatable, easily prepared food products that will help people to follow the [low-fat, high-carbohydrate] dietary principles outlined here.”

The 2015-20120 Dietary Guidelines continue this line of reasoning:

“During the past few decades, food products and menus have notably evolved in response to consumer demands and public health concerns. The food and beverage and food service sectors and settings have a unique opportunity to continue to evolve and better align with the Dietary Guidelines.”

Which means that there is one group that always LUVS the Dietary Guidelines. As Food Navigator-USA puts it:

“The 2015 Guidelines released Jan. 7 create a marketing opportunity for savvy manufacturers and industry stakeholders to promote their products through educational materials that help consumers better understand how to meet the report’s recommendations.”

The Dietary Guidelines have been helping sell “healthy food” to consumers since 1980, just as “healthy food” manufacturers have been helping sell the Guidelines to consumers.  But “healthy food” doesn’t always lead to “healthy people.”  Moronically enough, the new Guidelines recognize that calls for “healthy processed food” might end badly (flashback to CSPI campaigning to add trans fats to food):

“In [developing and reformulating “healthy” products], care should be taken to assess any potential unintended consequences so that as changes are made to better align with the Dietary Guidelines, undesirable changes are not introduced.”

That means when the onslaught of oily, whole-grain, artificially sweetened and flavored food products fails to improve the health of Americans or (heaven forfend!) makes things worse, we know who to blame.

We can blame the American public for not following the Guidelines.  We can blame policymakers for not enforcing them.  And we can blame food manufacturers for introducing “undesirable changes” into the food supply.  But we can’t blame the Guidelines.

They’re too slick for that.

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PS.  I do plan on continuing the conversation started by Jennifer Calihan’s guest post “Low Fat, High Maintenance:  How money buys lean and healthy–plus an alternative path to both.”  If you haven’t read it already, you should (and the comments–good stuff there too). But, I just gotta get a couple of Dietary Guidelines rants out of my system.

Low Fat, High Maintenance: How money buys lean and healthy–plus, an alternative path to both

The 2015[6] Dietary Guidelines are out today. Although restrictions on cholesterol and overall fat [read: oil] content of the diet have been lifted, the nutrition Needle of Progress has hardly budged, with saturated fat and sodium still lumped into the same “DANGER Will Robinson” category as trans fats and added sugars–and with cholesterol still carrying the caveat that “individuals should eat as little dietary cholesterol as possible.” The recommended “healthy eating pattern” calls for fat-free/low-fat dairy, lean meat, and plenty of whole grains, plus OIL. In other words, the diet is still low-fat and high-carb–just add vegetable oil [you know, locally sourced, whole-food canola, corn, and soy oil].

However, the most disturbing part of the Guidelines is Chapter 3, which heralds “a new paradigm in which healthy lifestyle choices at home, school, work, and in the community are easy, accessible, affordable, and normative.”  In other words, let’s make what we’ve determined is the healthy choice, the easy–and morally permitted–choice for everyone [read: especially for those minority and low-income populations who insist on eating stuff we disapprove of].

Thus, it seems appropriate that today’s featured post focuses less on nutrition and more on the cultural context in which nutrition happens.  Without further ado:

Low Fat, High Maintenance: How money buys lean and healthy–plus, an alternative path to both

Guest post by Jennifer Calihan at eatthebutter.org

It’s Friday evening. There is a chill in the air. The smell of ‘Walking Tacos’[i] wafts over from the row below.  A rousing, “Give me an ‘S’!” commands my attention. All the cues point to one thing – I am sitting at another high school football game. I’m not really a huge football fan, but my son plays on the team, and I love watching him.

walking-taco

The parents and fans from my son’s school all sit on one side of the field, so the stands are filled with friends and many warm, familiar faces. I am struck, as I always am, by how good everyone looks. I see a lot of grey hair on the men but not much on the women – funny how that works! The adults watching are at least 40, and some are probably mid-fifties. But what is truly striking about this crowd is how trim they all are. Are there some people struggling with their weight? Sure. But the majority of these folks are maintaining a normal weight. No sign of the obesity epidemic on this side of the field. And I wonder what I always wonder – how do they do it – really?

At half time, I take a walk over to the visitor side of the field to stretch my legs. Over here, the stands tell a different story. The parents and fans of the visiting team look…  well, they look like most American crowds. Although this crowd seems a little younger than the home team fans, most of the people here are struggling with their weight. In fact, our national averages would predict about 68% of these adults are too heavy; 38% would be obese, plus about another 30% overweight.  And, based on what I see, that sounds about right. But it is not the weight, per se, that worries me. It is the metabolic disease that often travels with excess weight that is cause for concern. Diabetes, heart disease, fatty liver… a future of pills and declining health.

Experts acknowledge that obesity and the diseases that travel with it are tied to income.  Simplistically, you might think something like, “more money = more food = more obesity,” but that is just not how it works. As most of you know, it is the reverse. “Less money = more obesity.” So it may not surprise you to hear that my son attends an independent school in an affluent area.  And the visiting team is from a less affluent suburb. So, the mystery is solved – skinny rich people on one side, and overweight middle-class people on the other.

What interests me is the, ‘How?’ As in, ‘How do the skinny rich people do it?’

I affectionately refer to my neighborhood, and others like it, as ‘the bubble.’ The bubble is safe… it is comfortable… it is beautiful. But how, exactly, does the bubble protect my family and my neighbors from the obesity epidemic? Just as it is not a happy accident that actresses age amazingly well, it is not a happy accident that the affluent stay lean. Most of them spend a lot of time and money on it. They have to. Our nation’s high-maintenance dietary recommendations require most eaters to invest a great deal of resources to combat the risk of obesity and diabetes that is built into low-fat eating. Unfortunately, this means middle-income and working class families, who may be lacking the resources to perform this maintenance, are launched on a path toward overweight and diabetes. What can be done to level the playing field?

Seven Ways Money Buys Thin

1. More Money Buys Better Food

 For many in the bubble, there is not a defined budget for groceries. And, let’s face it, that makes shopping successfully for healthy food – however you define it – just a tad easier.  To imagine the flexibility that wealth can afford, consider this inner dialog that happens in a Whole Foods aisle near you. In the bubble, a mom might consider: “Should I buy the wild salmon or the chicken tenders for dinner? Hmmm… let’s see here. $28.50 or $8.99? My, that is quite a price difference. But those tenders are pretty processed. And they aren’t gluten-free. I’ll go with the salmon this week – Johnny loves it, and it’s so healthy.”  If it doesn’t really matter if the food bill is $300 or $350 this week, why not buy the wild salmon?

Much has been written about how cheap the processed calories in products like soda and potato chips are, and how tempting those cheap calories are to people who are shopping, at least on some level, for the cheapest calorie. I find it hard to believe that any thinking mother is buying soda because it is a cheap way to feed her family.  My guess is that she is buying soda for other reasons: habit, caffeine, sweet treat, etc. But certainly, refined carbohydrates and refined oils, which I believe are uniquely fattening, are cheap and convenient and are often processed into something remarkably tasty.  So yes, I think small grocery budgets lead to more processed foods and more fattening choices.

way better etbHigher grocery budgets often lead to high-end grocery stores that offer exotic, ‘healthy’ products, which, on the margin, may be healthier than their conventional counterparts.  Quinoa pasta, hemp seed oil mayonnaise (affectionately known as ‘hippie butter’), cereals or crackers made from ancient grains, and anything made with chia seeds all come to mind. Last week, I saw Punkin Cranberry Tortilla Chips on an endcap. Seriously? (Yet, mmmm…  how inventive and seasonal!) The prices are ridiculous, but upscale shoppers snap up these small-batch, artisanal products, regardless. They may not be worth the money, and may not really taste all that good, but they carry an aura of health and make you feel really good about yourself when you put them in your cart.

The idea that money buys better food also rings true when eating out. The cheapest restaurants tend to offer more processed calories with fewer whole food choices. And, even on the same menu, the fresh, whole foods tend to be quite expensive, especially if you look at cost per calorie. Again, in the bubble, a mom might consider, “Pizza tonight? Or should we stop by Cornerstone, the local home-style restaurant, and get grilled chicken with broccoli and a salad?  Hmmm…  $20 or $60? Well, we did pizza last week; I think we should go to Cornerstone.”

The bottom line is that money can buy more choices and some of those choices are less likely to add pounds.

2. More Money Buys More Time to Cook and/or More Shortcuts

Most of the moms (and a rare dad or two) in my circles have time to shop and cook because they are not working full-time. Thus, higher family income can mean more home-cooked meals. Cooking at home gives families more control of ingredients and portions. It also tends to mean more whole food and less processed food, which most agree is better for weight control.vintage ladies AND logo

Of course, affluent working moms are the exception to this, as they have little time for grocery shopping and cooking. But, again, money can help here. Many of my friends who work full-time outsource the grocery shopping and/or cooking to a nanny, a housekeeper, or a personal chef service. Even in a mid-sized city like Pittsburgh, there are boutique, foodie storefronts that deliver healthy, home-made meals for $12-16 (each). Lately, some moms are using the on-line services (like Blue Apron, Hello Fresh, Plated, and even The Purple Carrot, which offers a vegan menu) that ship a simple recipe and the exact fresh ingredients needed to make it to a subscriber’s door each day. How convenient! For only $35 or $40, you can feed your family of four AND still get to cook dinner. Perfect. Many skip the whole experience and simply purchase fully cooked gourmet meals at high-end grocery stores, which tend to run $8-15 per person. Fabulous. What a nice option for the health-minded busy mom who is not on a budget. Of course, not all working mothers are quite so lucky.

3. More Money Buys More Time to Exercise And More Access To Exercise

I am a firm believer that one cannot exercise one’s way out of a diet full of nutritionally empty calories. BUT, if people get their diet headed in a decent direction, daily exercise can really help them cheat their way to thin even if they are still not eating right all of the time. So, exercise is certainly a factor in this puzzle, particularly for people eating low-fat diets that seem to require a steady, daily burn of calories. As a committed non-athlete, I am continually amazed by how much my friends exercise. Running, walking, biking, swimming, tennis, squash, paddle tennis – the list goes on and on. Now, small fitness facilities offer pricey, specialized workouts: lifting, yoga, Pilates, rowing, bootcamp, kick-boxing, TRX, Pure Barre, spinning, Crossfit, and the very latest – wait for it – OrangeTheory. These boutique fitness plays are becoming more common, and can run up to $500/month…  not kidding. Here’s more on this trend from the WSJ.

Whew. It is exhausting to even imagine keeping up with most of my friends and neighbors. But I give it a go…  sort of. Devoting an hour or more each day to exercise is much easier for those living in the bubble. Let’s be honest – people with money can afford to outsource some of the busywork of life. If you don’t like cleaning your house or mowing your lawn or weeding the flowerbeds or repainting the fence or doing laundry, don’t do it. Pay someone else to do those things, so you have time for spinning 3x a week plus Pilates (work that core) and tennis. Have baby weight to lose? No problem. Hire a babysitter and a trainer and you will make progress.

Good trainers, although expensive, often deliver more effective exercise, more efficient routines, more entertaining workouts, and better results. Appointments are scheduled and you pay whether you go or not, which makes showing up more likely. You can even find a buff guy who will yell at you if you find that motivating. Personal trainers are just one more way money buys thin.

When I think back to what my mother might have considered doing to stay fit when she was my age, I come up with one thing and one thing only: walking the golf course. And I lived up north, so the golf season was only 18 weeks long. She had no regular workout routine, nor did any of her friends. Did she have cut arms, toned abs, and look great in a bikini? Absolutely not. Was she overweight? Absolutely not. And she had the good sense not to wear a bikini, btw.  It’s amazing that she could maintain her weight without regularly scheduled exercise. Her game plan was old-fashioned: bacon and eggs fried in butter for breakfast, no starch at dinner, very occasional desserts, plus a couple very dry martinis, never before 6pm. She’s a size 10 at age 91, so I’d say it worked for her.

Tithe closetmes have changed. In the bubble, 50-year-old upper arms are proudly bared, even in winter, and women walking around in fitness gear is so commonplace that the industry has a term for this fashion trend: athleisure.  If you think I might be making that up, check out this WSJ article, “Are You Going to the Gym or Do You Just Dress That Way?” The fact that Nike’s sales of women’s products topped $5 billion in 2014 is a little startling, no? Some women even need a completely separate closet to house all of their Nike apparel. Khloe Kardashian claims her fitness closet is her favorite closet. Ummm…  not quite sure what to say about this, except that girl has a lot of sneakers.

One doesn’t have to be athletic to exercise, so I am guilty of some of this behavior (although I swear I only have one drawer for my fitness gear). I am sure there are some naturally thin couch potatoes among the parents of the students enrolled at my son’s school, but they are the exception. Most of the lean and affluent are working pretty hard to look the way they look.

4. More Money Buys Access to Better Ideas About What Makes You Overweight

Maybe it is your personal trainer who talks to you about trying a Paleo diet. Or, perhaps your trip to Canyon Ranch exposes you to a more whole food, plant-based, healthy fats approach to eating.  Or, if you prefer to ‘spa’ at Miraval, you might learn about Andrew Weil’s anti-inflammatory food pyramid. Maybe your friend recommends an appointment with a naturopathic MD who suggests that you try giving up grains. The point is, if you have money, you have a greater chance of hearing something other than ‘eat less, exercise more’ when you complain about your expanding waistline. The affluent have easy access to many different ideas about diet and health, so they can experiment with several and see which one works for them.

Today, one of the most popular alternative ways of eating is a plant-based, ultra-low-fat diet. Books and sites (like the in-your-face, aptly named Skinny Bitch brand) market snotty versions of this blueprint for weight loss to their upscale customers. I see many women in my circles eating this near vegan diet these days: lots of whole vegetables and grains, very little fat, with perhaps a little lean meat, fish or eggs occasionally. Although this is not my chosen approach, as it requires giving up too many of my favorite foods and leaves me perpetually hungry, it seems to deliver some pretty skinny results.  And, since it is in vogue, it is something that will be accommodated at parties in the bubble – plenty of crudité platters with hummus and beautiful roasted beet salads, sprinkled with pumpkin seeds, pomegranate kernels, and just a touch of olive oil. In affluent communities, being among friends and acquaintances who practice an alternative approach to eating means social activities are “safe” places to eat, not minefields of temptation. I don’t mean to suggest that people in less affluent suburbs have not heard of a vegan diet or only socialize around piles of nachos; I would maintain that those communities are as invested in their health as affluent ones. But, if your social circle has access to better food, as well as better information about food, you are more likely to be a part of a “culture of skinny.”

5. More Money Buys a ‘Culture of Skinny’

Living in the bubble means living among the lean. Which, as you might imagine, increases the odds that you will be one of them. There is a lot of peer pressure to look a certain way, and being surrounded by people who look that way certainly gets your attention. It also gives you hope that being thin is a reasonable expectation – as in, “If all my neighbors have figured it out, so can I.”  And, it helps that there will be healthier food at most gatherings. When the trays of cookies do come out, none of your friends will be reaching for more than one, either. So the bubble is sort of a support group for staying lean. As the success of AA can attest, when it comes to habits and willpower, support groups matter.

vintage ladies jane logoThere is even some research to back this up. Did you know that you are 40% more likely to become obese if you have a sibling who becomes obese, but 57% more likely to become obese if you have friend who becomes obese?[ii] It’s a little weird to think of obesity as socially contagious, but it seems that social environment trumps genetics. An article in Time explains it this way: “Socializing with overweight people can change what we perceive as the norm; it raises our tolerance for obesity both in others and in ourselves.”[iii] (Emphasis mine.)

Living immersed in the ‘culture of skinny’ makes the sacrifices you must make to stay that way more bearable. Misery loves company, and I often think that eating way too much kale and being hungry all the time is easier if you are doing it with friends…  Odd to think of widespread hunger in the affluent suburbs, I know, but I think there is a fair amount of self-imposed hunger here. Likewise, on the exercise front, you certainly won’t lack company on the paddle court or walking paths, and exercising with friends can truly be fun. Plus, you can take solace in the fact that you won’t be the only one foregoing the pleasure of lying on the couch with a glass of Chardonnay watching Downton Abby in order to make it to your spin class. In the bubble, the penalty for not keeping up with your diet and exercise regime is higher.  Being the only obese mom or dad standing on the sidelines at Saturday’s soccer game can feel a bit isolating. The ‘culture of skinny’ cuts both ways – it can serve as both a carrot and a stick.

6. More Money Buys Other Ways to Treat Yourself (and the Kids)

I attended a workshop about obesity and food deserts a couple of years ago. It was sponsored by a group of venture philanthropists (think: savvy business people advising and funding fledgling non-profits), hoping to shed some light on the obesity epidemic. One of our assignments was to go into a small market in a blighted urban neighborhood and try to buy food for a few meals for a single mother and two young children. Of course, the earnest healthy eaters (self-included) in our group dominated, and we came back with things like whole milk, regular oatmeal, vegetable soup, and turkey deli meat. Boy, were we – visitors to this world – going to prove that even in a food desert and on a budget, healthy eating was possible if we made wise choices. When we returned for the debrief, another mother said, “You know, we bought all this healthy stuff, but if I were that single mother, wouldn’t I want to bring home some joy? Like, something that would make my kids smile?” And, of course, she was right. If money were tight, would I really buy unsweetened oatmeal, disappoint my kids, and listen to the subsequent really loud whining? Probably not. I think I would bring home Captain Crunch and see some joy.vintage ladies eat it logo

In the bubble, breakfast does not have to be a treat. Like all mothers, I have to pick my battles, but breakfast can be one of mine. Would I be as likely to refuse to buy sweetened cereal if there were more important battles to fight? No. And, for the adults, maybe the food-reward cycle becomes less important when there are so many other ‘treats’ coming… the manicure, the tennis lesson, the new jeans… whatever it is that makes food less important.

7. More Money Buys Bariatric Surgery

If all else fails, people with resources have a surgical option. This is, of course, a very invasive approach to the problem – surgically altering the human anatomy to suit the modern diet rather than altering the modern diet to suit the human anatomy. But type 2 diabetes remission rates as high as 66% have been reported (two years post-op)[iv], so bariatric procedures offer more than just a cosmetic result.  Our health care providers love this option. (How exciting: a new profit center!) Expensive bariatric procedures are actually available outside the bubble because insurance will cover most of the costs. How interesting that this somewhat extreme solution is the tool that is subsidized enough to bring it within reach of our middle class citizens. But, of course, those without the means to fund the deductibles, out-of-pocket costs, and time off work cannot afford even this option.

Another Inconvenient Truth

Here’s the thing. As a nation, we have (perhaps inadvertently) chosen to push, EXCLUSIVELY, a very high-maintenance diet. (And I know high-maintenance when I see it.) A diet that requires most of its eaters to either perform hours of exercise each week, or endure daily hunger, or both, in order to avoid weight gain and/or diabetes. A diet that has taken us down the tedious path of measuring portions, counting calories, and wearing Fitbits. This is far from ideal, and has left too many of us hungry, tired, crabby, and sick, not to mention pacing around our homes at night in our daily pursuit of 10,000 steps. Yes, there are those genetically gifted people who can eat low-fat, not be chained to a treadmill, and remain skinny – ignore this irrelevant minority. Yes, there are neighborhoods of affluent people where most seem to make it work – ignore them, too. We should not let the success we see in privileged communities give us hope that our current low-fat dietary paradigm is workable. The bubble is a red herring; it telegraphs false hope.

Our nation’s overall results speak for themselves. Low-fat diet advice will never work for most Americans. Never-ever. Sticking, stubbornly, to our high-maintenance food paradigm is especially harmful for our working class and middle-income citizens; people who don’t have the time, money, or resources required to make the low-fat diet work, but care just as much about their health as those in the bubble. For them, we must move on.vintage ladies bathing suit logo

I am proposing that our obesity and diabetes epidemics reveal yet another inconvenient truth: our official dietary advice sets most people up for failure. Perhaps Jeb Bush could take a page out of Al Gore’s playbook and put himself on a post–campaign mission to shine a spotlight on this issue.  Jeb! has access, he has public speaking skills, he has bank, and, believe it or not, he’s Paleo. Who knew?

If Jeb! were to spread the word, what solutions could he promote?  What can any eater do to level the playing field a bit – to have a shot at vibrant health minus the prohibitive price tag of high-maintenance routines?

The Vintage Alternative

I run a small non-profit, Eat the Butter, that is all about real-food-more-fat eating. The main idea behind the site is that the USDA’s Dietary Guidelines have created many of our health problems, and going back to eating the way we used to eat, before they were issued, is a workable solution. The tagline is ‘Vintage Eating for Vibrant Health.’ Specifically, my site suggests some simple ideas about healthy eating. Eat real food. Unrefined. Whole food that has been around for a while. And don’t be afraid to eat more natural fat. To follow this advice, an eater must ignore some of the USDA’s guidelines. vintage ladies phone logoAnd there are millions of Americans doing just that. (Many of these rogue eaters are affluent, by the way.) I am trying to reach out to more – to every mother. It pains me that millions of mothers are teaching their kids to eat in a low-fat way that is likely to lead, when their kids reach their 30’s or 40’s, down the path of metabolic syndrome, just as it has for us. It is time for a different approach, informed by vintage, time-tested ideas (often backed up by thoroughly modern science) about the basic components of a healthy diet.

But can vintage eating be done outside the bubble – even on a budget? It worked pretty well in the 1950’s…  why not now?

Sometimes, back-to-basics can actually be pretty affordable… what could be more inexpensive and vintage than a glass of water out of the tap? Think of the groceries you would no longer need: almost all drinks – soda and Snapple and Gatorade and fruit juice (… alas, you might still ‘need’ your coffee and that glass of Chardonnay…); almost all packaged cereals and crackers and chips and snacks; almost all cookies and cereal bars and – God forbid – Pop Tarts. These products all contain highly processed ingredients and are relatively expensive for what you are getting. By buying whole, unprocessed food, the middleman is eliminated and so is his profit margin.  Whole foods are usually devoid of packaging or minimally packaged, and don’t typically require an advertising budget. So there are meaningful savings here, especially if you can buy in bulk and shop the sales.

I have lingered in the bubble long enough that saving money in the grocery aisles is not exactly my expertise.  My husband, much to his chagrin, can attest to this. I won’t insult you by offering second-hand tips, but there are plenty of smart women blogging about their take on buying high quality food on a budget. By mostly ignoring the packaged goods in the middle of the store, my hope is that you can offset much of the incremental spending you will do on the store’s perimeter: in the produce, dairy, and meat departments. These foods may be somewhat more expensive in general, but offer more nutrition for your food dollar and are more filling in the long run.

ETB_Postcard_Back_Cropped_900x900Can vintage eating be easy? Yes… perhaps not as easy as a drive-thru, but how long does it take to fry a pork chop? Scramble a couple of eggs? Open a can of green beans? Throw sweet potatoes in the oven? Vintage doesn’t have to be fancy. I bet you cannot drive to pick-up take-out in the time it takes to make a quick vintage meal. Simple vintage meals are the original fast food. Saturated fat is the original comfort food. If only we would give everyone permission to fry up some meat or fish and melt butter on their frozen peas. What a relief it would be for those who have very little slack in their lives and just want easy, satisfying meals that nourish them rather than fatten them.

The goal, after all, is not perfection. It is to move in the general direction of whole foods… not to be confused with Whole Foods, the grocery chain, which is definitely not where you want to go if you are on a budget ;-). Give up as many modern, food science inventions as you can stomach, replace them with vintage, whole food, and I bet you will see the ‘always hungry’ status that the processed stuff drives fade. Travel towards vintage eating just as far as your time, tastes, and budget will allow.  Then, see how you feel. Even if it doesn’t get you all the way to lean, it might just get you to healthy, which is really what this is about.

References

[i] ‘Walking Tacos’ are a high school snack stand special: open a snack-sized bag of Fritos and toss a couple of spoonfuls of taco meat, shredded lettuce, and grated cheese on top. Yum! Although initially put off by the idea of serving tacos in a foil bag of chips, I have made hundreds on my snack stand shifts and now marvel at the efficiency of this ingenious suburban housewife creation.

[ii] Christakis NA, Fowler JH. The Spread of Obesity in a Large Social Network over 32 Years. New England Journal of Medicine, July 26, 2007. 357-370-9.

[iii] Abedin S. The Social Side of Obesity: You are Who You Eat With. Time, September 3, 2009.

[iv] Puzziferri N. Long-term follow-up after bariatric surgery: a systematic review. JAMA. 2014 Sep 3;312(9):934-42.

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Figures from the author’s comments in the comment section below:

King county king county obesity

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It may be a new year, but in the world of nutrition, not much has changed–yet. If the amount of press dedicated to who gets to say what in the next edition of a document the previous edition of which insisted no American has ever paid one whit of attention to has taught us anything, it’s that “facts” don’t always do what we want them to do, right, Secretary Vilsack? And so, just like David Byrne, we’re stiiiilll waiting on the 2015 Dietary Guidelines, which were due out, like, last year already.

Like the Dietary Guidelines, my life is all about things changing and staying the same.  As both of my readers probably already know, I’m smack dab in the middle of a PhD program in communication, rhetoric, and digital media. Quite a switch from my work in nutrition? Not really. The things I work on in my studies now are the same things I was interested in as a PhD student in nutrition epidemiology: dietary recommendations, politics of food, the health gap, methodological issues in nutrition epidemiology of chronic disease, and the ethics of dietary policy. Only now I have a theoretical toolbox that is actually useful for critically examining those things.

Here’s the thing though. I thought that approaching nutrition from the perspective of rhetorical and communication theory would help me take a big step back and take a couple of deep breaths and have a nice cool, calm, totally “academic” attitude about things. Nope. The more I study this stuff, the more ticked off I get. In fact, the more sensitized I am to the rhetoric of nutrition and the better I can identify and understand the structures of privilege and power at work in the discourse surrounding food and health in America, the angrier it makes me.  Same as it ever was.

To avoid beginning the year with a full-on, foam-at-the-mouth rant, I am instead hosting a wonderful guest post from my good friend Jennifer Calihan over at EAT THE BUTTER.org. She has a smart, perceptive take on the past 35+ years of nutrition recommendations from a unique perspective. Her post, “Low Fat, High Maintenance,” provides some insight as to why the low fat dietary approach really does “work” for some Americans–and really doesn’t work for many more (and she does this without mentioning “insulin” once). If you haven’t already, you should check out her work.

Her post is the stepping stone to a different direction for my own writing. I’m sick of the diet wars, of “good” science vs. “bad” science, but I still think it is important to try to understand why all the talking heads of nutrition feel compelled to insist that everyone in the known universe can (and should) win at the game of “health through food” and in exactly the same way, despite vast differences in metabolic and genetic characteristics, and more importantly, economic and social contexts (I’m looking at you, Michael Pollan, Marion Nestle, Walter Willett, and–the biggest meat puppet of them all–David Katz). Jennifer not only brings a fresh new voice to the discussion, she directs our attention outside of our own bodies, to how all of us must negotiate our “food worlds” on very different terms.

Stay tuned. Jennifer’s post will be up later this week, followed by some commentary by me. As grad school allows, I’ll return to the regularly scheduled, full-on, foam-at-the-mouth rant already in progress.

Facts are simple and facts are straight
Facts are lazy and facts are late
Facts all come with points of view
Facts don’t do what I want them to
Facts just twist the truth around
Facts are living turned inside out
Facts are getting the best of them
Facts are nothing on the face of things
Facts don’t stain the furniture
Facts go out and slam the door
Facts are written all over your face
Facts continue to change their shape

–The Talking Heads, “Crosseyed and Painless”

New year, same old talking heads

Again, in 3-part harmony–it’s not about “the science”

Let me be straight.  I don’t believe in conspiracy theories.* There’s no Bacon-gate.  No Cowspiracy.  No Salami-mafia out to suppress sandwich meat.  But, as the students in my Introduction to Science, Technology, and Society course will tell you, there are professional interests (only one of which is funding) and careerism.  There is also the human desire to simply not be wrong.  In nutrition, this desire is personal.

(If I were queen of the world, every research article published about nutrition and chronic disease would list, in addition to “author affiliations” and “conflicts of interest,” what each researcher typically eats for breakfast every day.  You’d find out a lot more about “affiliations” and “interests” from that information than from anything else.)

And so there is this:  Meat and fat intake and colorectal cancer risk: A pooled analysis of 14 prospective studies.  It’s an abstract from the Proceedings of the American Association of Cancer Research, from back in 2004.  It found:

Greater intake of either red meat (excluding processed meat) or processed meat was not related to colorectal cancer risk.

Typically, such abstracts are presented at a conference, then later published.  This one never made it publication.  We don’t know why.

Trevor Butterworth does some speculating about the “whys” here:

When contacted by STATS.org, Smith-Warner said they wanted to add a few more studies before publishing their results next year. But the fact is that their colorectal cancer study had more subjects than many of the other studies published by the Pooling Project – and the four-year delay in publication cannot but raise the question of whether their results just didn’t fit in with the nutritional beliefs of Harvard’s School of Public Health, one of whose senior figures – Dr. Walter Willett – has long recommended limiting red meat and who, coincidentally, is a board member of the World Cancer Research Fund.

It’s not the first time studies that contradict the status quo in nutrition never made it publication.  This study also never got past conference proceedings, though there was an article about it in the Harvard Gazette and Walter Willett (who certainly seems to practice what he preaches) has his name on the abstract:

Greene, P., Willett, W., Devecis, J., and Skaf, A. (2003). Pilot 12-Week Feeding Weight-Loss Comparison: Low-Fat vs Low-Carbohydrate (Ketogenic) Diets (abstract presented at The North American Association for the Study of Obesity Annual Meeting 2003), Obesity Research, 11S, 95-OR.

Greene’s study found that a higher calorie low-carb diet resulted in more weight loss than a lower-calorie low-fat diet.  I’m not arguing about what this study might prove about diets in general, so back off, all you folks out there foaming at the mouth to pick it apart.  Truth is, you can’t really critique it, because it never got published.

Another study that almost didn’t make it out of the gate concluded that:

Our findings do not support the hypothesis that a diet consistent with the 2005 DGA benefits long-term weight maintenance in American young adults.

In a nutshell, Daisy Zamora found that black participants with a higher Diet Quality Index (according to the Dietary Guidelines for Americans) gained more weight over time than whites (with either a higher or lower Diet Quality Index).  More surprisingly, these black participants also gained more weight over time than blacks with a lower Diet Quality Index.

Again, I’m not arguing the strengths or shortcomings of this research. The part of the story that matters here is that Zamora worked on this study as part of her PhD research at UNC-Chapel Hill.  She found a tremendous amount of resistance to her findings, to the extent that she was counseled to “redo” her work without examining racial differences.

I’ve been hip-checked into the rails by the politics of nutrition science myself.

I guess that’s why, to some extent, I feel that all of the talk about “good” science vs. “bad” science in nutrition is misplaced.  How do we even know that the part of “the science” we get to see fairly represents the work that has been done when the whole process is so highly politicized and ideological?  How many grad students slogging away in labs or poking away at databases find things that never make it to publication because it would compromise the prevailing paradigm and their advisor’s funding (and don’t have the huevos that Zamora had to get her findings published anyway)? I feel pretty certain this doesn’t just happen in nutrition, but in nutrition it really matters to each of us, every day–and even more so to those who rely on government programs for food.

How did nutrition science become so politicized?  Dietary Guidelines, I’m looking at you.  When policy “chooses” a winner and a loser in a scientific controversy, things change. Science gets done differently. And when policy (dressed up as science) chooses a side in what we should/should not eat in order to prevent ostensibly preventable things like obesity and disease, well, all hell breaks loose. When we act like we “know” what foods cause/prevent disease, good health becomes entirely the responsibility of the individual.  If you get fat or sick–no matter what else is going in your world or in your body–it’s your own damn fault.

How do we un-politicize nutrition science? This article from Daniel Sarewitz, “Science can’t solve it,” offers some clues.  Although he’s focusing on new biotechnologies that have out-run our ethical frameworks for dealing with them, these remarks could just as well apply to diet-chronic disease science.  He calls for discussions and deliberations that:

… could address questions about what is acceptable and what isn’t, about appropriate governance frameworks for research, and about the relative priority of different lines of study given ongoing and inevitable uncertainties and disagreements about risks and benefits.

If there’s one thing we’ve got in diet-chronic disease science, it is “ongoing and inevitable uncertainties.”  It’s highly unlikely that science is going to solve those uncertainties anytime soon.  As for ethical frameworks, we have never given serious consideration to the ethical implications–not to mention the outright absurdity–of subjecting everyone in our diverse population to a single dietary prescription designed to prevent all of the major chronic diseases (none of which have ever been established as primarily nutritional in nature).

Until we get to these kinds of discussion, the creators of the 2015 Dietary Guidelines ought to listen to what Paul Marantz had to say back in 2010:

 When the evidence is murky, public health officials may best be served by exercising restraint, which is reflected by making no recommendation at all.

And when they don’t (cuz who can resist telling all those stupid Americans how to eat?), at the very least, we’ll all get a little smarter about “the science.”  As @Ted_Underwood put it on Twitter:

A stubborn love of bacon just taught Americans the diff. between p-values & effect size better than 100 stats courses could.

Works for me.

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Many thanks to Dr. Sarah Hallberg, without whom it would have taken me another 5 years to stumble across some of these articles.

*Run one PTA meeting and try to get a half-dozen fairly intelligent, well-educated adults to coordinate plans for a yard sale, and you’ll see what I mean.  We can’t agree on whether used children’s books should be 50 cents or $1–figuring out whether to ruin the health of Americans by buying off the media or silencing the scientists would be beyond any possible reckoning.

Dietary Drama–an Update (but not by me)

My favorite reality show–The 21st Century Diet Wars–has been off the charts drama lately.  Since I’m not going to be writing any commentary about it anytime soon, I thought I would point my faithful readers (all both of them) in the direction of my favorite moments so far.

1) Just in time for Halloween, Georgia Ede, MD, publishes a post on the scary Dietary Guidelines Advisory Report (just why they are scary depends on your own personal food orientation:  They’re letting cholesterol off the hook!  They’ve reduced meat to a footnote!) and the crapstorm that Nina Teicholz raised in the BMJ when she “attacked” that most sacred of (pasture-raised, GM free, organic, speaks Chicken as a second language) cow.  [Word to the rhetorically wise:  If someone accuses you of “attacking” some belief system, you can be sure they think that system should be beyond question. That’s why “questioning” gets framed as “attacking.” ]

Read it and laugh, or weep:  here.

2) This would be in the read it and weep category.  Mark Anthony Neal posted some excellent points–in an article by Lawrence Ware and Rebecca Martinez–about the whole “processed meat and cancer” issue.  While #smugvegetarians and #smugvegans are making like Church Lady and doing their superior dance in response to the new WHO report …

Remember Church Lady and her “superior dance”? Smugness never goes out style.

… what is often omitted is that observed links between these two factors may be related to issues of class as much–or more so–than any biological mechanism.  Outside of foodie-sharcooderie land, processed meats tend to be poor people food (I’m pretty sure the observational studies that linked processed meat to cancer didn’t have a huge representation of house-cured sopressata, air-dried bresaola, and lamb shank terrine).  This means that processed meats cluster with a whole lot of other health-related factors not necessarily under an individual’s control:  stress, limited access to health care, environmental pollutants–you get the picture. Whether or not there is a direct link between processed meat and cancer is less to the point than the article’s closing remarks:

We have a health crisis in this country.  Obesity, diabetes and cancer are ravishing disadvantaged communities. Too often this crisis is centered in personal responsibility, but we must also look at systemic conditions lest we blame the victims of poverty without equipping them with the tools necessary for positive health outcomes.

Tell it.  I raise this challenge to anyone who regularly reads (or writes) articles on nutrition epidemiology.  Show me a situation where a food, food component, or dietary pattern is linked to an adverse health outcome and the population that consumes that dietary evil is not also a population with significant differences in health behaviors and/or socioeconomic factors relative to the healthy outcome population.  I’ll be here, waiting.

Slice up your hot dogs, add tiny pickles, and whaa-laa: charcuterie.

Slice up your hot dogs, add tiny pickles, and whaa-laa: charcuterie.

Or maybe we should just encourage those poor folks to slice their store-brand hot dogs in creative ways and serve them with fancy mustard and tiny pickles.

3) And, then–this:

You’re welcome.

NO LOW-CARB FOR YOU!

I am emerging (briefly) from grad school hibernation–my husband jokes that I’m taking all my classes “pass/flail”–for a special cause that hits close to home, even though Jennifer Elliott, a dietitian who has been going the rounds with her various professional organizations and institutions, lives in Australia.

She apparently had the gall to suggest to a patient with type 2 diabetes that a low-carbohydrate diet might be beneficial.  Heavens.  What is the world coming to?  Next thing you know, people will start telling us that if we are allergic to poison ivy and it makes us itch all over, we might not want to roll in it.

If you haven’t had a good eyeball roll or facepalm for the day, you should check out her blog, where she recounts one episode after another of Orwellian-level doublespeak with the Dietitian Association of Australia.  It’s a situation I’m quite familiar with, albeit on a much smaller scale and with our homegrown Academy of Nutrition and Dietetics here in the US of A.

The most recent episode reveals her local health district administration (Southern New South Wales Health, SNSW Health to the locals), her former employer, forbidding Jennifer–or anyone else, one must presume–from offering advice about low-carbohydrate diets to patients or clients with diabetes.  What caught my attention was this remark, by Jennifer:

“Can you imagine having to tell a client with diabetes, who has lowered his BGLs [blood glucose levels], lost weight and come off all diabetes medications by reducing his carb intake, that he now has to start eating more carbs because SNSW Health says so !?”

Well, cue the Twilight Zone music, because we are going there.

What would it be like to tell someone (like my dad, another way this story hits close to home) who has been controlling their diabetes very-well-thank-you with a low carb diet, that they now must eat more carbs, cuz we said so?  Samuel Beckett, eat your heart out.**

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Enter “patient who could be my dad.” Let’s call him Mr. Louis Corbin (LC).  He greets the dutiful dietitian (DD) who is determined to adhere to SNSW Health policies.

LC:  G’Day Ms. Dietitian.

DD:  Hello, Mr. Corbin.  How can I help you?

LC:   Well, I feel like I need to change up my diet a bit, and I’d like some help from a wise, caring, trained professional who will treat me like an individual and not like an aggregated average of a dataset.

DD:  (Laughs demurely.) Well, of course.  As a trained professional, it’s my job to use my clinical judgment to help patients find out what works best for them.

LC:  Beauty!  So, I was diagnosed with pre-diabetes about 10 year ago.

DD:  Really?  Looking at your lab report, your blood sugar and HgA1c levels look perfectly normal.  Tell me about the medications that you are using.

LC:  Well, I’m not actually on any medications.  When I got my diagnosis yonks ago, I borrowed my cousin’s glucometer and figured out which foods were making my blood sugar go up.  I really limit those in my diet now, and my blood sugar seems to be well under control. But I’m getting a little tired of eggs and sausage for brekky every morning.

DD:  Eggs and sausage?  Is that it?

LC:  And some sautéed spinach or sliced tomatoes, most days.  But I’m hoping you can help me with some other brekky ideas.

DD:  Wait now.  There’s simply too much fat in the eggs and sausage, and there’s really not enough carbohydrate–you know, sugars and starches–in that meal–or in your diet in general it seems.  You’ll need to add some fruit and a couple of servings of whole wheat bread or cereal to your breakfast and …

LC:  But tomatoes are technically a fruit …

DD:  But they are a “low carbohydrate” fruit and so they don’t count.

LC:  … and I don’t eat bread or cereal–not even whole wheat.  Those were the things that made my blood sugar go up!

DD:  Of course. We need your blood sugar to go up.  You do know that your brain won’t work without glucose from healthy, whole grains, right?

LC:  My brain seems to be working fine.  I finished “The Age” crossword puzzle while I was in the waiting room!

DD:  Well, it’s quite clear to me that your brain must not be working properly–you’ve put yourself in grave danger.  You need AT LEAST 3 servings of carbohydrate per meal, and not just at breakfast I might add, in order for your body to function properly.

WTF

LC:  Three servings per meal!  Crikey! That will make my blood sugars go up for sure!

DD:  Well, yes.  As I said, your blood sugars need to go up.  You see, Mr. LC. , in your addled state, you’ve failed to understand that diabetes is a PROGRESSIVE disease.  And your diabetes hasn’t progressed at all.  In fact, it seems to be quite stalled.

Without progression, we’ll be unable to prescribe pre-insulin drugs like metformin and engage you in the numerous diabetes education programs we have ready and waiting.  Once you’ve been thoroughly well-versed in carbohydrate counting, let’s hope that we can get your diabetes back on track.  Hmmm.  We may need to start you out at 4 servings of carbohydrate per meal …

LC:  But, but, I don’t really want my diabetes to progress.

DD:  Nonsense.  That’s what diabetes does.  You’re deluding yourself if you think otherwise.  I’ve seen hundreds of patients with type 2 diabetes, and I treat them all the same way–with the official Australian Diabetes Society diet–and they all have gotten progressively worse.  So there.

Yes, I understand that your diabetes hasn’t progressed in 10 years on a low carbohydrate diet, but it’s clear why that is.  It’s good that you’ve come to me so we can reverse that trend.  I can help you choose foods that will be sure to start you down the road to full-blown diabetes.

LC:  But I’m feeling bloody top notch.  I’ve even lost a little weight since I started reducing my sugars and starches.

DD:  Oh dear.  I didn’t realize that.  You’ll really need to fill your plate with healthy whole grains so we can get some of that weight back on.  You’re never going to end up on insulin at the rate you’re going.  But no worries.  If you can stick with at least 4 servings of carbs per meal, we might be able to get you on insulin in a few years or so.  Once we’ve got you on a regular dose of insulin, you’ll keep packing the weight on, no problem.

LC:  But I don’t want to be on insulin …

DD:  No “buts.”  Sir, you don’t realize the seriousness of this situation.  It’s not just about the insulin.  Not only do we have prescriptions that need prescribing and diabetes educators that need to educate, we have wound clinics that need wounds, dialysis clinics that need failing kidneys, testing laboratories that need labs to test.  Have you any idea how many people you might put out of work by stalling your diabetes in its tracks?

Sponsors of the ADS

A “Who’s Who of pharmaceutical and medical supply companies”? Nah, just the sponsors of the last Australian Diabetes Society conference.

DD (Continuing): You’ve not only put yourself in danger, you’ve endangered our whole healthcare supply economy!  We have injections to make your blood sugar go down.  We have glucose tablets to make your blood sugar go back up.  We have monitors and supplies and diaries and trackers and coolers and carriers for all of the THINGS you will need when you have diabetes.

We have diabetes foot cream, insoles, socks, and shoes.  And wheelchairs for when your toes rot off–which I can assure you they will if you’ll only improve your diet.  Then you’ll get to use the freight elevator and get one of those special parking passes.  If you play your cards right and follow your diet as I prescribe it , you may even end up with one of those cute little scooters for getting around the grocery store.

LC:  But …

DD:  Now then.  Not to worry.  You’re on the right path now.  You wanted some brekky ideas? Here’s a low-fat, vegetarian recipe for blueberry hotcakes, with 46 grams of carbs.  It’s from “Diabetes Australia,” so you know it’s perfect for someone with diabetes!  It should get your blood sugar going for sure!  And here’s some coupons from the Australian Breakfast Cereal Manufacturers.  I picked up tons of them at my last dietitians conference–they’re working with us to make sure everyone has a healthy, whole grain, cereal product brekky EVERY DAY!

LC:  But …

DD:  No “buts.”  I’ll expect to see you back in about 6 months.  We’ll get that HgA1c moving in the right direction this time and have you on the road to complete and total dependence on the health care system in no time!  Bye now!

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What can you do besides resolve not to move to New South Wales anytime soon?  Write a quickie email to the New South Wales Health Minister, Jillian Skinner, telling her about your experiences as a patient, clinician, family member in successfully managing type 2 diabetes/pre-diabetes/metabolic syndrome/etc. with a carbohydrate-reduced diet.

Email:   office@skinner.minister.nsw.gov.au

CC Jennifer at:  jennifer@babyboomersandbellies.com

And, what the hey, let the Dietitians Association of Australia know what you think too: nationaloffice@daa.asn.au

If you are feeling particularly feisty, go to Jennifer’s blog and post your letter there too, to let her know you stand in solidarity with her.

I personally will be sending Minister Skinner a copy of this post :)

**And many thanks to Disco Stew who provided the authentic Australian translation of this conversation!

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Update:  In an appalling case of life-imitating-blog-imitating-life, Disco Stew sent me a link to this piece, written by Jane Feinmann, about type 2 diabetes and the continued use of a low-fat, carbohydrate-laden diet to “treat” it:

When I wrote about this dilemma in the Daily Mail recently, the piece triggered over 200 responses from readers caught in this invidious position.

Mary Megan from London was ‘stunned’ last year when her GP “recommended eating carbohydrates as part of a ‘healthy balanced diet’ when I know for a fact from having tested my blood sugar over the years that carbohydrates are the exact cause of my high blood sugar.”

Way to go, 21st century health care system. Sigh.