Guest Post: James Woodward on Why Science May Not Be Enough

I’d like to introduce readers to a friend and fellow grad student, James Woodward. His undergraduate work was in economics at Ohio University, and he has a Master’s in public policy from the University of Kentucky. He is continuing at UK as a PhD student in public policy and administration. He and I have had some of the most thought-provoking email threads in any of my correspondence & I give him a lot of credit for helping me think through the economics and policy parts of food-health system reform puzzle. His post will serve as a bridge to my next series on “Eatanomics” which will explore how food, health, and the economy are intertwined. James would like everyone to know that all the disclaimers that appear on this page apply equally to what appears in this post. His views are his own, and as with the best of minds, he anticipates that most are subject to change. But he raises some very interesting questions—he’s nearly as long-winded as I am, but it is worth a read.

Why New Science May Not Be Enough – James Woodward

Before going into my social science background, I thought I would mention my professional background as it relates to food. It’s nearly as extensive as my academic background. I worked in fast food for about two years, a pizza place for about two years, a dining hall for a quarter, and, finally, a pseudo-Mexican restaurant for about two years. As a result, my feelings toward actual food and, especially, its preparation are fairly ambivalent at this point. The fact that I spent large amounts of time working with flour (I made tens of thousands of tortillas over the course of my tenure at the Mexican place) is rather ironic given my recent decision to avoid the stuff as much as possible.

Nutrition Science Initiative founders Gary Taubes and Peter Attia are hoping to give the public some solid science on food-health relationships.

My schooling in economics was concurrent with much of this work and my reasons for working these jobs had much more to do with my own economic situation than with any particular desire to work with food. But my background in economics and, now, public policy, leads to me to view the issue of food and nutrition policy a bit differently than many others writing on this topic. Many approach problems relating to nutrition and health in terms of their public health consequences. Others stress the fact that nutrition policy is the product of bad and/or misinterpreted science. Gary Taubes and Peter Attia just launched their organization, NuSI, to address, and hopefully settle, that particular aspect of this issue. Both lines of research clearly have their merits. Ultimately, though, I think what everyone is most interested in is influencing the behavior of individuals.

Contrary, perhaps, to Peter Attia’s quote from Richard Feynman in a recent blog post, I think there is a role for social scientists to play in understanding the many issues and controversies surrounding diet, health and public policy. Some of us in the social sciences are, in fact, sensitive to the difficulty of establishing real truths from the data available to us. Further, I do not think that social phenomena like behaviors and decision-making are reducible to physical and chemical relationships quite yet. How fitting that nutrition, and especially nutritional epidemiology, often bears more resemblance to bad social science than it does to any sort of ‘hard’ science.

Ignoring the controversy surrounding what it is that makes people fat and what constitutes an ideal diet, it would be hard to argue that people are making “good” decisions about what they are eating, given the high prevalence of (ostensibly) diet-related health problems in the United States, the most visible of which is obesity. Since most people buy their own food rather than growing or raising it themselves, food buying decisions tend to be highly correlated with food eating decisions. So, to me, the ultimate question is: “What influences food buying decisions?” Again, Gary and Peter have, with good reason, chosen to stress the importance of food consumption decisions being driven by good science. But there are clearly more factors that influence food purchasing decisions than a careful weighing of the scientific evidence. I would argue that such an approach to most decisions is, in fact, fairly rare. To the extent that Gary and Peter are ultimately trying to influence public policy, I think it is self-evident based on a reading of the history that policymakers are not that likely to employ such an approach either.

One of the many things besides science that may influence food purchasing and consumption.

This is why I tend to conceptualize the problem in the area of food and nutrition policy as one of bad information rather than attributing it purely to bad science. If one takes the time to dig, there is plenty of science which refutes the conventional wisdom regarding the relationship between diet and health. So, while no rigorous, carefully controlled studies have been performed to refute the conventional wisdom and/or confirm the “insulin hypothesis”, to use Gary’s term, there is already a lot of evidence to suggest that it is valid and plenty of evidence which refutes the conventional wisdom. Performing such a rigorous test of these competing theories is obviously warranted, given the importance of the implications for settling this debate, but there is no guarantee that the results will be convincing to skeptics, policymakers, stakeholders or the public at large.

Thirty-odd years ago policymakers perceived an obvious threat to public health (saturated fat) and saw a clear remedy (tell people not to eat so much saturated fat) which made it more or less a no-brainer to act on that information and tell people to avoid eating saturated fat containing foods. Since then, those original beliefs about diet and health have had time to percolate and become more or less embedded in how most people think about what they eat. Adele and I have talked a little bit about overcoming our own biases when we decided to eat differently, biases that we were not necessarily aware we had in the first place.

How you spend your food dollar may depend on how many food dollars you have to spend.

There are more factors that influence food purchasing decisions than just beliefs about how that food will affect one’s health. Taste, culture, geography, morality, ethics, politics, and socioeconomic status are just a few observable characteristics of an individual that might affect what he or she decides to eat. In many people’s minds, there is very little conflict between these concerns and health-related ones. For example, there is a perception that following a vegetarian lifestyle is good for one’s body, one’s soul, and the environment compared to a diet based around animal products. Upon closer inspection, however, there is a great deal of ambiguity to this belief in all three spheres. Similarly, many athletes seem to be operating under the impression that carbohydrates are required to perform at a high level. Peter’s well-documented experience calls that belief into question. Breakfast is often lauded as the most important meal of the day in the United States yet I frequently snub it to no ill-effect. And so on.

I think it is important to keep these biases in mind when thinking about we’d like to go about changing behavior. It is tempting to think “if only the science were better” people’s behavior would change. This is clearly not enough, in my mind anyway. It is just as important to be convincing as it is to be right. If/when NuSi successfully settles this debate and has the biggest names in the field to back up its research; there is still the matter of convincing everyone else. NuSi does acknowledge this aspect of the issue, though I am interested to see how it is addressed in practice. There are the cognitive biases of all the other scientists to contend with. There are also the material and non-material incentives that seem to be ingrained in many of the stakeholders involved in this particular area of policy. For example, it has been noted elsewhere that stressing the importance of calories is convenient for those involved in the production of food since doing so means no particular foods (e.g., wheat and sugar) are likely to be admonished against because of their unique effects on the body per se but, rather, because of their caloric content. I have to imagine that such firms will do their very best to refute any evidence that says otherwise and may hire their own experts to do so.

In a “calories in, calories out” world, there’s room for all foods in a “healthy” diet.

Beyond the obvious material costs to stakeholders of changing the current nutritional paradigm are the much more difficult to quantify costs of changing people’s beliefs about such things. Despite taking a nutrition course years ago (for an easy science credit, I will admit), I did not have particularly strong thoughts about nutrition prior to about a year and a half ago. I knew I made less than optimal choices about what I ate (according to conventional wisdom that is) but I mostly ignored those concerns since my health seemed fine (more or less). It was therefore fairly costless for me to change my mind about how I approach my diet after the conventional wisdom failed for me. Physicians and dietitians are not like me, however. Many of them have devoted years of their lives to dispensing information and advice that they believe to be correct and helpful. Faced with an opposing and incongruent view, it is perfectly understandable that they would be very resistant to the implication that they have been misleading their patients. In a less extreme form, I am sometimes asked by friends and acquaintances for my thoughts relating to diet and health and then, after giving them, met with resistance and facts or beliefs that supposedly refute my position(s). Most of these people are not experts on this topic but, like most people, they need some justification for what they believe.

So what is my point in all this? It is probably not breaking news that people’s eating decisions are not purely based on a careful reading of the scientific evidence. Better science is probably a necessary part of making the case but I do not think it will be sufficient to affect the type of change that many people in the ‘Paleo’ or ‘Ancestral Health’ communities (or whatever other term you prefer) would like to see. As mentioned, most people are averse to the notion that their beliefs are wrong and, in my experience, will try to come up with some reason for why that is not the case, sometimes resorting to questionable sources for support. This is human nature, I think– cognitive dissonance perhaps, to borrow a term from the psychologists. Based on what I can see, most people are not even willing to entertain the idea that there is a controversy or room for debate about these competing paradigms. Especially skinny people.

I think this state of affairs needs to change if further research is to bear any fruit in the form of affecting individual behavior and/or public policy. Fortunately, there are many bloggers writing on this topic, all bringing their own perspectives to the table. The challenge will be finding enough common ground to get this message to a larger audience so that we get an actual public debate going. I read the New York Times ‘Health’ section fairly regularly (as a barometer for this type of thing, not necessarily for good information) and I am not seeing it so far. It would be a real shame if all that came of this renewed interest in an old paradigm was a relatively minor reduction in the prevalence of obesity.

What Simon Doesn’t Say: An Expose with a Hidden Agenda

The Academy of Nutrition and Dietetics (AND) is squirming over a recent report written by Michele Simon of Eat Drink Politics that address ANDs corporate sponsorship program. The president of AND warns members not to believe everything they read and to mind the source (I supposed the assumption is RDs would be too sheep-like to do otherwise? Good thing Daddy Sheep warned us!), saying  ” . . . the majority of the report consists of publicly available facts filtered through the author’s opinions. She is of course entitled to her opinions. But opinions are not facts.”

I’m no fan of the Academy of Nutrition and Dietetics (AND), although they haven’t yet revoked my membership. I’m also no fan of industrialized food, although I do think the food industry has an important role to play in reforming our food-health system. I am also not a big fan of hypocrisy, which is why I have a good bit of trouble with the report, entitled Are America’s Nutrition Professionals in the Pocket of Big Food?

The answer is—I believe—a resounding “yes,” and Healthy Nation Coalition has explored how this compromised position extends not just to the food industry but the USDA itself. Clearly, the AND is an industry-friendly organization, and the USDA relies on AND-trained dietitians to confirm its own industry-friendly guidelines.

While I applaud Simon’s efforts to hold the AND more accountable for its relationships with industry, AND leadership is correct in pronouncing Simon’s reporting as one-sided and biased.  Simon is happy to slam the health-washing, cultural insensitivity, and hidden agendas of food manufacturers and the Academy, but if the propaganda, insensitivity, and agendas are vegatarian*—well, then she’s just fine with it, thank you very much.

“Healthy” smoothies are okay with Simon; meaty cheesy Big Macs are not.

Simon complains that “the banners at the McDonald’s booth showed images of healthy foods like smoothies,” but didn’t show McRibs and Big Macs. The implication, of course is that “healthy” smoothies” (with 78 grams of sugar and 4 grams of protein) aren’t so bad—even if they are from McDonald’s—compared to those meaty, cheesy foods like a Big Mac. Never mind that your body actually needs the protein that a Big Mac can provide and has little use for the 78 grams of sugar in a smoothie, except for fat storage.

How dare the Dairy Council target lactose-intolerant African-Americans! Every one knows all African-Americans would be healthier on a vegan diet . . .

Simon quotes an RD who points out that it is culturally inappropriate for the National Dairy Council to target African-American and Hispanic communities, considering the high rates of lactose intolerance in those populations, a remark with which I fully agree. Simon then goes on to complain about the inappropriateness of the Pork Board handing out educational material at “a nutrition conference where almost no countering information could be found about how a meat-centered diet can lead to chronic disease”?  In fact it would inappropriate to provide such “countering information” as the declaration that a meat-centered diet leads to disease is an ideological stance and not a scientific one. I would go on to add that it is also a culturally-insensitive stance, as pork is at the center of not only African-American and Hispanic food culture (barbeque, chorizo), but Chinese and Eastern European cuisine as well (lup cheong and kielbasa). It seems cultural sensitivity is fine if it means we can take away meaty, cheesy foods—but not when such sensitivity would allow them.

It’s not culturally insensitive to ban pork products–like these lup cheong– from a healthy diet; we’re just doing everyone a favor.

Simon’s take on the not-so-hidden relationships between the AND and the food industry is well-trod ground as she herself acknowledges, but to Simon some associations are apparently more odious than others:

In 1995, New York Times reporter Marian Burros wrote about criticisms of the [AND] for taking funding from industry groups such as the Sugar Association, the Meat Board, and companies such as McDonald’s, CocaCola, and Mars. According to Burros: “Nothing negative is ever included in materials produced by the association, a fact that critics attribute to its link to industry.” In that same article, veteran sustainable food advocate and Columbia University Professor Joan Gussow noted that giving money to registered dietitians is how industry silences its critics.

Simon pointedly calls out the National Cattleman’s Beef Association as an “especially loyal” sponsor. But if giving money means AND will only say positive things about your food product, it’s difficult to explain AND’s resounding endorsement of vegetarian and vegan diets, with “tips of the day” like “Endless Meat-Free Options” and articles that show you how to “Build Muscle, No Steak Required,” plus the promotion of stories such as “All Red Meat is Bad for You” in their daily newsletter. If I were the Beef Association, I’d want my money back.

Private consulting firms that have a “good” agenda don’t need to be held to the same levels of transparency as the “bad” ones.

I fully commend Simon’s calls for transparency, but the transparency knife cuts both ways. The AND/industry report was authored by Simon under the auspices of Eat Drink Politics, a self-described (by Simon) “industry watchdog” group that is also a “private consulting firm.” As such, while Simon is willing to disclose some of its clients, she states that “Some of our clients and funders prefer to remain anonymous for various reasons and we respect those wishes” (emphasis mine). So while she accuses the International Food Information Council of being “an industry front group” (which I think is pretty accurate), we can’t really tell who or what Eat Drink Politics is a “front” for, although we can take an educated guess.

The Eat Drink Politics website alerts us to an alarming situation regarding Deceptive Health Claims:

“The food industry has a challenge on its hands. Most health experts agree that the optimum diet is one based mostly on whole, plant foods, the kind that come from nature and not a factory. So, to convince Americans they can still eat their favorite meat, cheese, soda and junk food, many companies are using meaningless labels such as “all-natural” and engaging in other deceptive marketing practices” (emphasis mine).

Yup, meat and cheese—that’s about as un-natural as it comes.

It doesn’t take a rocket scientist to look through the science and figure out that “most health experts” don’t actually agree that the “optimum” diet is based mostly on whole, plant foods (actually I’m pretty sure it just takes a journalist, specifically Gary Taubes). It’s also pretty easy to figure out what Simon’s idea of a “whole, plant food” diet is:

“A diet based on whole plant foods minimizes or eliminates all animal products, including meat, poultry, fish, dairy, eggs, and their byproducts.”

Can you say—vegan?

Simon goes to great lengths in her book Appetite for Profit to deny that she has any vegan agenda, as she has been accused of by the Center for Consumer Freedom (a group Simon depicts—again, accurately, in my opinion—as a food and beverage industry front group).  She’s clearly sensitive to the fact that the word “vegan” is too loaded with negative connotations to actually use it when she suggests that “a diet that resembles my own would be optimal for most people.”

She accuses Center for Consumer Freedom of keeping its corporate sponsorship anonymous in order to engage in more provocative PR claims and of manipulating language to make it look like she’s pushing a personal agenda. But she seems pretty comfortable with keeping her own sponsors anonymous, with using provocative claims to alarm the public, and with using consumer-friendly language to gloss over aspects of her own personal biases that the public may find off-putting. I guess she figures it’s okay because she’s believes she’s got “decades of accepted nutrition science” and a “scientifically supported view” on the side of her personal nutritional biases.

I think Simon’s 5 recommendations to AND are long overdue. There is no doubt that AND would benefit from increased transparency; more input from members; sponsorship guidelines; an elimination of corporate-sponsored education; and stronger policy leadership.

But I cannot support is what I think is Simon’s most disturbing suggestion, that AND commit itself to policy action now—specifically taxation of sugar-sweetened beverages**—before a full review of scientific evidence and long-term implications can be ascertained.

According to Simon, “not every policy issue or decision can wait for months (or years) of committee review and analysis.” On the contrary, I would argue that more policy decisions that attempt to manipulate the health behaviors of Americans by relying on unproven assumptions about the relationships between food and health can and should wait for months or years or indefinitely, until consistent, quality experimental data is obtained or until observational data reveal consistent and unmistakably-high risks. Right now, the health crisis that Simon seems intent on addressing (and I applaud her intentions, if not her methods) is at least in part a result of sweeping changes made to our food system 35 years ago without such evidence in hand.

Simon’s unquestioning belief in her own nutritional agenda is a result of that policy experiment, but it isn’t the solution. It’s time we stop trying to change the eating habits of our fellow Americans—which is the underlying intention behind taxing soda and believing that a diet that resembles your own is best for everyone else—and start trying to change the regulatory, economic, and political framework that restricts access to both the food and the knowledge that individuals need to make their own decisions about their own health.

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In case you missed my interview with Bob Fenton, a fellow blogger who has type 2 diabetes, you can find it here: 

Adele holds forth on diabetes, dietetics, and why the refusal to admit the limitations of our nutrition knowledge is a dangerous thing.

Next up is a guest post from a friend and fellow graduate student, James Woodward, whose background in economics and public policy gives him a rather different perspective on how we might go about accomplishing the task of reforming our food-health system.  It will also provide a bridge to my next series on “Eatanomics” which will explore how food, health, and the economy are intertwined. 

*”Vegatarian” is a term I use to indicate veganism disguised as vegetarianism. While lacto-ovo-vegetarian dietary patterns are complete and perfectly healthy, vegan diets must rely on fortification or supplementation to be complete, as acknowledged by the promoters of such diets (just read the “fine print”).

**Sugar-sweetened beverages are usually pretty nutritionally useless, but we simply don’t know what sort of unintended repercussions a soda tax will have, or where to draw the taxation line. One study has shown that beer-drinking households responded to a six-month soft drink tax by buying more beer.

Not Just Science: How nutrition got stuck in the past

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

David Frum

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

“become worryingly untethered from reality”

“develop a distorted sense of priorities”

and are “voluntarily putting themselves in the same cocoon”

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

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

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

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

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

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

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

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

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

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

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

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

How paleo might look from the outside.

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

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

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

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

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

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

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

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

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

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

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

Let’s quit bickering and get to work.

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

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

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

References:

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

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

Why Race Doesn’t Matter in Nutrition Policy

This is the first of a series looking at what does and doesn’t matter when it comes to nutrition policy. When I started out on this adventure, I thought that science would give me the answers to the questions I had about why public health and clinical recommendations for nutrition were so limited. Silly me. The science part is easy. But policy, politics, economics, industry, media framing, the scientific bureaucracy, cultural bias—now that stuff is crazy complicated. It’s like an onion: when you start peeling back the layers, you just want to cry. I am also honored to say that this post is part of the Diversity in Science Carnival on Latino / Hispanic Health: Science and Advocacy

When we began investigating relationships between diet and chronic disease, we didn’t pay much attention to race. The longest-running study of the relationship between dietary factors and chronic disease is the Framingham Heart Study, a study made up entirely of white, middle-class participants. Since 1951, the Framingham study has generated over 2 thousand journal articles and retains a central place in the creation of public health nutrition policy recommendations for all Americans.

More recent datasets—especially the large ones—are nearly as demographically skewed.

The Nurses’ Health Study is 97% Caucasian and consists of 122,000 married registered nurses who were between the ages of 30 and 55 when the study began in 1976. An additional 116,686 nurses ages 25 – 42 were added in 1989, but the racial demographics remained unchanged.

The Health Professionals’ Follow-up Study began in 1986, as a complementary dataset to the Nurses’ Health Study. It is 97% Caucasian and consists, as the name suggests, of 51, 529 men who were health professionals, aged 40-75, when the study began.

The Physicians’ Health Study began in 1982, with 29, 071 men between the ages of 40-84. The second phase started in 1997, adding men who were then over 50. Of participants whose race is indicated, 91% are Caucasian, 4.5% are Asian/Pacific Islander, 2% are Hispanic, and less than 1% are African-American or American Indian. I have detailed information about the racial subgroups of this dataset because I had to write the folks at Harvard and ask for them. Race was of such little interest that the racial composition of the participants is never mentioned in the articles generated from this dataset.

Over the years, these three mostly-white datasets have generated more journal articles than five of the more diverse datasets all put together.* These three datasets, all administered by Harvard, have been used to generate some of the more sensationalist nutrition headlines of the past few years–red meat kills, for instance–with virtually no discussion about the fact that the findings apply to a population–mostly white, middle to upper middle class, well-educated, health professionals, most of whom who were born before the atomic bomb–to which most of us do not belong.

Shift in demographics in past 50 years;
predicted shift in next 50 years

Although we did begin to realize that race and other characteristics might actually matter with regard to health (hence the existence of datasets with more diversity), we can’t really fault those early researchers for creating such lopsided datasets. At that point, not only was the US more white than it is now, scientific advances that would reveal more about how our genetic background might affect health had not yet been developed. We had not yet mapped the human genome; epigenetics (the study of the interaction between environmental inputs and the expression of genetic traits) was in its infancy, and biochemical individuality was little more than a glimmer in Roger Williams’ eye.

Socially, culturally, and I think, scientifically, we were all inclined to want to think that everyone was created equal, and this “equality” extended to how our health would be affected by food. Stephen Jay Gould’s 1981 book, The Mismeasure of Man, critiqued the notion that “the social and economic differences between human groups—primarily races, classes, and sexes—arise from inherited, inborn distinctions and that society, in this sense, is an accurate reflection of biology.” In the aftermath of the civil rights movement, with its embarrassingly racist behavior on the part of some representatives of the majority race and the heartbreaking violence over differences in something as superficial as skin color, it was patently unhip to suggest that racial differences were anything more than just skin deep.

But does that position still serve us now?

In the past 35 years, our population has become more diverse and nutrition science has become more nuanced—but our national nutrition recommendations have stayed exactly the same. The first government-endorsed dietary recommendations to prevent chronic disease were given to the US public in 1977. These Dietary Goals for Americans told us to reduce our intake of dietary saturated fat and cholesterol and increase our intake of dietary carbohydrates, especially grains and cereals in order to prevent obesity, diabetes, heart disease, cancer, and stroke.

Since 1980, the decreases in hypertension and serum cholesterol—health biomarkers—have been linked to Guidelines-directed dietary changes in the US population [1, 2, 3, 4].

“Age-adjusted mean Heart Disease Prevention Eating Index scores increased in both sexes during the past 2 decades, particularly driven by improvements in total grain, whole grain, total fat, saturated fatty acids, trans-fatty acids, and cholesterol intake.” [1]

However, with regard to the actual chronic diseases that the Dietary Guidelines were specifically created to prevent, the Dietary Guidelines have been a resounding failure. If public health officials are going to attribute victory on some fronts to Americans adopting dietary changes in line with the Guidelines, I’m not sure how to avoid the conclusion that they also played a part in the dramatic increases in obesity, diabetes, stroke, and congestive heart failure.

If the Dietary Guidelines are a failure, why have policy makers failed to change them?

It is not as if there is an overwhelming body of scientific evidence supporting the recommendations in the Guidelines. Their weak scientific underpinnings made the 1977 Dietary Goals controversial from the start. The American Society for Clinical Nutrition issued a report in 1979 that found little conclusive evidence for linking the consumption of fat, saturated fat, and cholesterol to heart disease and found potential risks in recommending a diet high in polyunsaturated fats [5]. Other experts warned of the possibility of far-reaching and unanticipated consequences that might arise from basing a one-size-fits-all dietary prescription on such preliminary and inconclusive data: “The evidence for assuming that benefits to be derived from the adoption of such universal dietary goals . . . is not conclusive and there is potential for harmful effects from a radical long-term dietary change as would occur through adoption of the proposed national goals” [6]. Are the alarming increases in obesity and diabetes examples of the “harmful effects” that were predicted? It does look that way. But at this point, at least one thing is clear: in the face of the deteriorating health of Americans and significant scientific evidence to the contrary, the USDA and HHS have continued to doggedly pursue a course of dietary recommendations that no reasonable assessment would determine to be effective.

But what does this have to do with race?

Maintaining the myth that a one-size diet approach works for everyone is fine if that one-size works for you—socially, financially, and in terms of health outcomes. The single positive health outcome associated with the Dietary Guidelines has been a decrease in heart attacks—but only for white people.

And if that one-size diet doesn’t fit in terms of health, if you end up with one of the other numerous adverse health effects that has increased in the past 35 years, if you’re a member of the mostly-white, well-educated, middle/upper-middle class demographic—you know, the one represented in the datasets that we continue to use as the backbone for our nutrition policy—you are likely to have the financial and social resources to eat differently from the Guideline recommendations should you choose to do so, to exercise as much as you need to, and to demand excellent healthcare if you get sick anyway. Even if you accept that these foods are Guidelines-recommended “healthy” foods, you are not stuck with the commodity crop-based processed foods for which our nutrition programs have become a convenient dumping ground.

In the meantime, low-income women, children, and minorities and older adults with limited incomes—you know, the exact population not represented in those datasets—remain the primary recipients of federal nutrition programs. Black, Hispanic, and American Indian kids are more likely to qualify for free or reduced-price school lunches; non-white participants make up 68% of the Special Supplemental Nutrition Program for Women, Infants, and Children enrollment. These groups have many fewer social, financial, and dietary options. If the food they’re given doesn’t lead to good health—and there is evidence that it does not—what other choices do they have?

When it comes to health outcomes in minorities and low-income populations, the “healthier” you eat, the less likely you are to actually be healthy. Among low-income children, “healthy eaters” were more likely to be obese than “less-healthy eaters,” despite similar amounts of sedentary screen time. Among low-income adults, “healthy eaters” were more likely to have health insurance, watch less television, and to not smoke. Yet the “healthy eaters” had the same rates of obesity as the “less-healthy heaters” and increased rates of diabetes, even after adjustment for age.

These associations don’t necessarily indicate a cause-effect relationship between healthy eating and health problems. But there are other indications that being a “healthy eater” according to US Dietary Guidelines does not result in good health. Despite adherence to “healthy eating patterns” as determined by the USDA Food Pyramid, African American children remain at higher risk for development of diabetes and prediabetic conditions, and African American adults gain weight at a faster pace than their Caucasian counterparts [7,8].

Adjusted 20-year mean weight change according to low or high Diet Quality Index (DQI) scores [8]

In this landmark study by Zamora et al, “healthy eaters” (with a high DQI) were compared to “less-healthy eaters” (with a low DQI). Everyone (age 18-30 at baseline) gained weight over time; the slowest gainers—white participants who were “healthy eaters”—still gained a pound a year. More importantly however, for blacks, being a “healthy eater” according to our current high-carbohydrate, low-fat recommendations actually resulted in more weight gain over time than being a “less healthy eater,” an outcome predicted by known differences in carbohydrate metabolism between blacks and whites [9].

Clearly, we need to expand our knowledge of how food and nutrients interact with different genetic backgrounds by specifically studying particular racial and ethnic subpopulations. Social equality does not negate small but significant differences in biology. But it won’t matter how much diversity we build into our study populations if the conclusions arrived at through science are discarded in favor of maintaining public health nutrition messages created when most human beings studied were of the adult, mostly white, mostly male variety.

Right now the racial demographics of the participants in an experimental trial or an observational study dataset doesn’t matter, and the reason it doesn’t is because the science doesn’t matter. What really matters? Maintaining a consistent public health nutrition message—regardless of its affect on the health of the population—that means never having to say you’re sorry for 35 years of failed nutritional guidance.

*ARIC – Atherosclerosis Risk In Communities (1987), 73% white; MESA – Multi Ethnic Study of Atherosclerosis (2000), 38% white, 28% African American, 12% Chinese, 22% Hispanic; CARDIA – Coronary Artery Risk Development in Young Adults (1985), 50% black, 50% white; SHS – Strong Heart Study (1988), 100% Native American; BWHS – Black Women’s Health Study(1995), 100% black women.

References:

1. Lee S, Harnack L, Jacobs DR Jr, Steffen LM, Luepker RV, Arnett DK. Trends in diet quality for coronary heart disease prevention between 1980-1982 and 2000-2002: The Minnesota Heart Survey. J Am Diet Assoc. 2007 Feb;107(2):213-22.

2. Hu FB, Stampfer MJ, Manson JE, Grodstein F, Colditz GA, Speizer FE, Willett WC. Trends in the incidence of coronary heart disease and changes in diet and lifestyle in women. N Engl J Med. 2000 Aug 24;343(8):530-7.

3. Fung TT, Chiuve SE, McCullough ML, Rexrode KM, Logroscino G, Hu FB. Adherence to a DASH-style diet and risk of coronary heart disease and stroke in women. Arch Intern Med. 2008 Apr 14;168(7):713-20. Erratum in: Arch Intern Med. 2008 Jun 23;168(12):1276.

4. Briefel RR, Johnson CL. Annu Rev Nutr. 2004;24:401-31. Secular trends in dietary intake in the United States.

5. Broad, WJ. NIH Deals Gingerly with Diet-Disease Link. Science, New Series, Vol. 204, No. 4398 (Jun. 15, 1979), pp. 1175-1178.

6. American Medical Association. Dietary goals for the United States: statement of The American Medical Association to the Select Committee on Nutrition and Human Needs, United States Senate. R I Med J. 1977 Dec;60(12):576-81.

7. Lindquist CH, Gower BA, Goran MI Role of dietary factors in ethnic differences in early risk of cardiovascular disease and type 2 diabetes. Am J Clin Nutr. 2000 Mar; 71(3):725-32.

8. Zamora D, Gordon-Larsen P, Jacobs DR Jr, Popkin BM. Diet quality and weight gain among black and white young adults: the Coronary Artery Risk Development in Young Adults (CARDIA) Study (1985-2005). American Journal of Clinical Nutrition. 2010 Oct;92(4):784-93.

9. Hite AH, Berkowitz VG, Berkowitz K. Low-carbohydrate diet review: shifting the paradigm. Nutr Clin Pract. 2011 Jun;26(3):300-8. Review.

RD does NOT stand for “Really Dumb”

All you need to do is google “dietitians are stupid.” (Go ahead, I’ll wait here.) “Dumbshit nutritionists” [Free the Animal] all over America are apparently giving out “misleading, scientifically vapid, and possibly harmful information” [Postpartum Punk]. Sadly, it is sometimes hard to argue with that.

The Academy of Nutrition and Dietetics has a professional “Code of Ethics” that states that all Registered Dietitians should avoid even the appearance of a conflict of interest.

“The dietetics practitioner does not invite, accept, or offer gifts, monetary incentives, or other considerations that affect or reasonably give an appearance of affecting his/her professional judgment.” *

At the same time, because the organization officially has exactly zero written standards for ensuring that its sponsors actually share the AND’s ostensible vision for “optimizing the nation’s health through food and nutrition,” the Academy of Nutrition and Dietetics accepts money from both food manufacturers and pharmaceutical companies and provides continuing education credits for attending workshops sponsored by Kellogg’s, Kraft and ConAgra.

So what might the Academy of Nutrition and Dietetics be doing with all of this funding? Right now, the AND is fighting a (mostly losing, thankfully) battle to create a complete monopoly on nutrition information and guidance—despite the fact that there is little evidence that this guidance contributes to positive health outcomes.

One the one hand, dietitians are encouraged to turn in anyone who does not rigidly adhere to both licensing standards and/or “professional” standards (some states have turned this into a professional development activity).  Anyone who gives out nutrition information without having the appropriate state-required licensing can be a target (Steve Cooksey’s story has been a newsworthy example of this). But—here’s the scary part—even dietitians with the right credentials can come under attack if they follow their professional judgement rather than the party line (see Annette Presley, below).

On the other hand, the “party line” approaches for weight loss are so ineffective, the federal government (and many states) won’t cover  many dietitian services to help people lose weight.    According to Dr. Wendy Long, chief medical officer of TennCare:

There’s really no evidence to support the fact that providing those services [from dietitians] would result in a decrease in medical cost, certainly not immediately, and even in the longer term.” 

This lack of evidence may be due in part to the (sadly) limited scope of dietetic education and practice. The AND treats the USDA as if it is a scientific authority and not a government agency whose first mandate is to “strengthen the American agricultural economy.” It limits the training of RDs to USDA/HHS-approved diet recommendations despite the fact that even mainstream nutrition establishment scientists feel that the current US dietary recommendations are misguided and inappropriate.

Despite these snugly-fitted, professional handcuffs, there are plenty of RDs out there who not only think for themselves, but who are working to change the system—each in her own way. What they have in common is an unwavering belief in the importance of food in creating healthier individuals and communities. Truly, these women are amazing:

Valerie Berkowitz MS RD CDN CDE worked with Dr. Robert Atkins for a number of years, but has gone one to create her own approach to healthy eating. Valerie is the author of The Stubborn Fat Fix: The Essential Guide to High Fiber, Low Carbohydrate, Whole Food Diets. The book is the basis for a learning module for continuing education credits for RDs—yup, you read that right. Thanks to Valerie’s commitment to making carbohydrate-reduction a mainstream option for health professionals, RDs can get continuing education credits for learning more about low-carb diets. More evidence of her commitment? I got to know Valerie well when I worked with her on a review paper on low-carbohydrate diets —while she had a newborn in tow. (All I did when my children were infants was pray for the opportunity to take a shower.)  Valerie works with her husband, Dr. Keith Berkowitz, as the Director of Nutrition at the Center for Balanced Health, while blogging, writing, and mothering four active children. I know, I know—it makes me want to take a nap just reading about her. But I promise she is fully human and a lovely person. Go visit her at Valerie’s Voice: For the Health of It.

Abby Bloch PhD RD is the Executive Director for Programs and Research at the Dr. Robert C. and Veronica Atkins Foundation. Like Jackie Eberstein, she also has a story about being interviewed by Dr. Atkins and telling him that if she found out that he was a fraud, she would shout it from the rooftops. Well, he wasn’t and she didn’t, and she’s been working with the Atkins Foundation ever since. She is an RD who, quite literally, wrote the book on feeding cancer patients. When she began her career, doctors didn’t think trying to meet the nutritional requirements of cancer patients was all that important: if they lived, they’d eat again eventually; if they didn’t, oh well. Abby’s book paved the way to the now commonplace understanding that appropriate nutrition could make the difference between the first outcome and the second.

Allison Boomer MPH RD is a food writer who brings her nutrition expertise and love for food together in her work for The Boston Globe and other media outlets. I met Allison when she was working on a piece in about fat and the Dietary Guidelines. It hasn’t always been easy for her to educate the public about the complex realities of how science and policy don’t always match up—she makes her editors rather nervous—but she understands the importance of conveying this information in a readable and entertaining manner. As we see the low-fat tide turning, it is due, at least in part, to efforts like hers.

Cassandra Forsythe PhD RD has worked with low-carb researcher Dr. Jeff Volek, but that doesn’t even begin to describe the breadth of her expertise. She combines a background in dietetics, nutrition, and exercise science with a particular interest in women’s health—especially mommy health. If you happen to be a reader with more of a passion for working out than I have (which is likely to be every reader) or if you are not interested in joining the “fat mother’s club” (as my brother so charmingly described the tendency of bearing children to leave women looking permanently 5 months pregnant), check out her fun/exhausting combination of “cute baby and badass mommy” blog.

Suzanne Hobbs PhD RD comes from a different nutrition perspective than many of the women on my list, but she is—quite literally—the only person in America whose area of expertise encompasses both nutrition care and nutrition policy and politics. She is a lifelong vegetarian who writes a newspaper column highlighting the nutrition benefits of a plant-based diet. But she is no more of a vegetarian hard-liner than I am a low-carb one. Instead, she understands that the food choices that people make are complicated, the environment in which those choices are made is confusing, and the real target of concern—for any nutritional paradigm—should be how to take this big messy picture and frame it in a way that will allow us to improve public health nutrition for everyone, rather than to promote any one nutrition agenda. She helped put vegetarian nutrition on the map in the world of dietitians as well as the world of policy. I’m hoping I can learn from her how to stretch the old “top-down” model of nutrition guidance into a new shape that allows us to start thinking differently about how to accommodate individualized nutrition to a public health framework.

Amanda Holliday MS RD LDN is a mother, wife, daughter, and granddaughter—who never relinquishes the importance of those roles as she juggles multiple professional demands as the Director of the University of North Carolina at Chapel Hill’s Registered Dietitian/Masters of Public Health Program, clinician, instructor, public health leader, and blogger. Her family relationships inspired her specialization in nutrition for older adults, another booming subpopulation of Americans for whom standard one-size-fits-all dietary recommendations are inappropriate. Both fearless and humble, she has more integrity in her pinkie toe than most public health advocates could hope to accumulate in their lives. I think she simply lacks the ability to tolerate hypocrisy. She has a deep appreciation for the power of science to improve patient care; she always insisted that her RD students hold themselves to much higher standards of scientific knowledge and expertise than is actually required for dietitians. She also has a healthy respect for the flaws and limitations of science in addressing the complicated needs of real individuals. She never lets her students forget that they are treating people, not symptoms.

Karen Holtmeier MPH RD LN is the RD counterpart to Mary Vernon’s MD leadership at the American Society for Bariatric Physicians as well as director of her own weight loss clinic. She has been educating dietitians and nurses that work with bariatric physicians about the positive health effects of carbohydrate reduction for over a decade, while remaining active within the RD professional community. Not an easy feat to pull off, but Karen is not only warm, funny, and politically savvy, she’s one of the most intrepid women I know. (Traveling by myself still is a little nerve-wracking–with a husband and three kids, I’m used to traveling in a mangy but secure pack loaded down with coolers, pillows, and a bookmobile’s worth of reading material; Karen thinks nothing of hopping in the car for an extended road trip, by herself, up the US west coast and into Canada—tralala. I love that.)

Kris Johnson RD (retired) is one of those “mystery women” I’d run into all over the internets. Like Carmen Sandiego, everywhere I’d go, she seems to have gotten there first. Outraged and intelligent commentary on the attempts of the Academy of Nutrition and Dietetics to create a monopoly on nutrition guidance?

As a retired and reformed dietitian, I can say flat out, dietitians do not understand all there is to know about nutrition. In fact conventional RD’s persist in promulgating some very bad science, such as the misguided advice to avoid saturated fat and cholesterol and aim for a low fat diet. Much of the really useful nutrition information I learned after I retired.

A science-based view of saturated fat in response to outdated precautionary warnings?

Those who have looked carefully at the research have found no evidence that natural saturated fats or cholesterol actually cause heart disease or any other health problem. . . . Excessive amounts of polyunsaturated fats and the trans fats derived from them are the real problem. The best way to improve important cardiac risk factors, that is increase HDL and lower triglycerides, is to limit carbs and most vegetable oils, while getting adequate natural saturated fats in the diet.

I think one of the coolest things about Kris is that she worked as an RD for 15 years, retired, and—instead of spending all day playing Suduko—then she went on to read and learn enough about the shifting paradigm in nutrition to become a vocal and articulate advocate for change. Amazing. Check her out at www.MercyViewMedow.org.

Amy Kubal MS RD LN is another dietitian who combines her expertise in nutrition with a love for athletics. As part of Robb Wolf’s team, she gives the “mainstream” RD designation a paleo twist. Her ability to bridge both worlds is a welcome sign of the times.

Stacia Nordin RD combines her nutrition expertise with permaculture knowledge and the desire to end hunger in Malawi, Africa in a socially, environmentally, and nutritionally sustainable way. Never Ending Food is a family endeavor she shares with her husband and her daughter (who was born in Malawi). I met her after getting a post about the AND’s campaign to create a monopoly on nutrition guidance yanked from an RD discussion board. Her response was sympathetic and encouraging, and she introduced me to a number of other RDs whose agreed with my position, but who had much better diplomacy skills than I do! (One day, we would like to create a network of nutrition professionals with an array of credentials—RD, CNS, CCN, CNC, health coach—to work together to create an environment where all of us can practice our profession with mutual respect.) In the meantime, Stacia and her family’s work continues to inspire me to think about how to make sure that our food reform efforts begin with the communities that they are intended to serve.

Annette Hunsberger Presley RD, co-author of The Liberation Diet, was censured by the (then) American Dietetic Association for recommending that her clients use butter instead of margarine. When told to review the ADA’s Evidence Analysis Library (whose idea of “evidence” is so limited and biased that I have a hard time typing the phrase with straight face) to get the “facts” straight and renounce this position, she did. Plus, she reviewed the rest of the science on the subject and reached a conclusion—as you may have guessed—with which the ADA was not at all happy. You can read her Hyperlipidemia Report here; it’s a pretty amazing piece of work.

Pam Schoenfeld RD is not only a wife, mother, clinician, and public health advocate, she is also the person I blame for getting me into this mess! Together we started Healthy Nation Coalition, and it’s been quite an adventure.I still have the email she sent Dr. Eric Westman (the MD I worked with at the Duke Lifestyle Clinic), and which he passed on to me, describing some of her experiences as an RD intern. Her passion, concern, and professional assessment of nutrition science were inspiring and contagious. She convinced me that I wasn’t too old to go back to school and that I’d come through the dietetic groupthink hazing intact. She was—more or less—right. She remains my hero, mentor, and dear friend.

Picture Franziska Spritzler RD CDE is applying her nutrition expertise to specifically help patients with diabetes (CDE stands for Certified Diabetes Educator).  As Type 2 diabetes has reached epidemic proportions in this country and across the globe, we seem to have forgotten that it is designated in the prominent physician’s handbook, The Merck Manual, as a “disorder of carbohydrate metabolism,” and that, prior to the widespread use of insulin, Type 2 diabetes was effectively treated with a carbohydrate-restricted diet.   As The Low-Carb Dietitian, Franziska is reviving this wisdom in her own practice and for the benefit of everyone struggling with diabetes.

Joanne Slavin PhD RD was a member of the 2010 Dietary Guidelines Advisory Committee. I started following her through the transcripts of those meetings. What caught my attention was her commitment to 3 things: science, food, and people.  She’s been slagged on in the paleo community for being—gasp—a realist about both food prices and the fact that grains can be a perfectly reasonable source of calories for some people—like the teenage male who lives at my house—who actually need calories and can tolerate-grains-just-fine-thank-you. [Labeling her a “dumbshit nutritionist” is—imho—part of why paleo has good reason to be worried about its own future as a fringe-y food and fitness fad. In the brave new world of nutrition, we have to feed everybody, not just the people who agree with that ideology.]

Here’s our “dumbshit nutritionist” speaking to the Registered Dietitians assembled at the North Carolina Dietetics Association conference in April 2012.  Fangirl that I am, I literally tried to write down everything she said:

“The 1977 Dietary Goals were based on politics, not science.”

“Humans can adapt to a wide variety of diets—from 80% carbs to 80% fat.”

“Increasing intake of plant foods, which are low sources of protein, is a bad idea for growing children.”

“People who eat more carbohydrates weigh less, so eat more carbohydrates. Um, it doesn’t work like that.”

“A lot of people don’t get enough protein because of what they are choosing.”

“Dietary advice often has unintended consequences.”

“Micromanaging the diet by imposing strict dietary rules is difficult to support with evidence-based nutrition science.”

“Pink slime was created to come up with a low-fat, high-protein thing to put into processed food.”

“I believe fat needs to go higher and carbs need to go down.”

“It is overall carbohydrate, not just sugar. Just to take sugar out is not going to have any impact on public health.”

Dr. Slavin is NOT a low-carb or paleo diet advocate; she is simply reporting on the realities of nutrition science and policy. But if you have any lingering concerns about her being a “lackey” for the USDA and food industry, here she neatly and sweetly skewers the whole paradigm:

The 2010 Dietary Guidelines for Americans supports less consumption of sodium, solid fats, and added sugars. Make half your grains whole and half your plate fruits and vegetables. Seems simple for the food industry—keep slashing salt (but make sure my food is safe), get rid of added sugar (but add fruit and fruit extracts to everything), and make chips, pizza crust, cookies, and all other grains “whole” so they are healthy. Probably a good idea to tax soda, outlaw French fries, ban chocolate milk in schools (added sugar is bad, right?), and over-regulate school lunch, restaurants, and food manufacturers. Let’s blame the victim too—we know fat people are lazy, uneducated, and low income—too bad they live in food deserts and don’t have access to fresh fruits and vegetables. Hope my BMI is under 25 today!

Dr. Slavin is a mainstream nutrition expert and RD.  She is also an independent thinker and a true scientist.  The paleo community’s stance in making nutritionists like Dr. Slavin out to be the “enemy” is not only short-sighted and counterproductive, it’s inaccurate.   People like her will pave the way for better public health nutrition for everyone–including those who choose paleo diets.

This list would not be complete without a shout-out to all the dietitians I’ve met at the newly-formed PaleoRD group started by Aglaee Jacob MS RD—who deserves her own hooray (Aglaee, Your Paleo RD! It rhymes and everything!). I hope that the existence of such a group—you don’t have to be “paleo” to join—will encourage other RDs to stand up for their own professional understanding of the science and not feel afraid of being censured. There is strength in joining our voices together.

I’d love to hear about other RDs who share the belief—to paraphrase Kris Johnson—that the Academy of Nutrition and Dietetics doesn’t know all there is to know about nutrition and the conviction that as dietitians and nutritionists, we can and should exercise our professional expertise and judgment to help heal the world through food.

* From:
American Dietetic Association. American Dietetic Association/Commission on Dietetic Registration code of ethics for the profession of dietetics and process for consideration of ethics issues. J Am Diet Assoc. 2009 Aug;109(8):1461-7.

Where the Women Are, Nutrition Edition

I really try not to pout too much when I see lists like the one below from Jimmy Moore’s 2012 survey on “most trusted resources for the information you received about health”:

After pouring through a couple hundred names that people shared, here were the top 10 who made the list in 2012:

1. Mark Sisson (30%)
2. Robb Wolf (23%)
3. Gary Taubes (21%)
4. Chris Kresser (15%)
5. Sean Croxton (10%)
6. Dr. Mike Eades (9%)
7. Dr. Robert Atkins/Atkins.com (8%%)
8. Dr. William Davis (7%)
9. Tom Naughton (7%)
10. Diane Sanfilippo (6%)

But seriously?  ONE woman?  ONE?  That’s it?????? Good grief.

The reasons for this imbalance are another blog post.  Instead, I chose to channel my energies into introducing some women who are leading the way—in their own way—in the world of nutrition.  If there appears to be a  “bias” in that most of these women–in one way or another–suggest that the current “grains are great” approach to nutrition is an unsound approach to good health, you might ask yourself how much that has to do with the prevailing bias within our current, and highly unsuccessful, nutrition paradigm.  These women are leaders, not followers.

To me, they are the Chers, Madonnas  and Dolly Partons of the nutrition world, although with a few exceptions, you may not recognize their names (which I know is part of the problem). Most have them have been around the block a time or two, and they know how the game is played—and rigged. They’ve succeed by being entirely who they are—tough-minded broads, compassionate caretakers, and reluctant warriors in the cause for good health for all.

Some of these women I’ve met, some I know well, some I’ve only admired from a safe distance afar. I wouldn’t expect all of these women to agree with—or even like—each other, or me, for that matter. Some of them may be appalled to find themselves on this list at all. Oh well. I don’t agree with all that each of them has to say, but I embrace the diversity and the chance to recognize some women I think have shown us how to have the huevos we need for the work ahead of us.

So—without further ado, and in alphabetical order (why not?)—here they are.

Judy Barnes Baker brought us this useful meme.

Judy Barnes Baker came this close to getting the American Diabetes Association to publish and endorse her reduced-carb cookbook. When that arrangement fell through, she got her cookbook published anyway and went on to publish another. Like Dana Carpender (see below), she’s been making life easier for those folks who want a low-carb approach to life.

Dana Carpender is a force of nature. She’s been holding the toast since 1996, and with her technogeek husband, Eric, has been able to bring us that message over the web since the dawn of the internet. Her book and cookbooks have been a lifeline for many trying to figure out exactly how to put into practice a way of eating that makes them feel healthy and happy. And boy, does she ever have a mouth on her. Sometimes I think it would be fun to lock her in a padded room with Frank Sacks and see who makes it out intact. I know where my money would be.

Laurie Cagnassola

Laurie Cagnassola, dog-lover extrodinaire, was, until recently, the Director of Nutrition and Metabolism Society, a leading low-carb oriented organization. She managed to gracefully meld the work she did with NMS with her own stance as a vegetarian. While Richard Feinman lambasted the entrenched interests in science and government out front, she worked tirelessly behind the scenes to build the fledgling reduced-carbohydrate nutrition community into a full-grown movement.  I expect we’ll hear more from her in the future.

Laura Dolson’s beautiful Low-Carb Pyramid

Laura Dolson has been writing about the food, science, and politics of low-carb nutrition for over a decade.  As a person who “walks the walk,” her posts on about.com are an informative and realistic guide to carbohydrate reduction.

Mary Dan Eades MD is the beautiful half (okay, the beautiful half on the right, for all you women out there drooling over her husband) of the royal (protein) power-couple of the carb-reduction world, Drs. Mike and Mary Dan Eades. They are the authors of multiple diet and lifestyle books beginning with Protein Power, which helped me navigate my own personal path to health many years ago. She may prefer to focus on singing, traveling, and grandkids now, but her voice is what gave the brilliant biochem wonkiness of Protein Power its warmth, humanity, and accessibility.

Jackie Eberstein RN was Dr. Robert Atkins right-hand RN for many years. She’s soft-spoken, with a backbone of steel and a heart of gold. She thought Atkins was “a quack” when she interviewed for the job. Thirty years later, she was still marveling at the improvement people could make in their health following his diet. But she’s no extremist. She taught me the importance of making sure calorie levels on a low-carb diet were appropriate. She’s got her hands full with her husband, Conrad, a charmer who can seriously rock a bow tie.

Mary G. Enig PhD is co-founder with Sally Fallon Morrell of the Weston A. Price foundation. Her work on fats led her to be one of the first voices raised in warning about the dangers of trans fats—and she’s been battling the seed oil industries attempts to silence and marginalize her work ever since.

Mary Gannon PhD, has—along with her research partner, Frank Nuttall—been working quietly on the low-biologically-available-glucose (inelegantly known as the LoBAG) diet for a decade now, although her work stretches back into the 70s. She is persistent in her efforts to understand the benefits of reduced carbohydrate and increased protein in helping to reverse the symptoms of type 2 diabetes.

Zoe Harcombe has been researching obesity for a couple of decades now. A UK writer, researcher, and nutritionist, her book, The Obesity Epidemic, is giving readers on the other side of the pond a different perspective on nutrition.

hartke is online podcast

Kimberly Hartke puts the “life” in lifestyle changes as the publicist for the Weston A Price Foundation. She’s collected enough stories from being on the front lines of the nutrition revolution to write a book, which I am truly hoping she will do one day soon.

Weigh loss success story

Misty Humphrey’s warmth and humor permeate her writing and advice on diet and health.   If there was ever a way to screw up getting healthy Misty’s done it and she’s honest and funny as she tells her story and helps her readers avoid the same pitfalls.

Lierre Keith’s Vegetarian Myth is not just another story of someone who found that their favored way of eating didn’t work and—prestochango—transformed themselves and their health by discovering The Truth About Food. The power of her book lies in her examination of the beautiful myth that underlies vegetarian thinking—that we can somehow peacefully eat our way to personal and global health without any regard for ourselves as critters who—just like all other critters—must function within an ecosystem that is nothing but one expression of eat/be eaten after another. I like to put her book on the shelf next to Jonathan Safran Foer’s goofball Eating Animals, which amounts to little more than a literary snuggie for vegans (JSF considers the American Dietetic Association the very last word in science-based nutrition information <guffaw>). I expect The Vegetarian Myth to simply drain the ink off the pages of Eating Animals out of sheer proximity.

CarbSane’s Evelyn Kocur, shows us–and the rest of the world–what the focused energy of one cranky woman who thinks we’ve been fed a load of crap looks like. Although I’m not a fan of her style—after years of listening to my mother scream, even reading someone else’s raging makes me want to hide under the bed—I can nevertheless admire the no-holds-barred way she skips the warm fuzzies and goes straight for the jugular. I really wish–every now and then–that I could pull that off.  Even when she’s missed the target by a mile, I have to give her credit for sheer firepower.

Sally Fallon Morrell is the director and co-founder (along with Dr. Mary Enig) of the Weston A. Price Foundation. Sally Fallon Morrell is a mother of four and a force of nature who doesn’t mince words. She’s ticked off at least one person in the paleo movement with regard to her stance on saturated fat, but—as far as I can tell—he’s ended up changing his position on the subject; she hasn’t changed hers.

Patty Siri-Tarino, PhD, is lead author of the meta-analysis on the lack of association between saturated fat and heart disease that changed the nature of conversation about nutrition and prevention of chronic disease.

No pink fluffy weights for Krista Scott-Dixon

Krista Scott-Dixon is the first person I found on the internet who said lifting big heavy things is for women too. She taught me—and countless numbers of other women–how to squat and that feminist theory and nutrition do so go together. And she makes fart jokes. You could really just not bother reading anything else I write and just read her stuff. Case in point: a free e-book entitled, Fuck Calories. (As Krista says: Yes, this book has cuss words. Many of them. Deal with it. Hey, it’s free. You get what the fuck you pay for.) Could she get any cooler? She’s married to a rocket scientist.

Mary Vernon MD has been at the forefront of reduced-carbohydrate nutrition for many years as a leader at the American Society of Bariatric Physicians. This group has partnered with the Nutrition and Metabolism Society to encourage conversation within the scientific/academic/clinical setting about reduced-carbohydrate nutrition: its pros and cons; the science behind it; and its clinical application. When national nutrition policy eventually catches on, it will be due in no small part to the fact that Mary Vernon and ASBP have already been offering this nutrition option to patients for years.

Regina Wilshire is the inspiration for a folder on my desktop entitled, Regina Brilliance. She is full of common sense and uncommon smarts. Wife, mother, and tireless blogger, her Weight of the Evidence (now on facebook too) has been a resource for intelligent and insightful commentary on nutrition since 2005. In the midst of the PubMed duels we so often find ourselves wrapped up in, her posts on eating well on a food stamp budget bring a welcome reality check.

Daisy Zamora PhD fought battle after battle (a story she’s agreed to let me tell one day) to publish her groundbreaking research on why our one-size-fits-all diet may be especially devastating to the health of minorities. It is not difficult to imagine why the powers-that-be would not want this indictment of the failure of our dietary recommendations to be made public. But beyond being a quiet crusader for rethinking our current dietary paradigm, she recognizes the importance and centrality of food in our lives and health. You have no idea how rare it is in the world of academic nutrition experts to find someone who eats and cooks and talks about food—as opposed to nutrients in food—and, get this, appears to actually like the stuff!

Let me know who’s on your list, or who I should add.

Plus, if that’s not enough, I found that, in putting together this list, many of the women I admire in the field of nutrition are–gasp–Registered Dietitians. Since RDs catch so much crap from the rest of the alternative nutrition community about being mindless-Academy-of-Nutrition-and-Dietetics-robots, I thought I’d put together a list of RDs who have inspired me to continue to work towards better health for all, despite our own professional organization’s insistence on using USDA/HHS policy as if it is science and its wince-inducing reliance on both food and pharma funding.

Next up: Where the Women Are, RD edition.

Why Fat is Still a Feminist Issue

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

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

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

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

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

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

[circa 1980]

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

[bacon eggs frowny face, circa 1984]

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

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

[Jane Fonda circa 1982]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I want my hour a day back?

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

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

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

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

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

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

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

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

References:

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

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

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

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

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

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

N of 1 Part 5: A Different Question

The magic formula

My friend, Andrew Abrahams, puts the current “diet wars” situation this way:

1.  the n of 1 view:  what works for you is what works, this is all that matters, end of story.

2.  the Platonic view: this is how your body/metabolism works, and so this is what you should do and if it isn’t working you probably are not doing right.

I think many of us start off being interested in nutrition because we like to know stuff, and knowing stuff about how to be healthy and fit is really cool because then you get to look better in your bathing suit than most or you can solve health problems that others can’t or any number of other minor acts of smug superiority masquerading as an objective search for knowledge. When we start out, we usually are completely immersed in perspective #2, that there is a “right” way to eat and exercise. We figure out what the “right” way is through various forms of scientific investigation/reporting brought to us by experts and/or the media; we apply that magic formula to ourselves, and we wait for the magic results to happen. If we are young and unencumbered by reality, they usually do—no matter what formula for fitness and health we’ve chosen from the ones offered by the experts—and we congratulate ourselves for our hard work and strength of character.

Enter reality. Crying babies. Crazy work hours. Demoralizing paychecks. Chronic injuries. Insane parents. Needy friends. Crying, crazy, demoralizing, chronically insane, needy life partners (No, my dear sweet rockstar hubby, I certainly couldn’t have had you in mind when I wrote this.)

A little reality can drop-kick your magic fitness formula into outer space.

For many of us, somewhere along the line, the magic formula stops working, or we stop working at the magic formula, or a little (or a lot) of both.

Some of us respond to this by looking for the next—better, easier, quicker, more doable—magic formula. Some of us respond by working even harder at the magic formula we haven’t given up on—yet. Some of us give up looking and trying because life is hard enough already.

But that doesn’t mean we’ve given up on the idea that there is a “right” way to go about being healthy. I was a low-fat vegetarian eater for 16 years because I thought it was the “right” way to eat. I’ve been a (mostly) low-carb, animal eater for 13 years, during most of which I thought I’d—finally—found the really “right” way to eat.

What I’d really found was a new and different way to be wrong.

I wasn’t wrong about the diet plan–for me. It helped me lose 60 pounds that I’ve kept off for 13 years without hunger, without a calculator, and without having to exercise more than I want to. What I was wrong about was being right. I was wrong about the magic formula—any magic formula.

[In blog posts yet to come, I’ll tell you all the story of the woman who changed my perspective on everything.]

I hate being wrong (although goodness knows I’m really good at it, from years of practice). I really want there to be a formula, magic or otherwise. I like order, routine, facts, and answers. Gray areas make me woozy. That’s why I love biochemistry. It’s a game with nothing but rules that, literally, every body has to follow.

But, to quote Andrew Abrahams again, a detailed understanding of the minutiae of biochemical mechanisms doesn’t really help us in the big messy world of real people. Although everyone is subject to the same biochemical rules, how those rules play out in any given individual is difficult—perhaps impossible—to predict.

I salute the work that Gary Taubes and Peter Attia are doing with NuSI, which will focus on providing randomized controlled experimental evidence regarding nutritional interventions. The idea is to have both highly controlled experiments and more “real world” ones. Hooray for both. These experiments may help us understand how well certain nutrition interventions work—in experimental situations with a selected group of individuals. As awesome as this might be for a scientific pursuit, this science still may not be of much help for you personally, depending on how closely matched you feel your life and your self are to the experimental conditions—and it won’t provide any easy answers for the hardest issue of all, public health policy.

One big long experiment

Is there a way to round up our messy, individual realities into comprehensible information that will eventually translate into meaningful policy? Maybe. Andrew Abrahams and others in the ancestral health community have been tossing around the idea of “n of 1” nutrition for a while. The basis for this approach is the idea that we all experiment. In fact, life is one big long experiment.

But how do we conduct these “n of 1” experiments in a manner that

  • helps the person doing the experiment learn the right lessons (rather than be distracted by coincidences or random events)?
  • helps the clinician give better nutrition guidance, not of the “one size fits all” variety?
  • helps the field of nutrition science develop more meaningful methods of investigation, especially with regard to long-term health and prevention of chronic disease?
  • helps us renegotiate the top-down, one-size-fits-all framework of current public health nutrition policy?

Andrew Abrahams had the brainchild of setting up a community for n of 1 nutritional experimentation to do exactly this.

As Andrew says, and I agree, individual characteristics, circumstances, and history are tremendously important as far as choosing food and activity that works for you. His idea is to create a way to help people with this n of 1 experimentation so they can evaluate how their body will respond to changes and find what’s right for them.

The purpose of this community would be to capture the wide variety of attributes that may contribute to the outcomes for any individual, and provide modeling tools that can help people make the right decisions about what changes to make.

From a participant’s perspective, it would:

  • provide a way for you to observe and analyze personal health in an organized and (more or less) objective fashion
  • give direction, support, and structure to your own n of 1 experimentation
  • create a community of fellow experimenters with whom you could compare/contrast results

From a health professional’s perspective, it would:

  • provide a way to assist clients/patients in find what works best for them without a superimposing “it’s supposed to work this way for everyone” bias
  • create a set of algorithms for adapting common patterns to individualized recommendations and further experimentation
    • For example: A postmenopausal female who wants to lose weight may start one way and experiment in a series of steps that is different from, say, a 30-year old marathoner who wants to have a healthy pregnancy.

From a researcher’s perspective, it would:

  • create a way to structure and conduct experiments across a variety of nutritional (and other) factors
  • allow sharing and analysis of both pooled results and case studies/series of relevant community members or subpopulations with common characteristics
  • develop tools allowing one to interpret the community results in an individual context, make predictions and suggest “next steps”
  • contribute to the development of modeling systems for complex and interrelated inputs and outputs

A different question means a different approach to public health

I see the value of n=1 as a scientific pursuit because it will teach us to ask a very different question than the one we’ve been asking.  We’ve been asking, “What way of eating will prevent chronic disease in most/all Americans?” Typically, nutrition epidemiology is recruited to try to answer that question with the idea that there is some factor or factors (like smoking and lung cancer) that can be included/eliminated to reach this goal.  We’ve been so phenomenally unsuccessful at chronic disease prevention with our current population-wide model that I think a new framework of investigation is needed. Thus, n of 1 investigation changes the question to something more like: “What way of eating will bring improved health to you now?”

As people make incremental changes toward shorter-term personal health goals, modeling tools can be used to map out “nearest neighbor” communities. These communities may be similar in terms of personal characteristics and health history, but also attributes relating to culture, region, lifestyle, ethnic and family background, education, income, etc. Over time, this information will reflect long-term health outcomes built on a background of complex human traits interacting with complex human environments.

The complexity of n of 1 nutrition seems to be the very opposite of public health nutrition. And it would be naïve to think that the concept of n of 1 will not be at least partially co-opted by the food, drug, and research industries (“Try new Methylation Carbonation –for PEMT polymorphisms!”).  But by its very nature, n of 1 nutrition resists being turned into yet another “magic formula.”  More importantly, it reframes our current approach to public health nutrition along two very important lines:

First, it weakens the current public health message that a one-size-fits-all dietary recommendation is appropriate. This is especially important because it has been assumed for 30+ years that dietary recommendations that are normed on one population are equally applicable to other populations. A landmark study published in 2010 shows that African-Americans who consumed a “healthier” diet according to Dietary Guidelines standards actually gained more weight over time than African-Americans who ate a “less healthy” diet [1].

DQI stands for Diet Quality Index. Blacks with a higher DQI had more weight gain over time than blacks with a lower DQI. From [1]



Second, n of 1 nutrition emphasizes the need to return to a focus on the provision of basic nutritional needs rather than prevention of chronic disease.  Balancing the complexity of the n of 1 concept (i.e. each human is radically different from another) with the simplicity of promoting/understanding essential nutrition (i.e. but each human shares these same basic needs provided by food) moves us away from the prevention model to the provision model. And the literature is pretty straightforward about what our basic nutritional needs are:

  • essential amino acids
  • essential fatty acids
  • vitamins and minerals
  • sufficient energy

Notice anything missing on that list of essentials? As the Institute of Medicine’s Food and Nutrition Board says: The lower limit of dietary carbohydrate compatible with life is apparently zero” (DRI, Ch. 6, 275) [2]. This doesn’t mean you can’t or shouldn’t eat carbohydrate foods, or that some carbohydrate foods aren’t beneficial for some people or even many people. Indeed, some of my best friends are carbs. But dietary carbohydrate is not an essential component of our nutritional needs and never has been (although it is a fine source of energy if energy is what is you need and you aren’t wearing a 6-month supply on your backside like I am). Rather, carbohydrate has been recommended as the source of the majority of our calories as a means of replacing the fat, saturated fat, and cholesterol that we’ve been told cause chronic disease.* This recommendation seems to have conveniently upsized the market for the industrialized and heavily marketed foods—made mostly from corn, wheat, and soy—that take up most of the space on our grocery store shelves.

But I think the most significant ramification of the history of our Dietary Guidelines is not its effect on diet so much as the acceptance of the notion that something as intimately and intricately related to our health, culture, personality, lifestyle, family, and history as food can and should be directed—in a most comprehensive manner—from a place exceedingly remote from the places where we actually get fed.

Focus on community

While the ostensible focus of n of 1 nutrition is the individual, the real focus is the community. Advances in both biological and social sciences are increasingly focused on what are now considered to be the primary determinants of health status for an individual: that person’s genetic community and that person’s present community. What health behaviors you as an individual think you “choose” have already been largely determined by social factors: culture, socioeconomic status, education, etc. Those behaviors interact with genetic and epigenetic mechanisms that you didn’t have much choice about either. Although every individual has some control over his/her health behaviors, many of the health outcomes that we think of as being a result of “individual choice” are already largely predetermined.

One of the enduring myths of healthcare in the US is that there are some folks out there who “choose” poor health. Maybe there are, but I’ve met a lot of people in poor health, and I’ve never met anyone who deliberately chose it.

As we find virtual “nearest neighbor” communities in our n of 1 nutrition database, we may be able to use this information to assist real communities to develop their own appropriate food-health systems. Despite our increasing diversity, much of America still clusters itself in communities that reflect shared characteristics which play leading roles in health and health behavior. Culturally-influenced food preferences and nutrition beliefs may be part of that community formation and/or may reinforce those communities. With scientific tools that embrace complexity and diversity, we can honor those characteristics that make one community (real or virtual) different from the next, rather than ignore them.

N of 1 nutritional approaches will give us a new way to think about public health nutrition and the individuals and communities most affected by nutrition policy. I’m proud to say that Healthy Nation Coalition will be supporting the project.

Up next:  My take on why nutrition is a feminist issue, or “I am Woman, hear my stomach growl.”

*While on a field trip to Washington, DC in January of 2010, I met Linda Meyers, one of the authors of reference #2 below. I asked her why carbohydrates were recommended as such a large part of our diet if there is no essential requirement for them. Her response was that the recommendation was based on prevention of chronic disease. I’m still not sure I get that.

References:

1. Zamora D, Gordon-Larsen P, Jacobs DR Jr, Popkin BM. Diet quality and weight gain among black and white young adults: the Coronary Artery Risk Development in Young Adults (CARDIA) Study (1985-2005). American Journal of Clinical Nutrition. 2010 Oct;92(4):784-93.

2. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients) (2005)

From Paleo to Public Health: We have met the enemy and we are them

Believe it or not, when I started this blog post, I wasn’t even thinking about the current sturm und drang in the paleo community. If you follow the paleo world gossip, you already know about it; if you’re not, this cartoon from xkcd.com says it all:

So—speaking of drama—social change stories are often built around drama triangles—also called triangles of power. In these triangles, there are three roles: victim, perpetrator, and rescuer. These roles can morph and change over time and depending on who is telling the story or who the audience is. In addition, a person or entity can be in more than one role at a time. [Note: This doesn’t mean that anyone actually IS a victim, perpetrator, rescuer; this is a construct used to describe a social dynamic, not enforce one.]

From the works of Eric Berne and Stephen Karpman.

We can think about this model in regard to the current commotion in the paleo community, but–more to my point–also in regard to the work we may be able to do as a community should we decide to get our collective act together and worry about something larger than ourselves for a while. (Perhaps we’ll need social media group therapy, culminating in a giant Skype conference call, where everybody joins twitter feeds and sings Kumbaya?)

There is value in the power of story-telling; the drama is part of what makes us want to be involved in cause. We can typically identify with the victim or the rescuer, or both; the perpetrator gives us a bad guy in an undeniably black hat on which to focus our things-we-love-to-hate passion. Policymakers often prefer stories to logical arguments; many of us do. But stories can also create false simplicity and black and white reasoning. They can create artificial walls and boundaries. Most dangerously for the nutrition reform movement, these stories can create a lack of respect for those we are trying to help (“We know what is best for you”) and a lack of humility with regard to our own fallibility (“We have the “right” answers this time”).

As nutrition reformers—from paleo to public health—what story are we going to tell?

We must be sensitive in our choice of who we place in the “victim” role. The “victim” is the one that pulls at our heartstrings, that gives the story its emotional weight. I think the real victims in the nutrition reform story are our next generation, the children who are not yet born but who will bear the burdens of a broken food-health system as much of the American public gets caught in a cycle of being misled, misfed, misdiagnosed, and mistreated. These are children who will grow up in a nation where the dream of good health belongs to a fortunate few and slips from the grasp of everyone else despite all good intentions and efforts otherwise. And because these particular victims don’t exist (yet), it saves us from the awkward position of “rescuing” people who don’t consider themselves to be victims.

Some people who are suffering from obesity and poor health today (some of us even) may see themselves as victims and choose to use the sense of outrage at being put in that position to help change the system. But not everyone will choose that role, and I suggest we not take the stance that “poor fat sick people” out there need our help.

It isn’t as if we have a shortage of casualties from the past 30-40 years of USDA/HHS dietary guidance. How about the environment, small farmers, taxpayers, or maybe the scientific integrity of a whole generation of nutrition scientists? In 1978, Dr. Al Harper, from the University of Wisconsin-Madison, warned that the Dietary Goals’ promise of better health for all with no risks, only benefits, had ” great potential for undermining both the science of nutrition and nutrition education” [1]. It would seem that to a large extent, he was right. As a nation, we’ve lost a lot in thirty years.

So who is to blame? Hmm. Good question.

Government?

Policymakers doing what policymakers do: making policy.

Well, it is hard to pin this all on a disembodied “government” because the government does what we allow it to do. As long as we the people allowed segregation, it continued. When we decided that segregation was no longer tolerable, laws were created to end it. Changing attitudes will change the institutions that in turn shape attitudes.

It doesn’t make a lot of sense to blame “the government,” when the general public has not developed a mature sense of healthy skepticism towards the government’s ability to protect us from ourselves. When the first Dietary Goals were released by the McGovern Committee in 1977 and the first Dietary Guidelines released by the USDA in 1980, the public could have refused to believe the low-fat-jello-pie-in-the-sky promises, but they didn’t—for reasons that may be more cultural than scientific in nature. I’m not convinced we would do so under similar circumstances today. Although we may now be more wary of the government’s ability to solve our problems, we tend to still hold out a childish hope that it will anyway. [Funny, to me anyway, story: It seems that a number of us who showed up for the paleo-libertarian dinner at AHS2012 were there less because of our libertarian ideals and more because we were happy to have someone else choosing our dinner destination and making reservations for us. Just a touch of irony there.]

In 1977 and in 1980, policymakers were applying the information that they had at the time to a well-intentioned goal of improving the health of all American; this is just the type of thing we expect from our policymakers. Did they seem to favor one side of the argument? Sure, but do we really think that—if we were in their position—we could work with complete objectivity? We couldn’t; there is no such thing. As we try to change public opinion and government policy, we will be working under the same constraints of humanness they were, with the only added advantage being that we can learn from the unintended consequences of these good intentions.

Industry?

Low-fat, whole grain, fiber-filled box of food: more nutrition information than actual nutrition.

Should we blame “the food industry”? We could.

Gary Taubes tells the story of one of the staff members of the McGovern Committee being approached by an industry analyst who tells him, “if you think people are going to start eating more broccoli and more kale and spinach because you’ve now put together dietary goals, you’re crazy. What you’ve said is people should eat less fat so the industry is going to jump on this and they’re going to create low fat products and they’re going to label them as heart healthy or whatever and they’re going to be able to carve out a portion of the market for their new products and everyone else is going to have to play catch-up and that’s what they’re going to do and the next thing you know you’re going to have shelf after shelf in the supermarket of junk foods that claim to be low fat and good for your heart.” As Gary Taubes points out, that’s exactly what happened. But is this the fault of industry?

Industry follows laws of supply and demand, using government recommendations as a marketing tool. Americans were happy to consume the products designed to lower our cholesterol and prevent heart disease then, because we thought doing so would contribute to good health. Now we, as a community hoping to expand our influence out to the rest of America, are happy to consume gluten-free snacks, grass-fed beef, and pemmican—for the exact same reason, because we think doing so will contribute to good health. We might have been sold a bill of goods by the food industry in the past 30 years, but by golly, we bought it.

Addressing the economic engines that make our food-health system go around is part of our challenge in shifting the paradigm. Working with the producers, especially the one at the bottom of the industrialized food chain, and the retailers, who must meet changing consumer demands—rather than lumping everyone together and clamping a big black hat on the whole thing—is a lot more likely to lead to success.

If there is a lesson to be learned here, maybe it is that we should be cautious about what health information we allow to be used on packaging and marketing, no matter what the nutrition paradigm. I don’t agree with Marion Nestle on much, but I agree with her that a box of food is no place for a tutorial on nutrition.

Science?

The only really bad scientists I know.

What about “bad science”? Isn’t that what got us into this mess?

I get the impression that a lot of us would like to blame “mainstream” nutrition—whomever or whatever that is—and the “bad science” it produces. I would offer some strong caution against this.

We want a different nutrition paradigm–specifically “our” paradigm, whatever that will be–to be “mainstream” one day, but it is a very tenuous position to say “they got it all wrong, but don’t worry, this timewe got it right.” All scientists are both trying to make a living and trying to improve the health of Americans. No scientist can control how his/her work is used (or misused) for public health policy. The scientists who have contributed to our current nutritional paradigm have been working–as all scientists do–within a framework shaped by personal experiences, cultural forces, financial pressures, political and career concerns, powerful individuals, and media soundbites.  The next generation of scientists will be no different. When scientists are asked to work on committees that create policy, they do, of course, bring to that work a more comprehensive understanding of their own area of study than of an area that offers a competing view.  The practices behind policy-making are responsible for making sure such views are balanced, not the scientists themselves.

In the early years of the Goals and Guidelines, a number of scientists did complain about the prematurity of those recommendations. I think most of us would like to think we’d be among those skeptics, but I’m not sure that we would. For the most part, people who then worked in the field of nutrition— dietitians, clinicians, young scientists—embraced these new dietary recommendations as progressive and much needed. Dr. Joanne Slavin told me the story of how the younger generation in her Department of Nutrition at the University of Minnesota thought Dr. Harper (see the quote above) was “behind the times” because he didn’t think it was such a great idea to tell everyone to reduce their fat intake. When we established policy to give an institutional framework to an ideal that was waiting for the science to catch up with it, we failed to prepare for the possibility that we might be wrong. If there is one lesson to learn from the past 30 years of interaction between nutrition science and public health policy, it is that we should prepare for that possibility.

Us?

To a large extent, the cultural forces that shaped our thinking about nutrition (and which in turn helped carry the scientific, policy, and industrial forces forward) were an extension of the culture wars of the 60s and 70s: suits vs. hippies. The suits (maybe the “lab coats”?) were the stodgy pinhead scientists, fiddling away in their labs, waiting to get the science “right,” while the country went to hell in a hamburger. The “hippies” of the McGovern committee—along with popular figures like Frances Moore Lappé, author of the wildly popular vegetarian cookbook, Diet for a Small Planet –saw changing the diet of Americans as a moral imperative that eclipsed concerns over the weak associations with diet and disease outcomes. This gave the low-fat diet an Age of Aquarius glow that offered a shiny new hope for ending chronic disease, and we swallowed it hook, line, and sinker.

Labeled the “barefoot boys of nutrition,” the creators of our first national dietary recommendations were a team of young, energetic, long-haired (for DC anyway)—and not coincidentally, white, well-educated, upper/middle class and male—idealists hoping to convince Americans to eat a more “natural” diet, a vision of the lead writer for the group, Nick Mottern, who remains a staunch advocate of minimally-processed foods (and who has never, by the way, been a vegetarian) [2,3]. With the exception of the food from animals vs. food from plants orientation (and I think we have more women in places of influence), how different is the paleo community from these origins?

In other words, in the immortal words of Pogo: We have met the enemy and he is us. “Us” is (upper) middle class, well-educated, young white people with an idealistic plan to change the world for the better. Now of course I don’t mean you or me personally. We can all find ways to excuse ourselves from this stereotype (I for one can claim that I’m not young—but otherwise, the description pretty much fits me exactly). But there is a lesson here to be learned: in creating an “enemy” to fight in the nutrition revolution, we had better choose very carefully. Let’s choose an “enemy” we actually want to eliminate permanently (i.e. not us).

I suggest that we not make a person, a group, an entity, or an institution either scapegoats or the enemy. Then who or what is to blame? What do we want to get rid of entirely?

Well, how about poorly-designed policy? Maybe one-size-fits-all guidelines (assuming we can agree that this concept should be eliminated)? Maybe a food-health system that lacks transparency, public involvement, and checks and balances? Maybe we could get rid of the framework that excludes the concept of food culture from any discussions about food policy?

If we can do that, it opens up the last piece of the triangle–the “rescuers”–to anyone who cares about the health of Americans: policymakers, health professionals, the public, food producers and manufacturers, scientists (even the nutrition epidemiologists whose science many of us love to hate), or, umm, maybe even each other.   If we can see a place for all of these groups, and all of us already in the “alternative nutrition” community, in shifting the future of America away from policies that have created little hope for the health of our next generation, we may begin to see them as allies (or at least future allies), rather than enemies. As such, we can enlist their help rather than trying to blame them or defeat them.

Right now I’m thinking we may need to try this out in our own little paleo/low-carb/WAPF/etc. communities first.

1. Harper AE. Dietary goals-a skeptical view. Am J Clin Nutr. 1978 Feb;31(2):310-21.

2. Broad, WJ. Jump in Funding Feeds Research on Nutrition. Science, New Series, Vol 204. No. 4397 (June 8, 1979). Pp. 1060-1061 + 1063-1064.

3. Mottern, N. Correspondence.

From Paleo to Paradigm-Shift: Building a Nutrition Reform Network

Brief recap: What can we do to transform this paleo-led, Ancestral Health Society-supported community into the public health, human rights revolution it could be?

According to Doug Imig at the University of Memphis, a protest becomes a movement when:

1) It defines and proclaims widely shared cultural norms.

2) It creates dense social networks.

3) It gives everybody something to do.

The first part of this process can seem daunting. What “shared cultural norms” do we have with other movements and organizations? I’ve spent the past couple of years trying to find common ground, including a semester in Washington, DC where I met people from many different organizations interested in policy, food, and nutrition reform. I’ve also quizzed lots of folks within the nutrition science establishment about basic principles with which we can all (mostly) agree. What I’ve found has led me to propose the following “shared cultural norms”:

  • Open, transparent and sustainable food-health systems will benefit all Americans.
  • There is no single dietary approach that will result in good health for everyone.
  • Nutrition messages are constructed and have embedded values and points of view.

[For an expanded discussion of these principles, see The REAL Paleo Challenge.]

“Shared cultural norms” become shared goals, and with shared goals, we can move together in one direction. Leading—and following—with humility and generosity will go a long way towards the next step: creating a large, dense social network of people willing to work together toward these common goals.

So let’s first take a look at the humility and generosity thing:

For paleo leaders, this begins at home. If you don’t write your own blog posts or research all your own material, be up front about the fact. Give credit to those who do the work for you. Believe it or not, there are people out there—your readers—who think that you do ALL of that work. Letting them know you don’t—and giving a name and a face to the people who help you out—takes you off a pedestal and lifts up the folks in the background. Don’t worry; there’s room enough for everyone. If inspiring people to get fit and healthy is your thing, inspire them to look at the bigger picture too. Insist on scientific integrity from yourself and others. Everybody makes mistakes, overstates the facts, fails to fact-check a source thoroughly or read the original materials carefully and critically; sometime new evidence or a new perspective changes our minds. Be humble in your claims about what food/nutrition can do and avoid nutritional scare tactics and absolutism. No one has all the answers.

For paleo followers, refuse to be captured and captivated by labels, leaders, controversy, and coolness. If thinking for yourself is what brought you to the paleo community in the first place, don’t check your brain at the door when you start listening to the folks you consider to be the experts. Don’t let the folks that you admire slide just because you agree with them or because you’re on the same side of the issue. If getting fit and healthy by following one of those inspiring leaders is what brought you, take it upon yourself to challenge them—and yourself—to look beyond personal health to the health of your community. Allow your paleo heroes to be human; no one has all the answers.

A sense of strength and unity within the paleo community will allow us to turn our sights and energies outward, rather than inward. I’m pleased to say that I think this has already begun. There has been a lot of reaching out to the other “alternative” nutrition communities, and I think we can give a great deal of credit to the folks at Ancestral Health Society for creating a space for this to happen. AHS and the paleo community is where the other alternative nutrition communities, Weston A Price Foundation and the low-carb folks, seem to intersect. At AHS2012, primalebrities Robb Wolf and Mark Sisson signed on as WAPF members and low-carb leaders Richard Feinman, Andreas Eenfeldt and Jimmy Moore were welcomed as respected members of the paleo community.

Robb Wolf and Mark Sisson truly leading the way to a paradigm-shifting network of nutrition reform. Photo courtesy of Ancestralize Me’s Laura Schoenfeld.

We can strengthen these connections by getting to know each other better, attending each other’s conferences, sharing information across groups and blogs, and by remembering that we are all working towards the same goals, even if our particular dietary approaches differ. We can all continue to support and promote AHS even if we don’t match the paleo template exactly. WAPF has a strong grassroots community; there is likely to be a chapter near you where you will find kindred spirits. I hope I don’t have to sell anyone on promoting Peter Attia’s and Gary Taubes’ NuSI once it is launched. For that matter, publicize the work of Healthy Nation Coalition (this would be my own agenda of course) and join us in trying to figure out ways to make this a long-term, self-sustaining social movement for everyone.

Cohesiveness within the movement will allow us to expand our diplomacy to other food and nutrition reform arenas. Remember, we don’t have to agree with everything another community may say or do, but if we have some common ground, we should build on it. Here are a few examples of organizations with which we may share common values (I’m sure you all can think of more):

Common ground? Probably, unless you think Twinkies are paleo.

Paleo leaders, you can open your doors a bit more. Find out what you can do to reach across nutrition reform community boundaries. It will broaden your audience base and the reach of your nutrition message, as well as help create a network of like-minded groups. Put as much effort into finding common ground with those whose general perspective you are not sure you quite align with as you do into ripping up the science you don’t agree with. Although there is no reason not to call out poorly-designed and -reported science when it shows up, be humane, humble and transparent when you do. Frequently it is underlying policies and paradigms at fault (perpetuated by media coverage), not the science or the scientists per se. Paleo leaders, not only can you get a low-carb or WAPF leader to do a guest post or interview, you could invite a vegan to help you find common ground within your two communities. See what those folks in the permaculture groups are up to and publicize it. There is some ridiculously awesome stuff going on that just happens to be, by default, mighty paleo-like. We should be supporting projects like The Food Web because, although not everyone is going to want to raise chickens, if we are going to talk sustainability, animal welfare, and support for small farmers—and I hope we are—the folks in the permaculture community are where the rubber meets the road.

Abe Connally and family explain permaculture at work. Result? A sustainable—and paleo—food system. Click on the picture to find out more.

For paleo followers: Reach across boundaries yourself—we have much to learn from each other and more similarity that we want to think we do. Next time you attend a paleo event and you see a person who doesn’t “look the paleo part,” go up to them and introduce yourself. Tell your story and listen to his/hers.  It actually might be more informative than standing in line to ask Mark Sisson if he thinks shirataki noodles are “primal.” Volunteer with AHS; join WAPF; check out Healthy Nation Coalition. We’re not cool or hip and frankly, our mission is more to get behind everybody else and push than get out front and lead, but we do good work.

And paleo followers, you can do something the paleo leaders can’t do (and isn’t that fun to know?). You can take this message out into your professional or academic world and treat it as a serious subject for closer examination in fields like: American studies, education, sociology, human development, maternal and child health, communication, ecology, political science, economics, psychology, health policy, etc. Doing this legitimizes the paradigm shift that is already underway. If you are concerned about sounding like a nutcase (because many outside of alternative nutrition communities have only been exposed to our default “healthy diet” definition), refer to the “shared cultural norms” above–they travel well. If we begin to look at the past 30 years of national nutrition policy as the cultural phenomenon that it is, we can begin to entertain the notion that perhaps it is time to move on.

Scientific measurements of skull sizes use to “prove” racial superiority? Science is shaped by culture; nutrition science is no different.

Consider Prohibition or the civil rights movement. Both were cultural events or paradigms where science was invoked to either defend or to undermine specific cultural norms. Our science has not magically become more “objective” since then; it is only in retrospect that we can see how cultural forces shaped the prevailing paradigms. Paleo followers can have that conversation in any arena that may be applicable, and use our dietary guidelines as an example.

Changing attitudes will change the institutions that shape those attitudes. But the biggest roadblock to shifting the paradigm remains.

A paradigm shift in—in science and in culture—must preserve, not trash, much of what has come before and recognize the advances made by those who have preceded us, even if (and maybe in this case, especially if) they are on the other side of the paradigm shift. Honestly, we have a really hard time with this, and I think this remains our primary challenge.

Next up: A place for everyone—including nutrition epidemiologists?