Why care about calories?

After the last blog post on calorie magic, my husband–whose intellectual response to people challenging me on the internet is to want to give them a virtual wedgie–asked me why I didn’t just engage those cute little white dude-o-scientists who are so pumped about how IT JUST MUST BE CALORIES CALORIES CALORIES CALORIES in some sort of PubMed duel to the finish.

My explanation:  I don’t do PubMed duels. PubMed is a wonderful thing, and the internet has given us tremendous access to a great deal of information, much of which is used to confirm our own preconceived notions, even if (especially if?) we don’t fully understand what those notions actually are. As I’ve said before, a pastiche of  PubMed citations frequently boils to a bunch of snapshots taken out of context of the larger literature–and out of context of a full understanding of physiological and biochemical realities, not to mention social and cultural ones–that may or may not express a physiologically significant or practically useful concept.

And this is problem: I’m not convinced that calories express a physiologically significant or practically useful concept. Here’s what I figure. If calories were so FREAKIN important, then my biochemistry books should be rife with information about them. But that does not seem to be the case.

[I took my first biochem class at age 45, weeping my way through one excruciatingly difficult exam after another. I emerged--bloodied by unbowed--to joyfully sign up for 3 more semesters. I don't consider myself an expert by any stretch; I just feel that biochemistry is sort of the key to the universe, certainly the universe of nutrition. If something doesn't make sense from a biochemical perspective--which would apply to about 90% of the Dietary Guidelines--it shouldn't be part of nutrition policy.]

I did this a while back, just for my own peace of mind, and I don’t know how useful it will be to any of you, but here’s what my collection of biochem books has to say about calories. Spoiler alert: Not much. [So you can stop here if you have a life.]

My biochemistry books, in order of how much I love them, least to most:

Advanced Nutrition and Human Metabolism (3rd Edition), 2000

James Groff & Sareen Gropper

I don’t know why I have this book.

–“Calorie” is indexed to a passage on units of energy in a discussion of thermodynamics. Calories are not mentioned again.

–“Calorimetry, direct” and “calorimetry, indirect” are indexed to passages discussing the measurements of energy expenditure. It contains this notable summary:

” Although changes in energy balance produce weight changes, the extent of these changes varies from person to person.”

 


Functional Biochemistry in Health and Disease, 2009

Eric Newsholme & Tony Leech

I got this book with great anticipation, as it seemed to promise a better integration of biochemistry and physiology than most biochem texts. But like some sort of weird Asian-fusion spicy wonton Alfredo dish, I guess it is just trying to do too much. There is not enough detail here for me, and the reader is left to sort of assume “magic elves in a box” in too many places, which–as far as I am concerned–defeats the whole point of learning biochemistry.

–“Calorie” is not indexed.

–“Calorimetry” is indexed. This couple of pages highlights the limitations of measuring calorie expenditure in the human body.


Biochemistry (4th Edition), Lippincott’s Illustrated Reviews, 2008

Pamela Champe, Richard Harvey, & Denise Farrier

This is the boy-toy of my biochem texts. I don’t love this book, but it is much more portable than my other biochem texts, so I can take it out in public without too much embarrassment.

–“Calorie” is not indexed.

–“Caloric consumption,” “caloric restriction, weight reduction and,” and “calorimeter” are indexed.

“Caloric consumption” addresses the fact that the source of the increase in calories consumed by Americans since 1971 is carbohydrates.

“Caloric restriction, weight reduction and” is indexed to a page includes the following helpful information:

 “Caloric restriction is ineffective over the long term for many individuals.”

 


Biochemistry (2nd Edition) , 1995

Donald Voet & Judith Voet

I approach the Voets with the reverence and respect due a giant doorstop of a book like this. Like that scary old professor who knows everything, it is intimidating, but, well, it knows everything.

“Calorie (cal)” and “Calorie, large (Cal)” are indexed to the same place. The indexing refers to a table that compares thermodynamic units and constants as an adjunct to a passage on the First Law of Thermodynamics. This passage contains a little nugget of joy for those of us who insist that conversations about weight management may need to consider more than just how many calories go “in” and how many calories go “out.” Unless you are a fully registered and certified geek, you may want to just skip ahead:

“Neither heat [i.e. what is measured by calories] nor work is separately a state function [i.e. quantities that depend only on the state of the system] because each is dependent on the path followed by a system in changing from one state to another . . . If [the First Law of Thermodynamics] is to be obeyed, heat must also be path dependent. It is therefore meaningless to refer to the heat or work content of a system (in the same way that it is meaningless to refer to the number of one dollar bills and ten dollar bills in a bank account containing $85.00).”

This is why when someone talks about a person storing “800 calories of energy as fat,” I hear something that makes about as much sense to me as saying a person can store “$85 dollars worth of money in his bank account as four twenties and a fiver.”

Calories are otherwise never mentioned again in the rest of the 1,310 pages of this book.

 

Biochemistry (6th edition), 2009

Mary Campbell & Shawn Farrell

Campbell y Farrell is my warm fuzzy teddy-bear of a biochem book. I LUV it. Cuddle up with C&F for a well-written, easy-to-understand (as these things go) romp through the wonders of biochem.

–“Calorie” is not indexed.

–“Caloric restriction” is indexed to a discussion of longevity and sirtuins, not weight loss or obesity.


Lehninger’s Principles of Biochemistry (4th Edition), 2005

David L. Nelson & Michael M. Cox

This is my favorite biochemistry book ever. If it were available and I were single, I would marry it in a hot second.

–“Calorie” is not indexed. Nor is “kilocalorie.” Nor anything else that I could think of having to do with “calories.”

There you have it.   Seems to me that all those broscientists want to talk about is something that doesn’t have a lot to do with the keys to the universe of nutrition.  I don’t mind talking biochemistry, but the basic biochemistry that I’m familiar with has virtually nothing to say about calories.

And if biochemistry isn’t too concerned with calories, why should you be?

 

 

The Magic of Calories

There have been a couple of interesting conversations on the interwebz involving calories lately. I don’t normally pay attention to these things because I am so busy napping being, well, busy, but I am paying attention to these conversations because they are both starring–ME!!!

Let’s face it, the whole “only calories matter, period” vs. “calories, shmalories” debate tends to be an oversimplification on both sides. But, the truth is, only one of these sides has been the primary focus of many decades of unsuccessful public health nutrition intervention. In that regard, the “all you have to do to lose weight is make sure your calories out exceed your calories in” stance deserves to be questioned.

To this end, Adam Kosloff has gathered a useful compendium of calories in-calories out naysayers (including yours truly):

Then, a different Adam, does some naysaying about the naysayers:

While it would be fun to naysay all the naysaying about the naysayers, rather I will just address the part starring ME!!!

In reference to my scientific-y calorie calculations about how long it would take me to “disappear altogether,” Adam the Second had this to say:

“Yes, If she were to drop her calories in by 500 a day and increase her calories out by 500, she would lose a shit load of weight after 6 months.”

Um, no I wouldn’t. I would lose about 30 pounds, then I would begin to regain. Because that’s what happened to me in my real life. Oh wait, but it probably didn’t happen to me in real life because I was a fat person then, and everybody knows that fat people lie about how much they really eat, and because everyone knows that scientific-y calculations are more real than anybody’s actual life.

Adam the Second:

“She just has to remember that metabolism will vary over that time span, so her calories will also have to. This is due to the body naturally requiring less calories [sic] as a smaller vessel, and also the body will lower non exercise energy expenditure (general fidgeting, moving around etc).”

WHAT? My metabolism is going to change over time because I’ve changed my eating patterns? That’s in direct contradiction to the whole “calories in, calories out” premise. There are no differentiated calorie labels that say “This low-fat yogurt contains 250 calories for those of you who haven’t been on a diet for 6 months, BUT it contains 5,680 calories for those of you who have.”

Yes, in more sophisticated venues, calorie calculators for “energy out” change with weight, but the overall premise stays the same and leads to the same conclusion.


So if I weigh 205 pounds, walking at a moderate pace for an hour burns 307 calories. Once I diet & exercise down to 180 pounds, I can burn only 270 pounds doing that same amount of exercise. Which means that now I have to eat EVEN less and move EVEN more to continue to lose weight (regardless of how little I was eating or how much I was moving in order to get to 180 pounds in the first place)? When does the madness stop???

Lucky for you, dear reader, I will now demonstrate, due to the magic of calories, that the whole “eat less, move more” ad infinitum ad nauseum ad starvatium ad exhaustium does stop and in fact–this is the magic part–even reverses itself.   All for the low low price of free.

Let’s take this whole calorie calculation/deficit/mumbo jumbo out for a “brisk pace” walk, shall we? One of the reasons I think that some folks are such diehard supporters of calories in-calories out, it that they’ve never actually been a fat person trying to navigate the terrain of the whole calorie-counting experience.  So let’s hold hands & try it together.

Let’s say I’m a big fat newbie. Let’s say I’m a 35-year-old, 5’10” OBESE female who weighs 240 pounds (not my current age or weight, but that’s approximately where I started in my own weight loss journey). I already know that I need to “eat less and move more” in order to lose weight, because that’s what my doctor told me. I go to a trusted source, the Mayo Clinic, for guidance (for those of you who want to play along at home, here’s the Mayo Clinic calculator).

First I need to know how many calories I actually require (so I can reduce them). I start off with a estimated energy requirement for my activity level, which I will calculate as “inactive” (“never or rarely include physical activity in your day”), because we all know that the reason that fat people are fat in the first place is because they are lazy slugs.

My calorie needs as calculated by the Mayo Clinic, by way of the Harris Benedict Equation and the Dietary Reference Intakes, are: 1850 calories/day.

The Mayo Clinic says: “Weight loss comes down to burning more calories than you take in. You can do that by reducing extra calories from food and beverages, and increasing calories burned through physical activity.”  They don’t provide any details about how to do this, but by consulting with the Academy of Nutrition and Dietetics, I find that “A negative energy balance is the most important factor affecting weight loss amount and rate” and that I can achieve this negative energy balance by decreasing my energy intake by about 500 calories/day or increasing my activity by about 500 calories/day–or doing both. Since “adipose tissue, which is mostly fat, contains about 3500 kcals/pound,” if I create a negative energy balance of 1000 calories/day, I’m 7000 calories down–or 2 pounds worth of fat–over the course of a week.

So here goes. I’m going to subtract 500 calories from my Mayo calculation (close your eyes, it’s a mathy part) in order to figure out that I should be eating: 1350 calories/day.

Okay, let’s say I add 500 calories of activity to my day. Using the handy-dandy chart below (also from the Mayo Clinic), I find have to walk for 1 hour and 45 minutes in order to burn 533 calories.

I am now at a caloric deficit of (at least) 1000 calories/day, which according to the super-duper magical 3500 calories = 1 pound of fat formula (Zoe Harcome explores the rigorous scientifically-proven assumptions behind the formula here) means I lose about 2 pounds a week. Not that this would always happen in real life, but okay, fine. Flash forward 5 months, I’m down 40 pounds. I now weigh 200 pounds.  At 200 pounds I am no longer OBESE, I’m just OVERWEIGHT, but I still have more weight to lose. Because my body is naturally going to “require less calories [sic]” because it is a “smaller vessel,” it is time to recalculate my energy needs.  To the Mayo Clinic calculator, Boy Wonder!

(What happened in my own real life when I dieted and exercised my way from 215 pounds to about 185 is that, not only did my weight loss stall, but I started to regain lost weight. Or at least, that’s what would have been happening to me if I hadn’t been lying about it to myself and my hunger and exhaustion weren’t complete figments of my feeble imagination, while in reality I stuffed my face with HoHos and laid around on the couch watching The Young and the Restless).

According to the “smaller vessel” theory, I should require fewer calories, but if I fill out the calculator–WTF??– I end up with more?

I weigh 40 pounds less, and I get to eat 200 more calories/day? I don’t get it, but the Mayo Clinic is a trusted source and I’m just a newbie, so on we go. I subtract my 500 calories/day so I can lose weight, now I am eating:  1550 calories/day

Okay, 1550 calories/day is not a lot, but it’s more than 1350 calories/day I was eating before.* I’m not sure why this is, but I’ll take it, because–even though I am a “smaller vessel”–clearly there must be some calorie magic at work. But while I may be able to eat (a little) more, on the other hand, now I have to exercise even more because my ability to burn calories has decreased (see chart below). Now I have to walk for 2 full hours each day in order to get my 500 calories out.

Following the magic 3500 calories calculation that exists in our magical perfect world, we can flash forward another 5 months. I now weigh 160 pounds, my goal weight. I am now no longer OBESE or even OVERWEIGHT, but thankfully, NORMAL.

But, being NORMAL, I am also now an even smaller “smaller vessel,” and because “the body will lower non exercise energy expenditure (general fidgeting, moving around etc),” it’s time to recalculate. This is really scary because if I could only eat 1850 calories/day as an inactive OBESE 240-pounder, will I even be allowed to eat at all now that I weigh 160 pounds?  Will I have to exercise half the day away in order to be able to “afford” the calories in a low-fat bran muffin?

Oh, I can hardly stand the–wait! Hmmm. Now hold on just a hot second here.

I can see by the calculator that at 160 pounds, I could be inactive and eat 1800 calories/day.

OH THANK YOU CHEESESAUCE!

Because I’ve been eating 1550 calories a day and walking for 2 hours every day, and I am FREAKIN TIRED AND HUNGRY and sick of spending 14 hours a week walking around and getting nowhere.

According to the magic of “calories in, calories out,” I can now eat (even) MORE and move (a lot) LESS and I will NOT gain weight. No matter what I eat–as long as I consume no more than 1800 calories/day, I can sit on my (now slender) ass all day long and never gain an ounce.

HOORAY for CALORIES!!!!

P.S. If you are by any chance wondering why an OBESE inactive female who weighs 240 pounds is only supposed to be eating 50 calories more a day (a 7.7 calorie/pound allotment) than a NORMAL weight inactive female who weighs 80 pounds less (an 11.3 calorie/pound allotment), that’s because NORMAL weight people are more honest and virtuous than OBESE people and therefore deserve more calories per pound body weight.

P.P.S. Dear Adam the Second should you happen by to read this. Not trying to pick a fight. Just trying to illustrate how the calories in-calories out principle–put to work in a real-life example–may be an overly simplistic (if not downright illogical) approach to weight loss for some folks. Hey, if it works for you & your buddies, great! But it doesn’t work for everyone, and the use of this paradigm as the foundation for public health nutrition practice has changed how we think about eating in ways that I would argue have done more harm than good.

P.P. P.S. For more snarkily outraged, or outrageously snarky, commentary on calories, try these calorie-free nuggets of wiseassedness:

Why Calories Count Fo’Shizzle

Calories in, calories out, Would You Please Go Now?

Calories? Again? Already?

*This is where calories in-calories out folks sometimes like to say “But you may have needed more calories.  If you cut your calories too much [whatever that means], you’ll crash your metabolism.” I don’t know. They may be right. But that’s not how the calories paradigm works. There are no “metabolism crashing” exceptions on the Mayo Clinic calculator.

 

Buy this book

This one. You can do it now; I’ll wait here. Oh, you need more encouragement? Read on.

 

This may be the one and only time I will shamelessly promote the work of any individual I didn’t give birth to.

Why? Because I think this actually matters (unlike so much of the other stuff I do).

Nina Teicholz’s book has been getting great publicity and stands a good chance of making the New York Times bestseller list. And with our help, she will. So let’s do it.

There is the obvious benefit that more people will read her book–books that are on the NYT bestseller list are frequently purchased by people who buy their books based on whether or not they are on the NYT bestseller list–and then maybe my future dissertation on the USDA/DHHS Dietary Guidelines will actually find a publisher one day.

But wait! There’s more. For the one low price of Teicholz’s book, you, my dear reader, will get free at no extra charge, an additional bonus offer of the chance to change the conversation about nutrition in America.

Howzat?

It’s an excellent book in many respects (see below), but its greatest contribution is to clearly outline the tangle of politics and personalities, funding streams and tenure tracks that has essentially shut down any substantial debate on this matter, a debate that by all rights should be taking place right now on campuses and in conference rooms across the country. She convincingly describes the headwinds that any researcher who questions the status quo is going to be fighting: lack of institutional funding, lack of collegial support, or just deafening silence. It’s not a level playing field out there, and as Eric Westman says to Teicholz, “this situation will not allow science to ‘self-correct.'”

This is exactly what I found in the Department of Nutrition at University of North Carolina’s Gillings School of Global Public Health, and a situation that I’ve heard described repeatedly–usually in whispers, after I promise never to divulge details–particularly from other graduate students in nutrition. This is not how science is supposed to work.

Teicholz also–in a chapter entitled “How Women and Children Fare on a Low-Fat Diet”–shows us why it is so important that the debate not be silenced or ignored. Because this is not just about science, but about a world view that has placed the health concerns of adult (mostly white) males above those of women and children. This is about civil rights. Our current dietary recommendations are based on moldy datasets involving a particularly narrow demographic and applied to all Americans, regardless of age, race, gender, or cultural heritage. As if this is not bad enough, these same policies, which have remained virtually unchanged for 35 years, have failed–miserably–to improve the health of Americans of any demographic. This is a travesty of public health, and we should all be horrified and outraged.

But what should horrify us most is that, despite the biased data, despite the abysmal public health outcomes, despite the decades worth of controversy, there is no serious academic, scientific, or policy debate on this issue. Not at Harvard, not at UNC, not at Yale, not in Washington, DC. There is a refusal to even acknowledge that–in the face of all of these contradictions and confusion–a debate would be appropriate. Teicholz’s work has prompted the very same “the science is settled so let’s stopping talking about it” pushback that her book so deftly demonstrates is at the heart of the problem. The CEO of the American Heart Association acts as if just occurred to her to recently defend the world against the dangers of those who might suggest that saturated fat is okay to eat, and never mentions Teicholz’s name once. Yup. Shut down the debate and ignore the person who started it at the same time. Go AHA.

It is this “science is settled” perspective that the public should find most alarming. It doesn’t matter what part of the carb-fat-calories-whatever-whatever issues you agree or disagree with. Clearly, there is plenty of room for debate. Clearly, the science isn’t settled. But the absence of any serious discussion tells us that the experts think this whole nutritiony sciencey thing is too complicated for us to worry our pretty widdle heads about and that any real debate would confuse our very tiny brains. We should just chillax and let the experts tell us what to do. That way, we get fat and sick, they get grants and tenure, and everyone lives (more or less) happily ever after.

If you are not mad as hell already, you should be. If you read this book, you might be.

And this, dear reader, is where you can make a difference.

Teicholz’s book is not just a good book. It’s a message–to book publishers, to policymakers, to the media, to researchers, to students interested in pursuing a career in nutrition. It’s a message that says: we want this issue to be taken seriously, we welcome debate and discussion, and we will accept some honest confusion and doubt in place of the charade of science we’ve been given. I encourage you all to buy a copy for yourself. And then buy a copy for every friend and family member you think might read it (or use it to press daisies, I’m not picky). Get a copy for your family doctor and your nephew in medical school. A copy for that high school senior that’s about to graduate. A copy for that guy at the farmers market who is always going on about how “lean” his pasture-raised pork is.

We need to put this book on the New York Times bestsellers list and keep it there until Teicholz is on Oprah and Oz and The View and 60 minutes and Rachael Ray and Space Ghost Coast to Coast. We need to get this party started and keep it going. You certainly don’t have to agree with all she says to appreciate that the conversation needs to continue.

Buying a copy (or multiple copies) of this book says: We are not going to take this (silence) anymore. Hey Harvard, hey AHA, hey USDA and DHHS. Let’s talk.

Convinced? You can stop here, head to Amazon or your local bookstore & stock up, then pour yourself an adult beverage and kick back, knowing you’ve done your part.  Oh, you want a real book review? Glutton for punishment you are. Fine. I wrote more words. Or you can catch a fine review here or here.

Adele’s Book Review:

If you are wondering how we got into the food-health mess we are in, and you are not satisfied with the “fat piggy Americans” or “Big Evil Food Industry” answers that get tossed around the internets, you really need this book.

If you bought Gary Taubes’ Good Calories, Bad Calories and really, truly meant to read it all the way through, but somehow could not, this is the book to really truly read instead.

Maybe you are thinking, hell, Adele, I actually did slog through Gary Taubes’ Good Calories, Bad Calories, and you want me to read another book on the same topic? Good grief! Can’t I just watch the FatHead movie again and call it a day?

I feel that pain. Like Taubes’ books, Teicholz’s book is thoroughly researched and well referenced. But it’s a very different book.

First of all, Teicholz writes like a dream. I get that parts of Taubes’ book tend to be as readable as an instruction manual for Windows 98 as written by David Foster Wallace. Teicholz has the facility of Michael Pollan, with a sharper intellect, more warmth, and a less condescending attitude. She assumes her audience is smart enough to follow her through the maze of science without wanting to stop to examine every risk ratio ever produced. At the same time, she brings us with her into those difficult moments in an interview when she has to ask a nice person a hard question. And she does ask some tough questions.

Second, she covers some very different territory than other books on this topic. One of the complaints leveled at the people who blame our current high rates of obesity and diabetes on carbohydrates is that this approach neglects to fully explore the possibility that a dramatic increase in consumption of polyunsaturated vegetable oils (particularly soybean oil) may have also been a primary contributor to the increase in obesity and chronic disease. Teicholz examines this issue, along with the science behind transfats and the Mediterranean diet, with some surprising revelations. So while the subtitle “Why Butter, Meat & Cheese Belong in a Healthy Diet,” sounds like it could have been tacked onto Good Calories, Bad Calories or Death by Food Pyramid (both fine books), Teicholz’s approach reveals a much more complex cascade of assumptions and accommodations that accompanied the calls to reduce the use of animal products in our diets.

Finally, even if you don’t care much about the whole fat-carb-blah-blah debate, her look at the personalities and politics of how nutrition science gets made is absolutely fascinating. Being in a communication and rhetoric program now, I hear a lot about the “constructedness” of science, that claims of fact don’t just emerge from the ether, but from a particular social and political context (which isn’t to say that researchers just “make up” science–you can’t “construct” a pancreas that secretes maraschino cherry juice–but what “facts” are presented to the public by scientists are shaped by many other influences besides the material world). Teicholz’s perspective is sympathetic–scientists are allowed to like sunny tourists spots too–but she doesn’t pull any punches. If you can’t separate science from sunshine, you should have stayed home.

Teicholz introduces the Atkins-Ornish “diet wars” (somewhere in me is a blog post on Dean Ornish and how crusading against Atkins apparently gave him, literally, a reason to live when he was a depressed and suicidal med student) and updates us on some of the folks–Stephen Phinney, Jeff Volek, Eric Westman–doing the very real work of testing the ideas raised by Atkins. This is story that needs to be told, and Teicholz has just covered a few of the players, but she acknowledged the folks–including Gary Taubes–who have done a great deal to make sure that the debate that is so badly needed doesn’t disappear completely.

It’s a fascinating time in history. The very beginnings of righting a mighty colossal mistake. Teicholz’s book will fill you in on the major players to get you started.  Stay tuned and between the two of us, we’ll keep giving you the play by play–and we’ll keep the conversation going. You can help. Buy the book.

The Real Paleo Challenge Redux

The original title of my presentation for the Ancestral Health Symposium 2013 was:

But now I feel like it should be more like:

What’s going on in Paleoland? Well, you can see Melissa McEwan’s take on it here, or itsthewoo’s take on it here. My concerns about paleo are wrapped up in the presentation below, and going into AHS 2013 I was more than a little nervous about saying what it is I wanted to say. See, I don’t consider myself “paleo” (or “low carb” or “insert whatever diet therapy you think I adhere to here”); I consider myself a nutritionist, a public health professional, and work in progress. I do recognize the fact that a lot of people who do consider themselves “paleo” attend AHS–and I consider a lot of them my friends and colleagues. While I see promising things in the group of people who have chosen a paleo path, I also agree with a great deal of what both Melissa McEwan and itsthewoo have to say. (I admit to some sadness over the demise of Paleodrama. Other people binge-watch House of Cards. Me, after a long week of rhetorical theory and critical studies, I would grab a tumbler of sangria and binge-read Paleodrama. To each her own.) The presentation would, I hoped, put some of the “issues” that I see happening in Paleoland on the table, without throwing out the potential for paleo to grow into something more than itself. Well.

Without further ado, here’s the presentation as it was in August. Updates and commentary that did not appear in the original are in [brackets].

It is an honor to be here at AHS and I am delighted to be in such esteemed company. I hope that I can bring to our conversations this weekend a little something to offend everyone.

The primary misconception that I deal with in public health nutrition is that our current policy is the same thing as science. Conversely, a primary misconception regarding reforming this policy is the idea that “If only we could get the right information to the public and to policymakers, things would be different.” Having the evidence to support a movement’s agenda is important, but public perceptions and national policies are shaped as much by social, political, and cultural forces as by science.

As we have seen in other movements, cultural change drives policy change, which in turn drives cultural change. The current mainstream definition of what constitutes a “healthy” diet is an excellent example of this. At one point in the not-too-distant past, a low-fat, low-calorie, plant-based diet was considered a “fad” – just as the stereotypical paleo diet is today. But it was not science alone—or even primarily—that shifted the public’s perceptions.

In fact, the science supporting this dietary guidance has been and remains weak, but that didn’t stop it from becoming policy. George McGovern’s Senate Select Committee, a group of young white liberal men full of well-meaning social concern, wanted to create a plan to reduce chronic disease (a reasonable public health goal), as well as lengthen the lifespan of their committee. They did their work against a backdrop of post-World War 2 wealth, comfort, and suburban complacency that was rapidly crumbling in the face of social movements that would polarize the population: civil rights, women’s liberation, and anti-war protests. Television brought bombings, riots, assassinations, and Watergate, into middle class living rooms and shook middle class faith in government and social order. Middle class complacency was quickly turning into anxiety and cynicism.

Some of this anxiety took shape specifically around matters related to food and health. Ancel Keys taught the public his theories about heart disease–a “disease of success” brought on by too much animal fat. Rachel Carson raised awareness of environmental toxins. Ralph Nader and the Center for Science in the Public Interest raised the alarm about chemicals in our food supply put there by corporate greed—a force which also was accused of contributing to hunger in America. Many groups, from feminists to Beatles fans, picked up on these issues—along with ethical concerns about animal welfare—by turning towards vegetarian diets. McGovern’s committee—as they said back then—was hip to all of this.

This is clear in their choice of reference material for the Dietary Goals, which included—of all things—a cookbook called Diet for a Small Planet. As much vegetarian manifesto as a source for recipes, it proposed that a plant-based diet was the best way to feed the hungry, save the Earth, protect our health, and usher in the Age of Aquarius. [It still does.] This cookbook assured middle-class America that what was good for us was also good for the world. Its influence is felt throughout the 1977 Goals, which counseled Americans to reduce consumption of meat, eggs, butter, and full-fat dairy, and increase intake of grains, cereals and vegetables oils, recommendations that have changed very little in nearly 40 years.

McGovern’s committee wanted to return America to a more “natural” way of eating—and what could be wrong with that? This “back to nature” stance earned the Committee the nickname “the barefoot boys of nutrition.” This “back to nature” idea not only recalled the “physical culture movement” that had long been a part of American life, it resonated with Puritan ethics that suggested that self-discipline and a little suffering—which Americans were going to need for such a radical change in diet—were a mark of moral goodness. Barefoot and back to nature, fresh air, sunshine and a little suffering—does any of this sound familiar?

Those initial Dietary Goals did not embed themselves in American culture based on the strength of their science—to say the least. They grabbed the attention of the media and the middle class because they played on the existential anxieties that cultural turmoil creates. They substantiated a notion that by changing their diets, Americans could control some of the frightening things in the world—hunger, pollution, disease. We could demonstrate just how much we cared about these issues, and we could do it from the comfort and safety of our own dinner table. We are still trying to do that even now.

Our current calls for reform in the areas of food, nutrition, and health reflect the same set of complex social problems, the same inescapable environmental problems, the same threats to our food supply that the creators of the 1977 Goals faced—only compounded by time, technological advances, and a distinct turn for the worse in the country’s (and the world’s) health.

The paleo community emerged as a protest against dietary guidance that seems to many to be scientifically shoddy, shallow, limited, and ineffective. The attention to calorie balance as the only way to maintain health seems to be especially—and unnecessarily—restrictive and unhelpful. But “paleo” in its stereotyped form takes a shape that is little different from the one to which it stands in opposition.

Both of approaches to nutrition are stuck in the past in two primary aspects:

Both suggest a linear and mechanistic approach to the food-health relationship. “Eat this/don’t eat that and all will be well.”

Second, and more subtly, both approaches reflect the cultural values and social power of those doing the reforming, but may not reflect the realities of the most vulnerable in our population, the ones who might benefit most genuine changes to the system.

People have been burnt once already by a “nutrition revolution” – they are confused, skeptical, and wary. They don’t want to get fooled again. Right now, paleo is not offering much that is truly revolutionary in terms of a new way to approach to food and health. Unless and until we are ready to give up some of the same concepts that we criticize the mainstream approach for using–it’s really just “meet the new boss, same as the old boss.”

We can’t generate the outrage we need to change the public’s world view, because we have not decided what our own priorities are: Do we care only about our own food and health, or do we care about everyone’s food and health?

With regard to food, current nutrition policies are a barrier to the growth of local food systems.

Farmers have difficulty expanding the market for locally-produced animal products because of dietary guidance that limits saturated fat and cholesterol intake. Meanwhile the paleo community is in upheaval for days—weeks, months?—debating the worthiness of butter from cows that are only 90% and not 100% grass-fed. How can we support long-term sustainable growth in local systems when our own standards are incoherent and possibly unreasonable?

We want our meat, eggs, and butter to come from happy, healthy cows and chickens. But what attention are we willing to spare for the health and happiness of farm workers—or the workers up and down the food supply chain?

With regard to health, nutrition is a civil rights issue.

We don’t want our wellness determined by an arbitrary marker like LDL, but are we willing to go to bat for someone else whose wellness is determined by an arbitrary marker like BMI?

The paleo community spends its energy debating how various sugars and starches may or may not be paleo. This is fascinating, but will it help people with diabetes who are never offered an alternative to a low-fat diet—despite the science that demonstrates the benefits of a carbohydrate-reduction in treating this disease?

The current nutrition paradigm use moldy datasets normed on white female healthcare professionals born during the first half of the last century to inform the dietary health of dark-skinned young males all over America. But is suggesting they return to their caveman roots any more appropriate?

These are huge issues—wicked problems—and we can’t fix them by replacing the old rules with some new ones. In order to be a leading force in the kind of social movement that might create authentic change in the system, paleo is going to have to move beyond the limited perspective that perpetuates many of the mistakes of the current nutrition paradigm.

I propose that we consider the idea of ancestral health—as distinct from “paleo”–as a way of framing food and nutrition reform to address both the cultural and the scientific limitations of previous approaches.

In terms of science, anthropology and evolutionary biology have shown us that diet is idiosyncratic and variable within and between populations, but not chaotic; there are certain nutritional requirements, but there are many ways to meet them.

Research into the human microbiome has shown us that we are not alone; and that the health of the microbial communities within and around us is a critical aspect of our own health.

Epigenetics, genomics, and other aspects of systems biology have begun to reveal the complexity of interactions between our genetic material and our environment, with food being a primary, but by no means the only, environmental exposure.

All of these concepts can and should be part of the ancestral health framework.

But as I said at the beginning, science is not enough. There are three critical components that turn a protest into a movement.

1) Development of widely-shared cultural norms, the violation of which is perceived as injustice. In order to develop those norms, we’re going to have to do some GROWING UP.

2) Development of a repertoire of actions that demonstrate that conditions can be altered. In order to create the sense of agency and change that we want, we are going to have to start DIGGING IN.

3) Development of a dense social networks that can work collectively against a common target. In order to create these alliances, we are going to have to begin REACHING OUT.

Growing up for paleo—as for many things—will to need to start with a little makeover. Like all good makeovers, this doesn’t mean abandoning the paleo identity completely, but it means looking—and moving—beyond it. There are precedents for this from other nutrition reform arenas.

For many people, hearing the term “vegan” bring a knee-jerk—and negative—reaction; but the term “vegetarian” does not. People who promote a vegan diet know this and can frequently be found using the term “vegetarian” instead. So that’s a marketing strategy, and a fairly wise one.

Now, take the phrase “Atkins diet” which can also elicit a negative, knee-jerk reaction. But scientists who study such diets have learned to use the phrase “reduced-carbohydrate” not only for PR purposes, but because the phrase “Atkins diet” does not encompass the different approaches to carbohydrate reduction that scientists are interested in.

How about paleo? It also elicits a negative, knee-jerk reaction from many and calls up stereotypes of privileged white males eating big hunks of meat on a stick—even though, as Hamilton Stapell showed us, those stereotypes may be somewhat inaccurate. As such, the term “paleo” limits what we can expect to accomplish as a framing device for conversations about food, health, and lifestyle. From this point forward I will use the term “paleo” to refer to the stereotyped and limited perspective and “ancestral health” to refer to an expanded and comprehensive approach to food-health reform.

By shifting the shared norms of our community towards an ancestral health framework—rather than being limited to paleo—we can move beyond the outdated concepts that we share with the current approach to nutrition and the problems that they create. We can—if we choose to—use an ancestral health framework to challenge those assumptions in a truly radical way.

[What follows is what I call the Top Ten Reasons Paleo Pisses Me Off, but my hubby, ever the diplomat, said not to say that.]

[Reason 10:]  So let’s just get this out there: The first assumption we need to challenge is the one that equates body size with health, which is interesting since according to Dr. Stapell, both of these are primary reasons to become part of the paleo community.

Mainstream approaches indicate that overweight and obese Americans need to eat less and move more to achieve a healthy weight according to an arbitrary cut-off on a simplistic measuring tool.

The paleo approach suggests that maybe strong is the new skinny. Or maybe “strong” is just another superficial way of assessing another’s worth.

The problem is that attention to body size rather than health and functionality can lead to a moralizing and pathologizing perspective that doesn’t reflect reality. Not only can this approach foster disordered eating behaviors and judgment calls about food, character, and lifestyle choices, it tells us little about overall health. We have no way of knowing, looking at these two women (Brittany on the left and Jennifer on the right—no headless women here), who eats what kind of food, who is healthy now, or who is going to live a long and functional life.

Our challenge is to use the ancestral health framework to recognize that a multiplicity of body shapes can be healthy and functional, and to acknowledge that much of body shape and size is determined genetically and can be influenced by factors other than diet and exercise. De-emphasizing body shape/size brings our focus to health, and especially for women, inter-generational health.

Women can—and do—have bellies, butts, and bingo flaps. Sisters who rock the paleo hardbody look—more power to you. Sisters who are more the Venus of Willendorf type—more power to you too. We can all meet at the pool and compare muscles & bra sizes & bingo flaps—and just get over ourselves and any fear of somebody tweeting about our butts.

[Reason 9:] Growing up also means moving beyond the idea that food and nutrition are the same thing.

Typical nutrition guidance discusses food as if all food choices are based only on nutrition.

Yeah, we tend to do the exact same thing.

The Problem: People are concerned about a lot of other things besides nutrition. Usually cost, convenience, and taste come first–

–followed by a host of other considerations, only one of which is nutrition.

An ancestral approach to food can embrace all of the factors that impact our food choices because it can look at food in its cultural—as well as biological—context. It can highlight the role of environmental stressors in overall health–including economic and time pressures that also impact food choices. Acknowledgement of food communities allows us to explore the role food beliefs and preferences play in food choices; these too are part of an anthropological and evolutionary perspective on food-health relationships.

[Reason 8:]  We need to move past the idea that food is medicine.

Mainstream nutrition has promised that a low-saturated fat ,low-cholesterol, low-calorie, low-sodium, whole grain diet will prevent chronic illnesses like heart disease, cancer, and diabetes.

Us: Same promise, different food.

Now, I’m not going to say that the paleo paradigm doesn’t have some better biochemistry behind it; in many [but not all] respects, it does. The problem is that food is still not medicine.

A nutritionally-appropriate diet should be the foundation of good health, but it doesn’t guarantee it. Both groups are making promises they can’t keep & this leads to skepticism, cynicism, and disillusionment. Most importantly, this framework take a complex social construct and a biological necessity—food—and reduces it to a mechanistic and simplistic intervention–medicine.

Medicine is for sick people and food is for everyone. We may use food as part of a therapy to “heal” a particular condition at a particular point in time, but that is not the same thing as a public health paradigm. We put casts on broken legs, but we don’t recommend that everyone wear casts in order to prevent legs from breaking.

An ancestral health approach offers an opportunity to move away from the view of the human condition as one of potential “illness” to be “avoided” to one of wellness to be maintained.  By focusing first and foremost on essential nutrition—and the many appropriate ways that it can be acquired–the emphasis is on having health, not preventing chronic disease. The recognition of the complexities of what we know and don’t know about the relationships between food and health brings into the public health forum other important aspects of lifestyle—sleep, stress, play, activity—that can contribute to health and well being.

[Reason 7:] There is no small irony in the fact that both plant-based and paleo ideology emphasize a return to “a more natural way of eating.” How does that happen? Because the notion of “a more natural way of eating” is not something that is easy to define. [More generally, the emphasis on a more "natural" way of doing things is a rhetorical device that implies "goodness" and fails to evaluate the issue at hand on its own terms.]

Mainstream nutrition suggests that returning to a “more natural” diet means eating a lot foods that our ancestors DIDN’T eat—either in the near or distant past—like vegetable oils, and avoiding a lot of foods they DID eat, like butter, eggs, meat, and lard.

Paleo suggests that returning to a “more natural” diet means NOT eating a lot of foods that our ancestors DID eat—at least in the not too distant past—like bread, legumes, and dairy, [and eating a lot of foods they DIDN'T eat i.e. coconut milk, unless your ancestors were Thai].

The problem is that “natural” is term useful for marketing, but not much else. It isn’t a scientific concept, or even one that makes a lot of sense culturally. We don’t really have a lot of solid information about what was “natural” for our distant ancestors—and the gene/environment interactions that may have occurred since then may make that information less relevant than how our more-recent ancestors lived, ate, and worked.

Here’s our challenge: Ancestral health principles got their start by focusing on paleolithic times—and that perspective is a valuable one—but we don’t have to be limited to that. An ancestral health framework can also allow us to look to the near-past for clues about our health now, should we choose to. Here’s the beauty of this approach: It’s already been sanctioned by mainstream nutrition, and by two of the leaders in nutrition reform, Michael Pollan and Gary Taubes.

In his landmark 1985 article, Sick Individuals and Sick Populations, epidemiologist Geoffrey Rose called for “The restoration of biological normality by the removal of” among other things “recently-acquired dietary deviations.” Gary Taubes indicates that Weston A. Price’s work about the health impacts of introducing new foods into native diets as the “most influential” thing he read in researching Good Calories, Bad Calories. Michael Pollan suggestion that we eat the way our great-grandparents ate has become a rallying cry for many people interested in food reform.

[The pie chart above] is a pretty reasonable picture of an “ancestral diet” from 1955 America: we got about half of our calories from plant-based starches and sugars—only 10% of those as fruits and vegetables—and about half from mostly animal-based proteins and fats. I’m not saying this is a perfect diet, but it does seem to be the one we were eating before the rapid rise in obesity and diabetes.

An ancestral framework can help us analyze the differences between how this food environment may be similar to or different from our current one, without having to invoke a past that didn’t exist, as the plant-based folks must in light of this information—or a past that is so distant that it’s hard to say what we really know about it [as the paleo folks must]. On the other hand, the 1955 –style 50/50 diet looks remarkably familiar. It’s not that hard. Or is it?

[Reason 6:] Well, we make it hard by invoking food rules that don’t always make a lot of sense. Everyone’s current favorite, on all sides of the nutrition issue, is: Avoid processed foods.

Michael Pollan says avoid processed foods unless you are talking about vegetable oils.

Paleoista says avoid processed foods unless you are talking about hydrolyzed fish protein powder.

Problem: Food rules means splitting hairs, drawing lines in the sand, and creating arbitrary divisions—and they usually end up making the food rule makers look silly at best and hypocritical at worst. Food rules are the easiest things to dismiss, discount, or disprove. We’re already enmeshed in a set of arbitrary, unreasonable, and incoherent standards [called the Dietary Guidelines for Americans]; no one is interested in a new and different one.

Skip the food rules. What we need are guiding principles from an ancestral health perspective that can apply to individuals, industry, and policymaking processes. For instance, if we frame concerns around the “recently acquired dietary deviations” I just mentioned, we have a guiding principle—upon which Geoffrey Rose, Gary Taubes and Michael Pollan all agree—for looking at the current scientific literature and for conducting future investigations. We might go back a few generations or many generations; either way we can remain true to our generational perspective of health without limiting ourselves to a particular set of food rules.

[Reason 5:] The politics of responsibility are a no-win situation for the public.

Mainstream nutrition assures folks that, if the low-fat, low-calorie diet isn’t working for you, you’re not doing it right. Paleo people assure newbies that if the high-fat, no-calorie-counting paleo diet isn’t working for you, you’re not doing it right.

And when that logic doesn’t fly, both groups blame the “obesogenic” environment.

Problem: Both approaches assume that “If only that poor sick, fat person had the “right” food or the “right” information or the “right” environment, they’d stop being so fat and sick.” These approaches call for policy reforms that will force industry to make “the healthy choice the easy choice” for people apparently deemed too irresponsible or stupid to make the healthy choice otherwise. But industry is responsible to the public, not for the public. That’s the job of public health.

Challenge: An ancestral health approach recognizes that poor health may be as much an outcome of environmental impacts and generational health—especially prenatal health–as food choices and activity. This shifts the focus away from the politics of responsibility and puts the attention on food industry and policy reform where it belongs, not on a product—which the consumer may or may not choose—but on the processes over which consumers have little control: federal approval of food additives, food and farm workers rights, food safety and food waste, environmental impacts of our current agricultural practices, and many other food-related practices, program, and polices that have been ignored in favor of telling people what to eat and do and blaming them when it doesn’t work.

[Reason 4:]  This one is a real “I’m rubber, you’re glue” thing. We complain about all those mainstream nutrition articles making sweeping generalizations about how animal fats will kill you—then we turn around and make sweeping generalizations about how vegetable oils will kill you. The vast majority of these claims—on both sides of the table–are unproven and even untested; in many cases they are untestable. [The science for both claims is primarily observational; other science may be experimental, but based on animal models and cell cultures. The few randomized, controlled dietary trials that exist are just that, highly controlled. The populations may or may not be generalizable to larger populations; the methods may or may not translate to the "real world."]

Problem is, we don’t know what we think we know about the relationships between diet and health. Plus, there’s a really good chance we will never know what we think we need to know about the relationships between diet and health.

Science and medicine as they have been practiced in America for the past half a century (or more) have relied on a mechanistic approach to these relationships that is now rapidly giving way to more complex thinking. The mechanistic approach has served the industries of research, medicine, food and pharmaceuticals–because what is simplified can be controlled–but it hasn’t served the health of humans.

Ancestral health principles can help us think about science differently. Nutrition science as it is practiced now is backwards looking—especially nutrition epidemiology which relies upon ancient datasets gleaned from populations which are hardly representative of our current world. It ignores the complex relationships between ourselves, our environment, and our heredity that science has more recently uncovered. Despite its name, ancestral health represents a forward-looking framework. As an approach to public health, it can herald a shift to a more holistic, yet evidence-based focus that recognizes individual, community, environment, and generational impacts on health. Consider the ancestral health community’s active encouragement of n of 1 experimentation. It is a perspective that can go beyond Joe Paleo fiddling with his macronutrient ratios to a place of leveraging new biomedical technology, new ways of modeling complex relationships, and a new focus on patient-centered outcomes to create a revolution in how we approach the science of diet and health. This is not anti-science, but an embrace of science in all its complexity. Such an approach brings us to our biggest philosophical challenge:

[Reason 3:] Can we acknowledge that one diet will not be right for everybody?

Right now, mainstream nutrition asserts that everyone will benefit from eating a low-fat, low-calorie diet.

At the same time, the paleo community asserts that everyone will benefit from eating a paleo diet.

The problem with a top-down, unilateral imposition of one-size-fits-all dietary recommendations is the same as it was in 1977: Who asked you to come up with a diet for me that might or might not help prevent a condition that I may or may not be concerned about? Remember that a skeptical public doesn’t want to get fooled again. New arrivals to our country, who aren’t yet aware of the abysmal failure of our current nutrition system, are being greeted with admonitions to give up traditional foods like eggs and meat—but then paleo doesn’t have a much different message to offer, except that instead they should give up traditional foods like bread and beans.

Ancestral health principles embrace the notion of change. Ancestral health acknowledges complexity. It only makes sense that an ancestral health approach to public health would recognize diverse paths to acquiring appropriate nutrition, with a focus on foods high in nutrient value, and frame dietary information in terms of the diversity of individual, cultural, environmental, and generational contexts. But will it?

[Reason 2:]  Many of the assumptions I’ve mentioned are deeply embedded in our thinking, and reflect the concerns, values, and social power of the mostly white, well-educated, well-paid, predominantly female thirty-somethings that make up the paleo community. Not that there’s anything wrong with that—information from other datasets have shown that white, well-educated women are also the ones that most closely adhere to the Dietary Guidelines food pattern, so the presence of this demographic in paleo may reflect an overall concern not only for weight and appearance, but for family and health. This is a good thing. This particular demographic also has a long history of being the backbone of successful social reform movements—from child labor to drunk driving laws.

But ladies—and gentlemen—we are going to have to do more than vote with our forks or food dollars.

Both paleo and plant-based reform efforts seem to believe that your financial support of the food you’d like to see other people eating is the best way to change the food-health system. You can just munch your way to a better world without ever having to encounter anyone who doesn’t appreciate the change you’re creating for them.

For paleo eaters, increased demand may increase production, making some foods more affordable for some people. It may support some farmers—as long as they keep up with and adhere to all of the “appropriate” [and possibly contradictory, unrealistic, and/or absurd] paleo food rules—but it isn’t necessarily going to change the status quo for the most vulnerable in our population, the ones most subject to the effects of dietary policy as it stands now. Me buying my eggs locally doesn’t help the low-income mothers who would like to spend their federal assistance farmers market vouchers on local eggs too, which they are not allowed to do. Face it, in the “vote with your food dollar” approach, some folks have a lot more votes than others. Changing your diet is not enough to change the world. We are going to have to put down our forks and dig in.

One of the things any successful social change effort has is a story, where the victims of injustice can be rescued from evil by the heroes. A successful social change effort also has a way for everyone—from individuals to the government—to be a hero. This takes the form of a repertoire of actions for changing conditions. These concrete actions give a sense of agency and urgency to the cause; they say to the world: come join us, we are being the change we want to see.

Being a hero and acting from a place of our own food-health values, however, does not mean going out into the world and trying to impose those values on someone who hasn’t asked for our help. Instead, it means sharing the privilege of health we have in a useful way [and this is a privilege based much more on social class than diet], so that others may have the food and the health that they want—just as we wish to have the food and health that we want. How can we do that?

For example: An ancestral health framework recognizes the importance of protein as essential to a nutritionally-adequate diet. But protein is also the single most expensive food source to provide to the less fortunate. Because it is so expensive, it also means that protein is the food source most lacking in diets of those who are in most need.

The state of Illinois has established a program to encourage hunters and anglers to donate deer and Asian carp—which is an invasive species in the Great Lakes–for processing into healthy, ready-to-serve meals. I don’t know what their standards for that are, but if you work to build a similar program in your area—or maybe you’ll head up a protein food drive for a local shelter–you get to help set the standards, remembering that the goal is not necessarily following all the “right” food rules, but feeding the hungry essential nutrition.

[A number of states have programs--with various names, but often called "Hunters for the Hungry"--that bring hunters, processors, state inspectors, and hunger relief organizations together to help supply sources of all-important high-quality protein to those in need.]

Community level programs can ripple outward and upward – and if they are organized with an ancestral framework in mind, those ideas ripple outward and upward as well.

Farm to Family initiatives bring food from local farmers to local, low-income families at prices they can afford—an effort that supports local farmers as well as community members at risk for hunger and poor nutrition. These initiatives typically focus on fresh produce, but some include meat and eggs—and wouldn’t the world be a better place if even more of them did? College students with mad social networking skills can mobilize volunteers and connect resources to get the program off the ground. Local public health agencies and faith-based organizations can raise awareness so that families at highest risk can be reached—and so their wants and needs can be heard and honored. Individuals and families can donate time and money, while businesses can facilitate logistics with donations of materials or space. Feedback from the community can support policy change at local, state, and federal levels.

The ancestral health community has the sort of talent to pull an effort like this off, but it involves not just getting out of the house, but getting out of our comfort zones.

[Reason 1:] The lack of diversity that often comes with being part of a community of like-minded people presents both an epistemic challenge and a logistical one. It can lead not only to closed minds, but to closed doors. Being able to act from a place of ancestral health principles—rather than paleo rules—can make it easier to reach out to others–the final thing needed to build a social movement.

Confirmation bias has been a pervasive aspect of mainstream nutrition, and in opposition to it, paleo culture often seems to have adopted a similarly insular stance. It can be reinforced by influence and funding, but most often it is simply a way of not being challenged in our own beliefs.

In mainstream nutrition, the USDA and HHS write the Dietary Guidelines. They also finance the research and the experts that they later choose for their “evidence-based analysis” of these guidelines, so it’s no surprise that both the research and the experts support the status quo.

Paleo leaders also have a vested financial interest in being paleo leaders—books, speaking engagements, products, and other various funding streams—just as paleo followers have an interest in remaining comfortable in their chosen ideology. We support our leaders; they tell us what we want to hear.

This problem, also known as epistemic closure, echo chambers, or a circle jerk, is that these positive feedback loops end up welcoming only people that think exactly like the people already in the group. Sadly, the smarter you are, the better you are at confirming your own beliefs about things—and we have a lot of wicked smart people in the paleo community. Unfortunately, circle jerks quickly turn into cluster, let’s call them “efforts” – where the circle of closed thinking causes the very problems that the circle of closed thinking is unable to address exactly because of its closed nature. Which is sort of where we are now—both in mainstream nutrition and in paleo.

Much of mainstream nutrition has built-in alliances with academia, industry, advocacy groups, and policymakers. In order to make our voices heard, we will need to establish connections with other communities who will work with us on common issues. The general rule in building networks of alliances is that there are no permanent friends and no permanent enemies; everyone is a future ally. You work together on issues and projects as long as your goals align.

This may make for strange bedfellows at times, but if we want to be more than a passing fad, we are going to have to reach out of our comfort zone and connect with other communities with whom we may not feel an immediate kinship but with whom we share some core values.

For example, the Health at Every Size community. This community has a strong presence in academic circles that look at feminist and diversity issues. While an alliance based on paleo thinking might not make sense, the ancestral health framework would have much in common with these Health at Every Size principles.

The Invest in Healthy Food Project being promoted by the Union of Concerned Scientists uses MyPlate as its nutrition reference point. Icky, right? But a closer look shows a focus on policy change that is fully compatible with ancestral health principles. Specifically citing the need for changes to commodity crop policies and crop insurance that would benefit the local farmers that we support.

Other communities with whom we are likely to have some common objectives are: other alternative food movements–yes, including vegans; sustainable agriculture and permaculture communities; government accountability groups; and hunger groups. We don’t have to agree on everything, just our shared goals. We can learn from them and they can learn from us.

We can reach out to foundations, the media, professional organizations, and faith-based communities. And it doesn’t have to be on a national level. We can find influential allies in these groups in our own local communities.

And in fact, that’s where I would urge us to start. As a community, we exist both nowhere and everywhere—which can make us feel more at home at places like AHS than we do in our own towns. But, to quote Rick Ingrasci, if you want to create a new culture—throw a better party. One of the wonderful traditional things we do as humans is celebrate and build community with food—but it’s hard to celebrate if you are busy agonizing, analyzing, and criticizing your—or your neighbor’s—food. We have the opportunity to NOT be those nutrition reform people.

I’m going to end with a story about last year’s Food Day in Durham, NC. This is sponsored by the Center for Science in the Public Interest, which operates from a plants-are-better, saturated-fat-kills perspective. At an organizational meeting last year, a room full of young white women—and one white male—were busy wringing their hands over the lack of diversity at last year’s Food Day events. Now Durham is a very diverse little city. In Durham, we talk more about race than NASCAR fans talk about racing. But Food Day tends to be an almost all-white event involving mostly college kids from Duke rather than people from the community. Why oh why is that? these ladies (and one gentleman) wanted to know. I suggested that maybe it’s because no Food Day events serve meat—and there are lots of local meat, egg, and cheese producers that we could support by promoting their foods. These women looked at me as if I had just created a loud, legume-based bodily emission—and the topic was never mentioned again.

Well, we can throw a better party. We can appeal to a wider, more diverse, and inclusive community. It will mean growing up, digging in, and reaching out. But there are plenty of people out there who are hungry for a sense of identity, for connection, and for change. Ancestral health as a social movement can serve that purpose, as well as serve our communities—and we can serve it with a side of bacon.

The “thank you” slide is my shout-out to those who have helped me think about the issues I’ve raised.

Laura Schoenfeld @ Ancestralize Me!

Beth Mazur @ Weight Maven

Melissa McEwan @ Hunt Gather Love

Robert Patterson @ Michael Rose’s 55

Chris Masterjohn @ The Daily Lipid

Doug Imig – The Urban Child Institute

Andrew Abrahams – Long Dream Farm

Michael Ostrolenk – The Transpartisan Center

Postscript: At some point during the AHS 2013 weekend, I pulled Aaron Blaisdell aside and asked him what the deal was with paleo and AHS. Here’s his response as I remember it (and I hope he will correct me if I misrepresent him). He said something to effect of: AHS is about bringing an evolutionary perspective to health, including but not limited to matters relating to diet and nutrition. Darwin’s evolutionary perspective has been an incredibly powerful tool in other areas of biology for understanding why things are the way they are and for formulating hypotheses and testing them out, but it is often neglected when it comes to health particularly in matters of food and diet. AHS is about promoting that perspective, not about promoting a particular diet. [See Aaron's comments below for an expansion on this.  Note to self:  Drink that glass of wine after you ask Aaron Blaisell questions like that.]

I heaved a big sigh of relief. “Paleo” I can do without–just as I can do without all of those other conveniently-labeled approaches to diet and health with massive cognitive bias blind spots: vegan, vegetarian, low-carb, low-fat, “eating the food,” whatever, whatever (although I’m happy for the people who find that being part of those communities gets them on a path to health that works for them). So I guess this is my massive cognitive bias blind spot. I still love those AHS folks.

Make me some science I can’t refuse

In case you missed it, in a recent article published in the American Journal of Preventive Medicine entitled Overstatement of Results in the Nutrition and Obesity Peer-Reviewed Literature (not making this up), the authors found that a lot of papers published in the field of obesity and nutrition have, shall we say, issues.

Well–as they say down South– I never!

The authors looked at over 900 scientific articles on nutrition or obesity published either in 2001 or 2011 in leading journals. They found that about 1 in 11 include “overreaching statements of results.” 

Here’s how the authors described statements that would be coded as “overreaching”:

  • reporting an associative relationship as causal
  • making policy recommendations based on observational data that show associations only (e.g., not cause and effect)
  • inappropriately generalizing to a population not represented by the sample studied

Frankly, I am totally offended. Someone needs to let these folks know that, in nutrition epidemiology, correlation actually does equal causation.

What’s more, nutrition policy recommendations are supposed to be based on observational data. Hello? Dietary Guidelines? (Seriously. You don’t expect public health nutrition people to do actual experiments now, do you? I mean, unless you are talking about our population-wide, no-control-group, 35-year experiment with low-fat diet recommendations, but that’s different.)

And we don’t mind generalizing conclusions to Everyone in the Whole Wide World based on data from a bunch of white health care professionals born before the atom bomb because, honestly, those are the only data we really care about.

Equating correlation and causation, over-generalizing observations, and then using these results as the basis of policy is the bread (whole wheat) and butter (substitute) of nutrition epidemiology of chronic disease (aka NECD – pronounced Southern-style as “nekked”). NECD has a long proud tradition of misinterpreting results this way, and dammit, nobody is going to take that away from us.

Early NECD researchers have in the past tried to tentatively misinterpret results by obliquely implying that observed nutritional patterns might perhaps have resulted in the disease under investigation. Wusses.

In 1990, Walter Willett and JoAnn Manson came along to show us how the pros do it. These mavericks were the ones who made bold inroads into the kind of overreaching conclusions that made NECD great. Their data come from an observational study of female registered nurses from 11 states in the US, born between 1921 and 1946, who were asked to remember and report what they ate 4 whole times between 1976 and 1984, plus remember and report what they weighed when they were 18 years old. From this dataset, which is clearly comprehensive, and this population, which is practically every female in the US, Willett, Manson and company naturally conclude that “obesity is a major cause of excess morbidity and mortality from coronary heart disease among women in the United States” (emphasis mine). None of this wimpy “associated with increased risk of” bullshooey, obesity CAUSES heart disease, they tell us, CAUSES IT!!!! BWHAAAHAAAAA!!!!!!!

It is on this foundation of intrepid willingness to misinterpret data that the science of NECD was built. This is why Walter Willett is the Big Kahuna at the Harvard School of Public Health. He has demonstrated the courage to misinterpret data in innovative and comprehensive ways, publishing articles throughout his career that indicate that even small increases in BMI—including BMI levels that are currently considered “normal”–cause chronic disease.

In 1999, in what is considered a landmark article in overstatement, one with which all NECD acolytes should familiarize themselves, he states unequivocally, in a review of observational data:

“Excess body fat is a cause of cardiovascular diseases, several important cancers, and numerous other medical conditions . . . “ (my emphasis). Hmmmm. Observed associations reported as causal? Ding!

The rest of that sentence reads: ” . . . and is a growing problem in many countries.” His data is once again gathered mostly from American white health care professionals born before the atom bomb. Generalization from specific populations to the rest of the world? Ding ding.

And what should we do with this conclusion, according to Willett? “Preventing weight gain and overweight among persons with healthy weights and avoiding further weight gain among those already overweight are important public health goals.” Using observed associations to make policy recommendations? Ding ding ding. In one fell swoop, Willett dexterously manages to use all three designated methods of overstatement and misinterpretation in the nutrition epidemiology NECD toolbox, demonstrating why he is considered by most researchers to be “the ‘father’ of nutrition epidemiology.” This man overstates and misinterprets in ways that the rest of us can only dream of doing.

Sadly, some epidemiologist have failed to follow in Willett’s footsteps. In January 2013, Katherine Flegal, an epidemiologist at the Centers for Disease Control and Prevention and the woman who first noted the remarkably rapid rise in obesity that began in the decade following the release of the 1977 Dietary Goals for Americans, published results that concluded that being overweight (or even mildly obese) is associated with a lower risk of death. At no point in her article does she suggest that overweight or obesity results in increased lifespan.

The response from Harvard? Walter Willett calls Flegal’s article ” a pile of rubbish” and insists that “no one should waste their time reading it” and rightly so. Why would anyone want to hear about “associations”? What kind of nonsense is that? Obviously Flegal lacks the professionalism it takes to make the leap from observation to causation.

But that’s okay. Willett and the Harvard Family know how to deal with this sort of thing.

“Someday, and that day appears to have come, I will call upon you to ignore the work of other scientists when their results contradict my own.”

Let’s face it, in the world of NECD, you can’t just have people like Flegal refusing to infer causation from observed results, just because they don’t want to. When that sort of thing happens, well, let’s just say, if she won’t do it, the Harvard Family will have to do it for her. And so they did.

In February 2013, Willett and company convened a Harvard Family gathering to, in their words, “elucidate inaccuracies in a recent high-profile JAMA article [i.e. Flegal's] which claimed that being overweight leads to reduced mortality” (emphasis mine). Which it didn’t–except now, voila, it does. It’s not personal, Dr. Flegal. It’s strictly science.

The Family get-together was held at the Harvard School of Public Health, a “neutral convening space” that is also ground zero for the Nurses’ Health Study I and II, the Physicians Health Study I and II, and the Health Professional Follow Up Study, three datasets that have generated many NECD articles that, unlike Flegal’s article, brilliantly illustrate the powers of misinterpreting observational data. That Flegal herself was invited, but “could not attend” tells us just how ashamed she must be of her inability to make over-reaching conclusions–or perhaps she was temporarily “incapacitated” if you know what I mean.

The webcast from the meeting show us how NECD should be done, with dazzling examples of overstatement and marvelous feats of misinterpretation.

In the world of NECD, PowerPoint arrows are a scientifically-acceptable method of establishing causation.

In her shining moment, Dr. JoAnn Manson, demonstrating that she has learned well from Willett, points to the slide above and asks: “How is it possible that overweight and obesity would cause all of these life-threatening conditions, increase their incidence, and then reduce mortality?” How indeed???

The panelists highlighted the importance of maintaining clear standards of overstatement and expressed concern that Flegal’s research could undermine future attempts of more credible researchers to misinterpret data as needed to protect the health of the public.

Because that’s what it’s all about folks: protection. Someone needs to protect the science from renegades like Flegal, and someone needs to protect the public from science.

We should be thankful that we have Willett and the Harvard Family there. They know that data like Flegal’s can only confuse the poor widdle brains of Americans. Allowing us to be exposed to such “rubbish” might lead us to the risky conclusion that perhaps overweight and mild obesity won’t cause all of us to die badly, or to the even more dangerous notion that observational data should remark only upon association, not causation. And we sure don’t want that to happen.

As Don Dr. Willett says, “It is important for people to have correct information about the relationship between health and body weight.” And when he wants us to have the correct information about the relationship between health and body weight, he’ll misinterpret it for us.

Take the science, leave the cannoli.

Never Too Early to Learn about Lowfat?

I am pleased to welcome Pam Schoenfeld MS RD as a guest blogger.  Pam has been inspiration to me for many years; she was the person who convinced me I could go back to school and get a degree in nutrition.  She works with individuals and families in a clinical setting and has become increasingly concerned about the messages about “healthy food” that are being given to young children.  Although the science on the dangers of dietary saturated fat and cholesterol has been hotly contested for decades, mainstream nutrition is now targeting preschoolers with messages about the evils of eggs and whole milk.  Pam shares her experiences and insights on this issue.  

As for me, I love my new PhD program in Communication, Rhetoric, and Digital Media, but it is kicking my butt.  Who knew critical cultural theory was harder than biochemistry?  I’m glad to have someone take over blogging duties for me as I am sleep-deprived, overworked, overwhelmed–and happier than a pig in slop.  Pam promises more to come, so stay tuned.

Samantha was in most ways a typical patient, slightly round in the middle but otherwise healthy. She knew a few things about healthy eating; she ate cereal with nonfat milk for breakfast, and made an effort to eat her fruits and vegetables. When I asked if she liked eggs, she said “yes, but only the whites.” When I asked why, she answered rather matter-of-factly, “the white is better for you than the yellow.” Her answer came as a surprise to me. Many of my patients are still concerned about eating egg yolks, but Samantha was only eight years old! Already she had somehow internalized the message that certain foods were best to avoid if you want to be healthy. She did not know that egg yolks were high in cholesterol; just that they were not good for her to eat. She did not know that nonfat milk was low in saturated fat; just that it was what her family always poured on their cereal and what she drank at school.

Despite the lack of science to support the claim, kids are increasingly being given the message that fat-free milk–even the kind with added sugar–is the healthiest choice.

The avoidance of egg yolks and the choice of low-fat or nonfat milk are so common among my patients that if she were just 5-10 years older, her answer would be completely expected. But she was so young, so eager to do the right thing, and yet so unaware that some of what she was being taught about nutrition was not evidence-based. So while I helped her plan meal choices that better met her needs, I gave her my best third-grader explanation about why whole eggs are actually one of the best foods she could eat. I left the subject of dairy fat for another day, as I suspected her mother and pediatrician wouldn’t agree with my view on this and I wanted to ensure that Sam would continue to see me.

I had assumed that these nutrition messages are so prevalent in our adult culture and media that young children simply absorb them by osmosis. But it turns out that more and more children as young as 3 are being targeted with nutrition information.

Nutrition information that adheres to controversial government dietary recommendations is targeting preschoolers with low-fat, grain-based dietary advice.

The latest issue of my professional dietetics journal arrived in the mail last month, and as usual, I skimmed the abstracts of poster presentations scheduled for the annual dietetics conference, aka “FNCE,” that will be held in Houston over the next 5 days. To my surprise, a few dozen of these abstracts described research on children’s diets, with eight reporting outcomes from programs targeted for preschool or grade-school age groups. (1) FNCE is by far the largest annual gathering of registered dietitians; it is at this venue that many RDs become informed on the research and practice recommendations in our field.

One group of researchers stated that because 75% of children are in organized childcare, it is the ideal setting for promoting healthy behaviors; a second group agreed that childcare settings are a prime environment for early intervention. I was reminded of my own dietetic internship, where I had to sing to Head Start pupils about the merits of low-fat milk while entertaining them with a cow puppet. Nutrition and health lessons directed to preschoolers are commonly delivered in the form of games and songs, but researchers are now studying the effectiveness of other methods.

I guess this should not surprise me, considering a 2011 Institute of Medicine (IOM) Report entitled “Early Childhood Obesity Prevention Policies.” The expert committee authoring the report stated “there is a growing awareness that efforts to prevent childhood obesity must begin before children even enter the school system.” Their “hope” is that this report will find its way to government policy makers who work in areas that impact young children in infancy and early childhood. In this report, nutritious and healthy foods for ages 2 and older are defined to be consistent with the Dietary Guidelines, which specify lean protein foods and low-fat or nonfat dairy products. (2)

Traditionally, the family has been the key environment where young children learn to develop eating habits and food preferences. But once children start school, teachers and peers gradually become the greatest influence. (3) Most people would undoubtedly be supportive of any initiative to educate young children about nutrition. After all, there has been an almost 2.5-fold increase in obesity in children ages 2-5 from 1980 to 2010, from 5% to 12.1% of this age group, and similar increases in older children. (4) So it would appear necessary to begin preventative measures at an early age.

Despite considerable evidence that shows that saturated fats are not linked to heart disease, the American Heart Association uses cartoon figures to teach kids that both whole (saturated) fats from animal products and transfats from processed oils are “the Bad Fats Brothers.”

It also appears that initiatives directed at young children are effective. In a recent study of 4-year olds given structured nutrition lessons in preschool, the children were able to correctly answer that “high-fat foods are bad for you and make you fat” even 5 months after the lessons ended. These lessons were only 10-15 minutes long, and the information wasn’t reviewed during the 5-month period, so the children’s ability to retain that lesson long-term indicates their receptivity to simple nutrition messages. (5) While it is unknown if the children consistently acted on this knowledge, it is clear they can and do retain simple “food rules,” even at the tender age of 4. The IOM committee would likely agree: “During infancy and early childhood, lifestyle behaviors that promote obesity are just being learned, and it is easier to establish new behaviors than to change existing ones.” (2)

So if childhood obesity is a huge problem and these early nutrition programs are effective in teaching children, why am I concerned? One reason is that the very same saturated fat- and cholesterol-containing foods that are negatively targeted in these nutrition lessons actually contain critical nutrients for growing children. Another reason is that if done improperly, nutrition lessons directed at children could easily pave the way for unhealthy relationships with food and issues with body image, among other unintended effects.

I will discuss these possibilities in more depth in upcoming posts, with further discussion on some disturbing recommendations from the IOM Early Childhood Obesity Prevention report.

References:

1. Journal of the Academy of Nutrition and Dietetics; 2013:113(9), A1-A120, suppl.

2. Institute of Medicine (IOM). 2011. Early Childhood Obesity Prevention Policies.Washington, DC: The National Academies Press.

3. Perez-Rodrigo C, Aranceta J. Public Health Nutrition. 2001;4(1A), 131-139.

4. Ogden CL, Carroll MD, Kit BK, Flegal KM. JAMA. 2012;307(5):483-490.

5. Nguyen SP, McCullough MB, Noble A. J Educ Psychol. 2011; 103(3): 594–606.

As the Calories Churn (Episode 3): The Blame Game

In the previous episode of As the Calories Churn, we explored the differences in food supply/consumption between America in 1970 and America in 2010.

We learned that there were some significant changes in those 40 years. We saw dramatic increases in vegetable oils, grain products, and poultry—the things that the 1977 Dietary Goals and the 1980 Dietary Guidelines told us to increase. We saw decreases in red meat, eggs, butter, and full-fat milk—things that our national dietary recommendations told us to decrease. Mysteriously, what didn’t seem to increase much—or at all—were SoFAS (meaning “Solid Fats and Added Sugars”) which, as far as the 2010 Dietary Guidelines for Americans are concerned, are the primary culprits behind our current health crisis. (“Solid Fats” are a linguistic sleight-of-hand that lumps saturated fat from natural animal sources in with processed partially-hydrogenated vegetables oils and margarines that contain transfats; SoFAS takes the trick a step further, by being not only a dreadful acronym in terms of implying that poor health is caused by sitting on our “sofas,” but by creating an umbrella term for foods that have little in common in terms of structure, biological function or nutrition.)

Around the late 70s or early 80s, there were sudden and rapid changes in America’s food supply and food choices and similar sudden and rapid changes in our health. How these two phenomena are related remains a matter of debate. It doesn’t matter if you’re Marion Nestle and you think the problem is calories or if you’re Gary Taubes and you think the problem is carbohydrate—both of those things increased in our food supply. (Whether or not the problem is fat is an open debate; food availability data points to an increase in added fats and oil, the majority of which are, ironically enough, the “healthy” monounsaturated kind; consumption data points to a leveling off of overall fat intake and a decrease in saturated fat—not a discrepancy I can solve here.) What seems to continue to mystify people is why this changed occurred so rapidly at this specific point in our food and health history.

Personally responsible or helplessly victimized?

At one time, it was commonly thought that obesity was a matter of personal responsibility and that our collective sense of willpower took a nosedive in the 80s, but nobody could ever explain quite why. (Perhaps a giant funk swept over the nation after The Muppet Show got cancelled, and we all collectively decided to console ourselves with Little Debbie Snack Cakes and Nickelodeon?) But because this approach is essentially industry-friendly (Hey, says Big Food, we just make the stuff!) and because no one has any explanation for why nearly three-quarters of our population decided to become fat lazy gluttons all at once (my Muppet Show theory notwithstanding) or for the increase of obesity among preschool children (clearly not affected by the Muppet Show’s cancellation), public health pundits and media-appointed experts have decided that obesity is no longer a matter of personal responsibility. Instead the problem is our “obesogenic environment,” created by the Big Bad Fast Processed Fatty Salty Sugary Food Industry.

Even though it is usually understood that a balance between supply and demand creates what happens in the marketplace, Michael Pollan has argued that it is the food industry’s creation of cheap, highly-processed, nutritionally-bogus food that has caused the rapid rise in obesity. If you are a fan of Pollanomics, it seems obvious that food industry—on a whim?—made a bunch of cheap tasty food, laden with fatsugarsalt, hoping that Americans would come along and eat it. And whaddaya know? They did! Sort of like a Field of Dreams only with Taco-flavored Doritos.

As a result, obesity has become a major public health problem.

Just like it was in 1952.

Helen Lee in thought-provoking article, The Making of the Obesity Epidemic (it is even longer than one of my blog posts, but well worth the time) describes how our obesity problem looked then:

“It is clear that weight control is a major public health problem,” Dr. Lester Breslow, a leading researcher, warned at the annual meeting of the western branch of the American Public Health Association (APHA).
 At the national meeting of the APHA later that year, experts called obesity “America’s No. 1 health problem.”

The year was 1952. There was exactly one McDonald’s in all of America, an entire six-pack of Coca-Cola contained fewer ounces of soda than a single Super Big Gulp today, and less than 10 percent of the population was obese.

In the three decades that followed, the number of McDonald’s restaurants would rise to nearly 8,000 in 32 countries around the world,
sales of soda pop and junk food would explode — and yet, against the fears and predictions of public health experts, obesity in the United States hardly budged. The adult obesity rate was 13.4 percent in 1960. In 1980, it was 15 percent. If fast food was making us fatter, it wasn’t by very much.

Then, somewhat inexplicably, obesity took off.”

It is this “somewhat inexplicably” that has me awake at night gnashing my teeth.

And what is Government going to do about it?

I wonder how “inexplicable” it would be to Ms. Lee had she put these two things together:

(In case certain peoples have trouble with this concept, I’ll type this very slowly and loudly: I’m not implying that the Dietary Guidelines “caused” the rise in obesity; I am merely illustrating a temporal relationship of interest to me, and perhaps to a few billion other folks. I am also not implying that a particular change in diet “caused” the rise in obesity. My focus is on the widespread and encompassing effects that may have resulted from creating one official definition of “healthy food choices to prevent chronic disease” for the entire population.)

Right now we are hearing calls from every corner for the government to create or reform policies that will reign in industry and “slim down the nation.” Because we’d never tried that before, right?

When smoking was seen as a threat to the health of Americans, the government issued a definitive report outlining the science that found a connection between smoking and risk of chronic disease. Although there are still conspiracy theorists that believe that this has all been a Big Plot to foil the poor widdle tobacco companies, in general, the science was fairly straightforward. Cigarette smoking—amount and duration—is relatively easy to measure, and the associations between smoking and both disease and increased mortality were compelling and large enough that it was difficult to attribute them to methodological flaws.

Notice that Americans didn’t wait around for the tobacco industry to get slapped upside the head by the FDA’s David Kessler in the 1990s. Tobacco use plateaued in the 1950s as scientists began to publicize reports linking smoking and cancer. The decline in smoking in America began in earnest with the release of Smoking and Health: Report of the Advisory Committee to the Surgeon General in 1964. A public health campaign followed that shifted social norms away from considering smoking as an acceptable behavior, and smoking saw its biggest declines before litigation and sanctions against Big Tobacco  happened in the 1990s.

Been there, done that, failed miserably.

In a similar fashion, the 1977 Dietary Goals were the culmination of concerns about obesity that had begun decades before, joined by concerns about heart disease voiced by a vocal minority of scientists led by Ancel Keys. Declines in red meat, butter, whole milk and egg consumption had already begun in response to fears about cholesterol and saturated fat that originated with Keys and the American Heart Association—which used fear of fat and the heart attacks they supposedly caused as a fundraising tactic, especially among businessmen and health professionals, whom they portrayed as especially susceptible to this disease of “successful civilization and high living.”  The escalation of these fears—and declines in intake of animal foods portrayed as especially dangerous—picked up momentum when Senator George McGovern and his Select Senate Committee created the 1977 Dietary Goals for Americans. It was thought that, just as we had “tackled” smoking, we could create a document advising Americans on healthy food choices and compliance would follow. But issue was a lot less straightforward.

To begin with, when smoking was at its peak, only around 40% of the population smoked. On the other hand, we expect that approximately 100% of the population eats.

In addition, the anti-smoking campaigns of the 1960s and 1970s built on a long tradition of public health messages—originating with the Temperance movement—that associated smoking with dirty habits, loose living, and moral decay. It was going to be much harder to fully convince Americans that traditional foods typically associated with robust good health, foods that the US government thought were so nutritionally important that in the recent past they had been “saved” for the troops, were now suspect and to be avoided.

Where the American public had once been told to save “wheat, meat, and fats” for the soldiers, they now had to be convinced to separate the “wheat” from the “meat and fats” and believe that one was okay and the others were not.

To do this, public health leaders and policy makers turned to science, hoping to use it just as it had been used in anti-smoking arguments. Frankly, however, nutrition science just wasn’t up to the task. Linking nutrition to chronic disease was a field of study that would be in its infancy after it grew up a bit; in 1977, it was barely embryonic. There was little definitive data to support the notion that saturated fat from whole animal foods was actually a health risk; even experts who thought that the theory that saturated fat might be linked to heart disease had merit didn’t think there was enough evidence to call for dramatic changes in American’s eating habits.

The scientists who were intent on waving the “fear of fat” flag had to rely on observational studies of populations (considered then and now to be the weakest form of evidence), in order to attempt to prove that heart disease was related to intake of saturated fat (upon closer examination, these studies did not even do that).

Nutrition epidemiology is a soft science, so soft that it is not difficult to shape it into whatever conclusions the Consistent Public Health Message requires. In large-scale observational studies, dietary habits are difficult to measure and the results of Food Frequency Questionnaires are often more a product of wishful thinking than of reality. Furthermore, the size of associations in nutrition epidemiological studies is typically small—an order of magnitude smaller than those found for smoking and risk of chronic disease.

But nutrition epidemiology had proved its utility in convincing the public of the benefits of dietary change in the 70s and since then has become the primary tool—and the biggest funding stream (this is hardly coincidental)—for cementing in place the Consistent Public Health Message to reduce saturated fat and increase grains and cereals.

There is no doubt that the dramatic dietary change that the federal government was recommending was going to require some changes from the food industry, and they appear to have responded to the increased demands for low-fat,whole grain products with enthusiasm. Public health recommendations and the food fears they engendered are (as my friend James Woodward puts it) “a mechanism for encouraging consumers to make healthy eating decisions, with the ultimate goal of improving health outcomes.” Experts like Kelly Brownell and Marion Nestle decry the tactics used by the food industry of taking food components thought to be “bad” out of products while adding in components thought to be “good,” but it was federal dietary recommendations focusing above all else on avoiding saturated fat, cholesterol, and salt that led the way for such products to be marketed as “healthy” and to become acceptable to a confused, busy, and anxious public. The result was a decrease in demand for red meat, butter, whole milk and egg, and an increase in demand for low-saturated fat, low-cholesterol, and “whole” grain products. Minimally-processed animal-based products were replaced by cheaply-made, highly-processed plant-based products, which food manufacturers could market as healthy because, according to our USDA/HHS Dietary Guidelines, they were healthy.

The problem lies in the fact that—although these products contained less of the “unhealthy” stuff Americans were supposed to avoid—they also contained less of our most important nutrients, especially protein and fat-soluble vitamins. We were less likely to feel full and satisfied eating these products, and we were more likely to snack or binge—behaviors that were also fully endorsed by the food industry.

Between food industry marketing and the steady drumbeat of media messages explaining just how deadly red meat and eggs are (courtesy of population studies from Harvard, see above), Americans got the message. About 36% of the population believe that UFOs are real; only 25% believe that there’s no link between saturated fat and heart disease. We are more willing to believe that we’ve been visited by creatures from outer space than we are to believe that foods that humans have been eating ever since they became human have no harmful effects on health. But while industry has certainly taken advantage of our gullibility, they weren’t the ones who started those rumors, and they should not be shouldering all of the blame for the consequences.

Fixing it until it broke

Back in 1977, we were given a cure that didn’t work for diseases that we didn’t have. Then we spent billions in research dollars trying to get the glass slipper to fit the ugly stepsister’s foot. In the meantime, the food industry has done just what we would expect it to do, provide us with the foods that we think we should eat to be healthy and—when we feel deprived (because we are deprived)—with the foods we are hungry for.

We can blame industry, but as long as food manufacturers can take any mixture of vegetable oils and grain/cereals and tweak it with added fiber, vitamins, minerals, a little soy protein or maybe some chicken parts, some artificial sweeteners and salt substitutes, plus whatever other colors/preservatives/stabilizers/flavorizers they can get away with and still be able to get the right profile on the nutrition facts panel (which people do read), consumers–confused, busy, hungry–are going to be duped into believing what they are purchasing is “healthy” because–in fact–the government has deemed it so. And when these consumers are hungry later—which they are very likely to be—and they exercise their rights as consumers rather than their willpower, who should we blame then?

There is no way around it. Our dietary recommendations are at the heart of the problem they were created to try to reverse. Unlike the public health approach to smoking, we “fixed” obesity until it broke for real.