Why care about calories?

After the last blog post on calorie magic, my husband–whose intellectual response to people challenging me on the internet is to want to give them a virtual wedgie–asked me why I didn’t just engage those cute little white dude-o-scientists who are so pumped about how IT JUST MUST BE CALORIES CALORIES CALORIES CALORIES in some sort of PubMed duel to the finish.

My explanation:  I don’t do PubMed duels. PubMed is a wonderful thing, and the internet has given us tremendous access to a great deal of information, much of which is used to confirm our own preconceived notions, even if (especially if?) we don’t fully understand what those notions actually are. As I’ve said before, a pastiche of  PubMed citations frequently boils to a bunch of snapshots taken out of context of the larger literature–and out of context of a full understanding of physiological and biochemical realities, not to mention social and cultural ones–that may or may not express a physiologically significant or practically useful concept.

And this is problem: I’m not convinced that calories express a physiologically significant or practically useful concept. Here’s what I figure. If calories were so FREAKIN important, then my biochemistry books should be rife with information about them. But that does not seem to be the case.

[I took my first biochem class at age 45, weeping my way through one excruciatingly difficult exam after another. I emerged–bloodied by unbowed–to joyfully sign up for 3 more semesters. I don’t consider myself an expert by any stretch; I just feel that biochemistry is sort of the key to the universe, certainly the universe of nutrition. If something doesn’t make sense from a biochemical perspective–which would apply to about 90% of the Dietary Guidelines–it shouldn’t be part of nutrition policy.]

I did this a while back, just for my own peace of mind, and I don’t know how useful it will be to any of you, but here’s what my collection of biochem books has to say about calories. Spoiler alert: Not much. [So you can stop here if you have a life.]

My biochemistry books, in order of how much I love them, least to most:

Advanced Nutrition and Human Metabolism (3rd Edition), 2000

James Groff & Sareen Gropper

I don’t know why I have this book.

–“Calorie” is indexed to a passage on units of energy in a discussion of thermodynamics. Calories are not mentioned again.

–“Calorimetry, direct” and “calorimetry, indirect” are indexed to passages discussing the measurements of energy expenditure. It contains this notable summary:

” Although changes in energy balance produce weight changes, the extent of these changes varies from person to person.”

 


Functional Biochemistry in Health and Disease, 2009

Eric Newsholme & Tony Leech

I got this book with great anticipation, as it seemed to promise a better integration of biochemistry and physiology than most biochem texts. But like some sort of weird Asian-fusion spicy wonton Alfredo dish, I guess it is just trying to do too much. There is not enough detail here for me, and the reader is left to sort of assume “magic elves in a box” in too many places, which–as far as I am concerned–defeats the whole point of learning biochemistry.

–“Calorie” is not indexed.

–“Calorimetry” is indexed. This couple of pages highlights the limitations of measuring calorie expenditure in the human body.


Biochemistry (4th Edition), Lippincott’s Illustrated Reviews, 2008

Pamela Champe, Richard Harvey, & Denise Farrier

This is the boy-toy of my biochem texts. I don’t love this book, but it is much more portable than my other biochem texts, so I can take it out in public without too much embarrassment.

–“Calorie” is not indexed.

–“Caloric consumption,” “caloric restriction, weight reduction and,” and “calorimeter” are indexed.

“Caloric consumption” addresses the fact that the source of the increase in calories consumed by Americans since 1971 is carbohydrates.

“Caloric restriction, weight reduction and” is indexed to a page includes the following helpful information:

 “Caloric restriction is ineffective over the long term for many individuals.”

 


Biochemistry (2nd Edition) , 1995

Donald Voet & Judith Voet

I approach the Voets with the reverence and respect due a giant doorstop of a book like this. Like that scary old professor who knows everything, it is intimidating, but, well, it knows everything.

“Calorie (cal)” and “Calorie, large (Cal)” are indexed to the same place. The indexing refers to a table that compares thermodynamic units and constants as an adjunct to a passage on the First Law of Thermodynamics. This passage contains a little nugget of joy for those of us who insist that conversations about weight management may need to consider more than just how many calories go “in” and how many calories go “out.” Unless you are a fully registered and certified geek, you may want to just skip ahead:

“Neither heat [i.e. what is measured by calories] nor work is separately a state function [i.e. quantities that depend only on the state of the system] because each is dependent on the path followed by a system in changing from one state to another . . . If [the First Law of Thermodynamics] is to be obeyed, heat must also be path dependent. It is therefore meaningless to refer to the heat or work content of a system (in the same way that it is meaningless to refer to the number of one dollar bills and ten dollar bills in a bank account containing $85.00).”

This is why when someone talks about a person storing “800 calories of energy as fat,” I hear something that makes about as much sense to me as saying a person can store “$85 dollars worth of money in his bank account as four twenties and a fiver.”

Calories are otherwise never mentioned again in the rest of the 1,310 pages of this book.

 

Biochemistry (6th edition), 2009

Mary Campbell & Shawn Farrell

Campbell y Farrell is my warm fuzzy teddy-bear of a biochem book. I LUV it. Cuddle up with C&F for a well-written, easy-to-understand (as these things go) romp through the wonders of biochem.

–“Calorie” is not indexed.

–“Caloric restriction” is indexed to a discussion of longevity and sirtuins, not weight loss or obesity.


Lehninger’s Principles of Biochemistry (4th Edition), 2005

David L. Nelson & Michael M. Cox

This is my favorite biochemistry book ever. If it were available and I were single, I would marry it in a hot second.

–“Calorie” is not indexed. Nor is “kilocalorie.” Nor anything else that I could think of having to do with “calories.”

There you have it.   Seems to me that all those broscientists want to talk about is something that doesn’t have a lot to do with the keys to the universe of nutrition.  I don’t mind talking biochemistry, but the basic biochemistry that I’m familiar with has virtually nothing to say about calories.

And if biochemistry isn’t too concerned with calories, why should you be?

 

 

Advertisements

The Magic of Calories

There have been a couple of interesting conversations on the interwebz involving calories lately. I don’t normally pay attention to these things because I am so busy napping being, well, busy, but I am paying attention to these conversations because they are both starring–ME!!!

Let’s face it, the whole “only calories matter, period” vs. “calories, shmalories” debate tends to be an oversimplification on both sides. But, the truth is, only one of these sides has been the primary focus of many decades of unsuccessful public health nutrition intervention. In that regard, the “all you have to do to lose weight is make sure your calories out exceed your calories in” stance deserves to be questioned.

To this end, Adam Kosloff has gathered a useful compendium of calories in-calories out naysayers (including yours truly):

Then, a different Adam, does some naysaying about the naysayers:

While it would be fun to naysay all the naysaying about the naysayers, rather I will just address the part starring ME!!!

In reference to my scientific-y calorie calculations about how long it would take me to “disappear altogether,” Adam the Second had this to say:

“Yes, If she were to drop her calories in by 500 a day and increase her calories out by 500, she would lose a shit load of weight after 6 months.”

Um, no I wouldn’t. I would lose about 30 pounds, then I would begin to regain. Because that’s what happened to me in my real life. Oh wait, but it probably didn’t happen to me in real life because I was a fat person then, and everybody knows that fat people lie about how much they really eat, and because everyone knows that scientific-y calculations are more real than anybody’s actual life.

Adam the Second:

“She just has to remember that metabolism will vary over that time span, so her calories will also have to. This is due to the body naturally requiring less calories [sic] as a smaller vessel, and also the body will lower non exercise energy expenditure (general fidgeting, moving around etc).”

WHAT? My metabolism is going to change over time because I’ve changed my eating patterns? That’s in direct contradiction to the whole “calories in, calories out” premise. There are no differentiated calorie labels that say “This low-fat yogurt contains 250 calories for those of you who haven’t been on a diet for 6 months, BUT it contains 5,680 calories for those of you who have.”

Yes, in more sophisticated venues, calorie calculators for “energy out” change with weight, but the overall premise stays the same and leads to the same conclusion.


So if I weigh 205 pounds, walking at a moderate pace for an hour burns 307 calories. Once I diet & exercise down to 180 pounds, I can burn only 270 pounds doing that same amount of exercise. Which means that now I have to eat EVEN less and move EVEN more to continue to lose weight (regardless of how little I was eating or how much I was moving in order to get to 180 pounds in the first place)? When does the madness stop???

Lucky for you, dear reader, I will now demonstrate, due to the magic of calories, that the whole “eat less, move more” ad infinitum ad nauseum ad starvatium ad exhaustium does stop and in fact–this is the magic part–even reverses itself.   All for the low low price of free.

Let’s take this whole calorie calculation/deficit/mumbo jumbo out for a “brisk pace” walk, shall we? One of the reasons I think that some folks are such diehard supporters of calories in-calories out, it that they’ve never actually been a fat person trying to navigate the terrain of the whole calorie-counting experience.  So let’s hold hands & try it together.

Let’s say I’m a big fat newbie. Let’s say I’m a 35-year-old, 5’10” OBESE female who weighs 240 pounds (not my current age or weight, but that’s approximately where I started in my own weight loss journey). I already know that I need to “eat less and move more” in order to lose weight, because that’s what my doctor told me. I go to a trusted source, the Mayo Clinic, for guidance (for those of you who want to play along at home, here’s the Mayo Clinic calculator).

First I need to know how many calories I actually require (so I can reduce them). I start off with a estimated energy requirement for my activity level, which I will calculate as “inactive” (“never or rarely include physical activity in your day”), because we all know that the reason that fat people are fat in the first place is because they are lazy slugs.

My calorie needs as calculated by the Mayo Clinic, by way of the Harris Benedict Equation and the Dietary Reference Intakes, are: 1850 calories/day.

The Mayo Clinic says: “Weight loss comes down to burning more calories than you take in. You can do that by reducing extra calories from food and beverages, and increasing calories burned through physical activity.”  They don’t provide any details about how to do this, but by consulting with the Academy of Nutrition and Dietetics, I find that “A negative energy balance is the most important factor affecting weight loss amount and rate” and that I can achieve this negative energy balance by decreasing my energy intake by about 500 calories/day or increasing my activity by about 500 calories/day–or doing both. Since “adipose tissue, which is mostly fat, contains about 3500 kcals/pound,” if I create a negative energy balance of 1000 calories/day, I’m 7000 calories down–or 2 pounds worth of fat–over the course of a week.

So here goes. I’m going to subtract 500 calories from my Mayo calculation (close your eyes, it’s a mathy part) in order to figure out that I should be eating: 1350 calories/day.

Okay, let’s say I add 500 calories of activity to my day. Using the handy-dandy chart below (also from the Mayo Clinic), I find have to walk for 1 hour and 45 minutes in order to burn 533 calories.

I am now at a caloric deficit of (at least) 1000 calories/day, which according to the super-duper magical 3500 calories = 1 pound of fat formula (Zoe Harcome explores the rigorous scientifically-proven assumptions behind the formula here) means I lose about 2 pounds a week. Not that this would always happen in real life, but okay, fine. Flash forward 5 months, I’m down 40 pounds. I now weigh 200 pounds.  At 200 pounds I am no longer OBESE, I’m just OVERWEIGHT, but I still have more weight to lose. Because my body is naturally going to “require less calories [sic]” because it is a “smaller vessel,” it is time to recalculate my energy needs.  To the Mayo Clinic calculator, Boy Wonder!

(What happened in my own real life when I dieted and exercised my way from 215 pounds to about 185 is that, not only did my weight loss stall, but I started to regain lost weight. Or at least, that’s what would have been happening to me if I hadn’t been lying about it to myself and my hunger and exhaustion weren’t complete figments of my feeble imagination, while in reality I stuffed my face with HoHos and laid around on the couch watching The Young and the Restless).

According to the “smaller vessel” theory, I should require fewer calories, but if I fill out the calculator–WTF??– I end up with more?

I weigh 40 pounds less, and I get to eat 200 more calories/day? I don’t get it, but the Mayo Clinic is a trusted source and I’m just a newbie, so on we go. I subtract my 500 calories/day so I can lose weight, now I am eating:  1550 calories/day

Okay, 1550 calories/day is not a lot, but it’s more than 1350 calories/day I was eating before.* I’m not sure why this is, but I’ll take it, because–even though I am a “smaller vessel”–clearly there must be some calorie magic at work. But while I may be able to eat (a little) more, on the other hand, now I have to exercise even more because my ability to burn calories has decreased (see chart below). Now I have to walk for 2 full hours each day in order to get my 500 calories out.

Following the magic 3500 calories calculation that exists in our magical perfect world, we can flash forward another 5 months. I now weigh 160 pounds, my goal weight. I am now no longer OBESE or even OVERWEIGHT, but thankfully, NORMAL.

But, being NORMAL, I am also now an even smaller “smaller vessel,” and because “the body will lower non exercise energy expenditure (general fidgeting, moving around etc),” it’s time to recalculate. This is really scary because if I could only eat 1850 calories/day as an inactive OBESE 240-pounder, will I even be allowed to eat at all now that I weigh 160 pounds?  Will I have to exercise half the day away in order to be able to “afford” the calories in a low-fat bran muffin?

Oh, I can hardly stand the–wait! Hmmm. Now hold on just a hot second here.

I can see by the calculator that at 160 pounds, I could be inactive and eat 1800 calories/day.

OH THANK YOU CHEESESAUCE!

Because I’ve been eating 1550 calories a day and walking for 2 hours every day, and I am FREAKIN TIRED AND HUNGRY and sick of spending 14 hours a week walking around and getting nowhere.

According to the magic of “calories in, calories out,” I can now eat (even) MORE and move (a lot) LESS and I will NOT gain weight. No matter what I eat–as long as I consume no more than 1800 calories/day, I can sit on my (now slender) ass all day long and never gain an ounce.

HOORAY for CALORIES!!!!

P.S. If you are by any chance wondering why an OBESE inactive female who weighs 240 pounds is only supposed to be eating 50 calories more a day (a 7.7 calorie/pound allotment) than a NORMAL weight inactive female who weighs 80 pounds less (an 11.3 calorie/pound allotment), that’s because NORMAL weight people are more honest and virtuous than OBESE people and therefore deserve more calories per pound body weight.

P.P.S. Dear Adam the Second should you happen by to read this. Not trying to pick a fight. Just trying to illustrate how the calories in-calories out principle–put to work in a real-life example–may be an overly simplistic (if not downright illogical) approach to weight loss for some folks. Hey, if it works for you & your buddies, great! But it doesn’t work for everyone, and the use of this paradigm as the foundation for public health nutrition practice has changed how we think about eating in ways that I would argue have done more harm than good.

P.P. P.S. For more snarkily outraged, or outrageously snarky, commentary on calories, try these calorie-free nuggets of wiseassedness:

Why Calories Count Fo’Shizzle

Calories in, calories out, Would You Please Go Now?

Calories? Again? Already?

*This is where calories in-calories out folks sometimes like to say “But you may have needed more calories.  If you cut your calories too much [whatever that means], you’ll crash your metabolism.” I don’t know. They may be right. But that’s not how the calories paradigm works. There are no “metabolism crashing” exceptions on the Mayo Clinic calculator.

 

Buy this book

This one. You can do it now; I’ll wait here. Oh, you need more encouragement? Read on.

 

This may be the one and only time I will shamelessly promote the work of any individual I didn’t give birth to.

Why? Because I think this actually matters (unlike so much of the other stuff I do).

Nina Teicholz’s book has been getting great publicity and stands a good chance of making the New York Times bestseller list. And with our help, she will. So let’s do it.

There is the obvious benefit that more people will read her book–books that are on the NYT bestseller list are frequently purchased by people who buy their books based on whether or not they are on the NYT bestseller list–and then maybe my future dissertation on the USDA/DHHS Dietary Guidelines will actually find a publisher one day.

But wait! There’s more. For the one low price of Teicholz’s book, you, my dear reader, will get free at no extra charge, an additional bonus offer of the chance to change the conversation about nutrition in America.

Howzat?

It’s an excellent book in many respects (see below), but its greatest contribution is to clearly outline the tangle of politics and personalities, funding streams and tenure tracks that has essentially shut down any substantial debate on this matter, a debate that by all rights should be taking place right now on campuses and in conference rooms across the country. She convincingly describes the headwinds that any researcher who questions the status quo is going to be fighting: lack of institutional funding, lack of collegial support, or just deafening silence. It’s not a level playing field out there, and as Eric Westman says to Teicholz, “this situation will not allow science to ‘self-correct.'”

This is exactly what I found in the Department of Nutrition at University of North Carolina’s Gillings School of Global Public Health, and a situation that I’ve heard described repeatedly–usually in whispers, after I promise never to divulge details–particularly from other graduate students in nutrition. This is not how science is supposed to work.

Teicholz also–in a chapter entitled “How Women and Children Fare on a Low-Fat Diet”–shows us why it is so important that the debate not be silenced or ignored. Because this is not just about science, but about a world view that has placed the health concerns of adult (mostly white) males above those of women and children. This is about civil rights. Our current dietary recommendations are based on moldy datasets involving a particularly narrow demographic and applied to all Americans, regardless of age, race, gender, or cultural heritage. As if this is not bad enough, these same policies, which have remained virtually unchanged for 35 years, have failed–miserably–to improve the health of Americans of any demographic. This is a travesty of public health, and we should all be horrified and outraged.

But what should horrify us most is that, despite the biased data, despite the abysmal public health outcomes, despite the decades worth of controversy, there is no serious academic, scientific, or policy debate on this issue. Not at Harvard, not at UNC, not at Yale, not in Washington, DC. There is a refusal to even acknowledge that–in the face of all of these contradictions and confusion–a debate would be appropriate. Teicholz’s work has prompted the very same “the science is settled so let’s stopping talking about it” pushback that her book so deftly demonstrates is at the heart of the problem. The CEO of the American Heart Association acts as if just occurred to her to recently defend the world against the dangers of those who might suggest that saturated fat is okay to eat, and never mentions Teicholz’s name once. Yup. Shut down the debate and ignore the person who started it at the same time. Go AHA.

It is this “science is settled” perspective that the public should find most alarming. It doesn’t matter what part of the carb-fat-calories-whatever-whatever issues you agree or disagree with. Clearly, there is plenty of room for debate. Clearly, the science isn’t settled. But the absence of any serious discussion tells us that the experts think this whole nutritiony sciencey thing is too complicated for us to worry our pretty widdle heads about and that any real debate would confuse our very tiny brains. We should just chillax and let the experts tell us what to do. That way, we get fat and sick, they get grants and tenure, and everyone lives (more or less) happily ever after.

If you are not mad as hell already, you should be. If you read this book, you might be.

And this, dear reader, is where you can make a difference.

Teicholz’s book is not just a good book. It’s a message–to book publishers, to policymakers, to the media, to researchers, to students interested in pursuing a career in nutrition. It’s a message that says: we want this issue to be taken seriously, we welcome debate and discussion, and we will accept some honest confusion and doubt in place of the charade of science we’ve been given. I encourage you all to buy a copy for yourself. And then buy a copy for every friend and family member you think might read it (or use it to press daisies, I’m not picky). Get a copy for your family doctor and your nephew in medical school. A copy for that high school senior that’s about to graduate. A copy for that guy at the farmers market who is always going on about how “lean” his pasture-raised pork is.

We need to put this book on the New York Times bestsellers list and keep it there until Teicholz is on Oprah and Oz and The View and 60 minutes and Rachael Ray and Space Ghost Coast to Coast. We need to get this party started and keep it going. You certainly don’t have to agree with all she says to appreciate that the conversation needs to continue.

Buying a copy (or multiple copies) of this book says: We are not going to take this (silence) anymore. Hey Harvard, hey AHA, hey USDA and DHHS. Let’s talk.

Convinced? You can stop here, head to Amazon or your local bookstore & stock up, then pour yourself an adult beverage and kick back, knowing you’ve done your part.  Oh, you want a real book review? Glutton for punishment you are. Fine. I wrote more words. Or you can catch a fine review here or here.

Adele’s Book Review:

If you are wondering how we got into the food-health mess we are in, and you are not satisfied with the “fat piggy Americans” or “Big Evil Food Industry” answers that get tossed around the internets, you really need this book.

If you bought Gary Taubes’ Good Calories, Bad Calories and really, truly meant to read it all the way through, but somehow could not, this is the book to really truly read instead.

Maybe you are thinking, hell, Adele, I actually did slog through Gary Taubes’ Good Calories, Bad Calories, and you want me to read another book on the same topic? Good grief! Can’t I just watch the FatHead movie again and call it a day?

I feel that pain. Like Taubes’ books, Teicholz’s book is thoroughly researched and well referenced. But it’s a very different book.

First of all, Teicholz writes like a dream. I get that parts of Taubes’ book tend to be as readable as an instruction manual for Windows 98 as written by David Foster Wallace. Teicholz has the facility of Michael Pollan, with a sharper intellect, more warmth, and a less condescending attitude. She assumes her audience is smart enough to follow her through the maze of science without wanting to stop to examine every risk ratio ever produced. At the same time, she brings us with her into those difficult moments in an interview when she has to ask a nice person a hard question. And she does ask some tough questions.

Second, she covers some very different territory than other books on this topic. One of the complaints leveled at the people who blame our current high rates of obesity and diabetes on carbohydrates is that this approach neglects to fully explore the possibility that a dramatic increase in consumption of polyunsaturated vegetable oils (particularly soybean oil) may have also been a primary contributor to the increase in obesity and chronic disease. Teicholz examines this issue, along with the science behind transfats and the Mediterranean diet, with some surprising revelations. So while the subtitle “Why Butter, Meat & Cheese Belong in a Healthy Diet,” sounds like it could have been tacked onto Good Calories, Bad Calories or Death by Food Pyramid (both fine books), Teicholz’s approach reveals a much more complex cascade of assumptions and accommodations that accompanied the calls to reduce the use of animal products in our diets.

Finally, even if you don’t care much about the whole fat-carb-blah-blah debate, her look at the personalities and politics of how nutrition science gets made is absolutely fascinating. Being in a communication and rhetoric program now, I hear a lot about the “constructedness” of science, that claims of fact don’t just emerge from the ether, but from a particular social and political context (which isn’t to say that researchers just “make up” science–you can’t “construct” a pancreas that secretes maraschino cherry juice–but what “facts” are presented to the public by scientists are shaped by many other influences besides the material world). Teicholz’s perspective is sympathetic–scientists are allowed to like sunny tourists spots too–but she doesn’t pull any punches. If you can’t separate science from sunshine, you should have stayed home.

Teicholz introduces the Atkins-Ornish “diet wars” (somewhere in me is a blog post on Dean Ornish and how crusading against Atkins apparently gave him, literally, a reason to live when he was a depressed and suicidal med student) and updates us on some of the folks–Stephen Phinney, Jeff Volek, Eric Westman–doing the very real work of testing the ideas raised by Atkins. This is story that needs to be told, and Teicholz has just covered a few of the players, but she acknowledged the folks–including Gary Taubes–who have done a great deal to make sure that the debate that is so badly needed doesn’t disappear completely.

It’s a fascinating time in history. The very beginnings of righting a mighty colossal mistake. Teicholz’s book will fill you in on the major players to get you started.  Stay tuned and between the two of us, we’ll keep giving you the play by play–and we’ll keep the conversation going. You can help. Buy the book.

Never Too Early to Learn about Lowfat?

I am pleased to welcome Pam Schoenfeld MS RD as a guest blogger.  Pam has been inspiration to me for many years; she was the person who convinced me I could go back to school and get a degree in nutrition.  She works with individuals and families in a clinical setting and has become increasingly concerned about the messages about “healthy food” that are being given to young children.  Although the science on the dangers of dietary saturated fat and cholesterol has been hotly contested for decades, mainstream nutrition is now targeting preschoolers with messages about the evils of eggs and whole milk.  Pam shares her experiences and insights on this issue.  

As for me, I love my new PhD program in Communication, Rhetoric, and Digital Media, but it is kicking my butt.  Who knew critical cultural theory was harder than biochemistry?  I’m glad to have someone take over blogging duties for me as I am sleep-deprived, overworked, overwhelmed–and happier than a pig in slop.  Pam promises more to come, so stay tuned.

Samantha was in most ways a typical patient, slightly round in the middle but otherwise healthy. She knew a few things about healthy eating; she ate cereal with nonfat milk for breakfast, and made an effort to eat her fruits and vegetables. When I asked if she liked eggs, she said “yes, but only the whites.” When I asked why, she answered rather matter-of-factly, “the white is better for you than the yellow.” Her answer came as a surprise to me. Many of my patients are still concerned about eating egg yolks, but Samantha was only eight years old! Already she had somehow internalized the message that certain foods were best to avoid if you want to be healthy. She did not know that egg yolks were high in cholesterol; just that they were not good for her to eat. She did not know that nonfat milk was low in saturated fat; just that it was what her family always poured on their cereal and what she drank at school.

Despite the lack of science to support the claim, kids are increasingly being given the message that fat-free milk–even the kind with added sugar–is the healthiest choice.

The avoidance of egg yolks and the choice of low-fat or nonfat milk are so common among my patients that if she were just 5-10 years older, her answer would be completely expected. But she was so young, so eager to do the right thing, and yet so unaware that some of what she was being taught about nutrition was not evidence-based. So while I helped her plan meal choices that better met her needs, I gave her my best third-grader explanation about why whole eggs are actually one of the best foods she could eat. I left the subject of dairy fat for another day, as I suspected her mother and pediatrician wouldn’t agree with my view on this and I wanted to ensure that Sam would continue to see me.

I had assumed that these nutrition messages are so prevalent in our adult culture and media that young children simply absorb them by osmosis. But it turns out that more and more children as young as 3 are being targeted with nutrition information.

Nutrition information that adheres to controversial government dietary recommendations is targeting preschoolers with low-fat, grain-based dietary advice.

The latest issue of my professional dietetics journal arrived in the mail last month, and as usual, I skimmed the abstracts of poster presentations scheduled for the annual dietetics conference, aka “FNCE,” that will be held in Houston over the next 5 days. To my surprise, a few dozen of these abstracts described research on children’s diets, with eight reporting outcomes from programs targeted for preschool or grade-school age groups. (1) FNCE is by far the largest annual gathering of registered dietitians; it is at this venue that many RDs become informed on the research and practice recommendations in our field.

One group of researchers stated that because 75% of children are in organized childcare, it is the ideal setting for promoting healthy behaviors; a second group agreed that childcare settings are a prime environment for early intervention. I was reminded of my own dietetic internship, where I had to sing to Head Start pupils about the merits of low-fat milk while entertaining them with a cow puppet. Nutrition and health lessons directed to preschoolers are commonly delivered in the form of games and songs, but researchers are now studying the effectiveness of other methods.

I guess this should not surprise me, considering a 2011 Institute of Medicine (IOM) Report entitled “Early Childhood Obesity Prevention Policies.” The expert committee authoring the report stated “there is a growing awareness that efforts to prevent childhood obesity must begin before children even enter the school system.” Their “hope” is that this report will find its way to government policy makers who work in areas that impact young children in infancy and early childhood. In this report, nutritious and healthy foods for ages 2 and older are defined to be consistent with the Dietary Guidelines, which specify lean protein foods and low-fat or nonfat dairy products. (2)

Traditionally, the family has been the key environment where young children learn to develop eating habits and food preferences. But once children start school, teachers and peers gradually become the greatest influence. (3) Most people would undoubtedly be supportive of any initiative to educate young children about nutrition. After all, there has been an almost 2.5-fold increase in obesity in children ages 2-5 from 1980 to 2010, from 5% to 12.1% of this age group, and similar increases in older children. (4) So it would appear necessary to begin preventative measures at an early age.

Despite considerable evidence that shows that saturated fats are not linked to heart disease, the American Heart Association uses cartoon figures to teach kids that both whole (saturated) fats from animal products and transfats from processed oils are “the Bad Fats Brothers.”

It also appears that initiatives directed at young children are effective. In a recent study of 4-year olds given structured nutrition lessons in preschool, the children were able to correctly answer that “high-fat foods are bad for you and make you fat” even 5 months after the lessons ended. These lessons were only 10-15 minutes long, and the information wasn’t reviewed during the 5-month period, so the children’s ability to retain that lesson long-term indicates their receptivity to simple nutrition messages. (5) While it is unknown if the children consistently acted on this knowledge, it is clear they can and do retain simple “food rules,” even at the tender age of 4. The IOM committee would likely agree: “During infancy and early childhood, lifestyle behaviors that promote obesity are just being learned, and it is easier to establish new behaviors than to change existing ones.” (2)

So if childhood obesity is a huge problem and these early nutrition programs are effective in teaching children, why am I concerned? One reason is that the very same saturated fat- and cholesterol-containing foods that are negatively targeted in these nutrition lessons actually contain critical nutrients for growing children. Another reason is that if done improperly, nutrition lessons directed at children could easily pave the way for unhealthy relationships with food and issues with body image, among other unintended effects.

I will discuss these possibilities in more depth in upcoming posts, with further discussion on some disturbing recommendations from the IOM Early Childhood Obesity Prevention report.

References:

1. Journal of the Academy of Nutrition and Dietetics; 2013:113(9), A1-A120, suppl.

2. Institute of Medicine (IOM). 2011. Early Childhood Obesity Prevention Policies.Washington, DC: The National Academies Press.

3. Perez-Rodrigo C, Aranceta J. Public Health Nutrition. 2001;4(1A), 131-139.

4. Ogden CL, Carroll MD, Kit BK, Flegal KM. JAMA. 2012;307(5):483-490.

5. Nguyen SP, McCullough MB, Noble A. J Educ Psychol. 2011; 103(3): 594–606.

Processed Meats Declared Too Dangerous For Human Consumption

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

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

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

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

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

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

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

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

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

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

…and many more meat products

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

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

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

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

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

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


Sources:

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

A Heaping Dish of Humility and a Side of Caution

This was not on the menu at the “Is Nutrition Research Keeping Pace with Policy and Consumers” panel at the Consumer Federation of America’s National Food Policy Conference.

I’m not sure what I expected, but I was encouraged by the fact that during other presentations at the conference, I had heard murmurs that perhaps we don’t really know what we mean what we say “healthy food” and that the public has some real concerns about what they are being told about nutrition.  So I was manifestly disappointed to hear just another rallying cry for the status quo from the academics and policymakers on this panel.

A panelist from the National Cancer Institute asserted–despite those rumors heard elsewhere in the conference–that we “do have consensus” about what constitutes a healthy diet: “lean meat, whole grains, more fresh fruits and vegetables, and reduced saturated fat, sugar, trans-fats, and sodium.”  Linda Van Horn, who chaired the 2010 Dietary Guidelines Advisory Committee, told the audience that:  “We know what the problem is in obesity.  It’s the calories.  The calories.”  She went on to let us all know that if we just had policies that would help Americans follow the recommendations that are already in place, we could reverse the obesity crisis.  Sigh.  Make the healthy choice the easy choice for poor stupid fat Americans?  Again?  Already?

And–yes–in case you are wondering, I was quivering with rage by the time the panel finished talking (yogic breathing sadly not helping).  When my turn to ask a question arrived, I reminded the panel of the changes that we’ve already made in our diets–reduced red meat and egg consumption, increased whole grains and fresh fruits and vegetables, switched whole milk for low fat milk–and yet obesity and chronic disease continue to rise.  My question to them was, “When are nutrition experts and policymakers going to quit blaming the consumer for not following the food rules and start thinking about whether or not the advice we’ve been given is truly effective?”

After the panel, the gentleman next to me said “Good question.”  Yeah, I thought so too, but I got a truly lousy response from Dr. Van Horn:  “We may have reduced red meat, but we’ve increased sugar.”  Have we? Why might that have happened–if indeed it has?*  “No one is blaming the consumer; the fault lies with the food industry.”  This, at a conference devoted to showing consumers how their choices have driven the actions of industry. To blame industry is to blame the consumer; it’s just a sneaky and, frankly, dishonest way of doing it.

Ironically, the next day BMJ published an editorial with a completely different perspective. In it, Gary Taubes  (science writer and champion for the return of common-sense and intellectual rigor in the world of nutrition science)** suggests that instead of yet another round of “making the healthy choice the easy choice” for poor stupid fat Americans who haven’t the good sense to lose weight and stay healthy the way they’ve been told to for the past 35 years, perhaps nutrition experts might try a different tact:

“We believe that ultimately three conditions are necessary to make progress in the struggle against obesity and its related chronic diseases—type 2 diabetes, most notably. First is the acceptance of the existence of an alternative hypothesis of obesity, or even multiple alternative hypotheses, with the understanding that these, too, adhere to the laws of physics and must be tested rigorously.

Second is a refusal to accept substandard science as sufficient to establish reliable knowledge, let alone for public health guidelines. When the results of studies are published, the authors must be brutally honest about the possible shortcomings and all reasonable alternative explanations for what they observed.

Finally, if the best we’ve done so far isn’t good enough—if uncontrolled experiments and observational studies are unreliable, which should be undeniable—then we have to find the willingness and the resources to do better. “

While I find plenty to disagree with here (high glycemic grains?  really?), Taubes outlines some fascinating aspects of the history of obesity research and sheds some light on why the calories in-calories out hypothesis won out over the endocrinological (say it 5 times fast) one—and what nutritional mayhem has ensued since.  (Read the whole thing.  You’ll be glad you did.  I’ll wait here.)

His editorial reminds us that when it comes to the question of what dietary pattern will prevent obesity and chronic disease, we really don’t know much.  And it makes clear that what is needed now is a view toward a future where we will approach this question with much more humility and caution than we have in the past.

I’m going to suggest now–and you dear readers help me remember–that this time next year, we need to take Consumer Federation’s Food Policy Conference by storm.  It isn’t expensive (I think registration is $90, cheaper still if you are a student).  We are, after all, consumers.   The meeting is full of industry reps, policymakers, journalists, as well as academics.  It’s a small enough venue that I believe we can make our voices heard.  We can let them know that the current definition of “healthy food” doesn’t work for all of us & we, as consumers, want different choices and different information.

I get the impression that the current crop of nutrition experts and academics isn’t interested in trying this new dish–humility with a side of caution.  Since these folks seem to want to persist in keeping the public’s health on a trajectory where they can be the solution to the problems they have caused, perhaps we can find some ways to  “make the reasonable choice the easy choice” for them.

I’ll rent the hotel room & anybody who wants to can bring a sleeping bag–paleo sleepers can spread their bearskins on the floor.  Let’s do it.

*The truth is we don’t really know how sugar intake has changed.  Dietary data and food availability data offering conflicting views.  A mean of 15.8% of consumed calories was from added sugars in this study; data from 2010.  This study estimated that 26% of calories were from added sugar; data from 1977-1978.

**Full disclosure:  I know, and usually actually like, Gary Taubes.  But he does not pay me to say nice things about him & I disagree with him as much as I agree.

TMAO? LMAO.

Move over saturated fat and cholesterol. There’s a new kid on the heart disease block: TMAO.

TMAO is not, as I first suspected, a new internet acronym that I was going to have to get my kids to decipher for me, while they snickered under their collective breaths. Rather, TMAO stands for Trimethylamine N-oxide, and it is set to become the reigning king of the “why meat is bad for you” argument. Former contenders, cholesterol and saturated fat, have apparently lost their mojo. After years of dominating the heart disease-diet debate, it turns out they were mere poseurs, only pretending to cause heart disease, the whole time distracting us from the true evils of TMAO.

The news is, the cholesterol and saturated fat in red meat can no longer be held responsible for clogging up your arteries. TMAO, which is produced by gut bacteria that digest the carnitine found in meat, is going to gum them up instead. This may be difficult to believe, especially in light of the fact that, while red meat intake has declined precipitously in the past 40 years, prevalence of heart disease has continued to climb. However, this is easily accounted for by the increase in consumption of Red Bull—which also contains carnitine—even though it is not, as some may suspect, made from real bulls (thank you, BW).

Here to explain once again why we should all be afraid of eating a food our ancestors ignorantly consumed in scandalous quantities (see what happened to them?  they are mostly dead!) is the Medical Media Circus! Ringleader for today is the New York Times’ Gina Kolata, who never met a half-baked nutrition theory she didn’t like (apparently Gary Taubes’ theory regarding carbohydrates was not half-baked enough for her).

Step right up folks and meet TMAO, the star of “a surprising new explanation of why red meat may contribute to heart disease” (because, frankly, the old explanations aren’t looking too good these days).

We know that red meat maybe almost probably for sure contributes to heart disease, because that wild bunch at Harvard just keeps cranking out studies like this one, Eat Red Meat and You Will Die Soon.

This study and others just like it definitely prove that if you are a white, well-educated, middle/upper-middle class health professional born between 1920 and 1946 and you smoke and drink, but you don’t exercise, watch your weight, or take a multivitamin, then eating red meat will maybe almost probably for sure increase your risk of heart disease. With evidence like that, who needs evidence?

Flying like the Wallenda family in the face of decades of concrete and well-proven assumptions that the reason we should avoid red meat is because of its saturated fat and cholesterol content, the daring young scientists who discovered the relationship between TMAO and heart disease “suspected that saturated fat and cholesterol made only a minor contribution to the increased amount of heart disease seen in red-meat eaters” [meaning that is, the red-meat eaters that are white, well-educated, middle/upper-middle class health professionals, who smoke and drink and don’t exercise, watch their weight, or take a multivitamin; emphasis mine].

Perhaps their suspicions were alerted by studies such as this one, that found that, in randomized, controlled trials, with over 65 thousand participants, people who reduced or changed their dietary fat intake didn’t actually live any longer than the people who just kept eating and enjoying the same artery-clogging, saturated fat- and cholesterol-laden foods that they always had. (However, this research was able to determine that a steady diet of broiled chicken breasts does in fact make the years crawl by more slowly.)

You can almost ALWAYS catch something on a fishing expedition.

Our brave scientists knew they couldn’t just throw up their hands and say “Let them eat meat!” That would undermine decades of consistent public health nutrition messaging and those poor stupid Americans might get CONFUSED—and we wouldn’t want that! So, instead the scientists went on a “scientific fishing expedition” (Ms. Kolata’s words, not mine) and hauled in a “little-studied chemical called TMAO that gets into the blood and increases the risk of heart disease.” Luckily, TMAO has something to do with meat. [As Chris Masterjohn points out, it also has something to do with fish, peas, and cauliflower, but–as I’m sure these scientists noticed immediately–those things do not contain meat.] Ta-da! Problemo solved.

Exactly how TMAO increases the risk of heart disease, nobody knows. But, good scientists that they are, the scientists have a theory. (Just to clarify, in some situations the word theory means: a coherent group of tested general propositions, commonly regarded as correct. This is not one of those situations.) The researcher’s think that TMAO enables cholesterol to “get into” artery walls and prevents the body from excreting “excess” cholesterol. At least that’s how it works in mice. Although mice don’t normally eat red meat, it should be noted that mice are exactly like people except they don’t have Twitter accounts. We know this because earlier mouse studies allowed scientists to prove beyond the shadow of a doubt that dietary cholesterol and saturated fat cause heart disease mice definitely do not have Twitter accounts.

Look, just because the scientists can’t explain how TMAO does all the bad stuff it does, doesn’t mean it’s not in there doing, you know, bad stuff. Remember, we are talking about molecules that are VERY VERY small and really small things can be hard to find–unless of course you are on a scientific fishing expedition.

What will happen to the American Heart Association’s seal of approval now that saturated fat and cholesterol are no longer to be feared?

Frankly, I’m relieved that we FINALLY know exactly what has been causing all this heart disease. Okay, so it’s not the saturated fat and cholesterol that we’ve been avoiding for 35 years. Heck, everybody makes mistakes. Even though Frank Sacks and Robert Eckel, two scientists from the American Heart Association, told us for decades that eating saturated fat and cholesterol was just greasing the rails on the fast track to death-by-clogged-arteries, they have no reason to doubt this new theory. And even though they apparently had no reason to doubt the now-doubtful old theory, at least not until just now—as a nation, we can rest assured that THIS time, they got it right.

Now that saturated fat and cholesterol are no longer Public Enemies Number One and Two, whole milk, cheese, eggs, and butter—which do not contain red meat—MUST BE OKAY! I guess there’s no more need for the AHA’s dietary limits on saturated fat, or for the USDA Guidelines restrictions on cholesterol intake, or for those new Front of Package labels identifying foods with too much saturated fat. Schools can start serving whole milk again, butter will once again be legal in California, and fat-free cheese can go back to being the substance that mouse pads are made out of. Halla-freaking- looyah! A new day has dawned.

But—amidst the rejoicing–don’t forget: Whether we blame saturated fat or cholesterol or TMAO, meat is exactly as bad for you now as it was 50 years ago.