“The Food Pyramid? It’s just wrong.”

June 29, 2017June 29, 2017Adele Hite, PhD MPH RD 24 Comments

“A diet based on food that turns to sugar once it’s in your body was never going to end well.” The last 35 years of dietary advice summed up in one tweet-worthy sentence, and the whole embarrassing public health nutrition fiasco explained in less than 3 minutes.

Hooboy, do I have a treat for you.

Despite the recent nobody-is-listening-so-we’d-better-yell-louder American Heart Association report that encourages everyone to chug soybean oil like it’s cheap beer, butter is baaaaack–and starring in its own video.

My friend, Jenni Calihan at EatTheButter is the mastermind behind this, but I’ll humbly take credit for some “editorial input” here.

Watch first, then we’ll talk:

First of all: I’m still snickering over the “not based on rigorous science” frame:

Next: Maybe you’re a newbie to the world of non-mainstream, it’s-actually-okay-to-eat-animal-fat nutrition, or maybe you are just nutrition-skeptic curious, or maybe you’ve been around all of the various dietary dogma blocks. For whatever reason, if you get a little uncomfortable with all the hyperbole, oversimplification, and finger-pointing about who Made America Fat–the cows! the Snackwells! the stupid lazy gluttonous Americans!–this little video offers a straightforward, easy-to-understand explanation for our current nutrition quandary, without resorting to distortions, exaggerations, and the blame game.

I’m happy to take some credit for that. For me, when you’re talking physiology and biochemistry (crackers turn into sugar, fat doesn’t “make you fat”), things are pretty straightforward. But it gets trickier talking about “good” or “bad” science or what the Food Pyramid did or didn’t do, or cause.

This is one my favorite things about this video: Although the relationship between dietary guidance and outcomes is noted, cause and effect regarding the specifics of the diet is not explicitly stated (although I suspect that various parties will infer what they will).

For example, when the voice-over says “The Food Pyramid? It’s just wrong,” does that mean, “The science behind the Food Pyramid is just wrong” or that “Pyramid-shaped food advice is just wrong”? The first is an argument waiting to happen, but the second just says that the advice we gave out–whether pyramid- or plate-shaped–was, for some reason, the wrong advice for most Americans.

Was it all those starches turning to sugar after few minutes in our stomachs? Did eating less nutrient-dense food, like red meat, mean we ended up eating more food overall in order to be adequately nourished? Did the division of food in to “good” and “bad” categories set up cycles of “good” and “bad” eating? Or, to get all academic on you, did the application of the halo of “healthy” to cheap, convenient, tasty, but nutritionally lacking industrialized food, coupled with a neoliberalist imperative to make health the responsibility of the individual and “solutions” to health a matter of the marketplace, make many Americans–particularly those caught in a widening income gap and increasing economic pressures–more susceptible to eating patterns that exacerbated all of the other toxicities of modern life?

You don’t have to answer that.

My point is that we (really) don’t know what exactly about our dietary advice is the problem, and—as far as I am concerned at this point—it doesn’t matter.

For 20th (and now 21st) century Americans, this kind of dietary advice, provided in this particular political, sociocultural, industrial, and economic context, simply did not—and still does not—“work” to keep Americans healthy. That’s it. We can argue until the grass-fed cows come home about why it didn’t work, but it didn’t work. Acknowledge and move on.

And in the meantime, you can share this video with friends and family and know that it got the “hyperbole-free” stamp of approval from me.

Alternative Fa(c)ts

May 6, 2017May 9, 2018Adele Hite, PhD MPH RD 24 Comments

I’ve been meaning to blog about this for a while now, but as always: grad school. However, today in my inbox appeared a call to sign a petition sponsored by the Nutrition Coalition to have federal dietary guidance based on sound scientific evidence. Now, I’m all for that–assuming of course, we could agree on what we mean by “sound” and by “scientific” and by “evidence” in the area of nutrition and chronic disease relationships.

Much to my surprise, the first reform that is called for is “to let Americans know that the low-fat diet is no longer officially recommended.” This part makes sense, although it’s kind of old news (see below). The Dietary Guidelines for Americans (affectionately known as the DGA) haven’t recommended a “low-fat” diet since 1995.

But the petition goes on to say that “the DGA have quietly dropped previous limits on total fat.” So what’s my problem?

Walter Willett and Frank Hu say the limits on fat are gone.

Nina Teicholz says the limits on fat are gone.

Great minds think alike, right? Those pesky limits must be gone.

Inconveniently, the folks at the USDA and HHS say this:

An upper limit on total fat intake was not removed from the DGA.

I am less concerned about whether or not the upper limits on fat are officially gone (they aren’t), and more interested in why parties as diverse in their perspectives on diet as the dudes at Harvard and the dudettes at Nutrition Coalition would both agree that they are (when they aren’t). I mean we’re talking about folks who know more than a little about nutrition and policy, and they can’t seem to figure out what the DGA actually say.

Could it be that the USDA and HHS are attempting to rhetorically distance themselves from limits on fat without the policy implications that come with making that official? They’re willing to date the “no more low fat” thinking, but don’t want to put a ring on it?

After all, whether or not you think people followed low-fat guidance, or didn’t follow low-fat guidance, or we can’t tell one way or the other because everybody lies about what they eat anyway, using the authority of the federal government to prescribe a single dietary pattern to everyone over the age of two in the hopes of reducing the risk of every single chronic disease known to mankind–including obesity, which wasn’t even a disease until we made it one–simply did not work out the way we thought it would.

I’m not arguing here about whether or not a low-fat diet is a problem (I suspect it is for a lot of folks and not so much for others), but it seems low-fat dietary guidance is.

The folks who write the DGA seem to have recognized this issue 17 years ago. In 1995, the guidance on fat in the DGA said “Choose a diet low in fat,” and specifically, to limit total fat intake to 30% of calories. But then this happened:

In 2000, the DGA said, “Choose a diet that is moderate in total fat.” But. The limit on total fat intake remained exactly the same: 30% of calories. So rhetorically, no more low-fat diet; materially, same old, same old.
In 2005, both the “low fat” and “moderate fat” language are avoided. In the meantime, the total fat intake limit is, quietly, raised, to 35% of calories. Maybe they thought if they shifted the limit on total fat without actually saying anything about it, no one would notice. And, it seems, pretty much no one did.
In 2010, the range for fat intake remains the same as in 2005: 20-35% of calories.
In 2015, nothing changes. The range for fat intake is between 20-35% of calories for adults, 25-35% for people younger than 18 years old.

In other words, it does look like the DGA have slowly been modifying–without completely relinquishing–their call for Americans not to eat a lot of fat. At the same time, language in the DGA–and in my correspondence with the USDA/HHS–makes it sound like the fat limits aren’t their fault. They are just following (reinforcing, supporting, and promoting as policy) the limits set by the National Academies.

Which may explain why it did take some persistence on my part to get this info from the government. (If a PhD program has taught me nothing else, it has taught me persistence.)

In my first email, I asked what I thought was a pretty straightforward question:

In the 2015 DGA policy document, is there a recommended limit on the percentage of calories in the diet that should come from fat, and if so, what is it?

I got this response:

Thank you for your email. The 2015-2020 Dietary Guidelines for Americans recommends following a healthy eating pattern that accounts for all foods and beverages within an appropriate calorie level. Key Recommendations describe the components of a healthy eating pattern and highlight components to limit. Additionally, supporting text acknowledges that healthy eating patterns should be within the Acceptable Macronutrient Distribution Ranges (AMDRs) for protein, carbohydrates, and total fats. For example, page 35 of the PDF states that “healthy eating patterns can be flexible with respect to the intake of carbohydrate, protein, and fat within the context of the AMDR,” and Table A3-1, which outlines the Healthy U.S.-Style Eating Pattern, one example of a healthy eating pattern, states that “calories from protein, carbohydrate, and total fats should be within the AMDRs.”

In other words, wtf?

I tried again:

Thank you so much for your reply. But I’m not sure it answers my question in that the information that you point to seems to have been interpreted different ways.

The heading for the table which references the AMDR in the DGA document says this: “Daily Nutritional Goals for Age-Sex Groups Based on Dietary Reference Intakes and Dietary Guidelines Recommendations.” Beneath that it indicates that, except for children under the age of three, total dietary fat should be limited to no more than 35% of calories. This, to me, sounds like a limit on total fat calories as as part of the official policy document that is the DGA.

But, the parts of the text you reference that point to the AMDR seem to have been interpreted by others as the AMDR recommending one thing, while the DGA recommend something else.

Dr. Frank Hu has said about the 2015-2020 DGA that, “Another important positive change is the removal of an upper limit for total dietary fat …” Dr. Walter Willett has said, “The 2016 Dietary Guidelines are improved in some important ways, especially the removal of the restriction on percentage of calories from total fat …”

So, to put it quite simply, have the upper limits on percentage of calories from total fat been removed? Would it be possible to get an official “yes” or “no” answer to that question?

And this is what I got back:

Thank you for your email. The 2015-2020 DGAs recommends total fat intake within the AMDRs. As you know, the AMDRs are set by the Health and Medicine Division (formerly the Institute of Medicine), not through the Dietary Guidelines process.

An upper limit on total fat intake was not removed from the DGA.

The AMDR for total fats for adults is 20-35% of total kcal.

So, long story long: Have the “official” upper limits on total fat intake been lifted? No.

Do the officials in charge of the “official” limits want to come right out and say this? Um, well, uh … hmmm … perhaps maybe not in so many words.

And every 5 years. There are. So. Many. More. Words.

Speaking strictly in terms of association, we could say that the number of words in the Dietary Guidelines are directly and strongly related to increases in rates of obesity.

Maybe the problem isn’t the fat that is or is not in the diet. Maybe the problem is the words about fat that are–or are not, depending on your version of reality–in the guidelines.

And if you’ve made it this far and are interested in still more words on nutrition and rhetoric, I’ve had the pleasure of getting to chat with a number of different folks about my studies and where they are taking me. If you want to know what I’m reading, writing, and thinking about in that never-ending PhD program I’m in, here it is:

Diana Rogers at Sustainable Dish: We do a deep dive into social and political history behind the Dietary Guidelines, the price of meat in the 1970s, and how Diet for a Small Planet is not a low-fat cookbook. Tune in and you can hear me talk about the “dietary imaginary” and how we’ve lost the ability to think for ourselves about food.

Peter Defty at Optimal Fat Burning: We chat about the Dietary Guidelines, calories, and changing body size norms. Tune in and you can hear me talk about how a post-menopausal body can turn even the best diet into body fat and a bad attitude.

Laura and Kelsey at The Ancestral RDs: We talk about ethical problems associated with the Dietary Guidelines and how a feisty little start-up in Canada is working to make them irrelevant.

Speaking of that feisty little start-up in Canada, Approach Analytics, here’s some more about them and their work to “democratize the nutrition knowledge-making process.”

Please join me at AHS 2017, where–surprise–I’ll just keep on talking! I’m looking forward to discussing the ideas behind democratizing nutrition knowledge-making and more about how “n of 1” nutritional approaches, together with the power of population-based information, can sidestep an information-gathering system that serves to maintain the status of mainstream dietary guidance, but does little to help the public.

Finally, if you missed AHS 2016 and you haven’t heard me yammer on enough about the 2015 Dietary Guidelines, now’s your chance. Pull this up on YouTube and you’ll get see me do a couple of different versions of happy dance.

Low Fat, High Maintenance: How money buys lean and healthy–plus, an alternative path to both

January 7, 2016March 25, 2017Adele Hite, PhD MPH RD 70 Comments

The 2015[6] Dietary Guidelines are out today. Although restrictions on cholesterol and overall fat [read: oil] content of the diet have been lifted [sorta, not really], the nutrition Needle of Progress has hardly budged, with saturated fat and sodium still lumped into the same “DANGER Will Robinson” category as trans fats and added sugars–and with cholesterol still carrying the caveat that “individuals should eat as little dietary cholesterol as possible.” The recommended “healthy eating pattern” calls for fat-free/low-fat dairy, lean meat, and plenty of whole grains, plus OIL. In other words, the diet is still low-fat and high-carb–just add vegetable oil [you know, locally sourced, whole-food canola, corn, and soy oil].

However, the most disturbing part of the Guidelines is Chapter 3, which heralds “a new paradigm in which healthy lifestyle choices at home, school, work, and in the community are easy, accessible, affordable, and normative.” In other words, let’s make what we’ve determined is the healthy choice, the easy–and morally permitted–choice for everyone [read: especially for those minority and low-income populations who insist on eating stuff we disapprove of].

Thus, it seems appropriate that today’s featured post focuses less on nutrition and more on the cultural context in which nutrition happens. Without further ado:

Low Fat, High Maintenance: How money buys lean and healthy–plus, an alternative path to both

Guest post by Jennifer Calihan at eatthebutter.org

It’s Friday evening. There is a chill in the air. The smell of ‘Walking Tacos’[i] wafts over from the row below. A rousing, “Give me an ‘S’!” commands my attention. All the cues point to one thing – I am sitting at another high school football game. I’m not really a huge football fan, but my son plays on the team, and I love watching him.

The parents and fans from my son’s school all sit on one side of the field, so the stands are filled with friends and many warm, familiar faces. I am struck, as I always am, by how good everyone looks. I see a lot of grey hair on the men but not much on the women – funny how that works! The adults watching are at least 40, and some are probably mid-fifties. But what is truly striking about this crowd is how trim they all are. Are there some people struggling with their weight? Sure. But the majority of these folks are maintaining a normal weight. No sign of the obesity epidemic on this side of the field. And I wonder what I always wonder – how do they do it – really?

At half time, I take a walk over to the visitor side of the field to stretch my legs. Over here, the stands tell a different story. The parents and fans of the visiting team look… well, they look like most American crowds. Although this crowd seems a little younger than the home team fans, most of the people here are struggling with their weight. In fact, our national averages would predict about 68% of these adults are too heavy; 38% would be obese, plus about another 30% overweight. And, based on what I see, that sounds about right. But it is not the weight, per se, that worries me. It is the metabolic disease that often travels with excess weight that is cause for concern. Diabetes, heart disease, fatty liver… a future of pills and declining health.

Experts acknowledge that obesity and the diseases that travel with it are tied to income. Simplistically, you might think something like, “more money = more food = more obesity,” but that is just not how it works. As most of you know, it is the reverse. “Less money = more obesity.” So it may not surprise you to hear that my son attends an independent school in an affluent area. And the visiting team is from a less affluent suburb. So, the mystery is solved – skinny rich people on one side, and overweight middle-class people on the other.

What interests me is the, ‘How?’ As in, ‘How do the skinny rich people do it?’

I affectionately refer to my neighborhood, and others like it, as ‘the bubble.’ The bubble is safe… it is comfortable… it is beautiful. But how, exactly, does the bubble protect my family and my neighbors from the obesity epidemic? Just as it is not a happy accident that actresses age amazingly well, it is not a happy accident that the affluent stay lean. Most of them spend a lot of time and money on it. They have to. Our nation’s high-maintenance dietary recommendations require most eaters to invest a great deal of resources to combat the risk of obesity and diabetes that is built into low-fat eating. Unfortunately, this means middle-income and working class families, who may be lacking the resources to perform this maintenance, are launched on a path toward overweight and diabetes. What can be done to level the playing field?

Seven Ways Money Buys Thin

1. More Money Buys Better Food

For many in the bubble, there is not a defined budget for groceries. And, let’s face it, that makes shopping successfully for healthy food – however you define it – just a tad easier. To imagine the flexibility that wealth can afford, consider this inner dialog that happens in a Whole Foods aisle near you. In the bubble, a mom might consider: “Should I buy the wild salmon or the chicken tenders for dinner? Hmmm… let’s see here. $28.50 or $8.99? My, that is quite a price difference. But those tenders are pretty processed. And they aren’t gluten-free. I’ll go with the salmon this week – Johnny loves it, and it’s so healthy.” If it doesn’t really matter if the food bill is $300 or $350 this week, why not buy the wild salmon?

Much has been written about how cheap the processed calories in products like soda and potato chips are, and how tempting those cheap calories are to people who are shopping, at least on some level, for the cheapest calorie. I find it hard to believe that any thinking mother is buying soda because it is a cheap way to feed her family. My guess is that she is buying soda for other reasons: habit, caffeine, sweet treat, etc. But certainly, refined carbohydrates and refined oils, which I believe are uniquely fattening, are cheap and convenient and are often processed into something remarkably tasty. So yes, I think small grocery budgets lead to more processed foods and more fattening choices.

Higher grocery budgets often lead to high-end grocery stores that offer exotic, ‘healthy’ products, which, on the margin, may be healthier than their conventional counterparts. Quinoa pasta, hemp seed oil mayonnaise (affectionately known as ‘hippie butter’), cereals or crackers made from ancient grains, and anything made with chia seeds all come to mind. Last week, I saw Punkin Cranberry Tortilla Chips on an endcap. Seriously? (Yet, mmmm… how inventive and seasonal!) The prices are ridiculous, but upscale shoppers snap up these small-batch, artisanal products, regardless. They may not be worth the money, and may not really taste all that good, but they carry an aura of health and make you feel really good about yourself when you put them in your cart.

The idea that money buys better food also rings true when eating out. The cheapest restaurants tend to offer more processed calories with fewer whole food choices. And, even on the same menu, the fresh, whole foods tend to be quite expensive, especially if you look at cost per calorie. Again, in the bubble, a mom might consider, “Pizza tonight? Or should we stop by Cornerstone, the local home-style restaurant, and get grilled chicken with broccoli and a salad? Hmmm… $20 or $60? Well, we did pizza last week; I think we should go to Cornerstone.”

The bottom line is that money can buy more choices and some of those choices are less likely to add pounds.

2. More Money Buys More Time to Cook and/or More Shortcuts

Most of the moms (and a rare dad or two) in my circles have time to shop and cook because they are not working full-time. Thus, higher family income can mean more home-cooked meals. Cooking at home gives families more control of ingredients and portions. It also tends to mean more whole food and less processed food, which most agree is better for weight control.

Of course, affluent working moms are the exception to this, as they have little time for grocery shopping and cooking. But, again, money can help here. Many of my friends who work full-time outsource the grocery shopping and/or cooking to a nanny, a housekeeper, or a personal chef service. Even in a mid-sized city like Pittsburgh, there are boutique, foodie storefronts that deliver healthy, home-made meals for $12-16 (each). Lately, some moms are using the on-line services (like Blue Apron, Hello Fresh, Plated, and even The Purple Carrot, which offers a vegan menu) that ship a simple recipe and the exact fresh ingredients needed to make it to a subscriber’s door each day. How convenient! For only $35 or $40, you can feed your family of four AND still get to cook dinner. Perfect. Many skip the whole experience and simply purchase fully cooked gourmet meals at high-end grocery stores, which tend to run $8-15 per person. Fabulous. What a nice option for the health-minded busy mom who is not on a budget. Of course, not all working mothers are quite so lucky.

3. More Money Buys More Time to Exercise And More Access To Exercise

I am a firm believer that one cannot exercise one’s way out of a diet full of nutritionally empty calories. BUT, if people get their diet headed in a decent direction, daily exercise can really help them cheat their way to thin even if they are still not eating right all of the time. So, exercise is certainly a factor in this puzzle, particularly for people eating low-fat diets that seem to require a steady, daily burn of calories. As a committed non-athlete, I am continually amazed by how much my friends exercise. Running, walking, biking, swimming, tennis, squash, paddle tennis – the list goes on and on. Now, small fitness facilities offer pricey, specialized workouts: lifting, yoga, Pilates, rowing, bootcamp, kick-boxing, TRX, Pure Barre, spinning, Crossfit, and the very latest – wait for it – OrangeTheory. These boutique fitness plays are becoming more common, and can run up to $500/month… not kidding. Here’s more on this trend from the WSJ.

Whew. It is exhausting to even imagine keeping up with most of my friends and neighbors. But I give it a go… sort of. Devoting an hour or more each day to exercise is much easier for those living in the bubble. Let’s be honest – people with money can afford to outsource some of the busywork of life. If you don’t like cleaning your house or mowing your lawn or weeding the flowerbeds or repainting the fence or doing laundry, don’t do it. Pay someone else to do those things, so you have time for spinning 3x a week plus Pilates (work that core) and tennis. Have baby weight to lose? No problem. Hire a babysitter and a trainer and you will make progress.

Good trainers, although expensive, often deliver more effective exercise, more efficient routines, more entertaining workouts, and better results. Appointments are scheduled and you pay whether you go or not, which makes showing up more likely. You can even find a buff guy who will yell at you if you find that motivating. Personal trainers are just one more way money buys thin.

When I think back to what my mother might have considered doing to stay fit when she was my age, I come up with one thing and one thing only: walking the golf course. And I lived up north, so the golf season was only 18 weeks long. She had no regular workout routine, nor did any of her friends. Did she have cut arms, toned abs, and look great in a bikini? Absolutely not. Was she overweight? Absolutely not. And she had the good sense not to wear a bikini, btw. It’s amazing that she could maintain her weight without regularly scheduled exercise. Her game plan was old-fashioned: bacon and eggs fried in butter for breakfast, no starch at dinner, very occasional desserts, plus a couple very dry martinis, never before 6pm. She’s a size 10 at age 91, so I’d say it worked for her.

Times have changed. In the bubble, 50-year-old upper arms are proudly bared, even in winter, and women walking around in fitness gear is so commonplace that the industry has a term for this fashion trend: athleisure. If you think I might be making that up, check out this WSJ article, “Are You Going to the Gym or Do You Just Dress That Way?” The fact that Nike’s sales of women’s products topped $5 billion in 2014 is a little startling, no? Some women even need a completely separate closet to house all of their Nike apparel. Khloe Kardashian claims her fitness closet is her favorite closet. Ummm… not quite sure what to say about this, except that girl has a lot of sneakers.

One doesn’t have to be athletic to exercise, so I am guilty of some of this behavior (although I swear I only have one drawer for my fitness gear). I am sure there are some naturally thin couch potatoes among the parents of the students enrolled at my son’s school, but they are the exception. Most of the lean and affluent are working pretty hard to look the way they look.

4. More Money Buys Access to Better Ideas About What Makes You Overweight

Maybe it is your personal trainer who talks to you about trying a Paleo diet. Or, perhaps your trip to Canyon Ranch exposes you to a more whole food, plant-based, healthy fats approach to eating. Or, if you prefer to ‘spa’ at Miraval, you might learn about Andrew Weil’s anti-inflammatory food pyramid. Maybe your friend recommends an appointment with a naturopathic MD who suggests that you try giving up grains. The point is, if you have money, you have a greater chance of hearing something other than ‘eat less, exercise more’ when you complain about your expanding waistline. The affluent have easy access to many different ideas about diet and health, so they can experiment with several and see which one works for them.

Today, one of the most popular alternative ways of eating is a plant-based, ultra-low-fat diet. Books and sites (like the in-your-face, aptly named Skinny Bitch brand) market snotty versions of this blueprint for weight loss to their upscale customers. I see many women in my circles eating this near vegan diet these days: lots of whole vegetables and grains, very little fat, with perhaps a little lean meat, fish or eggs occasionally. Although this is not my chosen approach, as it requires giving up too many of my favorite foods and leaves me perpetually hungry, it seems to deliver some pretty skinny results. And, since it is in vogue, it is something that will be accommodated at parties in the bubble – plenty of crudité platters with hummus and beautiful roasted beet salads, sprinkled with pumpkin seeds, pomegranate kernels, and just a touch of olive oil. In affluent communities, being among friends and acquaintances who practice an alternative approach to eating means social activities are “safe” places to eat, not minefields of temptation. I don’t mean to suggest that people in less affluent suburbs have not heard of a vegan diet or only socialize around piles of nachos; I would maintain that those communities are as invested in their health as affluent ones. But, if your social circle has access to better food, as well as better information about food, you are more likely to be a part of a “culture of skinny.”

5. More Money Buys a ‘Culture of Skinny’

Living in the bubble means living among the lean. Which, as you might imagine, increases the odds that you will be one of them. There is a lot of peer pressure to look a certain way, and being surrounded by people who look that way certainly gets your attention. It also gives you hope that being thin is a reasonable expectation – as in, “If all my neighbors have figured it out, so can I.” And, it helps that there will be healthier food at most gatherings. When the trays of cookies do come out, none of your friends will be reaching for more than one, either. So the bubble is sort of a support group for staying lean. As the success of AA can attest, when it comes to habits and willpower, support groups matter.

There is even some research to back this up. Did you know that you are 40% more likely to become obese if you have a sibling who becomes obese, but 57% more likely to become obese if you have friend who becomes obese?[ii] It’s a little weird to think of obesity as socially contagious, but it seems that social environment trumps genetics. An article in Time explains it this way: “Socializing with overweight people can change what we perceive as the norm; it raises our tolerance for obesity both in others and in ourselves.”[iii] (Emphasis mine.)

Living immersed in the ‘culture of skinny’ makes the sacrifices you must make to stay that way more bearable. Misery loves company, and I often think that eating way too much kale and being hungry all the time is easier if you are doing it with friends… Odd to think of widespread hunger in the affluent suburbs, I know, but I think there is a fair amount of self-imposed hunger here. Likewise, on the exercise front, you certainly won’t lack company on the paddle court or walking paths, and exercising with friends can truly be fun. Plus, you can take solace in the fact that you won’t be the only one foregoing the pleasure of lying on the couch with a glass of Chardonnay watching Downton Abby in order to make it to your spin class. In the bubble, the penalty for not keeping up with your diet and exercise regime is higher. Being the only obese mom or dad standing on the sidelines at Saturday’s soccer game can feel a bit isolating. The ‘culture of skinny’ cuts both ways – it can serve as both a carrot and a stick.

6. More Money Buys Other Ways to Treat Yourself (and the Kids)

I attended a workshop about obesity and food deserts a couple of years ago. It was sponsored by a group of venture philanthropists (think: savvy business people advising and funding fledgling non-profits), hoping to shed some light on the obesity epidemic. One of our assignments was to go into a small market in a blighted urban neighborhood and try to buy food for a few meals for a single mother and two young children. Of course, the earnest healthy eaters (self-included) in our group dominated, and we came back with things like whole milk, regular oatmeal, vegetable soup, and turkey deli meat. Boy, were we – visitors to this world – going to prove that even in a food desert and on a budget, healthy eating was possible if we made wise choices. When we returned for the debrief, another mother said, “You know, we bought all this healthy stuff, but if I were that single mother, wouldn’t I want to bring home some joy? Like, something that would make my kids smile?” And, of course, she was right. If money were tight, would I really buy unsweetened oatmeal, disappoint my kids, and listen to the subsequent really loud whining? Probably not. I think I would bring home Captain Crunch and see some joy.

In the bubble, breakfast does not have to be a treat. Like all mothers, I have to pick my battles, but breakfast can be one of mine. Would I be as likely to refuse to buy sweetened cereal if there were more important battles to fight? No. And, for the adults, maybe the food-reward cycle becomes less important when there are so many other ‘treats’ coming… the manicure, the tennis lesson, the new jeans… whatever it is that makes food less important.

7. More Money Buys Bariatric Surgery

If all else fails, people with resources have a surgical option. This is, of course, a very invasive approach to the problem – surgically altering the human anatomy to suit the modern diet rather than altering the modern diet to suit the human anatomy. But type 2 diabetes remission rates as high as 66% have been reported (two years post-op)[iv], so bariatric procedures offer more than just a cosmetic result. Our health care providers love this option. (How exciting: a new profit center!) Expensive bariatric procedures are actually available outside the bubble because insurance will cover most of the costs. How interesting that this somewhat extreme solution is the tool that is subsidized enough to bring it within reach of our middle class citizens. But, of course, those without the means to fund the deductibles, out-of-pocket costs, and time off work cannot afford even this option.

Another Inconvenient Truth

Here’s the thing. As a nation, we have (perhaps inadvertently) chosen to push, EXCLUSIVELY, a very high-maintenance diet. (And I know high-maintenance when I see it.) A diet that requires most of its eaters to either perform hours of exercise each week, or endure daily hunger, or both, in order to avoid weight gain and/or diabetes. A diet that has taken us down the tedious path of measuring portions, counting calories, and wearing Fitbits. This is far from ideal, and has left too many of us hungry, tired, crabby, and sick, not to mention pacing around our homes at night in our daily pursuit of 10,000 steps. Yes, there are those genetically gifted people who can eat low-fat, not be chained to a treadmill, and remain skinny – ignore this irrelevant minority. Yes, there are neighborhoods of affluent people where most seem to make it work – ignore them, too. We should not let the success we see in privileged communities give us hope that our current low-fat dietary paradigm is workable. The bubble is a red herring; it telegraphs false hope.

Our nation’s overall results speak for themselves. Low-fat diet advice will never work for most Americans. Never-ever. Sticking, stubbornly, to our high-maintenance food paradigm is especially harmful for our working class and middle-income citizens; people who don’t have the time, money, or resources required to make the low-fat diet work, but care just as much about their health as those in the bubble. For them, we must move on.

I am proposing that our obesity and diabetes epidemics reveal yet another inconvenient truth: our official dietary advice sets most people up for failure. Perhaps Jeb Bush could take a page out of Al Gore’s playbook and put himself on a post–campaign mission to shine a spotlight on this issue. Jeb! has access, he has public speaking skills, he has bank, and, believe it or not, he’s Paleo. Who knew?

If Jeb! were to spread the word, what solutions could he promote? What can any eater do to level the playing field a bit – to have a shot at vibrant health minus the prohibitive price tag of high-maintenance routines?

The Vintage Alternative

I run a small non-profit, Eat the Butter, that is all about real-food-more-fat eating. The main idea behind the site is that the USDA’s Dietary Guidelines have created many of our health problems, and going back to eating the way we used to eat, before they were issued, is a workable solution. The tagline is ‘Vintage Eating for Vibrant Health.’ Specifically, my site suggests some simple ideas about healthy eating. Eat real food. Unrefined. Whole food that has been around for a while. And don’t be afraid to eat more natural fat. To follow this advice, an eater must ignore some of the USDA’s guidelines. And there are millions of Americans doing just that. (Many of these rogue eaters are affluent, by the way.) I am trying to reach out to more – to every mother. It pains me that millions of mothers are teaching their kids to eat in a low-fat way that is likely to lead, when their kids reach their 30’s or 40’s, down the path of metabolic syndrome, just as it has for us. It is time for a different approach, informed by vintage, time-tested ideas (often backed up by thoroughly modern science) about the basic components of a healthy diet.

But can vintage eating be done outside the bubble – even on a budget? It worked pretty well in the 1950’s… why not now?

Sometimes, back-to-basics can actually be pretty affordable… what could be more inexpensive and vintage than a glass of water out of the tap? Think of the groceries you would no longer need: almost all drinks – soda and Snapple and Gatorade and fruit juice (… alas, you might still ‘need’ your coffee and that glass of Chardonnay…); almost all packaged cereals and crackers and chips and snacks; almost all cookies and cereal bars and – God forbid – Pop Tarts. These products all contain highly processed ingredients and are relatively expensive for what you are getting. By buying whole, unprocessed food, the middleman is eliminated and so is his profit margin. Whole foods are usually devoid of packaging or minimally packaged, and don’t typically require an advertising budget. So there are meaningful savings here, especially if you can buy in bulk and shop the sales.

I have lingered in the bubble long enough that saving money in the grocery aisles is not exactly my expertise. My husband, much to his chagrin, can attest to this. I won’t insult you by offering second-hand tips, but there are plenty of smart women blogging about their take on buying high quality food on a budget. By mostly ignoring the packaged goods in the middle of the store, my hope is that you can offset much of the incremental spending you will do on the store’s perimeter: in the produce, dairy, and meat departments. These foods may be somewhat more expensive in general, but offer more nutrition for your food dollar and are more filling in the long run.

Can vintage eating be easy? Yes… perhaps not as easy as a drive-thru, but how long does it take to fry a pork chop? Scramble a couple of eggs? Open a can of green beans? Throw sweet potatoes in the oven? Vintage doesn’t have to be fancy. I bet you cannot drive to pick-up take-out in the time it takes to make a quick vintage meal. Simple vintage meals are the original fast food. Saturated fat is the original comfort food. If only we would give everyone permission to fry up some meat or fish and melt butter on their frozen peas. What a relief it would be for those who have very little slack in their lives and just want easy, satisfying meals that nourish them rather than fatten them.

The goal, after all, is not perfection. It is to move in the general direction of whole foods… not to be confused with Whole Foods, the grocery chain, which is definitely not where you want to go if you are on a budget ;-). Give up as many modern, food science inventions as you can stomach, replace them with vintage, whole food, and I bet you will see the ‘always hungry’ status that the processed stuff drives fade. Travel towards vintage eating just as far as your time, tastes, and budget will allow. Then, see how you feel. Even if it doesn’t get you all the way to lean, it might just get you to healthy, which is really what this is about.

References

[i] ‘Walking Tacos’ are a high school snack stand special: open a snack-sized bag of Fritos and toss a couple of spoonfuls of taco meat, shredded lettuce, and grated cheese on top. Yum! Although initially put off by the idea of serving tacos in a foil bag of chips, I have made hundreds on my snack stand shifts and now marvel at the efficiency of this ingenious suburban housewife creation.

[ii] Christakis NA, Fowler JH. The Spread of Obesity in a Large Social Network over 32 Years. New England Journal of Medicine, July 26, 2007. 357-370-9.

[iii] Abedin S. The Social Side of Obesity: You are Who You Eat With. Time, September 3, 2009.

[iv] Puzziferri N. Long-term follow-up after bariatric surgery: a systematic review. JAMA. 2014 Sep 3;312(9):934-42.

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Figures from the author’s comments in the comment section below:

The 2015 Dietary Advisory Committee Report: A Summary

February 23, 2015April 3, 2018Adele 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.

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:

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.

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?

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.)

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*Thank you, Steve Wiley.

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

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

July 23, 2013July 23, 2013Adele Hite, PhD MPH RD 29 Comments

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

July 3, 2013July 8, 2013Adele Hite, PhD MPH RD 46 Comments

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 [2^nd 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).

What 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.”

As the Calories Churn (Episode 1): Nooooo, not the carbs!!!

July 2, 2013July 2, 2013Adele Hite, PhD MPH RD 69 Comments

Oh the drama! Some of the current hyperventilating in the alternative nutrition community–sugar is toxic, insulin is evil, vegetable oils give you cancer, and running will kill you–has, much to my dismay, made the alternative nutrition community sound as shrill and crazed as the mainstream nutrition one.

When you have ~~self-appointed nutrition experts~~ food writers like Mark Bittman agreeing feverishly with a pediatric endocrinologist with years of clinical experience like Robert Lustig, we’ve crossed over into some weird nutrition Twilight Zone where fact, fantasy, and hype all swirl together in one giant twitter feed of incoherence meant, I think, to send us into a dark corner where we can do nothing but nibble on organic kale, mumble incoherently about inflammation and phytates, and await the zombie apocalypse.

No, carbohydrates are not evil—that’s right, not even sugar. If sugar were rat poison, one trip to the county fair in 4th grade would have killed me with a cotton candy overdose. Neither is insulin, now characterized as the serial killer of hormones (try explaining that to a person with type 1 diabetes).

But that doesn’t mean that 35 years of dietary advice to increase our grain and cereal consumption, while decreasing our fat and saturated fat consumption has been a good idea.

I have gotten rather tired of seeing this graph used as a central rationale for arguing that the changes in total carbohydrate intake over the past 30 years have not contributed to the rising rates of obesity.

The argument takes shapes on 2 fronts:

1) We ate 500 grams of carbohydrate per day in 1909 and 500 grams in 1997 and WE WEREN’T FAT IN 1909!

2) The other part of the argument is that the TYPE of carbohydrate has shifted over time. In 1909, we ate healthy, fiber-filled unrefined and unprocessed types of carbohydrates. Not like now.

Okay, let’s take closer look at that paper, shall we? And then let’s look at what really matters: the context.

The data used to make this graph are not consumption data, but food availability data. This is problematic in that it tells us how much of a nutrient was available in the food supply in any given year, but does not account for food waste, spoilage, and other losses. And in America, we currently waste a lot of food.

According to the USDA, we currently lose over 1000 calories in our food supply–calories that don’t make it into our mouths. Did we waste the same percentage of our food supply across the entire century? Truth is, we don’t know and we are not likely to find out—but I seriously doubt it. My mother and both my grandmothers—with memories of war and rationing fresh in their minds—would be no more likely to throw out anything remotely edible as they would be to do the Macarena. My mother has been known to put random bits of leftover food in soups, sloppy joes, and—famously—pancake batter. To this day, should your hand begin to move toward the compost bucket with a tablespoon of mashed potatoes scraped from the plate of a grandchild shedding cold virus like it was last week’s fashion, she will throw herself in front of the bucket and shriek, “NOOOOOO! Don’t throw that OUT! I’ll have that for lunch tomorrow.”

You know what this means folks: in 1909, we were likely eating MORE carbohydrate than we are today. (Or maybe in 1909, all those steelworkers pulling 12 hour days 7 days a week, just tossed out their sandwich crusts rather than eat them. It could happen.)

BUT–as with butts all over America including mine, it’s a really Big BUT: How do I explain the fact that Americans were eating GIANT STEAMING HEAPS OF CARBOHYDRATES back in 1909—and yet, and yet—they were NOT FAT!!??!!

Okay. Y’know. I’m up for this one. Not only is problematic to the point of absurdity to compare food availability data from the early 1900s to our current food system, life in general was a little different back then. At the turn of the century,

average life expectancy was around 50
the nation had 8,000 cars
and about 10 miles of paved roads.

In 1909, neither assembly lines nor the Titanic had happened yet.

The labor force looked a little different too:

Primary occupations made up the largest percentage of male workers (42%)—farmers, fisherman, miners, etc.—what we would now call manual laborers. Another 21% were “blue collar” jobs, craftsmen, machine operators, and laborers whose activities in those early days of the Industrial Revolution, before many things became mechanized, must have required a considerable amount of energy. And not only was the work hard, there was a lot of it. At the turn of the century, the average workweek was 59 hours, or close to 6 10-hour days. And it wasn’t just men working. As our country shifted from a rural agrarian economy to a more urban industrialized one, women and children worked both on the farms and in the factories.

This is what is called “context.”

In the past, nutrition epidemiologists have always considered caloric intake to be a surrogate marker for activity level. To quote Walter Willett himself:

“Indeed, in most instances total energy intake can be interpreted as a crude measure of physical activity . . . ” (in: Willett, Walter. Nutritional Epidemiology. Oxford University Press, 1998, p. 276).

It makes perfect sense that Americans would have a lot of carbohydrate and calories in their food supply in 1909. Carbohydrates have been—and still are—a cheap source of energy to fuel the working masses. But it makes little sense to compare the carbohydrate intake of the labor force of 1909 to the labor force of 1997, as in the graph at the beginning of this post (remember the beginning of this post?).

After decades of decline, carbohydrate availability experienced a little upturn from the mid 1960s to the late 1970s, when it began to climb rapidly. But generally speaking, carbohydrate intake was lower during that time than at any point previously.

I’m not crazy about food availability data, but to be consistent with the graph at the top of the page, here it is.

Data based on per capita quantities of food available for consumption:

	1909	1975	Change
Total calories	3500	3100	-400
Carbohydrate calories	2008	1592	-416
Protein calories	404	372	-32
Total fat calories	1098	1260	+162

Saturated fat (grams)	52	47	-5
Mono- and polyunsaturated fat (grams)	540	738	+198
Fiber (grams)	29	20	-9

To me, it looks pretty much like it should with regard to context. As our country went from pre- and early industrialized conditions to a fully-industrialized country of suburbs and station wagons, we were less active in 1970 than we were in 1909, so we consumed fewer calories. The calories we gave up were ones from the cheap sources of energy—carbohydrates—that would have been most readily available in the economy of a still-developing nation. Instead, we ate more fat.

We can’t separate out “added fats” from “naturally-present fats” from this data, but if we use saturated fat vs. mono- and polyunsaturated fats as proxies for animal fats vs. vegetable oils (yes, I know that animal fats have lots of mono- and polyunsaturated fats, but alas, such are the limitations of the dataset), then it looks like Americans were making use of the soybean oil that was beginning to be manufactured in abundance during the 1950s and 1960s and was making its way into our food supply. (During this time, heart disease mortality was decreasing, an effect likely due more to warnings about the hazards of smoking, which began in earnest in 1964, than to dietary changes; although availability of unsaturated fats went up, that of saturated fats did not really go down.)

As for all those “healthy” carbohydrates that we were eating before we started getting fat? Using fiber as a proxy for level of “refinement” (as in the graph at the beginning of this post—remember the beginning of this post?), we seemed to be eating more refined carbohydrates in 1975 than in 1909—and yet, the obesity crisis was still yet a gleam in Walter Willett’s eyes.

While our lives in 1909 differed greatly from our current environment, our lives in the 1970s were not all that much different than they are now. I remember. As much as it pains me to confess this, I was there. I wore bell bottoms. I had a bike with a banana seat (used primarily for trips to the candy store to buy Pixie Straws). I did macramé. My parents had desk jobs, as did most adults I knew. No adult I knew “exercised” until we got new neighbors next door. I remember the first time our new next-door neighbor jogged around the block. My brothers and sister and I plastered our faces to the picture window in the living room to scream with excitement every time she ran by; it was no less bizarre than watching a bear ride a unicycle.

In 1970, more men had white-collar than blue-collar jobs; jobs that primarily consisted of manual labor had reached their nadir. Children were largely excluded from the labor force, and women, like men, had moved from farm and factory jobs to more white (or pink) collar work. The data on this is not great (in the 1970s, we hadn’t gotten that excited about exercise yet) but our best approximation is that about 35% of adults–one of whom was my neighbor–exercised regularly, with “regularly” defined as “20 minutes at least 3 days a week” of moderately intense exercise. (Compare this definition, a total of 60 minutes a week, to the current recommendation, more than double that amount, of 150 minutes a week.)

Not too long ago, the 2000 Dietary Guidelines Advisory Committee (DGAC) recognized that environmental context—such as the difference between America in 1909 and America in 1970—might lead to or warrant dietary differences:

“There has been a long-standing belief among experts in nutrition that low-fat diets are most conducive to overall health. This belief is based on epidemiological evidence that countries in which very low fat diets are consumed have a relatively low prevalence of coronary heart disease, obesity, and some forms of cancer. For example, low rates of coronary heart disease have been observed in parts of the Far East where intakes of fat traditionally have been very low. However, populations in these countries tend to be rural, consume a limited variety of food, and have a high energy expenditure from manual labor. Therefore, the specific contribution of low-fat diets to low rates of chronic disease remains uncertain. Particularly germane is the question of whether a low-fat diet would benefit the American population, which is largely urban and sedentary and has a wide choice of foods.” [emphasis mine – although whether our population in 2000 was largely “sedentary” is arguable]

The 2000 DGAC goes on to say:

“The metabolic changes that accompany a marked reduction in fat intake could predispose to coronary heart disease and type 2 diabetes mellitus. For example, reducing the percentage of dietary fat to 20 percent of calories can induce a serum lipoprotein pattern called atherogenic dyslipidemia, which is characterized by elevated triglycerides, small-dense LDL, and low high-density lipoproteins (HDL). This lipoprotein pattern apparently predisposes to coronary heart disease. This blood lipid response to a high-carbohydrate diet was observed earlier and has been confirmed repeatedly. Consumption of high-carbohydrate diets also can produce an enhanced post-prandial response in glucose and insulin concentrations. In persons with insulin resistance, this response could predispose to type 2 diabetes mellitus.

The committee further held the concern that the previous priority given to a “low-fat intake” may lead people to believe that, as long as fat intake is low, the diet will be entirely healthful. This belief could engender an overconsumption of total calories in the form of carbohydrate, resulting in the adverse metabolic consequences of high carbohydrate diets. Further, the possibility that overconsumption of carbohydrate may contribute to obesity cannot be ignored. The committee noted reports that an increasing prevalence of obesity in the United States has corresponded roughly with an absolute increase in carbohydrate consumption.” [emphasis mine]

Hmmmm. Okay, folks, that was in 2000—THIRTEEN years ago. If the DGAC was concerned about increases in carbohydrate intake—absolute carbohydrate intake, not just sugars, but sugars and starches—13 years ago, how come nothing has changed in our federal nutrition policy since then?

I’m not going to blame you if your eyes glaze over during this next part, as I get down and geeky on you with some Dietary Guidelines backstory:

As with all versions of the Dietary Guidelines after 1980, the 2000 edition was based on a report submitted by the DGAC which indicated what changes should be made from the previous version of the Guidelines. And, as will all previous versions after 1980, the changes in the 2000 Dietary Guidelines were taken almost word-for-word from the suggestions given by the scientists on the DGAC, with few changes made by USDA or HHS staff. Although HHS and USDA took turns administrating the creation of the Guidelines, in 2000, no staff members from either agency were indicated as contributing to the writing of the final Guidelines.

But after those comments in 2000 about carbohydrates, things changed.

Beginning with the 2005 Dietary Guidelines, HHS and USDA staff members are in charge of writing the Guidelines, which are no longer considered to be a scientific document whose audience is the American public, but a policy document whose audience is nutrition educators, health professionals, and policymakers. Why and under whose direction this change took place is unknown.

The Dietary Guidelines process doesn’t have a lot of law holding it up. Most of what happens in regard to the Guidelines is a matter of bureaucracy, decision-making that takes place within USDA and HHS that is not handled by elected representatives but by government employees.

However, there is one mandate of importance: the National Nutrition Monitoring and Related Research Act of 1990, Public Law 445, 101st Cong., 2nd sess. (October 22, 1990), section 301. (P.L. 101-445) requires that “The information and guidelines contained in each report required under paragraph shall be based on the preponderance of the scientific and medical knowledge which is current at the time the report is prepared.”

The 2000 Dietary Guidelines were (at least theoretically) scientifically accurate because scientists were writing them. But beginning in 2005, the Dietary Guidelines document recognizes the contributions of an “Independent Scientific Review Panel who peer reviewed the recommendations of the document to ensure they were based on a preponderance of scientific evidence.” [To read the whole sordid story of the “Independent Scientific Review Panel,” which appears to neither be “independent” nor to “peer-review” the Guidelines, check out Healthy Nation Coalition’s Freedom of Information Act results.] Long story short: we don’t know who–if anyone–is making sure the Guidelines are based on a complete and current review of the science.

Did HHS and USDA not like the direction that it looked like the Guidelines were going to take–with all that crazy talk about too many carbohydrates – and therefore made sure the scientists on the DGAC were farther removed from the process of creating them?

Hmmmmm again.

Dr. Janet King, chairwoman of the 2005 DGAC had this to say, after her tenure creating the Guidelines was over: “Evidence has begun to accumulate suggesting that a lower intake of carbohydrate may be better for cardiovascular health.”

Dr. Joanne Slavin, a member of the 2010 DGAC had this to say, after her tenure creating the Guidelines was over: “I believe fat needs to go higher and carbs need to go down,” and “It is overall carbohydrate, not just sugar. Just to take sugar out is not going to have any impact on public health.”

It looks like, at least in 2005 and 2010, some well-respected scientists (respected well enough to make it onto the DGAC) thought that—in the context of our current environment—maybe our continuing advice to Americans to eat more carbohydrate and less fat wasn’t such a good idea.

I think it is at about this point that I begin to hear the wailing and gnashing of teeth of those who don’t think Americans ever followed this advice to begin with, because—goodness knows—if we had, we wouldn’t be so darn FAT!

So did Americans follow the advice handed out in those early dietary recommendations? Or did Solid Fats and Added Sugars (SoFAS—as the USDA/HHS like to call them—as in “get up offa yur SoFAS and work your fatty acids off”) made us the giant tubs of lard that we are just as the USDA/HHS says they did?

Stay tuned for the next episode of As the Calories Churn, when I attempt to settle those questions once and for all. And you’ll hear a big yellow blob with stick legs named Timer say, “I hanker for a hunk of–a slab or slice or chunk of–I hanker for a hunk of cheese!”

Why Fat is Still a Feminist Issue

September 20, 2012November 30, 2016Adele Hite, PhD MPH RD 24 Comments

Sing along when the chorus rolls around (with apologies to Helen Reddy):

Yes I ate brown rice
And anything whole grain
Yes I’ve exercised
And look how much I’ve gained
If I have to, I won’t eat anything
I am fat
I am invisible
I am WOMAAAAAAAN!

The United Nations declared 1975 to be International Woman’s Year. Unfortunately, we haven’t really come a long way, baby, since then. Right now, I’m going to sidestep the whole media-generated body image issue, the glass labyrinth, the mommy wars, the “strong is the new sexy” idea (which somehow won out over my own personal favorite “smart is the new sexy” with campaign ads of slightly-unwashed-looking ladies without pedicures huddled over lab benches) and all the other complexities of contemporary feminist theory, and just focus on one little segment of how our national nutrition recommendations might have sucked the life out of women in general for the past 30 plus years.

We’ve been acting like the whole low-fat/low-glycemic/low-carb/paleo/whatever nutrition argument is a PubMed duel between scientists, and the fact that we are surrounded by lousy, nutrient-poor, cheap food is the fault of the Big Evil Food Industry. Let’s focus our attention regarding the current health crisis in America where it really belongs: on short-sighted, premature, poorly-designed (albeit well-intentioned) public health recommendations that were legitimized with the 1977 Dietary Goals for Americans and institutionalized as US policy beginning with the 1980 Dietary Guidelines for Americans. Yes, fat is still a feminist issue. But I’m not talking about body fat.

The scientific underpinnings for these recommendations came primarily from studies done with white men. And although the science conducted on these white guys was generally inconclusive, the white guys in Washington—in an attempt to prevent what they saw as a looming health crisis in America—recommended that Americans consume a diet high in carbohydrates and low in fat. And although these premature recommendations have certainly not prevented any health crises in America (the appearance seems to be just the opposite, see: Public Health Nutrition’s Epic Fail), they’ve also had serious repercussions in other respects for the rest of us, i.e. the ones of us who are not white men. [Please don’t take this as a “I hate white guys” thing; I love white guys. I gave birth to two of them.] I’m going to get into the “not white” part of the equation in another post (perhaps unimaginatively titled, Why Nutrition a Racial Issue), but let me focus just on the “not men” part.

For those of us who are not men (and mostly not poor and not part of a minority group), the 1970’s brought us Charlie’s Angels and the Bionic Woman. Women were given the message that we should be able to do and have “it all” (whatever “it all” was). The expectation was that you could “bring home the bacon, fry it up in a pan” and be thin, gorgeous, and sexy (and white) while you did it.

[circa 1980]

Only now bacon (and eggs for that matter) was forbidden, and as the eighties evolved into the nineties, breakfast became granola bars or rice cakes, nibbled virtuously while we drove the kids to school on our way to the job where we got paid less than the men with whom we worked. All the while, we were convinced that we could continue to fit into our tailored power suits by eating a diet that wasn’t designed with our health in mind.

[bacon eggs frowny face, circa 1984]

As with nearly every other aspect in the fight for equal opportunities and treatment, our health as women was based on a single shiny little myth: success would come to those who were willing to work hard, sacrifice, and follow the rules. Airbrushed media images of buns of steel and boobies of plastic sold a diet-exercise message based on an absurdly crude formula—”calories in, calories out”— with one simple rule that would guarantee success: “eat less and move more.”

So we did. We ate less and exercised more and got tired and hungry and cranky—and when all that work didn’t really work in terms of giving us the bodies we were told we should have, we bought treadmills and diet pills, Lean Cuisines and leg warmers. We got our health advice from Jane (“feel the burn”) Fonda and Marie (“I’m a little bit country”) Osmond. We flailed through three decades of frustration, culminating— unsurprisingly enough—in the self-flagellation of Spanx® and the aptly-named Insanity®.

[Jane Fonda circa 1982]

Some of us “failed” by eating more (low-fat, high-carb) food and getting fat, and some of us “succeeded” by developing full-blown eating disorders, and some of us fought the battle and won sometimes and lost other times and ended up with closets full of size 6 (“lingering illness”) to size 26 (“post pregnancy number 3”) clothes. Most of us—no matter what the result—ended up spending a great deal of time, money, and energy trying to follow the rules to good health with the deck stacked against us. If we got fat, we blamed ourselves, and if we didn’t get fat it was because we turned our lives into micromanaged, most-virtuous eater/exerciser contests. Either way, our lives were reduced, distracted, and endlessly unsatisfying. We were hungry for more in so many ways and aching for rest in so many others, but our self-imposed denial and exhaustion allowed us to control, at least for a bit, the one thing we felt like we could control, that we’d fought to be able to control: our bodies.

We stopped cooking and started counting. We stopped resting and playing and started exercising. We stopped seeing food as love and started seeing it as the enemy. We didn’t embrace these bodies that were finally, tenuously, ours; we fought them too.

Access to high quality nutrition has always been divided along gender lines [1]. There was a time–not that long ago–in our world when men, by virtue of their size, stature, place as breadwinner (i.e. because of their “man-ness”) were entitled to a larger piece of meatloaf than their sisters (a practice that persists in many cultures still). How many of us (of a certain age) have heard, “Let you brother have the last piece of chicken, he’s a growing boy”? Now–conveniently–women would do their own restricting. Gloria Steinem, with a fair amount of prescience that seems to predict the epigenetic contributions of diet to obesity, noted in her 1980 essay The Politics of Food:*

“Millions of women on welfare eat a poor and starchy diet that can permanently damage the children they bear, yet their heavy bodies are supposed to signify indulgence. Even well-to-do women buy the notion that males need more protein and more strength. They grow heavy on sugar and weak on diets . . . Perhaps food is still the first sign of respect–or the lack of it–that we pay to each other and to our bodies.”

Dieting and exercising not only provided a massive distraction and timesuck for women, it helped maintain a social order that the feminist movement otherwise threatened to undermine, one where women were undernourished and overworked, in a word: weak.

And when the scientists finally got around to testing the whole low-fat thing on (80% white) women? The verdict, published in 2006, looked like this:

The results, published in the Journal of the American Medical Association, showed no benefits for a low-fat diet. Women assigned to this eating strategy did not appear to gain protection against breast cancer [2], colorectal cancer [3], or cardiovascular disease [4]. And after eight years, their weights were generally the same as those of women following their usual diets [5].

But it was too late. We’d raised a generation of daughters who look at us and don’t want to be us, but they don’t know how to cook and they don’t know what to believe about nutrition and they too are afraid of food. Some end up drinking the same Kool-Aid we did, except that—in the hubris of a youth that doesn’t contain hallucination-inducing sleep deprivation from babies and/or stress and/or a career on life-support, where diet and exercise and rest are, like Peter Frampton’s hair, a dim memory—they think they will succeed where we failed. Or maybe they’ve found the vegan-flavored or paleo-flavored Kool-Aid. But they are still counting and exercising and battling.

White women have been [irony alert] scientifically proven to be more likely to closely follow the high-carb, low-fat dietary ideal set forth by the Dietary Guidelines than any other demographic [6]. (Black guys—who may not be all that convinced that rules created by the US government are in their best interests, given some history lessons—are likely to have the lowest adherence.) White women apparently are really good at following rules that were not written with them in mind and which have not been shown to offer them any health benefits whatsoever (but which have proven immensely beneficial for the food and fitness—not to mention pharmaceutical—industries). The best little rule-followers of all are the dietitians of the Academy of Nutrition and Dietetics (87% white women), who heartily endorsed the 2010 Dietary Guidelines, which reinforced and reiterated 30 years of low-fat, high-carb dogma despite the Harvard-based science that demonstrated that it offered no benefits to women. (Interesting tidbit: The Academy of Nutrition and Dietetics has elected two male presidents in the past decade despite the fact that men make up only 5% of the membership. My husband thinks the organization has “daddy issues.”)

In 2010, the American Medical Association recommended that women of normal weight (that’s less than 40% of us, by the way) who wanted to stay that way “while consuming their usual diet” (i.e. low-fat, high carb) would have to exercise for an hour a day.

[Other reassuring conclusions from that study: There was an overall weight gain over the 13-year time frame. Exercising for anything less than 7 hours per week was associated with weight gain over time. If a woman was already fat, increased exercise was more likely to be related to increased weight than weight loss. If these messages don’t scream to women all over America, “GIVE UP NOW!!!” I don’t know what would. By the way, those of us who go out and skip and jump and run because we like to and it makes our hearts truly happy are not exercising. We’re playing. I love to wave at those women from my couch.**]

But let’s get back to that hour a day for just a second.

Take a look at a recent study by Dr. David Ludwig, out of Harvard. It demonstrated that people who had recently been dieting (something that would apply to almost every woman in America), and were eating a low-fat diet, had to add an hour a day of exercise in order to keep their “calories in, calories out” balanced, while those on a reduced-carbohydrate diet expended that same amount of energy just going about their business.

What is all the women in the world who have been unsuccessfully battling their bulge woke up tomorrow morning and said:

I want my hour a day back?

For those of us who do not want to exercise for an hour just to maintain our weights or for those of us for whom exercise isn’t doing a damn thing except making us hungry and cranky and tired while we gain weight, we don’t have to. Instead, we can eat fewer of those USDA/HHS/dietitian-pushed, nutritionally-pathetic, low-fat whole-grain carbohydrate foods and more truly nourishing food and do whatever we please with that extra hour.

Who knows what changes we can make to a world that desperately needs our help? In America alone, this would mean giving around–ooh let’s just say–50 million adult women an extra hour a day. That’s an extra 365 hours a year per woman, an extra 18 billion hours of womanpower a year total.

We could stop exercising and start playing. Stop counting calories and start enjoying feeling nourished. Start putting the love back into our food and embracing the bodies we have and the bodies of the men, women, and children all around us. I know that some of us would find that hour well spent just napping. Others of us might use that hour to figure out how to dismantle the system that stole it from us in the first place.

I can bring home the bacon, fry it up in a pan. And eat it.

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

In my own personal celebration of Asskicking Women of Food, I think (I hope) my next post will be: The Grande Dames (Goddesses? Queens?) of Nutrition

*Thanks to Gingerzingi for bringing this to my attention. What a great essay–look for it in a collection entitled Outrageous Acts and Everyday Rebellions.

**I have absolutely nothing against activities that bring inner/outer strength and happiness. But exercise in the 80s and 90s was not about being happy or strong–it was about punishing ourselves (feel the burn? seriously?) in order to win at a game–being in total control of everything in our lives from babies to bodies to boardrooms–whose rules were created within the very social construct we were trying to defeat.

References:

1. Bentley, Amy (1996) Islands of Serenity: Gender, Race, and Ordered Meals during World War II. Food and Foodways 6(2):131-156.

2. Prentice RL, Caan B, Chlebowski RT, et al. Low-fat dietary pattern and risk of invasive breast cancer: the Women’s Health Initiative Randomized Controlled Dietary Modification Trial. JAMA. 2006; 295:629-42.

3. Beresford SA, Johnson KC, Ritenbaugh C, et al. Low-fat dietary pattern and risk of colorectal cancer: the Women’s Health Initiative Randomized Controlled Dietary Modification Trial. JAMA. 2006; 295:643-54.

4. Howard BV, Van Horn L, Hsia J, et al. Low-fat dietary pattern and risk of cardiovascular disease: the Women’s Health Initiative Randomized Controlled Dietary Modification Trial. JAMA. 2006; 295:655-66.

5. Howard BV, Manson JE, Stefanick ML, et al. Low-fat dietary pattern and weight change over 7 years: the Women’s Health Initiative Dietary Modification Trial. JAMA. 2006; 295:39-49.

6. Sijtsma FP, Meyer KA, Steffen LM et al. Longitudinal trends in diet and effects of sex, race, and education on dietary quality score change: the Coronary Artery Risk Development in Young Adults study. Am J Clin Nutr. 2012 Mar;95(3):580-6. Epub 2012 Feb 1.

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

July 31, 2012July 31, 2012Adele Hite, PhD MPH RD 14 Comments

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

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

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

Let’s start with the basics:

When a person decreases their “energy in,” that person’s “energy out” also goes down. For example, take Ancel Keys’ early starvation experiments.
When a person increases their “energy out,” that person’s “energy in” goes up. For example, take my 6’7″ basketball- & soccer-playing nephew out for dinner.

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

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

Turtles can, can you?

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

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

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

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

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

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

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

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

Yeah, in these kids too.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What? you say. The food we eat?

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

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

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

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

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

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

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

To paraphrase the immortal words of Dr. Suess:

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

The time has come.

The time is now.

Just go.

Go.

Go!

I don’t care how.

“Calories in, calories out”

I don’t care how.

“Calories in, calories out”

Will you please

GO NOW!

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

If Nutrition Experts Built Bridges–

March 23, 2012March 26, 2018Adele Hite, PhD MPH RD 10 Comments

If you are an engineer, your plan—bottom line, no fudging about—has to WORK. All. The. Time. It’s what we expect from engineers.

On the other hand, if you are a Government-Approved Nutrition Expert, your plan doesn’t have to work AT ALL.

Which may be why we don’t let Nutrition Experts build bridges.

To ensure a more impressive rate of success, engineers tend to build their bridges and elevators based on a few mysterious but fundamental concepts like physics (or as we say around here, fweezix). Now, to paraphrase Barbie, I understand that physics is TOUGH. But it is also, well, insurmountably the real deal, and anything that defies the laws of physics is generally—for lack of a better word—considered to be magic.

Now, from my biochemistry classes, it looks like the principles of nutrition are built on chemistry, and the principles of chemistry are built on—you guessed it!—politics physics But when I step across the hall to my public health classes, then the principles of nutrition are based on the Dietary Guidelines, which—as they tend to be in defiance of the laws of physics—I guess must be magic!

Despite the rockin’ groove, I’m not sure that I believe in magic.

But Calories In = Calories out is not magic, it’s physics, right? It seems indisputable—a veritable law of thermodynamics—that if you consume fewer calories than you expend, you will lose weight. Conversely, if you consume more calories than you expend, you will gain weight. Duh.

Sometimes when things aren’t working (i.e. major bridge oopie ), we get a glimpse of the realities of the physics behind the system. Let’s take a look at a category of individuals that do lose weight easily—too easily: Type 1 diabetics. A type 1 diabetic could eat 5000 calories a day, never move a muscle, and still lose weight (for the record: this is not a good thing). What happens to those calories? Why don’t they get stored as fat (hello? calories IN?) A type 1 diabetic can’t store them as fat. Why not? No insulin. Without insulin, the body cannot store energy at all. Type I diabetics must be given insulin or they literally waste away. It’s not because they try harder; it’s because of physics.

What this means is that it can’t just be the amount of calories that we are consuming, but also the source. And in the case of unnecessary carbohydrates in the diet, it’s likely to be both. The increase in caloric intake we’ve seen in the past 30 years has come almost entirely from industrialized carbohydrate food products—subsidized and endorsed by the USDA.

Would obesity rates have skyrocketed without the Guidelines prompting Americans to eat fewer animal products—especially meat and eggs which contain Very Scary saturated fat and cholesterol—and more whole grain cereal products? We’ll never know. But physics does tell us that carbohydrate foods have particular qualities that affect fat storage and metabolism, specifically: “A high carbohydrate meal stimulates the production of insulin. Insulin inhibits the body’s ability to use fat for energy and stimulates the uptake of fat and its storage as triacylglycerol” (Campbell & Farrell, 2009). That’s straight from my biochemistry textbook.

Now I don’t care if you eat carbs or not. Some of my best friends are carbs. But can we stop pretending that somehow—magically—there’s no relationship between the two figures above?

Apparently we can’t. According to many Nutrition Experts, including Marion Nestle, our low-fat Dietary Guidelines can be blamed only in that they do not do more to “address caloric intake, portion size, inactivity, and other contributors to obesity” (Woolf & Nestle, 2008). Notice that “caloric intake,” “portion size” and “inactivity” are all things that are our fault—in contrast to a diet recommendation of mostly carbohydrates, something the USDA and HHS are responsible for. In other words, if chubby little Americans can’t “achieve energy balance” by eating less and exercising more, it’s not because the Guidelines aren’t helping us, it’s because we are simply not trying hard enough.

(True Confession: I mostly just wanted to draw that cartoon.)

Should we reduce our calories? Maybe not a bad idea for some folks.

What kind of calories should we reduce? Ask an engineer. Unless you believe in magic . . .

References:

Campbell MK, Farrell SO. Biochemistry, 6^th ed. United States: Thomson, 2009. p. 730.

Centers for Disease Control and Prevention (CDC). Trends in intake of energy and macronutrients–United States, 1971-2000. Morbidity and Mortality Weekly Report. 2004 Feb 6;53(4):80-2.

Woolf SH, Nestle M. Do dietary guidelines explain the obesity epidemic? American Journal of Preventive Medicine. 2008 Mar;34(3):263-5.

Eathropology

Nutrition made critical.

Tag low fat

“The Food Pyramid? It’s just wrong.”

Alternative Fa(c)ts

Low Fat, High Maintenance: How money buys lean and healthy–plus, an alternative path to both

Low Fat, High Maintenance: How money buys lean and healthy–plus, an alternative path to both

The 2015 Dietary Advisory Committee Report: A Summary

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

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

As the Calories Churn (Episode 1): Nooooo, not the carbs!!!

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

If Nutrition Experts Built Bridges–

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Low Fat, High Maintenance: How money buys lean and healthy–plus, an alternative path to both

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