One of my long-term goals is to provide an easy-to-understand guide to some basic nutrition principles for clinicians and the general public to use. The idea is simply to give a counterbalance to the current low-fat, low-saturated fat, low-cholesterol, low-sodium, high-carbohydrate, high-fiber, whole-grain USDA/HHS dietary recommendations.
You know how people say “If you want something done right, you have to do it yourself”? Well, this applies to figuring out what you should eat to be healthy. Experts from universities and media outlets with their sweeping nutrition recommendations have a very limited ability to help you as an individual. Research from data sets, artificial experimental protocols, or animals will not tell you what will make you feel full of energy, satisfied, nourished, and healthy–or what diet you can comfortably fit into your life without making yourself and everyone around you crazy. The over-riding message from me, someone who could perhaps be considered a nutrition expert, is “Stop listening to nutrition experts already!” You can include me in that because I’m not going to tell you what to eat anyway. But I might be able to help you figure it out for yourself.
Eathropology 
Hi I came late to your blog on Reducing Carbohydrates but there are a number of key points that need attention – I should say that I have been on a low carb diet for many years and am a healthy 76 year old in consequence. I am also a nutritionist that has never accepted the USA, WHO or other dietary recommendations. The points I want to make:
1. Following the 1980 guidelines US citizens did not switch to a low fat diet, the facts show that they increased caloric intake by an average of 300 Calories per day, meaning some would have increased them by 1000 Calories. Around 60% of these calories were from carbohydrates. What happened and has lead to the eptdemic of obesity and related metabolic disorders is that they switch many of the carbohydrates to fructose sugar and at the same time the fats to high omega 6 oilseeds – soya, corn, sunflower that are guaranteed to cause these disorders through inflammation unless a balancing intake of omega 3 is taken to lower the ratio of omega 6 to omega 3 to less than 4:1
http://howldb.com/p/will-the-new-dietary-guidelines-make-us-even-fatter-0u18ez
2. It is not enough to speak of low carbohydrates. What we really mean is low simple carbohydrates = simple starches and especially sugars with a high glycaemic value that rapidly produce glucose. We need to consume carbohydrates that provide beta glucans and inulins to feed our biome and ensure an effective gut health and immune response – oats is a good source that also provides anti-inflammatory avenanthramides. Structural carbohydrates in the form of fruits and vegetables should provide 25 + grams of fibre per day.
3. The brain neurons prefers ketones such that 70% of energy for the brain can be provided from this source that results from the breakdown of the glycerol molecule of triglycerides in the liver. The dietary requirement for carbohydrates apart from their fibre and beta f glucan supply is zero.
4. Protein needs to be limited to less than 0.7 grams per kilogram of lean mass – around 45 g/day for mature females and 55 g/day for mature males – pregnant women and growing children need more. The reason is that higher protein intake, especially as branch chain glucogenic amino acids (valine, leucine and isoleucine) promote the mTOR pathway that stimulates the growth of tumours, as does glutamine. This means that protein of adequate amino acid composition should make up no more than 10 – 15% of normal calorie – those required for a lean person.
5. As stated above the triglycerides in the diet should be a good mix of saturated, medium chain length (avocado olive, coconut and palm oils etc) and omega fatty acids from nuts, krill etc.to give an omega 6 to omega 3 ratio of less than 4:1. The correct balance of zinc to copper is also important here.
5. Intermittent fasting and exercise are also important but another topic for another day.
Has it occurred to you that you are a healthy 76 year old for reasons that don’t have a lot to do with diet? 🙂
I appreciate all of the commentary. For my readers, I would add that this sort of detailed nutrition wonkery is just the thing for some folks & not so useful for others. Like diets themselves, dietary information must be sort of “do it yourself” in terms of how much you feel you need (to think) you know.
I have never been one to advocate for one diet over others or to propose that there is an “optimal” diet; nutrition science is simply not advanced enough in its methodology to make unequivocal connections between diet or dietary components and long term health or disease. I assume from your comments that you’ve done plenty of deep diving in nutrition science. In which case you are aware that the complexity of human metabolism, with its complex interactions of genetic/epigenetic expressions–exists within and interacts with an exponentially even more complex network of flora & fauna–each with their own complex genetic/epigenetic expressions. Add to this material and immaterial exposures–toxins, structural inequalities–which affect all of the preceding and you have a situation where, past the provision of essential nutrients that otherwise lead to diseases of deficiency (and we don’t know nearly as much as we should about those, having been distracted by the idea that we could prevent chronic disease my micromanaging a nation’s food choices), we don’t know all that much.
That said, I do think that people should be given choices when it comes to what we think we know, which was the point of the “Reducing Carbohydrates” information. Some people have reasons for steering away from saturated fats or fats in general. Some people are happy counting calories. Some people feel better watching their carb intake. Some people enjoy a life that revolves around micro-managing their own dietary intake based on this or that piece of science. Some people just eat whatever gets put in front of them & subsist on coffee otherwise (not naming any names here). Some people think that spending anything more than a minimal amount of attention focused on food/nutrition/weight management/long-term health outcomes is a counterproductive waste of time.
I say do whatever makes your body feel happy and healthy now, today and tomorrow. We don’t know enough about the links between diet and chronic disease to offer promises of functionality or longevity based on nutrition science.
Adele
“this sort of detailed nutrition wonkery”
“nutrition science is simply not advanced enough in its methodology to make unequivocal connections between diet or dietary components and long term health or disease.”
Your ignorance in this area astounds me for one who claims to write about nutrition. I an a nutritional biochemist and my starting point is epigenetics, both of the 150 types of human cells and those of the biome. The link between nutrition, lifestyle and environment (epigenetics) and disorders of the metabolic syndrome ( obesity, diabetes, CVD, cancer, arthritis, dementia, Alzheimer’s) have been known starting in the 1920’s with epilepsyand have been researched in great detail since Otto Warbug’s and Krebs’s Nobel Prizes in the 1950’s for sorting out the biochemistry of cellular metabolism. See for example:
http://www.diagnosisdiet.com/what-causes-cancer/
http://www.ncl.ac.uk/magres/research/diabetes/reversal.htm
At a cellular level the human or animal body is not concerned with such vague terms as carbohydrates, proteins, fats, fruits and vegetables but in the balance of metabolites (glucose, fatty acids, amino acids, minerals, trace metals, antioxidants etc) delivered in the amounts and balance of metabolites delivered to the cells of which there are at least 45. For example, as I stated in my earlier response, the balance between omega 6 and omega 3 is critical as one causes inflammation that is directly linked to the incidence of these disorders and one acts against it but both have other critical roles. Ditto for all the other nutrients. Persons are free to choose whatever foods they like provided they meet these requirements and do not do so in excess or with imbalances. For those of your followers who might be interested in real nutritional advice they can check their diet balance using a free app called Cronometer:
https://cronometer.com/mercola/
You clearly have nothing to teach me or other on this subject so I will be unsubscribing.
Spoken like a true nutritional biochemist! Never mind that “lifestyle” and “environment” are themselves words that can represent many different things depending on exactly whose body you’re talking about. I love nutritional biochemistry & I think it has many more useful insights than, say, nutritional epidemiology. But both have their limits.
Not trying to pick a fight–although it seems I can’t avoid them–I appreciate your insights. Really. (Otherwise, I would not have posted the comment to which I am responding.) I’m saying that what we learn in a lab, from a mouse or a cell culture, or even from a clinical trial is helpful, but it isn’t everything. It can’t be. I’m not a social constructionist by a long stretch–the material world exerts itself through science; it’s one of the best ways that it can do so in a way that we can “read” and use–but there is little knowledge gained in science that is not also a product of the humans and the worlds that produce that knowledge.
As for my ignorance, I willingly acknowledge it. The more I know, the more I know I don’t know. And one of the things that I know I don’t know is what to tell people about what they should and should not be eating that will ensure a long and healthy–as if I even knew how to apply that term to a world of people whose idea of health might vary dramatically from person to person, as if that term might not shift around a good bit even for one individual–life.
I’d love to see some info on do-it-yourself diets for adults with ADHD. 🙂
Hi Heather, I’m not convinced that diet can be a be-all curative for a lot of conditions. That said, I would start with nutritional sufficiency, i.e. making sure that all macro- and micro-nutrients needs are met, including (especially) adequate high-quality protein and essential fatty acids.
Adele: I could not agree more. I find it very troublesome that as nutrition epidemiologists, our goal seems to be on making sweeping generalizations and recommendations for everybody…while helping nobody. How is it possible that the massive flaws that pervade our diet assessment methodologies be reduced to a line or two in a often-ignored “Limitations” section of a manuscript, while these recommendations make headlines? How come there seems to be little in the way of ‘nutrition epidemiology ethics’?
I really like your idea of ‘helping others help themselves.’ But from a research perspective, the big question in my mind is, how can we do population-level research that is actually useful? (Or at the very least, not harmful).
Thanks for stopping by–those are all great questions. Here’s just a thought or two: One of the concepts I was introduced to at UNC’s Nutrition Research Institute in Kannapolis (by Dr. May) is the idea of “shoe leather” epidemiology, which–and I’m over-simplifying here–is doing epidemiology as field work.
For example, say you had a handful of people in a small Southern town that were controlling their diabetes by diet alone (or so you heard). So let’s treat this as if it is an “outbreak of healthiness.” Are they in fact healthy? What are they eating/not eating? What other characteristics do they share in terms of socioeconomic level, genetics, racial/ethnic background, maybe even a healthcare provider or friend or faith community?
Then: Can we learn anything useful from these folks to see if we can “spread” the “outbreak of healthiness” to other members of this community?
With more sophisticated data collection (esp in terms of biomarkers), mathematical modeling, and extensive outreach from social media, we could begin to trace “health communities” from the ground up–group them and sort them in various ways as we have the data to do so, and then provide patterns of behavior, lifestyle, SES factors, etc. that allow others to learn from communities of health that are similar in important characteristics to themselves. For a young, low-income African-American male with a family history of diabetes living in rural NC, I’m just not sure how helpful it is for us to tell him that in order to be healthy, he should eat the way we found worked for a bunch of white female married healthcare professionals all born before the end of WW2 (and not all that well, I might add).
And that’s just my thinking about it–there are bigger & better brains at work on this (Meghan Slining comes to mind). The main thing is that I think for nutrition epidemiology to be relevant in the future, we are going to have to get out from in front of computers and get our hands dirty in the real world. We need to stop looking backwards so very much (although the past still has things to teach us) and begin to look at what is going on in real time.
From the conclusion of,
A critique of Geoffrey Rose’s ‘population strategy’ for preventive medicine.
B G Charlton
J R Soc Med. 1995 November; 88(11): 607–610. PMCID: PMC1295381
It would be unwise, in our present state of ignorance, to adopt the wholesale reduction of ‘risk factors’ as a standard tool of health policy. The population strategy is not a valid option for the prevention of the major causes of mortality in the UK because their causes are not known. This applies to coronary heart disease, strokes, Alzheimer-type dementia, and cancers of the breast, stomach, bowel and prostate. Until their causes are established, these diseases are not legitimate targets for mass interventions, however well-intentioned, because the costs will almost certainly outweigh the benefits. Mass prevention should be confined to conditions (such as lung cancer and road traffic accidents?) where causation is (reasonably) well understood although it must be remembered, even in these circumstances, that established causation is a pre-requisite for intervention and not a carte blanche for draconian measures.
Rose was, I believe, profoundly mistaken to imply that the actual practice of clinical medicine is ‘a superficial and symptomatic’ response to disease, by comparison with his untested utopian dreams of a ‘radical’ ‘population-wide approach’ (p 100). Furthermore, it is conflating two different meanings of the concept of causation to state that ‘only the social and political approach confronts the root causes’ of bad health (p 100). On the contrary, medical science comprises the only set of disciplines that can reliably determine causation of disease. It is the assumption that health gains can result from observation and manipulation without the need for understanding which I find superficial and symptomatic. Human health is too complex, and ethical considerations too important, for social engineers safely to employ wholesale management of public lifestyle without secure knowledge of the mechanisms by which these interventions are supposed to operate.
The conclusion seems clear: implementation of the population strategy would, at present, be premature and fraught with hazards to health and human happiness. With preventive medicine the only safe maxim for a situation of uncertainty is–’if in doubt: do nothing’. This should be the default position for all those concerned with health policy.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1295381/
Ok, Kenny. That’s a little weird. I was reading that article just last night. It’s a good one–thanks for bringing it into the conversation. It’s also good to go and reread Roses’s “Sick Individuals, Sick Populations” to hear the parts of his message that still resonate, such as the call for the “restoration of biological normality by the removal of an abnormal exposure (eg, stopping smoking, controlling air pollution, moderating some of our recently-acquired dietary deviations).” These are worthy public health considerations, especially as what things can be considered “abnormal exposures” have increased exponentially in our post-industrial world–not the least of which are in our food. Some may matter; some may not–but we’ve been so focused on removing the stuff that is found NATURALLY in our food, that we’ve neglected to look elsewhere.
I have been trying to follow a lower carb diet now for 20 weeks, I am having some problems with it, maybe the carbs were to low, I do find some days I have to eat more carbs (carb cravings you know) and other days low carb is a snap. I still find myself suffering hypoglycmia symptoms, at night fasting nervousness, inability to sleep extreme hunger, I have done the really low carb diet before it didn’t work, I still suffered hypo symptoms especially after not eating for 6 hours. mostly during the night. I keep it around 25-30 percent now, works a bit better but still having insomina. and still having the nervousness after not eating for say 4-6 hours depending on whether I am still up and about or sleeping. but I have tried everything else, so what else can I do?
Hmmm. I’m wondering what the relationship between your carb cravings during the day and other symptoms are. How about trying to just focus on breakfast? Nice plateful of eggs/meat/veggies/cheese/etc at breakfast and just follow your body’s signals the rest of the day. Every low-carb protocol I’ve ever seen has folk go “cold turkey” on lowering carbs & then, after a period of very low-carb eating–add them back in until weight loss stops. That may be counterproductive in a lot of different ways. Maybe trying lowering carbs–one meal at a time, starting with breakfast–one week at a time, until weight loss starts? That way you won’t end up going any lower than you need to, maybe? Since I don’t have a detailed diet/health history, that’s probably my most intelligent suggestion . . .