Well. This is awkward.
A big scoop blows the cover on how, back in the 1960s, some gullible Harvard researchers were funded by the Evil Sugar Industry to make sure that fat (and not sugar) took the fall as the cause of all of America’s problems, including the cancellation of Lost in Space.
One of those aforementioned oh-so-easily-corrupted scientists was none other than Mark Hegsted, the mastermind behind the McGovern’s Dietary Goals (okay, the mastermind behind the Machiavegiann, Nick Mottern, who actually wrote the 1977 Dietary Goals¹), and, as we all know by now, this set the whole nation down the path to mainlining sugar whilst shunning perfectly good food like pork ribs.
So the scene is this: Mark Hegsted (and his co-authors, McGandy and Stare) are sitting around their labs at Harvard, minding their own beeswax, fillin’ up test tubes, and lookin’ through microscopes. Y’know, doin’ science. Along comes Evil Sugar, waving big fat stacks of green under their noses. Suddenly, Hegsted and company are payola zombies, mindlessly extolling the virtues of sucrose.
Sigh.
One of the reasons I love my life is I get to teach a class called “Introduction to Science, Technology, and Society” to a bunch of bright-eyed, smart, and exceptionally polite undergraduates at North Carolina State University. Last week we did an activity to help them get a feel for the ways in which science is a social process. One of the things we talked about were “interests,” including funding, but we also discussed the fact that “follow the money” is almost always an inadequate explanation for how and what knowledge gets created in science. My students figured out pretty quickly that scientists have multiple interests, biases, concerns, and limitations–and that these all compete for a place in the process of transforming bits of reality into the “facts” that are the outcomes of scientific knowledge production.
“Evil Sugar Corrupts Scientists” is an attention-grabbing headline, but the historical picture is a bit muddier.
Inconvenient historical moment part 1: Let’s start with the fact that in 1965, Hegsted, McGandy, and Stare (and a nutrition instructor named Myers) published a paper entitled, “Quantitative Effects of Dietary Fat on Serum Cholesterol in Man.”² In this article, the researchers–who used fats and oils supplied by Proctor & Gamble and milk and ice cream supplied by the Hood Milk Company–developed something that would come to be known as the Hegsted equation, which predicts the relationship between fats in the diet and serum cholesterol. That they tested these fats and oils by incorporating them into “waffles, muffins, cakes, cookies, pie crust, biscuits, salad dressings, and spreads for bread” was beside the point; their focus of concern was fats in the diet and serum cholesterol. [Let me briefly remind you that part of the rationale behind their experiment was to contradict the conclusion stated by Ancel Keys a decade earlier, that dietary cholesterol does not have an effect on serum cholesterol.]
So, in 1967, when this same group of researchers (minus Myers) publishes a review entitled, “Dietary Fats, Carbohydrates, and Atherosclerotic Vascular Disease,” we already know which macronutrient they think is the most important contributor to heart disease, and we already know that they are more concerned about serum cholesterol than any other biomarker. My guess is that the Evil Sugar Industry knew this as well, and that’s why this group of researchers was asked to write a review. Most of the review consists of summarizing studies where dietary carbohydrate is held constant while the type of carbohydrate–sucrose, glucose, starch, etc.–was varied. It’s not a big surprise to me, and it shouldn’t be to you, that they found, in most cases, sugar didn’t have a much different impact on total cholesterol than starches or other sugars. In a few cases, sugar/sucrose is found to increase triglycerides–and they duly note this. This is Rhetoric of Science 101: Determined critics can poke holes in any experimental system or rationale; those same scientists can find sound reasons to justify their own methods and thinking. They don’t (necessarily) need funding from an involved industry to be motivated to do this.
Hegsted and company’s unsurprising conclusion is this:
“The major evidence today suggests only one avenue by which diet may affect the development and progression of atherosclerosis. This is by influencing the levels of serum lipids, especially serum cholesterol …”
This is also a conclusion which would render the Hegsted equation central to determining what constitutes a healthy diet. How ’bout that?
They go on to add that limited evidence demonstrates a “slightly significant role for the kind and amount of dietary carbohydrate” in the regulation of serum lipids, the effects of which are “more pronounced when diets low in fat are consumed.” From their perspective, they don’t think dietary carbohydrate is worth talking about, except in the context of a low-fat diet. And, if you read their 1965 paper, you already know that Hegsted and co. think type of fat is more important than overall amount because that’s where they said, “Dietary advice to lower the total fat intake is likely to be self-defeating.”
They end with this:
“Since diets low in fat and high in sugar are rarely taken, we conclude that the practical significance of differences in dietary carbohydrate is minimal in comparison to those related to dietary fat and cholesterol” (emphasis mine).
From their perspective, a diet low in fat does not imply a diet high in sugar. The most commonly used sugars at that time were cane and beet–complicated politics kept prices fairly high–and corn syrup had not yet achieved widespread use.
They could not envision a future where sugar (as high-fructose corn syrup) would be a cheap replacement for fat. They could envision a future where vegetable oils would be a cheap replacement for saturated fat; this, in fact, was already beginning to occur in some sectors of the food industry.
Both figures above are from the 1977 Dietary Goals for Americans. Which brings us to …
Inconvenient historical moment part 2: Yes, Hegsted was the scientist who was the primary supporter of McGovern’s 1977 Goals. That much is true. So let’s chase that lead. In the first edition of the 1977 Goals, Goal Number 5 said: “Reduce sugar consumption by about 40 percent to account for about 15 percent of total energy intake.” This doesn’t sound like the work of someone in cahoots with Evil Sugar.
1st edition Dietary Goals, February 1977
But wait, there’s more! In the second edition of the 1977 Dietary Goals (the one where Michael Pollan whines about the meat people bullying the committee into revising the “reduce meat” statement to say “reduce saturated fat”), the “decrease sugar” goal has been moved up to Goal Number 3 and says, “Reduce the consumption of refined and processed sugars by about 45 percent to account for about 10 percent of total energy intake.”
2nd edition Dietary Goals, December 1977
This was still on Hegsted’s watch. How do we reconcile the increase in sugar restrictions with this (particular) conspiracy theory?
Aside from anachronistic analyses and inconsistencies that can’t be explained simply by pointing to a funding source, the current media spin on the Hegsted/Evil Sugar story suggests some pretty problematic assumptions:
- Hegsted was completely neutral on the topic of fats and carbohydrates in the diet until sugar industry money came along.
- Hegsted is a “dupe” and has no morals or backbone as a scientist.
- The article would have (somehow) been different without sugar industry money.
My students know better. I know this because all of the comments just above came from them when I asked them if they could think of any problems with the way the issue was being characterized in the media. Folks feeding the media frenzy should know better too.
Blaming Big Food money for everything that is wrong with nutrition science and policy suggests it was all was just-fine-thank-you until Big Food came along and messed it up.
One of the problems with this view is that it encourages us to believe there is no such thing as ideological (or other) biases in science, just money. So when Walter Willett calls research that contradicts his own “a pile of rubbish,” are we to assume that his belief that even the slightest bit of weight gain will cause you to die badly is the result of his being secretly funded by Jenny Craig? After all, the “pile of rubbish” research (which suggests that maybe overweight and even obesity are not so horrible) was funded by the government.
And, in the current media framework, government funding is without bias, just ask the mustachioed man himself:
Pointing the finger at Big Food money to explain away the problems in nutrition science and policy posits a particularly wild assumption: government funding = no conflict of interest. But, as Marion Nestle’s favorite diversionary tactic, it does work to steer the conversation away from how the federal government funded plenty of its own reviews that emphasized fat and dismissed the involvement of sugar in the development of heart disease. Nestle worked on one herself.³
Blaming the involvement of Big Food money for flaws in the scientific process is the same as blaming Big Food for obesity. They are both simply indirect ways of blaming individuals for their bad behavior: When Evil Sugar waved that bag of money under Hegsted’s nose, he didn’t have to take it, now did he?
Should anyone think I’ve gone off the deep end–I did just finish my written exams, so this is a distinct possibility–I’m not defending the sugar industry. I am, however, defending the reputation of Mark Hegsted.
Why is it is that, on the one hand, we insist on characterizing nutrition science as unquestionably sound and definitive and nutrition scientists as inherently neutral and objective, and on the other hand, we assume that nutrition scientists will sell every bit of their scientific integrity to the highest bidder at the drop of a bundle of cash and create fishy science–which no one finds the least bit fishy until we hear about this transaction?
If we are willing to accept a more nuanced view, we might consider this:
Government is as “interested” in particular outcomes from science as is any corporation. They provide support for preferred views in terms of funding as well as other resources that corporations don’t necessarily have, such as public platforms, training, positions of authority, and access to important information or policymakers. Government funders back nutrition scientists who reliably produce results they like–but that’s a conversation Marion Nestle doesn’t want to have.
For their part, scientists are human and biased in ways that can’t always be accounted for by–and that might be more powerful than–funding. Nutrition science, in particular, is full of a priori reasoning and lousy methodology propped up only by time and reputation–but that’s a conversation Walter Willett doesn’t want to have.
The field of nutrition science is massively overrun with weak associations, contradictory results, and experiments that incorporate preconceived notions about the relationships between food and health into the methods used to test those relationships. Instead of positioning Hegsted and his fellow investigators as dupes of Evil Sugar who then pulled the strings that poisoned America, we might ask why Willett and Nestle want to make sure that problems in nutrition science and policy are framed by a narrative that excludes their part in them.
***********************************************************************
- Actually, according to Nick Mottern himself, he’s not a vegetarian.
- If you would like a copy of this article–or any other article I refer to in this post–for your personal use as a nutrition researcher, let me know.
- Hegsted’s work definitely influenced this document–in the form of the Hegsted equation which is reprinted therein. His sugar review is nowhere to be found.
Eathropology 
I knew the Science article below sounded familiar! 🙂 You really were ahead of the game!
Was there ever really a “sugar conspiracy”?
David Merritt Johns, Gerald M. Oppenheimer
Science 16 Feb 2018:
Vol. 359, Issue 6377, pp. 747-750
DOI: 10.1126/science.aaq1618
http://science.sciencemag.org/content/359/6377/747.full
Thanks for this link! I’m delighted to see other folks calling Marion Nestle out on this.
Hi, I hope everything is going well. I sending this comment because of the following article. I am very disappointed and I thought you would be best at refuting the articles comment about getting enough nutrients. Thanks: http://www.huffingtonpost.com/entry/this-is-what-all-effective-weight-loss-diets-have-in-common_us_583c599ae4b09b6056014f01?section=us_healthy-living
Here’s the problematic quote:
I feel like Christopher Gardner, whose work I admire, really knows better than that. The rather ridiculous premise of this claim is that carbohydrates are a “nutrient” that should make up about half of your calories, thus diets with carbohydrate percentages that are lower than that couldn’t possibly provide appropriate amount of “nutrients.”
The logic, as it is in much of nutrition, is tautological. It’s like saying people whose incomes are below the “poverty line” suffer from lack of sufficient income that would prevent them from being impoverished. Well, yes. The real question in both cases is how are the “goalposts” established?
In fact, the IOM 2005 Macronutrient Report states quite clearly that “the lower limit of dietary carbohydrate compatible with life apparently is zero” (p. 275). Which should not be interpreted as saying no one ever needs to, or should ever, eat carbohydrates. It is saying that as a “nutrient,” a lack of carbohydrate does not seem to produce a disease of deficiency. Are many of us happier (mind/body/soul) with some carbs in our diet? No doubt. But they are non-essential.
When I asked Linda Meyers, who helped to write the “book version” of this report, why the AMDRs don’t reflect the “zero requirement,” she said that the carbohydrate recommendation had to do with avoiding recommending higher levels of fat, for reasons having to do with development of chronic disease (i.e. not about “nutrients”).
An interesting aside, in the “book” version of the IOM report, the zero requirement statement is nowhere to be found. Rather the book states, “The amount of dietary carbohydrate that confers optimal health in humans is unknown,” which is true as far as it goes, but then we don’t know the amount of anything that “confers optimal health in humans.”
thanks
By a strange coincidence I was considering asking a dietician who appeared in a blog which of my nutritious foods I should delete from my diet in order to cram in my recommended 230 – 300g carbs from Hearthealthywholegrains, but as they do she vanished after a negative comment.
It’s entertaining to run things through a nutrient database and see how much of what you gain by eating broccoli instead of pasta, eggs and bacon instead of cereal, etc.
Fat soluble nutrients and the likes of choline are often inadequate in HCLF. My Vitamin D just tested at 95 WITHOUT supplementing and I suspect my current large dose of Vacherin d’Or or other cheese is keeping my K2 and CLA consumption up. Liver every week or two is good for almost everything, along with a wide range of meat, fish and vegetables. I can’t think of much I would get from Belvita and the products of Cereal Partners, two of our UK dieticians’ latest sponsors. Oh wait, yes I can, excess quantities of glucose and insulin, plus statins, H2 blockers, antidepressants, and the “two or three” diabetes drugs I was “expected to be on by now”.
Someone (could have been you!) opined that we are overfed but malnourished. Add in overmeducated, oh look a relevant typo! I also recently typoed deiticians which was equally apt.
I love this question: “Which of my nutritious foods should I delete from my diet in order to cram in my recommended 230 – 300g carbs from Hearthealthywholegrains?”
I might have said that malnourishment could explain what we interpret as “overeating.” 🙂 It’s very likely that people do, at times, eat more than they really need to (hello? Thanksgiving?), but no “mainstream” nutrition expert has quite adequately explained why Americans, on average, began “overeating” beginning around 1980, y’know, right about when our low-fad diet (my contribution to the typo collection) appeared. Could it have something to do with the fact that we asked people to switch out more nutritious food for less nutritious food and people just kept eating in order to get the nutrition their bodies required?
I’ve read this suggested, and the stock answer is that there are no “micronutrient sensors”. Yes of course it’s gluttony and sloth, whatever else? Hmmm, when my mother was young up until when I was young there were very few fat people, especially fat kids, and strangely the problem was addressed by cutting out starch and sugar. Even more strangely obesity was often blamed on “glands”. Imagine that.
We don’t have “calorie sensors” either, yet–at least before 1980–we humans were really good at regulating our body weight. How do you figure? Why do animals visit “mineral licks”? Oh good grief. Like we know everything there is to know about why people eat.
Same for me since 2004, and for a metric sh1tload of others, well-controlled diabetics, people who lost and kept off scads of weight, etc. etc.
One BIG factor for me was the Reactive Hypoglycemia. Stephan Guyenet says this does not exist, which means it must be true. I’ve always lacked a proper Phase 1 insulin response but still after 63 years my Phase 2 is none too shabby. This resulted in my BG shooting up by 1 hour postprandial, my insulin following but then failing to shut off properly, causing glucose to fall through the floor after 3 – 4 hours. When my metabolism was carb-based (most of my life, dammit!) I would have to eat carbs every 2 – 3 hours or I could literally fall over.
Now I am fuelled principally on fats and ketones everything has evened out. I have a small breakfast, just enough to tell my liver my throat hasn’t been cut and it doesn’t need to dump a bolus of glucose, then I routinely go 5 – 8 hours and often 10 hours or more before I feel like eating again. Usually I have one main meal between late afternoon and late evening and another snack at night, sometimes two smaller meals. Either way most of my nutrients arrive at once, and my body then has no difficulty partitioning them out during the whole day and night.
Yet dieticians routinely tell people, especially diabetics, to eat three meals and three snacks with an (equally huge) number of carbs in each. Just to be on the safe side many people snack in between their snacks, and wash them down with bucketloads of soda, or orange juice. There’s simply no time when they are not awash in insulin, glucose and other food running constantly into the bloodstream, which breaks pretty much everything.
In the past there was a tendency to three meals of varying size and composition and not much else. Probably one reason the Kitavans get away with all their carbs, I believe they tend only to eat once a day.
Yet another factor . . .
I’ve got to vent. (BTW, Adele if you wish to erase this comment because it is only marginally connected to this blog post, I will have no ill feelings.) I just read a post by Dr. Malcolm Kendrick https://drmalcolmkendrick.org/2016/09/26/buy-this-new-book/ and another by Dr. Zoe Harcombe http://www.zoeharcombe.com/2016/10/mediterranean-diet-could-prevent-20000-deaths/
These articles show how piss poor nutritional science is and has been. In fact, it is not science at all but quackery with some notable exceptions. The real problem is not with the food and pharmaceutical industries, who are required and expected to do what is necessary to sell their products, and it is not the government’s fault with its politicians, who are expected and actually must compromise in a million ways to hell to get elected and get laws passed. No it is the quacks stumbling along in the nutrition field.
Maybe It is because I identify as somewhat of a nerd that I take such offense at their…whatever. Scientists must follow the scientific method and not some wishy washy best guess because the subject matter is complicated. They must be ONLY after the truth. This includes looking for errors in their pet theory and for ways to honestly and fully tell others of the true results of their experiments. Using numbers to lie is just being a marketing person or a politician. Grrrr!
Thanks, I feel better.
I feel your frustration with the part of nutrition science that consist of observational studies that attempt to tie foods or dietary patterns to long-term health outcomes. It is certainly not a biological science anyway, as nutrition epidemiologist study neither food nor disease. They don’t study people at all; they study surveys, models, and datasets. You can be a nutrition epidemiologist your entire career and never have to meet any human person for research purposes ever, even though what you purport to study is humans, their eating habits, and their health.
My question is how did we come to accept this sort of stuff as science? Why were we convinced at the time?
Cast your mind back to before Hegsted, maybe as far as WW2. I’m sure you if anyone would know of this.
Long long ago on a blog far, far away I read about a social psychology experiment which was intended to get people to spread nutritional information between themselves using “folk ways”. I found some other information on this but can no longer remember where or what it was called.
Originally this was done with the best of intentions – to guard against malnutrition.
I suspect the same social manipulation/marketing techniques have since been perverted to insert into society memes like Arterycloggingsaturatedfat and Hearthealthywholegrains which are almost impossible to eliminate, especially among researchers.
The nearest modern thing I found that is at all similar is
http://oldwayspt.org
one look at the sponsors tells you what is really occurring.
The result of course has been to produce a population that is overfed and yet malnourished. Epic fail 😦
I think–but I’m not sure–you might be referring to the Committee on Food Habits organized during WW2 (executive secretary, Margaret Mead). They took a cultural anthropology approach to getting Americans to change their food habits, emphasizing working through networks of friends & acquaintances. It was labor-intensive & not terribly successful, but one of the members of the committee, Kurt Lewin did conduct what has been called “a landmark study” in democratic social engineering (Biltekoff, 2013, 63-64). He had housewives participate in “guided group discussions,” in which a facilitator led them towards predetermined conclusions about feeding their families. Apparently, it got good results. I think the natural descendant of this type of study is probably Brian Wansink, with his “gatekeeper” approach. Here’s a link from Wansink that covers some of this.
Thank you! That was the one!
See, I have a brilliant memory but my recall is increasingly FUBAR. I have to thumb through a whole bunch of stuff I no longer need to remember but can’t forget before I find what I’m looking for.
Pity the paper falls off at the end with the championing of low fat. That was one thing I DID remember.
I have outsourced my memory to my hard drive–and I take good notes on the books I’ve read 🙂 That was from one on my exam list.
That works when you remember what what’s on your hard drive is called! Probably 12347a.pdf.
I wonder what Margaret Mead would make of the internet. I mean, here we all are, busily overturning dogma in favour of science. Then some people come along and try overturning dogma with other dogma *cough* food reward *cough* safe starches *cough*
I have a very helpful tagging/search system, but it is true that any files collected before that system are in a black hole of uselessness. I think Margaret Mead would be very interested in the communities that are formed in these battles over “truth” on the internet.
Quis custodiet ipsos custodes?, indeed. You know, I do a lot of functional and acceptance testing, and the nutrition world sounds like having the application developer also write the acceptance criteria and perform the test. Can’t go wrong with that 🙂
Also, enjoying the USGPO blast-from-the-past pages. Good lord, where did you get those? Microfiche?
Ah, microfiche. Those were the days. Except now most of my archival research is through Hathi Trust digital library. Hours (days, really, or maybe years) of fun. Congressional hearings are my favorite 🙂
There are so many things wrong with the world of nutrition and its public health applications in the service of prevention of chronic disease, but the complete lack of accountability–from scientists who push their research as the foundation for policy to policymakers who establish recommendations as if the science is settled–is surely one of the most egregious. If the Dietary Guidelines are supposed to help Americans prevent chronic disease, why has there never been some sort of evaluation of the policy based on incidence of chronic disease?
Because in a sane world the result would get a lot of people sacked.
Yes Adele, you should write a nice long article and then i see a book in your future with, hopefully, plenty of good snark. Anyway, great post. Made me think.
This post reminded me of when I went to see Joel Salatin give a talk in Portland, Oregon. As a right leaning libertarian and devote Christian, he started his talk by joking about how he had come into the den of left leaning liberals to do battle. But he said he was very stoked because he had been on the debate team in school and was looking forward to the challenge. Well, sure enough, during the question and answer period, one in the standing room only crowd of liberals questioned Joel. Big government is not the problem he challenged Joel. It is big food companies. Well, to the enjoyment of everyone they went back and forth for quite a while. Finally, someone else was able to point out that the operative word in their discussion was ‘big’. Very quick everyone agreed that we needed to buy locally as the sponsors of the talk was a local farmers’ market.
But having thought about your post, I think even buying locally has problems. I mean who is to say your local dairy man is not more interested in profits than healthy milk. Joel would argue that you would know that instinctively because you would know the dairy man. Well that is easily said but not so easily done. In fact, greedy dairy men of old are why we have pasteurized milk today.
So is it big government, local government, big business, small business? Well I would argue that universities and colleges share a lot of the blame. These institutions are not set up to find the truth but to make a profit and/or a reputation of success. Professors are required to publish, do research, join/advise non-profit associations, advise government, give talks and, importantly, defend their research. Also, they must be careful to adhere mostly to the theories and opinions of the leaders of their school. A scientist fearlessly looking for holes in their own or their mentor’s theory is a difficult ideal to reach and sustain.
So, too pessimistic? Yeah, a little. But that is just the human way. We are not Vulcans. But like Captain Kirk, we must keep trying to find and explain the truth. To give up would mean that many diabetics on the planet Earth will go blind needlessly. At least, the LCHF scientists are not being thrown into jail or excommunicated like some scientists of old and those on planets where no one has gone before.
Stopping the publication of the DGA is like trying to get the genie back into the bottle. Even though I agree with all of your arguments to stop the DGA, the low fat meme is out there. It will continue to maim. Then without the DGA, what will fill the void? Big Food has a lot of money and investments to defend. Not to mention Big Government, Universities and Non-profits. No, respectively, I disagree with that path at this point in time. We must just keep fighting to find and teach the truth. Who said we must teach, teach, teach? Teach in schools, teach thru government policy and teach via non-profits.
So, in conclusion, I think the fight must, as you mentioned, go to NAM. Of course, I don’t mean Vietnam but the National Academy of Medicine.
You’ve made many good points & this is something I go over a lot in my head. Would we really be better off with no DGA? But I think we also need to ask, who might the elimination of the DGA affect most, and how?
This is just a best guess (and maybe you all can envision some other scenarios), but here’s the things that I think the elimination of the DGA would (or at least, should) change:
1) food labeling – no more health claims on packaged food; the far right column (with recommended percentage of calories of macronutrients) would go away (ingredients and absolute values would remain)
2) school lunches – this is a messy situation, but I remember a dietitian who ran a school lunch program telling us that after they met their “fat” quotient, they had to add sugar to the food to meet the calorie standard; absence of federal guidance might open up opportunities for local programs to meet local needs rather than to have to adhere to these sorts of decontexualized standards
3) food industry – the food industry would no longer benefit from trying to manufacture/advertise “healthy” foods by reformulating products to meet the DGA standards (which they have been doing for 35 years); they could still do it, of course, but the “carrot” of being able to apply health claims to processed foods would be replaced by the “stick” of exceeding FDA-allowed health claims (which follow DGA guidance–no guidance/no health claims, as it was before the whole low-fat thing came along)
4) research – this is a huge question mark, but absent DGA standards, scientists might be more encouraged to ask different questions and might be more comfortable with finding answers that don’t fit preconceived notions of what a healthy diet is
In this last regard, I think of what my experience was in the School of Public Health at UNC-Chapel Hill. Without such a powerful influence on funding streams in place, to question the conventional wisdom of what a healthy diet is (and such conventional wisdom would likely exist with or without the DGA) would not be as threatening. Because I do think you are right about how powerful paradigms shape research agendas; this has always been the case.
But the DGA did something I think no policy should ever do: It resolved a scientific question and ended a scientific controversy–in the name of “we must do SOMETHING,” in a situation that was far from being a public health emergency. I don’t think we can fix that by taking the approach of “we must do SOMETHING ELSE!” I think it is time to rethink the whole thing.
Would the elimination of the DGA improve the health of Americans? I don’t know. Maybe some sort of dietary guidance is needed, but we are nowhere near knowing what that guidance might be.
I’m pretty sure I’ve ranted about this before, but here it is again: There’s a world of difference between an effective diet and effective dietary policy. Let’s say we do change the DGA to allow fat, even saturated fat, and to restrict carbs. Consumers are now demanding high-fat foods because the DGAs say, raise your fat intake and reduce your carbs. So food manufacturers and restaurants pour soybean oil into their products (because even with new DGA, veg oil is cheaper than butter and lard), thus changing the ratio of fat to carbs to meet whatever high-fat labeling the FDA comes up with. But, because high fat/low carb products still don’t have much protein in them, people consume more calories than they should (easy to do with foods high in fat even if they are theoretically more satiating), but their carb intake isn’t so low that they don’t end up storing those calories as fat. In the meantime, ratios of o-6s to o-3 get even more skewed than they already are. Law of unintended consequences.
Until we can answer the question Paul Marantz raised here–do we know that issuing dietary guidance of any kind will do more good than harm?–then we should stop doing it.
Yeah, it does seem like I’m trying to stuff the genie back in the bottle, but the truth is that America is a very different place than it was in the 1970s. We’re not going to go back in time, we are going to remove a policy that is, and has been for a while now, an anachronism. It’s a zombie policy, stumbling forward under its own weight, and it needs to be put out of its misery. That doesn’t mean we can’t ever have federal dietary guidance ever again, but top-down, one-size-fits-all dietary health policy for the prevention of chronic disease in a diverse, ever-changing, and increasingly networked population is simply inappropriate.
Well, your response has been rattling around in my head for a couple of days now. But today I read Dr. Ludwig’s articles in CNN and JAMA and I now believe that the DGA should be continued. See http://edition.cnn.com/2016/10/05/opinions/debate-low-fat-diet-ludwig/index.html
Dr. Ludwig mentions the many ways that the public and the food industry were taught to embrace the low fat, high carb diet. So, to me that zombie diet is much more deadly than the zombie DGA. The DGA is just a teaching tool. And the errors that Ludwig, Taubes, etc have pointed out need to be rooted out and…well, I don’t know how you kill a zombie as I’ve never watched a zombie movie.
Of course, you point out that we don’t know exactly what advice to put in the DGA at this point in time. Two quick points would be advocate whole foods and the uniqueness of each person and their metabolism. Then, what about just simply recommending that we eat like we did just before the DGA were created. As more research is completed we make changes. This may be difficult because the times have changed. However, you could also say that about the 1970’s compared to the 1960’s, but we went ahead and changed our diet then anyway.
On the bright side of life, the fact that Congress had a hearing on the DGA shows that politicians are starting to notice the damage that has been done. Also, groups like the Nutrition Coalition are putting some political empowerment behind LCHF. Then there are the increasing number of doctors and bloggers spreading the Word, Glory Be to our Fat and Tasty! And don’t forget about the free internet and the power of the crowd. The number of comments sent to the DGAC was in the thousands. Then all of the recent articles in some of the top medical journals, like JAMA and BMJ, is definitely a step into the bright side of life. Quietly, NuSI is still rolling along with its privately funded research.
Unfortunately, science was co-opted by a needy and egotistical politician to just do something before he went out of the lime light. But now the science must just simply march on and do its job with the media looking over its shoulder. This means more noise and politics. But as Dr. Ludwig said, “this failure (the LFHC diet advice) warrants a rigorous examination, efforts to mitigate existing harms and robust government funding to test new ideas.” Then the DGA can be an effective tool to help mitigate the harm.
Apologies for the slow response–trying to pass my exams 🙂 (Which–hooray!–I did.) You raise some really interesting points & I want to be sure to say, first off that I don’t pretend to have any sort of final answer on these issue. I’m still trying to think this all through & I appreciate you wresting with these ideas with me.
You note: “Two quick points would be advocate whole foods and the uniqueness of each person and their metabolism. Then, what about just simply recommending that we eat like we did just before the DGA were created.” It’s hard to disagree with with either of these, but how “whole foods” gets defined (and by whom) has been a problem. Last time I went through the whole PhD exam process, I suggested an epi study that followed people who eat a “whole foods” diet vs. those ate a more processed diet. I was peppered with questions–not unreasonable, in retrospect–that I identify exactly how I would define/measure/track these “whole foods” vs. “processed foods” diets. I’m not sure my answers were very satisfactory then & I’m not sure I could do much better now. I do think it would be very reasonable for federal guidance to assert that diet/health issues will vary considerably by individual, but I’m not sure it is in the best interest of the government or any other institution to do that. I’m also not sure we can recommend that Americans “eat like we did just before the DGA were created” because I’m not sure that it isn’t federally backed dietary policy, in and of itself, that’s the problem. In other words, any diet that becomes “policy mandated” is immediately something else besides an approach to dietary health. Most specifically, it becomes a yardstick by which food manufacturers can create foods to “match” the policy. And the squishy-ness of definition of “whole foods” is going to be tied to that.
I agree with Ludwig here: “this failure (the LFHC diet advice) warrants a rigorous examination, efforts to mitigate existing harms and robust government funding to test new ideas.” At the same time, and I sound like a broken record I know, the guidelines were never just about science. A social-political agenda was covered with a thin veneer of science & that agenda happened to support and coincide with a lot of other (economic) agendas. From this perspective, I’m not sure this is something more/better science can fix.
You can never really prove a scientific hypothesis; you can only try to disprove it. A hypothesis gains credibility if many honest attempts fail to disprove it. So government funded research should try to disprove the official dietary recommendations. But that is not how it works, as research money is allocated by administrators who have self-interest that their recommendations be correct.
Industries that are hurt by dietary recommendation can fund their own research, and if done properly can reverse flawed dietary recommendations. This appears to be the case with dietary cholesterol.
But saturated fat is a very odd case. As the primary source of saturated fat, the dairy industry actually benefits from confused recommendations. Before dietary recommendations, dairy fat was highly prized and was extracted from milk to meet the demand for butter and cheese. This left a lot a skim milk which had to be thrown away. The dietary recommendations against saturated fat allowed dairy to profit from low-fat milk sold as health food. But as the public learned to shun saturated fat, dairy needed a way to encourage its consumption.
New research has cast doubt on the saturated fat guidelines, and the sale of butter is up. But you still need to guarantee a market for low-fat dairy, so the discredited dietary recommendation on saturated fat was allowed to stand, which justified the rule to allow only low-fat dairy in the school lunch program. It is unlikely that the dairy industry will fund the research that will settle the issue. We need a way for the public to demand the government to provide the necessary funding.
Your point about the dairy industry is a good one. Dairy has certainly benefited from the confusion and from members of the public who never could make the switch in the first place. When vegamaniacs buttonhole me with a lecture about Big Meat and Big Dairy running the Dietary Guidelines, I try to remind that that meat and dairy interests are significantly divergent. (Plus if Big Meat paid some lobbyists to convince policymakers to give them a favored spot in federal dietary guidance, they need to get their money back).
The skim milk/butterfat/cheese thing is an excellent example of the tangled web that is our food industry. You can’t change one aspect without affecting many others.
It would be nice if the public had more input into how government funds were spent on science, but–as I’m always saying–science isn’t the problem. From the beginning, this was not about science, but about a lot of social and political (and a few economic) agendas. Science was a thin, but important, veneer that made the whole pill easy for the public to swallow.
Dietary science is needed to undo the damage it has already done. But for the misuse of science, we would not have the fear of saturated fat. Just telling people that sugar is bad will not change their diet unless they are offered an affordable alternative. The health foods in the dietary guidelines are expensive, especially the nuts. Saturated fat is cheap and people naturally like it. Removing its stigma will allow a natural shift away from excessive sugar.
If funding is provided to verify the work of Ron Krauss, that the kind of LDL raised by saturated fat is harmless, then the debate over saturated fat will be settled. We cannot expect funding to come from industry. It has to come from government, which will respond to the demands of the people.
I see your point, but I’m not quite sure it works that way (I’m thinking of the recent dust-up with Kevin Hall’s study, funded by both NIH and Nusi). My point being that I think we already have science that exonerates sat fat. It’s the official dietary guidance–and all that cascades from it–that’s the problem.
And after watching the DGAC maneuver around the science for these last Guidelines, I have little hope that those will ever drop the sat fat restriction. What I need to do now is catch up with the NAM stuff (now that I’ve got the sugar conspiracy off my chest)! Maybe that will give me some hope.
The whole Evil Government is such a sexy rhetorical stance, especially in the USA & you work it for sure.
“Government is as “interested” in particular outcomes from science as is any corporation.”
Is the government “interested” or the “whole Evil Food Industry” acting via the government because it has more credibility?
The focus on macro-nutrients as the problem is likely mainly a scientific problem. That is what is easiest to study, especially in large studies.
Social reasons for health problems are much harder to study, but I would intuitively expect them to be most important.
“Is the government “interested” or the “whole Evil Food Industry” acting via the government because it has more credibility?” Like a conspiracy parfait–layers upon layers? I don’t believe in the “Evil Government” stance either & I hope I didn’t give that impression. I’m just saying you can’t exclude government from having interests. In general I don’t believe in conspiracy theories. I’d rather think that Mark Hegsted was doing his best to make the world a healthier place (and also be able to be a practicing scientist, have his views heard, get paid, have colleagues that agreed with him and maybe even admired him, etc.). I believe the same thing about Robert Lustig. The fact that their beliefs are in diametrical opposition is not, I don’t think, a matter of opposed intentions. Shoot, I think McGovern’s committee were hoping to not only improve the health of Americans, but to improve the condition of our environment. Their progressive “save the world” intentions were admirably enacted in the work they did reducing hunger in America. Their 1977 Goals can’t be explained by “favoring” the fat hypothesis over the sugar hypotheses. First of all, that’s not really the case, and second of all, there was a hell of a lot more going on.
Do various industry do their best to work through government? No doubt, but that relationship is a two-way street as well. At least in regard to nutrition, the government called (still calls) specifically upon the food industry and food producers to create foods that comply with nutritional guidance, and the food industry complies. (What the government doesn’t do is forbid foods that don’t comply with nutritional guidance from being created as well).
“Social reasons for health problems are much harder to study, but I would intuitively expect them to be most important.” I was actually having this conversation with my husband last night. Social epidemiology seems to report the exact same findings as nutritional epidemiology: lower-income/status folks are less healthy than higher income/status folks. In nutritional epidemiology, we explain the finding by saying “it’s the diet; lower-income/status folks just need to eat like rich people.” But another way to explain it–better, as far as I’m concerned, is this.
Thank you very much for linking to that study. Wonderful to read that research is done on the social causes of decease and health. I do not remember having read about such studies in the media, while they do have space for every underpowered correlation study between something many people eat and deceases.
There is no need to call investments by corporations “conspiracies”. They just do what they are made for: making money. In every individual case it will normally be hard to prove, but corporations are not charities. They give money to make more money.
I do not know exactly how nutritional science funding works in the USA, but the way I know it for the natural sciences in Europe, the scientists make the decisions on individual projects. The money comes from the government and partially they will prescribe the research topics, but normally they do not decide which scientific project get funded and they do not exert influence on the results of the study.
I’ve been doing a lot of reading on social determinants of chronic disease & I agree that the topic doesn’t get nearly enough attention. This is due, at least in part, to the fact that social conditions are much harder to change; it is much easier (and more corporate-friendly) to tell people to eat more oat bran or whatever.
Also, the Big Bad Food Industry may do many Big Bad Things. But it also feeds (relatively) safe, (relatively) healthy food to a lot of people, every day.
The grant-funding process in the U.S. is part mind-reading, part paradigm-following puzzle solving, part rhetoric, part good timing, and a lot of “cumulative advantage,” meaning the scientists who get grants are more likely to get future grants. In doling out funds, “The Government” gets represented by groups of reviewers who carry into the review process many of the same problems we hear about with regard to peer review in journals. In many regards, it is an exercise in gatekeeping. I know, specifically, of two diet-disease experimental trials that were awarded funds for the arms of the trials that studied low-fat or Mediterranean-style diets, but the researchers were told that the low-carb arms would not be funded. In one case, the investigator went elsewhere to fund the whole trial; in the other case, the researchers just dropped the low-carb arm. I’ve been told by a researcher who puts in grant applications to study low-carb diets that he has been told by one reviewer “we don’t need to study low-carb diets; we know they work,” and–by another reviewer commenting on the same grant–“we don’t need to study low-carb diets, we know they kill people.”
In my rhetoric of science reading (and remember these are folks talking about issues that have nothing to do with nutrition), there is little argument that the influence of governmental funding agencies and legislative bodies over potential scientific research is “profound.”
Public perception has been that the pro-fat position was influenced by the meat and dairy industry, and the anti-fat position was untainted. The revelation that Hegsted and Stare had ties to the sugar lobby levels the playing field. All researchers need funding. Ultimately, it should be the quality of their work that gives them credibility. Proving that Hegsted took money from the sugar lobby does not automatically discredit his work, as much as it removes the argument that opposing research should be dismissed because of the source of funding.
These are all very good points–unfortunately the “leveling the playing field” effect of having to admit that both sides of the debate have ties to food industry still leaves out the biggest player in nutrition science: the government.
“Machiavegiann” — Oh, man, that one took me a sec, but once it registered…
Adele, you are a GEM. Some people can do snark, some people can do humor, some can do truly intelligent and unique insights. You somehow manage to do all three in just about every blog post of yours I’ve read.
Marion Nestle and Michael Pollan both have very good intentions, and they get a lot of things right, but boy, do they go wrong here and there, too. Like another commenter said, I wish they would stop using these two as the go-to people for pithy and seemingly untouchable/incontrovertible truths. (Willett, too. Seems like scarcely an article gets printed in a mainstream newspaper or magazine that doesn’t have Uncle Walt weighing in.)
Agree with Stephen T: “A basic rule of science is that when your results contradict your theory, the theory must be wrong. Any physicist or engineer knows that, but seemingly no one involved with writing nutritional guidelines.” Considering the amazing, almost incomprehensible amount of data “massaging” that goes on in nutrition research, I can’t possibly fathom what a “happy ending” might consist of in this twisted “science.” ;D What’s happened in nutrition research is that it really doesn’t matter what the data show, because the hypothesis is assumed to be true, regardless, and studies are designed and conducted with the expected outcome already in mind. So when the expected outcome does *not* come, or, indeed, the *opposite* outcome occurs, rather than question the initial hypothesis, it’s all about hand-wringing and apologizing because obviously the study didn’t go far enough.
Ex: A low-fat, low-calorie didn’t result in significant fat loss? Well, oops, our study obviously wasn’t low *enough* in calories and fat, since we already *know* this diet should have led to fat loss. (Which opens up the question, if we were already soooo sure of stuff like this, why bother conducting any more research? Everybody could have packed up their toys and gone home forty years ago.)
Exercising two hours a day didn’t lead to fat loss? Oh, well, since we *know* exercise *must,* without fail, result in fat loss, then our data show that people need to exercise MORE than two hours a day. Give us more funding so we can do a study where people exercise three hours a day…
It’s no wonder people literally need professional help to do their grocery shopping these days.
Good work, Adele. Keep at it!
Thanks so much! That means a lot to me. Tricky subject …
Leaving aside the general question of whether you’ve gone off the deep end, this is a great piece. I don’t know about defending Heisted (he has had bad influence in vilifying fat, but you are hitting the real question about blaming the sponsor which has had a very bad influence. Good job. ============================================================= Richard David Feinman Professor of Cell Biology SUNY Downstate Medical Center
cell (917) 554-7794 office (718) 270-2252
blog: http://feinmantheother.com
Support research on ketogenic diets for cancer . =============================================================
>
Thanks for the kind words & for not pursuing the question of whether or not I’ve gone off the deep end.
It’s awkward defending Hegsted. I don’t agree with the theory he built his career on & I think he is absolutely biased by that. But it is really difficult for me to think that he was just doing the bidding of the sugar industry. This is the guy who, upon being presented with the first draft of what would end up being the 1st edition of the 1977 Goals, said, “You can’t print this, it reads like some health food nut wrote it.” I shudder to think what the Goals might have looked like without his insisting on being able to make statements based on science, as unbalanced as that view might have been.
That said, the problem at this point is not the dead folks. It’s the real-live folks who insist that the only lens that explains the mess that is nutrition science & policy is the “blaming the sponsor” one. But notice, it’s only “blame the sponsor” when the sponsor is industry–not the government.
My biggest problem with all of this is that when there is data that runs both ways (e.g., saturated fat/fat is bad or sugar is bad), we select one of them. The data for basically everything written in the two sets of guidelines above is all over the map, and there are few to no RCTs for any of this data (and the RCTs there are are ignored if they don’t agree with your preconceived notions), yet we select one choice. Why? Why can’t we say “We’re not sure how you should eat. We think maybe eating X to levels of Y is good, but we really don’t know”? But we don’t. We have to choose even with unreliable data. And that should not happen.
I understand your point that Hegsted has probably been inappropriately singled out in this. But I for one am angry. I ate a low fat diet for YEARS (decades, really) because I thought the “experts” knew what they were doing and it was healthy. Looking back, I see now that I was always hungry, had tremendous blood swings that caused effects such as depression and anger, and was building an insulin resistance that would later give me all kinds of health problems. It took me years and the reading of many books before I could trust in eating fat. Even now, I look at food and can’t help myself and remark about how much fat is in it.
Since eating exactly the opposite of those guidelines (except I don’t or very rarely eat sugar), I’ve lost over 50 pounds and taken back my health. The current guidelines do not fit people who are or who have a propensity to be insulin resistant. In fact, the current guidelines are a death sentence to these people.
So, while I agree with your article, I’m happy that we’re discussing this. I’m happy that my wife remarked about how fat was singled out and not sugar. I want the process of selecting our guidelines to change, and I want what’s in our guidelines to change. If we have to “take down” (and I do not mean that in a violent sense at all) people like Hegsted, and Willet, and anybody else, we should do it. We cannot be controlled by people like these. They should not have influence over us.
I have changed what I eat, but the guidelines are so ensconced in culture that they affect everything. I went to my doctor, and he was happy that my HDL went up. He remarked that it was probably because I was exercising. I didn’t want to tell him — in fact was AFRAID to tell him — that I’ve actually decreased my exercise over the last three years and the increase in HDL is because I eat as much fat and as few carbs per day as I can. I have to lie to him because the nutritional field is so screwed up that everything it says is wrong. I shouldn’t have to do that. (And don’t get me started on the meals served in school, which are all low fat and high “whole” grains. Again, completely wrong but caused by guidelines.)
I feel your frustration here, Bob. But I would also wager that your low-fat diet was not particularly high in sugar. My low-fat, calorie-controlled, home-cooked vegetarian diet (that eventually resulted in weight gain, hypertension, and elevated glucose levels) was not sugar-free, but I didn’t use a lot of “processed sugar.” I did however use a lot of (whole grain) starches and fruit purees. So, I’m pissed that not only did I get fed a bunch of malarkey about fat, but nobody bothered to tell me that (at least for some people), there’s not a lot of metabolic difference between starch and sugar (which is pretty much what Hegsted’s earlier paper shows) and that “natural sugar” is just sugar.
I personally would like our guidelines to simply go away.
1) If government-funded science is reliable and trustworthy, why has the guidance based on this science not been successful? Most (if not all) of the studies you’ll find in the USDA’s Nutrition Evidence Library are up-to-date studies, funded by USDA/HHS, with any conflicts of interest clearly disclosed. Howz that workin for us? It isn’t, so maybe we should just stop.
2) Maybe the problem is that the “good” government-funded science gets mangled or softened by industry influence when guidelines are made? If the problem with industry influence is as powerful and pervasive as Marion Nestle says it is, then we can’t possibly create reliable nutrition policy. So maybe we should just stop.
3) Or maybe the problem is that the relationship between diet and health any individual is complex, idiosyncratic, and constantly shifting. Not the kind of situation that lends itself to one-size-fits-all, top-down guidance. So maybe we should just stop.
The problem with making this all about Big Food–and people who are deceased and can’t defend themselves in the first place–is that it protects the very much alive individuals and institutions who benefit from the industry (and it is an industry) of nutrition science that makes them well-funded and/or well-regarded “experts” on what you and everybody else should be eating.
The article starring John Ioannidis that was in the Atlantic a few years ago is worth a read. Here’s the heart of the issue (from that article, which ends with what I consider to be the best dietary guidance ever:
Bob, why is such a well informed man afraid to tell his doctor the truth? With probably less knowledge than you, I point out to my doctor that the countries in the world with the highest consumption of saturated fat also have the lowest rates of heart disease. Can she explain how that works? Of course not. She’s following guidelines and they say take this statin. I say no thanks.
A basic rule of science is that when your results contradict your theory, the theory must be wrong. Any physicist or engineer knows that, but seemingly no one involved with writing nutritional guidelines. I followed the low-fat nonsense for twenty years and also feel aggrieved at the harm done to me.
Brilliant shred, as always. Thank you for your considered write-up on this! Will they ever – ever – stop running to Marion Nestle for quotes in nutrition news articles?! Argh, so frustrating.
The whole Evil Food Industry is such a sexy rhetorical stance & MN works it for sure. However, her book on the topic is full of really misleading–if not fully illogical–statements about the relationships between industry and dietary guidance. One day, I hope that I will be in a position to write a nice long journal article to that effect 🙂