Dietary Guidelines for Americans: We don’t need no stinkin’ science

I know, I know. I never post. I never call. I don’t bring you flowers. It’s a wonder we’re still together. I have the usual list of excuses:

1) GRADUATE SCHOOL

But before I disappear off the face of the interwebz once again, I thought I share with you a quickie post on the science behind our current Dietary Guidelines. Even as we speak, the USDA and DHHS are busy working on the creation of the new 2015 Dietary Guidelines for Americans, which are shaping up to be the radically conservative documents we count on them to be.

For just this purpose, the USDA has set up a very large and impressive database called the Nutrition Evidence Libbary (NEL), where it conducts “systematic reviews to inform Federal nutrition policy and programs.” NEL staff collaborate with stakeholders and leading scientists using state-of-the-art methodology to objectively review, evaluate, and synthesize research to answer important diet-related questions in a manner that allows them to reach a conclusion that they’ve previously determined is the one they want.

It’s a handy skill to master. Here’s how it’s done.

The NEL question:

What is the effect of saturated fat intake on increased risk of cardiovascular disease or type 2 diabetes?

In the NEL, they break the evidence up into “cardiovascular” and “diabetes” so I’ll do the same, which means we are really asking: What is the effect of saturated fat (SFA) intake on increased risk of cardiovascular disease?

Spoiler alert–here’s the answer: “Strong evidence” indicates that we should reduce our intake of saturated fat (from whole foods like eggs, meat, whole milk, and butter) in order to reduce risk of heart disease. As Gomer Pyle would say, “SUR-PRIZE, SUR-PRIZE.”

Aaaaaaaand . . . here’s the evidence:

The 8 studies rated “positive quality” are in blue; the 4 “neutral quality” studies are in gray. The NEL ranks the studies as positive and neutral (less than positive?), but treats them all the same in the review. Fine. Whateverz.

According to the exclusion criteria for this question, any study with a dropout rate of more than 20% should be eliminated from the review. These 4 studies have dropout rates of more than 20%. They should have been excluded. They weren’t, so we’ll exclude them now.

Also, according to NEL exclusion criteria for this question, any studies that substituted fat with carbohydrate or protein, instead of comparing types of fat, should be excluded. Furtado et al 2008 does not address the question of varying levels of saturated fat in the diet. In fact, saturated fat levels were held constant–at 6% of calories–for each experimental diet group. So, let’s just exclude this study too.

One study–Azadbakht et al 2007–was conducted on teenage subjects with hypercholesterolemia. Since the U.S. Dietary Guidelines are not meant to treat medical conditions and are meant for the entire population, this study should not have been included in the analysis. Furthermore, the dietary intervention not only lowered saturated fat content of the diet but cholesterol content too. So it would be difficult to attribute any outcomes only to changes in saturated fat intake. The study should not have been included, so let’s take care of that for those NEL folks.

 

In one study–Buonacorso et al 2007–total cholesterol levels did not change when dietary saturated fat was increased: “Plasma TC [total cholesterol] and triacylglycerol levels were NS [not significantly] changed by the diets, by time (basal vs. final test), or period (fasting vs. post-prandial) according to repeated-measures analysis.” This directly contradicts the conclusion of the NEL. Hmmmm. So let’s toss this study and see what’s left.

In these four studies, higher levels of saturated fat in the diet made some heart disease risk factors get worse, but other risk factors got better. So the overall effect on heart disease risk was mixed or neutral. As a result, these studies do not support the NEL conclusion that saturated fat should be reduced in order to reduce risk of heart disease.

 

That leaves one lone study. A meta-analysis of eleven observational studies. Seeing as the whole point of a meta-analysis is to combine studies with weak effects to see if you end up with a strong one, if saturated fat was really strongly associated with heart disease, we should see that, right? Right. What this meta-analysis found was that among women over 60, there is no association between saturated fat and coronary events or deaths. Among adult men of any age, there is no association between saturated fat and coronary events or deaths. Only in women under the age of 60 is there is a small inverse association between risk of coronary events or deaths and the reduction of saturated fat in the diet. That sounds like it might be bad news—at least for women under 60—but this study also found a positive association between monounsaturated fats—you know, the “good fat,” like you would find in olive oil—and risk of heart disease. If you take the results of this study at face value–which I wouldn’t recommend–then olive oil is as bad for you as butter.

So there’s your “strong” evidence for the conclusion that saturated fat increases risk of heart disease.

 

Just recently, Frank Hu of the 2015 Dietary Guidelines Advisory Committee was asked what we should make of the recent media attention to the idea that saturated fat is not bad for you after all (see this video at 1:06:00). Dr. Hu reassured us that, no, saturated fat still kills. He went on to say that the evidence to prove this, provided primarily by a meta-analysis created by USDA staffers (and we all know how science-y they can be), is MUCH stronger than that used by the 2010 Committee.

Well, all I can say is:  it must be.  Because it certainly couldn’t be any weaker.

 

 

The Real Paleo Challenge Redux

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

But now I feel like it should be more like:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Yeah, we tend to do the exact same thing.

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

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

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

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

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

Us: Same promise, different food.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Laura Schoenfeld @ Ancestralize Me!

Beth Mazur @ Weight Maven

Melissa McEwan @ Hunt Gather Love

Robert Patterson @ Michael Rose’s 55

Chris Masterjohn @ The Daily Lipid

Doug Imig – The Urban Child Institute

Andrew Abrahams – Long Dream Farm

Michael Ostrolenk – The Transpartisan Center

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

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

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

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

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

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

Personally responsible or helplessly victimized?

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

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

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

Just like it was in 1952.

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

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

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

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

Then, somewhat inexplicably, obesity took off.”

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

And what is Government going to do about it?

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

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

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

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

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

Been there, done that, failed miserably.

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

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

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

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

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

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

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

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

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

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

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

Fixing it until it broke

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

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

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

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

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

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

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

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

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

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

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

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

Here are the differences in types of food availability data: 

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

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

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

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

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

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

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

Loss adjusted food availability:

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

*Red meat: beef, veal, pork, lamb

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

You are what you eat

From your head down to your feet

Thinks like meat and eggs and fish you

Need to build up muscle tissue

Hello appetite control?

More protein!

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

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

My all-time favorite Timer PSA was this one:

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

I hanker for a hunk of cheese.

When I’m dancing a hoedown

And my boots kinda slow down,

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

I hanker for a hunk of

A slab or slice or chunk of–

A snack that is a winner

And yet won’t spoil my dinner–

I hanker for hunk of CHEESE!

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

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

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

The NaCl Debacle Part 2: We don’t need no stinkin’ science!

Sodium-Slashing Superheroes Low-Sodium Larry and his bodacious side-kick Linda “The Less Salt the Better” Van Horn team up to protect Americans from the evils lurking in a teaspoon of salt!
(Drawings courtesy of Butcher Billy)

Yesterday, we found our Sodium-Slashing Superheroes Larry and Linda determined to make sure that no American endangered his/her health by ingesting more than ¾ of a teaspoon of salt a day. But recently, an Institute of Medicine report determined that recommendations to reduce sodium intake to such low levels provided no health benefits and could be detrimental to the health of some people. [In case you missed it and your job is really boring, you can read Part 1 of the NaCl Debacle here.]

Our story picks up as the 2010 USDA/HHS Dietary Guidelines Advisory Committee, fearlessly led by Linda and Larry, arrives at the foregone conclusion that most, if not all, US adults would (somehow) benefit from reducing their sodium intake to 1500 mg/day.  The American Heart Association, in a report written by—surprise!—Larry and Linda, goes on to state that “The health benefits [of reducing sodium intake to 1500 mg/day] apply to Americans in all groups, and there is no compelling evidence to exempt special populations from this public health recommendation.”

Does that mean there is “compelling evidence” to include special populations, or for that matter ordinary populations, in this 1500 mg/day recommendation? No, but who cares?

Does that mean there is science to prove that “excess” sodium intake (i.e. more than ¾ of a teaspoon of salt a day) leads to high blood pressure and thus cardiovascular disease, or that salt makes you fat, or that sodium consumption will eventually lead to the zombie apocalypse? No, no, and no—but who cares?

Larry and Linda KNOW that salt is BAD. Science? They don’t need no stinkin’ science.

Because the one thing everyone seems to be able to agree on is that the science on salt does indeed stink. The IOM report has had to use many of the same methodologically-flawed studies available to the 2010 Dietary Guidelines Advisory Committee, full of the same confounding, measurement error, reverse causation and lame-ass dietary assessment that we know and love about all nutrition epidemiology studies.  But the 2010 Dietary Guidelines Advisory Committee didn’t actually bother to look at these studies.

Why not?  (And let me remind you that the Dietary Guidelines folks usually <heart> methodologically-flawed study designs, full of confounding, measurement error, reverse causation and lame-ass dietary assessment.)

First, a little lesson in how the USDA/HHS folks create dietary guidance meant to improve the health and well-being of the American people:

  1. Take a clinical marker, whose health implications are unclear, but whose levels we can measure cheaply and easily (like blood pressure, cholesterol, weight).
  2. Suggest that this marker—like Karnac the Magnificent—can somehow predict risk of a chronic disease whose origins are multiple and murky (like obesity, heart disease, cancer).
  3. Use this suggestion to establish some arbitrary clinical cut offs for when this marker is “good” and “bad.” (Note to public health advocacy organizations: Be sure to frequently move those goalposts in whichever direction requires more pharmaceuticals to be purchased from the companies that sponsor you.)
  4. Find some dietary factor that can easily and profitably be removed from our food supply, but whose intake is difficult to track (like saturated fat, sodium, calories).
  5. Implicate the chosen food factor in the regulation of the arbitrary marker, the details of which we don’t quite understand. (How? Use observational data—see methodological flaws above—but hunches and wild guesses will also work.)
  6. Create policy that insists that the entire population—including people who, by the way, are not (at least at this point) fat, sick or dead—attempt to prevent this chronic disease by avoiding this particular dietary factor. (Note to public health advocacy organizations: Be sure to offer food manufacturers the opportunity to have the food products from which they have removed the offensive component labeled with a special logo from your organization—for a “small administrative fee,” of course.)
  7. Commence collecting weak, inconclusive, and inconsistent data to prove that yes indeedy this dietary factor we can’t accurately measure does in fact have some relationship to this arbitrary clinical marker, whose regulation and health implications we don’t fully understand.
  8. Finally—here’s the kicker—measure the success of your intervention by whether or not people are willing to eat expensive, tasteless, chemical-filled food devoid of the chosen food factor in order to attempt to regulate the arbitrary clinical marker.
  9. Whatever you do, DO NOT EVER measure the success of your intervention by looking at whether or not attempts to follow your intervention has made people fat, sick, or dead in the process.
  10. Ooops. I think I just described the entire history of nutrition epidemiology of chronic disease.

Blood pressure is easy to measure, but we don’t always know what causes it to go up (or down). There is no real physiological difference between having a blood pressure reading of 120/80, which will get you a diagnosis of “pre-hypertension” and a fistful of prescriptions, and a reading of 119/79, which won’t.  Blood pressure is not considered to be a “distinct underlying cause of death,” which means that, technically, no one ever dies of blood pressure (high or low). We certainly don’t know how to disentangle the effects of lowering dietary sodium on blood pressure from other effects (like weight loss) that may be related to dietary changes that are a part of an attempt to lower sodium (and we have an embarrassingly hard time collecting accurate dietary intake information from Food Fantasy Questionnaires anyway). We also know that individual response to sodium varies widely.

So doesn’t it make perfect sense that the folks at the USDA/HHS should ignore science that investigates the relationship between sodium intake and whether or not a person stayed out of the hospital, had a heart attack, or up and died? Well, it doesn’t to me, but nevertheless the USDA/HHS has remained obsessively fixated on one thing and one thing only, what effects reducing sodium has on blood pressure,  and they pay not one whit of attention to what effects reducing sodium has on, say, aliveness.

So let’s just get this out there and agree to agree: reducing sodium in most cases will reduce blood pressure.  But then, just to be clear, so will dismemberment, dysentery, and death.  We can’t just assume that lowering sodium will only affect blood pressure or will only positively affect health (I mean, we can’t unless we are Larry or Linda). Recent research, which prompted the IOM review, indicates that reducing sodium will also increase triglyceride levels, insulin resistance, and sympathetic nervous system activity. For the record, clinicians generally don’t consider these to be good things.

This may sound radical but in their review of the evidence, the IOM committee decided to do a few things differently.

First, they gave more weight to studies that determined sodium intake levels through multiple high-quality 24-hour urine collections. Remember, this is Low-Sodium Larry’s favorite way of estimating intake.

Also, they did not approach the data with a predetermined “healthy” range already established in their brains. Because of the extreme variability in intake levels among population groups, they decided to—this is crazy, I know—let the outcomes speak for themselves.

Finally, and most importantly, in the new IOM report, the authors, unlike Larry and Linda, focused on—hold on to your hats, folks!—actual health outcomes, something the Dietary Guidelines Have. Never. Done. Ever.

The IOM committee found, in a nutshell:

“that evidence from studies on direct health outcomes is inconsistent and insufficient to conclude that lowering sodium intakes below 2,300 mg per day either increases or decreases risk of CVD outcomes (including stroke and CVD mortality) or all-cause mortality in the general U.S. population.”

In other words, there is no science to indicate that we all need to be consuming less than ¾ of a teaspoon of salt a day. Furthermore, while there may be some subpopulations that may benefit from sodium reduction, reducing sodium intake to 1500 mg/day may increase risk of adverse health outcomes for people with congestive heart failure, diabetes, chronic kidney disease, or heart disease. (If you’d like to wallow in some of the studies reviewed by the IOM, I’ve provided the Reader’s Digest Condensed Version at the bottom of the page.)

Of course, the American Heart Association, eager to provide the public with the most up-to-date recommendations about heart health as long as they don’t contradict outdated recommendations of which the AHA is fond, responded to the IOM report by saying, “The American Heart Association is not changing its position. The association rejects the Institute of Medicine’s conclusions because the studies on which they were based had methodological flaws.”

Um, hello AHA? Exactly what completely non-existent, massive, highly-controlled and yet highly-generalizable randomized controlled trials about sodium intake and health effects were you planning on using to make your case? I believe it was the AHA that mentioned that “It is well-known, however, that such trials are not feasible because of logistic, financial, and often ethical considerations.” Besides, I don’t know what the AHA is whining about. The quality of the science hardly matters if you are not going to pay any attention to it in the first place.

No, folks that giant smacking sound you hear is not my head on my keyboard. That was the sound of science crashing into a giant wall of Consistent Public Health Message. Apparently, those public health advocates at the AHA seem to think that changing public health messages—even when they are wrong—confuses widdle ol’ Americans. The AHA—and the USDA/HHS team—doesn’t want us to have to worry our pretty little heads about all that crazy scientifical stuff with big scary words and no funny pictures or halftime shows.

Frankly, I appreciate that. I hate to have my pretty little head worried. But there’s one other problem with this particular Consistent Public Health Message. Not only is there no science to back it up; not only is it likely to be downright detrimental to the health of certain groups of people; not only is it likely to introduce an arsenal of synthetic chemical salt-replacements that will be consumed at unprecedented levels without testing for negative interactions or toxicities (remember how well that worked out when we replaced saturated fat with partially-hydrogenated vegetable oils?)—it is, apparently, incompatible with eating food.

Researchers set out to find what would really happen if Americans were muddle-headed and sheep-like enough to actually try to reduce their sodium intake to 1500 mg/day. They discovered that, “the 2010 Dietary Guidelines for sodium were incompatible with potassium guidelines and with nutritionally adequate diets, even after reducing the sodium content of all US foods by 10%.”  Way to go, Guidelines

While these researchers suggested that a feasibility study (this is a scientifical term for “reality check”) should precede the issuing of dietary guidelines to the public, I have a different suggestion.

How about we just stop with the whole 30-year-long dietary experiment to prevent chronic disease by telling Americans what not to eat? I hate to be the one to point this out, but it doesn’t seem to be working out all that well.  It’s hard to keep assuming that the AHA and the USDA/HHS mean well when, if you look at it for what it is, they are willing to continue to jeopardize the health of Americans just so they don’t have to admit that they might have been wrong about a few things.  I suppose if a Consistent Public Health Message means anything, it means never having to say you’re sorry for 30 years-worth of lousy dietary advice.

Marion Nestle has noted that, up until now, “every single committee that has dealt with this question [of sodium-reduction] says, ‘We really need to lower the sodium in the food supply.’ Now either every single committee that has ever dealt with this issue is delusional, which I find hard to believe—I mean they can’t all be making this up—[or] there must be a clinical or rational basis for the unanimity of these decisions.”

Weeeell, I got some bad news for you, Marion. Believe it. They have been delusional. They are making this up. And no, apparently there is no clinical or rational basis for the unanimity of these decisions.

But, thanks to the IOM report, perhaps we can no longer consider these decisions to be unanimous.

Praise the lard and pass the salt.

Read ’em and weep:  The Reader’s Digest Condensed Version of the science from the IOM report.  Studies marked with an asterix (*) are studies that were available to the 2010 Dietary Guidelines Advisory Committee.  

Studies that looked at Cardiovascular Disease, Stroke, and Mortality

*Cohen et al. (2006)

When intakes of sodium less than 2300 mg per day were compared to intakes greater than 2300 mg per day, the “lower sodium intake was statistically significantly associated with increased risk of all-cause mortality.”

*Cohen et al. (2008)

When a fully-adjusted (for confounders) model was used, “there was a statistically significant higher risk of CVD mortality with the lowest vs. the highest quartile of sodium intake.”

Gardener et al. (2012)

Risk of stroke was positively related to sodium intake when comparing the highest levels of intake to the lowest levels of intake. There was no statistically significant increase in risk for those consuming between 1500 and 4000 mg of sodium per day.

*Larsson et al. (2008)

“The analyses found no significant association between dietary sodium intake and risk of any stroke subtype.”

*Nagata et al. (2004)

“Among men, a 2.3-fold increased risk of stroke mortality was associated with the highest tertile of sodium intake.” That sounds bad, but the average sodium intake in the high-risk group was 6613 mg per day. The lowest risk group had an average intake of 4070 mg per day. “Thus, the average sodium intake in the US would be within the lowest tertile of this study.”

Stolarz-Skrzypek at al. (2011)

“Overall, the authors found that lower sodium intake was associated with higher CVD mortality.”

Takachi et al. (2010)

The authors found “a significant positive association between sodium consumption at the highest compared to the lowest quintile and risk of stroke.” As with the Nagata (2004) study, this sounds bad, but the average sodium intake in the high-risk group was 6844 mg per day. The lowest risk group had an average intake of 3084 mg per day. “Thus, the average sodium intake in the US would be close to the lowest quintile of this study.”

*Umesawa et al. (2008)

“The authors found an association between greater dietary sodium intake and greater mortality from total stroke, ischemic stroke, and total CVD.” However, as with the Nagata and the Takchi studies (above), lower quintiles—in this case, quintiles one and two—would be comparable to average US intake.

Yang et al. (2011)

Higher usual sodium intake was found to be associated with all-cause mortality, but not cardiovascular disease mortality or ischemic heart disease mortality. “However, the finding that correction for regression dilution increased the effect on all-cause mortality, but not on CVD mortality, is inconsistent with the theoretical causal pathway.”  In other words, high sodium intake might be bad for health, but not because it raises blood pressure and leads to heart disease.

Studies in Populations 51 Years of Age or Older

*Geleijnse et al. (2007)

“This study found no significant difference between urinary sodium level and risk of CVD mortality or all-cause mortality.” Relative risk was lowest in the medium intake group, with an average estimated intake of 2, 415 mg/day.

Other

“Five of the nine reported studies in the general population listed above also analyzed the data on health outcomes by age and found no interaction (Cohen et al., 2006, 2008; Cook et al., 2007; Gardener et al., 2012; Yang et al., 2011).”

Studies in Populations with Chronic Kidney Disease

Dong et al. (2010)

“The authors found that the lowest sodium intake was associated with increased mortality risk.”

Heerspink et al. (2012)

“Results from this study suggest that ARBs were more effective at decreasing CKD progression and CVD when sodium intake was in the lowest tertile” which had an estimated average sodium intake of about 2783 mg/day.

Studies on Populations with Cardiovascular Disease

Costa et al. (2012)

“Dietary sodium intake was estimated from a 62-itemvalidated FFQ. . . . Significant correlations were found between sodium intake and percentage of fat and calories in daily intake. . . . Overall, for the first 30 days and up to 4 years afterward, total mortality was significantly associated with high sodium intake.”

Kono et al. (2011)

“Cumulative risk analysis found that a salt intake of greater than the median of 4,000 mg of sodium) was associated with higher stroke recurrence rate. Univariate analysis of lifestyle management also found that poor lifestyle, defined by both high salt intake and low physical activity, was significantly associated with stroke recurrence.

O’Donnell et al. (2011)

“For the composite outcome, multivariate analysis found a U-shaped relationship between 24-hour urine sodium and the composite outcome of CVD death, MI, stroke, and hospitalization for CHF.” In other words, both higher (>7,000 mg per day estimated intake) and lower (<2,990 mg per day estimated intake) intakes of sodium were associated with increased risk of heart disease and mortality.

Studies on Populations with Prehypertension

*Cook et al. (2007)

In a randomized trial comparing a low sodium intervention with usual intake, lower sodium intake did not significantly decrease risk of mortality or heart disease events.

*Cook et al. (2009)

No significant increase in risk of adverse cardiovascular outcomes was associated with increased sodium excretions levels.

Other

“Several other studies discussed in this chapter analyzed data on health outcomes by blood pressure and found no statistical interactions (Cohen et al., 2006, 2008; Gardener et al., 2012; O’Donnell et al., 2011; Yang et al., 2011).”

Studies on Populations with Diabetes

Ekinci et al. (2011)

Higher sodium intakes were associated with decreased risk of all-cause mortality and heart disease mortality.

Tikellis et al. (2013)

“Adjusted multivariate regression analysis found urinary sodium excretion was associated with incident CVD, with increased risk at both the highest [> 4,401 mg/day] and lowest [<2,346 mg/day] urine sodium excretion levels. When analyzed as independent outcomes, no significant associations were found between urinary sodium excretion and new CVD or stroke after adjustment for other risk factors.”

Other

“Two other studies discussed in this chapter analyzed the data on health outcomes by diabetes prevalence and found no interaction (Cohen et al., 2006; O’Donnell et al., 2011).”

Studies in Populations with Congestive Heart Failure

Arcand et al. (2011)

High sodium intake levels (≥2,800 mg per day) were significantly associated with acute decompensated heart failure, all-cause hospitalization, and mortality.

Lennie et al. (2011)

“Results for event-free survival at a urinary sodium of ≥3,000 mg per day varied by the severity of patient symptoms.” In people with less severe symptoms, sodium intake greater than 3,000 mg per day was correlated with a lower disease incidence compared to those with a sodium intake less than 3,000 mg per day. Conversely, people with more severe symptoms who had a sodium intake greater than 3,000 mg per day had a higher disease incidence than those with sodium intakes less than 3,000 mg per day.

Parrinello et al. (2009)

“During the 12 months of follow-up, participants receiving the restricted sodium diet [1840 mg/day] had a greater number of hospital readmissions and higher mortality compared to those on the modestly restricted diet [2760 mg/day].”

*Paterna et al. (2008)

The lower sodium intake group [1840 mg/day] experienced a significantly higher number of hospital readmissions compared to the normal sodium intake group [2760 mg/day].

*Paterna et al. (2009)

A significant association was found between the low sodium intake [1,840 mg per day]) and hospital readmissions. The group with normal sodium diet [2760 mg/day] also had fewer deaths compared to all groups receiving a low-sodium diet combined.

The NaCl Debacle Part 1: Salt makes you fat?

Don’t look now, but I think the Institute of Medicine’s new report on sodium just bitch-slapped the USDA/HHS 2010 Dietary Guidelines.

In case you have a life outside of the nutritional recommendation roller derby, the IOM recently released a report that comes to the conclusion that restricting sodium intake to 1500 mg/day may increase rather than reduce health risks. Which is a little weird, since the 2010 Dietary Guidelines did a great job of insisting that any American with high blood pressure, all blacks, and every middle-aged and older adult—plus anyone who has ever eaten bacon or even thought about eating bacon, i.e. nearly everybody—should limit their salt intake to 1500 mg of sodium a day, or less than ¾ of a teaspoon of salt. The American Heart Association was, of course, aghast. The AHA thinks EVERYBODY should be limited to less than ¾ teaspoon of salt a day, including people who wouldn’t even think about thinking about bacon.

Why are the AHA and USDA/HHS so freaked out about salt?  And how did the IOM reach such a vastly different conclusion than that promoted by the AHA and the Dietary Guidelines?  Fasten your seat belts folks, it’s gonna be a bumpy blog.

First, it is helpful to examine why the folks at AHA and USDA/HHS are so down on salt.  The truth: we have no freakin’ idea. Salt has been around since what, the dawn of civilization maybe? It is an essential nutrient, and it plays an important role in preserving food and preventing microbial growth (especially on bacon). But Americans could still be getting too much of a good thing. Everybody at the AHA seems to think that Americans consume “excessive amounts” of sodium. (Of course, just about anything looks excessive compared to less than ¾ of a teaspoon.) But do we really consume too much sodium?

Back in 2010, Dr. Laurence I-Know-More-About-Sodium-Than-Your-Kidneys-Do Appel (or as his friends call him, “Low-Sodium Larry”), one of the leading advocates for a salt-free universe, acknowledged that “The data is quite murky. We just don’t have great data on sodium trends over time. I wish that we did. But I can’t tell you if there’s been an increase or decrease.”

Well, Low-Sodium Larry, I can, and I am about to make your wish come true.

According to recent research done by that wild bunch of scientific renegades at Harvard, in the past 60 years sodium intake levels have . . .drumroll, please . . .  not done much of anything.

Hey, that doesn’t sound right! Everyone knows that it is virtually impossible to get an accurate measure of sodium intake from dietary questionnaires; people are probably just “under-reporting” their salt intake like they “under-report” everything else. Low-Sodium Larry has previously insisted that one of the reasons the data is so murky is that few epidemiological studies measure sodium intake accurately and that, “really, you should do 24-hour urinary sodium excretions to do it right.”

The guys at Harvard looked at studies that did it right.  This systematic analysis of 38 studies from the 1950s to the present, found that 24-hour urinary sodium excretion (the “gold” standard—omg, I could not resist that—of dietary sodium intake estimation) has neither increased nor decreased, but has remained essential stable over time. Despite the fact that Americans are apparently hoovering up salt like Kim Kardashian hoovers up French fries—and with much the same results, i.e. puffing up like a Macy’s Thanksgiving Day balloon—for whatever reason we simply aren’t excreting more of it in our urine.

According to that same study however, despite the lack of increase in sodium excretion (which is supposed to accurately reflect intake—but that can’t be right), high blood pressure rates in the population have been increasing. Duh. Everyone knows that eating lots of salt makes your blood pressure go up. But have the rates of high blood pressure in America really been going up?

Age-Adjusted Prevalence of Hypertension (2009 NIH Chart Book)

Well, no.  Not really. The Harvard dudes cite a report that goes back to 1988-1994 data, and yes, rates of high blood pressure have been creeping slowly back up since then. This is because from 1976-1980 to 1988-1994, rates of high blood pressure plummeted for most segments of the American population.

We don’t know why rates of high blood pressure fell during the 70s and early 80s. It may have been that the Dietary Guidelines told people to eat more potassium-filled veggies and people actually tried to follow the Dietary Guidelines, which would have had a positive effect on high blood pressure. On the other hand, it could have been largely due to the sedating influence of the soft rock music of that era blanketing the airwaves with the mellow tones of England Dan and John Ford Coley, Christopher Cross, Ambrosia, and the like (youtube it, you young whippersnappers out there). We also don’t know why rates are going back up. Rising rates of obesity may be part of the problem, but it is also entirely possible that piping the Monsters of Lite Rock through every PA system in the country might save our health care system a lot of time and trouble.

This is what we (think we) know:

  • High-sodium diets might possibly maybe sometimes be a contributor to high blood pressure.
  • Rates of high blood pressure are going (back) up.
  • Obesity rates are definitely going up.

Ergo pro facto summa cum laude, it is clear—using the logic that seems to undergird the vast majority of our public health nutrition recommendations—salt makes you fat.  The USDA/HHS has been faced with rapidly rising rates of obesity which, until now, they have only been to pin on the laziness and gluttony of Americans.  But if salt makes us fat, that might explain why the USDA/HHS doesn’t want us to eat it.

After all, the biomechanics of this is pretty straightforward. If you eat too much sodium (which we must be), but you don’t pee it out (which we aren’t), you must be retaining it and this is what makes your blood pressure and your weight both go way up. They didn’t really cover the physics of this in my biochemistry classes so you’ll have to ask Dr. Appel how this works because he knows more about sodium than your kidneys do. But I think it must be true. After all, this is the mechanism that explains the weight loss behind carbohydrate-reduced diets, right? I myself reduced my carb intake and lost 60 pounds of water weight!

And besides, taking the salt out of our food will give food manufacturers the opportunity to make food more expensive and tasteless while adding synthetic ingredients whose long-term effects are unknown—just what the American consumer wants!

For a while there, we thought the whole idea was to reduce sodium in order to reduce blood pressure in order to reduce diseases of the circulatory system, like heart failure, stroke, and coronary heart disease . That didn’t seem to work out so well, because the whole time that sodium intake was staying stable (if we want to believe the urinary sodium excretion data) and high blood pressure rates were going down (although they are starting to go back up), rates of those diseases have gone up:

Age-Adjusted Prevalence of Heart Failure (2009 NIH Chart Book)

Age-Adjusted Prevalence of Stroke (2009 NIH Chart Book)

Age-Adjusted Prevalence of Coronary Heart Disease (2007 NIH Chart Book)

So if reducing blood pressure to reduce cardiovascular disease isn’t the answer, then we must need to reduce blood pressure to reduce obesity! By jove, I think we’ve got it!

The USDA/HHS must have known the “salt makes you fat” notion would be a tough sell, I mean, what with the lack of any shred of supporting science and all that. (But then, the “salt causes high blood pressure which causes cardiovascular disease” argument hasn’t exactly been overburdened by evidence either, and that never seemed to stop anyone.) So the 2010 Dietary Guidelines brought together the American Heart Association’s Superheroes of Sodium Slashing, Low-Sodium Larry and his bodacious salt-subduing sidekick, Linda Van Horn, both of whom had been preaching the gospel of sodium-reduction as a preventive health measure with little conclusive evidence to support their recommendations.  The USDA/HHS knew that with Linda and Larry on the team, it didn’t matter how lame the science, how limited the data, or how ludicrous the recommendation, these two could be counted on to review any and all available evidence and reliably come up with the exact same concrete and well-proven assumptions they’d been coming up with for years.

The Sodium-Slashing Superheroes–Drs. Lawrence Appel and Linda Van Horn– ready to make the world safe for bland, unappetizing food everywhere! (Drawings courtesy of Butcher Billy)

So here’s the cliffhanger:  Will Linda and Larry be able to torture the science on salt into confessing its true role in the obesity crisis?

Tune in tomorrow, when you’ll hear Linda and Larry say: “Science? We don’t need no stinkin’ science.”

A beautifully-written summary by Emily Contois regarding the recent Critical Nutrition Symposium held at UC-Santa Cruz. Organized by Julie Guthman, author of Weighing In, this symposium brought together food scholars from around the country (plus me) and invited us and the audience to participate in a thought-provoking and nuanced conversation about food, nutrition, culture, and ways of knowing.

Emily Contois

On March 8, 2013, I had the pleasure of attending the Critical Nutrition Symposium at UC Santa Cruz, organized by Julie Guthman, author of Weighing In. The event was spawned from a roundtable discussion at last year’s Association for the Study of Food and Society conference. The symposium brought together an interdisciplinary group of scholars to critically examine what is missing from conventional nutrition science research and practice, discuss why it matters, and brainstorm how to move forward in an informed and balanced way. What follows are a few of my favorite key ideas from the day’s discussions.

Adele Hite, a registered dietitian and public health advocate who is not afraid to ask big and delightfully confrontational questions regarding nutrition science, began the day by dissecting Michael Pollan’s now famous aphorism—Eat food. Not too much. Mostly plants. Step by step, she revealed the decades of revisionist myth…

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National Nutrition Policy – just a little out of touch?

My good friend, Laura Schoenfeld, must have just returned from the UNC-Chapel Hill MPH/RD program’s annual field trip to Washington, DC, because she just wrote a terrific blog post about her experiences. It reminded me of my own field trip a few years back, as she reports hearing “statements like “the tenets of nutrition are stable,” that “the science of what we should eat is almost irrelevant,” and that “we know what people should be eating, but we don’t know how to get them to eat that way.” Yup–the science of what we should eat is almost irrelevant. Read the whole post. It’s gem.

Nutrition Policy

One of the major themes I heard come up over and over during our three days in Washington D.C. was the emphasis on “science-based” nutrition policy. From the Dietary Guidelines themselves, to the policies created to enact the guidelines, to the food manufacturers’ efforts to create product based on those guidelines, it would seem that taking an evidence-based approach is the gold standard for nutrition in our country. After all, why would we want to enact national nutrition policies that cost billions of dollars but don’t actually work?

The major issue I saw over the three days was that most of the speakers were under the impression that their understanding of nutrition science was infallible and completely up-to-date. I heard statements like “the tenets of nutrition are stable,” that “the science of what we should eat is almost irrelevant,” and that “we know what people should be eating, but we…

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Not Just Science: How nutrition got stuck in the past

Nostalgia for a misremembered past is no basis for governing a diverse and advancing nation.

David Frum

The truth is that I get most of my political insight from Mad Magazine; they offer the most balanced commentary by far. However, I’ve been very interested in the fallout from the recent election, much more so than I was in the election itself; it’s like watching a Britney Spears meltdown, only with power ties. I kept hearing the phrase “epistemic closure” and finally had to look it up. Now, whether or not the Republican party suffers from it, I don’t care (and won’t bother arguing about), but it undeniably describes the current state of nutrition. “Epistemic closure” refers to a type of close-mindedness that precludes any questioning of the prevailing dogma to the extent that the experts, leaders, and pundits of a particular paradigm:

“become worryingly untethered from reality”

“develop a distorted sense of priorities”

and are “voluntarily putting themselves in the same cocoon”

Forget about the Republicans. Does this not perfectly describe the public health leaders that are still clinging blindly to the past 35 years of nutritional policy?  The folks at USDA/HHS live in their own little bubble, listening only to their own experts, pretending that the world they live in now can be returned to an imaginary 1970s America, where children frolicked outside after downing a hearty breakfast of sugarless oat cereal and grown-ups walked to their physically-demanding jobs toting homemade lunches of hearty rye bread and shiny red apples.

Remember when all the families in America got their exercise playing outside together—including mom, dad, and the maid? Yeah, me neither.

So let me rephrase David Frum’s quote above for my own purposes: Nostalgia for a misremembered past is no basis for feeding a diverse and advancing nation.

If you listen to USDA/HHS, our current dietary recommendations are a culmination of science built over the past 35 years on the solid foundation of scientific certainty translated into public health policy. But this misremembered scientific certainty wasn’t there then and it isn’t here now; the early supporters of the Guidelines were very aware that they had not convinced the scientific community that they had a preponderance of evidence behind them [1]. Enter the first bit of mommy-state* government overreach. When George McGovern’s (D) Senate Select Committee came up with the 1977 Dietary Goals for Americans, it was a well-meaning approach to not only reduce chronic disease, a clear public health concern, but to return us all to a more “natural” way of eating. This last bit of ideology reflected a secular trend manifested in the form of the Dean Ornish-friendly Diet for a Small Planet, a vegetarian cookbook that smushed the humanitarian and environmental concerns of meat-eating in with some flimsy nutritional considerations, promising that a plant-based diet was the best way to feed the hungry, save the planet, safeguard your health, and usher in the Age of Aquarius.  This was a pop culture warm-fuzzy with which the “traditional emphasis on the biochemistry of disease” could not compete [2].

If you listen to some folks, the goofy low-fat, high-carb, calories in-calories out approach can be blamed entirely on this attempt of the Democrats to institutionalize food morality. But, let’s not forget that the stage for the Dietary Guidelines fiasco was set earlier by Secretary of Agriculture Earl Butz, an economist with many ties to large agricultural corporations who was appointed by a Republican president. He initiated the “fencerow to fencerow” policies that would start the shift of farm animals from pastureland to feed lots, increasing the efficiency of food production because what corn didn’t go into cows could go into humans, including the oils that were a by-product of turning crops into animal feed. [Update: Actually, not so much Butz’s fault, as I’ve come to learn, because so many of these policies were already in place before he came along. Excellent article on this here.]

When Giant Agribusiness—they’re not stupid, y’know—figured out that industrialized agriculture had just gotten fairydusted with tree-hugging liberalism in the form of the USDA Guidelines, they must have been wetting their collective panties. The oil-refining process became an end in itself for the food industry, supported by the notion that polyunsaturated fats from plants were better for you than saturated fats from animals, even though evidence for this began to appear only after the Guidelines were already created and only through the status quo-confirming channels of nutrition epidemiology, a field anchored solidly in the crimson halls of Harvard by Walter Willett himself.

Between Earl Butz and McGovern’s “barefoot boys of nutrition,” somehow corn oil from refineries like this became more “natural” than the fat that comes, well, naturally, from animals.

And here we are, 35 years later, trying to untie a Gordian knot of weak science and powerful industry cemented together by the mutual embarrassment of both political orientations. The entrenched liberal ivory-tower interests don’t want look stupid by having to admit that the 3 decades of public health policy they created and have tried to enforce have failed miserably. The entrenched big-business-supporting conservative interests don’t want to look stupid by having to admit that Giant Agribusiness, whose welfare they protect, is now driving up government spending on healthcare by acting like the cigarette industry did in the past and for much the same reasons.

These overlapping/competing agendas have created the schizophrenic, conjoined twins of a food industry-vegatarian coalition, draped together in the authority of government policy. Here the vegans (who generally seem to be politically liberal rather than conservative, although I’m sure there are exceptions) play the part of a vocal minority of food fundamentalists whose ideology brooks no compromise. (I will defend eternally the right for a vegan–or any fundamentalist–to choose his/her own way of life; I draw the line at having it imposed on anyone else–and I squirm a great deal if someone asks me if that includes children.)  The extent to which vegan ideology and USDA/HHS ideology overlap has got to be a strange bedfellow moment for each, but there’s no doubt that the USDA/HHS’s endorsement of vegan diets is a coup for both. USDA/HHS earns a politically-correct gold star for their true constituents in the academic-scientific-industrial complex, and vegans get the nutritional stamp of approval for a way of eating that, until recently, was considered by nutritionists to be inadequate, especially for children.

Like this chicken, the USDA/HHS loves vegans—at least enough to endorse vegan diets as a “healthy eating pattern.”

But if the current alternative nutrition movement is allegedly representing the disenfranchised eaters all over America who have been left out of this bizarre coalition, let us remember that, in many ways, the “alternative” is really just more of the same. If the McGovern hippies gave us “eat more grains and cereals, less meat and fat,” now the Republican/Libertarian-leaning low-carb/primaleo folks have the same idea only the other way around—and with the same justification.  “Eat more meat and fat, fewer grains and cereals;” it’s a more “natural” way to eat.

As counterparts to the fundamentalist vegans, we have the Occupy Wall street folks of the alternative nutrition community—raw meaters who sleep on the floor of their caves and squat over their compost toilets after chi running in their Vibrams. They’re adorably sincere, if a little grubby, and they have no clue how badly all the notions they cherish would get beaten in a fight with the reality of middle-Americans trying to make it to a PTA meeting.

How paleo might look from the outside.

To paraphrase David Frum again, the way forward in food-health reform is collaborative work, and although we all have our own dietary beliefs, food preferences, and lifestyle idiosyncrasies, the immediate need is for a plan with just this one goal: we must emancipate ourselves from prior mistakes and adapt to contemporary realities.

Because the world in which we live is not the Brady Bunch world that the many of us in nutrition seem to think it is.

Frum makes the point that in 1980, when the Dietary Guidelines were first officially issued from the USDA, this was still an overwhelmingly white country. “Today, a majority of the population under age 18 traces its origins to Latin America, Africa, or Asia. Back then, America remained a relatively young country, with a median age of exactly 30 years. Today, over-80 is the fastest-growing age cohort, and the median age has surpassed 37.” Yet our nutrition recommendations have not changed from those originally created on a weak science base of studies done on middle-aged white people. To this day, we continue to make nutrition policy decisions on outcomes found in databases that are 97% white. The food-health needs of our country are far more diverse now, culturally and biologically. And another top-down, one-size-fits-all approach from the alternative nutrition community won’t address that issue any more adequately than the current USDA/HHS one.

For those who think the answer is to “just eat real food,” here’s another reality check: “In 1980, young women had only just recently entered the workforce in large numbers. Today, our leading labor-market worry is the number of young men who are exiting.” That means that unless these guys are exiting the workforce to go home and cook dinner, the idea that the solution to our obesity crisis lies in someone in each American household willingly taking up the mind-numbingly repetitive and eternally thankless chore of putting “real food” on the table for the folks at home 1 or more times a day for years on end—well, it’s as much a fantasy as Karl Rove’s Ohio outcome.

David Frum points out that “In 1980, our top environmental concerns involved risks to the health of individual human beings. Today, after 30 years of progress toward cleaner air and water, we must now worry about the health of the whole planetary climate system.” Today, our people and our environment are both sicker than ever. We can point our fingers at meat-eaters, but saying we now grow industrialized crops in order to feed them to livestock is like saying we drill for oil to make Vaseline. The fact that we can use the byproducts of oil extraction to make other things—like Vaseline or livestock feed—is a happy value-added efficiency in the system, no longer its raison d’etre. Concentrated vertical integration has undermined the once-proud tradition of land stewardship in farming. Giving this power back to farmers means taking some power away from Giant Agribusiness, and neither party has the political will to do that, especially when together they can demonize  livestock-eating while promoting corn oil refineries.

If we all just stopped eating meat, then we wouldn’t have to plant so much corn, right? Right?

And it’s not just our food system that has changed: “In 1980, 79 percent of Americans under age 65 were covered by employer-provided health-insurance plans, a level that had held constant since the mid-1960s. Back then, health-care costs accounted for only about one 10th of the federal budget. Since 1980, private health coverage has shriveled, leaving some 45 million people uninsured. Health care now consumes one quarter of all federal dollars, rapidly rising toward one third—and that’s without considering the costs of Obamacare.”  That the plant-based diet that was institutionalized by liberal forces and industrialized by conservative ones is a primary part of this enormous rise in healthcare costs is something no one on either side of the table wants to examine. Diabetes—the symptoms of which are fairly easily reversed by a diet that excludes most industrialized food products and focuses on meat, eggs, and veggies—is the nightmare in the closet of both political ideologies.

David Frum quotes the warning from  British conservative, the Marquess of Salisbury, “The commonest error in politics is sticking to the carcass of dead policies.”

Right now, it is in the best interest of both parties to stick to our dead nutrition policies and dump the ultimate blame on the individuals (we gave you sidewalks and vegetable stands–and you’re still fat! cry the Democrats; we let the food industry have free reign so you could make your own food choices–and you’re still fat! cry the Republicans). It’s a powerful coalition, resistant to change no matter who is in control of the White House or Congress.

What can be done about it, if anything? To paraphrase Frum once again, a 21st century food-health system must be economically inclusive, environmentally responsible, culturally modern, and intellectually credible.

We can start the process by stopping with the finger-pointing and blame game, shedding our collective delusions about the past and the present, and recognizing the multiplicity of concerns that must be addressed in our current reality. Let’s begin by acknowledging that—for the most part—the people in the spotlight on either side of the nutrition debate don’t represent the folks most affected by federal food-health policies. It is our job as leaders, in any party and for any nutritional paradigm, to represent those folks first, before our own interests, funding streams, pet theories, or personal ideologies. If we don’t, each group—from the vegatarians to folks at Harvard to the primaleos—runs the risk of suffering from its own embarrassing form of epistemic closure.

Let’s quit bickering and get to work.

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

*This was too brilliant to leave buried in the comments section:

“Don’t you remember the phrase “wait til your father gets home”? You want to know what the state is? It’s Big Daddy. Doesn’t give a damn about the day to day scut, just swoops in to rescue when things get out of hand and then takes all the credit when the kids turn out well, whether it’s deserved or not. Equates spending money with parenting, too.”–from Dana

So from henceforth, all my “mommy-state” notions are hereby replaced with “Big Daddy,” a more accurate and appropriate metaphor.  And I never metaphor I didn’t like.

References:

1. See Select Committee on Nutrition and Human Needs of the United States Senate. Dietary Goals for the United States. 2nd ed. Washington, DC: US Government Printing Office; 1977b. Dr. Mark Hegsted, Professor of Nutrition at Harvard School of Public Health and an early supporter of the 1977 Goals, acknowledged their lack of scientific support at the press conference announcing their release: “There will undoubtedly be many people who will say we have not proven our point; we have not demonstrated that the dietary modifications we recommend will yield the dividends expected . . . ”

2. Broad, WJ. Jump in Funding Feeds Research on Nutrition. Science, New Series, Vol 204. No. 4397 (June 8, 1979). Pp. 1060-1061 + 1063-1064. In a series of articles in Science in 1979, William Broad details the political drama that allowed the “barefoot boys of nutrition” from McGovern’s committee to put nutrition in the hands of the USDA.

Not Just Science: Nutrition & Politics

Now that food–along with religion and politics–has joined the list of things you don’t talk about with friends, I thought I’d do my post-Election day best to offend everyone equally by highlighting just how political food and nutrition is these days.

I like to try to pass myself off as generally apolitical (on principle, I refuse to vote straight-ticket anything—but it could be I’m just a control freak who likes filling in all the bubbles myself). If forced to confess, underneath it all I’m a bleeding-heart liberal who wants to save trees and whales and who tends to blame the world’s ills on old white dudes (even—or especially –the one I’m married to).

But there’s another subtlety (and don’t tell my bleeding-heart liberal friends or they won’t invite me to anymore parties): I’d vote for ANYONE who was serious about fixing our food-health system, but—politically-speaking—who is going to do that?

Restructure subsidies, agricultural insurance, and agricultural financing to support small farmers rather than giant agribusiness? Who would do this? Democrats like feeding the excess corn, wheat, and soy commodities to the hungry people in America who are getting fatter and sicker by the minute as a result (It’s healthy!). Republicans like the big businesses that control those commodities. Everyone says they care for small farmers but no one does anything about it.

Federal nutrition program foods: plenty of soybean oil, corn syrup, gluten, and sugar, with a little arsenic thrown in for good measure

Modify food safety regulations to take into account size and type of operation? Democrats are all about protecting the public and regulating industry, but they are also all about “protecting” the public from the raw milk that those stupid Americans are stupid enough to drink. Republicans are more likely to support the dairy industry–the folks with the vested interest in outlawing raw milk–but also more likely to say the government shouldn’t be telling stupid Americans what they should and shouldn’t drink.

Somebody needs to tell Michelle that “moving more” makes kids hungry more; nothing wrong with that, but they’re not gonna “eat less” as a result.

End the one-size-fits all dietary recommendations? Thank you Michelle Obama for giving renewed vigor to the physiology-defying “eat less, move more” concept. Thank you, giant mom-and-pop-squashing Walmart, for playing right along.

You don’t like Obamacare? You do like Obamacare? You’re both right. Health reform is a joke until we focus on preventive measures that begin with feeding everyone adequate essential nutrition, not preventing chronic disease with foods that don’t prevent chronic disease.

Republicans believe that obesity is a personal responsibility; food and lifestyle choices by the public should not be interfered with by the government. Except when it comes to whether or not the public can know what is actually in the food they choose, in which case, the right to free speech when it comes to putting “health” claims on cereal boxes becomes the right to abstain from speech when it comes to putting GMO information there.

Democrats believe that it is up to the government to intervene in the market when personal choices become a public concern. So Democrats are out to make the “healthy choice” (a phrase that is an embarrassment to true meaning of both words) the easy choice for those poor stupid fat people out there who are too lazy and gluttonous to take care of their own health, never mind that the Democrat’s idea of “healthy” and “choice”  is limited to the USDA/HHS definition of both.

Republicans support the soda industry’s desire not to be taxed. Democrats are hoping butter and meat will be taxed next.

Thank goodness for the Libertarians—who are hard at work legalizing pot so the nation can now get the collective munchies. Watch for the Democrats to insist on restricted access to McDonald’s for those with medical marijuana prescriptions, while the Republicans fight for Monsanto’s right to patent all cannabis seeds grown anywhere ever by anyone. That backyard plot of weed will only be legal for about ten minutes before the Democrats start regulating the fun out of it and the Republicans hand everyone’s right to get stupid over to ConAgra.

Meanwhile, the rich get richer, the poor get fatter and sicker, and we all—rich and poor and middle-class alike—waste precious time, money, and attention on nutrition recommendations that support ideology and industry and do little for our nation’s very real health crisis. Politicians like Nixon and Clinton have undermined the nation’s ability to believe that any politicians can be trusted;  advice from the USDA/HHS, Ornish, and Atkins have done the same for nutrition. It’s a wonder we don’t all turn on, give in, and pig out.