From Paleo to Public Health: We have met the enemy and we are them

Believe it or not, when I started this blog post, I wasn’t even thinking about the current sturm und drang in the paleo community. If you follow the paleo world gossip, you already know about it; if you’re not, this cartoon from xkcd.com says it all:

So—speaking of drama—social change stories are often built around drama triangles—also called triangles of power. In these triangles, there are three roles: victim, perpetrator, and rescuer. These roles can morph and change over time and depending on who is telling the story or who the audience is. In addition, a person or entity can be in more than one role at a time. [Note: This doesn’t mean that anyone actually IS a victim, perpetrator, rescuer; this is a construct used to describe a social dynamic, not enforce one.]

From the works of Eric Berne and Stephen Karpman.

We can think about this model in regard to the current commotion in the paleo community, but–more to my point–also in regard to the work we may be able to do as a community should we decide to get our collective act together and worry about something larger than ourselves for a while. (Perhaps we’ll need social media group therapy, culminating in a giant Skype conference call, where everybody joins twitter feeds and sings Kumbaya?)

There is value in the power of story-telling; the drama is part of what makes us want to be involved in cause. We can typically identify with the victim or the rescuer, or both; the perpetrator gives us a bad guy in an undeniably black hat on which to focus our things-we-love-to-hate passion. Policymakers often prefer stories to logical arguments; many of us do. But stories can also create false simplicity and black and white reasoning. They can create artificial walls and boundaries. Most dangerously for the nutrition reform movement, these stories can create a lack of respect for those we are trying to help (“We know what is best for you”) and a lack of humility with regard to our own fallibility (“We have the “right” answers this time”).

As nutrition reformers—from paleo to public health—what story are we going to tell?

We must be sensitive in our choice of who we place in the “victim” role. The “victim” is the one that pulls at our heartstrings, that gives the story its emotional weight. I think the real victims in the nutrition reform story are our next generation, the children who are not yet born but who will bear the burdens of a broken food-health system as much of the American public gets caught in a cycle of being misled, misfed, misdiagnosed, and mistreated. These are children who will grow up in a nation where the dream of good health belongs to a fortunate few and slips from the grasp of everyone else despite all good intentions and efforts otherwise. And because these particular victims don’t exist (yet), it saves us from the awkward position of “rescuing” people who don’t consider themselves to be victims.

Some people who are suffering from obesity and poor health today (some of us even) may see themselves as victims and choose to use the sense of outrage at being put in that position to help change the system. But not everyone will choose that role, and I suggest we not take the stance that “poor fat sick people” out there need our help.

It isn’t as if we have a shortage of casualties from the past 30-40 years of USDA/HHS dietary guidance. How about the environment, small farmers, taxpayers, or maybe the scientific integrity of a whole generation of nutrition scientists? In 1978, Dr. Al Harper, from the University of Wisconsin-Madison, warned that the Dietary Goals’ promise of better health for all with no risks, only benefits, had ” great potential for undermining both the science of nutrition and nutrition education” [1]. It would seem that to a large extent, he was right. As a nation, we’ve lost a lot in thirty years.

So who is to blame? Hmm. Good question.

Government?

Policymakers doing what policymakers do: making policy.

Well, it is hard to pin this all on a disembodied “government” because the government does what we allow it to do. As long as we the people allowed segregation, it continued. When we decided that segregation was no longer tolerable, laws were created to end it. Changing attitudes will change the institutions that in turn shape attitudes.

It doesn’t make a lot of sense to blame “the government,” when the general public has not developed a mature sense of healthy skepticism towards the government’s ability to protect us from ourselves. When the first Dietary Goals were released by the McGovern Committee in 1977 and the first Dietary Guidelines released by the USDA in 1980, the public could have refused to believe the low-fat-jello-pie-in-the-sky promises, but they didn’t—for reasons that may be more cultural than scientific in nature. I’m not convinced we would do so under similar circumstances today. Although we may now be more wary of the government’s ability to solve our problems, we tend to still hold out a childish hope that it will anyway. [Funny, to me anyway, story: It seems that a number of us who showed up for the paleo-libertarian dinner at AHS2012 were there less because of our libertarian ideals and more because we were happy to have someone else choosing our dinner destination and making reservations for us. Just a touch of irony there.]

In 1977 and in 1980, policymakers were applying the information that they had at the time to a well-intentioned goal of improving the health of all American; this is just the type of thing we expect from our policymakers. Did they seem to favor one side of the argument? Sure, but do we really think that—if we were in their position—we could work with complete objectivity? We couldn’t; there is no such thing. As we try to change public opinion and government policy, we will be working under the same constraints of humanness they were, with the only added advantage being that we can learn from the unintended consequences of these good intentions.

Industry?

Low-fat, whole grain, fiber-filled box of food: more nutrition information than actual nutrition.

Should we blame “the food industry”? We could.

Gary Taubes tells the story of one of the staff members of the McGovern Committee being approached by an industry analyst who tells him, “if you think people are going to start eating more broccoli and more kale and spinach because you’ve now put together dietary goals, you’re crazy. What you’ve said is people should eat less fat so the industry is going to jump on this and they’re going to create low fat products and they’re going to label them as heart healthy or whatever and they’re going to be able to carve out a portion of the market for their new products and everyone else is going to have to play catch-up and that’s what they’re going to do and the next thing you know you’re going to have shelf after shelf in the supermarket of junk foods that claim to be low fat and good for your heart.” As Gary Taubes points out, that’s exactly what happened. But is this the fault of industry?

Industry follows laws of supply and demand, using government recommendations as a marketing tool. Americans were happy to consume the products designed to lower our cholesterol and prevent heart disease then, because we thought doing so would contribute to good health. Now we, as a community hoping to expand our influence out to the rest of America, are happy to consume gluten-free snacks, grass-fed beef, and pemmican—for the exact same reason, because we think doing so will contribute to good health. We might have been sold a bill of goods by the food industry in the past 30 years, but by golly, we bought it.

Addressing the economic engines that make our food-health system go around is part of our challenge in shifting the paradigm. Working with the producers, especially the one at the bottom of the industrialized food chain, and the retailers, who must meet changing consumer demands—rather than lumping everyone together and clamping a big black hat on the whole thing—is a lot more likely to lead to success.

If there is a lesson to be learned here, maybe it is that we should be cautious about what health information we allow to be used on packaging and marketing, no matter what the nutrition paradigm. I don’t agree with Marion Nestle on much, but I agree with her that a box of food is no place for a tutorial on nutrition.

Science?

The only really bad scientists I know.

What about “bad science”? Isn’t that what got us into this mess?

I get the impression that a lot of us would like to blame “mainstream” nutrition—whomever or whatever that is—and the “bad science” it produces. I would offer some strong caution against this.

We want a different nutrition paradigm–specifically “our” paradigm, whatever that will be–to be “mainstream” one day, but it is a very tenuous position to say “they got it all wrong, but don’t worry, this timewe got it right.” All scientists are both trying to make a living and trying to improve the health of Americans. No scientist can control how his/her work is used (or misused) for public health policy. The scientists who have contributed to our current nutritional paradigm have been working–as all scientists do–within a framework shaped by personal experiences, cultural forces, financial pressures, political and career concerns, powerful individuals, and media soundbites.  The next generation of scientists will be no different. When scientists are asked to work on committees that create policy, they do, of course, bring to that work a more comprehensive understanding of their own area of study than of an area that offers a competing view.  The practices behind policy-making are responsible for making sure such views are balanced, not the scientists themselves.

In the early years of the Goals and Guidelines, a number of scientists did complain about the prematurity of those recommendations. I think most of us would like to think we’d be among those skeptics, but I’m not sure that we would. For the most part, people who then worked in the field of nutrition— dietitians, clinicians, young scientists—embraced these new dietary recommendations as progressive and much needed. Dr. Joanne Slavin told me the story of how the younger generation in her Department of Nutrition at the University of Minnesota thought Dr. Harper (see the quote above) was “behind the times” because he didn’t think it was such a great idea to tell everyone to reduce their fat intake. When we established policy to give an institutional framework to an ideal that was waiting for the science to catch up with it, we failed to prepare for the possibility that we might be wrong. If there is one lesson to learn from the past 30 years of interaction between nutrition science and public health policy, it is that we should prepare for that possibility.

Us?

To a large extent, the cultural forces that shaped our thinking about nutrition (and which in turn helped carry the scientific, policy, and industrial forces forward) were an extension of the culture wars of the 60s and 70s: suits vs. hippies. The suits (maybe the “lab coats”?) were the stodgy pinhead scientists, fiddling away in their labs, waiting to get the science “right,” while the country went to hell in a hamburger. The “hippies” of the McGovern committee—along with popular figures like Frances Moore Lappé, author of the wildly popular vegetarian cookbook, Diet for a Small Planet –saw changing the diet of Americans as a moral imperative that eclipsed concerns over the weak associations with diet and disease outcomes. This gave the low-fat diet an Age of Aquarius glow that offered a shiny new hope for ending chronic disease, and we swallowed it hook, line, and sinker.

Labeled the “barefoot boys of nutrition,” the creators of our first national dietary recommendations were a team of young, energetic, long-haired (for DC anyway)—and not coincidentally, white, well-educated, upper/middle class and male—idealists hoping to convince Americans to eat a more “natural” diet, a vision of the lead writer for the group, Nick Mottern, who remains a staunch advocate of minimally-processed foods (and who has never, by the way, been a vegetarian) [2,3]. With the exception of the food from animals vs. food from plants orientation (and I think we have more women in places of influence), how different is the paleo community from these origins?

In other words, in the immortal words of Pogo: We have met the enemy and he is us. “Us” is (upper) middle class, well-educated, young white people with an idealistic plan to change the world for the better. Now of course I don’t mean you or me personally. We can all find ways to excuse ourselves from this stereotype (I for one can claim that I’m not young—but otherwise, the description pretty much fits me exactly). But there is a lesson here to be learned: in creating an “enemy” to fight in the nutrition revolution, we had better choose very carefully. Let’s choose an “enemy” we actually want to eliminate permanently (i.e. not us).

I suggest that we not make a person, a group, an entity, or an institution either scapegoats or the enemy. Then who or what is to blame? What do we want to get rid of entirely?

Well, how about poorly-designed policy? Maybe one-size-fits-all guidelines (assuming we can agree that this concept should be eliminated)? Maybe a food-health system that lacks transparency, public involvement, and checks and balances? Maybe we could get rid of the framework that excludes the concept of food culture from any discussions about food policy?

If we can do that, it opens up the last piece of the triangle–the “rescuers”–to anyone who cares about the health of Americans: policymakers, health professionals, the public, food producers and manufacturers, scientists (even the nutrition epidemiologists whose science many of us love to hate), or, umm, maybe even each other.   If we can see a place for all of these groups, and all of us already in the “alternative nutrition” community, in shifting the future of America away from policies that have created little hope for the health of our next generation, we may begin to see them as allies (or at least future allies), rather than enemies. As such, we can enlist their help rather than trying to blame them or defeat them.

Right now I’m thinking we may need to try this out in our own little paleo/low-carb/WAPF/etc. communities first.

1. Harper AE. Dietary goals-a skeptical view. Am J Clin Nutr. 1978 Feb;31(2):310-21.

2. Broad, WJ. Jump in Funding Feeds Research on Nutrition. Science, New Series, Vol 204. No. 4397 (June 8, 1979). Pp. 1060-1061 + 1063-1064.

3. Mottern, N. Correspondence.

From Paleo to Paradigm-Shift: Building a Nutrition Reform Network

Brief recap: What can we do to transform this paleo-led, Ancestral Health Society-supported community into the public health, human rights revolution it could be?

According to Doug Imig at the University of Memphis, a protest becomes a movement when:

1) It defines and proclaims widely shared cultural norms.

2) It creates dense social networks.

3) It gives everybody something to do.

The first part of this process can seem daunting. What “shared cultural norms” do we have with other movements and organizations? I’ve spent the past couple of years trying to find common ground, including a semester in Washington, DC where I met people from many different organizations interested in policy, food, and nutrition reform. I’ve also quizzed lots of folks within the nutrition science establishment about basic principles with which we can all (mostly) agree. What I’ve found has led me to propose the following “shared cultural norms”:

  • Open, transparent and sustainable food-health systems will benefit all Americans.
  • There is no single dietary approach that will result in good health for everyone.
  • Nutrition messages are constructed and have embedded values and points of view.

[For an expanded discussion of these principles, see The REAL Paleo Challenge.]

“Shared cultural norms” become shared goals, and with shared goals, we can move together in one direction. Leading—and following—with humility and generosity will go a long way towards the next step: creating a large, dense social network of people willing to work together toward these common goals.

So let’s first take a look at the humility and generosity thing:

For paleo leaders, this begins at home. If you don’t write your own blog posts or research all your own material, be up front about the fact. Give credit to those who do the work for you. Believe it or not, there are people out there—your readers—who think that you do ALL of that work. Letting them know you don’t—and giving a name and a face to the people who help you out—takes you off a pedestal and lifts up the folks in the background. Don’t worry; there’s room enough for everyone. If inspiring people to get fit and healthy is your thing, inspire them to look at the bigger picture too. Insist on scientific integrity from yourself and others. Everybody makes mistakes, overstates the facts, fails to fact-check a source thoroughly or read the original materials carefully and critically; sometime new evidence or a new perspective changes our minds. Be humble in your claims about what food/nutrition can do and avoid nutritional scare tactics and absolutism. No one has all the answers.

For paleo followers, refuse to be captured and captivated by labels, leaders, controversy, and coolness. If thinking for yourself is what brought you to the paleo community in the first place, don’t check your brain at the door when you start listening to the folks you consider to be the experts. Don’t let the folks that you admire slide just because you agree with them or because you’re on the same side of the issue. If getting fit and healthy by following one of those inspiring leaders is what brought you, take it upon yourself to challenge them—and yourself—to look beyond personal health to the health of your community. Allow your paleo heroes to be human; no one has all the answers.

A sense of strength and unity within the paleo community will allow us to turn our sights and energies outward, rather than inward. I’m pleased to say that I think this has already begun. There has been a lot of reaching out to the other “alternative” nutrition communities, and I think we can give a great deal of credit to the folks at Ancestral Health Society for creating a space for this to happen. AHS and the paleo community is where the other alternative nutrition communities, Weston A Price Foundation and the low-carb folks, seem to intersect. At AHS2012, primalebrities Robb Wolf and Mark Sisson signed on as WAPF members and low-carb leaders Richard Feinman, Andreas Eenfeldt and Jimmy Moore were welcomed as respected members of the paleo community.

Robb Wolf and Mark Sisson truly leading the way to a paradigm-shifting network of nutrition reform. Photo courtesy of Ancestralize Me’s Laura Schoenfeld.

We can strengthen these connections by getting to know each other better, attending each other’s conferences, sharing information across groups and blogs, and by remembering that we are all working towards the same goals, even if our particular dietary approaches differ. We can all continue to support and promote AHS even if we don’t match the paleo template exactly. WAPF has a strong grassroots community; there is likely to be a chapter near you where you will find kindred spirits. I hope I don’t have to sell anyone on promoting Peter Attia’s and Gary Taubes’ NuSI once it is launched. For that matter, publicize the work of Healthy Nation Coalition (this would be my own agenda of course) and join us in trying to figure out ways to make this a long-term, self-sustaining social movement for everyone.

Cohesiveness within the movement will allow us to expand our diplomacy to other food and nutrition reform arenas. Remember, we don’t have to agree with everything another community may say or do, but if we have some common ground, we should build on it. Here are a few examples of organizations with which we may share common values (I’m sure you all can think of more):

Common ground? Probably, unless you think Twinkies are paleo.

Paleo leaders, you can open your doors a bit more. Find out what you can do to reach across nutrition reform community boundaries. It will broaden your audience base and the reach of your nutrition message, as well as help create a network of like-minded groups. Put as much effort into finding common ground with those whose general perspective you are not sure you quite align with as you do into ripping up the science you don’t agree with. Although there is no reason not to call out poorly-designed and -reported science when it shows up, be humane, humble and transparent when you do. Frequently it is underlying policies and paradigms at fault (perpetuated by media coverage), not the science or the scientists per se. Paleo leaders, not only can you get a low-carb or WAPF leader to do a guest post or interview, you could invite a vegan to help you find common ground within your two communities. See what those folks in the permaculture groups are up to and publicize it. There is some ridiculously awesome stuff going on that just happens to be, by default, mighty paleo-like. We should be supporting projects like The Food Web because, although not everyone is going to want to raise chickens, if we are going to talk sustainability, animal welfare, and support for small farmers—and I hope we are—the folks in the permaculture community are where the rubber meets the road.

Abe Connally and family explain permaculture at work. Result? A sustainable—and paleo—food system. Click on the picture to find out more.

For paleo followers: Reach across boundaries yourself—we have much to learn from each other and more similarity that we want to think we do. Next time you attend a paleo event and you see a person who doesn’t “look the paleo part,” go up to them and introduce yourself. Tell your story and listen to his/hers.  It actually might be more informative than standing in line to ask Mark Sisson if he thinks shirataki noodles are “primal.” Volunteer with AHS; join WAPF; check out Healthy Nation Coalition. We’re not cool or hip and frankly, our mission is more to get behind everybody else and push than get out front and lead, but we do good work.

And paleo followers, you can do something the paleo leaders can’t do (and isn’t that fun to know?). You can take this message out into your professional or academic world and treat it as a serious subject for closer examination in fields like: American studies, education, sociology, human development, maternal and child health, communication, ecology, political science, economics, psychology, health policy, etc. Doing this legitimizes the paradigm shift that is already underway. If you are concerned about sounding like a nutcase (because many outside of alternative nutrition communities have only been exposed to our default “healthy diet” definition), refer to the “shared cultural norms” above–they travel well. If we begin to look at the past 30 years of national nutrition policy as the cultural phenomenon that it is, we can begin to entertain the notion that perhaps it is time to move on.

Scientific measurements of skull sizes use to “prove” racial superiority? Science is shaped by culture; nutrition science is no different.

Consider Prohibition or the civil rights movement. Both were cultural events or paradigms where science was invoked to either defend or to undermine specific cultural norms. Our science has not magically become more “objective” since then; it is only in retrospect that we can see how cultural forces shaped the prevailing paradigms. Paleo followers can have that conversation in any arena that may be applicable, and use our dietary guidelines as an example.

Changing attitudes will change the institutions that shape those attitudes. But the biggest roadblock to shifting the paradigm remains.

A paradigm shift in—in science and in culture—must preserve, not trash, much of what has come before and recognize the advances made by those who have preceded us, even if (and maybe in this case, especially if) they are on the other side of the paradigm shift. Honestly, we have a really hard time with this, and I think this remains our primary challenge.

Next up: A place for everyone—including nutrition epidemiologists?

The REAL Paleo Challenge: How NOT to be Just Another Elitist Fad for Skinny White People Wearing Goofy Shoes

The blogsphere is beginning to rattle with commentary on the recent Ancestral Health Symposium 2012 events. Some folks who don’t necessarily “look the paleo part” have voiced concern about feeling excluded or marginalized as the conversation/social activities/celebrity parade seemed dominated by:

  • white people
  • young people
  • thin/athletic/fit people
  • men
  • well-educated, upper-middle class socioeconomic status people
  • people wearing goofy-looking shoes

You can read my take on why that might be the case here: AHS 2012 and the BIG BUTT: Lessons in Nutritional Literacy.

I understand that an NPR reporter was at the event, interviewing some of the movers and shakers. There was some concern that the reporter seemed to think that the paleo movement is a bit of an elitist fad. I understand this perspective, and on many levels, I agree.

As a “fad,” the paleo movement is a bunch of highly enthusiastic people with a lot of disposable income and time who are deeply committed to a particular way of being fit and healthy. It has its leaders, it controversies, its “passwords” (can you say “coconut oil” or “adrenal burnout”?), and its stereotypical paleo dude or dudette. As a fad, it would be destined to go the way of all of other diet and health fads—including Ornish and Atkins, Pritikin and Scarsdale, extending all the way back to the “Physical Culture” movement of the earlier part of this century (Hamilton Stapell spoke about this at AHS2012).

The original paleo chick – no high heels on this lady

Is it elitist? Well, there are some ways that it is possible that the paleo movement may marginalize the very folks who might benefit most from its efforts. Maybe an African-American guy still sensitive to the fact that his grandfather was consider “primitive” might not want to get his full cavemen on. Maybe a Mexican-American woman who remembers her abuela telling her stories about being too poor to have shoes doesn’t really want to go back to being barefoot just yet. Maybe an older, heavier person simply feels intimidated by all the young healthy fit people swarming to the front of the food line.

But the paleo movement does not have to be an elitist fad unless insists on limiting itself to its current form, and I believe the people at the Ancestral Health Society  are working hard to make sure that doesn’t happen. This is why I really love these folks. I don’t mean the paleo leaders like Mark Sisson or Robb Wolf, although I’m sure they’re good people; I’ve just only met them briefly. I mean those somewhat geeky-looking-in-an-adorable-sort-of-way folks in the brown T-shirts who hung in the background and made it all happen for us last week. Notice that they don’t call themselves the Paleo Health Society, right? I love them because they ask good questions, they question themselves, they think long-term, and they’ve created a community that allows these conversations to take place.

So, what do we do to transform this paleo-led, AHS-supported community into the public health, human rights revolution it could be?

According to Doug Imig at the University of Memphis, a protest becomes a movement when:

1) It defines and proclaims widely shared cultural norms.

2) It creates dense social networks.

3) It gives everybody something to do.

Each of these deserves its own blog post, so let’s look at the first—and most important—item: widely shared cultural norms. This is where the “elitist fad” part of paleo falls short, but not really. Because in all my encounters with paleo folks and people from AHS, I find norms and values that the culture as a whole can embrace. Here’s the weird thing, I’ve spend the past couple of years also talking to mainstream scientists, from one end of the diet spectrum to another, including Joanne Slavin, a down-to-earth, warm, wonderful lady who was on the most recent Dietary Guidelines Advisory Committee and Henry Blackburn, who is a delightful gentleman and a protégé of Ancel Keys. Guess what? We all have some values in common.

Here are some concepts that I think may unite us all, from vegan to primal, from slow food to open government, from “mainstream” scientist to “fringe scientists” like Gary Taubes (yes, one of my UNC instructors referred to GT as a “fringe scientist,” although another found his views “very convincing”—go figure):

We must create an open, transparent, and sustainable food-health system.

The RD that inspired me to take an internship at the American Dietetic Association for a semester, Mary Pat Raimondi, said: “We need a food system to match our health system.” And whatever shape either of those systems may take, she is absolutely right. Conversations about food must encompass health; conversations about health must encompass food.

Right now our food-health system is closed. Directives come from the top down, public participation is limited to commentary. The people who are most affected by our nutrition policies are the farthest removed from their creation. We need to change that.

Right now our food-health system lacks transparency. USDA and HHS create nutrition policy behind doors that only seem to be transparent. Healthy Nation Coalition spent a year filing Freedom of Information Acts in order to get the USDA to reveal the name of a previously-anonymous “Independent Scientific Panel” whose task, at least as it was recognized in the Acknowledgments of the Dietary Guidelines, was to peer-review “the recommendations of the document to ensure they were based on a preponderance of scientific evidence.” You can read more about this here, but the reality is that this panel appears to not be a number of the things it is said to be. This is not their fault (i.e. the members of the panel), but an artifact of a system that has no checks and balances, no system of evaluation, and answers to no outside standards of process or product. This must change.

Our food-health system must be sustainable. And Pete Ballerstedt would say, yes, Adele, but what do you mean by “sustainable”? And to that I say—I mean it all:

Environmental sustainability – Nobody wants dead zones in the Gulf or hog lagoons poisoning the air. But environmental sustainability can’t be approached from the perspective of just one nutritional paradigm, because a food-health system must also have:

Cultural sustainability – We are not all going to become vegans or paleo eaters. Our food-health system must support a diversity of dietary approaches in ways that meet other criteria of sustainability.

Economic sustainability – Our food-health system must recognize the realities of both producers and consumers and address the economic engines that make our food-health system go around.

Political and scientific sustainability – Our food-health system must become a policy dialogue and a scientific dialogue. Think of how civil rights evolved: an equal rights law was passed, then overturned, a Jim Crow law was passed, then overturned, an equal right law was passed, then upheld, etc. etc. This dialogue reflected changing social norms and resistance to those changes. But we have no way to have a similar sort dialogue in our food-health system.

What would the world look like if, in 1980, an imaginary Department of Technology was given oversight of the development of all knowledge and production associated with technology? Production of food and knowledge about food (i.e. nutrition) became centralized within the USDA/HHS in 1977-1980 and there have been no policy levers built into the system to continue the conversation, as it were, since then. The Dietary Guidelines have remained virtually unchanged since 1977; our underlying assumptions about nutrition science have remained virtually unchanged since 1977. That’s like being stuck in the age of microwaves the size of Volkswagens, mainframe computers with punchcards, and “Pong.” We need a way for our food-health system to reflect changing social and scientific norms.

One of the primary shifts in understanding that has taken hold since 1977 is that:

There is no one-size-fits-all diet that works for everyone.

In 1979, Dr. William Weil Jr at the Department of Human Development at Michigan State University, voiced concern about “the frequent use of cross-national and cross-ethnic inferences” [Weil WB Jr. National dietary goals. Are they justified at this time? Am J Dis Child. 1979 Apr;133(4):368-70.]  He went on to day that we cannot assume that “because ‘a’ and ‘b’ are correlated in one population group that they will also be correlated in another group” yet our one-size-fits-all dietary recommendations make just that assumption.

There were more scientific articles generated from the Nurses’ Health Study–composed of 97% white women–in 2009 alone, than in the entire 10+ year history of the Black Women’s Health Study. Those large epidemiological studies done with a mostly white dataset are what drive our policy making, even though evidence also points to fact that we should not be making the assumptions to which Dr. Weil referred. A landmark study published in 2010 shows that African-Americans who consumed a “healthier” diet according to Dietary Guidelines standards actually gained more weight over time than African-Americans who ate a “less healthy” diet [Zamora D, Gordon-Larsen P, Jacobs DR Jr, Popkin BM. Diet quality and weight gain among black and white young adults: the Coronary Artery Risk Development in Young Adults (CARDIA) Study (1985-2005). American Journal of Clinical Nutrition. 2010 Oct;92(4):784-93].

.

DQI stands for Diet Quality Index. Blacks with a higher DQI had more weight gain over time than blacks with a lower DQI. From Zamora et al.

Even with a more homogenous population, this issue applies. Remember all those discussions about “safe starches” you heard at AHS2012?

This concept also captures the emerging knowledge of how genetic variability affects nutrition needs and health, i.e. individualized nutrition, a very useful buzzword. I have lots to say about n of 1 nutrition coming up soon. But, most of all, not trying to cram everyone into the same nutritional paradigm captures reality of our own lives and choices about food. Which brings me to:

Food is not just about nutrition, and nutrition is not just about science.*

When we all begin to question our own assumptions about food and nutrition, we will be better able to reach across communities, create common ground, and be humble about our way forward.

We need to understand and help others understand that all nutrition messages are constructed and contain embedded values and points of view.

We need to learn to ask and teach others to ask: Who made the message and why? Who may benefit or be harmed? How might people interpret this message differently?

We need to think and help others to think about income and funding models, industry, and the framing of dietary problems by scientist, bloggers, and the media (and I don’t just mean “the other guys”—apply these critical thinking skills to your own nutrition/food community).

Nothing about our food and nutrition thinking was born in a vacuum. Food is a part of our cultural and social fabric. It allows us to belong; it allows us to define ourselves. Even as we strive to find better science and to shift our current diet-nutrition paradigm, we must approach this with the understanding that there is no truly objective science. How science gets used, especially in the policy arena moves us even farther from that non-existent ideal. Even as we strive to improve public health, we must understand that we don’t always know what “health” and “healthy food” means to the people we think we are trying to serve.

If these points sound remarkably like the mission statement for Healthy Nation Coalition, my non-profit, then you’ve been paying attention. But it is not my plan for HNC to “lead” any nutrition reform movement as much as it is for us to get behind everyone else and shove them in the same direction. There is very much a herding kittens aspect to this (as Jorge of VidaPaleo.com pointed out), but as a former high school teacher and mother of three, this is not new territory to me.

So, yes, I have an agenda. Everyone has an agenda. I’ll spell mine out for you:

Somewhere out there in America, today, there is a young African-American girl being born into a country where many—if not most—of the forces in her world will propel her towards a future where she will gain weight, get sick, have both of her legs amputated, get dialysis three times a week, be unemployed and unemployable, on disability and welfare, and—this is what gets me out of bed in the morning and drags my weary ass to one more round of getting punched in the face by those very forces arrayed against her—she will, somewhere underneath it all, blame herself for her situation. I’m an old white lady, in a position of relative power and knowledge. I don’t know this young lady, and she doesn’t know me. She doesn’t owe me anything because she’s not asking for my help. But it is my job in this life to begin—at the very least—to shift those forces so that she has a better opportunity to choose a different life if she wants to. That’s all I care about. I don’t care who gets credit or who gets the cushy book deal.  I just want it to happen.  I would want the world to do the same for my children if they had not had the privilege of birthright that they do. That child is my child as sure as the three that live here and drive me crazy are. All I ask of the paleo community is that she be your child too. And if, as a community, you decide to adopt this child, well then, don’t worry about becoming an elitist fad made up of goofy-shoe wearing white people destined to fade into obscurity. Instead, you all will change the world.

Next Up: What makes a movement? (and I mean a social change one, not the bowel-y kind)

*Much of what follows borrows liberally from the work of Charlotte Biltekoff at UC-Davis, a wonderfully warm and intelligent woman who has been working on and thinking about this issue for—believe it or not—longer than Gary Taubes. She has a book coming out next summer which, IMHO, will be the social/cultural partner to Good Calories, Bad Calories.

AHS 2012 and the BIG BUTT: Lessons in Nutritional Literacy

An anonymous butt of a close friend who gave me permission to use her rump to make a point.

The comments are starting to come in:  Ancestral Health Symposium 2012 was fun BUT (and it’s a really BIG BUT), the conversation/social activities/celebrity parade seemed dominated by:

  • white people
  • young people
  • thin/athletic/fit people
  • men
  • well-educated, upper-middle class socioeconomic status people
  • people wearing goofy-looking shoes

Some folks who did not fit into these categories very well are expressing that they felt excluded and marginalized. All I can say is, well, yup. It shouldn’t really surprise us, but it should give us an opportunity to look closely at why this is the case.

Buckle your seat belt—ask for an extension if you need one—it’s gonna be a bumpy ride.

Right now, “looking the paleo part” is important in the paleo community. Think: gorgeous Laura Schoenfeld  or any of the adorable white guys at AHS 2012—so ubiquitous and uniformly handsome as to be practically interchangeable (with my apologies to them all, as the individuals I did meet were charming and intelligent—yes, Dan Pardi, Colin Champ, and Ben Greenfield, I mean you). It is easier for you to become a valued member of a community if you look the part. Why? Because health, especially dietary health, is—for us middle class white people—a stand-in for character.*

“Looking the part” demonstrates to the world that you are, indeed, a “responsible good eater.” If you are overweight, if you have obvious health deficits, if you are not white, if you are old—you stray from the community’s ideal of a “responsible good eater”—no matter what your diet actually is. Not “looking the part” tars you, however subtly, with the brush of “unhealthy other.”

How did the concept of “unhealthy other” come to be?  The mainstreaming of nutrition science and the middle class’s current obsession with it emerged at the same time. The 60’s and 70’s brought us race riots, civil rights and equal rights marches, economic instability, political turmoil, sex, drugs, rock and roll, and really long lines for gas. It seemed for a while that the stature of the white middle class that was so securely ensconced in the Leave it to Beaver suburbs in the 50s was being flooded with “others,” on the verge of disappearing altogether into the muddy waters of social change.

Meat, veggies, tubers, maybe some dairy. Could this be retro-neo-primal eating?

Thus, when the Dietary Goals for Americans emerged at the end of the 70’s, the middle class seized this opportunity to create a place for itself in opposition to “the unhealthy other”—we know them in our heart of hearts as “icky fat people.” And who are these icky fat people?

Mostly they are women, mostly they are black, and mostly they are poor. For women, the non-Hispanic black population has the highest prevalence of overweight (78 percent) and obesity (50.8 percent) of any subpopulation in America.

  • At age 8, 48% of African-American girls (compared to 15% of white girls) have begun sexual development. Females that go through puberty earlier have a higher prevalence of being overweight, and in fact, these two factors seem to be related.
  • Adolescence is a critical period for the development of overweight/obesity, and it is also when major racial/ethnic differences in overweight/obesity become apparent.
  • Overweight/obesity at adolescence strongly tracks into adulthood.
  • Obese female adolescents become adults who on average earn lower wages and are at increased risk of living in poverty.**

Black women are twice as likely as white women to develop diabetes, heart disease, and many other chronic “lifestyle-related illnesses.” “Lifestyle-related illnesses” are considered to be ones that you bring upon yourself because of your lifestyle choices, or, in the newer world of nutrition policy groupthink, are inflicted upon you because of the obesogenic environment. (A recent NEMJ article discusses how, although policymakers see obesity as a socioecological issue, fat people see it as their own damn fault, viewpoints that are not mutually exclusive nor entirely invalid, but both are built on a faulty science base that I don’t need to preach to the choir about.)

Either way, we—the white middle-class “responsible good eaters”—can place ourselves in a position of distributing, shall we say, the noblesse oblige of nutrition and health. For the middle class, nutrition and health are a way of visibly demonstrating to the world that we care. [Note:  This isn’t to say that white people are bad for caring or that the people they care about are “victims” of ignorance or genetics or social institutions.  This is simply a way to a examine a particular social dynamic that may be at play. I have seen one group of white folks after another–from veg*n to paleo– wringing their hands over the issue of obesity in underserved populations. They all mean well. But they talk about these populations from such a distance that I don’t even recognize my friends and neighbors from here in Durham, NC. ]

This lady cares.

Middle class, educated, fit white person:

“I care about my health so I eat right and exercise right. Not only do I eat right, but I make sure my family eats right too, so that my family can be healthy and not be a burden on the health care system or society. By eating right, I also demonstrate how much I care about my world, as my way of eating right is also what is right for the environment, the economy, small farmers, and poor, fat, dark-skinned people. Lucky for me, as the world seems to be well-supplied with poor, fat, dark-skinned people, I can enter a health care/fitness/nutrition/public health/natural-paleo-farmfresh-local-food real or virtual career and be assured of many more years of professional activity and income because, well, to be honest, those poor, fat, dark-skinned people simply don’t have the knowledge or wherewithal to really care about their health, so I’m here to help them eat right and get healthy [and stop being so poor and fat and dark-skinned].”

To me, one of the most interesting and ironic things about our current “alternative” foods movement is that this type of sentiment can be applied equally well to the veg*n groups as to the paleo groups. The biggest differences? The veg*ns tend to be white ladies with organic salads and the paleos tend to be white guys with grass-fed steak. Both kinds of foods and both kinds of whiteness are equally unavailable, and perhaps somewhat undesirable, to “the unhealthy other” population. To add insult to irony, many of us in both the veg*n and paleo world were once, at least in our own minds, “the unhealthy other.” But we figured it out, got our act together, applied our intestinal fortitude and good moral character and became—visibly, for all the world to see—reformed “responsible good eaters” of the fine upstanding variety.

What are the implications of this notion of “the unhealthy other” and the middle class white folks who care so much about helping them?

“The unhealthy other” is what allows us to believe, when we see an icky fat person, “if only that person would/could eat like I do, they wouldn’t be fat.” Which means we are inclined to either:

1) Stuff “the unhealthy other” full of the nutrition knowledge that we love and cherish and if it doesn’t work for them, obviously they are just not doing it right and it’s their own damn fault

or

2) Work to make “the healthy choice” (whatever that means) “the easy choice” (whatever that means) for “the unhealthy other” and once we succeed, if they are still unhealthy, they don’t deserve our compassion and humanity because, after all, it’s their own damn fault

Hate to break it to you all, these are the exact same methods the current mainstream nutrition paradigm uses, and if  we limit ourselves to this way of thinking, we can expect the exact same results.  In other words, the paleo movement—as Hamilton Stapell alluded to in his AHS 2012—is destined to become just another elitist fad.

Can we change that?  Yes.  How?  Yeah, I got a few suggestions.

Stay tuned for:  Paleo:  Just Another Elitist Fad for Skinny White People Wearing Goofy Shoes–or NOT?

*Much of what follows borrows liberally from the work of Charlotte Biltekoff at UC-Davis, a wonderfully warm and intelligent woman who has been working on and thinking about this issue for—believe it or not—longer than Gary Taubes. She has a book coming out next summer which, IMHO, will be the social/cultural partner to Good Calories, Bad Calories.

**This comes straight from a lecture in my Nutrition of Children and Mothers class, fall 2009, by Dr. Penny Gordon-Larsen.