A Heaping Dish of Humility and a Side of Caution

This was not on the menu at the “Is Nutrition Research Keeping Pace with Policy and Consumers” panel at the Consumer Federation of America’s National Food Policy Conference.

I’m not sure what I expected, but I was encouraged by the fact that during other presentations at the conference, I had heard murmurs that perhaps we don’t really know what we mean what we say “healthy food” and that the public has some real concerns about what they are being told about nutrition.  So I was manifestly disappointed to hear just another rallying cry for the status quo from the academics and policymakers on this panel.

A panelist from the National Cancer Institute asserted–despite those rumors heard elsewhere in the conference–that we “do have consensus” about what constitutes a healthy diet: “lean meat, whole grains, more fresh fruits and vegetables, and reduced saturated fat, sugar, trans-fats, and sodium.”  Linda Van Horn, who chaired the 2010 Dietary Guidelines Advisory Committee, told the audience that:  “We know what the problem is in obesity.  It’s the calories.  The calories.”  She went on to let us all know that if we just had policies that would help Americans follow the recommendations that are already in place, we could reverse the obesity crisis.  Sigh.  Make the healthy choice the easy choice for poor stupid fat Americans?  Again?  Already?

And–yes–in case you are wondering, I was quivering with rage by the time the panel finished talking (yogic breathing sadly not helping).  When my turn to ask a question arrived, I reminded the panel of the changes that we’ve already made in our diets–reduced red meat and egg consumption, increased whole grains and fresh fruits and vegetables, switched whole milk for low fat milk–and yet obesity and chronic disease continue to rise.  My question to them was, “When are nutrition experts and policymakers going to quit blaming the consumer for not following the food rules and start thinking about whether or not the advice we’ve been given is truly effective?”

After the panel, the gentleman next to me said “Good question.”  Yeah, I thought so too, but I got a truly lousy response from Dr. Van Horn:  “We may have reduced red meat, but we’ve increased sugar.”  Have we? Why might that have happened–if indeed it has?*  “No one is blaming the consumer; the fault lies with the food industry.”  This, at a conference devoted to showing consumers how their choices have driven the actions of industry. To blame industry is to blame the consumer; it’s just a sneaky and, frankly, dishonest way of doing it.

Ironically, the next day BMJ published an editorial with a completely different perspective. In it, Gary Taubes  (science writer and champion for the return of common-sense and intellectual rigor in the world of nutrition science)** suggests that instead of yet another round of “making the healthy choice the easy choice” for poor stupid fat Americans who haven’t the good sense to lose weight and stay healthy the way they’ve been told to for the past 35 years, perhaps nutrition experts might try a different tact:

“We believe that ultimately three conditions are necessary to make progress in the struggle against obesity and its related chronic diseases—type 2 diabetes, most notably. First is the acceptance of the existence of an alternative hypothesis of obesity, or even multiple alternative hypotheses, with the understanding that these, too, adhere to the laws of physics and must be tested rigorously.

Second is a refusal to accept substandard science as sufficient to establish reliable knowledge, let alone for public health guidelines. When the results of studies are published, the authors must be brutally honest about the possible shortcomings and all reasonable alternative explanations for what they observed.

Finally, if the best we’ve done so far isn’t good enough—if uncontrolled experiments and observational studies are unreliable, which should be undeniable—then we have to find the willingness and the resources to do better. “

While I find plenty to disagree with here (high glycemic grains?  really?), Taubes outlines some fascinating aspects of the history of obesity research and sheds some light on why the calories in-calories out hypothesis won out over the endocrinological (say it 5 times fast) one—and what nutritional mayhem has ensued since.  (Read the whole thing.  You’ll be glad you did.  I’ll wait here.)

His editorial reminds us that when it comes to the question of what dietary pattern will prevent obesity and chronic disease, we really don’t know much.  And it makes clear that what is needed now is a view toward a future where we will approach this question with much more humility and caution than we have in the past.

I’m going to suggest now–and you dear readers help me remember–that this time next year, we need to take Consumer Federation’s Food Policy Conference by storm.  It isn’t expensive (I think registration is $90, cheaper still if you are a student).  We are, after all, consumers.   The meeting is full of industry reps, policymakers, journalists, as well as academics.  It’s a small enough venue that I believe we can make our voices heard.  We can let them know that the current definition of “healthy food” doesn’t work for all of us & we, as consumers, want different choices and different information.

I get the impression that the current crop of nutrition experts and academics isn’t interested in trying this new dish–humility with a side of caution.  Since these folks seem to want to persist in keeping the public’s health on a trajectory where they can be the solution to the problems they have caused, perhaps we can find some ways to  “make the reasonable choice the easy choice” for them.

I’ll rent the hotel room & anybody who wants to can bring a sleeping bag–paleo sleepers can spread their bearskins on the floor.  Let’s do it.

*The truth is we don’t really know how sugar intake has changed.  Dietary data and food availability data offering conflicting views.  A mean of 15.8% of consumed calories was from added sugars in this study; data from 2010.  This study estimated that 26% of calories were from added sugar; data from 1977-1978.

**Full disclosure:  I know, and usually actually like, Gary Taubes.  But he does not pay me to say nice things about him & I disagree with him as much as I agree.

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28 thoughts on “A Heaping Dish of Humility and a Side of Caution

  1. I think today is the day we should start the petition, letter-writing campaign and general movement to stop the USDA guidelines. They were probably ill-advised since there was an inherent contradiction in having doctors and other people involved in therapy specifically giving advice to that part of the population that was not sick. The experts share a similar point of view in an area that has great dissension. They are all of the same cut, from the AOE fraternity (architects of the obesity epidemic). In any case, beyond the inherent contradiction in providing therapeutic advise for people who are normal, and the limitations of the credentials, they have accomplished little beyond re-defining adult-onset diabetes as type 2, and have the chutzpah to blame the population for getting sick following their advice. As first author of the deconstruction of the guidelines, you are a likely leader of SUSDAG (Stop the USDA guidelines). I will provide the logo. Any takers?

  2. It really makes the case for adopting Football rules. End of season, bottom of league? thank you for your contribution, goodbye. New management, new coaches and first pick in the draft of promising new scientists. The problem we have is “Track Record” doesn’t count; profound and protracted failure is clear but those responsible are not ejected. The current state is perhaps better explained by parasitology than nutrition.

    1. Dave, brilliant as always. I hear a lot about how industry has stymied progress in the obesity crisis, but I feel fairly certain that as much (or more) ossification comes from the scientific-academic-political complex.

  3. Oh no…sorry for the typos in my post. (That’s what I get for going too fast and not proofreading.) I committed my most hated cardinal sin: “their” instead of “they’re.” Ugh…just looking at it makes me cringe.

    1. I had a professor circle one of those in an essay I wrote. I was cringing with embarrassment when I read the comment he left in the margin: “I do this all the time.” Your in good company 😉

  4. Here’s the thing. Consensus leads to stupidity. They seem to really behave as if agreement makes something true.
    Perhaps you can clarify the milk/aspartame situation in a future post. I am unsure if the aspartame won’t be shown on the label AT ALL or if it is just the case that something so adulterated can no longer be called “milk” and has to be labeled as merely a beverage.

    1. As to your first point, my husband always likes to say, in regard to some “consensus” opinion about diet and disease: “Tell that to my pancreas.” Human biology doesn’t give a rat’s aspartame about consensus.

      As for the aspartame/milk issue, while the milk industry fights to not have to label milk as having aspartame in it, the whole battle serves to inform the public that their milk has aspartame in it. Concerned consumers will flood the internet with information about the evils of the milk industry and what other kinds of milk to buy instead. (Before this began, consumers were already moving towards “alternative” milk options: whole milk, raw milk, soy/rice/almond milk.) Milk producers/retailers who are savvy to this will point to the products that are aspartame-free (look for follow-up legislation to prevent them from doing this). As milk buying habits shift–and have no doubt that the slightest tremor of such shifts are felt throughout the industry–you can be sure that, very soon, the only people left with no choice but to drink aspartame-laced skim milk will be WIC families, old folks, school kids, and people in prison. Eventually, you’ll see “voluntary removal” of aspartame from milk until it disappears from the milk supply (perhaps to be replaced by all-natural agave nectar, decimating the tequila industry and resulting in suicidal tendencies on my part) and even the consumers at the mercy of national nutrition programs will be spared.

      1. thanks! Hey, another reason that getting old sucks. I know what is included in the meals on wheels-type food programs, and it ain’t pretty. Maybe I should start a butter-on-wheels program to deliver the missing butter to all those folks.

    1. Yeah, BINGO. This is nowhere more apparent than it is in nutrition. We heard a brief discussion of the discovery of vitamins in my program, but past that, you’d think that all considerations of diet-disease relationships sprang fully-formed from the forehead of Walter Willett.

      1. HA! Oh, man. Adele, if you ever decide to abandon the nutrition field (and with things going the way they are, I wouldn’t blame you), I think you have a future in comedy writing! (Your line about suicide by agave anger supports this too.)

        I’m a huge Taubes fan, and he’s spot-on here. Even if people entrenched in the established paradigm disagree about the causation of obesity (and all the correlated conditions), isn’t it only fair to the public that we at least entertain the notion of *re-asking the questions*? What are they so d@mn afraid of?

        This is so personal for me. I’m one of the people who spent (or should I say “misspent”) years doing “ALL THE RIGHT THINGS,” and had nothing–*nothing* to show for it. (Except piss-poor self esteem and a touch of self-loathing. Instead of questioning the paradigm I was following, I blamed *myself.* *I* must not be working hard enough…*I* must not be disciplined enough. If one hour a day on the treadmill isn’t enough, maybe I need to do two. Of course it was always my fault, rather than incorrect information. This is why I love Taubes — he refutes the notion that obesity is a moral problem, that it’s a character flaw. It’s so easy to “blame the victim.” If the secret is to just eat less and move more, then obviously–*obviously*–people are overweight because their gluttonous and lazy. Wow. It’s be nice if it were that simple, huh? I like that Taubes has always suggested an alternative POV for people like me — people who were never afraid of a tough workout. People who dutifully put I Can’t Believe It’s Not Butter Light on their whole grain English muffin, and who ate salads with boneless, skinless chicken breast (fat-free dressing on the side, of course). People who did all this and were STILL HEAVY…heavier than their friends who lived on steady diets of fast food and were allergic to exercise.

        Sorry for the rant. It’s just, I know I’m not alone with this, and the fact that so many authorities continue to pedal this failed approach amounts to nothing less than an utter disregard for the truth, and a wholesale rejection of the scientific method in favor of personal judgments about people’s character. Now that I’m starting my nutrition practice, I’ve always told myself that if I can spare just one young woman the self-esteem nightmare I put myself through years ago, I’ll consider myself a professional success.

        If establishment researchers, doctors, dieticians, and other clinicians weren’t so busy looking down their noses at overweight people, they might take a look around and see a whole other world around them.

        (From Amy, who now eats more fat than she ever did in the past and is maintaining the lowest weight and best fitness of her life. Keep the pasta; please pass the steak! In fact, it’s too bad that where I work, the coffee shop only has half and half. I have to keep heavy cream in the break room fridge for myself.)

        1. “This is so personal for me. I’m one of the people who spent (or should I say “misspent”) years doing “ALL THE RIGHT THINGS,” and had nothing–*nothing* to show for it. (Except piss-poor self esteem and a touch of self-loathing. Instead of questioning the paradigm I was following, I blamed *myself.* *I* must not be working hard enough…*I* must not be disciplined enough. If one hour a day on the treadmill isn’t enough, maybe I need to do two. Of course it was always my fault, rather than incorrect information. This is why I love Taubes — he refutes the notion that obesity is a moral problem, that it’s a character flaw. It’s so easy to “blame the victim.” If the secret is to just eat less and move more, then obviously–*obviously*–people are overweight because their gluttonous and lazy. Wow. It’s be nice if it were that simple, huh? I like that Taubes has always suggested an alternative POV for people like me — people who were never afraid of a tough workout. People who dutifully put I Can’t Believe It’s Not Butter Light on their whole grain English muffin, and who ate salads with boneless, skinless chicken breast (fat-free dressing on the side, of course). People who did all this and were STILL HEAVY…heavier than their friends who lived on steady diets of fast food and were allergic to exercise.”

          And this is why I was about to levitate with fury during that panel discussion. In clinic, I talked to person after person with this same story. I went through it myself (rescued by a nearby med school library and the help of Protein Power), but actually never thought to blame “the system” until my days in clinic, when I realized it was not just me and something weird about my own experience. Then, when I really started to dig into the literature and history–and GCBC came out–that’s when I started to realize that we are talking about a civil rights issue. We have the right to complete information–not just information that provides “a consistent public health message.” We have the right to be asked–not told–what foods help us feel healthy and nourished. We have the right not to be treated like idiots or liars or mindless consumers.

          I don’t know what they are afraid of, but I can only assume it is us. That when we decide we are the experts (and we are), that they won’t be any more. That if we stop listening to their solutions to a problem we didn’t have until they created it, that they’ll have to look for another line of work. It is–as it has always been–about power, control, turf, funding.

          And this is why I caution Gary Taubes (and paleo leaders and anyone else who thinks they know better than we do what we should eat) to not build another “one size fits all” top-down edifice. Help us learn, do the science & help us understand it, but I’ve had my fill of food rules & personal blame–from all quarters. Let’s make sure everyone has the essentials (the real ones, not the make-believe “chronic disease prevention” ones), let’s clean up the food system and the food policy system so there is more transparency and less food information pollution–then let’s walk away from it & leave people & their food choices alone & focus on some things that may matter much more to the public’s health: environment, stress, alcohol (agave nectar notwithstanding), etc.

          Whew! I guess one good rant deserves another.

  5. So frustrating! They are so determined that one size fits all! If there is anything I’ve learned over the past few years of intense reading and lay learning and dieting, it’s that everyone is different. Something in general may work well for most people, like low carb. But how low is low? And which source is best. Which source is worst? Nothing is ever 100% for everyone. If it was, there would be no thin people eating bread and potatoes and no fat people eating all paleo.

    They may be able to cover symptoms of a lot of things and offer suggestions, but in the end everyone has to find the details that work best for them. Once in a while I think I’ve found my answer, but alas, not yet. 🙂

    1. Very well said. I guess I don’t understand why it is so difficult for the folks making the “food rules” to get this. Sometimes I think the worst fallout of the whole Dietary Guidelines scenario is this food absolutism, which can be found in all food ideology camps.

  6. The low-fat recommendations are inconsistent with the MESA papers on circulating trans-palmitoleic acid (a good dairy fat – and hence dietary saturated fat – marker) and diabetes risk. These are multi-ethnic prospective studies that don’t rely on food frequency questionnaires, and that use a real disease diagnosis as an end point. It is hard to see anything here other than a whopping protective effect of dairy fat against DM2.

    2013:
    “In prospective analyses, trans-palmitoleate was independently associated with lower incident diabetes (P-trend = 0.02), including a 48% lower risk in quintile 5 compared with quintile 1 (HR: 0.52; 95% CI: 0.32, 0.85). All findings were similar between men and women and between different race-ethnic subgroups.”
    http://www.ncbi.nlm.nih.gov/pubmed/23407305

    2010:
    “Trans-palmitoleate was associated with substantially lower incidence of diabetes, with multivariable-hazard-ratios=0.41 (95%CI=0.27–0.64) and 0.38 (95%CI=0.24–0.62) in quintile-4 and quintile-5, versus quintile-1.”
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056495/

    and see also: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2980960/

    1. Thanks for sharing these. I haven’t taken a close look at this science yet.

      For me the whole low-fat/skim milk issues is more practical: My son, who is 14 and something like 5’10”–and who just might break 100 lbs soaking wet with rocks in his pockets–only likes whole milk. At school, his choices are low-fat milk, with or without added sugar & flavor. Now rabid parents–there was one at the conference–are up in arms shrieking about how the kids are being given milk with added sugar & flavor! (She was also convinced that cupcakes served at class birthday parties are evil incarnate and have resulted in the downfall of Western civilization as we know it.)

      It made no sense to say that this food–whole milk–that some of us have been happily consuming for generations (others haven’t & I don’t see why they should start now, unless they want to) was, as of 1977, BAD. We simply did not have the science to say this & it is sort of ridiculous that we now have to have new & improved studies to reverse thinking on an issue that should have never been an issue in the first place.

      I think I’m babbling now . . .

  7. You can investigate food advertising and trade journals like Food Navigator and other sources. I think you will find that a major factor is what Linda Van Horn recommends (Van Horn in the generic sense). The supermarkets are full of low fat because Van Horn said it was good. They now try to sell things as whole grain/fiber. But you can’t blame her. She is not accountable. There is no opposition. In the end there has to be new oversight but I am beginning to agree with Mark Twain, that there is no organization so despicable that they don’t have some saving grace with the possible exception of the United States Congress.

  8. You write “To blame industry is to blame the consumer; it’s just a sneaky and, frankly, dishonest way of doing it.”

    While I believe I understand why you say this, I’m not sure that this statement is entirely accurate. Industry may largely be reflecting consumer demands, but I also believe that some industry practices are not consumer-driven and may have their own implications for public health (for example, unlabeled aspartame in milk).

    Yet another complicated factor to tease out? Or am I misunderstanding your point?

    1. You are very right that there are industry practices that benefit industry first & the consumer second, or not at all. And we used to live in a time when industry could actually get away with those things. Those days are largely over (topic of another panel discussion at this same conference–I’ll write about that one too).

      Wait and see how long unlabeled aspartame hangs around. You will soon see, in some form or another, consumers being reassured that their milk does not contain aspartame, because consumers don’t want aspartame in their milk and they will find ways to purchase milk that has that assurance. The list of things that industry has voluntarily removed from its products (or voluntarily added) based on consumer preference gets longer all the time.

      We run into problems when those consumer preferences are driven by misinformation, especially from the nutrition community. Which is exactly what Richard is getting at. The group that pays the most attention to the Dietary Guidelines are industry. Their push to increase whole grains and decrease salt began as soon as Linda Van Horn (the actual one) hinted that the 2010 Guidelines would focus on that. They did, consumers looked for ways to increase whole grains & decrease sodium and industry was ready (at least until everyone figured out they didn’t really like low-sodium foods).

      1. I think if you look at different sources, you’ll see different data. Intake data (see references above, or Richard’s reference) typically shows that sugar consumption is going down. Food supply data typically shows that added sugars have gone up (by about 4.7 percentage points). The trouble with food supply data is knowing how much actually goes into people & we are not all that great at figuring that out.

        What is more interesting is that Van Horn sidestepped the question, blamed the consumer (who is eating all of this sugar, right?), no–wait–blamed industry (who has very sneakily put all this sugar in our otherwise perfectly healthy processed foods?), and once again, let 35 years of dietary recommendations that don’t work–for WHATEVER REASON–off the hook.

  9. As always, great article…I’m just going to speculate (and I was born in 1981), but I can’t fathom sugar intake hasn’t increased greatly. Though, from what I’ve read it seems to have been stable since the 70s, with the greatest rise in carbohydrates… Candy, soda, juice drinks, flavored yogurts, etc have to be more widely consumed these days than they were 40 yrs ago… again, just my thoughts.

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