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.

“Broccoli has more protein than steak”—and other crap

Of all the asinine things that I read about nutrition—and let me tell you, I read a lot of them—this one has got to be the asininniest: Broccoli has more protein than steak.

I’ve seen this idiotic meme repeated many times, but the primary source of this stupid—see also: delusional, ludicrous, and absurd—notion seems to be Dr. Joel Furhman. My mom—bless her little osteoporotic soul—keeps his books down at the beach cottage. I don’t think she does it to taunt me, but you never know. I was a bad kid, and payback may be in order. My family has forbidden me to read Dr. Furhman’s books, to pick them up, or to even glance at the covers because the resulting full-on nutrition-rant kills everybody’s beach buzz.

However, as of last week, I have officially maxed out my tolerance for just ignoring this nonsense. So, note to my family: Read no further, it will kill your beach buzz.

According the Dr. Furhman’s book, Eat to Live, a 100-calorie portion of sirloin steak has 5.4 grams of protein, and a 100-calorie portion of broccoli has 11.2 grams of protein. This is rubbish. According to the USDA’s Agricultural Research Service’s Nutrient Data Laboratory database, 100 calories of broiled beef, top sirloin steak has exactly 11.08 grams of protein and 100 calories of chopped, raw broccoli has exactly 8.29. I’m not sure what universe Dr. Furhman lives in, but in my universe, 8.29 is less than 11.08.

I can explain the discrepancy in numbers by the simple fact that Dr. Furhman and I used different sources for our information. Dr. Furham wrote his book—the one that contains the piece of drivel under consideration—in 2005, but he chose to reference a nutrition book written in 1986 (Adams, C. 1986. Handbook of the Nutritional Value of Foods in Common Units, New York: Dover Publications). Just to put things in perspective, in 1986, the internet and DVDs had not yet been invented, no one knew who Bart Simpson was, and it would be another couple of years before Taylor Swift even draws her first ex-boyfriend-bashing breath.

Here’s what I can’t explain: Why, oh why did he dig up a reference nearly two decades old and not just use the USDA internet database, which is—and has been since the 1990s—available to anyone with a library card and a half a brain? While I do not wish to speculate on exactly which of these tools Dr. Furhman might be lacking, suffice it to say that it would take less than 10 minutes for any blogger interested in the truth of the matter to find a more recent source of information—assuming of course that bloggers who perpetuate this particular fiction are interested in the truth.

But wait—before you foam at the mouth too much, Adele—8.29 grams of protein is fair bit of protein.  There is only a difference of a couple of grams of protein between broccoli and steak.  Yes, I would agree, those numbers are a lot closer than you might expect, and this might actually be nutritionally important, if—Big If—all protein were created equal. Which it isn’t.

While I am a big fan of coming at nutrition from an individualized perspective, and I am aware that nutrition scientists don’t have any monopoly on truth, we have managed to nail down a few essential things that human must acquire from the food that they eat. In terms of essentiality, after calories and fluid comes protein—or more specifically, essential amino acids (there are more essentials, but they are not the topic of this particular rant). Because these amino acid requirements are so important (a particular form of starvation, kwashiorkor, involves not overall calorie deprivation, but protein deficit in the context of adequate or near-adequate calories), the World Health Organization has established specific daily requirements of the essential amino acids that are necessary for health.

Let’s see how similar caloric intakes of steak and broccoli stack up when comparing how these two foods provide for essential amino acid requirements. A 275-calorie portion of steak (4 ounces) has 30.5 grams of protein and comes very close to meeting all the daily essential amino acid requirements for a 70 kg adult. A 277-calorie portion of broccoli is not only way more food—you’ll be chewing for a long time as you try to make it through 9 ¼ cups of broccoli—exactly NONE of the daily essential amino acid requirements for an adult are met:

EssentialAmino acids (g) Daily requirement 70 kg adult (g) Essential amino acids (g) in 275 calories of steak (4 oz or 113.33 g) Essential amino acids (g) in 277 calories of chopped, raw broccoli (9.25 cups)
histidine 0.70 0.975 ( +0.275) 0.48 (-0.22)
isoleucine 1.400 1.391 (-0.009) 0.643 (-0.757)
leucine 2.730 2.431 (-0.299) 1.05 (-1.68)
lysine 2.100 2.583 (+0.483) 1.099 (-1.001)
methionine 0.70 0.796 (+0.096) 0.309 (-0.391)
cysteine 0.28 0.394 (+ 0.114) 0.228 (-0.052)
threonine 1.050 1.221 (+0.171) 0.716 (-0.334)
tryptophan 0.280 0.201 (-0.079) 0.269 (-0.011)
valine 1.82 1.516 (-0.304) 1.018 (-0.802)

In reality, it takes twice that much broccoli, or over 18 cups, containing nearly twice as many calories, in order to get anywhere near meeting all essential amino acid requirements.  While I’m willing to concede that individual amino acid requirements may vary considerably, I am not willing to concede that similar caloric amounts of steak and broccoli provide a similar supply of those requirements.  I’m no broccoli basher (it’s sooo yummy baked with cheese & a little bacon on top), but as a protein source, even a lot leaves a lot to be desired.

Oh yeah? Well then, “how on earth do animals like elephants, gorillas and oxen get so big and strong eating only plants? A diverse plant-based diet can obviously support a big, powerful body.” Sure it can. If you’re an elephant or a gorilla or an ox.

In general, human bodies don’t work very efficiently without a regular dietary supply of all essential amino acids: “It would be difficult to find a protein that did not have at least one residue of each of the common 20 amino acids. Half of these amino acids are essential, and if the diet is lacking or low in even one of these essential amino acids, then protein synthesis is not possible” [Emphasis mine; reference: Campbell & Farrell’s Biochemistry, 6th edition]. Protein synthesis allows us to grow, heal, reproduce, and function in general. One of the specific outcomes of protein deficiency in humans is stunting, i.e. where humans who would otherwise grow bigger, don’t.

Dr. Furhman seems to think that those of us who “believe” that food from animals provides a more biologically complete source of protein than food from plants “never thought too much about how a rhinoceros, hippopotamus, gorilla, giraffe, or elephant became so big eating only vegetables.” Hmmm. I have to say, I’m thinking the same thing about Dr. Furhman. Maybe he is unaware that humans aren’t really all that much like rhinoceroses, hippos, gorillas, giraffes, or elephants. But then maybe he just hangs out with a different crowd than I do.

Once again, armed with a library card and half a brain, it is not too difficult to figure out—assuming you did think about how those animals got so big eating only plants and didn’t just mindlessly parrot Dr. Furham’s poorly-researched blather—that, as Gomer Pyle would say, surprise! surprise! Humans and other large mammals ARE different.

While non-ruminants (like humans) must get their essential amino acids from their diet, ruminants (like giraffes) “may also acquire substantial amounts of these amino acids through the digestion of microbial protein synthesized in the rumen” (see: Amino Acids in Animal Nutrition, edited by J.P. Felix D’Mello). This may come as a bit of a shock to Dr. Furhman and his readership, but humans don’t actually have rumens and utilizing this particular approach to the acquisition of essential amino acids from plant matter ain’t gonna work for us.

You can get plenty of protein from a plants-only diet by eating like a hippo.

Other non-ruminant grazers—see elephants, rhinos, and hippos—have a different eating strategy. They “eat for volume and low extraction.” In other words, the relatively low availability of protein in the food is overcome by the high volume consumed. In that regard—assuming you aspire to an elephant-like, rhino-like, or hippo-like bod—it may be possible to get sufficient protein from a strictly plant-based diet. If you don’t mind eating all the time. And pooping. Less than half of what is consumed by the high-volume grazers is utilized by the body; the rest—like a handsome stranger—is just passin’ through (see: Nutritional Ecology of the Ruminant, by Peter J. van Soest). If the idea of literally flushing over half of what you eat down the toilet doesn’t bother you, then this strategy actually might work.

ooooh! Can we? Please?

So what about gorillas? This particular primate-to-primate comparison has been tossed all around the internet. Why can’t we just eat plants like gorillas do? Gorillas, although not so good at Jeopardy, are big and strong and they’re vegans, so we should all be vegans too, right? Aside from the fact that we don’t really know exactly what gorillas are eating much of the time, it does seem that they eat a lot of bugs along with their plants. So unless you have a particularly fastidious gorilla, some dietary protein won’t be vegan. Compared to humans, gorillas also have a much larger proportion of the gut devoted to fermentation—again, another source for microbes to contribute to the nutritional completeness of a plants-only diet. And, again, a high volume of food is consumed to compensate for the low nutritional value of it. You won’t have to worry about half your food going down the toilet, though. Those who want to live like gorillas can just eat that poop instead of flushing it. This provides the body with another opportunity to extract nutrition from the substance formerly known as food and may also help explain the willingness of Dr. Furhman’s readers to swallow what he’s shoveling.

I have nothing against a plants-only diet—in whatever form it takes—if that’s what a person want to do and it makes him/her happy. I have no more interest in converting a vegan to omnivory than I do in having a vegan attempt to convert me to swearing off bacon. I am also aware that there is more—much more—to food choices than the nutritional content of the food chosen.

But I’m afraid this is just one of those situations where ideology has been sent to do the work of science. Ideology has its place, and science has its flaws. Truth, facts, and beliefs can be hard to define and harder still to separate. I get all that. But – to quote Neil deGrasse Tyson – “The good thing about science is that it’s true whether or not you believe in it.” Unfortunately, for all those gorilla-wannabees out there, the reverse also applies: Believing in something doesn’t make it true. You can believe all you want that broccoli is a better source of protein than steak, but your ribosomes don’t have access to a keyboard and they might vote differently.

Now, dear readers, if you ever run across some library-card-challenged blogger out there perpetuating Dr. Furhman’s little myth, you have a link to help spill some sunshine on the matter.

Calories? Again? Already?

Are we not sick of this subject already?

There have been some excellent articles and lots of “food for thought” on this topic recently.

Robb Dunn did a guest post at Scientific American about “The Hidden Truths About Calories,” which—to summarize in a way that does no justice to the article at all—basically boils down to the fact that most of the hidden truths about calories are so hidden we simply don’t know much about them at all. (I second this: Why Calories Count Fo’ Shizzle.)

Go Kaleo has a great post on this topic called “Putting the (Calorie) Pieces Together.” 

And Regina Wilshire has a puzzle for us at Weight of the Evidence called “Working Through A Stall.” 

Sooooooo – do calories in general matter, or is only the “kinds” of calories (i.e. the “good” kind vs the “bad” kind) that matter?

I think Go Kaleo said it very well: “All that black and white thinking has got people believing a false dilemma: It’s EITHER ‘calories in vs. calories out’ OR ‘the kind of calories you eat’ that matters!” She’s right in saying that it is a false dichotomy.

Neither approach comes close to acknowledging the complex interplay of factors that is human metabolism. I’m down on the calories in/calories out paradigm because it is so limited in scope, but I am equally down on any paradigm that says they don’t matter at all.

There are far too many unknowns about how the energy content of the food we eat interacts with the energy needs of our bodies to insist upon a singular health-maintenance paradigm based on “calories in, calories out.” At the same time, there are far too many unknowns about insulin metabolism (we currently don’t even have agreed-upon ways to measure and discuss insulin dysregulation) to create a new singular health-maintenance paradigm based on “fat in, carbohydrates out.”

One thing that complicates the picture is that we equate the metabolic situation that causes fat gain with the metabolic situation that will induce fat loss. My understanding of the biochemistry is that there are two necessary aspects to weight gain: excess calories to store (although we seldom know how to measure or even estimate what we mean by “excess”) and the insulin signal that provides the mechanism for storage to take place. Remove one of these factors—again with the caveat that we have a limited understanding of what “excess calories” means—and you won’t have weight gain.

Weight loss may be a different matter entirely. For weight loss to take place, we have to figure out NOT ONLY how to not create a metabolic situation where these two factors are at play, we also have to figure out how to convince our body to reverse the fat-storage process. This may involve processes which go beyond just one eliminating insulin-stimulating carbohydrate foods because—unless someone has Type 1 diabetes—some basal levels of insulin (and we may or may not know what they are or if they are “normal” or how that matters) are always present. This may also involve processes which go beyond just eliminating “excess” calories because, as I hope I’ve made clear, we don’t really even know what that means.

Some people can reduce overall calorie intake and lose weight (this usually also involves a lowering of carbohydrate foods that stimulate insulin release) ; some people can just reduce their carbohydrate food intake  and lose weight (this usually also involves lowering calories available for storage); some people have to do both–deliberately and carefully—in order to lose weight. The trick is how to do this without

  1. inducing willpower-withering hunger pangs
  2. depriving the body of essential nutrition
  3. creating other metabolically-unfortunate side effects/consequences.

The answer will not be the same for everyone. Reducing the number of nutritionally-empty carbohydrates gets at both the calorie and the carbohydrate issue–so that’s sort of a no-brainer, but carbs and calories are not all that matter.

Like what?

Metabolism matters. Nourishment matters. Information signaling—provided by your body’s encounters with the environment, including food encounters–matters.

Do calories affect these things? YES!!! Do carbs affect these things? YES!!! Are there about a bazillion other things that affect these things? YES!!!

When the clinic doors at the Duke Lifestyle Medicine Clinic open, the first two patients through those doors were both very much alike and radically different.

Both were “obese” adult white males, but that’s about where the resemblance ended. One gentleman, who was almost as big around as he was tall, was actually pretty healthy. Most, if not all, of what we think of as meaningful or predictive health biomarkers (blood pressure, cholesterol, glucose, etc) were normal. His problems were primarily orthopedic; i.e. his weight was impacting his hip and knee joints.

The other gentleman was far less obese, but his weight (as you may guess) was concentrated in his abdomen, his predictive health biomarkers were in the toilet, and he had a bag of prescriptions meant to normalize those biomarkers to prove it.

I (now) think of the first gentleman as having “simple” obesity and the second gentleman as having “metabolic” obesity. Such fat patterning has also been referred to as gynoid obesity (“pear”) and android (“apple”) obesity, and the different health consequences of each have been recognized, but even these differences are over-simplified concepts.

Android obesity (Gentleman #2) has been associated with excess insulin and with more metabolic derangement than gynoid obesity. It has been fairly well explained at this point that, aside from its role as a fat storage mechanism, excess insulin causes other metabolic problems.*

Is gynoid obesity (Gentleman #1) primarily associated with “excess” calories or “excess” storage of calories, rather than insulin dysregulation? We don’t know. Can “excess” calories cause other problems besides those leading to fat storage? We don’t know that either. One of the problems with asking these questions is—again—how we define “excess.”

Either way, the next step is to recognize that how we address different types of obesity may also need to be different. One type of obesity may be best addressed by a focus on reducing carbohydrate intake. The other type could be addressed by a focus on decreasing calories in and increasing calories out—however you want to do that. (As above, either approach involves some aspects of the other.)

But even differentiating dietary approaches based on fat-patterning must acknowledge that if there is a spectrum—with simple obesity on one end and metabolic obesity on the other—that any individual can be located anywhere along that spectrum and thus a combination of approaches would have to be used to address the needs of the individual, which may need to go beyond both carbs and calories.

It is crucial to remember that our bodies not really designed to either “gain”or “lose” weight, but to respond to our environment by small shifts in– up-regulating and down-regulating—the production of proteins, enzymes, and other biomolecules to meet the pressures of the environment. We are adapted to adapt. Food is one of the primary signals our bodies get about our environment. Food lets the body know what the conditions are like “out there” so that we can make appropriate adjustments “in here.” These adjustments, we know now, can be passed on from one generation to the next, so that our offspring are also prepared for what is “out there.”

What the body is looking for—all the time, without exception—is essential nourishment and adequate energy (and again our definition of “adequate” is as problematic as our definition of “excess”).  Note to paleo-thinking readers:  the origins of the paleo diet emphasize acquiring essential nutrition, rather than forbidding non-essential foods. This point may be the most important aspect of ancestral nutrition. (And thanks to Katherine Morrison for calling this to my attention.)

An eating pattern that conveys to our body that the environment is lacking in either of these things is going to result in metabolic adjustments to this information. What the adjustment looks like is going to depend on genetic factors (What food environment were your ancestors adapted to?), and epigenetic factors (Did you have an adequately-nourished mom?), and previous adaptive adjustments (Does your body regularly have to respond to caloric highs or lows? to regular bouts of intense energy expenditure? to reduced nutrition?), in addition to those other bazillion things we don’t know about yet.

So what are we going to do about it? I am so glad you asked. I’ve been trying to work my way to a blog post about n of 1, or individualized nutrition, for weeks now. I think I’m about there.

*See the work of Gerald Reaven and Wenhong Cao, for example.

The Mobius Strip of Policy Change


I love working with individuals, but it takes policy-level change to really make an impact on public health. Policy, however, is a double-edged sword. Decades-long cascades of unintended consequences can arise from well-intentioned policy. The Dietary Guidelines started out in 1980 as an unmandated humble little 40-page booklet offering nutrition guidance to the public, while freely admitting that “we don’t know enough about nutrition to identify an “ideal” diet for each individual” and that “in those chronic conditions where diet may be important . . . the roles of specific nutrients have not been defined.”

Since then, I’m still not sure how, the Dietary Guidelines have become the center of all information and decision-making surrounding food and nutrition in America—in policy, healthcare, industry, media, and science (where researchers should know better than to use a policy document as the basis for scientific research). And—for better or worse—Americans have actually shifted their eating habits to fall in line with Guidelines recommendations (see: Americans don’t follow the Guidelines—or do they?)


The Guidelines were created to prevent chronic disease.  They have changed very little in 30 years, while rates of obesity, diabetes, and other chronic disease have rapidly increased (see: Public Health Nutrition’s Epic Fail). Currently, there is no “policy lever” for changing the way the Guidelines are created or administered. The Guidelines have no system of checks and balances, no outcome evaluation process, and no way to counter the influence of entrenched special interests (including both the food and science industries).

Right now, it seems that no amount of public outcry, accumulation of scientific evidence otherwise, or increase in diseases the Guidelines were meant to prevent can shift them from their current staked position that a high-carbohydrate, high-fiber, low-fat, low-cholesterol, low-saturated fat, low-sodium diet is right for all Americans. Under the USDA/HHS “calories in, calories out” paradigm, it’s Americans that need to change (“eat less and move more”), not nutrition policy. Policy changes are urged only to “make the healthy choice the easy choice”  for fat stupid Americans (especially low-income ones) who apparently otherwise don’t care and can’t think.

I would expect such policy reform to have, as Jon Stewart put it, “the draconian government overreach we all love with the probable lack of results we expect.”

So what kind of policy reform should we be working towards? One of the Big Questions I ponder is whether we need to replace the current USDA/HHS Dietary Guidelines with “better” ones, or find a different way to create nutrition policy, or just ditch all government-sanctioned nutritional recommendations altogether. (Other Big Questions: What’s for dinner? and How can I further embarrass my children?)

I don’t fundamentally oppose or support government-funded nutrition programs. If they were administered differently, I might like them a lot more. If we are going to use government funds to feed people, we will need some way of guiding that process. Right now, our federally-funded nutrition programs have a tendency to serve as outlets for cheap industrialized food, and I’m afraid that our nutrition guidance has not only allowed, but encouraged that role. On the other hand, scrapping that guidance altogether may leave government programs that are struggling for funds vulnerable to choosing food from the lowest bidder, which would only serve to reinforce the current situation.

I also have problems with replacing one-size-fits-all Guidelines with different one-size-fits-all Guidelines because that process denies the very real variability in nutritional needs and preferences of individuals and diverse sub-populations. Worse yet, it teaches people that answers about nutrition come from packages and experts rather than the body’s response to food.

As a transition, or middle ground, I currently favor the idea of locally-determined nutritional policies and programs. Sounds good, right? Nutrition programs could be tailored to meet the needs of the community they serve.

But this is where the confluence of things needed to make this type of policy shift happen turns into a Dilbert cartoon. Everything that needs to happen requires something else to happen first until it all loops back on itself like a Mobius strip.


Let’s take school lunches.  

Ideally, the type of school lunches served should be determined by the members of the community eating them, i.e. the kids, parents, teachers, etc.  This allows for appropriate community-level health, ethnic, cultural, regional, seasonal, and economic adjustments and prevent fiascos like the Los Angeles lunchroom garbage cans filled with “healthy” lunches (like “brown rice cutlets”).

Ideally, a trained professional at the local level, for instance an RD, would be able to guide this process, balancing the nutritional needs of that specific community with other social and cultural factors, creating an affordable menu, and modifying the program based on outcomes.  But this would mean that the RD would have to have training across the spectrum of nutrition science, rather just following USDA/HHS policy statements which are based on research done on white (frequently male) adults circa 1970-1980 and which may not be applicable to other populations.

This in turn would require the nutrition curriculum for health professionals to not be skewed by entrenched interests in academics, politics, and industry (and would probably require almost a complete re-thinking of 30 years of nutrition epidemiology).

This would require the USDA/HHS and other institutions to support–through funding, publication, and use—nutrition research that may possibly undermine or even contradict 30 years of previous nutritional guidance. This research would not only provide a knowledge base for health professionals, but would provide an unbiased source of information for consumers which would help to create informed stakeholders in the nutrition-food system.

At the same time, industry, producers, and growers would have to work with the community to make foods available that meet the demands of the local program at a reasonable cost.  And right now—due to agricultural practices and USDA policies—foods that are widely and cheaply available to federal nutrition programs are the ones that the USDA/HHS Guidelines have determined are “healthy” even though this definition of “healthy” seems to be based, at least in part, on whether or not those foods are widely and cheaply available for federal nutrition programs.

See what I mean?  I have a hard time figuring out where we need to insert the monkey-wrench that will stop the endless cogs from turning out the same policies, practices, and programs that have been radically unsuccessful for the past 30 years.

Which won’t, of course, stop me from trying.

As I’ve been working with Healthy Nation Coalition and tossing ideas around with people who are also working on this issue, I’ve found some that I believe are fundamental to fixing our food-health system. These concepts originated with people much smarter than me, but I am hoping that in my academic work and in our non-profit work at Healthy Nation Coalition, I will have the opportunity to be a part of developing them further:

1) N of 1 Nutrition – a movement towards more individualized nutrition, although the “1” can also be a family, community, or other subpopulation

2) Nutritional Literacy – a movement to foster an understanding of the cultural forces that shape our nutritional beliefs and our relationships to food and food communities

3) Open Nutrition – a movement to raise awareness regarding the laws, policies, institutions, and other social, economic and cultural forces that may impact access to nutrition information and development of sustainable systems that produce foods that support health

It takes about 30 years for any given scientific paradigm to shift. It is time. But how will we do it differently? I think these concepts are the “next steps” that will help us steer the next 30 years of nutrition in a direction that may help us avoid another cascade of unintended consequences down the road. More on each soon.


Calories in, Calories out, Would You Please Go Now!

Ah, calories! Let me count the ways . . . that calorie-counting is a limited, grossly over-simplified, and ultimately highly unproductive way of addressing weight or health.

According to some, the key to health and a healthy weight is making sure your calories in = calories out. This is called being “in energy balance,” and, according to the USDA 2010 Dietary Guidelines, this is what most Americans are “out of.” We are fat because we eat more calories than we need—whatever that means. And the only way to NOT be fat is to “eat less and move more.”

Sounds simple enough. So why doesn’t it seem to work all that well?

Let’s start with the basics:

  • When a person decreases their “energy in,” that person’s “energy out” also goes down. For example, take Ancel Keys’ early starvation experiments.

  • When a person increases their “energy out,” that person’s “energy in” goes up. For example, take my 6’7″ basketball- & soccer-playing nephew out for dinner.


[Shameless Auntie plug: check out his latest endeavor, “Kicking across Carolina]

Eating less and moving more is like breathing underwater: not impossible, but somewhat awkward and unnatural. Some turtles can breathe underwater through their butts; some people can eat less and move more. For a lot of us, we are as likely to be as successful at the former as we are at the latter.


Turtles can, can you?

What? you say. But it’s SO obvious. People who eat less, weigh less; how much simpler could it be?

Except that we don’t really have a lot of data that demonstrates that this is the case. Oddly enough, this is a cross-cultural, age-independent, apparently universal, problem.

For example, for these American Indians, higher BMI is associated with lower calorie intake.


From: Xu J, Eilat-Adar S, Loria C, et al. Dietary fat intake and risk of coronary heart disease: the Strong Heart Study. Am J Clin Nutr. 2006 Oct;84(4):894-902.

In this Mediterranean population, higher BMI is associated with lower calorie intake.


From: Casas-Agustench P, Bulló M, Ros E, Basora J, Salas-Salvadó J; Nureta-PREDIMED investigators. Cross-sectional association of nut intake with adiposity in a Mediterranean population. Nutr Metab Cardiovasc Dis. 2011 Jul;21(7):518-25. Epub 2010 Mar 9.

In these kids, higher BMI is associated with lower calorie intake.


From: Qureshi MM, Singer MR, Moore LL. A cross-sectional study of food group intake and C-reactive protein among children. Nutr Metab (Lond). 2009 Oct 12;6:40.

Yeah, in these kids too.


The trend continues as kids become teenagers. Strangely, the teens who move more, eat more; the teens who move less, eat less. And, surprise, higher BMI is associated with lower calorie intake. Hmmm.


From: Patrick K, Norman GJ, Calfas KJ, et al. Diet, physical activity, and sedentary behaviors as risk factors for overweight in adolescence. Arch Pediatr Adolesc Med. 2004 Apr;158(4):385-90.

As you may be aware, some researchers do have an explanation for this phenomenon: Fat people lie. That’s certainly a much more convenient explanation than examining the possibility that there is more to nutrition metabolism than “calories in, calories out.

Sadly, this lying stuff apparently starts young. In this study, the researchers concluded that the 9-year old girls under investigation are apparently lying about how much they eat:

“Importantly, this study found that the positive association between energy intake and adiposity was observed only after excluding implausible energy intake reports, but not in the total sample which included implausible reporters, the majority of which were overweight children who under-reported energy intake.”

This means there is no association between calories and overweight in the general sample. An association is only found if the researchers exclude “implausible” intakes of overweight children who “under-report” what they eat. The researchers determine which intake levels were “implausible” because they know how to calculate how much fat kids are supposed to be eating:

“Physiologically plausible reports of energy intake were determined by comparing reported energy intake with predicted energy requirements.”

In other words, if the chubby little girls don’t eat as much as the researchers think they should be eating, as calculated using formulas that are notoriously inaccurate, then the conclusion is that they (the girls, not the researchers) are lying.

Luckily, the folks at the USDA are totally on top of this issue and can give us a clear explanation of what is going on:

“One would expect to find a strong positive association between caloric intake and a measure of body fatness, such as the body mass index (BMI).”

Yes, one would, if one thought that all that really matters is how many calories go in and how many calories go out.

“However, nutrition studies using self-reported food intake data, such as the CSFII data, have failed to find such an association, . . . ”

Y’don’t say? Hmmm. Wonder why that could be? Maybe nutrition is more complicated than a simple energy balance equation?

” . . . primarily because overweight persons tend to underreport intakes to a greater degree than healthy weight persons.”

Oh right, I forgot. So, they’re all lying? Native Americans, people in other countries, old people, young kids (or maybe their parents)?

Also, at any given time, overweight persons may be on weight-loss diets. ” [emphasis mine]

Ohhh.  That might help explain things. In other words, fat people either do not have the moral fortitude to be honest with themselves or anyone else about how much they eat, or they are—bravely, in the face of ridiculous odd against them—reducing the number of calories they eat.

In a study examining the association between calorie intake and BMI in women who are dieting, the investigators found, big surprise, an inverse association between BMI and calories (Ballard-Barbash R, Graubard I, Krebs-Smith SM, Schatzkin A, Thompson FE. Contribution of dieting to the inverse association between energy intake and body mass index. Eur J Clin Nutr. 1996 Feb;50(2):98-106.).

In other words, higher BMI is associated with lower calorie intake.  The researchers conclude that:

“Intermittent energy restriction appeared to be a significant factor in the reduced energy intake reported among overweight women in this sample.”  

The women aren’t lying; they’re dieting. Maybe they’re doing both!

Two-thirds of Americans are overweight or obese.  Apparently, two-thirds of Americans are either lying or dieting, or maybe both.

If you are a lying fat person, we can’t really draw any reasonable conclusions from the epidemiological data we gather about your eating habits. Furthermore, weight loss programs based on “calories in, calories out” are not likely to help you because you lie about what you eat anyway.

If you are a dieting fat person, we can’t really draw any reasonable conclusions from the epidemiological data we gather about your eating habits. Furthermore, weight loss programs based on “calories in, calories out” are not likely to help you because conventional weight loss programs are not likely to help anyone.

It is just a thought, but perhaps is it time to think about whether there are other things—besides normal human metabolism–that may affect “energy balance.” Quick brainstorm list off the top of my head:

  • genetics
  • epigenetics
  • environmental toxins
  • hormonal status
  • lifestage
  • disease state
  • medications
  • infection/inflammation
  • sleep patterns
  • stress
  • gut flora
  • and last but not least, the food you eat

What? you say. The food we eat?

If you want to be obsessed about calories going in and out, it makes sense to figure out which foods might cause fewer calories to go in and which food might cause more calories to go out. We don’t have all the answers—and it is my personal perspective that individual response is what matters most—but, here are a few clues:

In this study, participants who ate eggs for breakfast (with no other deliberate dietary changes) consumed 400 fewer calories over the course of the day than the participants who ate bagels, i.e. calories in went down.


From: Ratliff J, Leite JO, de Ogburn R, Puglisi MJ, VanHeest J, Fernandez ML. Consuming eggs for breakfast influenced plasma glucose and ghrelin, while reducing energy intake during the next 24 hours in adult men. Nutr Res. 2010 Feb;30(2):96-103.

In this study, when participants consumed a diet with reduced carbs and increased fat, resting and total energy expenditure tended to go up compared to when the same participants consumed diets with higher carb and lower fat content, i.e. calories out went up.


From: Ebbeling CB, Swain JF, Feldman HA, Wong WW, Hachey DL, Garcia-Lago E, Ludwig DS. Effects of dietary composition on energy expenditure during weight-lossmaintenance. JAMA. 2012 Jun 27;307(24):2627-34.

So, strangely enough, simply by choosing foods that are specifically NOT recommended in the current low-fat, low-cholesterol, high-carbohydrate diet promoted by the USDA/HHS, you may be able to alter your “energy balance” so that there are fewer calories coming in and more calories going out, without having to change anything else.

It’s time to quit condemning 9-year-old girls to a lifetime of hunger and frustration with “calories in, calories out” dieting, or accusations about them lying about what they eat, or both.

To paraphrase the immortal words of Dr. Suess:

“Calories in, calories out” will you please go now!

The time has come.

The time is now.

Just go.

Go.

Go!

I don’t care how.

“Calories in, calories out”

I don’t care how.

“Calories in, calories out”

Will you please

GO NOW!

Next up: The Mobius strip of policy & the future of nutrition

Why are Americans so much fatter than Europeans?

I have a lot to catch up on after a month of qualifying exam craziness and 3 weeks tooling around Germany and Italy. (If it was supposed to be relaxing, why did we bring the kids?). I’m working to improve my blogging efforts, so I’m treating you all a different blogging style for a while. I vow to no longer spend 2 weeks “perfecting” a post—you have no idea how challenging this internets thingy is to us old folks—and instead I will try to bombard you with random stories and thoughts incoherently melded together by my overriding simmering impatience with the current food/nutrition situation. When I get boring or redundant, let me know.

“That can’t be good for you.”

The carbs vs. fat debate took on a new perspective for me in Germany, where—at least where we were, in Bavaria—the population seems to love both! The question floated in and out of our conversations over lovely meats and cheeses, tomatoes and mangoes, bread and olives (my husband’s family were the most wonderful hosts!): Why are Americans so much fatter than Europeans?

Here’s a menu item from a Munich restaurant.

Loosely translates to “fat with fat”

Crispy pork fat is mixed with lard and spread on dark bread. I ordered it, and it was delicious.  The Bavarian people seem to love saturated fat in all its many forms, but most especially when it comes from pigs.

At the same time, I’ve also never seen such a healthy bunch of old people.  We visited the German Alps (a popular vacation spot for older Germans) and the town was filled with people in their 80s and even 90s out toddling around.  Those with canes took the easier walks around town, but many were hiking (yes, even with canes) and there were plenty of older folks up on the harder trails as well.  Oddly enough, they didn’t look super fit or anything, just not too fat (although most were what we would call a little “heavy”).

The Germans do love to be outdoors, and they love to walk, but they don’t seem to be exercise fanatics the way Americans are. I overheard a group of Germans discussing an American friend they knew who “ran 6 or 7 miles a day.” After a few murmurs that I couldn’t quite interpret at first, one young lady seemed to speak for the group when she concluded, “That can’t be good for you.”

Surprise! All calories are NOT created equal

As with exercise, the culture that surrounds food seems to be very different. No one seems to really care about calories. Serving sizes were enormous. Menus, however, do designate if an item contains artificial colors, sweeteners, added “antioxidants” –and whether the ingredients are likely to be frozen or the items prepared off-site. Only about 25% of the retail space in a grocery store is given over to processed foods (which leaves lots of room for a wide variety of beer!). Everywhere we went (even after hiking an hour or so up a mountain), people were hanging out in beer gardens, eating and drinking and generally having a lovely time of it.  Everywhere we went, the food was excellent.

Of course, I must point out that Germany is also experiencing an increase in obesity. It may take longer for it to catch up to the Bavarians, who tend to be skeptical about “progress,” which means they may be more likely to resist the relatively new-fangled low-fat approach to nutrition adopted by the US 30 years ago. Good thing, too. While we were in Germany, a new study done by David Ludwig at Harvard was released which adds to the body of literature that seems to indicate that USDA/HHS-recommended low-fat diets are not going to be the answer to our obesity crisis. The reaction to that study by the arbiters of nutrition fashion at the NY Times was very interesting.

In a surprising reversal from his many years of advocating for the “eat less, move more” approach, Mark Bittman seemed ready to acknowledge that, hey, maybe not all calories are created equal. I was thrilled to see this (even though Bittman didn’t bother to add “My bad for the previous 13 years worth of misinformation”) not just because it is scientifically accurate, but because of the adverse affects that I feel the “calories in, calories out” approach has had on how Americans relate to food. “Calories in/out” not only misses the metabolic effects of food, but—by treating food primarily as fuel—it also dismisses food as a part of our social tapestry and our cultural heritage. This approach also easily lends itself to creating an ethics of “good” eating behavior vs. “bad.”

Embracing sacrifice?

The savory handful of meaty goodness that is a doner kebab

If food is just fuel for the body, there is no reason to enjoy it, to savor it, to wax poetic about it (as my kids did over the Turkish doner kebabs–“savory handfuls of meaty goodness”–we had in Munich). You just eat it, as “ethically” as possible, and carry on with your hair shirt weaving.

James McWilliams (who is probably a really nice guy, but strikes me as being someone who would be a real buzz-kill at a party) exemplifies what may be a uniquely American notion, that eating should be a Puritanical experience of acquiring nutrition in the most joyless way possible:

“To really eat ethically more often than not means to avoid the primacy and exclusivity of taste. It means to forgo foods usually associated with “fine dining”—rich cheeses, meat, luscious desserts, and seafood dished out in fancy restaurants—in exchange for (as Mark Bittman’s work quietly reiterates) a humble bowl of beans, greens, and whole grains cooked up at home (with the leftovers eaten all week for lunch). It means, in essence, embracing sacrifice, even asceticism. Any committed vegan will have some sense of what this entails.”

I’m inclined to extend that young German woman’s assessment of her American friend’s exercise habits to this approach to food: That can’t be good for you. It may adequately feed your body (of course, it may not do that either), but it seems like it might shrivel your soul up just a little.

I find it difficult to imagine the Germans ever adopting this approach to food (ditto the Italians). Would McWilliams then consider the entire culture of food we encountered in Europe to be “unethical?” Germans and Italians were all about the “primacy of taste.” If the food police in America extend their current crackdown to saturated fat, I’ll be joining my father-in-law and his wife in Munich, where lard will never be four-letter word. (Yeah, I know. In German, it’s more like a fourteen-letter word.)

Connection vs. alienation

I’ll be the first to admit that the problem is a complicated one, but it is worth considering: maybe what helps make Americans fatter than Europeans is our attitude towards food. It seems counter-intuitive, but maybe if we cared more about food and what it means to us, we’d actually eat differently. It’s not a matter of quality over quantity, but a matter of connection vs. alienation. And it’s not just a white people thing either.

My friend, Elisa Maldonado wrote a terrific article about her experience with the standard American approach to “healthy eating.” You can find her article here. A friend of hers commented on the article, saying that “being both mexican american and native [her] body always felt weird and unhealthy” when she tried follow standard recommendations. Elisa and her friend make a case for the possibility that our ethnic background influences what dietary pattern will work better for us. If we can connect to (rather than be alienated from) both our traditional food cultures and the messages our own bodies send us in response to food, we may stand a better chance of discovering what foods leave us satisfied and healthy—in both body and soul. And we won’t have to “embrace sacrifice” to get there.  

Why Calories Count—Fo’Shizzle

Calories are the Radical Terrorist Plot of food. We don’t really know what they are, where they are, or how to successfully avoid them, but they affect all aspects of our lives: how much we eat, how often we exercise, whether or not we feel good about ourselves (our notions of “good” and “bad” behavior frequently revolve around how many calories we’ve avoided/consumed/burned/sat on). Like the Radical Terrorist Plot thing, sometimes it means our lives can get a little weird.

We do know one thing about calories though. According to Marion Nestle,
. . . many people in the world are consuming more calories than they need and becoming overweight and obese.” Simply put, we’re fat because we eat TOO MANY CALORIES—whatever that means.


So—exactly why do calories count?


Luckily, Nutrition Expert Marion Nestle has now written a whole big book to help us understand the mysteries of calories. She very thoughtfully posted an interview of herself being interviewed about the book on her website so we could all see what she thought about her own book. But she’s such a smart person, being a Nutrition Expert and all, I was concerned that some folks would have trouble figuring out exactly what she was saying. I hope this helps clarify things.

Calories count because they are easy to understand.

According to Marion Nestle, “Calories are a convenient way to say a great deal about food, nutrition, and health.” This is true. For instance, calories can tell you a great deal about how many calories are in your food, without having to take into account anything about nutrition or health.

Marion Nestle explains that the idea behind calories is abstract but simple: “They are a measure of the energy in food and in the body . . .” This is also true. In addition, calories are a way to measure the guilt quotient (lotsa calories) and marketability (teensyweensy amounts of calories) of food, making calories an exceptionally useful concept to both food manufacturers and those working on developing an unhealthy relationship to food.

Calories—as well as guilt and marketability—in food can be determined directly by using a bomb calorimeter, which measures the exact calorie content of food by igniting and burning a dried portion of it. In case you’re wondering, this is EXACTLY how your body measures calories too!

Marion Nestle explains that “Calories measure energy to keep bodies warm, power essential body functions, move muscles, or get stored as fat.” I would add that I don’t really know what calories do either, but if you use calories to keep your body warm, I guess my hot flashes make me “da bomb (calorimeter).” [I so crack myself up]. Hey, but then wouldn’t menopause turn us all into skinny bitches instead of fat ones?

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Calories count because calories are very confusing.

Marion Nestle explains that the reasons we haven’t been able to grasp the whole calories in-calories out thing is that “Even talking about calories is difficult. For starters, calorie counts are given in no less than five different units — calories, Calories, kilocalories, Joules, and kilojoules (along with their abbreviations cal, Cal, kcal, J, and kJ).” These concepts are so confusing to regular folks that only Nutrition Experts like Marion Nestle and Michael Pollan actually KNOW how many calories people should really be eating; the rest of the country is just guessing.

And when Americans “self report” on how many calories they eat? Well, let’s just say they are “underreporting,” shall we?

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Calories count because we don’t count them.

Government-Approved Nutrition Experts—not unlike Marion Nestle—MUST make a Big Statement about the Plight of Fat Americans, oh, about every year or so (it’s in their job description). When Slender Motivated Upper-class Gainfully-employed (code name: SMUG) Americans who read the New York Times need to know why we just can’t seem to get those fat stupid Americans to stop being so fat and stupid, they can call on Nutrition Experts–not unlike Marion Nestle–who KNOW the problem is that Americans eat too many calories—whatever that means. By keeping the focus on calories in-calories out, Nutrition Experts and food writers know that they can count on Americans to continue not counting calories, just as they have not counted them for hundreds of thousands of years, thus guaranteeing job security and future book contracts all around.

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Calories count because we do count them.

According to Nutrition Expert Marion Nestle, “The U.S. diet industry is worth about $60 billion a year.” Clearly, Americans are willing to shell out for just about anything if they think it will help them figure out why they can’t lose weight when they are doing everything they’ve been told to do for the past 30 years, including eating less fat, eating more carbohydrates, and exercising.

As long as Nutrition Experts can keep Americans counting calories, the food industry, the diet industry, the exercise industry, and the Nutrition Expert industry can keep counting the Benjamins. No calories in a Benjamin—it’s all fiber, baby.


A high fiber Benjamin

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Calories count because we can’t count them.

According to Nutrition Expert Marion Nestle, you can’t see, taste, or smell calories. This means calories are like Santa Claus and the Easter Bunny. You would have no way of knowing they even exist if there weren’t a giant academic-scientific-industrial-media complex devoted to the worship of calories and keeping them alive in our hearts and minds!


Spoiler alert: This is not the real Easter Bunny.  Like calories, the real Easter Bunny is invisible.

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Calories count because we can count them.

Fortunately, there’s an easy way to keep track of your calories even though you can’t see, taste, or smell them.

Marion Nestle says that the best way to measure calories is to step on a scale. So, lessee. I stepped on the scale and I weigh 160 pounds. If I’m 55% water (hooray, no calories there!), and 4% minerals (wait, does calcium have calories?), and then 13% protein (4 calories), 24% fat (9 calories) and 4% carbohydrate (4 calories), well then, hmm multiply by and convert and carry the one and—got it!—I’m exactly 194766.884 I’m exactly 206112.371 calories.

That means if I decrease my calorie intake by 500 calories a day (this where all that helpful calorie information on the side of the box of low-fat, high-fiber, individually calorie-control portion food comes in handy) and increase my activity by 500 calories a day (which I understand I can do simply through insanity, which—according to my children—should not be much of a stretch), that means that on November 10, 2012, sometime around noon, I will disappear altogether because all my calories will be gone. See how easy that is.


Counting calories is easy with a few simple tools.

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Calories count because we should count them.

Because counting calories is sooooo easy, anybody should be able to succeed at maintaining energy balance. There are lots of ways to demonstrate to the world that YOU have the intelligence, willpower, stamina, time, money, and Fine Upstanding Moral Character to keep your calorie balance in check.

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Calories count because counting calories is the only way to keep track of how many calories are in your food.

As with most other important things in life, if you can’t count it, it doesn’t count.

According to Marion Nestle, calories are derived from food. This is true of course, but only if you actually eat it. If you do decide to eat food, it’s really important to know how many calories are in your food.

This is why accurate calorie counts on everything we eat are so important! Turns out that your 500-calorie Leen Quizeen entrée may really contain—brace yourself—540 calories! With such inaccuracies in the calorie labeling of food, it’s no wonder Americans are fat.

According to Marion Nestle, this gross inaccuracy of calorie counts means that, “it works better to eat smaller portions than to try to count calories in food.” Lucky for us, food manufacturers make handy little portion-controlled packages of healthy whole grain food for us. And thoughtful Exercise Experts have given us calorie counts for every activity you can think of!


Healthy BAKED (not FRIED) whole grain portion-controlled fish-shaped food-like substance.

For example: An hour of coal mining equals 5 bags of 100-calorie whole grain goldfish, but since those food companies probably snuck in some extra calories in just to mess with us, if you’re coal mining for an hour, you should probably only eat 4 bags.

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Calories count because they are the only thing in your food worth counting.

Marion Nestle says, “Although diets with varying proportions of fat, carbohydrate, and protein may be easier for you to stick to or be more satiating, the bottom line is that if you want to reduce your body weight, you still need to consume fewer calories.” In other words, whether or not you feel full or satisfied has nothing to do with whether or not you’ll consume fewer calories. The reason we consume too many calories is because portion sizes are bigger, soda is cheaper, TV shows are more interesting, and couches are more comfortable than ever before. Plus the intelligence, moral fiber, character, and willpower of the American people are in serious decline.

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What can we do about the “calorie” problem?

According to Marion Nestle, “many groups have a stake in how calories are marketed, perceived, labeled, and promoted”—with the obvious exception of Nutrition Experts writing books about calories. They have NO dog in this fight.

Food manufacturers want Americans to eat a lot of calories, which totally explains why they sneak extra calories into our food for free without telling us.

This is why efforts to do something about obesity must focus on eating less of the foods that don’t come from food manufacturers—like eggs and meat—and focus on eating more foods that come in boxes and bags and cans that have a CALORIE count on them! Of course, Americans should also consume less soda, fast food, snacks, and other highly profitable items. That is, unless these are highly profitable items that Nutrition Experts really like! And really, it would go a long way towards solving our childhood obesity problem if we could only get calorie counts on beer for goodness sake! Darn that alcohol industry.


Thanks to lobbying efforts of the alcohol industry, there is no CALORIE label on this beer!

As Marion Nestle says, “On the societal level, we need measures to make it easier for people to eat less.” We need to work to change the food environment to one that makes it easier to eat healthfully, because—just between you and me—most Americans are just not willing to take charge of their own health.

Things YOU can do to “make the healthy choice the easy choice” for all those poor stupid fat people:

  • Support labeling laws—those poor stupid fat folks need accurate calorie counts on their movie popcorn, darn it!
  • Insist on more Government Approved Information about Nutrition (code name: GAIN)—because it’s been such smashing success so far!
  • Support controls on food advertising to children. The current childhood obesity crisis clearly demonstrates that parents can’t be trusted with complicated decisions like how to feed their children. This is where Nutrition Experts–not unlike Marion Nestle–can advise the FDA, the FCC, NASA, and NASCAR about the nutritional differences  (i.e. calorie counts) between a whole grain bagel (OK!)* and a frosted donut (Oh no you don’t!)** so parents won’t have to worry their pretty little heads about it anymore.
  • Support agricultural policies that encourage consumption of fruits and vegetables (but not eggs and pork chops) from local food systems.  Everyone knows that 90 calories of kale and kohlrabi are less fattening–and even more importantly, many times more virtuous–than the 90 calories in an egg.
  • Help create environments that encourage physical activity, like cities without public transportation. Those fat people standing in line for a bus would burn a lot more calories if they were WALKING to work!

SMUG Americans must remember: those stupid fat people are not just fat and stupid. In the face of our “obesogenic” environment, they are helpless. You need to be the change you want to see—especially in the seat next to you on an airplane.

That right, SMUG Americans, only YOU can prevent fat people.

*330 calories

**270 calories

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