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Again, in 3-part harmony–it’s not about “the science”

Adele Hite, PhD MPH RD 38 Comments

Let me be straight.  I don’t believe in conspiracy theories.* There’s no Bacon-gate.  No Cowspiracy.  No Salami-mafia out to suppress sandwich meat.  But, as the students in my Introduction to Science, Technology, and Society course will tell you, there are professional interests (only one of which is funding) and careerism.  There is also the human desire to simply not be wrong.  In nutrition, this desire is personal.

(If I were queen of the world, every research article published about nutrition and chronic disease would list, in addition to “author affiliations” and “conflicts of interest,” what each researcher typically eats for breakfast every day.  You’d find out a lot more about “affiliations” and “interests” from that information than from anything else.)

And so there is this:  Meat and fat intake and colorectal cancer risk: A pooled analysis of 14 prospective studies.  It’s an abstract from the Proceedings of the American Association of Cancer Research, from back in 2004.  It found:

Greater intake of either red meat (excluding processed meat) or processed meat was not related to colorectal cancer risk.

Typically, such abstracts are presented at a conference, then later published.  This one never made it publication.  We don’t know why.

Trevor Butterworth does some speculating about the “whys” here:

When contacted by STATS.org, Smith-Warner said they wanted to add a few more studies before publishing their results next year. But the fact is that their colorectal cancer study had more subjects than many of the other studies published by the Pooling Project – and the four-year delay in publication cannot but raise the question of whether their results just didn’t fit in with the nutritional beliefs of Harvard’s School of Public Health, one of whose senior figures – Dr. Walter Willett – has long recommended limiting red meat and who, coincidentally, is a board member of the World Cancer Research Fund.

It’s not the first time studies that contradict the status quo in nutrition never made it publication.  This study also never got past conference proceedings, though there was an article about it in the Harvard Gazette and Walter Willett (who certainly seems to practice what he preaches) has his name on the abstract:

Greene, P., Willett, W., Devecis, J., and Skaf, A. (2003). Pilot 12-Week Feeding Weight-Loss Comparison: Low-Fat vs Low-Carbohydrate (Ketogenic) Diets (abstract presented at The North American Association for the Study of Obesity Annual Meeting 2003), Obesity Research, 11S, 95-OR.

Greene’s study found that a higher calorie low-carb diet resulted in more weight loss than a lower-calorie low-fat diet.  I’m not arguing about what this study might prove about diets in general, so back off, all you folks out there foaming at the mouth to pick it apart.  Truth is, you can’t really critique it, because it never got published.

Another study that almost didn’t make it out of the gate concluded that:

Our findings do not support the hypothesis that a diet consistent with the 2005 DGA benefits long-term weight maintenance in American young adults.

In a nutshell, Daisy Zamora found that black participants with a higher Diet Quality Index (according to the Dietary Guidelines for Americans) gained more weight over time than whites (with either a higher or lower Diet Quality Index).  More surprisingly, these black participants also gained more weight over time than blacks with a lower Diet Quality Index.

Again, I’m not arguing the strengths or shortcomings of this research. The part of the story that matters here is that Zamora worked on this study as part of her PhD research at UNC-Chapel Hill.  She found a tremendous amount of resistance to her findings, to the extent that she was counseled to “redo” her work without examining racial differences.

I’ve been hip-checked into the rails by the politics of nutrition science myself.

I guess that’s why, to some extent, I feel that all of the talk about “good” science vs. “bad” science in nutrition is misplaced.  How do we even know that the part of “the science” we get to see fairly represents the work that has been done when the whole process is so highly politicized and ideological?  How many grad students slogging away in labs or poking away at databases find things that never make it to publication because it would compromise the prevailing paradigm and their advisor’s funding (and don’t have the huevos that Zamora had to get her findings published anyway)? I feel pretty certain this doesn’t just happen in nutrition, but in nutrition it really matters to each of us, every day–and even more so to those who rely on government programs for food.

How did nutrition science become so politicized?  Dietary Guidelines, I’m looking at you.  When policy “chooses” a winner and a loser in a scientific controversy, things change. Science gets done differently. And when policy (dressed up as science) chooses a side in what we should/should not eat in order to prevent ostensibly preventable things like obesity and disease, well, all hell breaks loose. When we act like we “know” what foods cause/prevent disease, good health becomes entirely the responsibility of the individual.  If you get fat or sick–no matter what else is going in your world or in your body–it’s your own damn fault.

How do we un-politicize nutrition science? This article from Daniel Sarewitz, “Science can’t solve it,” offers some clues.  Although he’s focusing on new biotechnologies that have out-run our ethical frameworks for dealing with them, these remarks could just as well apply to diet-chronic disease science.  He calls for discussions and deliberations that:

… could address questions about what is acceptable and what isn’t, about appropriate governance frameworks for research, and about the relative priority of different lines of study given ongoing and inevitable uncertainties and disagreements about risks and benefits.

If there’s one thing we’ve got in diet-chronic disease science, it is “ongoing and inevitable uncertainties.”  It’s highly unlikely that science is going to solve those uncertainties anytime soon.  As for ethical frameworks, we have never given serious consideration to the ethical implications–not to mention the outright absurdity–of subjecting everyone in our diverse population to a single dietary prescription designed to prevent all of the major chronic diseases (none of which have ever been established as primarily nutritional in nature).

Until we get to these kinds of discussion, the creators of the 2015 Dietary Guidelines ought to listen to what Paul Marantz had to say back in 2010:

 When the evidence is murky, public health officials may best be served by exercising restraint, which is reflected by making no recommendation at all.

And when they don’t (cuz who can resist telling all those stupid Americans how to eat?), at the very least, we’ll all get a little smarter about “the science.”  As @Ted_Underwood put it on Twitter:

A stubborn love of bacon just taught Americans the diff. between p-values & effect size better than 100 stats courses could.

Works for me.

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Many thanks to Dr. Sarah Hallberg, without whom it would have taken me another 5 years to stumble across some of these articles.

*Run one PTA meeting and try to get a half-dozen fairly intelligent, well-educated adults to coordinate plans for a yard sale, and you’ll see what I mean.  We can’t agree on whether used children’s books should be 50 cents or $1–figuring out whether to ruin the health of Americans by buying off the media or silencing the scientists would be beyond any possible reckoning.

Dietary Drama–an Update (but not by me)

Adele Hite, PhD MPH RD 31 Comments

My favorite reality show–The 21st Century Diet Wars–has been off the charts drama lately.  Since I’m not going to be writing any commentary about it anytime soon, I thought I would point my faithful readers (all both of them) in the direction of my favorite moments so far.

1) Just in time for Halloween, Georgia Ede, MD, publishes a post on the scary Dietary Guidelines Advisory Report (just why they are scary depends on your own personal food orientation:  They’re letting cholesterol off the hook!  They’ve reduced meat to a footnote!) and the crapstorm that Nina Teicholz raised in the BMJ when she “attacked” that most sacred of (pasture-raised, GM free, organic, speaks Chicken as a second language) cow.  [Word to the rhetorically wise:  If someone accuses you of “attacking” some belief system, you can be sure they think that system should be beyond question. That’s why “questioning” gets framed as “attacking.” ]

Read it and laugh, or weep:  here.

2) This would be in the read it and weep category.  Mark Anthony Neal posted some excellent points–in an article by Lawrence Ware and Rebecca Martinez–about the whole “processed meat and cancer” issue.  While #smugvegetarians and #smugvegans are making like Church Lady and doing their superior dance in response to the new WHO report …

Remember Church Lady and her “superior dance”? Smugness never goes out style.

… what is often omitted is that observed links between these two factors may be related to issues of class as much–or more so–than any biological mechanism.  Outside of foodie-sharcooderie land, processed meats tend to be poor people food (I’m pretty sure the observational studies that linked processed meat to cancer didn’t have a huge representation of house-cured sopressata, air-dried bresaola, and lamb shank terrine).  This means that processed meats cluster with a whole lot of other health-related factors not necessarily under an individual’s control:  stress, limited access to health care, environmental pollutants–you get the picture. Whether or not there is a direct link between processed meat and cancer is less to the point than the article’s closing remarks:

We have a health crisis in this country.  Obesity, diabetes and cancer are ravishing disadvantaged communities. Too often this crisis is centered in personal responsibility, but we must also look at systemic conditions lest we blame the victims of poverty without equipping them with the tools necessary for positive health outcomes.

Tell it.  I raise this challenge to anyone who regularly reads (or writes) articles on nutrition epidemiology.  Show me a situation where a food, food component, or dietary pattern is linked to an adverse health outcome and the population that consumes that dietary evil is not also a population with significant differences in health behaviors and/or socioeconomic factors relative to the healthy outcome population.  I’ll be here, waiting.

Slice up your hot dogs, add tiny pickles, and whaa-laa: charcuterie.

Slice up your hot dogs, add tiny pickles, and whaa-laa: charcuterie.

Or maybe we should just encourage those poor folks to slice their store-brand hot dogs in creative ways and serve them with fancy mustard and tiny pickles.

3) And, then–this:

You’re welcome.

NO LOW-CARB FOR YOU!

Adele Hite, PhD MPH RD 76 Comments

I am emerging (briefly) from grad school hibernation–my husband jokes that I’m taking all my classes “pass/flail”–for a special cause that hits close to home, even though Jennifer Elliott, a dietitian who has been going the rounds with her various professional organizations and institutions, lives in Australia.

She apparently had the gall to suggest to a patient with type 2 diabetes that a low-carbohydrate diet might be beneficial.  Heavens.  What is the world coming to?  Next thing you know, people will start telling us that if we are allergic to poison ivy and it makes us itch all over, we might not want to roll in it.

If you haven’t had a good eyeball roll or facepalm for the day, you should check out her blog, where she recounts one episode after another of Orwellian-level doublespeak with the Dietitian Association of Australia.  It’s a situation I’m quite familiar with, albeit on a much smaller scale and with our homegrown Academy of Nutrition and Dietetics here in the US of A.

The most recent episode reveals her local health district administration (Southern New South Wales Health, SNSW Health to the locals), her former employer, forbidding Jennifer–or anyone else, one must presume–from offering advice about low-carbohydrate diets to patients or clients with diabetes.  What caught my attention was this remark, by Jennifer:

“Can you imagine having to tell a client with diabetes, who has lowered his BGLs [blood glucose levels], lost weight and come off all diabetes medications by reducing his carb intake, that he now has to start eating more carbs because SNSW Health says so !?”

Well, cue the Twilight Zone music, because we are going there.

What would it be like to tell someone (like my dad, another way this story hits close to home) who has been controlling their diabetes very-well-thank-you with a low carb diet, that they now must eat more carbs, cuz we said so?  Samuel Beckett, eat your heart out.**

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Enter “patient who could be my dad.” Let’s call him Mr. Louis Corbin (LC).  He greets the dutiful dietitian (DD) who is determined to adhere to SNSW Health policies.

LC:  G’Day Ms. Dietitian.

DD:  Hello, Mr. Corbin.  How can I help you?

LC:   Well, I feel like I need to change up my diet a bit, and I’d like some help from a wise, caring, trained professional who will treat me like an individual and not like an aggregated average of a dataset.

DD:  (Laughs demurely.) Well, of course.  As a trained professional, it’s my job to use my clinical judgment to help patients find out what works best for them.

LC:  Beauty!  So, I was diagnosed with pre-diabetes about 10 year ago.

DD:  Really?  Looking at your lab report, your blood sugar and HgA1c levels look perfectly normal.  Tell me about the medications that you are using.

LC:  Well, I’m not actually on any medications.  When I got my diagnosis yonks ago, I borrowed my cousin’s glucometer and figured out which foods were making my blood sugar go up.  I really limit those in my diet now, and my blood sugar seems to be well under control. But I’m getting a little tired of eggs and sausage for brekky every morning.

DD:  Eggs and sausage?  Is that it?

LC:  And some sautéed spinach or sliced tomatoes, most days.  But I’m hoping you can help me with some other brekky ideas.

DD:  Wait now.  There’s simply too much fat in the eggs and sausage, and there’s really not enough carbohydrate–you know, sugars and starches–in that meal–or in your diet in general it seems.  You’ll need to add some fruit and a couple of servings of whole wheat bread or cereal to your breakfast and …

LC:  But tomatoes are technically a fruit …

DD:  But they are a “low carbohydrate” fruit and so they don’t count.

LC:  … and I don’t eat bread or cereal–not even whole wheat.  Those were the things that made my blood sugar go up!

DD:  Of course. We need your blood sugar to go up.  You do know that your brain won’t work without glucose from healthy, whole grains, right?

LC:  My brain seems to be working fine.  I finished “The Age” crossword puzzle while I was in the waiting room!

DD:  Well, it’s quite clear to me that your brain must not be working properly–you’ve put yourself in grave danger.  You need AT LEAST 3 servings of carbohydrate per meal, and not just at breakfast I might add, in order for your body to function properly.

WTF

LC:  Three servings per meal!  Crikey! That will make my blood sugars go up for sure!

DD:  Well, yes.  As I said, your blood sugars need to go up.  You see, Mr. LC. , in your addled state, you’ve failed to understand that diabetes is a PROGRESSIVE disease.  And your diabetes hasn’t progressed at all.  In fact, it seems to be quite stalled.

Without progression, we’ll be unable to prescribe pre-insulin drugs like metformin and engage you in the numerous diabetes education programs we have ready and waiting.  Once you’ve been thoroughly well-versed in carbohydrate counting, let’s hope that we can get your diabetes back on track.  Hmmm.  We may need to start you out at 4 servings of carbohydrate per meal …

LC:  But, but, I don’t really want my diabetes to progress.

DD:  Nonsense.  That’s what diabetes does.  You’re deluding yourself if you think otherwise.  I’ve seen hundreds of patients with type 2 diabetes, and I treat them all the same way–with the official Australian Diabetes Society diet–and they all have gotten progressively worse.  So there.

Yes, I understand that your diabetes hasn’t progressed in 10 years on a low carbohydrate diet, but it’s clear why that is.  It’s good that you’ve come to me so we can reverse that trend.  I can help you choose foods that will be sure to start you down the road to full-blown diabetes.

LC:  But I’m feeling bloody top notch.  I’ve even lost a little weight since I started reducing my sugars and starches.

DD:  Oh dear.  I didn’t realize that.  You’ll really need to fill your plate with healthy whole grains so we can get some of that weight back on.  You’re never going to end up on insulin at the rate you’re going.  But no worries.  If you can stick with at least 4 servings of carbs per meal, we might be able to get you on insulin in a few years or so.  Once we’ve got you on a regular dose of insulin, you’ll keep packing the weight on, no problem.

LC:  But I don’t want to be on insulin …

DD:  No “buts.”  Sir, you don’t realize the seriousness of this situation.  It’s not just about the insulin.  Not only do we have prescriptions that need prescribing and diabetes educators that need to educate, we have wound clinics that need wounds, dialysis clinics that need failing kidneys, testing laboratories that need labs to test.  Have you any idea how many people you might put out of work by stalling your diabetes in its tracks?

Sponsors of the ADS

A “Who’s Who of pharmaceutical and medical supply companies”? Nah, just the sponsors of the last Australian Diabetes Society conference.

DD (Continuing): You’ve not only put yourself in danger, you’ve endangered our whole healthcare supply economy!  We have injections to make your blood sugar go down.  We have glucose tablets to make your blood sugar go back up.  We have monitors and supplies and diaries and trackers and coolers and carriers for all of the THINGS you will need when you have diabetes.

We have diabetes foot cream, insoles, socks, and shoes.  And wheelchairs for when your toes rot off–which I can assure you they will if you’ll only improve your diet.  Then you’ll get to use the freight elevator and get one of those special parking passes.  If you play your cards right and follow your diet as I prescribe it , you may even end up with one of those cute little scooters for getting around the grocery store.

LC:  But …

DD:  Now then.  Not to worry.  You’re on the right path now.  You wanted some brekky ideas? Here’s a low-fat, vegetarian recipe for blueberry hotcakes, with 46 grams of carbs.  It’s from “Diabetes Australia,” so you know it’s perfect for someone with diabetes!  It should get your blood sugar going for sure!  And here’s some coupons from the Australian Breakfast Cereal Manufacturers.  I picked up tons of them at my last dietitians conference–they’re working with us to make sure everyone has a healthy, whole grain, cereal product brekky EVERY DAY!

LC:  But …

DD:  No “buts.”  I’ll expect to see you back in about 6 months.  We’ll get that HgA1c moving in the right direction this time and have you on the road to complete and total dependence on the health care system in no time!  Bye now!

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What can you do besides resolve not to move to New South Wales anytime soon?  Write a quickie email to the New South Wales Health Minister, Jillian Skinner, telling her about your experiences as a patient, clinician, family member in successfully managing type 2 diabetes/pre-diabetes/metabolic syndrome/etc. with a carbohydrate-reduced diet.

Email:   office@skinner.minister.nsw.gov.au

CC Jennifer at:  jennifer@babyboomersandbellies.com

And, what the hey, let the Dietitians Association of Australia know what you think too: nationaloffice@daa.asn.au

If you are feeling particularly feisty, go to Jennifer’s blog and post your letter there too, to let her know you stand in solidarity with her.

I personally will be sending Minister Skinner a copy of this post 🙂

**And many thanks to Disco Stew who provided the authentic Australian translation of this conversation!

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Update:  In an appalling case of life-imitating-blog-imitating-life, Disco Stew sent me a link to this piece, written by Jane Feinmann, about type 2 diabetes and the continued use of a low-fat, carbohydrate-laden diet to “treat” it:

When I wrote about this dilemma in the Daily Mail recently, the piece triggered over 200 responses from readers caught in this invidious position.

Mary Megan from London was ‘stunned’ last year when her GP “recommended eating carbohydrates as part of a ‘healthy balanced diet’ when I know for a fact from having tested my blood sugar over the years that carbohydrates are the exact cause of my high blood sugar.”

Way to go, 21st century health care system. Sigh.

I went to the 2015 Dietary Guidelines Report oral comments session and all I got was this lousy video clip

Adele Hite, PhD MPH RD 41 Comments

I had the pleasure of sharing the condensed version of my summary of the 2015 Dietary Guidelines Advisory Committee Report with the folks in Washington earlier this week.

If your idea of fun is watching paint dry, you can catch the full series of comments here.  I’m at 46.24 minutes (at the end, you can play “spot the dietitian” who doesn’t think my comments are one bit amusing).

If you sit through it all, you’ll notice that it’s pretty much an industry vs. vegans cage-match.  Which, unfortunately, leads the folks in the D.C. bubble to think that all “regular folks” (i.e. non-industry) are vegans.

Do me a favor.  Head on over to HHS.gov and provide some written comments of your own.  They can be short, sweet, to the point, but add something! Oral comments (like mine) do not have any more “weight” than written ones.

Yeah, I know what you’re thinking.  Why bother? It’s not going to change anything.  You’re probably right.  It isn’t.  But do it anyway.  The vegatarian community has been vocal, active, present, and heavily invested in this process since the Dietary Guidelines began.  How do you think a vegan diet went from being a “dangerous fad” back in the 1970s to being part of national nutrition policy in 2010?  It’s not like it somehow got “healthier.”

If I try to make the case to policymakers that the rest of America kinda likes eating dead animals, the response is, well, why didn’t we hear from them?  Like attending a funeral “to pay respects to the dead,” it seems (and is) pretty pointless in some regards.  But it does matter.  If not for these specific Guidelines, then for the next ones.

Healthy Nation Coalition has a preliminary analysis of the DGAC Report here that you can use for inspiration.  Or take a few tips from our coalition letter here.

Better yet, tell the folks writing the Guidelines your own story about food and health.  Let them know their Guidelines don’t work for everyone.  And get any friends, neighbors, and co-workers who would rather not have a “culture of health” enforcing their right to eat lentil burgers to pitch in too.

Hey, if I can wear pantyhose for 6 hours straight in order to look presentable at this meeting, the least you can do is go fill out a form.  You can do that in your pajamas.

Written comments accepted through end of day on May 8.

The 2015 Dietary Advisory Committee Report: A Summary

Adele Hite, PhD MPH RD 45 Comments

Last week, the Dietary Guidelines Advisory Committee released the report containing its recommendations for the 2015 Dietary Guidelines for Americans.   The report is 572 pages long, more than 100 pages longer than the last report, released 5 years ago.  Longer than one of my blog posts, even. Despite its length and the tortured governmentalese in which it is written, its message is pretty clear and simple. So for those of you who would like to know what the report says, but don’t want to read the whole damn thing, I present, below, its essence:

Dear America,

You are sick–and fat.  And it’s all your fault. 

Face it.  You screwed up.  Somewhere in the past few decades, you started eating too much food. Too much BAD food.  We don’t know why.  We think it is because you are stupid.

We don’t know why you are stupid.

You used to be smart–at least about food–but somewhere in the late 1970s or early 1980s, you got stupid. Before then, we didn’t have to tell you what to eat.  Somehow, you just knew. You ate food, and you didn’t get fat and sick.

But NOW, every five years we have to get together and rack our brains to try and figure out a way to tell you how to eat–AGAIN.  Because no matter what we tell you, it doesn’t work. 

The more we tell you how to eat, the worse your eating habits get. And the worse your eating habits get, the fatter and sicker you are.  And the fatter and sicker you are, the more we have to tell you how to eat. 

DGA - Length & Obesity 1980-2010

Look. You know we have no real way to measure your eating habits.  Mostly because fat people lie about what they eat and most of you are now, technically speaking, fat.  But we still know that your eating habits have gotten worse. How?  Because you’re fat.  And, y’know, sick.  And the only real reason people get fat and sick is because they have poor eating habits.  That much we do know for sure.

And because, for decades now,  we have been telling you exactly what to eat so you don’t get fat and sick, we also know the only real reason people have poor eating habits is because they are stupid.  So you must be stupid.

Let’s make this as clear as possible for you:

sick fat stupid people

And though it makes our hearts heavy to say this, unfortunately, and through no fault of their own, people who don’t have much money are particularly stupid.  We know this because they are sicker than people who have money.  Of course, money has nothing to do with whether or not you are sick.  It’s the food, stupid.

We’ll admit that some of the responsibility for this rests on our shoulders.  When we started out telling you how to eat, we didn’t realize how stupid you were.  That was our fault.

In 1977, a bunch of us got together to figure out how to make sure you would not get fat and sick.  You weren’t fat and sick at the time, so we knew you needed our help.

We told you to eat more carbohydrates–a.k.a., sugars and starches–and less sugar.  How simple is that?  But could you follow this advice?  Nooooooo.  You’re too stupid.

We told you to eat food with less fat. We meant for you to buy a copy of the Moosewood Cookbook and eat kale and lentils and quinoa.  But no, you were too stupid for that too.  Instead, you started eating PRODUCTS  that said “low-fat” and “fat-free.”  What were you thinking?

We told you to eat less animal fat. Obviously, we meant JUST DON’T EAT ANIMALS.  But you didn’t get it.  Instead, you quit eating cows and started eating chickens.  Hellooooo?  Chickens are ANIMALS.

After more than three decades of us telling you how to eat, it is obvious you are too stupid to figure out how to eat.  So we are here to make it perfectly clear, once and for all.

FIRST:  Don’t eat food with salt in it.

Even though food with salt in it doesn’t make you fat, it does raise your blood pressure.  Maybe.  Sometimes.  And, yes, we know that your blood pressure has been going down for a few decades now, but it isn’t because you are eating less salt because you’re not.  And it’s true that we really have no idea whether or not reducing your intake of salt prevents disease. But all of that is beside the point.

Here’s the deal:  Salt makes food taste good.  And when food tastes good, you eat it.  We’re opposed to that.  But since you are too stupid to actually stop eating food, we are going to insist that food manufacturers stop putting salt in their products.  That way, their products will grow weird microorganisms and spoil rapidly–and will taste like poop.

This will force everyone to stop eating food products and get kale from the farmer’s market (NO SALT ADDED) and lentils and quinoa in bulk from the food co-op (NO SALT ADDED).  Got it?

Also, we are working on ways to make salt shakers illegal. 

Ban Salt Shakers

 

NEXT:  Don’t eat animals. At all.  EVER.

We told you not to eat animals because meat has lots of fat, and fat makes you fat.  Then you just started eating skinny animals. So we’re scrapping the whole fat thing.  Eat all the fat you want.  Just don’t eat fat from animals, because that is the same thing as eating animals, stupid.

We told you not to eat animals because meat has lots of cholesterol, and dietary cholesterol makes your blood cholesterol go up.  Now our cardiologist friends who work for pharmaceutical companies and our buds over at the American Heart Association have told us that avoiding dietary cholesterol won’t actually make your blood cholesterol go down.  They say:  If you want your blood cholesterol to go down, take a statin.  Statins, in case you are wondering, are not made from animals so you can have all you want.  

Eggs? you ask.  We’ve ditched the cholesterol limits, so now you think you can eat eggs?  Helloooo?  Eggs are just baby chickens and baby chickens are animals and you are NOT ALLOWED TO EAT ANIMALS.  Geez.

Yes, we are still hanging onto that “don’t eat animals because of saturated fat” thing, but we know it can’t last forever since we can’t actually prove that saturated fat is the evil dietary villain we’ve been saying it is.  So …

Here’s the deal:  Eating animals doesn’t just kill animals.  It kills the planet.  If you keep killing animals and eating them WE ARE ALL GOING TO DIE.  And it’s going to be your fault, stupid.

And especially don’t eat red meat.  C’mon.  Do we have to spell this out for you?  RED meat? 

RED meat = COMMUNIST meat.  Does Vladimir Putin look like a vegan?  We thought not. 

 

 If you really must eat dead rotting flesh, we think it is okay to eat dead rotting fish flesh, as long as it is from salmon raised on ecologically sustainable fish farms by friendly people with college educations. 

FINALLY:  Stop eating–and drinking–sugar.

Okay, we know we told you to eat more carbohydrate food.  And, yes, we know sugar is a carbohydrate. But did you really think we were telling you to eat more sugar?  Look, if you must have sugar, eat some starchy grains and cereals. The only difference between sugar and starch is about 15 minutes in your digestive tract.  But …

Here’s the deal:  Sugar makes food taste good.  And when food tastes good, you eat it.  Like we said, we’re opposed to that.  But since you are too stupid to actually stop eating food, we are going to insist that food manufacturers stop putting sugar in their products.  That way, their products will grow weird microorganisms and spoil rapidly–and will taste like poop.

This will force everyone to stop eating food products and get kale from the farmer’s market (NO SUGAR ADDED) and lentils and quinoa in bulk from the food co-op (NO SUGAR ADDED).  Got it?

Ban cupcakes

 

Hey, we know what you’re thinking.  You’re thinking “Oh, I’ll just use artificial sweeteners instead of sugar.”  Oh NOOOO you don’t.  No sugar-filled soda.  No diet soda.  Water only. Capiche?

 So, to spell it all out for you once and for all:

DO NOT EAT food that has salt or sugar in it, i.e. food that tastes good.  Also, don’t eat animals.

DO EAT kale from your local farmers’ market, lentils and quinoa from your local food co-op,  plus salmon. Drink water.  That’s it. 

And, since we graciously recognize the diversity of this great nation, we must remind you that you can adapt the above dietary pattern to meet your own health needs, dietary preferences, and cultural traditions. Just as long as you don’t add salt, sugar, or dead animals.

Because we have absolutely zero faith you are smart enough to follow even this simple advice, we are asking for additional research to be done on your child-raising habits (Do you let your children eat food that tastes good?  BAAAAD parent!) and your sleep habits (Do you dream about cheeseburgers?  We KNOW you do and that must stop!  No DEAD IMAGINARY ANIMALS!)

And–because we recognize your deeply ingrained stupidity when it comes to all things food, and because we know that food is the only thing that really matters when it comes to health, we are proposing  America create a national “culture of health” where healthy lifestyles are easier to achieve and normative.

“Normative” is a big fancy word that means if you eat what we tell you to eat, you are a good person and if you eat food that tastes good, you are a bad person. We will know you are a bad person because you will be sick. Or fat. Because that’s what happens to bad people who eat bad food.

We will kick-off this “culture of health” by creating an Office of Dietary Wisdom that will make the healthy choice–kale, lentils, quinoa, salmon, and water–the easy choice for all you stupid Americans.  We will establish a Food Czar to run the Office of Dietary Wisdom because nothing says “America, home of freedom and democracy” like the title of a 19th-century Russian monarch.*

The primary goal of the “culture of health” will be to enforce your right to eat what we’ve determined is good for you. 

This approach will combine the draconian government overreach we all love with the lack of improvements we expect, resulting in a continued demand for our services as the only people smart enough to tell the stupid people how to eat.**

 Look.  We know we’ve been a little unclear in the past.  And we know we’ve reversed our position on a number of things. Hey, our bad.  And when, five years from now, you stupid Americans are as sick and fat as ever, we may have to change up our advice again based, y’know, on whatever evidence we can find that supports the conclusions we’ve already reached.

But rest assured America.

No matter what the evidence says, we are never ever going to tell you it’s okay to eat salt, sugar, or animals.  And, no matter what the evidence says, we are never ever going to tell you that it’s not okay to eat grains, cereals, or vegetable oils.  And you can take that to the bank.  We did.

Love and kisses,

Committee for Government Approved Information on Nutrition (Code name: G.A.I.N.)

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

*Thank you, Steve Wiley.

**Thank you, Jon Stewart, for at least part of this line.

 

Figure out Food: Eat what works!

Adele Hite, PhD MPH RD 6 Comments

No, that’s not the name of my new blog (although it is awfully catchy, isn’t it?), but it sure does capture the spirit of my own approach to nutrition these days.

It’s the name of what I think will be the future of nutrition–an app that helps you figure out what to eat to be healthy by connecting what you eat to how you feel.  Can I get an “It’s about damn time”?

Kenny's app

Wading through the muck of nutrition science and public health, I’ve learned just a few things that I can say with assurance:

1) We know very little about the relationship between diet and prevention of chronic disease.  Somebody tells you that they have a scientifically proven diet for preventing chronic disease?  This person may have a diet, it may even work (as far as we can tell at the moment), but it not going to be scientifically proven because we simply don’t have the science to prove it.  As they say in the biz, our methodology sucks green tomatoes.

2) The focus in public health (and private care) on weight loss is misguided.  Weight loss does not equal health and even if it did, we’re really bad at helping people do it successfully and long-term.  Does weight loss result in better health?  Sometimes.  But is that due to the weight loss per se, or due to whatever metabolic changes had to happen in order for weight loss to occur?  And, truth is, sometimes attempts at weight loss compromise health.  Loss of muscle mass, disordered eating patterns, nutritional deficiencies, restricted lifestyle, hunger, fatigue, general misery and bitchiness–all of these can accompany attempts at weight loss & may cause more problems than they solve.

BUT–and it’s a big but, like it always is–food is really important.  Some foods make us feel satisfied and full of energy and ready to leap over tall buildings with nary a second thought.  Other foods make us Sleepy and Sneezy and Dopey and a few other dwarves that Snow White didn’t meet:  Cranky, Burpy, and Farty.

And foods that make my body happy are not necessarily the ones that make yours happy.

How do we know which foods are which?  

Ta-da!  Kenny Gow to the rescue with a totally cool app that he’s been working on for a while now.

The main thing to know about this app is that it’s about having health now (not about weight loss or disease prevention–see above) and it’s about you (not an aggregate of information from datasets full of people who aren’t you).

I think it’s pretty cool & when I eventually get back to working with patients, I hope this app is there to help me help them.  But–for that to happen, he needs some support from us.

With that in mind, check out his Indiegogo campaign, which I’m about to donate to, as soon as I finish this blog post.

Fist-bump to Gingerzini who beat me to it.

 

 

 

 

What if there were no Dietary Guidelines?

Adele Hite, PhD MPH RD 27 Comments

I don’t get excited about much these days.  Mostly because I’m too sleep deprived from studying until 2:00 AM.  But I’m pretty excited about this.

I’ve been wanting to write this piece for a long time.  The wonderful folks at Examine.com encouraged me to go ahead and do it.

Check it out:  What if there were no Dietary Guidelines?  

 

Examine com pix

Changing the Dietary Guidelines

Adele Hite, PhD MPH RD 28 Comments

If you have been following any of the Dietary Guidelines Advisory Committee’s meetings (who does that anyway? I mean, unless you are a total geek like I am), then you might have noticed that the next Guidelines seem very likely to continue to promote the same nutritional advice that has proven largely ineffective for more than 35 years.

In my other, not-quite-so-snarky, life, I am not Wonder Woman (but oh, what I wouldn’t give for a pair of bracelets of submission). However, I am director of the Healthy Nation Coalition, a loose affiliation of healthcare and public health professionals, scientists, and concerned citizens who think it is time we did nutrition a little differently. Right now, we are creating a coalition of supporters to speak out against the direction the current 2015 Dietary Guidelines are taking and to offer an alternative approach.

This letter will be delivered to the Secretaries of the U.S. Departments of Agriculture and Health and Human Services, selected policymakers, and interested media outlets. We hope to add to the momentum that has been building in the national media calling for a change in our national dietary guidance (see Nina Teicholz’ book, Big Fat Surprise, and her recent op-ed in the Wall Street Journal).

The letter is copied below (or you can use this link to the pdf–the pdf is where all the citations are, because I know how you love citations).

If you wish to sign on, you can use this quick form to add your information to the letter. If you’re interested, but don’t want to read the whole boring letter, check out Mark Sisson’s blog post about it.  It’s lots more fun.

In a nutshell, we are asking for Dietary Guidelines that are geared toward the general public and focused on adequate essential nutrition.

This is not a call for low-carb, high-fat dietary recommendations, or paleo ones, and it takes no stance on the whole “calories in, calories out” versus hormonal regulation etc. etc. issue.  So if you want to criticize this approach, don’t start bitching about low-carb diets or CICO, or I’ll know that you haven’t bothered to actually read this and I won’t feel guilty about deleting your comments.  Beyond that, if you have genuine objections to this approach, suggest a better one–or go away.   What we are doing now isn’t working.  What we need is productive conversation about what to do differently.

Healthy Nation Coalition Letter – 2015 Dietary Guidelines for Americans

Dear Secretary Burwell and Secretary Vilsack,

At the conclusion of the sixth meeting of the 2015 Dietary Guidelines Advisory Committee (DGAC), we write to express concern about the state of federal nutrition policy and its long history of failure in preventing the increase of chronic disease in America. The tone, tenor, and content of the DGAC’s public meetings to date suggest that the 2015 Dietary Guidelines for Americans (DGA) will perpetuate the same ineffective federal nutrition guidance that has persisted for nearly four decades but has not achieved positive health outcomes for the American public.

We urge you to adhere to the initial Congressional mandate that the DGA act as “nutritional and dietary information and guidelines for the general public” and are “based on the preponderance of the scientific and medical knowledge which is current at the time the report is prepared.”

Below we lay out specific objections to the DGA:
· they have contributed to the increase of chronic diseases;
· they have not provided guidance compatible with adequate essential nutrition;
· they represent a narrow approach to food and nutrition inconsistent with the nation’s diverse cultures, ethnicities, and socioeconomic classes;
· they are based on weak and inconclusive scientific data;
· and they have expanded their purpose to issues outside their original mandate.

As you prepare to consider the 2015 DGAC’s recommendations next year, we urge you to fulfill your duty to create the dietary foundation for good health for all Americans by focusing on adequate essential nutrition from whole, nourishing foods, rather than replicating guidance that is clearly failing.

The DGA have contributed to the rapid rise of chronic disease in America.

In 1977, dietary recommendations (called Dietary Goals) created by George McGovern’s Senate Select Committee advised that, in order to reduce risk of chronic disease, Americans should decrease their intake of saturated fat and cholesterol from animal products and increase their consumption of grains, cereal products, and vegetable oils. These Goals were institutionalized as the DGA in 1980, and all DGA since then have asserted this same guidance. During this time period, the prevalence of heart failure and stroke has increased dramatically. Rates of new cases of all cancers have risen. Most notably, rates of diabetes have tripled. In addition, although body weight is not itself a measure of health, rates of overweight and obesity have increased dramatically. In all cases, the health divide between black and white Americans has persisted or worsened.

While some argue that Americans have not followed the DGA, all available data show Americans have shifted their diets in the direction of the recommendations: consuming more grains, cereals, and vegetable oils, while consuming less saturated fat and cholesterol from whole foods such as meat, butter, eggs, and full-fat milk. Whether or not the public has followed all aspects of DGA guidance does not absolve the U.S. Departments of Agriculture (USDA) and Health and Human Services (DHHS) from ensuring that the dietary guidance provided to Americans first and foremost does no harm.

The DGA fail to provide guidance compatible with essential nutrition needs.

The 1977 Dietary Goals marked a radical shift in federal dietary guidance. Before then, federal dietary recommendations focused on foods Americans were encouraged to eat in order to acquire adequate nutrition; the DGA focus on specific food components to limit or avoid in order to prevent chronic disease. The DGA have not only failed to prevent chronic disease, in some cases, they have failed to provide basic guidance consistent with nutritionally adequate diets.
· Maillot, Monsivais, and Drewnowski (2013) showed that the 2010 DGA for sodium were incompatible with potassium guidelines and with nutritionally adequate diets in general.
· Choline was recognized as an essential nutrient in 1998, after the DGA were first created. It is crucial for healthy prenatal brain development. Current choline intakes are far below adequate levels, and choline deficiency is thought to contribute to liver disease, atherosclerosis and neurological disorders. Eggs and meat, two foods restricted by current DGA recommendations, are important sources of choline. Guidance that limits their consumption thus restricts intake of adequate choline.
· In young children, the reduced fat diet recommend by the DGA has also been linked to lower intakes of a number of important essential nutrients, including calcium, zinc, and iron.

Following USDA and DHHS guidance should not put the most vulnerable members of the population at risk for nutritional inadequacy. DGA recommendations should be emphasizing whole foods that provide essential nutrition, rather than employing a reductionist approach based on single food components to exclude these foods from the diet.

The DGA’s narrow approach to food and health is inappropriate for a diverse population.

McGovern’s 1977 recommendations were based on research and food patterns from middle class Caucasian American populations. Since then, diversity in America has increased, while the DGA have remained unchanged. DGA recommendations based on majority-white, high socioeconomic status datasets have been especially inappropriate for minority and low-income populations. When following DGA recommendations, African American adults gain more weight than their Caucasian counterparts, and low-income individuals have increased rates of diabetes, hypertension, and high cholesterol. Long-standing differences in environmental, genetic and metabolic characteristics may mean recommendations that are merely ineffective in preventing chronic disease in white, middle class Americans are downright detrimental to the long-term health of black and low-income Americans.

The DGA plant-based diet not only ignores human biological diversity, it ignores the diversity of American foodways. DGA guidance rejects foods that are part of the cultural heritage of many Americans and indicates that traditional foods long considered to be important to a nourishing diet should be modified, restricted, or eliminated altogether: ghee (clarified butter) for Indian Americans; chorizo and eggs for Latino Americans; greens with fatback for Southern and African Americans; liver pâtés for Jewish and Eastern European Americans.

Furthermore, recommendations to prevent chronic disease that focus solely on plant-based diets is a blatant misuse of public health authority that has stymied efforts of researchers, academics, healthcare professionals, and insurance companies to pursue other dietary approaches adapted to specific individuals and diverse populations, specifically, the treatment of diabetes with reduced-carbohydrate diets that do not restrict saturated fat. In contradiction of federal law, the DGA have had the effect of limiting the scope of medical nutrition research sponsored by the federal government to protocols in line with DGA guidance.

The DGA are not based on the preponderance of current scientific and medical knowledge.

The science behind the current DGA recommendations is untested and inconsistent. Scientific disagreements over the weakness of the evidence used to create the 1977 Dietary Goals have never been settled. Recent published accounts have raised questions about whether the scientific process has been undermined by politics, bias, institutional inertia, and the influence of interested industries.

Significant scientific controversy continues to surround specific recommendations that:
1. Dietary saturated fat increases the risk of heart disease: Two recent meta-analyses concluded there is no strong scientific support for dietary recommendations that restrict saturated fat. Studies cited by the 2010 DGAC Report demonstrate that in some populations, lowering dietary saturated fat actually worsens some biomarkers related to heart disease.
2. Dietary cholesterol increases the risk of heart disease: Due to a lack of evidence, nearly all other Western nations have dropped their limits on dietary cholesterol. In 2013, a joint panel of the American Heart Association and the American College of Cardiology did the same.
3. Polyunsaturated vegetable oils reduce the risk of heart disease and should be consumed as the primary source of dietary fat: Recent research renews concerns raised in response to the 1977 Dietary Goals that diets high in the omega-6 fatty acids present in vegetable oils may actually increase risk of chronic disease or death.
4. A diet high in carbohydrate, including whole grains, reduces risk of chronic disease: Clinical trials have demonstrated that diets with lower carbohydrate content improve risk factors related to heart disease and diabetes. Janet King, Chair of the 2005 DGAC, has stated that “evidence has begun to accumulate suggesting that a lower intake of carbohydrate may be better for cardiovascular health.”
5. A low-sodium diet reduces risk of chronic disease: A 2013 Institute of Medicine report concludes there is insufficient evidence to recommend reducing sodium intake to the very low levels set by the DGA for African-Americans of any age and adults over 50.

In all of these cases, contradictory evidence has been ignored in favor of maintaining outdated recommendations that have failed to prevent chronic disease.

More generally, “intervention studies, where diets following the Dietary Guidelines are fed long-term to human volunteers, do not exist,” and food patterns recommended by the DGA “have not been specifically tested for health benefits.” The observational research being used for much of the current DGAC activities may suggest possible associations between diet and disease, but such hypotheses must then be evaluated through rigorous testing. Applying premature findings to public health policy without adequate testing may have resulted in unintended negative health consequences for many Americans.

The DGA have overstepped their original purpose.

The DGA were created to provide nutrition information to all Americans. However, the current 112-page DGA, with 29 recommendations, are considered too complex for the general public and are directed instead at policymakers and healthcare professionals, contradicting their Congressional mandate.

Federal dietary guidance now goes far beyond nutrition information. It tells Americans how much they should weigh and how to lose weight, even recommending that each American write down everything that is eaten on a daily basis. This focus on obesity and weight loss has contributed to extensive and unrecognized “collateral damage”: fat-shaming, eating disorders, discrimination, and poor health from restrictive food habits. At the same time, researchers at the Centers for Disease Control have shown that overweight and obese people are often as healthy as their “normal” weight counterparts. Guidance related to body weight should meet individual health requirements and be given by a trained healthcare practitioner, not be dictated by federal policy.

The DGA began as an unmandated consumer information booklet. They are now a powerful political document that regulates a vast array of federal programs and services, dictates nationwide nutrition standards, influences agricultural policies and health-related research, and directs how food manufacturers target consumer demand. Despite their broad scope, the DGA are subject to no evaluation or accountability process based on health outcomes. Such an evaluation would demonstrate that they have failed to fulfill their original goal: to decrease rates of chronic disease in America.

Despite this failure, current DGAC proceedings point to an expansion of their mission into sustainable agriculture and environmental concerns. While these are important issues, they demonstrate continued “mission creep” of the DGA. The current narrow DGA focus on plant-based nutrition suggests a similarly biased approach will be taken to environmental issues, disregarding centuries of traditional farming practices in which livestock play a central role in maintaining soil quality and ecological balance. Instead of warning Americans not to eat eggs and meat due to concerns about saturated fat, cholesterol, and obesity, it is foreseeable that similar warnings will be given, but for “environmental” reasons. This calls for an immediate refocusing of the purpose of the DGA and a return to nutritional basics.

Solution: A return to essential nutrition guidance

As our nation confronts soaring medical costs and declining health, we can no longer afford to perpetuate guidelines that have failed to fulfill their purpose. Until and unless better scientific support is secured for recommendations regarding the prevention of chronic disease, the DGA should focus on food-based guidance that assists Americans in acquiring adequate essential nutrition.

Shifting the focus to food-based guidance for adequate essential nutrition will create DGA that:
· are based on universally accepted and scientifically sound nutritional principles: Although more knowledge is needed, the science of essential nutrient requirements is firmly grounded in clinical trials and healthcare practice, as well as observational studies.
· apply to all Americans: Essential nutrition requirements are appropriate for everyone. Lack of essential nutrients will lead without exception to diseases of deficiency.
· include traditionally nourishing foods: A wide variety of eating patterns can provide adequate essential nutrition; no nourishing dietary approaches or cultural food traditions would be excluded or discouraged.
· expand opportunities for research: With dietary guidance focused on adequate essential nutrition, researchers, healthcare providers, and insurance companies may pursue dietary programs and practices tailored to individual risk factors and diverse communities without running afoul of the DGA and while ensuring that basic nutrition needs are always met.
· direct attention towards health and well-being: Focus will be directed away from intermediate markers, such as weight, which may be beyond individual control, do not consistently predict health outcomes, and are best dealt with in a healthcare setting.
· are clear, concise, and useful to the public: Americans will be able to understand and apply such guidance to their own dietary patterns, minimizing the current widespread confusion and resentment resulting from federal dietary guidance that is poorly grounded in science.

It is the duty of USDA and DHHS leadership to end the use of controversial, unsuccessful and discriminatory dietary recommendations. USDA and DHHS leadership must refuse to accept any DGA that fail to establish federal nutrition policy based on the foundation of good health: adequate essential nutrition from wholesome, nourishing foods. It is time to create DGA that work for all Americans.

 

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

Adele Hite, PhD MPH RD 50 Comments

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.

 

 

Why care about calories?

Adele Hite, PhD MPH RD 50 Comments

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

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

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

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

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

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

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

James Groff & Sareen Gropper

I don’t know why I have this book.

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

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

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

 


Functional Biochemistry in Health and Disease, 2009

Eric Newsholme & Tony Leech

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

–“Calorie” is not indexed.

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


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

Pamela Champe, Richard Harvey, & Denise Farrier

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

–“Calorie” is not indexed.

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

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

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

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

 


Biochemistry (2nd Edition) , 1995

Donald Voet & Judith Voet

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

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

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

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

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

 

Biochemistry (6th edition), 2009

Mary Campbell & Shawn Farrell

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

–“Calorie” is not indexed.

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


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

David L. Nelson & Michael M. Cox

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

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

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

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