Dietary Drama–an Update (but not by me)

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

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

Read it and laugh, or weep:  here.

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

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

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

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

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

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

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

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

3) And, then–this:

You’re welcome.

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31 thoughts on “Dietary Drama–an Update (but not by me)

  1. Hello, Adele

    Thank you for your intelligence, your sanity, and your wonderful sense of humor! Love the videos:)

    Nutritional epidemiology studies, in my opinion, are not worth anyone’s time or energy, and I believe the media needs to simply stop publishing the “results” of such studies. The scientific method requires that the (biased) hypotheses generated by observational methods be tested to see whether they are true or not. I’m not aware of any clinical studies demonstrating that meat causes any human health problem. If you or anyone else knows of one, I’d love to see it.

    1. I’m just so glad you took on the whole BMJ/meat/cancer thing with such aplomb. I take it as a compliment of the highest order that Charles Grashow apparently can’t tell us apart.

    1. Charles, twice I’ve asked whether you recommend Americans eat a diet consisting of 50 – 60% carbohydrates. You’re unwilling to answer. I wonder why?

      Of course not everyone who eats a high carb diet is obese, but very many are. Indeed, aren’t there now more obese people than ‘normal’ weight people? They can’t all be dismissed as greedy and irresponsible. It may be possible for some people to eat a variety of diets without becoming fat or obese, but for most people the low-fat diet is a failure and miserable experience. Most people feel hungry all the time, which surely explains why this diet fails so consistently.

      As you know Europe has numerous examples of countries that eat a high-fat diet and have excellent records on heart disease, but on Tom Naughton’s site you lamely attempt to dismiss this as the ‘French paradox’. It’s also the Swiss, German, Swedish, Dutch, Belgian, Norwegian, Icelandic and Spanish paradox. There are plenty more examples. This paradox is a widespread and inconvenient reality for you. European countries with the lowest rates of fat consumption have the highest rates of heart disease, often dramatically so. How many confounding examples does it take to make someone reconsider? I think at some point you’ll be the last advocate of statins.

      1. “not everyone who eats a high carb diet is obese, but very many are”

        What is the composition of these high carb diets? The SAD or, for example, a WFPB diet?

        As to the Swiss paradox, for example try looking at this

        http://www.huffingtonpost.com/tara-stiles/why-arent-the-swiss-fat_b_156582.html

        I would say that this applies to most European countries – more physical activity and eating LESS total calories.

        As to statins, my doctor has suggested an N=1 experiment for me and I’ve agreed. Stop the statin, continue with my present diet,exercise and supplement regimen and re-test lipids in 6 months.

        It will be interesting to see what happens

  2. @tephen T

    “Charles, do you really recommend Americans eat a diet consisting of 50-60% carbs?

    How high does the rate of obesity have to go before you see the folly of that? Sure, some Americans eat badly, and would probably do so regardless of the recommendations, but many people are eating badly by trying to follow the low-fat guidelines. This particularly applies to diabetics.”

    SO – all of the people who lose weight by following a very low fat diet, Pritikin, McDougall, Esselstyn, etc. should be obese according to you?

    Why are they not obese?? Maybe calories count??

    How do you explain people put on a high carbohydrate macrobiotic diet have been taken off all meds within 21 days??

    1. It … almost … rhymes … sooooo close 🙂 If I’ve made gingerzini laugh, I can consider the time spent torturing the English language into my idea of humor well spent.

  3. Thanks Adele! In a new plot twist straight out of Desperate Housewives the New Zealand Ministry of Health decided to create a moral panic over coconut oil.

    Regarding the social confounders with regard to diet-health, this is very relevant to the meat-cancer link.
    Who eats most red meat? Farmers and blue collar men. Who eats most processed meat? The working poor. Exposure to carcinogens in dust form (workplace dust) is associated with colon cancer because dust brought out of lungs and nasal cavity is swallowed automatically.

    Where we can lay some “blame” on processed meat is in terms of old-fashioned nutrition science (the non-imaginary sort).
    Higher intake of vitamin B6 and high levels of the active form PLP is protective against colon cancer. OR about 0.5 for PLP from memory. Meat and other whole protein foods are good sources of B6, processed meat is a very lousy source. The metabolism of protein creates most of the demand for PLP and processed meat is a good source of protein.
    Ergo, processed meat replacing whole protein foods in a refined carb diet = relatively low B6 intake and PLP levels = increased cancer risk. Relevant roles of PLP besides amino acid and glutathione metabolism are nitrite metabolism and selenium incorporation into selenocysteine.

    1. Wait. What? Moral panic over coconut oil? But coconut oil is the answer to the new “fat is okay, just not fat from animals” paradigm, right?

      Your point about carcinogens being more difficult to avoid in some workplaces (factories) rather than others (office buildings)is exactly the sort of thing we can’t tease apart in observational studies, though has never stopped us from insisting that all poor people need to do in order to improve their health is make their eating habits look more like those of privileged white women (Figure 1 is especially interesting).

      The connection to B6 is an interesting one & makes me think that there’s this whole path of nutrition science, focused on essential nutrition, that has been neglected in favor of pursuit of (relatively speaking) cheap sexy observational studies between diet and chronic disease.

    1. First line of the linked article: “National dietary guidelines have become an easy target for those looking for a scapegoat for bad diets in prosperous countries.” Move along, friends. No rhetoric here, no sirree Bob. Thanks Charles, one for the files–although I almost typed “flies” which seemed pretty appropriate 🙂

      1. My main problem with the meat/processed meat is that they put this in the same category as cigarette smoking and asbestos. That is ludicrous. Even if the link between red meat/processed meat is clear (and since it’s all based on epidemiological evidence, it’s nowhere near clear), the effect is tiny. Compare the relative risk of smoking and lung cancer, which is in the thousands of percent (I’ve seen 2,500% as an estimate), with the relative of risk of meat and cancer, which is around 20%. And actual risk is much, much smaller for meat. There is no way that meat = cigarettes.

        It just depresses me that there is no institution I can trust. I used to believe in the “experts” and diligently followed the low fat paradigm and everything else for that matter. Even when I went on a low carb diet and suddenly felt better than I had in a long time, I couldn’t believe it was true: the “experts” said it couldn’t be true, I had to have 130 grams of carbohydrates a day or my brain would cease functioning or I couldn’t exercise. It took me YEARS to realize my body proved them wrong. And because of this, I no longer believe any institution. I don’t believe in MyPlate (it’s completely wrong in my opinion and unsupported by scientific evidence), but I also no longer believe anything said by the CDC, AHA. WHO, you name it. None of them can be trusted. That’s not the way it should be. I should be able to trust some institution. I’ve yet to find that institution, though.

        One of the people in the congressional hearings said something like “my constituents simply don’t believe in this stuff anymore”. They’re right. Many of us do not. And because of that, we also don’t believe in things being said by many or all government bodies. That’s not a good thing.

        1. BobM, you’ve hit the nail on the head. Christopher Mayes, who works in public health ethics, has an excellent post on this.

          The folks who created the 1977 Dietary Goals said, we might not have all the evidence, but there are no possible negative consequences to making these low-fat recommendations. Which is just ridiculous. Whether or not negative consequences actually arise, there are always possible negative outcomes. And whether or not you want to blame Americans for not following the recommendations–or blame the recommendations for being a bad thing to follow–doesn’t matter. We still have to deal with the negative consequences, one of which is loss of faith in public health (Al Harper predicted this back in 1978). Refusal to acknowledge this, plus the deliberate connection of funding of future science to the policy (hence the explosive growth of nutrition epidemiology) and the failure to put into place any sort of health-related evaluation system, has created a scienceless policy zombie that (imho) nothing short of a change in legislation can stop.

          Do I get bonus points for a zombie reference on Halloween?

          1. How can you or anyone else say that the 1977 dietary goals were low fat??

            http://zerodisease.com/archive/Dietary_Goals_For_The_United_States.pdf

            US Dietary Goals

            1) Increase carbohydrate consumption to account for 55 to 60 percent of the energy (caloric) intake

            2) Reduce overall fat consumption from approximately 40 to 30 percent energy intake.

            3) Reduce saturated fat consumption to account for about 10 percent of total energy intake; and balance that with poly-unsaturated and mono-unsaturated fats, which should account for about 10 percent of total energy intake.

            4) Reduce cholesterol consumption to about 300 mg a day.
            .
            5) Reduce sugar consumption by about 40 percent to account for about 15 percent of total energy intake.

            6) Reduce salt consumption by about 50 to 85 percent to approximately 3 grams a day.

            The goals also suggest
            eating more fruits, vegetables and whole grains

            decreasing consumption of meat and increasing consumption of poultry and fish

            decrease consumption of butterfat, eggs and other high cholesterol foods
            substitute non-fat milk for whole milk

            decrease consumption of sugar and foods high in sugar content

            decrease consumption of salt and foods high in salt content

            SO – please explain to me why a diet of 30 percent fat is low fat??
            With the exception of non-fat milk what is so radical about these recommendations??

            Maybe the reason Americans have health problems is they VOLUNTARILY eat CRAP and too much of it.

            1. Seriously? They’re lowering fat. They’re lowering saturated fat. From where it was in the 60s. Huge changes were produced in the population as seen across Nurses and Health Professionals studies. You can’t call it moderate fat, as fat is much less than carbohydrate (moderate fat would have fat and carbohydrate equal, as was the case before the guidelines).
              Sure you can go lower, and no doubt many did – if we take it that many sensibly ignored this advice, then many others took it much further, because Americans nearly reached these goals overall.
              Americans ate more crap because, by pulling out the fats naturally in their protein foods, these recommendations exposed them to hunger and an increase in the production of crap.

            2. Charles, do you really recommend Americans eat a diet consisting of 50-60% carbs?

              How high does the rate of obesity have to go before you see the folly of that? Sure, some Americans eat badly, and would probably do so regardless of the recommendations, but many people are eating badly by trying to follow the low-fat guidelines. This particularly applies to diabetics.

            3. I have seen this situation frequently myself. It might be nice for people like Charles to sit in front of a keyboard and type of vitriol like this, but I’d be interested in witnessing him saying this to a woman who has been struggling to avoid the diabetes that she has seen consume the lives of her sister and brother by counting every calorie, planning every bite, and keeping, by golly, the fat content of her diet as low as possible–and still gaining weight and gaining weight. She feels powerless to stop the trend, but she hasn’t given up. She’s hungry and exhausted, but determined to avoid the situation her loved ones are already in. I suppose Charles, with his extensive real-world experience in dietary management with actual human beings from various walks of life, would have the right answer for her after he was done accusing her of “VOLUNTARILY eating CRAP and too much of it.” Gotta love the interwebz.

            4. @Adele Hite

              “Maybe the reason Americans have health problems is they VOLUNTARILY eat CRAP and too much of it” that I treasure.”

              ” I have seen this situation frequently myself. It might be nice for people like Charles to sit in front of a keyboard and type of vitriol like this, but I’d be interested in witnessing him saying this to a woman who has been struggling to avoid the diabetes that she has seen consume the lives of her sister and brother by counting every calorie, planning every bite, and keeping, by golly, the fat content of her diet as low as possible–and still gaining weight and gaining weight. She feels powerless to stop the trend, but she hasn’t given up. She’s hungry and exhausted, but determined to avoid the situation her loved ones are already in. I suppose Charles, with his extensive real-world experience in dietary management with actual human beings from various walks of life, would have the right answer for her after he was done accusing her of “VOLUNTARILY eating CRAP and too much of it.” Gotta love the interwebz.:

              1) I can show you multiple studies where insulin dependent T2D have been taken off all meds within 21 days on a very low fat high carbohydrate macrobiotic diet.

              2) I would have to know more of this woman “who has been struggling to avoid the diabetes that she has seen consume the lives of her sister and brother by counting every calorie, planning every bite, and keeping, by golly, the fat content of her diet as low as possible–and still gaining weight and gaining weight.” More about her diet, activity level, etc. Is she’s eating unhealthy low fat CRAP then she bears some responsibility.

              3) As to the statement that you treasure so much can you deny that Americans average caloric consumption has INCREASED by 300-500 calories per day in the last 20 years or so. Can you deny that Americans are eating more fats food than ever and that the portion sizes have dramatically INCREASED.

              4) The 2 factors that drive T2D are being overweight and inactivity – that’s personal responsibility.

            5. 1) Studies, even ones that have people in them, are not people. What works on average–and that’s how studies show results, by averaging outcomes–doesn’t necessarily work for any given individual. Even carbohydrate reduction, which can be really helpful for people with type 2 diabetes, does not “work” in every case.
              2) And that’s what we really want. For whomever is sick to bear some responsibility. Because that’s what we’re all about here. BLAME. We love BLAME. (Those are the Charles Grashow honorary ALL CAPS.)
              3) Which does not help answer the question as to “why” calorie consumption and/or portion sizes increased. Maybe people were hungrier. Maybe there are some complex interactions between eating behavior and being told what foods are “good” and what foods are “bad” that we don’t fully understand. MAYBE WE ARE ALL DUPES OF THE FOOD SYSTEM AND BY GOD IF WE JUST LISTENED TO THE WISDOM OF SELF-APPOINTED INTERNET EXPERTS OF EVERYTHING LIKE CHARLES, WE WOULDN’T HAVE THESE PROBLEMS. (More Charles Grashow honorary ALL CAPS. Or did I over do it that time?)
              4) Which does not explain why we can/do reverse the high blood glucose that is the hallmark of diabetes (without which, you can’t even get a diagnosis of diabetes, darn it) with carbohydrate reduction. Not always, but often. Frequently, these folks don’t increase activity levels (for various reasons) and they often remain overweight and even obese (for various reasons). So if these folks take PERSONAL RESPONSIBILITY for their diabetes by reducing their carbohydrate intake but remain (relatively) inactive and/or overweight or obese, what’s that? Oh, wait. That’s right. WE JUST PLAIN DON’T LIKE PEOPLE WHO ARE FAT AND LAZY. (CGHAC). No judgement, though.

              Charles, it’s Halloween. Don’t you need to go shout at the neighbor kids to get off your lawn, or something?

            6. @Adele

              Just curious as to why you’ve removed ALL references to your ketogenic diet experiment from your blog?

              http://diabeticmediterraneandiet.com/2013/08/02/dr-georgia-edes-raves-about-her-ketogenic-diet-experience/
              Dr. Georgia Edes Raves About Her Ketogenic Diet Experience

              My diet consists almost entirely of roasted chicken (with skin), duck (with skin), duck fat, turkey, fish, chicken liver, zucchini, spinach, plantain chips, berries, lettuce, small amounts of black coffee, and salt. I’ve been avoiding chocolate entirely. Every once in a while I eat beef, pork, or a very small amount of cheese, or when at a restaurant might order something that includes a cream, wine, or butter-based sauce, but these don’t usually agree with me, so I keep them to a minimum, and most days I completely avoid them. I steer clear of preserved, smoked, cured, aged, fermented, canned, and processed foods whenever possible.

              When you click the link you get this

              http://www.diagnosisdiet.com/ketosis-month-4/
              Page not found
              It seems we can’t find what you’re looking for. Perhaps searching, or one of the links below, can help.

              rewriting history are we now??

            7. Oh dear, it seems Charles that you’ve discovered not only my diabolical attempt to re-write history, but to be everyone on the internet all at the same time.

              It is true that I have driven through the state of Georgia (you got me there) and my so-called name “Adele” does have two “e’s” and a “d” in it (a coincidence? I think not!). That does practically mean that in real-life I am someone who goes by the so-called name of “Georgia Edes,” right?

              Or do all of us old white ladies just look the same to you?

            8. Dietary guidance that deals with macronutrient content distribution is, in my experience, almost always discussed in relative terms. So, a “low-carb” diet may not be, in some folks thinking, actually “low,” but may be, in fact, relatively low compared to a standard. In this case, as you illustrate, 40% fat was the “standard,” making 30% “low” relative to that. And just a little FYI, the Dietary Guidelines themselves refer, beginning in 1990, to a diet “low in fat.” In 2000, the wording was changed to a diet “moderate” in fat, without any change in the 30% limit of overall fat. The folks in charge of the science/policy frequently use the term “low fat.” Here’s a few:

              “The country’s big low-fat message backfired,” says Dr. Frank Hu, professor of nutrition and epidemiology at the Harvard School of Public Health. “The overemphasis on reducing fat caused the consumption of carbohydrates and sugar in our diets to soar. That shift may be linked to the biggest health problems in America today.”

              “In the early 1990s, we ate low-fat everything and we didn’t get thinner, says Alice Lichtenstein, a professor of nutrition science and policy at Tufts University in Massachusetts. “There’s your proof.”
              Alice Lichtenstein, vice-chair of the American Heart Association Nutrition Committee, in “Fat is Where It’s At.” Ode, June/July 2009, Volume 7, Issue 9.

              “National guidelines/recommendations for low-fat diets may be particularly inappropriate for weight loss for women with insulin resistance.”
              Christopher Gardner, PhD, Director of Nutrition Studies at the Stanford Prevention Research Center and an Associate Professor of Medicine at Stanford University. Presentation at North American Association for the Study of Obesity Conference, 2008.

              But it is statements like this “Maybe the reason Americans have health problems is they VOLUNTARILY eat CRAP and too much of it” that I treasure. And I love the fact that someone will voluntarily find my blob and post them here for me to keep forever & ever. This kind of statement illustrates all of the reasons I got involved in this in the first place. Thanks for this Charles. It illustrates nearly everything that went wrong with public health efforts to link nutrition and chronic disease, no matter what you call the diet.

            9. “4) The 2 factors that drive T2D are being overweight and inactivity – that’s personal responsibility.”

              Utter bollocks – and that’s the polite version.

              I’ve read estimates that 5 – 20% of “Type 2 diabetics” are non-overweight. The actual number will never be known so long as doctors believe diabetes is *caused* by being overweight and will never suspect or diagnose it in normal weight people. Anecdotally from diabetes newsgroups, forums and blogs, we are legion, I’d tend towards the 20% end of the spectrum.

              Inactive? One of my favourite activities has always been walking. Of course to do so in the past, when I was eating a high carb low fat diet and would crash both physically and mentally after 2 – 3 hours, I would need to carry food and drink and carb up every couple of hours. Same when doing Extreme Gardening. Or housework. Or anything much.

              By eating LCHF, dictated by my glucometer, controlling BG, insulin levels and insulin resistance, I routinely go 6 – 8 hours and often 10 hours or more without any desire to eat, let alone the necessity of going face down in the carbs.

              By contrast, the only thing that caused me to gain weight was a dietician with her infernal need to remove even more fat from my diet and replace it with even more heartheathywholegrains. This also left me semipermanently exhausted and constantly hungry.

              I am of course “just an anecdote” but you would be surprised just how many of us anecdotes there are. Only in the last decade or so have we started to appear in studies on PubMed.

              Further anecdote – I passed my first gallstone in my twenties while eating an Ornish-style high carb low fat grain-based vegan diet. This became a regular occurrence while eating HCLF and was obviously blamed on “too much fat”, yet anecdotally I have met a few others who developed gallstones on the same “healthy” diet, and it was only when I read a post by Andreas Eenfeldt and the following responses that I realised just how commonplace this was – and the mechanism by which it occurs. NOT going back there again.

          2. Adele, I don’t know if you’ve read the Credit Suisse report about fat (entitled “Fat: The New Health Paradigm”), but I believe they’re totally correct. Everything they say is true (in my opinion) and supported by the latest evidence. They make the following comment:

            “One of the biggest myths in nutrition is that saturated fat intake above a certain level—say 10% based on most dietary guidelines—significantly increases your risk of heart attack. This conclusion that has held for almost half a century is inconsistent with the wealth of epidemiological data or scientific evidence in the form of clinical randomized trials. Plenty of research funding has been earmarked to study and back this hypothesis, yet we cannot find a single research paper written in the last ten years that supports this conclusion. On the contrary, we can find at least 20 studies that dismiss this hypothesis.”

            So, these bankers, beholden to no one but their investors, get the latest diet research TOTALLY RIGHT. Yet our own DGAC either ignore these studies or don’t care, since they have to keep going on the current path. And these bankers make the salient point that we’ve been searching for years for evidence that saturated fat is bad for us, and we can’t find it. If that’s the case, haven’t we proven that maybe saturated fat ISN’T bad for us? And yet no one changes course, even in the face of evidence that “lowly” bankers can see is overwhelmingly against the current status quo.

            It doesn’t make sense. So, it’s no wonder that people are tuning out the current recommendations.

            Thank you for the links to additional reading materials, and good job on the zombie reference! 😉

            1. Yes, I’ve read the Credit Suisse report & it only serves to confirm my oft-repeated mantra: it’s not about the science. Sigh.

  4. Great post, Adele, thanks for chiming in on this news this week. You make a great point, and thanks for alerting me and other readers to Neal’s response; I hadn’t seen this yet anywhere else. Cheers.

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