Will the real Dietary Guidelines please stand up?

I don’t say this very often (or ever).  I was wrong.  I think.

Here I’ve been laboring under the assumption that the 2015 Dietary Guidelines tell the American public to eat a diet lower in fat (because we eat “too much” of it now) and higher in carbohydrate (especially from whole grains like whole wheat–because we don’t eat “enough” of those now), to eat less salt, and to “eat as little dietary cholesterol as possible.” But according to a document recently released from a source at the Center for Nutrition Policy and Promotion (CNPP) that isn’t what the Guidelines say.  Or at least not exactly. Maybe.

The good folks at CNPP were asked to respond to Kris Gunnar’s list of  “20 Mainstream Nutrition Myths (Debunked by Science)”  with the idea being that the Guidelines are about as “mainstream” as nutrition advice gets.  The hope was that, if the good folks at CNPP could explain why their advice is ostensibly “backed by science” and yet is “debunked by science,” we would all sleep a little better at night, even if we still insisted on eating bacon and eggs in the morning.

The good folks at CNPP rose to the challenge and cleared things right up.  But, to quote the inimitable if soporific Crosby, Stills and Nash, “just beneath the surface of the mud, there’s more mud.  Surprise.”

Below, I’ve restated their responses as dietary guidance arranged in an order that I found amusing.  The number of the corresponding “Myth” from Kris Gunnars is given as well, so that those of you with split screens or dual monitors can play along at home.

According to the good folks at CNPP, the 2015 Dietary Guidelines for Americans:

  • do not recommend Americans eat a diet low in total fats or high in carbohydrates, particularly from grains. (Myth 1)
  • do not encourage eating low-fat foods. (Myth 12)
  • do not suggest avoiding saturated fat.(Myth 16)1
  • do not say saturated fat raises LDL cholesterol. (Myth 6)2
  • do not suggest Americans should avoid egg yolks, nor do they suggest that dietary cholesterol is linked to heart disease. (Myth 4)3
  • do not suggest eating red meat raises risk of disease. (Myth 13)4
  • do not say seed and vegetable oils lower cholesterol levels. (Myth 20)5
  • do not recommend the population restrict sodium intake (Myth 2)6
  • acknowledge there may be more to weight management and diet-related diseases than calories in-calories out. (Myth 15) 7
  • do not state sugar is harmful. (Myth 19)8

I know what you’re thinking.   Adele’s mind has finally blown a gasket from reading all those big words they have in grad school.  I’m not going to argue that point, but you can check the CNPP’s response for yourself right here.

This response also acknowledges that current scientific evidence regarding the reduction of full-fat dairy is contradictory (Myth 10) and that a variety of eating patterns can produce weight loss (Myth 8).  It also says that  3-5 cups of coffee a day can be part of a healthy diet (Myth 7)–hallafreakinlujah– but whole wheat products?  Meh (Myth 5).

I can see the helpful public health messages now:

You should not avoid egg yolks, but you should eat as little dietary cholesterol as possible, even though dietary cholesterol consumption is not linked to heart disease.

You don’t need to choose low-fat foods, just choose fat-free or low-fat milk, yogurt, and cheese even though it might not actually help you avoid chronic disease .

You should shift to lower sodium consumption without restricting your intake of sodium.

What’s going on here?

Good question.  Perhaps the good folks at CNPP didn’t actually read the Dietary Guidelines this time around.  Who, except for me, has that kind of time?  Or maybe they had a hard time finding them. Once you get to the health.gov/dietaryguidelines/ site, you have to click through 3 menus or links before you get to the actual guidelines (try it), which are a swarm of footnotes and “see more” hyperlinks.  Even Marion Nestle complained about how hard all those “annoying drop-down boxes” are to navigate.  It’s possible the good folks at CNPP just assumed that the other good folks over at DHHS–responsible for Guidelines online labyrinth–were paying attention so they didn’t have to.

Or maybe it means that it’s actually really hard to get words to say what you want them to say without them saying other things that you don’t want them to say.  And this is especially difficult when you are asked to make sweeping recommendations based on a weak scientific evidence base that both supports and contradicts past guidance, which you can’t contradict even when you can’t support it, because, then what?

No wonder the good folks at CNPP are having a hard time getting their story straight.

To tell the truth, I have a lot of sympathy for the message-makers there at the USDA.  We created the Dietary Guidelines 35 years ago assuming zero potential negative consequences.  True, the scientific evidence didn’t strongly support the recommendations, but whatever.  Whether they followed the recommendations or not, hey, the health trajectory of Americans couldn’t get any worse, could it?  We knew the Guidelines would significantly impact the food industry, but that could only be a good thing, right?  And we meant for Guidelines to set the direction for nutrition research, but since science is only about facts and never about politics or funding, any errors or biases in our original rationale would be quickly discovered and corrected, no?

Now it seems pretty clear that we might have spent a little more time thinking through the whole “Let’s make sweeping dietary recommendations that are meant to apply to every single American alive over the age of 2 as a method of preventing every single major chronic disease known to humankind “ thing before shrugging our shoulders and saying “Oh, no worries.  It will all work out.”  Now the folks at the USDA have used up their wishes and are left trying to stuff the genie back in the bottle with nothing but semantics and poor website design.

Will the real Dietary Guidelines please stand up?

If only they had a leg to stand on.

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1.  They just want you to reduce your intake of saturated fat without actually avoiding it.

2. They do recommend limiting saturated fats based on the notion that somehow this will reduce risk of heart disease. But let’s leave LDL cholesterol levels out of this. What did they ever do to you?

3.  But Americans still should eat as little dietary cholesterol as possible, just fyi.

4.  Eating red meat does not raise risk of disease, but not eating red meat lowers it. Um.  Weird, right?

5.  But you should eat vegetable oils instead of animal fats, because, well, because.

6. They do want you to shift to lower sodium consumption, just not by restricting your intake.

7.  Although they remain singularly obsessed with calories in and out, there’s apparently no need for you to be.

8.  But you shouldn’t eat very much of it anyway, because, well, because.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Works for me.

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

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

Processed Meats Declared Too Dangerous For Human Consumption

Processed meats have been declared too dangerous for human consumption by pseudo-experts who are unable to differentiate between observational studies and clinical trials, thus posing tremendous risks to the collective IQ of the interwebz reading public [1].

The World Cancer Research Fund recently completed a detailed review of 7,000 studies covering links between diet and cancer. A grand total of 11 of these were actual clinical trials that tested two different dietary approaches or supplementation on cancer outcomes. Two of these 11 trials tested a dietary intervention, both using a low-fat diet versus a usual diet control. Researchers found that, “The low fat dietary pattern intervention did not reduce the risk of invasive colorectal cancer in any of its subsites” [2]. In other words, avoiding fat in foods like bacon, sausage, pork chops, and pepperoni will not reduce your risk of colon cancer; however, it may reduce your enjoyment of life considerably, and that, in itself, is a pain in the butt.

Upon conclusion, it is evident that reading research summaries written by people who don’t know the difference between an observational study and a clinical trial is dangerous for human intellect and the acquisition of accurate information. Consumers should stop reading processed articles full of information pollution and should instead watch re-runs of Gilligan’s Island. 

What are processed meats?
Processed meats include bacon, sausage, hot dogs, sandwich meat, packaged ham, pepperoni, salami and nearly all meat found in prepared frozen meals. Processed meats are usually manufactured with an ingredient known as sodium nitrate, which is often linked to cancer by pseudo-experts who don’t know how to look up stuff in PubMed. Sodium nitrate is primarily used as a colour fixer by meat companies to make the packaged meats look bright red and fresh. Monosodium glutamate is also added on a regular basis to enhance the savoury flavour. An extra letter “u” added to words can also enhance colour and savoury flavour.

Sodium Nitrate has been strongly linked to the formation of cancer-causing nitrasamines [sic] in the human body, leading to a sharp increase in the risk of cancer for those consuming them. This is especially frightening, since as far as actual science goes, there is no such thing as a nitrasamine. Scientists are very concerned, however, about nitrosamines, which do, in fact, actually exist. Their concern reflects a growing body of evidence that people writing about nutrition on the internet actually have no idea about which they are ostensibly talking:

“There has been widespread discussion about health risks related to the amount of nitrate in our diet. When dietary nitrate enters saliva it is rapidly reduced to nitrite in the mouth by mechanisms discussed above. Saliva containing large amounts of nitrite is acidified in the normal stomach to enhance generation of N-nitrosamines, which are powerful carcinogens in the experimental setting. More recently, it has been suggested that nitric oxide in the stomach could also be carcinogenic. A great number of studies have been performed examining the relationship between nitrate intake and gastric cancer in humans and animals. In general it has been found that there is either no relationship or an inverse relationship, such that a high nitrate intake is associated with a lower rate of cancer. Recently, studies have been performed suggesting that not only is nitrate harmless but in fact it may even be beneficial. Indeed, acidified nitrite may be an important part of gastric host defense against swallowed pathogens. The results presented here further support the interpretation that dietary nitrate is gastroprotective. They also suggest that the oral microflora, instead of being potentially harmful, is living in a true symbiotic relationship with its host. The host provides nitrate, which is an important nutrient for many anaerobic bacteria. In return, the bacteria help the host by generating the substrate (nitrite) necessary for generation of nitric oxide in the stomach” [3].

A 2005 Hawaii University study found that reading articles about processed meats written by ninnies who can’t spell “nitrosamine” increased the risk of a 5-point IQ reduction by 67%, whilst another study found that it increased the risk of twerking by 50%. These are scary numbers for those consuming articles about processed meats on a regular basis.

Monosodium glutamate (MSG) is a second dangerous-sounding chemical found in virtually all processed meat products. MSG is thought by people who are unable to navigate PubMed to be a dangerous excitotoxin linked to neurological disorders such as migraine headaches, Alzheimer’s disease, loss of appetite control, obesity and unrestrained blogging. Nutrition bloggers use MSG to add a deceptively scientifical-sounding level of paranoia to their articles about the addictive savory flavor of dead-tasting processed meat products. This will deflect unwary readers’ attention away from inane and poorly-worded concepts such as “addictive savory flavor of dead-tasting processed meat products.” On the other hand, the Joint FAO/WHO Expert Committee on Food Additives, the Scientific Committee for Food of the European Commission, the Federation of American Societies for Experimental Biology, and the Food and Drug Administration all concluded that, although there may be a subpopulation of people sensitive to its effects, no health risk have been found to be associated with MSG [4]. But what do they know?

Food items to check carefully for aliveness before piling them into your cart:

  • Beef jerky
  • Bacon
  • Sausage
  • Pepperoni
  • Hot dogs
  • Sandwich meat
  • Deli slices
  • Ham

…and many more meat products

If it’s so dangerous to consume such stupidity, why are they allowed to write it?

Unfortunately nowadays, access to operational brain cells is not a prerequisite for access to a keyboard and a WordPress account. That and First Amendment concerns have allowed unsuspecting readers curious about the real health effects of some food components to be misled, confused, and frightened by the insidious repetition of poorly-researched half-truths written by bloggers with a frail grasp on reality and an affinity for really big words that they don’t quite know the meaning of, like nitrso , um, nitarsa, um, nirstirammidngieaygyieg.

Unfortunately, these bloggers seem to hold tremendous influence over the blogosphere, and as a result consumers have little protection from dangerous propaganda intentionally added to internet, even in places that aren’t Reddit.

To avoid the dangers of idiot bloggers writing about processed meats:

  • Always read primary sources for yourself. If there are no primary sources, leave a pleasantly snarky comment to that effect on the blog site and never go there again.
  • Don’t read any articles about sodium nitrate or MSG from bloggers who don’t know how to spell “nitrosamine.”
  • Avoid eating red meats served by restaurants, schools, hospitals, hotels or other institutions without asking for it to be served thick and juicy, just the way you like it. This will give you the courage and moral fortitude to look up stuff yourself on PubMed, without having to rely on bloggers who don’t know how to spell “nitrosamine.”
  • If you are fixated on fresh something, be fixated on Fresh Prince.
  • Avoid processed blog material as much as possible
  • Spread the word and tell others about the dangers of reading idiot blogs about the dangers of sodium nitrate and MSG

Vitamin C naturally found in lime juice that has been gently squeezed into a tumbler of tequila has been shown to help prevent the formation of permanent facepalms after accidently ingesting an idiot nutrition blog and can help protect you from the devastating IQ-lowering effects of blobbers who cant spll. The best defense of course is to avoid the interwebz all together and go dancewalking.


Sources:

  1. http://hollyleehealth.com/2013/04/02/processed-meats-declared-too-dangerous-for-human-consumption/
  2. http://www.wcrf.org/PDFs/Colorectal-cancer-CUP-report-2010.pdf
  3. http://www.jci.org/articles/view/19019