Not Just Science: How nutrition got stuck in the past

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

David Frum

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

“become worryingly untethered from reality”

“develop a distorted sense of priorities”

and are “voluntarily putting themselves in the same cocoon”

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

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

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

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

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

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

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

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

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

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

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

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

How paleo might look from the outside.

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

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

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

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

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

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

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

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

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

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

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

Let’s quit bickering and get to work.

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

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

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

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

References:

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

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

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Not Just Science: Nutrition & Politics

Now that food–along with religion and politics–has joined the list of things you don’t talk about with friends, I thought I’d do my post-Election day best to offend everyone equally by highlighting just how political food and nutrition is these days.

I like to try to pass myself off as generally apolitical (on principle, I refuse to vote straight-ticket anything—but it could be I’m just a control freak who likes filling in all the bubbles myself). If forced to confess, underneath it all I’m a bleeding-heart liberal who wants to save trees and whales and who tends to blame the world’s ills on old white dudes (even—or especially –the one I’m married to).

But there’s another subtlety (and don’t tell my bleeding-heart liberal friends or they won’t invite me to anymore parties): I’d vote for ANYONE who was serious about fixing our food-health system, but—politically-speaking—who is going to do that?

Restructure subsidies, agricultural insurance, and agricultural financing to support small farmers rather than giant agribusiness? Who would do this? Democrats like feeding the excess corn, wheat, and soy commodities to the hungry people in America who are getting fatter and sicker by the minute as a result (It’s healthy!). Republicans like the big businesses that control those commodities. Everyone says they care for small farmers but no one does anything about it.

Federal nutrition program foods: plenty of soybean oil, corn syrup, gluten, and sugar, with a little arsenic thrown in for good measure

Modify food safety regulations to take into account size and type of operation? Democrats are all about protecting the public and regulating industry, but they are also all about “protecting” the public from the raw milk that those stupid Americans are stupid enough to drink. Republicans are more likely to support the dairy industry–the folks with the vested interest in outlawing raw milk–but also more likely to say the government shouldn’t be telling stupid Americans what they should and shouldn’t drink.

Somebody needs to tell Michelle that “moving more” makes kids hungry more; nothing wrong with that, but they’re not gonna “eat less” as a result.

End the one-size-fits all dietary recommendations? Thank you Michelle Obama for giving renewed vigor to the physiology-defying “eat less, move more” concept. Thank you, giant mom-and-pop-squashing Walmart, for playing right along.

You don’t like Obamacare? You do like Obamacare? You’re both right. Health reform is a joke until we focus on preventive measures that begin with feeding everyone adequate essential nutrition, not preventing chronic disease with foods that don’t prevent chronic disease.

Republicans believe that obesity is a personal responsibility; food and lifestyle choices by the public should not be interfered with by the government. Except when it comes to whether or not the public can know what is actually in the food they choose, in which case, the right to free speech when it comes to putting “health” claims on cereal boxes becomes the right to abstain from speech when it comes to putting GMO information there.

Democrats believe that it is up to the government to intervene in the market when personal choices become a public concern. So Democrats are out to make the “healthy choice” (a phrase that is an embarrassment to true meaning of both words) the easy choice for those poor stupid fat people out there who are too lazy and gluttonous to take care of their own health, never mind that the Democrat’s idea of “healthy” and “choice”  is limited to the USDA/HHS definition of both.

Republicans support the soda industry’s desire not to be taxed. Democrats are hoping butter and meat will be taxed next.

Thank goodness for the Libertarians—who are hard at work legalizing pot so the nation can now get the collective munchies. Watch for the Democrats to insist on restricted access to McDonald’s for those with medical marijuana prescriptions, while the Republicans fight for Monsanto’s right to patent all cannabis seeds grown anywhere ever by anyone. That backyard plot of weed will only be legal for about ten minutes before the Democrats start regulating the fun out of it and the Republicans hand everyone’s right to get stupid over to ConAgra.

Meanwhile, the rich get richer, the poor get fatter and sicker, and we all—rich and poor and middle-class alike—waste precious time, money, and attention on nutrition recommendations that support ideology and industry and do little for our nation’s very real health crisis. Politicians like Nixon and Clinton have undermined the nation’s ability to believe that any politicians can be trusted;  advice from the USDA/HHS, Ornish, and Atkins have done the same for nutrition. It’s a wonder we don’t all turn on, give in, and pig out.

Why Race Doesn’t Matter in Nutrition Policy

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

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

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

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

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

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

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

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

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

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

But does that position still serve us now?

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

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

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

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

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

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

But what does this have to do with race?

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

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

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

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

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

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

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

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

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

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

References:

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

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

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

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

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

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

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

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

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

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.

The Mobius Strip of Policy Change


I love working with individuals, but it takes policy-level change to really make an impact on public health. Policy, however, is a double-edged sword. Decades-long cascades of unintended consequences can arise from well-intentioned policy. The Dietary Guidelines started out in 1980 as an unmandated humble little 40-page booklet offering nutrition guidance to the public, while freely admitting that “we don’t know enough about nutrition to identify an “ideal” diet for each individual” and that “in those chronic conditions where diet may be important . . . the roles of specific nutrients have not been defined.”

Since then, I’m still not sure how, the Dietary Guidelines have become the center of all information and decision-making surrounding food and nutrition in America—in policy, healthcare, industry, media, and science (where researchers should know better than to use a policy document as the basis for scientific research). And—for better or worse—Americans have actually shifted their eating habits to fall in line with Guidelines recommendations (see: Americans don’t follow the Guidelines—or do they?)


The Guidelines were created to prevent chronic disease.  They have changed very little in 30 years, while rates of obesity, diabetes, and other chronic disease have rapidly increased (see: Public Health Nutrition’s Epic Fail). Currently, there is no “policy lever” for changing the way the Guidelines are created or administered. The Guidelines have no system of checks and balances, no outcome evaluation process, and no way to counter the influence of entrenched special interests (including both the food and science industries).

Right now, it seems that no amount of public outcry, accumulation of scientific evidence otherwise, or increase in diseases the Guidelines were meant to prevent can shift them from their current staked position that a high-carbohydrate, high-fiber, low-fat, low-cholesterol, low-saturated fat, low-sodium diet is right for all Americans. Under the USDA/HHS “calories in, calories out” paradigm, it’s Americans that need to change (“eat less and move more”), not nutrition policy. Policy changes are urged only to “make the healthy choice the easy choice”  for fat stupid Americans (especially low-income ones) who apparently otherwise don’t care and can’t think.

I would expect such policy reform to have, as Jon Stewart put it, “the draconian government overreach we all love with the probable lack of results we expect.”

So what kind of policy reform should we be working towards? One of the Big Questions I ponder is whether we need to replace the current USDA/HHS Dietary Guidelines with “better” ones, or find a different way to create nutrition policy, or just ditch all government-sanctioned nutritional recommendations altogether. (Other Big Questions: What’s for dinner? and How can I further embarrass my children?)

I don’t fundamentally oppose or support government-funded nutrition programs. If they were administered differently, I might like them a lot more. If we are going to use government funds to feed people, we will need some way of guiding that process. Right now, our federally-funded nutrition programs have a tendency to serve as outlets for cheap industrialized food, and I’m afraid that our nutrition guidance has not only allowed, but encouraged that role. On the other hand, scrapping that guidance altogether may leave government programs that are struggling for funds vulnerable to choosing food from the lowest bidder, which would only serve to reinforce the current situation.

I also have problems with replacing one-size-fits-all Guidelines with different one-size-fits-all Guidelines because that process denies the very real variability in nutritional needs and preferences of individuals and diverse sub-populations. Worse yet, it teaches people that answers about nutrition come from packages and experts rather than the body’s response to food.

As a transition, or middle ground, I currently favor the idea of locally-determined nutritional policies and programs. Sounds good, right? Nutrition programs could be tailored to meet the needs of the community they serve.

But this is where the confluence of things needed to make this type of policy shift happen turns into a Dilbert cartoon. Everything that needs to happen requires something else to happen first until it all loops back on itself like a Mobius strip.


Let’s take school lunches.  

Ideally, the type of school lunches served should be determined by the members of the community eating them, i.e. the kids, parents, teachers, etc.  This allows for appropriate community-level health, ethnic, cultural, regional, seasonal, and economic adjustments and prevent fiascos like the Los Angeles lunchroom garbage cans filled with “healthy” lunches (like “brown rice cutlets”).

Ideally, a trained professional at the local level, for instance an RD, would be able to guide this process, balancing the nutritional needs of that specific community with other social and cultural factors, creating an affordable menu, and modifying the program based on outcomes.  But this would mean that the RD would have to have training across the spectrum of nutrition science, rather just following USDA/HHS policy statements which are based on research done on white (frequently male) adults circa 1970-1980 and which may not be applicable to other populations.

This in turn would require the nutrition curriculum for health professionals to not be skewed by entrenched interests in academics, politics, and industry (and would probably require almost a complete re-thinking of 30 years of nutrition epidemiology).

This would require the USDA/HHS and other institutions to support–through funding, publication, and use—nutrition research that may possibly undermine or even contradict 30 years of previous nutritional guidance. This research would not only provide a knowledge base for health professionals, but would provide an unbiased source of information for consumers which would help to create informed stakeholders in the nutrition-food system.

At the same time, industry, producers, and growers would have to work with the community to make foods available that meet the demands of the local program at a reasonable cost.  And right now—due to agricultural practices and USDA policies—foods that are widely and cheaply available to federal nutrition programs are the ones that the USDA/HHS Guidelines have determined are “healthy” even though this definition of “healthy” seems to be based, at least in part, on whether or not those foods are widely and cheaply available for federal nutrition programs.

See what I mean?  I have a hard time figuring out where we need to insert the monkey-wrench that will stop the endless cogs from turning out the same policies, practices, and programs that have been radically unsuccessful for the past 30 years.

Which won’t, of course, stop me from trying.

As I’ve been working with Healthy Nation Coalition and tossing ideas around with people who are also working on this issue, I’ve found some that I believe are fundamental to fixing our food-health system. These concepts originated with people much smarter than me, but I am hoping that in my academic work and in our non-profit work at Healthy Nation Coalition, I will have the opportunity to be a part of developing them further:

1) N of 1 Nutrition – a movement towards more individualized nutrition, although the “1” can also be a family, community, or other subpopulation

2) Nutritional Literacy – a movement to foster an understanding of the cultural forces that shape our nutritional beliefs and our relationships to food and food communities

3) Open Nutrition – a movement to raise awareness regarding the laws, policies, institutions, and other social, economic and cultural forces that may impact access to nutrition information and development of sustainable systems that produce foods that support health

It takes about 30 years for any given scientific paradigm to shift. It is time. But how will we do it differently? I think these concepts are the “next steps” that will help us steer the next 30 years of nutrition in a direction that may help us avoid another cascade of unintended consequences down the road. More on each soon.


Big Fat Liars

Since 1980, Americans have gotten progressively more lazy and gluttonous. As if this were not bad enough, apparently about 2/3 of the population—the fat 2/3 of the population—have also become unrepentant liars. Although we have no way to explain this precipitous decline in the moral fiber of Americans, we know it must be happening because Americans seem to be getting fatter and fatter even though many of these fat Americans report that they are not eating more calories than their normal-weight, honest, hard-working counterparts.

It seems that when we gave the USDA and HHS the responsibility for determining what food was healthy for each of as individuals, Government Approved Nutrition Experts also developed a magical ability (in Nutrition, we love magic!) to tell the difference between what was Truly True and what was a Big Fat Lie. Here’s a response I got to a food record assignment during an introductory Nutrition course:

Question: What are your barriers to meeting the MyPyramid recommendations? (In other words, what might prevent you from consuming the recommended amount of each food group?)
My answer (after describing the low-carb diet that I used to lose weight and improve my migraines):I have a history of glucose intolerance and overweight/obesity.  Past a certain point of consumption, carbohydrates make me gain weight, raise my blood     pressure, reduce my energy levels, give me migraines, make my blood sugar wonky, and leave me hungry and cranky.  I stick to fiber-rich, nutrient-dense, non-starchy vegetables for my carbohydrates, although I do eat fruit when it is in season locally.
Instructor’s response (I am not making this up):  It is actually the total calories that make you gain weight, not the carbohydrates.  The high fat intake would be more detrimental than the whole grains and fiber rich vegetables.  Refined carbohydrates would cause the symptoms you describe but using whole grains and high fiber fruits and vegetables should not do so.  You need carbohydrate for your brain to function.  It does not function on fat and protein calories.  In fact eating a low carbohydrate diet such as you describe would make you tired, give you migraines, make you hungry and cranky.

Silly me! Of course the Nutrition Expert knows what REALLY caused my weight gain and migraines. Obviously the lack of carbohydrate to my brain prevented me from realizing her innate superiority at understanding and interpreting my own personal experiences. Either that or I’m just a Big Fat Liar.

Let me introduce you to another Nutrition Expert with the magical ability to tell Truth from Fat People Fiction–Michael Pollan:

Consider: When the study began, the average participant weighed in at 170 pounds and claimed to be eating 1,800 calories a day. It would take an unusual metabolism to maintain that weight on so little food. And it would take an even freakier metabolism to drop only one or two pounds after getting down to a diet of 1,400 to 1,500 calories a day — as the women on the “low-fat” regimen claimed to have done. Sorry, ladies, but I just don’t buy it. (Pollan M. Unhappy Meals)

The women in the Women’s Health Initiative (to which Pollan refers) are: Female. Post-menopausal. Overweight. From my experience at the Duke Lifestyle Medicine Clinic (director, Dr. Eric Westman), just about any woman who met those three criteria exhibited this sort of “freaky metabolism.” Not only is it possible for a woman in that hormonal situation to maintain her weight on 1800 kcals/day, it may be absolutely impossible for her to lose weight on 1400-1500 kcals/day—if she’s eating foods that enhance fat storage and prevent fat utilization (carbs, I’m lookin’ at you). In fact, not only did I see many other women like this in clinic, I stopped losing weight myself (at 185 pounds) eating 1200-1500 calories a day—and I wasn’t even postmenopausal. But then, at that point, I wasn’t a Nutrition Expert either. Not like Michael Pollan.

I always wonder why Mr. Investigative Journalist/Nutrition Expert Pollan didn’t go out find a few real live overweight, post-menopausal women and ask them what their personal experiences were with weight loss instead of simply discounting the experiences—and calling into question the humanity and integrity—of the “ladies” in the study. Oh wait, if the ladies he interviews are overweight, they’d all just LIE to him!

Anyway, why ask a real person, when you have Science on your side? Here’s a nutrition textbook explaination just how it is that we KNOW fat people lie:

Another approach to check for underreporting is to compare reported usual energy intake with resting energy expenditure calculated using various equations . . . If a subject’s reported usual energy intake is <1.2 times his or her calculated REE, underreporting of energy, and therefore nutrient, intake is highly likely. (Lee & Nieman, 2007).

In other words, if fat people don’t eat as much as we think they should be eating according to calculations that are known to be notoriously inaccurate, they must be “underreporting” (this is a complicated Scientific Term that means “lying about”) how much they eat. In my current Obesity class at UNC, Dr. Andrew Swick has confirmed—through evaluations done in a metabolic chamber—that some overweight/obese women have energy requirements as low as 1200-1300 calories (hmm, “freaky metabolism” maybe?),  requirements that would be far below “calculated requirements” referred to above. Dr. Swick pointed out to us that some fat people don’t, in fact, eat that much food.

But we should never let reality stand in the way of Government Approved Nutrition Information (code name: GAIN). Our good buddies at the USDA and HHS prepared this helpful chart for the 2010 Dietary Guidelines Advisory Committee Report to show how many calories Americans are consuming compared to the recommended ranges:

The vertical lines are recommended calorie ranges; the pink triangles are the average calorie intake in each group. Caloric intake appears to be within the recommended range for all age levels; adult women in general seem to be consuming at the very low end of their caloric range, about as many calories as a preschool male. That’s right, women over the age of 50 eat, on average, about as much food as 2-5 year old boys.

This must be more of that “freaky metabolism” thing to which Mr. Pollan refers. Or—wait—maybe they are all just LYING (the old ladies, not the little boys): the 2010 Dietary Guidelines for Americans go on to say, “While these estimates do not appear to be excessive, the numbers are difficult to interpret because survey respondents, especially individuals who are overweight or obese, often underreport dietary intake.” And we know what “underreport” means, right?

According the USDA and HHS, Americans aren’t fat because they are told to eat foods they don’t need to eat, Americans are fat because they eat too much–and then lie about it.

So, let me sum this up for the folks at home:

Fat people say that they don’t eat more calories than their normal weight (and apparently morally superior) counterparts.  But we know they are lying because Nutrition Experts—like Michael Pollan—KNOW how much fat people eat should be eating (i.e. A LOT of food—otherwise, golly, they wouldn’t be so darn fat).  ).  He KNOWS this because he’s a Nutrition Expert and because we have scientists who have calculations that tell us how much fat people are supposed to eat (i.e. A LOT) so when fat people say they don’t each as much as scientists think they eat (i.e. A LOT), well then, the only possible explanation for that is that the fat people are LYING!  And if that’s not enough evidence for you (and really, it should be), you can absolutely believe that that fat people LIE about how much they eat because the Government says they do.

And the government never lies.

References:

Lee RD and Nieman DC. Nutritional Assessment, 4th ed. Boston: McGraw Hill, 2007.

Pollan M. Unhappy Meals. The New York Times Magazine, January 28, 2007

U.S. Department of Agriculture and U.S. Department of Health and Human Services. Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010. June 15, 2010.

U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010. http://www.cnpp.usda.gov/DGAs2010-PolicyDocument.htm Accessed January 31, 2010.

If Nutrition Experts Built Bridges–

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

References:

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

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

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