I went to the 2015 Dietary Guidelines Report oral comments session and all I got was this lousy video clip

I had the pleasure of sharing the condensed version of my summary of the 2015 Dietary Guidelines Advisory Committee Report with the folks in Washington earlier this week.

If your idea of fun is watching paint dry, you can catch the full series of comments here.  I’m at 46.24 minutes (at the end, you can play “spot the dietitian” who doesn’t think my comments are one bit amusing).

If you sit through it all, you’ll notice that it’s pretty much an industry vs. vegans cage-match.  Which, unfortunately, leads the folks in the D.C. bubble to think that all “regular folks” (i.e. non-industry) are vegans.

Do me a favor.  Head on over to HHS.gov and provide some written comments of your own.  They can be short, sweet, to the point, but add something! Oral comments (like mine) do not have any more “weight” than written ones.

Yeah, I know what you’re thinking.  Why bother? It’s not going to change anything.  You’re probably right.  It isn’t.  But do it anyway.  The vegatarian community has been vocal, active, present, and heavily invested in this process since the Dietary Guidelines began.  How do you think a vegan diet went from being a “dangerous fad” back in the 1970s to being part of national nutrition policy in 2010?  It’s not like it somehow got “healthier.”

If I try to make the case to policymakers that the rest of America kinda likes eating dead animals, the response is, well, why didn’t we hear from them?  Like attending a funeral “to pay respects to the dead,” it seems (and is) pretty pointless in some regards.  But it does matter.  If not for these specific Guidelines, then for the next ones.

Healthy Nation Coalition has a preliminary analysis of the DGAC Report here that you can use for inspiration.  Or take a few tips from our coalition letter here.

Better yet, tell the folks writing the Guidelines your own story about food and health.  Let them know their Guidelines don’t work for everyone.  And get any friends, neighbors, and co-workers who would rather not have a “culture of health” enforcing their right to eat lentil burgers to pitch in too.

Hey, if I can wear pantyhose for 6 hours straight in order to look presentable at this meeting, the least you can do is go fill out a form.  You can do that in your pajamas.

Written comments accepted through end of day on May 8.

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The 2015 Dietary Advisory Committee Report: A Summary

Last week, the Dietary Guidelines Advisory Committee released the report containing its recommendations for the 2015 Dietary Guidelines for Americans.   The report is 572 pages long, more than 100 pages longer than the last report, released 5 years ago.  Longer than one of my blog posts, even. Despite its length and the tortured governmentalese in which it is written, its message is pretty clear and simple. So for those of you who would like to know what the report says, but don’t want to read the whole damn thing, I present, below, its essence:

Dear America,

You are sick–and fat.  And it’s all your fault. 

Face it.  You screwed up.  Somewhere in the past few decades, you started eating too much food. Too much BAD food.  We don’t know why.  We think it is because you are stupid.

We don’t know why you are stupid.

You used to be smart–at least about food–but somewhere in the late 1970s or early 1980s, you got stupid. Before then, we didn’t have to tell you what to eat.  Somehow, you just knew. You ate food, and you didn’t get fat and sick.

But NOW, every five years we have to get together and rack our brains to try and figure out a way to tell you how to eat–AGAIN.  Because no matter what we tell you, it doesn’t work. 

The more we tell you how to eat, the worse your eating habits get. And the worse your eating habits get, the fatter and sicker you are.  And the fatter and sicker you are, the more we have to tell you how to eat. 

DGA - Length & Obesity 1980-2010

Look. You know we have no real way to measure your eating habits.  Mostly because fat people lie about what they eat and most of you are now, technically speaking, fat.  But we still know that your eating habits have gotten worse. How?  Because you’re fat.  And, y’know, sick.  And the only real reason people get fat and sick is because they have poor eating habits.  That much we do know for sure.

And because, for decades now,  we have been telling you exactly what to eat so you don’t get fat and sick, we also know the only real reason people have poor eating habits is because they are stupid.  So you must be stupid.

Let’s make this as clear as possible for you:

sick fat stupid people

And though it makes our hearts heavy to say this, unfortunately, and through no fault of their own, people who don’t have much money are particularly stupid.  We know this because they are sicker than people who have money.  Of course, money has nothing to do with whether or not you are sick.  It’s the food, stupid.

We’ll admit that some of the responsibility for this rests on our shoulders.  When we started out telling you how to eat, we didn’t realize how stupid you were.  That was our fault.

In 1977, a bunch of us got together to figure out how to make sure you would not get fat and sick.  You weren’t fat and sick at the time, so we knew you needed our help.

We told you to eat more carbohydrates–a.k.a., sugars and starches–and less sugar.  How simple is that?  But could you follow this advice?  Nooooooo.  You’re too stupid.

We told you to eat food with less fat. We meant for you to buy a copy of the Moosewood Cookbook and eat kale and lentils and quinoa.  But no, you were too stupid for that too.  Instead, you started eating PRODUCTS  that said “low-fat” and “fat-free.”  What were you thinking?

We told you to eat less animal fat. Obviously, we meant JUST DON’T EAT ANIMALS.  But you didn’t get it.  Instead, you quit eating cows and started eating chickens.  Hellooooo?  Chickens are ANIMALS.

After more than three decades of us telling you how to eat, it is obvious you are too stupid to figure out how to eat.  So we are here to make it perfectly clear, once and for all.

FIRST:  Don’t eat food with salt in it.

Even though food with salt in it doesn’t make you fat, it does raise your blood pressure.  Maybe.  Sometimes.  And, yes, we know that your blood pressure has been going down for a few decades now, but it isn’t because you are eating less salt because you’re not.  And it’s true that we really have no idea whether or not reducing your intake of salt prevents disease. But all of that is beside the point.

Here’s the deal:  Salt makes food taste good.  And when food tastes good, you eat it.  We’re opposed to that.  But since you are too stupid to actually stop eating food, we are going to insist that food manufacturers stop putting salt in their products.  That way, their products will grow weird microorganisms and spoil rapidly–and will taste like poop.

This will force everyone to stop eating food products and get kale from the farmer’s market (NO SALT ADDED) and lentils and quinoa in bulk from the food co-op (NO SALT ADDED).  Got it?

Also, we are working on ways to make salt shakers illegal. 

Ban Salt Shakers

 

NEXT:  Don’t eat animals. At all.  EVER.

We told you not to eat animals because meat has lots of fat, and fat makes you fat.  Then you just started eating skinny animals. So we’re scrapping the whole fat thing.  Eat all the fat you want.  Just don’t eat fat from animals, because that is the same thing as eating animals, stupid.

We told you not to eat animals because meat has lots of cholesterol, and dietary cholesterol makes your blood cholesterol go up.  Now our cardiologist friends who work for pharmaceutical companies and our buds over at the American Heart Association have told us that avoiding dietary cholesterol won’t actually make your blood cholesterol go down.  They say:  If you want your blood cholesterol to go down, take a statin.  Statins, in case you are wondering, are not made from animals so you can have all you want.  

Eggs? you ask.  We’ve ditched the cholesterol limits, so now you think you can eat eggs?  Helloooo?  Eggs are just baby chickens and baby chickens are animals and you are NOT ALLOWED TO EAT ANIMALS.  Geez.

Yes, we are still hanging onto that “don’t eat animals because of saturated fat” thing, but we know it can’t last forever since we can’t actually prove that saturated fat is the evil dietary villain we’ve been saying it is.  So …

Here’s the deal:  Eating animals doesn’t just kill animals.  It kills the planet.  If you keep killing animals and eating them WE ARE ALL GOING TO DIE.  And it’s going to be your fault, stupid.

And especially don’t eat red meat.  C’mon.  Do we have to spell this out for you?  RED meat? 

RED meat = COMMUNIST meat.  Does Vladimir Putin look like a vegan?  We thought not. 

 

 If you really must eat dead rotting flesh, we think it is okay to eat dead rotting fish flesh, as long as it is from salmon raised on ecologically sustainable fish farms by friendly people with college educations. 

FINALLY:  Stop eating–and drinking–sugar.

Okay, we know we told you to eat more carbohydrate food.  And, yes, we know sugar is a carbohydrate. But did you really think we were telling you to eat more sugar?  Look, if you must have sugar, eat some starchy grains and cereals. The only difference between sugar and starch is about 15 minutes in your digestive tract.  But …

Here’s the deal:  Sugar makes food taste good.  And when food tastes good, you eat it.  Like we said, we’re opposed to that.  But since you are too stupid to actually stop eating food, we are going to insist that food manufacturers stop putting sugar in their products.  That way, their products will grow weird microorganisms and spoil rapidly–and will taste like poop.

This will force everyone to stop eating food products and get kale from the farmer’s market (NO SUGAR ADDED) and lentils and quinoa in bulk from the food co-op (NO SUGAR ADDED).  Got it?

Ban cupcakes

 

Hey, we know what you’re thinking.  You’re thinking “Oh, I’ll just use artificial sweeteners instead of sugar.”  Oh NOOOO you don’t.  No sugar-filled soda.  No diet soda.  Water only. Capiche?

 So, to spell it all out for you once and for all:

DO NOT EAT food that has salt or sugar in it, i.e. food that tastes good.  Also, don’t eat animals.

DO EAT kale from your local farmers’ market, lentils and quinoa from your local food co-op,  plus salmon. Drink water.  That’s it. 

And, since we graciously recognize the diversity of this great nation, we must remind you that you can adapt the above dietary pattern to meet your own health needs, dietary preferences, and cultural traditions. Just as long as you don’t add salt, sugar, or dead animals.

Because we have absolutely zero faith you are smart enough to follow even this simple advice, we are asking for additional research to be done on your child-raising habits (Do you let your children eat food that tastes good?  BAAAAD parent!) and your sleep habits (Do you dream about cheeseburgers?  We KNOW you do and that must stop!  No DEAD IMAGINARY ANIMALS!)

And–because we recognize your deeply ingrained stupidity when it comes to all things food, and because we know that food is the only thing that really matters when it comes to health, we are proposing  America create a national “culture of health” where healthy lifestyles are easier to achieve and normative.

“Normative” is a big fancy word that means if you eat what we tell you to eat, you are a good person and if you eat food that tastes good, you are a bad person. We will know you are a bad person because you will be sick. Or fat. Because that’s what happens to bad people who eat bad food.

We will kick-off this “culture of health” by creating an Office of Dietary Wisdom that will make the healthy choice–kale, lentils, quinoa, salmon, and water–the easy choice for all you stupid Americans.  We will establish a Food Czar to run the Office of Dietary Wisdom because nothing says “America, home of freedom and democracy” like the title of a 19th-century Russian monarch.*

The primary goal of the “culture of health” will be to enforce your right to eat what we’ve determined is good for you. 

This approach will combine the draconian government overreach we all love with the lack of improvements we expect, resulting in a continued demand for our services as the only people smart enough to tell the stupid people how to eat.**

 Look.  We know we’ve been a little unclear in the past.  And we know we’ve reversed our position on a number of things. Hey, our bad.  And when, five years from now, you stupid Americans are as sick and fat as ever, we may have to change up our advice again based, y’know, on whatever evidence we can find that supports the conclusions we’ve already reached.

But rest assured America.

No matter what the evidence says, we are never ever going to tell you it’s okay to eat salt, sugar, or animals.  And, no matter what the evidence says, we are never ever going to tell you that it’s not okay to eat grains, cereals, or vegetable oils.  And you can take that to the bank.  We did.

Love and kisses,

Committee for Government Approved Information on Nutrition (Code name: G.A.I.N.)

***********************************************************************************

*Thank you, Steve Wiley.

**Thank you, Jon Stewart, for at least part of this line.

 

Changing the Dietary Guidelines

If you have been following any of the Dietary Guidelines Advisory Committee’s meetings (who does that anyway? I mean, unless you are a total geek like I am), then you might have noticed that the next Guidelines seem very likely to continue to promote the same nutritional advice that has proven largely ineffective for more than 35 years.

In my other, not-quite-so-snarky, life, I am not Wonder Woman (but oh, what I wouldn’t give for a pair of bracelets of submission). However, I am director of the Healthy Nation Coalition, a loose affiliation of healthcare and public health professionals, scientists, and concerned citizens who think it is time we did nutrition a little differently. Right now, we are creating a coalition of supporters to speak out against the direction the current 2015 Dietary Guidelines are taking and to offer an alternative approach.

This letter will be delivered to the Secretaries of the U.S. Departments of Agriculture and Health and Human Services, selected policymakers, and interested media outlets. We hope to add to the momentum that has been building in the national media calling for a change in our national dietary guidance (see Nina Teicholz’ book, Big Fat Surprise, and her recent op-ed in the Wall Street Journal).

The letter is copied below (or you can use this link to the pdf–the pdf is where all the citations are, because I know how you love citations).

If you wish to sign on, you can use this quick form to add your information to the letter. If you’re interested, but don’t want to read the whole boring letter, check out Mark Sisson’s blog post about it.  It’s lots more fun.

In a nutshell, we are asking for Dietary Guidelines that are geared toward the general public and focused on adequate essential nutrition.

This is not a call for low-carb, high-fat dietary recommendations, or paleo ones, and it takes no stance on the whole “calories in, calories out” versus hormonal regulation etc. etc. issue.  So if you want to criticize this approach, don’t start bitching about low-carb diets or CICO, or I’ll know that you haven’t bothered to actually read this and I won’t feel guilty about deleting your comments.  Beyond that, if you have genuine objections to this approach, suggest a better one–or go away.   What we are doing now isn’t working.  What we need is productive conversation about what to do differently.

Healthy Nation Coalition Letter – 2015 Dietary Guidelines for Americans

Dear Secretary Burwell and Secretary Vilsack,

At the conclusion of the sixth meeting of the 2015 Dietary Guidelines Advisory Committee (DGAC), we write to express concern about the state of federal nutrition policy and its long history of failure in preventing the increase of chronic disease in America. The tone, tenor, and content of the DGAC’s public meetings to date suggest that the 2015 Dietary Guidelines for Americans (DGA) will perpetuate the same ineffective federal nutrition guidance that has persisted for nearly four decades but has not achieved positive health outcomes for the American public.

We urge you to adhere to the initial Congressional mandate that the DGA act as “nutritional and dietary information and guidelines for the general public” and are “based on the preponderance of the scientific and medical knowledge which is current at the time the report is prepared.”

Below we lay out specific objections to the DGA:
· they have contributed to the increase of chronic diseases;
· they have not provided guidance compatible with adequate essential nutrition;
· they represent a narrow approach to food and nutrition inconsistent with the nation’s diverse cultures, ethnicities, and socioeconomic classes;
· they are based on weak and inconclusive scientific data;
· and they have expanded their purpose to issues outside their original mandate.

As you prepare to consider the 2015 DGAC’s recommendations next year, we urge you to fulfill your duty to create the dietary foundation for good health for all Americans by focusing on adequate essential nutrition from whole, nourishing foods, rather than replicating guidance that is clearly failing.

The DGA have contributed to the rapid rise of chronic disease in America.

In 1977, dietary recommendations (called Dietary Goals) created by George McGovern’s Senate Select Committee advised that, in order to reduce risk of chronic disease, Americans should decrease their intake of saturated fat and cholesterol from animal products and increase their consumption of grains, cereal products, and vegetable oils. These Goals were institutionalized as the DGA in 1980, and all DGA since then have asserted this same guidance. During this time period, the prevalence of heart failure and stroke has increased dramatically. Rates of new cases of all cancers have risen. Most notably, rates of diabetes have tripled. In addition, although body weight is not itself a measure of health, rates of overweight and obesity have increased dramatically. In all cases, the health divide between black and white Americans has persisted or worsened.

While some argue that Americans have not followed the DGA, all available data show Americans have shifted their diets in the direction of the recommendations: consuming more grains, cereals, and vegetable oils, while consuming less saturated fat and cholesterol from whole foods such as meat, butter, eggs, and full-fat milk. Whether or not the public has followed all aspects of DGA guidance does not absolve the U.S. Departments of Agriculture (USDA) and Health and Human Services (DHHS) from ensuring that the dietary guidance provided to Americans first and foremost does no harm.

The DGA fail to provide guidance compatible with essential nutrition needs.

The 1977 Dietary Goals marked a radical shift in federal dietary guidance. Before then, federal dietary recommendations focused on foods Americans were encouraged to eat in order to acquire adequate nutrition; the DGA focus on specific food components to limit or avoid in order to prevent chronic disease. The DGA have not only failed to prevent chronic disease, in some cases, they have failed to provide basic guidance consistent with nutritionally adequate diets.
· Maillot, Monsivais, and Drewnowski (2013) showed that the 2010 DGA for sodium were incompatible with potassium guidelines and with nutritionally adequate diets in general.
· Choline was recognized as an essential nutrient in 1998, after the DGA were first created. It is crucial for healthy prenatal brain development. Current choline intakes are far below adequate levels, and choline deficiency is thought to contribute to liver disease, atherosclerosis and neurological disorders. Eggs and meat, two foods restricted by current DGA recommendations, are important sources of choline. Guidance that limits their consumption thus restricts intake of adequate choline.
· In young children, the reduced fat diet recommend by the DGA has also been linked to lower intakes of a number of important essential nutrients, including calcium, zinc, and iron.

Following USDA and DHHS guidance should not put the most vulnerable members of the population at risk for nutritional inadequacy. DGA recommendations should be emphasizing whole foods that provide essential nutrition, rather than employing a reductionist approach based on single food components to exclude these foods from the diet.

The DGA’s narrow approach to food and health is inappropriate for a diverse population.

McGovern’s 1977 recommendations were based on research and food patterns from middle class Caucasian American populations. Since then, diversity in America has increased, while the DGA have remained unchanged. DGA recommendations based on majority-white, high socioeconomic status datasets have been especially inappropriate for minority and low-income populations. When following DGA recommendations, African American adults gain more weight than their Caucasian counterparts, and low-income individuals have increased rates of diabetes, hypertension, and high cholesterol. Long-standing differences in environmental, genetic and metabolic characteristics may mean recommendations that are merely ineffective in preventing chronic disease in white, middle class Americans are downright detrimental to the long-term health of black and low-income Americans.

The DGA plant-based diet not only ignores human biological diversity, it ignores the diversity of American foodways. DGA guidance rejects foods that are part of the cultural heritage of many Americans and indicates that traditional foods long considered to be important to a nourishing diet should be modified, restricted, or eliminated altogether: ghee (clarified butter) for Indian Americans; chorizo and eggs for Latino Americans; greens with fatback for Southern and African Americans; liver pâtés for Jewish and Eastern European Americans.

Furthermore, recommendations to prevent chronic disease that focus solely on plant-based diets is a blatant misuse of public health authority that has stymied efforts of researchers, academics, healthcare professionals, and insurance companies to pursue other dietary approaches adapted to specific individuals and diverse populations, specifically, the treatment of diabetes with reduced-carbohydrate diets that do not restrict saturated fat. In contradiction of federal law, the DGA have had the effect of limiting the scope of medical nutrition research sponsored by the federal government to protocols in line with DGA guidance.

The DGA are not based on the preponderance of current scientific and medical knowledge.

The science behind the current DGA recommendations is untested and inconsistent. Scientific disagreements over the weakness of the evidence used to create the 1977 Dietary Goals have never been settled. Recent published accounts have raised questions about whether the scientific process has been undermined by politics, bias, institutional inertia, and the influence of interested industries.

Significant scientific controversy continues to surround specific recommendations that:
1. Dietary saturated fat increases the risk of heart disease: Two recent meta-analyses concluded there is no strong scientific support for dietary recommendations that restrict saturated fat. Studies cited by the 2010 DGAC Report demonstrate that in some populations, lowering dietary saturated fat actually worsens some biomarkers related to heart disease.
2. Dietary cholesterol increases the risk of heart disease: Due to a lack of evidence, nearly all other Western nations have dropped their limits on dietary cholesterol. In 2013, a joint panel of the American Heart Association and the American College of Cardiology did the same.
3. Polyunsaturated vegetable oils reduce the risk of heart disease and should be consumed as the primary source of dietary fat: Recent research renews concerns raised in response to the 1977 Dietary Goals that diets high in the omega-6 fatty acids present in vegetable oils may actually increase risk of chronic disease or death.
4. A diet high in carbohydrate, including whole grains, reduces risk of chronic disease: Clinical trials have demonstrated that diets with lower carbohydrate content improve risk factors related to heart disease and diabetes. Janet King, Chair of the 2005 DGAC, has stated that “evidence has begun to accumulate suggesting that a lower intake of carbohydrate may be better for cardiovascular health.”
5. A low-sodium diet reduces risk of chronic disease: A 2013 Institute of Medicine report concludes there is insufficient evidence to recommend reducing sodium intake to the very low levels set by the DGA for African-Americans of any age and adults over 50.

In all of these cases, contradictory evidence has been ignored in favor of maintaining outdated recommendations that have failed to prevent chronic disease.

More generally, “intervention studies, where diets following the Dietary Guidelines are fed long-term to human volunteers, do not exist,” and food patterns recommended by the DGA “have not been specifically tested for health benefits.” The observational research being used for much of the current DGAC activities may suggest possible associations between diet and disease, but such hypotheses must then be evaluated through rigorous testing. Applying premature findings to public health policy without adequate testing may have resulted in unintended negative health consequences for many Americans.

The DGA have overstepped their original purpose.

The DGA were created to provide nutrition information to all Americans. However, the current 112-page DGA, with 29 recommendations, are considered too complex for the general public and are directed instead at policymakers and healthcare professionals, contradicting their Congressional mandate.

Federal dietary guidance now goes far beyond nutrition information. It tells Americans how much they should weigh and how to lose weight, even recommending that each American write down everything that is eaten on a daily basis. This focus on obesity and weight loss has contributed to extensive and unrecognized “collateral damage”: fat-shaming, eating disorders, discrimination, and poor health from restrictive food habits. At the same time, researchers at the Centers for Disease Control have shown that overweight and obese people are often as healthy as their “normal” weight counterparts. Guidance related to body weight should meet individual health requirements and be given by a trained healthcare practitioner, not be dictated by federal policy.

The DGA began as an unmandated consumer information booklet. They are now a powerful political document that regulates a vast array of federal programs and services, dictates nationwide nutrition standards, influences agricultural policies and health-related research, and directs how food manufacturers target consumer demand. Despite their broad scope, the DGA are subject to no evaluation or accountability process based on health outcomes. Such an evaluation would demonstrate that they have failed to fulfill their original goal: to decrease rates of chronic disease in America.

Despite this failure, current DGAC proceedings point to an expansion of their mission into sustainable agriculture and environmental concerns. While these are important issues, they demonstrate continued “mission creep” of the DGA. The current narrow DGA focus on plant-based nutrition suggests a similarly biased approach will be taken to environmental issues, disregarding centuries of traditional farming practices in which livestock play a central role in maintaining soil quality and ecological balance. Instead of warning Americans not to eat eggs and meat due to concerns about saturated fat, cholesterol, and obesity, it is foreseeable that similar warnings will be given, but for “environmental” reasons. This calls for an immediate refocusing of the purpose of the DGA and a return to nutritional basics.

Solution: A return to essential nutrition guidance

As our nation confronts soaring medical costs and declining health, we can no longer afford to perpetuate guidelines that have failed to fulfill their purpose. Until and unless better scientific support is secured for recommendations regarding the prevention of chronic disease, the DGA should focus on food-based guidance that assists Americans in acquiring adequate essential nutrition.

Shifting the focus to food-based guidance for adequate essential nutrition will create DGA that:
· are based on universally accepted and scientifically sound nutritional principles: Although more knowledge is needed, the science of essential nutrient requirements is firmly grounded in clinical trials and healthcare practice, as well as observational studies.
· apply to all Americans: Essential nutrition requirements are appropriate for everyone. Lack of essential nutrients will lead without exception to diseases of deficiency.
· include traditionally nourishing foods: A wide variety of eating patterns can provide adequate essential nutrition; no nourishing dietary approaches or cultural food traditions would be excluded or discouraged.
· expand opportunities for research: With dietary guidance focused on adequate essential nutrition, researchers, healthcare providers, and insurance companies may pursue dietary programs and practices tailored to individual risk factors and diverse communities without running afoul of the DGA and while ensuring that basic nutrition needs are always met.
· direct attention towards health and well-being: Focus will be directed away from intermediate markers, such as weight, which may be beyond individual control, do not consistently predict health outcomes, and are best dealt with in a healthcare setting.
· are clear, concise, and useful to the public: Americans will be able to understand and apply such guidance to their own dietary patterns, minimizing the current widespread confusion and resentment resulting from federal dietary guidance that is poorly grounded in science.

It is the duty of USDA and DHHS leadership to end the use of controversial, unsuccessful and discriminatory dietary recommendations. USDA and DHHS leadership must refuse to accept any DGA that fail to establish federal nutrition policy based on the foundation of good health: adequate essential nutrition from wholesome, nourishing foods. It is time to create DGA that work for all Americans.

 

The Real Paleo Challenge Redux

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

But now I feel like it should be more like:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Yeah, we tend to do the exact same thing.

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

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

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

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

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

Us: Same promise, different food.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Laura Schoenfeld @ Ancestralize Me!

Beth Mazur @ Weight Maven

Melissa McEwan @ Hunt Gather Love

Robert Patterson @ Michael Rose’s 55

Chris Masterjohn @ The Daily Lipid

Doug Imig – The Urban Child Institute

Andrew Abrahams – Long Dream Farm

Michael Ostrolenk – The Transpartisan Center

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

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

Make me some science I can’t refuse

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

Well–as they say down South– I never!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Take the science, leave the cannoli.

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

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

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

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

Personally responsible or helplessly victimized?

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

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

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

Just like it was in 1952.

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

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

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

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

Then, somewhat inexplicably, obesity took off.”

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

And what is Government going to do about it?

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

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

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

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

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

Been there, done that, failed miserably.

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

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

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

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

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

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

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

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

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

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

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

Fixing it until it broke

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

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

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

As the Calories Churn (Episode 2): Honey, It’s Not the Sugar

In the previous episode of As the Calories Churn, we looked at why it doesn’t really make sense to compare the carbohydrate intake of Americans in 1909 to the carbohydrate intake of Americans in 1997.  [The folks who read my blog, who always seem to be a lot smarter than me, have pointed out that, besides not being able to determine differing levels of waste and major environmental impacts such as a pre- or early-industrial labor force and transportation, there would also be significant differences in:  distribution and availability; what was acquired from hunted/home-grown foods; what came through the markets and ended up as animal rather than human feed; what other ingredients these carbohydrates would be packaged and processed with; and many other issues.  So in other words, we not comparing apples and oranges; we are comparing apples and Apple Jacks (TM).]

America in 1909 was very different from America in 1997, but America in 1970 was not so much, certainly with regard to some of the issues above that readers have raised.  By 1970, we had begun to settle into post-industrial America, with TVs in most homes and cars in most driveways.  We had a wide variety of highly-processed foods that were distributed through a massive transportation infrastructure throughout the country.

Beginning in the mid-1960s, availability of calories in the food supply, specifically from carbohydrates and fats had begun to creep up.  So did obesity.  It makes sense that this would be cause for concern from public health professionals and policymakers, who saw a looming health crisis ahead if measures weren’t taken–although others contended that our food supply was safer and more nutritious than it had ever been and that public health efforts should be focused on reducing smoking and environmental pollutants.

What emerged from the political and scientific tug-of-war that ensued (a story for another blog post) were the 1977 Dietary Goals for Americans.  These goals told us to eat more grains, cereals and vegetable oils and less fat, especially saturated fat.

Then, around 1977 – 1980, in other words around the time of the creation of the USDA’s recommendations to increase our intake of grains and cereals (both carbohydrate foods) and to decrease our intake of fatty foods, we saw the slope of availability of carbohydrate calories increase dramatically, while the slope of fat calories flattened–at least until the end of the 1990s (another story for another blog post).

[From food availability data, not adjusted for losses.]

The question is:  How did the changes in our food supply relate to the national dietary recommendations we were given in 1977?  Let’s take a closer look at the data that we have to work with on this question.

Dear astute and intelligent readers: From this point on, I am primarily using loss-adjusted food availability data rather than food availability data. Why? Because it is there, and it is a better estimate of actual consumption than unadjusted food availability data. It only goes back to around 1970, so you can’t use it for century-spanning comparisons, but if you are trying to do that, you’ve probably got another agenda besides improving estimation anyway. [If the following information makes you want to go back and make fun of my use of unadjusted food availability data in the previous post, go right ahead. In case you didn’t catch it, I think it is problematic to the point of absurdity to compare food availability data from the early 1900s to our current food system—too many changes and too many unknowns (see above).  On the other hand, while there are some differences, I think there are enough similarities in lifestyle and environment (apart from food) between 1970 and 2010 to make a better case for changes in diet and health being related to things apart from those influences.]

Here are the differences in types of food availability data: 

Food availability data: Food availability data measure the use of basic commodities, such as wheat, beef, and shell eggs for food products at the farm level or an early stage of processing. They do not measure food use of highly processed foods– –in their finished form. Highly processed foods–such as bakery products, frozen dinners, and soups—are not measured directly, but the data includes their less processed ingredients, such as sugar, flour, fresh vegetables, and fresh meat.

Loss-Adjusted Food Availability: Because food availability data do not account for all spoilage and waste that accumulates in the marketing system and is discarded in the home, the data typically overstate actual consumption. Food availability is adjusted for food loss, including spoilage, inedible components (such as bones in meat and pits in fruit), plate waste, and use as pet food.

The USDA likes to use unadjusted food availability data and call it “consumption” because, well: They CAN and who is going to stop them?

The USDA—and some bloggers too, I think—prefer unadjusted food availability data.  I guess they have decided that if American food manufacturers make it, then Americans MUST be eating it, loss-adjustments be damned. Our gluttony must somehow overcome our laziness, at least temporarily, as we dig the rejects and discards out of the landfills and pet dishes—how else could we get so darn fat?

I do understand the reluctance to use dietary intake data collected by NHANES, as all dietary intake data can be unreliable and problematic  (and not just the kind collected from fat people).  But I guess maybe if you’ve decided that Americans are being “highly inaccurate” about what they eat, then you figure it is okay be “highly inaccurate” right back at Americans about what you’ve decided to tell them about what they eat.  Because using food availability data and calling it “consumption” is to put it mildly, highly inaccurate, by a current difference of over 1000 calories.

On the other hand, it does sound waaaaaay more dramatic to say that Americans consumed 152 POUNDS (if only I could capitalize numbers!) per person of added sweeteners in 2000 (as it does here), than it does to say that we consumed 88 pounds per person that year (which is the loss-adjusted amount). Especially if you are intent on blaming the obesity crisis on sugar.

Which is kinda hard to do looking at the chart below.

Loss adjusted food availability:

Calories per day 1970 2010
Total 2076 2534 +458
Added fats and oils 338 562 +224
Flour and cereal products 429 596 +167
Poultry 75 158 +83
Added sugars and sweeteners 333 367 +34
Fruit 65 82 +17
Fish 12 14 +2
Butter 29 26 -3
Veggies 131 126 -5
Eggs 43 34 -9
Dairy 245 232 -13
Red meat* 349 267 -82
Plain whole milk 112 24 -88

*Red meat: beef, veal, pork, lamb

Anybody who thinks we did not change our diet dramatically between 1970 and the present either can’t read a dataset or is living in a special room with very soft bouncy walls. Why we changed our diet is still a matter of debate. Now, it is my working theory that the changes that you see above were precipitated, at least in part, by the advice given in the 1977 Dietary Goals for Americans, which was later institutionalized, despite all kinds of science and arguments to the contrary, as the first Dietary Guidelines for Americans in 1980.

Let’s see if my theory makes sense in light of the loss-adjusted food availability data above (and which I will loosely refer to as “consumption”).  The 1977 [2nd Edition] Dietary Goals for Americans say this:

#1 – Did we increase our consumption of grains? Yes. Whole? Maybe not so much, but our consumption of fiber went from 19 g per day in 1970 to 25 g per day in 2006 which is not much less than the 29 grams of fiber per day that we were consuming back in 1909 (this is from food availability data, not adjusted for loss, because it’s the only data that goes back to 1909).

The fruits and veggies question is a little more complicated. Availability data (adjusted for losses) suggests that veggie consumption went up about 12 pounds per person per year (sounds good, but that’s a little more than a whopping half an ounce a day), but that calories from veggies went down. Howzat? Apparently Americans were choosing less caloric veggies, and since reducing calories was part of the basic idea for insisting that we eat more of them, hooray on us. Our fruit intake went up by about an ounce a day; calories from fruit reflects that. So, while we didn’t increase our vegetable and fruit intake much, we did increase it. And just FYI, that minuscule improvement in veggie consumption didn’t come from potatoes. Combining fresh and frozen potato availability (adjusted for losses), our potato consumption declined ever so slightly.

#2 – Did we decrease our consumption of refined sweeteners? No. But we did not increase our consumption as much as some folks would like you to think. Teaspoons of added (caloric) sweeteners per person in our food supply (adjusted for waste) went from 21 in 1970 to 23 in 2010.  It is very possible that some people were consuming more sweeteners than other people since those numbers are population averages, but the math doesn’t work out so well if we are trying to blame added sweeteners for 2/3 of the population gaining weight.  It doesn’t matter how much you squint at the data to make it go all fuzzy, the numbers pretty much say that the amount of sweeteners in our food supply has not dramatically increased.

#3 – Did we decrease our consumption of total fat? Maybe, maybe not—depends on who you want to believe. According to dietary intake data (from our national food monitoring data, NHANES), in aggregate, we increased calories overall, specifically from carbohydrate food, and decreased calories from fat and protein. That’s not what our food supply data indicate above, but there you go.

Change in amount and type of calories consumed from 1971 to 2008
according to dietary intake data

There is general agreement , however, from both food availability data  and from intake data, that we decreased our consumption of the saturated fats that naturally occur with red meat, eggs, butter, and full-fat milk (see below), and we increased our consumption of “added fats and oils,” a category that consists almost exclusively of vegetable oils, which are predominantly polyunsaturated and which were added to foods–hence the category title–such as those inexpensive staples, grains and cereals, during processing.

#4 – Did we decrease our consumption of animal fat, and choose “meat, poultry, and fish which will reduce saturated fat intake”? Why yes, yes we did. Calories from red meat—the bearer of the dreaded saturated fat and all the curses that accompany it—declined in our food system, while poultry calories went up.

(So, I have just one itty-bitty request: Can we stop blaming the rise in obesity rates on burgers? Chicken nuggets, yes. KFC, yes. The buns the burgers come on, maybe. The fries, quite possibly. But not the burgers, because burgers are “red meat” and there was less red meat—specifically less beef—in our food supply to eat.)

Michael Pollan–ever the investigative journalist–insists that after 1977, “Meat consumption actually climbed” and that “We just heaped a bunch more carbs onto our plates, obscuring perhaps, but not replacing, the expanding chunk of animal protein squatting in the center.”   In the face of such a concrete and well-proven assumption, why bother even  looking at food supply data, which indicate that our protein from meat, poultry, fish, and eggs  “climbed” by just half an ounce?

In fact, there’s a fairly convenient balance between the calories from red meat that left the supply chain and the calories of chicken that replaced them. It seems we tried to get our animal protein from the sources that the Dietary Goals said were “healthier” for us.

#5 – Did we reduce our consumption of full-fat milk? Yes. And for those folks who contend this means we just started eating more cheese, well, it seems that’s pretty much what we did. However, overall decreases in milk consumption meant that overall calories from dairy fat went down.

#6 – Did we reduce our consumption of foods high in cholesterol? Yes, we did that too. Egg consumption had been declining since the relative affluence of post-war America made meat more affordable and as cholesterol fears began percolating through the scientific and medical community, but it continued to decline after the 1977 Goals.

#7 – Salt? No, we really haven’t changed our salt consumption much and perhaps that’s a good thing. But the connections between salt, calorie intake, and obesity are speculative at best and I’m not going to get into them here (although I do kinda get into them over here).

food supply and Dietary GoalsWhat I see when I look at the data is a good faith effort on the part of the American people to try to consume more of the foods they were told were “healthy,” such as grains and cereals, lean meat, and vegetable oils. We also tried to avoid the foods that we were told contained saturated fat—red meat, eggs, butter, full-fat milk—as these foods had been designated as particularly “unhealthy.” No, we didn’t reduce our sweetener consumption, but grains and cereals have added nearly 5 times more calories than sweeteners have to our food supply/intake.

Although the America of 1970 is more like the America of today than the America of 1909, some things have changed. Probably the most dramatic change between the America of the 1970s and the America of today is our food-health system. Women in the workplace, more suburban sprawl, changing demographics, increases in TV and other screen time—those were all changes that had been in the works for a long time before the 1977 Dietary Goals came along. But the idea that meat and eggs were “bad” for you? That was revolutionary.

And the rapid rises in obesity and chronic diseases that accompanied these changes? Those were pretty revolutionary as well.

One of my favorite things to luck upon on a Saturday morning in the 70s—aside from the Bugs Bunny-does-Wagner cartoon, “What’s Opera, Doc?“—were the public service announcements featuring Timer, an amorphous yellow blob with some sing-along information about nutrition:

You are what you eat

From your head down to your feet

Thinks like meat and eggs and fish you

Need to build up muscle tissue

Hello appetite control?

More protein!

Meat and eggs weren’t bad for you. They didn’t cause heart disease. You needed them to build up muscle tissue and to keep you from being hungry!

But in 1984, when this showed up on the cover of Time magazine (no relation to Timer the amorphous blob), I—along with a lot of other Americans—was forced to reconsider what I’d learned on those Saturday morning not that long ago:

My all-time favorite Timer PSA was this one:

When my get up and go has got up and went,

I hanker for a hunk of cheese.

When I’m dancing a hoedown

And my boots kinda slow down,

Or any time I’m weak in the knees . . .

I hanker for a hunk of

A slab or slice or chunk of–

A snack that is a winner

And yet won’t spoil my dinner–

I hanker for hunk of CHEESE!

In the 80s, when I took up my low-fat, vegetarian ways, I would still hanker for a hunk of cheese, but now I would look for low-fat, skim, or fat-free versions—or feel guilty about indulging in the full-fat versions that I still loved.

I’m no apologist for the food industry; such a dramatic change in our notions about “healthy food” clearly required some help from them, and they appear to have provided it in abundance.  And I’m not a fan of sugar-sweetened beverages or added sweeteners in general, but dumping the blame for our current health crisis primarily on caloric sweeteners is not only not supported by the data at hand, it frames the conversation in a way that works to the advantage of the food industry and gives our public health officials a “get out of jail free card”  for providing 35 years worth of lousy dietary guidance.

Next time on As the Calorie Churns, we’ll explore some of the interaction between consumers, industry, and public health nutrition recommendations. Stay tuned for the next episode, when you’ll get to hear Adele say: “Pollanomics: An approach to food economics that is sort of like the Field of Dreams—only with taco-flavored Doritos.”