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.

Advertisements

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?

The REAL Paleo Challenge: How NOT to be Just Another Elitist Fad for Skinny White People Wearing Goofy Shoes

The blogsphere is beginning to rattle with commentary on the recent Ancestral Health Symposium 2012 events. Some folks who don’t necessarily “look the paleo part” have voiced concern about feeling excluded or marginalized as the conversation/social activities/celebrity parade seemed dominated by:

  • white people
  • young people
  • thin/athletic/fit people
  • men
  • well-educated, upper-middle class socioeconomic status people
  • people wearing goofy-looking shoes

You can read my take on why that might be the case here: AHS 2012 and the BIG BUTT: Lessons in Nutritional Literacy.

I understand that an NPR reporter was at the event, interviewing some of the movers and shakers. There was some concern that the reporter seemed to think that the paleo movement is a bit of an elitist fad. I understand this perspective, and on many levels, I agree.

As a “fad,” the paleo movement is a bunch of highly enthusiastic people with a lot of disposable income and time who are deeply committed to a particular way of being fit and healthy. It has its leaders, it controversies, its “passwords” (can you say “coconut oil” or “adrenal burnout”?), and its stereotypical paleo dude or dudette. As a fad, it would be destined to go the way of all of other diet and health fads—including Ornish and Atkins, Pritikin and Scarsdale, extending all the way back to the “Physical Culture” movement of the earlier part of this century (Hamilton Stapell spoke about this at AHS2012).

The original paleo chick – no high heels on this lady

Is it elitist? Well, there are some ways that it is possible that the paleo movement may marginalize the very folks who might benefit most from its efforts. Maybe an African-American guy still sensitive to the fact that his grandfather was consider “primitive” might not want to get his full cavemen on. Maybe a Mexican-American woman who remembers her abuela telling her stories about being too poor to have shoes doesn’t really want to go back to being barefoot just yet. Maybe an older, heavier person simply feels intimidated by all the young healthy fit people swarming to the front of the food line.

But the paleo movement does not have to be an elitist fad unless insists on limiting itself to its current form, and I believe the people at the Ancestral Health Society  are working hard to make sure that doesn’t happen. This is why I really love these folks. I don’t mean the paleo leaders like Mark Sisson or Robb Wolf, although I’m sure they’re good people; I’ve just only met them briefly. I mean those somewhat geeky-looking-in-an-adorable-sort-of-way folks in the brown T-shirts who hung in the background and made it all happen for us last week. Notice that they don’t call themselves the Paleo Health Society, right? I love them because they ask good questions, they question themselves, they think long-term, and they’ve created a community that allows these conversations to take place.

So, what do we do to transform this paleo-led, AHS-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.

Each of these deserves its own blog post, so let’s look at the first—and most important—item: widely shared cultural norms. This is where the “elitist fad” part of paleo falls short, but not really. Because in all my encounters with paleo folks and people from AHS, I find norms and values that the culture as a whole can embrace. Here’s the weird thing, I’ve spend the past couple of years also talking to mainstream scientists, from one end of the diet spectrum to another, including Joanne Slavin, a down-to-earth, warm, wonderful lady who was on the most recent Dietary Guidelines Advisory Committee and Henry Blackburn, who is a delightful gentleman and a protégé of Ancel Keys. Guess what? We all have some values in common.

Here are some concepts that I think may unite us all, from vegan to primal, from slow food to open government, from “mainstream” scientist to “fringe scientists” like Gary Taubes (yes, one of my UNC instructors referred to GT as a “fringe scientist,” although another found his views “very convincing”—go figure):

We must create an open, transparent, and sustainable food-health system.

The RD that inspired me to take an internship at the American Dietetic Association for a semester, Mary Pat Raimondi, said: “We need a food system to match our health system.” And whatever shape either of those systems may take, she is absolutely right. Conversations about food must encompass health; conversations about health must encompass food.

Right now our food-health system is closed. Directives come from the top down, public participation is limited to commentary. The people who are most affected by our nutrition policies are the farthest removed from their creation. We need to change that.

Right now our food-health system lacks transparency. USDA and HHS create nutrition policy behind doors that only seem to be transparent. Healthy Nation Coalition spent a year filing Freedom of Information Acts in order to get the USDA to reveal the name of a previously-anonymous “Independent Scientific Panel” whose task, at least as it was recognized in the Acknowledgments of the Dietary Guidelines, was to peer-review “the recommendations of the document to ensure they were based on a preponderance of scientific evidence.” You can read more about this here, but the reality is that this panel appears to not be a number of the things it is said to be. This is not their fault (i.e. the members of the panel), but an artifact of a system that has no checks and balances, no system of evaluation, and answers to no outside standards of process or product. This must change.

Our food-health system must be sustainable. And Pete Ballerstedt would say, yes, Adele, but what do you mean by “sustainable”? And to that I say—I mean it all:

Environmental sustainability – Nobody wants dead zones in the Gulf or hog lagoons poisoning the air. But environmental sustainability can’t be approached from the perspective of just one nutritional paradigm, because a food-health system must also have:

Cultural sustainability – We are not all going to become vegans or paleo eaters. Our food-health system must support a diversity of dietary approaches in ways that meet other criteria of sustainability.

Economic sustainability – Our food-health system must recognize the realities of both producers and consumers and address the economic engines that make our food-health system go around.

Political and scientific sustainability – Our food-health system must become a policy dialogue and a scientific dialogue. Think of how civil rights evolved: an equal rights law was passed, then overturned, a Jim Crow law was passed, then overturned, an equal right law was passed, then upheld, etc. etc. This dialogue reflected changing social norms and resistance to those changes. But we have no way to have a similar sort dialogue in our food-health system.

What would the world look like if, in 1980, an imaginary Department of Technology was given oversight of the development of all knowledge and production associated with technology? Production of food and knowledge about food (i.e. nutrition) became centralized within the USDA/HHS in 1977-1980 and there have been no policy levers built into the system to continue the conversation, as it were, since then. The Dietary Guidelines have remained virtually unchanged since 1977; our underlying assumptions about nutrition science have remained virtually unchanged since 1977. That’s like being stuck in the age of microwaves the size of Volkswagens, mainframe computers with punchcards, and “Pong.” We need a way for our food-health system to reflect changing social and scientific norms.

One of the primary shifts in understanding that has taken hold since 1977 is that:

There is no one-size-fits-all diet that works for everyone.

In 1979, Dr. William Weil Jr at the Department of Human Development at Michigan State University, voiced concern about “the frequent use of cross-national and cross-ethnic inferences” [Weil WB Jr. National dietary goals. Are they justified at this time? Am J Dis Child. 1979 Apr;133(4):368-70.]  He went on to day that we cannot assume that “because ‘a’ and ‘b’ are correlated in one population group that they will also be correlated in another group” yet our one-size-fits-all dietary recommendations make just that assumption.

There were more scientific articles generated from the Nurses’ Health Study–composed of 97% white women–in 2009 alone, than in the entire 10+ year history of the Black Women’s Health Study. Those large epidemiological studies done with a mostly white dataset are what drive our policy making, even though evidence also points to fact that we should not be making the assumptions to which Dr. Weil referred. 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 [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].

.

DQI stands for Diet Quality Index. Blacks with a higher DQI had more weight gain over time than blacks with a lower DQI. From Zamora et al.

Even with a more homogenous population, this issue applies. Remember all those discussions about “safe starches” you heard at AHS2012?

This concept also captures the emerging knowledge of how genetic variability affects nutrition needs and health, i.e. individualized nutrition, a very useful buzzword. I have lots to say about n of 1 nutrition coming up soon. But, most of all, not trying to cram everyone into the same nutritional paradigm captures reality of our own lives and choices about food. Which brings me to:

Food is not just about nutrition, and nutrition is not just about science.*

When we all begin to question our own assumptions about food and nutrition, we will be better able to reach across communities, create common ground, and be humble about our way forward.

We need to understand and help others understand that all nutrition messages are constructed and contain embedded values and points of view.

We need to learn to ask and teach others to ask: Who made the message and why? Who may benefit or be harmed? How might people interpret this message differently?

We need to think and help others to think about income and funding models, industry, and the framing of dietary problems by scientist, bloggers, and the media (and I don’t just mean “the other guys”—apply these critical thinking skills to your own nutrition/food community).

Nothing about our food and nutrition thinking was born in a vacuum. Food is a part of our cultural and social fabric. It allows us to belong; it allows us to define ourselves. Even as we strive to find better science and to shift our current diet-nutrition paradigm, we must approach this with the understanding that there is no truly objective science. How science gets used, especially in the policy arena moves us even farther from that non-existent ideal. Even as we strive to improve public health, we must understand that we don’t always know what “health” and “healthy food” means to the people we think we are trying to serve.

If these points sound remarkably like the mission statement for Healthy Nation Coalition, my non-profit, then you’ve been paying attention. But it is not my plan for HNC to “lead” any nutrition reform movement as much as it is for us to get behind everyone else and shove them in the same direction. There is very much a herding kittens aspect to this (as Jorge of VidaPaleo.com pointed out), but as a former high school teacher and mother of three, this is not new territory to me.

So, yes, I have an agenda. Everyone has an agenda. I’ll spell mine out for you:

Somewhere out there in America, today, there is a young African-American girl being born into a country where many—if not most—of the forces in her world will propel her towards a future where she will gain weight, get sick, have both of her legs amputated, get dialysis three times a week, be unemployed and unemployable, on disability and welfare, and—this is what gets me out of bed in the morning and drags my weary ass to one more round of getting punched in the face by those very forces arrayed against her—she will, somewhere underneath it all, blame herself for her situation. I’m an old white lady, in a position of relative power and knowledge. I don’t know this young lady, and she doesn’t know me. She doesn’t owe me anything because she’s not asking for my help. But it is my job in this life to begin—at the very least—to shift those forces so that she has a better opportunity to choose a different life if she wants to. That’s all I care about. I don’t care who gets credit or who gets the cushy book deal.  I just want it to happen.  I would want the world to do the same for my children if they had not had the privilege of birthright that they do. That child is my child as sure as the three that live here and drive me crazy are. All I ask of the paleo community is that she be your child too. And if, as a community, you decide to adopt this child, well then, don’t worry about becoming an elitist fad made up of goofy-shoe wearing white people destined to fade into obscurity. Instead, you all will change the world.

Next Up: What makes a movement? (and I mean a social change one, not the bowel-y kind)

*Much of what follows borrows liberally from the work of Charlotte Biltekoff at UC-Davis, a wonderfully warm and intelligent woman who has been working on and thinking about this issue for—believe it or not—longer than Gary Taubes. She has a book coming out next summer which, IMHO, will be the social/cultural partner to Good Calories, Bad Calories.