We are missing the big picture when it comes to nutrition

With the exception of rare and particularly bleak days, I don’t tend to think of myself as a moron — nor, as far as I can tell, do those who know me well and love me. I will hazard a guess that neither you nor those who love you think of you as a moron, either. So let’s be bold, proffer one another the mutual benefit of any disparate doubts, and declare: We are not morons!

I propose, then, that this be the year we stop ingesting as if we were. Still with me? Let’s find out.

On the matter of morons, I think they are very much the exception rather than the rule. I have met a lot of people over my years. I’ve taken care of many patients over decades and come to know their intimate thoughts as the privilege of doctoring uniquely allows and requires. So I know firsthand that most of us are endowed with our fair portion of both sense and sensitivity. Formal education, the color of a collar, degrees and credentials don’t distinguish us nearly as much as some might like to think. In most ways that matter, most people have that practical brand of folksy wisdom and intelligence that serve most handily on any given day.

And yet, as a matter of routine we are fed a steady diet of both food and food for thought as if we were abject morons. That’s how it’s served to us — but of course, only we get to decide whether or not to swallow such insalubrious slop. It’s a New Year, and time for new chances. Here’s our chance to stop the slop.

On the matter of common sense, I have been driven many times over the span of my career to lament the fact that it isn’t nearly common enough. But as just noted, I think it really is — in most areas. We apply it routinely to finances, home care, our careers and our families. We just turn it off when captivating promises about effortless weight loss, miraculous vitality, or age reversal waft our way. The result, of course, tends to be that even as we get fater, sicker and older, we get poorer — spending our sensibly earned money on a senseless parade of false promises.

On the matter of food, we have the law of unintended but perfectly predictable consequences working against our hopes and dreams. The truth about food and health is quintessentially like the forest obscured by those darn trees. Embracing the notion that we actually have to eat well, overall, and be active, to optimize our health suppresses magical thinking in ways we seem unwilling to sanction. So, instead, we continue to focus — as we have now for calamitous decades — on one food, nutrient, nutrient grouping, or ingredient at a time, all the while missing the big picture.

have written beforemore than once, about how egregiously misguided this is. It does nothing but play into the designs of Big Food, which is delighted to reshuffle their very short list of favorite cheap ingredients into new versions of junk and profit from our preoccupation du jour. If we fixate on cutting fat, we can have low-fat cookies. If we fixate on carbs, we can have low-carb brownies. If we fixate on fructose, we are privileged to trade not up but sideways to equally sugary but now “high-fructose corn syrup free” versions of the same rubbish. If we focus on sugar, we have the opportunity to keep runnin’ on donuts, but now sweetened with aspartame. If we focus on aspartame, well, then it’s back to sugar.

If we fixate on gluten, we can have gluten-free junk. If grains are bad, there are innumerable ways to eat badly without them, just as there are with them. If meat is the enemy, there is a whole universe of variations on the theme of vegan junk food to explore.

This is not theoretical. We have been inventing new ways to eat badly for literal decades, with the profound ills of modern epidemiology to show for it. The suspended animation of common sense and an apparent unwillingness to learn from the follies of nutritional history consign us to repeat them again and again.

While some of this results from the resilient wish that wishful thinking can overcome all, and some from an unwillingness to just grow up about weight and health and treat them with the same serious respect we apply to other things that matter, like wealth – another significant part of our problem is our penchant for personalized dogma. Everyone seems to know the truth about nutrition with near religious fervor – despite the fact that, just as with religion, equally informed, equally passionate people hold altogether opposing views.

I know, because I hear routinely from all factions. The ardent vegans cite their favorite studies to point out the misguided lunacy of the low-carb and Paleo enthusiasts. The Paleo enthusiasts cite their preferred literature to lob insults at advocates for vegetarianism. I am bombarded with literature exonerating saturated fat; literature indicting saturated fat; and literature implicating omega-6 polyunsaturates instead. And for the most part, since I try to read all of the relevant literature rather than only the studies that support a position I’ve already taken, I wind up unable to support anyone’s claims for owning the divine truth. The result tends to be that factions in every direction hurl frequent insults at my head. I’ve taken to wearing a helmet and soldiering on.

Most recently, I came upon just such a projectile in the form of an alleged review of my bookDisease Proof, on Amazon. I say “alleged” review because, as asserted in the review itself, the reviewer had neither bought nor read the book. Rather, the ostensible reviewer had — in some comment made by somebody somewhere — discovered that I/the book supposedly “recommended” low-fat dairy, and since they knew full-fat dairy to be superior, I clearly had not done my homework and my book could not possibly be worth reading.

Such is the insidious danger of dogma. When someone asserts an opinion we don’t already own, we are obligated to presume them ignorant, neglectful, or idiotic, rather than allow for the possibility that their opinion differs from ours precisely because they HAVE done their homework. We seem disinclined to acknowledge that equally informed parties might disagree, let alone that the other party might actually know something we don’t, perish the thought.

I have done my homework, and then some — in the form of three editions of a comprehensively referenced nutrition textbook for health care professionals, among other efforts. And the truth about dairy is… we really don’t know the exact truth about dairy. The DASH trials clearly show potential advantages of including dairy in the diet (and, in the case of DASH, low- and non-fat dairy preferentially). There are studies to suggest benefits related to bone health and weight control, but most are short-term or observational.

There are also studies to suggest that dairy can do harm related to cancer risk. And there are studies of extremely healthful dairy-free diets invoked to support a “told you so” position by the vegan community. There is, as well, the prevailing norm in mammalian biology: mammals, with us the notable exception, don’t consume dairy after they are weaned from their mother’s milk.

The topic of dairy is in rather a constant froth because competing factions can cite competing studies to support almost any position they like. This is all symptomatic of the same kind of echo-chamber escalation that accounts for religious radicalization, as detailed in the book Going to Extremes. If you seek out and read only opinions you already have, you will inevitably wind up convinced that you know, and perhaps own, the truth, the whole truth, and nothing but the truth. If you only associate with others who agree, you will convince yourself that all right-minded people think as you do. Everyone else? Morons!

But folks, looking for the evidence that supports our preconceptions makes conviction on any given topic a self-fulfilling prophecy. Instead, do the hard part of homework: Read the literature you like and the literature you dislike with equal diligence. If you can manage to do so, without undue bias, you are apt to discover that “the other guys” aren’t such morons after all. The current crop of “grains are the enemy” apostles might find it difficult to refute all of the “meat is the enemy” evidence if they confronted it with open-minded skepticism. And vice versa.

In fact, if you require of yourself a bird’s-eye view of what we do and don’t know about nutrition, you reach the conclusion that it’s very hard to reach any dogmatic conclusion about details. The theme of healthful eating is very well and very consistently established. Variations on the theme, however ardently they are defended, are much more about personal preference and preconception than preferential evidence.

Diets can be good or bad with or without dairy, and with or without the fat from dairy. Putting dairy into a diet, or taking it out, can confer benefit or harm depending on what dairy products we mean, what those added products are displacing, or by what they are replaced. The same is true of meat, and wheat; grains and gluten; saturated fat, polyunsaturated fat and sugar; oat bran, olive oil, fish or eggs. It’s that whole pesky forest-through-the-trees thing again. We will never get out of the dark woods of modern epidemiology until we accept that.

For now, we start a new year with a whole new crop of diet books telling us that every prior diet book vilified the wrong scapegoat, or canonized the wrong agent of salvation. We begin a new year being fed the same several highly processed ingredients ever at the ready to be blended into whatever particular version of junk the prevailing palate demands, with front-of-pack banner ads accentuating the positive and subordinating the rest. When it comes to putting lipstick on a pig, Madison Avenue is hard to beat. Of course, if the prevailing palate demanded only wholesome foods in a balanced array – food, not too much, mostly plants – the profit-driven proliferation of equally junky food and food for thought would abruptly end.

So here we are — at the start of a year, reflecting on the long-overdue end of the junk food era. We can stay sequestered in our echo chambers, unleashing our dogmas to go out, teeth bared and ears laid back, to wage war on our behalf. If we do, any plea we send out to Big Food, fad-diet authors and mass media to stop feeding us like morons will surely fall on deaf ears, for our gripes will never rise above the ka-chinging din of cash registers. Let’s be blunt, folks: if we act like morons, and reach for our credit cards like fatuous nincompoops, we will indeed continue to be fed just so.

But there’s no need to hope or whine or wring our hands. We are in charge. We could, any time we like, see past the truculent trees to the genuine promise of that forest. We could, any time we like, get out of the woods. We could listen more, pontificate less, acknowledge that we like what we like without pretending to know what nobody knows. We could put what we do know to far better use, any time we like.

Any time we like we could refuse to eat like morons by deciding not to swallow any more baloney. This could be that year. I really do hope so, but having learned from the follies of my own history, I’m keeping my helmet on.

David L. Katz is the founding director, Yale-Griffin Prevention Research Center. He is the author of Disease-Proof: The Remarkable Truth About What Makes Us Well.

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  • Sara Stein MD

    Wow. Did you just use this blog to sell your book?! The reality is that most diet books are probably correct….for some subset of the population. Perhaps the reason for the constant deluge of disparate diet information, and the ever changing pyramid, is that we have not yet had the knowledge to incorporate individualized genetics into nutrition recommendations. That day will come, when we will be able to say, you don’t have a gene to metabolize dairy or beef or gluten or high fat or legumes, etc. We will be able to say you need to eat paleo or vegan or DASH or Mediterranean, etc. In the meantime, the best clue for health is figuring out which foods cause inflammation or IBS or migraine in your diet, and leaving them out. To do so requires simple eating, because once foods become complex, such as processed foods, it’s very difficult to identify a culprit.

    So what we can say, is while Weight Watchers, South Beach, Atkins, etc, may be a good weight loss program for you, don’t eat their packaged foods. Eat fresh whole foods. Avoid pesticides and GMO if possible. Drink alot of pure water, like your pet does. Identify your eating pattern, and if you’ve gained weight on it, maybe it’s not ideal. Find the foods that give you sustained energy, and identify the foods that exhaust you. Vary what you eat.

    Is that in some book somewhere?

  • leslie fay

    Amen! I have tried for years to get my brain to like green beans instead of a doughnut without any success whatsoever. I’ve tried all manner of things to keep myself from starving most of the day after having food police-sized servings with even less success. I’ve tried to get over my intense dislike of an almost daily work-out but it still exhausts me and takes up precious time needed for other activities. I can be good the majority of time, I rarely eat a lot of processed food and I don’t ever drink soda(actually a major coup that I have achieved) but there’s just no way that I am able to say that I won’t ever eat something that is pure pleasure. Yes, I’m speaking of that doughnut. When someone writes a book or sells a product that will make my pleasure centers all light up like new year in Times Square when I sit down to a dry chicken breast(size of a deck of cards of course), puree’d cauliflower that people(who obviously have no tastebuds) tell me is “just like” mashed potatoes and finish with plain non-fat yogurt and fresh berries which I read is a “good” substitute for ice cream please let me know. Until then when I am having a treat I will have that doughnut. A real Dunkin Doughnuts doughnut. Perhaps even two.

    • Ryan

      Nothing wrong with a donut or two here and there. It’s when you have a donut or two every single day that it becomes problematic. The biggest thing wrong with how most Americans eat is that it is simply so mindless. No one ever thinks about WHY they’re eating that donut, or ever pauses to maybe let the craving pass (most cravings pass in about 15 minutes, especially if you drink a big glass of water when you have one). There’s nothing wrong with a little indulgence every now and then. I am on a pretty strict, mostly vegan diet, but Friday is my day to splurge on whatever I want, so I generally do, but even though I allow myself, I also often don’t. Once you go long enough eating the good stuff, exercising regularly, and noticing how much better you feel, you really stop craving the shitty stuff. Or if you do crave it, you either don’t eat it because you know you’ll feel like shit afterwards, or you eat much less than you might normally (1 donut instead of 2, or even just half of one). I truly believe it’s all about reprogramming both our brains and our tastebuds.

  • http://www.thenutritionista.ca/ Erin @ thenutritionista.ca

    The most fundamental rule of nutrition: eat real food.

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