Tag politics

Alternative Fa(c)ts

Adele 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.

Length of DGA & obesity rates

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.

 

Sugar and Spite: Mark Hegsted and the Great Sugar Conspiracy

Adele Hite, PhD MPH RD 48 Comments

Well. This is awkward.

A big scoop blows the cover on how, back in the 1960s, some gullible Harvard researchers were funded by the Evil Sugar Industry to make sure that fat (and not sugar) took the fall as the cause of all of America’s problems, including the cancellation of Lost in Space.

One of those aforementioned oh-so-easily-corrupted scientists was none  other than Mark Hegsted, the mastermind behind the McGovern’s Dietary Goals (okay, the mastermind behind the Machiavegiann, Nick Mottern, who actually wrote the 1977 Dietary Goals¹), and, as we all know by now, this set the whole nation down the path to mainlining sugar whilst shunning perfectly good food like pork ribs.

So the scene is this:  Mark Hegsted (and his co-authors, McGandy and Stare) are sitting around their labs at Harvard, minding their own beeswax, fillin’ up test tubes, and lookin’ through microscopes.  Y’know, doin’ science.  Along comes Evil Sugar, waving big fat stacks of green under their noses.  Suddenly, Hegsted and company are payola zombies, mindlessly extolling the virtues of sucrose.

sugar-zombie

Sigh.

One of the reasons I love my life is I get to teach a class called “Introduction to Science, Technology, and Society” to a bunch of bright-eyed, smart, and exceptionally polite undergraduates at North Carolina State University.  Last week we did an activity to help them get a feel for the ways in which science is a social process.  One of the things we talked about were “interests,” including funding,  but we also discussed the fact that “follow the money” is almost always an inadequate explanation for how and what knowledge gets created in science.  My students figured out pretty quickly that scientists have multiple interests, biases, concerns, and limitations–and that these all compete for a place in the process of transforming bits of reality into the “facts” that are the outcomes of scientific knowledge production.

“Evil Sugar Corrupts Scientists” is an attention-grabbing headline, but the historical picture is a bit muddier.

Inconvenient historical moment part 1:  Let’s start with the fact that in 1965, Hegsted, McGandy, and Stare (and a nutrition instructor named Myers) published a paper entitled, “Quantitative Effects of Dietary Fat on Serum Cholesterol in Man.”²  In this article, the researchers–who used fats and oils supplied by Proctor & Gamble and milk and ice cream supplied by the Hood Milk Company–developed something that would come to be known as the Hegsted equation, which predicts the relationship between fats in the diet and serum cholesterol.  That they tested these fats and oils by incorporating them into “waffles, muffins, cakes, cookies, pie crust, biscuits, salad dressings, and spreads for bread” was beside the point; their focus of concern was fats in the diet and serum cholesterol. [Let me briefly remind you that part of the rationale behind their experiment was to contradict the conclusion stated by Ancel Keys a decade earlier, that dietary cholesterol does not have an effect on serum cholesterol.]

So, in 1967, when this same group of researchers (minus Myers) publishes a review entitled, “Dietary Fats, Carbohydrates, and Atherosclerotic Vascular Disease,” we already know which macronutrient they think is the most important contributor to heart disease, and we already know that they are more concerned about serum cholesterol than any other biomarker.  My guess is that the Evil Sugar Industry knew this as well, and that’s why this group of researchers was asked to write a review.  Most of the review consists of summarizing studies where dietary carbohydrate is held constant while the type of carbohydrate–sucrose, glucose, starch, etc.–was varied.  It’s not a big surprise to me, and it shouldn’t be to you, that they found, in most cases, sugar didn’t have a much different impact on total cholesterol than starches or other sugars. In a few cases, sugar/sucrose is found to increase triglycerides–and they duly note this.  This is Rhetoric of Science 101:  Determined critics can poke holes in any experimental system or rationale; those same scientists can find sound reasons to justify their own methods and thinking.   They don’t (necessarily) need funding from an involved industry to be motivated to do this.

Hegsted and company’s unsurprising conclusion is this:

“The major evidence today suggests only one avenue by which diet may affect the development and progression of atherosclerosis.  This is by influencing the levels of serum lipids, especially serum cholesterol …”

This is also a conclusion which would render the Hegsted equation central to determining what constitutes a healthy diet. How ’bout that?

They go on to add that limited evidence demonstrates a “slightly significant role for the kind and amount of dietary carbohydrate” in the regulation of serum lipids, the effects of which are “more pronounced when diets low in fat are consumed.”   From their perspective, they don’t think dietary carbohydrate is worth talking about, except in the context of a low-fat diet. And, if you read their 1965 paper, you already know that Hegsted and co. think type of fat is more important than overall amount because that’s where they said, “Dietary advice to lower the total fat intake is likely to be self-defeating.”

They end with this:

“Since diets low in fat and high in sugar are rarely taken, we conclude that the practical significance of differences in dietary carbohydrate is minimal in comparison to those related to dietary fat and cholesterol” (emphasis mine).

From their perspective, a diet low in fat does not imply a diet high in sugar. The most commonly used sugars at that time were cane and beet–complicated politics kept prices fairly high–and corn syrup had not yet achieved widespread use.

sugar-usage-in-1875-1975

They could not envision a future where sugar (as high-fructose corn syrup) would be a cheap replacement for fat. They could envision a future where vegetable oils would be a cheap replacement for saturated fat;  this, in fact, was already beginning to occur in some sectors of the food industry.

veg-oil-use-from-1977-goals

Both figures above are from the 1977 Dietary Goals for Americans. Which brings us to …

Inconvenient historical moment part 2: Yes, Hegsted was the scientist who was the primary supporter of McGovern’s 1977 Goals.  That much is true.   So let’s chase that lead.  In the first edition of the 1977 Goals, Goal Number 5 said: “Reduce sugar consumption by about 40 percent to account for about 15 percent of total energy intake.”   This doesn’t sound like the work of someone in cahoots with Evil Sugar.

1st-ed-1977-goals

1st edition Dietary Goals, February 1977

But wait, there’s more!  In the second edition of the 1977 Dietary Goals (the one where Michael Pollan whines about the meat people bullying the committee into revising the “reduce meat” statement to say “reduce saturated fat”), the “decrease sugar” goal has been moved up to Goal Number 3 and says, “Reduce the consumption of refined and processed sugars by about 45 percent to account for about 10 percent of total energy intake.”

2nd edition Dietary Goals, December 1977

This was still on Hegsted’s watch.  How do we reconcile the increase in sugar restrictions with this (particular) conspiracy theory?

Aside from anachronistic analyses and inconsistencies that can’t be explained simply by pointing to a funding source, the current media spin on the Hegsted/Evil Sugar story suggests some pretty problematic assumptions:

  • Hegsted was completely neutral on the topic of fats and carbohydrates in the diet until sugar industry money came along.
  • Hegsted is a “dupe” and has no morals or backbone as a scientist.
  • The article would have (somehow) been different without sugar industry money.

My students know better.  I know this because all of the comments just above came from them when I asked them if they could think of any problems with the way the issue was being characterized in the media.  Folks feeding the media frenzy should know better too.

Blaming Big Food money for everything that is wrong with nutrition science and policy suggests it was all was just-fine-thank-you until Big Food came along and messed it up.

One of the problems with this view is that it encourages us to believe there is no such thing as ideological (or other) biases in science, just money.  So when Walter Willett calls research that contradicts his own “a pile of rubbish,” are we to assume that his belief that even the slightest bit of weight gain will cause you to die badly is the result of his being secretly funded by Jenny Craig?  After all, the “pile of rubbish” research (which suggests that maybe overweight and even obesity are not so horrible) was funded by the government.

And, in the current media framework, government funding is without bias, just ask the mustachioed man himself:

“Most contemporary researchers, including Willett, also acknowledge that publicly funded studies are preferable. ‘Ideally, all research would be publicly funded, so there would not be any conflict of interest,’ he says.”

Pointing the finger at Big Food money to explain away the problems in nutrition science and policy posits a particularly wild assumption:  government funding = no conflict of interest. But, as Marion Nestle’s favorite diversionary tactic, it does work to steer the conversation away from how the federal government funded plenty of its own reviews that emphasized fat and dismissed the involvement of sugar in the development of heart disease.  Nestle worked on one herself.³

Blaming the involvement of Big Food money for flaws in the scientific process is the same as blaming Big Food for obesity.  They are both simply indirect ways of blaming individuals for their bad behavior:  When Evil Sugar waved that bag of money under Hegsted’s nose, he didn’t have to take it, now did he?

Should anyone think I’ve gone off the deep end–I did just finish my written exams, so this is a distinct possibility–I’m not defending the sugar industry.  I am, however, defending the reputation of Mark Hegsted.

Why is it is that, on the one hand, we insist on characterizing nutrition science as unquestionably sound and definitive and nutrition scientists as inherently neutral and objective, and on the other hand, we assume that nutrition scientists will sell every bit of their scientific integrity to the highest bidder at the drop of a bundle of cash and create fishy science–which no one finds the least bit fishy until we hear about this transaction?

If we are willing to accept a more nuanced view, we might consider this:

Government is as “interested” in particular outcomes from science as is any corporation. They provide support for preferred views in terms of funding as well as other resources that corporations don’t necessarily have, such as public platforms, training, positions of authority, and access to important information or policymakers. Government funders back nutrition scientists who reliably produce results they like–but that’s a conversation Marion Nestle doesn’t want to have.

For their part, scientists are human and biased in ways that can’t always be accounted for by–and that might be more powerful than–funding.  Nutrition science, in particular, is full of a priori reasoning and lousy methodology propped up only by time and reputation–but that’s a conversation Walter Willett doesn’t want to have.

The field of nutrition science is massively overrun with weak associations, contradictory results, and experiments that incorporate preconceived notions about the relationships between food and health into the methods used to test those relationships.  Instead of positioning Hegsted and his fellow investigators as dupes of Evil Sugar who then pulled the strings that poisoned America, we might ask why Willett and Nestle want to make sure that problems in nutrition science and policy are framed by a narrative that excludes their part in them.

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  1. Actually, according to Nick Mottern himself, he’s not a vegetarian.
  2. If you would like a copy of this article–or any other article I refer to in this post–for your personal use as a nutrition researcher, let me know.
  3. Hegsted’s work definitely influenced this document–in the form of the Hegsted equation which is reprinted therein.  His sugar review is nowhere to be found.

Will the real Dietary Guidelines please stand up?

Adele Hite, PhD MPH RD 37 Comments

I don’t say this very often (or ever).  I was wrong.  I think.

Here I’ve been laboring under the assumption that the 2015 Dietary Guidelines tell the American public to eat a diet lower in fat (because we eat “too much” of it now) and higher in carbohydrate (especially from whole grains like whole wheat–because we don’t eat “enough” of those now), to eat less salt, and to “eat as little dietary cholesterol as possible.” But according to a document recently released from a source at the Center for Nutrition Policy and Promotion (CNPP) that isn’t what the Guidelines say.  Or at least not exactly. Maybe.

The good folks at CNPP were asked to respond to Kris Gunnar’s list of  “20 Mainstream Nutrition Myths (Debunked by Science)”  with the idea being that the Guidelines are about as “mainstream” as nutrition advice gets.  The hope was that, if the good folks at CNPP could explain why their advice is ostensibly “backed by science” and yet is “debunked by science,” we would all sleep a little better at night, even if we still insisted on eating bacon and eggs in the morning.

The good folks at CNPP rose to the challenge and cleared things right up.  But, to quote the inimitable if soporific Crosby, Stills and Nash, “just beneath the surface of the mud, there’s more mud.  Surprise.”

Below, I’ve restated their responses as dietary guidance arranged in an order that I found amusing.  The number of the corresponding “Myth” from Kris Gunnars is given as well, so that those of you with split screens or dual monitors can play along at home.

According to the good folks at CNPP, the 2015 Dietary Guidelines for Americans:

  • do not recommend Americans eat a diet low in total fats or high in carbohydrates, particularly from grains. (Myth 1)
  • do not encourage eating low-fat foods. (Myth 12)
  • do not suggest avoiding saturated fat.(Myth 16)1
  • do not say saturated fat raises LDL cholesterol. (Myth 6)2
  • do not suggest Americans should avoid egg yolks, nor do they suggest that dietary cholesterol is linked to heart disease. (Myth 4)3
  • do not suggest eating red meat raises risk of disease. (Myth 13)4
  • do not say seed and vegetable oils lower cholesterol levels. (Myth 20)5
  • do not recommend the population restrict sodium intake (Myth 2)6
  • acknowledge there may be more to weight management and diet-related diseases than calories in-calories out. (Myth 15) 7
  • do not state sugar is harmful. (Myth 19)8

I know what you’re thinking.   Adele’s mind has finally blown a gasket from reading all those big words they have in grad school.  I’m not going to argue that point, but you can check the CNPP’s response for yourself right here.

This response also acknowledges that current scientific evidence regarding the reduction of full-fat dairy is contradictory (Myth 10) and that a variety of eating patterns can produce weight loss (Myth 8).  It also says that  3-5 cups of coffee a day can be part of a healthy diet (Myth 7)–hallafreakinlujah– but whole wheat products?  Meh (Myth 5).

I can see the helpful public health messages now:

You should not avoid egg yolks, but you should eat as little dietary cholesterol as possible, even though dietary cholesterol consumption is not linked to heart disease.

You don’t need to choose low-fat foods, just choose fat-free or low-fat milk, yogurt, and cheese even though it might not actually help you avoid chronic disease .

You should shift to lower sodium consumption without restricting your intake of sodium.

What’s going on here?

Good question.  Perhaps the good folks at CNPP didn’t actually read the Dietary Guidelines this time around.  Who, except for me, has that kind of time?  Or maybe they had a hard time finding them. Once you get to the health.gov/dietaryguidelines/ site, you have to click through 3 menus or links before you get to the actual guidelines (try it), which are a swarm of footnotes and “see more” hyperlinks.  Even Marion Nestle complained about how hard all those “annoying drop-down boxes” are to navigate.  It’s possible the good folks at CNPP just assumed that the other good folks over at DHHS–responsible for Guidelines online labyrinth–were paying attention so they didn’t have to.

Or maybe it means that it’s actually really hard to get words to say what you want them to say without them saying other things that you don’t want them to say.  And this is especially difficult when you are asked to make sweeping recommendations based on a weak scientific evidence base that both supports and contradicts past guidance, which you can’t contradict even when you can’t support it, because, then what?

No wonder the good folks at CNPP are having a hard time getting their story straight.

To tell the truth, I have a lot of sympathy for the message-makers there at the USDA.  We created the Dietary Guidelines 35 years ago assuming zero potential negative consequences.  True, the scientific evidence didn’t strongly support the recommendations, but whatever.  Whether they followed the recommendations or not, hey, the health trajectory of Americans couldn’t get any worse, could it?  We knew the Guidelines would significantly impact the food industry, but that could only be a good thing, right?  And we meant for Guidelines to set the direction for nutrition research, but since science is only about facts and never about politics or funding, any errors or biases in our original rationale would be quickly discovered and corrected, no?

Now it seems pretty clear that we might have spent a little more time thinking through the whole “Let’s make sweeping dietary recommendations that are meant to apply to every single American alive over the age of 2 as a method of preventing every single major chronic disease known to humankind “ thing before shrugging our shoulders and saying “Oh, no worries.  It will all work out.”  Now the folks at the USDA have used up their wishes and are left trying to stuff the genie back in the bottle with nothing but semantics and poor website design.

Will the real Dietary Guidelines please stand up?

If only they had a leg to stand on.

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1.  They just want you to reduce your intake of saturated fat without actually avoiding it.

2. They do recommend limiting saturated fats based on the notion that somehow this will reduce risk of heart disease. But let’s leave LDL cholesterol levels out of this. What did they ever do to you?

3.  But Americans still should eat as little dietary cholesterol as possible, just fyi.

4.  Eating red meat does not raise risk of disease, but not eating red meat lowers it. Um.  Weird, right?

5.  But you should eat vegetable oils instead of animal fats, because, well, because.

6. They do want you to shift to lower sodium consumption, just not by restricting your intake.

7.  Although they remain singularly obsessed with calories in and out, there’s apparently no need for you to be.

8.  But you shouldn’t eat very much of it anyway, because, well, because.

Put away the tinfoil hats–but, still, WTF?

Adele Hite, PhD MPH RD 12 Comments

I’m not a conspiracy theorist.  Really. But as I wade through the thicket of science studies and rhetoric of science readings I have on my desk, I am more and more impressed with the power of paradigmatic thinking to distort how scientific knowledge is produced and disseminated.

Daisy Zamora and company have once again climbed in their wayback machine to reanalyze data from the Minnesota Coronary Survey, which began in 1968.  The vegetable oil intervention reduced saturated fat intake by about half and cholesterol consumption by about two-thirds, while nearly tripling the intake of polyunsaturated fat. Surprise, surprise–they found that although the vegetable oil intervention reduced cholesterol levels, the intervention also led to more heart attacks and increased risk of death. [The press release on the study is here; the study itself is here.]

Let me just add that the original study outcomes–which did not support the diet-heart hypothesis even then–were not published until many years after the study ended, in fact, after its primary investigator retired.

So, we’ve seen something like this with a red-meat-causes-cancer publication, a low-carb-more-calories-more-weight-loss one, and one of Zamora’s earlier studies, which she had to move mountains to get published.

Zamora and her team’s previous trip in the wayback machine turned up some interesting findings then too, which suggested that vegetable oils, far from being the “healthy” alternative to butter, might actually be contributing to increased risk of death from heart disease.

Zamora and her co-investigators politely refer to these sort of anomalies as “incomplete publication,” as in:

“… incomplete publication of important data has
contributed to the overestimation of benefits – and the underestimation of potential risks – of replacing
saturated fat with vegetable oils rich in linoleic acid.”

All I want to say, before going back and burying my head once again in my books, is that

1) Daisy Zamora and Christopher Ramsden are rockstars, and

2) “incomplete publication” of results from diet-heart trials is part of the reason that the folks at the USDA and DHHS have published guidelines where “oils” get to have their own category.

They aren’t trying to kill us on purpose.  Really.

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Update:  You know you’ve increased the amount of sunshine in the world when your work gets Walter Willett to offer up yet another snotty comment (see here for previous peevishness) about any research that doesn’t align with his: “Walter Willett, the chairman of the nutrition department at the Harvard T.H. Chan School of Public Health, called the research ‘irrelevant to current dietary recommendations’ that emphasize replacing saturated fat with polyunsaturated fat.”

He’s right of course. Any science that doesn’t uphold the orthodoxy really is irrelevant to current dietary recommendations.

Keeping it Simply Stupid: Marion Nestle’s “Rogue Guidelines”

Adele Hite, PhD MPH RD 58 Comments

One of the things I do to irritate myself into a state of incoherence is read the comments section on interwebz articles that propose to address our national concerns about food and health. A constantly recurring theme about eating a “healthy diet”–100% guaranteed to appear in any comment section–is “It’s so simple. Just [do this thing].”*

I blame the Dietary Guidelines (but then I blame the Dietary Guidelines for everything–when my car won’t start, it’s those damn  Guidelines again).  They began the long proud tradition of over-simplifying nutrition guidance to the point of uselessness, a tradition that Michael Pollan, and now Marion Nestle, has taken to new levels of banality. This oversimplification not only displays an unholy disregard for any sort of cultural, economic, or metabolic differences between humans, but–when you get down to the details (the main ingredients of which are always devilish)–it “simply” doesn’t say much of anything.

Marion Nestle and Tamar Haspel wrote a whole long article about the “6 easy steps” to eating better, reproduced in the boxes below.  Ranting in regular type?  That’s me.

Go through the fine print of the omnibus spending bill just passed by Congress, and you’ll see that the 2015 Dietary Guidelines, scheduled for release in — you guessed it — 2015, have been pushed out to 2016. You wouldn’t think that the government’s efforts, every five years, to help Americans eat more healthfully would turn into a political football. But when its appointed scientists reviewed the literature on meat and health, for example, they did something quite radical. They said what they meant with no equivocations: Americans should eat less meat.

In order to keep things simple, it’s best if you ignore any historical facts that might add nuance–or reality–to your story.  Like the fact that this 38-year-old “radical” idea to “eat less meat” arrived in the first edition of the 1977 Dietary Goals.  Yes, this statement was changed in the 2nd edition of the 1977 Goals, but not–as Marion Nestle and Michael Pollan would have it–due to the fact that Evil Meat ran roughshod over the science. Of course the meat folks were upset; this call to “eat less meat” had about as much science behind it as similar suggestions at the time that vegetable oil could cause health problems, which is to say, not enough to justify public health policy. Yet, due to reasons more social, political, and economic than scientific, the prohibitions about meat are still with us, while concerns about vegetable oil have faded out of mainstream nutrition

Numerous physicians and scientists represented in the 1977 Dietary Goals for the United States: Supplemental Views, point out that (as McGovern himself and one of his primary supporters, Dr. Mark Hegsted, admit) the case against meat had never been proven. They go on to argue that suggesting that Americans remove/reduce an important source of nutrition in their diet (meat) may have unforeseen negative consequences. Norton Spritz (NYU School of Medicine) states: “… there are serious nutritional problems that affect many Americans that are clearly related to dietary inadequacies particularly of high quality protein …” George M. Briggs (Professor of Nutrition at UC-Berkeley) states: “There is good evidence that those who consume meat at the average level or more have as good health records and freedom from chronic disease as those who do not.”

The switch in language in the 2nd edition of the 1977 Goals to decreasing “saturated fat” intake rather than “meat” in general was not because there was more conclusive science to support that approach, but because it was politically more tenable.  Meat producers could try to–and did–breed animals with a reduced amount of the ostensible evil food component, saturated fat, in their product. But saturated fat wasn’t really the problem now, was it?

F.A. Kummerow (Director, The Burnsides Research Laboratory, University of Illinois, Urbana-Champaign) points out: “Your data indicates that animal fat consumption has decreased 24 pounds and vegetable fat consumption has increased 34 pounds/capita from 1940 to 1974. Yet, coronary disease has increased during a time period that this change took place. Why blame animal fats?” (See Nina Teicholz’s neato graph for a visual of the trend.) Well, because they come from animals, and there are all sorts of social and cultural reasons that some people are opposed to eating animals, that’s why. Why these people got to make the rules for the rest of us is a story for a different day.

Scientists voiced a number of valid concerns about the wisdom of telling Americans to eat less meat in 1977, many of which are still valid today:  over 40% of Americans, mostly females,  have inadequate protein intake.  But that complicates the narrative, doesn’t it?

As if that were not radical enough — previous committees had pussyfooted with such euphemisms as “choose lean meats to reduce saturated fat” — this committee insisted on an additional reason beyond health: environmental considerations.

 The result? Uproar.

Why have an uproar about a group of nutrition scientists (for the rigors of nutrition science, see below) making declarations about environmental issues? Perhaps next year, we can have the EPA make dietary recommendations.

Arguments like the ones over the Dietary Guidelines, fueled by lobbyists, politicians and agenda-driven groups, make diet advice seem maddeningly inconsistent, but the fundamentals haven’t changed much at all.

Sigh.  “Fundamentals”? Really?  Which fundamentals would you be talking about now?  The “fundamentals” of 1955 when more than half of our calories came from meat, eggs, milk, cream, fats and oils? Oh, and adult diabetes was virtually unheard of.

eat like your grandmother

 

It’s time to take back the process, so we’re going rogue and issuing our own Dietary Guidelines, untainted by industry lobbying, unrestricted by partisan politics. Here, in six easy steps, is our advice for the new year: what we think dietary guidelines ought to say.

Really?  Untainted by industry lobbying? Because wheat and vegetable oil interests never lobby–only Evil Meat.  That’s why the bottom of Marion Nestle’s beloved Food Pyramid ended up being ALL MEAT. Wait?  No?  Nevermind.

1. Eat more plants. You heard it from your grandmother. You heard it from Michael Pollan. Now you hear it from us: Eat your vegetables. Add fruits, beans and whole grains, and the wide-ranging plant category should make up most of your diet. Variety is the key. Plants offer us such an astonishing range of roots, stems, leaves, flowers, buds and seeds that there is bound to be something even the most jaded vegetable skeptic can love.

It’s just so simple.  Eat more plants. The biggest increase in calories during the rise in obesity and diabetes in America came from flour, cereal, and vegetable oils.  That’s right.  Plants.

Food supply changes calories

As for your grandmother (or great-grandmother), she ate at least 10% of her calories from vegetables and fruit, and so should you (see above).

2.  Don’t eat more calories than you need. Although on any given day it’s hard to tell whether you’re doing that, over the long term, your scale is a sure-fire indicator. If the pounds are going up, eat less.

It’s just so simple.  Don’t eat more calories than you need, whatever that means.  You can’t really tell when you’ve overeaten–until after the fact–at which point you should eat less.  If you’re hungry when you “eat less,” tough luck.  Suck it up, you wuss, you’ve already had more calories than you “need.”

Let’s pause here for the good news. If you follow our first two guidelines, you can stop worrying. Everything else is fine-tuning, and you have plenty of leeway.

That was the “good news”?

3. Eat less junk. “And what’s junk?” we hear you asking. We have faith that you know exactly what junk is. It’s foods with lots of calories, plenty of sugar and salt, and not nearly enough nutritional value. It’s soda and sugary drinks. It’s highly processed, packaged foods designed to be irresistible. It’s fast food. You know it when you see it. When you do, don’t eat too much of it.

It’s just so simple.  Eat less “junk.”  And since we know that it’s really mostly minorities and poor people who eat all the “junk” food, we should start by eliminating all the  poor people by giving them more money so they don’t go around being poor.  After that we should encourage a massive influx of people of color into the U.S. so minorities won’t be minorities anymore and will therefore stop eating junk food.  Problem solved.

4.  Eat a variety of foods you enjoy. There is research on the health implications of just about any food you can think of. Some — such as fish — may be good for you. You should eat others — such as meat and refined grains — in smaller amounts. The evidence for most foods is so inconsistent that you should never force yourself to eat them if you don’t want to, or deny yourself if you do. If you love junk foods, you get to eat them, too (in moderation, of course). You have bought yourself that wiggle room by making sure the bulk of your diet is plants and by not eating more than you need.

It’s just so simple.  And by plants you mean flour, cereal, and vegetable oil, right?  And by “not eating more than you need” you mean, well, you don’t know what you mean and neither do we.

This is an appropriate place to talk about a phrase that has been thrown around a lot in the Dietary Guidelines brouhaha: “science-based.”

As a journalist (Tamar) and a scientist (Marion), we’re very much in favor of science. But in this situation, the food industry’s frequent calls for “science-based” guidelines really mean, “We don’t like what you said.”

So, let me see if I understand this?  When the food industry calls for “science-based” guidelines, that’s a bad thing?  But if a bunch of (mostly) scientists call for “science-based” guidelines** that’s a good thing? This is getting a little confusing.

Arriving at truths about human nutrition isn’t easy.

But wait, you said these are “6 easy steps”?  Ooooooh.  Light bulb moment.  You’re not actually planning on telling us any “truths about human nutrition,” are you?  Ah, this is all beginning to make sense.

We can’t keep research subjects captive and feed them controlled diets for the decades it takes many health problems to play out. Nor can we feed them something until it kills them. We have to rely on animal research, short-term trials and population data, all of which have serious limitations and require interpretation — and intelligent people can come to quite different opinions about what those studies mean.

Which is why “eat some if you like it” isn’t a wishy-washy cop-out. It acknowledges science’s limitations. We do know that plants are good, and we do know that junk foods aren’t, but in between is an awful lot of uncertainty. So, eat more plants, eat less junk, and eat that in-between stuff moderately. That is exactly the advice science demands.

“We do know that plants are good.”  Which plants are you talking about? Corn, wheat, soy = plants, right?  And how do we know these plants (whichever plants you mean) are “good”?  Surely not through the vagaries of nutrition science, with all of its “serious limitations.”  You’ve just made the case that nutrition science is a poorly disciplined loudmouth whose “demands” we might very well ignore.  Oh wait. Right.  This is the part about not exactly telling us any “truths about human nutrition.”

What we eat and how we eat go hand in hand. We’ve all been there, sitting in front of a screen and finding that, all of a sudden, that bag, box or sleeve of something crunchy and tasty is all gone.

We’re so focused on what to eat that how to eat gets short shrift. So: 

5.  Find the joy in food. Eat mindfully and convivially. One of life’s great gifts is the need to eat, so don’t squander it with mindless, joyless consumption. Try to find pleasure in every meal, and share it with friends, relatives, even strangers.

Just remember that your mindful, joyful consumption should be Mostly Plants.  Thank goodness flour, cereal, and vegetable oils are Mostly Plants, so that I may mindfully and joyfully eat those Strawberry PopTarts.  It’s just so simple.

Poptarts are Mostly Plants

 

Learn to cook. The better you cook, the better you eat. There are days when cooking feels like a chore, but there are also days when you find profound satisfaction in feeding wholesome homemade food to people you love.

“Learn to cook.”  It’s just so simple.

  1. First, use your copious spare time to chillax with some Ina Garten YouTube videos.
  2. Once you “know” how to cook, assemble some easy-to-prepare menu ideas that will meld seamlessly with your work schedule, your workout schedule, your partner’s work schedule, your partner’s workout schedule, and your kids’ soccer/ trombone/tap dancing schedule.  Or maybe your two-jobs and day-care and public transportation schedule. Or any variation on the above in your oh-so-simple life.
  3. Then go shopping and buy all the stuff you need (this step requires money, just FYI). Don’t forget to take your reusable hippie bags.
  4. Carry all the stuff home in the back of your Prius, or on the bus, or if the scale is telling you that you’ve had more calories than you “need,” you can just hoof it home, fatso.
  5. Put all of your groceries away. Try to find a place where the food won’t spoil, and your kids/partner/roommate won’t eat it before it becomes dinner. Recycle your plastic bags since your forgot to use your hippie ones.
  6. At the appointed hour, begin. Chop. Stir. Sauté. All the things.
  7. Call those “people you love” to the table.
  8. Search your soul for that “profound satisfaction” you’ve been promised when the “people you love” use this opportunity to gripe about flavor, color, consistency, and smell of the lovingly prepared food that sucked up hours of your life, which they then proceed to snarf down in 7 minutes flat before bolting from the table in order to escape your nonstop bitching about what a thankless task cooking is.

[Snarky aside:  This advice about cooking?  It just applies to poor slobs like you and me.  As for Marion Nestle herself, she’d prefer not to:  “I eat out a lot and don’t cook much for myself.” ]

And foods you make at home are worlds apart from foods that manufacturers make in factories. No home kitchen ever turned out a Lunchable.

In her “home kitchen,” my mom used to make us bologna and processed cheese food sandwiches on Wonder Bread.  As a special treat, she would sometimes leave the red plastic strip on the bologna.  Extra fiber.  But, most assuredly, not a Lunchable.

If you go out in the world armed only with these guidelines, you’ll do great. Sure, there’s much more to know, if you want to know it. We’ve forged careers writing about food and nutrition, and either one of us could talk micronutrients until your eyes glaze over. But these few basics are all you need to make good food decisions. Choose foods you like — heavy on the plants, light on the junk — cook them and enjoy them.

 It really is that simple.

Simple. Simply useless.  And not exactly “rogue” either.  The 2010 Dietary Guidelines include some form of every single one of these “rogue” guidelines–including the directive to cook and eat at home, preferably with your family, whether you like them or not–even if the 2015 ones don’t.

The only truly “rogue” statement Haspel and Nestle make is in the headline, and it is one with which I concur:

Forget government guidelines.

Simple.

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

*Nowadays, when I see an online nutrition article with a comment section, I get out my FATSO card & see how many comments it takes for me to score a FATSO.  FATSO is like BINGO, only renamed in honor of America’s moral panic over body size.

**But not too science-based. According to the two letters sponsored by Center for Science in the Public Interest (motto: “Transfattingforming the American diet”), the members of the Dietary Guidelines Advisory Committee and a number of other nutrition-related organizations both opposed the notion that “Any new recommendations or changes to the 2010 Guidelines must be based on conclusions rated “Grade 1: Strong” by the Nutrition Evidence Library (NEL) rubric.”  In other words, the scientists–not the food industry–would like to have Guidelines based on weak conclusions from a scientific field whose methodology is already pretty weak.  Nice one, scientists.

It may be a new year, but in the world of nutrition, not much has changed–yet. If the amount of press dedicated to who gets to say what in the next edition of a document the previous edition of which insisted no American has ever paid one whit of attention to has taught us anything, it’s that “facts” don’t always do what we want them to do, right, Secretary Vilsack? And so, just like David Byrne, we’re stiiiilll waiting on the 2015 Dietary Guidelines, which were due out, like, last year already.

Like the Dietary Guidelines, my life is all about things changing and staying the same.  As both of my readers probably already know, I’m smack dab in the middle of a PhD program in communication, rhetoric, and digital media. Quite a switch from my work in nutrition? Not really. The things I work on in my studies now are the same things I was interested in as a PhD student in nutrition epidemiology: dietary recommendations, politics of food, the health gap, methodological issues in nutrition epidemiology of chronic disease, and the ethics of dietary policy. Only now I have a theoretical toolbox that is actually useful for critically examining those things.

Here’s the thing though. I thought that approaching nutrition from the perspective of rhetorical and communication theory would help me take a big step back and take a couple of deep breaths and have a nice cool, calm, totally “academic” attitude about things. Nope. The more I study this stuff, the more ticked off I get. In fact, the more sensitized I am to the rhetoric of nutrition and the better I can identify and understand the structures of privilege and power at work in the discourse surrounding food and health in America, the angrier it makes me.  Same as it ever was.

To avoid beginning the year with a full-on, foam-at-the-mouth rant, I am instead hosting a wonderful guest post from my good friend Jennifer Calihan over at EAT THE BUTTER.org. She has a smart, perceptive take on the past 35+ years of nutrition recommendations from a unique perspective. Her post, “Low Fat, High Maintenance,” provides some insight as to why the low fat dietary approach really does “work” for some Americans–and really doesn’t work for many more (and she does this without mentioning “insulin” once). If you haven’t already, you should check out her work.

Her post is the stepping stone to a different direction for my own writing. I’m sick of the diet wars, of “good” science vs. “bad” science, but I still think it is important to try to understand why all the talking heads of nutrition feel compelled to insist that everyone in the known universe can (and should) win at the game of “health through food” and in exactly the same way, despite vast differences in metabolic and genetic characteristics, and more importantly, economic and social contexts (I’m looking at you, Michael Pollan, Marion Nestle, Walter Willett, and–the biggest meat puppet of them all–David Katz). Jennifer not only brings a fresh new voice to the discussion, she directs our attention outside of our own bodies, to how all of us must negotiate our “food worlds” on very different terms.

Stay tuned. Jennifer’s post will be up later this week, followed by some commentary by me. As grad school allows, I’ll return to the regularly scheduled, full-on, foam-at-the-mouth rant already in progress.

Facts are simple and facts are straight
Facts are lazy and facts are late
Facts all come with points of view
Facts don’t do what I want them to
Facts just twist the truth around
Facts are living turned inside out
Facts are getting the best of them
Facts are nothing on the face of things
Facts don’t stain the furniture
Facts go out and slam the door
Facts are written all over your face
Facts continue to change their shape

–The Talking Heads, “Crosseyed and Painless”

New year, same old talking heads

Adele Hite, PhD MPH RD 8 Comments

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

Adele Hite, PhD MPH RD 38 Comments

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Works for me.

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

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

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

Make me some science I can’t refuse

Adele Hite, PhD MPH RD 49 Comments

In case you missed it, in a recent article published in the American Journal of Preventive Medicine entitled Overstatement of Results in the Nutrition and Obesity Peer-Reviewed Literature (not making this up), the authors found that a lot of papers published in the field of obesity and nutrition have, shall we say, issues.

Well–as they say down South– I never!

The authors looked at over 900 scientific articles on nutrition or obesity published either in 2001 or 2011 in leading journals. They found that about 1 in 11 include “overreaching statements of results.” 

Here’s how the authors described statements that would be coded as “overreaching”:

  • reporting an associative relationship as causal
  • making policy recommendations based on observational data that show associations only (e.g., not cause and effect)
  • inappropriately generalizing to a population not represented by the sample studied

Frankly, I am totally offended. Someone needs to let these folks know that, in nutrition epidemiology, correlation actually does equal causation.

What’s more, nutrition policy recommendations are supposed to be based on observational data. Hello? Dietary Guidelines? (Seriously. You don’t expect public health nutrition people to do actual experiments now, do you? I mean, unless you are talking about our population-wide, no-control-group, 35-year experiment with low-fat diet recommendations, but that’s different.)

And we don’t mind generalizing conclusions to Everyone in the Whole Wide World based on data from a bunch of white health care professionals born before the atom bomb because, honestly, those are the only data we really care about.

Equating correlation and causation, over-generalizing observations, and then using these results as the basis of policy is the bread (whole wheat) and butter (substitute) of nutrition epidemiology of chronic disease (aka NECD – pronounced Southern-style as “nekked”). NECD has a long proud tradition of misinterpreting results this way, and dammit, nobody is going to take that away from us.

Early NECD researchers have in the past tried to tentatively misinterpret results by obliquely implying that observed nutritional patterns might perhaps have resulted in the disease under investigation. Wusses.

In 1990, Walter Willett and JoAnn Manson came along to show us how the pros do it. These mavericks were the ones who made bold inroads into the kind of overreaching conclusions that made NECD great. Their data come from an observational study of female registered nurses from 11 states in the US, born between 1921 and 1946, who were asked to remember and report what they ate 4 whole times between 1976 and 1984, plus remember and report what they weighed when they were 18 years old. From this dataset, which is clearly comprehensive, and this population, which is practically every female in the US, Willett, Manson and company naturally conclude that “obesity is a major cause of excess morbidity and mortality from coronary heart disease among women in the United States” (emphasis mine). None of this wimpy “associated with increased risk of” bullshooey, obesity CAUSES heart disease, they tell us, CAUSES IT!!!! BWHAAAHAAAAA!!!!!!!

It is on this foundation of intrepid willingness to misinterpret data that the science of NECD was built. This is why Walter Willett is the Big Kahuna at the Harvard School of Public Health. He has demonstrated the courage to misinterpret data in innovative and comprehensive ways, publishing articles throughout his career that indicate that even small increases in BMI—including BMI levels that are currently considered “normal”–cause chronic disease.

In 1999, in what is considered a landmark article in overstatement, one with which all NECD acolytes should familiarize themselves, he states unequivocally, in a review of observational data:

“Excess body fat is a cause of cardiovascular diseases, several important cancers, and numerous other medical conditions . . . “ (my emphasis). Hmmmm. Observed associations reported as causal? Ding!

The rest of that sentence reads: ” . . . and is a growing problem in many countries.” His data is once again gathered mostly from American white health care professionals born before the atom bomb. Generalization from specific populations to the rest of the world? Ding ding.

And what should we do with this conclusion, according to Willett? “Preventing weight gain and overweight among persons with healthy weights and avoiding further weight gain among those already overweight are important public health goals.” Using observed associations to make policy recommendations? Ding ding ding. In one fell swoop, Willett dexterously manages to use all three designated methods of overstatement and misinterpretation in the nutrition epidemiology NECD toolbox, demonstrating why he is considered by most researchers to be “the ‘father’ of nutrition epidemiology.” This man overstates and misinterprets in ways that the rest of us can only dream of doing.

Sadly, some epidemiologist have failed to follow in Willett’s footsteps. In January 2013, Katherine Flegal, an epidemiologist at the Centers for Disease Control and Prevention and the woman who first noted the remarkably rapid rise in obesity that began in the decade following the release of the 1977 Dietary Goals for Americans, published results that concluded that being overweight (or even mildly obese) is associated with a lower risk of death. At no point in her article does she suggest that overweight or obesity results in increased lifespan.

The response from Harvard? Walter Willett calls Flegal’s article ” a pile of rubbish” and insists that “no one should waste their time reading it” and rightly so. Why would anyone want to hear about “associations”? What kind of nonsense is that? Obviously Flegal lacks the professionalism it takes to make the leap from observation to causation.

But that’s okay. Willett and the Harvard Family know how to deal with this sort of thing.

“Someday, and that day appears to have come, I will call upon you to ignore the work of other scientists when their results contradict my own.”

Let’s face it, in the world of NECD, you can’t just have people like Flegal refusing to infer causation from observed results, just because they don’t want to. When that sort of thing happens, well, let’s just say, if she won’t do it, the Harvard Family will have to do it for her. And so they did.

In February 2013, Willett and company convened a Harvard Family gathering to, in their words, “elucidate inaccuracies in a recent high-profile JAMA article [i.e. Flegal’s] which claimed that being overweight leads to reduced mortality” (emphasis mine). Which it didn’t–except now, voila, it does. It’s not personal, Dr. Flegal. It’s strictly science.

The Family get-together was held at the Harvard School of Public Health, a “neutral convening space” that is also ground zero for the Nurses’ Health Study I and II, the Physicians Health Study I and II, and the Health Professional Follow Up Study, three datasets that have generated many NECD articles that, unlike Flegal’s article, brilliantly illustrate the powers of misinterpreting observational data. That Flegal herself was invited, but “could not attend” tells us just how ashamed she must be of her inability to make over-reaching conclusions–or perhaps she was temporarily “incapacitated” if you know what I mean.

The webcast from the meeting show us how NECD should be done, with dazzling examples of overstatement and marvelous feats of misinterpretation.

In the world of NECD, PowerPoint arrows are a scientifically-acceptable method of establishing causation.

In her shining moment, Dr. JoAnn Manson, demonstrating that she has learned well from Willett, points to the slide above and asks: “How is it possible that overweight and obesity would cause all of these life-threatening conditions, increase their incidence, and then reduce mortality?” How indeed???

The panelists highlighted the importance of maintaining clear standards of overstatement and expressed concern that Flegal’s research could undermine future attempts of more credible researchers to misinterpret data as needed to protect the health of the public.

Because that’s what it’s all about folks: protection. Someone needs to protect the science from renegades like Flegal, and someone needs to protect the public from science.

We should be thankful that we have Willett and the Harvard Family there. They know that data like Flegal’s can only confuse the poor widdle brains of Americans. Allowing us to be exposed to such “rubbish” might lead us to the risky conclusion that perhaps overweight and mild obesity won’t cause all of us to die badly, or to the even more dangerous notion that observational data should remark only upon association, not causation. And we sure don’t want that to happen.

As Don Dr. Willett says, “It is important for people to have correct information about the relationship between health and body weight.” And when he wants us to have the correct information about the relationship between health and body weight, he’ll misinterpret it for us.

Take the science, leave the cannoli.

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

Adele 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 [2nd Edition] Dietary Goals for Americans say this:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

You are what you eat

From your head down to your feet

Thinks like meat and eggs and fish you

Need to build up muscle tissue

Hello appetite control?

More protein!

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

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

My all-time favorite Timer PSA was this one:

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

I hanker for a hunk of cheese.

When I’m dancing a hoedown

And my boots kinda slow down,

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

I hanker for a hunk of

A slab or slice or chunk of–

A snack that is a winner

And yet won’t spoil my dinner–

I hanker for hunk of CHEESE!

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

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

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

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

Adele 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:Labor force 1900 - 2000

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!”