SnackWells What to think if you are a “well informed” person when the information changes so often and quickly? Melinda Wenner Moyer’s article in Aeon, Against Grain, is a good place to start. She observes:
In the midst of all the claims and counterclaims, there is a single clear piece of common ground. Experts of every stripe ask dieters to avoid refined sugars and grains. ‘Losing body weight on a plant-based diet is much less likely to occur if the diet includes too many refined carbohydrates,’ writes Cornell’s T. Colin Campbell in his book, The China Study, based in part on his Cornell-Oxford-China study research. Esselstyn instructs his dieters to consume only whole-grain products and avoid fruit juice. And McDougall urges his readers to eat complex carbohydrates instead of refined sugars and flours. … So where does all this leave us, other than confused and wondering if we should stop eating cupcakes? On the health side, the science does collectively suggest, but not prove, that a calorie is not always just a calorie, and that carbohydrates – particularly refined ones – might have unique metabolic effects that increase risk for chronic disease. Indeed, the notion that sugar and refined carbs are dangerous seems to be the one point on which nutrition scientists at either end of the carb-fat spectrum agree. I suspect that my weight-loss success a decade ago had something to do with the fact that, by cutting out wheat, I was replacing some refined carbohydrates with other macronutrients.
The problem here is what Jim Manzi in Uncontrolled terms “high causal density.” The most famous researchers, such as Dean Ornish and Robert Atkins, tend to present you with one-size-fits-all strident solutions. But the fact is that there are people who remain thin, who do not exercise, and consume processed carb and sugar.* I know them, and you probably know them. There are many factors which go into the end product of a person’s physical appearance and overall morbidity risk. On an aggregate scale of societies a few significant variables changing can result in enormous differences in outcomes, but people need to see efficacy on the individual level, and the causal signals can be confusing (in particular if efficacy varies from person to person for the same regime!). A bigger issue has been institutional health’s monomaniacal focus on fat and a few biomarkers has left many not trusting scientific recommendations. That focus is shifting, as science does update. Unfortunately the generation of new robust inferences is noisy and prone to dead ends in domains of high causal density. This is not always the case in public health. It turns out that the model of germ theory is not too subtle; it describes the world in pretty uncomplicated terms. Similarly, why and how vaccines work is tractable because the etiology of how you get polio is much easier to tackle than how you get type 2 diabetes. In all likelihood there are many ways to get type 2 diabetes, and multiple factors impact different people at different weights (e.g., there are people with a greater genetic disposition to type 2 diabetes given the same exercise and nutritional regimes, though one might be able to explain this with something like the nature of fat deposition). This reality of science as a messy and iterative process is obvious to anyone who practices science. A year ago I had a conversation with a friend who happens to be a professor of biology at a university, and we were talking about the problems with convincing the public about the efficacy of vaccination. He admitted that he had a bit of guilt in this area because when it came to his own health he took a very critically-rational perspective as to what his physicians told him. As someone who was aware of the protean nature of scientific literature he had no great confidence that the recommendations from on high were definitive or the “final answer.” Another friend who is a medical doctor did admit to me that for him patients who had a good science background were a pleasure to work with because for them healthcare was a collaborative process in which they were active participants, instead of being recipients of his commands ex cathedra. This reality is why I am somewhat uncomfortable with the “Because Science” meme. It attributes to science almost Solomonic powers of judgment, and in actuality is wielded to reinforce the prior conceptions of interlocutors. Where does that leave us? Describing a problem is not a solution, and due to the nature of the reality here there isn’t an easy answer. But it does imply to me that we should be cautious about engineering aspects of human life when the scientific basis for that engineering is less than certain. The war on fat and salt over the past few generations have been due to putting science forward as the basis of policy which turned out to not be robust. In the case of salt the establishment has even done an about face, “the government says there is no good reason based on health outcomes for many Americans to drive their sodium consumption down to the very low levels recommended in national dietary guidelines.” Salt tastes good, so one can imagine just how much utility was left on the table because people changed their diet to become more insipid. Policies have consequences. * Whether they are healthy is a different question obviously. ** One issue is that the different options might be superior for different people.
Increasingly new way of thinking about diet has been to focus less on the latest science, and fall back on cultural culinary history. “Eat like your grandmother cooked” is trendy advice proffered by influential writers such as Mark Bittman and Michael Pollan. But by removing heavily processed foods it might be a major upgrade from modern diets, which are designed to sustain the profits of the food industry, not our own health (that’s a negative externality, the cost of which they don’t have to eat). Whether you go mostly plant-based or carnivorous, you’re probably going to be fitter in either direction, even if one is superior to the other at the end of the day.** Instead of deduction from what we know, anengineering an appropriate nutritional outcome, in the best course of action in the near future is probably “hipster nutrition.” Artisan hand-crafted diets which look back to the past, though in a non-ironic fashion, might be the best way to go because they’re the outcome of hundreds of years of innovation and experimentation. If you don’t have randomized control trials, go with the next best thing. History.
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I’m not sure I see much reason to think my Grandmothers cooking is any more or less healthy then processed foods. Food industry products aren’t (generally) designed with my health in mind, but I doubt Grandma was cooking with a focus on preventing adult onset diabetes or heart disease. I suspect the main purpose of traditional foods was to make the most out of limited resources and to taste good.
My wife is Vietnamese, and its pretty clear that the traditional foods in her family had as a primary purpose making the most out of the limited protein supply available to Vietnamese peasants. This was certainly “healthy” in that context, but in a modern setting where nutritional health problems are much more subtle then lack of protein or other macro-nutriants, I don’t see much reason to think its more or less healthy then processed TV dinners or whatever.
I guess you never meet my grandmother. She was a terrible cook. Her food was bland, greasy, and tasteless.
“But the fact is that there are people who remain thin, who do not exercise, and consume processed carb and sugar.* ”
Hey, I resemble that remark!
In “The Compass of Pleasure” (highly recommended!), David Linden points out that body weight is ~80% heritable (just like height, which also saw massive increases in Western population over the last century, presumably due to a sudeen abundance of high-energy foods). Weight homeostasis in humans is remarkably precise and powerful. Diet and exercise can produce moderate long-term weight loss, but for the morbidly obese they don’t seem to do much.
That doesn’t mean that intervention is futile. For example, it is known that stress interacts with the machinery of weight regulation and addiction. While stress has a large heritable component in the wild, it can certainly be affected by environmental interventions. Also, biological interventions that do produce results are those that interfere with the actual machinery of weight homeostasis, like gastric bypasses (smaller stomach = earlier onset of “satiety” signals = sustainable weight loss).
re: heritability. that’s the fraction of variation in pop explained by variation in genes. a big deal, but let’s be cautious about making individual predictions (even with height there’s a lo of variance around expected value for offspring. full sib height correlates only .5). i think the big thin re: weight/obesity is norm of reaction effects. social context matters a lot.
the homeostasis issue is a big one. but it seems that people want to grab onto it a little too eagerly. it’s the new ‘my metabolism is slow.’ people are bad at judging how much they exercise and eat.
I don’t see much reason to think its more or less healthy then processed TV dinners or whatever.
the problem is that processed foods tend to have lots of additives to make them tasty. often sugar (even if savory or not sweet, it seems to have an effect on purchases). it’s rarely apples to apples comparison, because production of food was simpler back then and had fewer additives.
also, obviously ‘eat like your grandma’ is not a definitive and literal piece of advice.
yeah, most nutrition seems like voodoo so i’ve kinda tuned it out. also don’t like the Because Science meme as it’s mostly used by people who dislike un-PC science.
i’m one of those lucky people who can’t gain weight – i eat an insane amount of candy and whatever else but find it hard to gain weight. this winter during the polar vortex i estimate i was eating 4,000-7,000 calories a day depending on how much shoveling was done that day. my body definitely “runs hot” if that matters – i over heat quickly and don’t get cold easily even though i’m skinny.
this is a good doc on the power of genes regulating size
http://youtu.be/dAQr77QMJiw
As readers of me might know, convention health wisdom is in reality nearly useless or less than useless. Truth be told, we have no good evidence linking diet – within the range of diets that can be broadly considered “normal” (e.g., not eating dirt) – to any health outcome. The facts on the ground are plain to see to anyone who takes a critical look at it. But holding on to conventional wisdom plus our own quasi-religious ideas on health and healthy behaviors blinds people from seeing it.
For one, the primary problem, and the reasons for generations of contradictory and ultimately wrong health advice is that it is based on worthless observation studies. People with X do Y or eat Z. That can tell you nothing about the causes, but the underlying assumption that behavior is the reason for health outcomes, good and bad, keeps us relying on them. (Some health wisdom is based on tiny randomized controlled trials, often with less than 100 subjects and durations of a few weeks; this of course is insufficient to generalize to the world).
There are three key posts of mine anyone interested in this topic should look at:
Even George W. Bush Has Heart Disease | JayMan’s Blog
Trans Fat Hysteria and the Mystery of Heart Disease | JayMan’s Blog
HBD is Life and Death | JayMan’s Blog
Main points:
*There is considerable regional variation in both lifespan and cause of death. These correlate with race/ethnicity. Variation within countries, such as the U.S., clearly show that ethnic origin is the key association, not necessarily regional behavior
*One reliable predictor of health outcomes is heredity. Most ailments are highly heritable. Cancer is an interesting exception to this
*Along that line, another strong predictor of poor health and shorter life is IQ. Specifically, simple reaction time. All of the poor health outcomes found, such as the ones infamously associated with obesity, stem from the fact that obesity is itself inversely associated with IQ. Indeed, one study found that when IQ is controlled, virtually all of the connection between obesity and shorter lifespan disappeared! Again, cancer is an interesting exception to that pattern
*A look at the most common causes of death over the past 100 years reveals a telling pattern: deaths from the “diseases of modernity” (cardiovascular disease, cancer) have risen only after the main causes of death in the past – (“preventable”) infectious disease – fell. It seems that it’s not necessarily anything specific to modern civilization that causes these things; it’s just that people are living long enough to die from them today
Cancer is an interesting case. Most cancers have pretty low heritabilities. In addition, unlike most any other health outcome, cancer appears uncorrelated with IQ. These shine the light directly on pathogens as the likely cause of most cancers, as argued by Greg Cochran and Paul Ewald. A pathogenic source has been identified for many cancers already, including those caused by HPV, stomach cancer (Helicobacter pylori bacterium), many leukemias/lymphomas (human T-cell lymphotropic virus). Cochran and Ewald argued that many other health ailments (including heart disease) many be due to pathogenic involvement:
Infectious Causation of Disease: An Evolutionary Perspective (2000)
With the case of obesity, it is indeed highly heritable (~80%). We can argue the (correct) point that heritability is context-specific, but, really, this is irrelevant: we are in the modern context. As such, a highly genetic source to most of the variance in today’s body weight is the reality. As well, it is indeed effectively immutable like many heritable traits. Every single weight loss intervention tried thus far has failed to yield sustained weight loss. This includes low-carb diets. Diets (+exercise) simply don’t work. “Social reinforcement” is yet another canard, born out, at best, of tiny and often short RCTs. Even the efficacy of surgery is questionable, as none have been subject to truly random clinical trials (for “ethical” reasons).
On this, it’s important to note that we can think of this or that individual exception – Satoshi Kanazawa’s “manwho” statistics. But when it comes to health wisdom, especially on weight, we make grand prescriptions that imply a population-wide treatment. It would then be helpful if we knew that these things were effective group-wide. It turns out that they are not.
Additionally, it’s unclear to the extent that behavior is behind weight. The question may turn out to be not even wrong. If, as it appears, obesity is the result of the interaction between certain genotypes and the modern environment – one that sets the body’s energy stores towards attaining and maintaining some higher weight – then all behaviors (e.g., feeding) will act accordingly (hunger and the feeling of energy availability, for example). Thin people generally don’t have to “try” to be thin. They just are from the normal course of their behaviors.
Even smoking, the thing we are told is something that effects health that we can control may turn out not to be so. Large, long-duration RCTs on smokers found that those who were told to quit had no improved health over the control group with no such instruction. This one took me as a surprise, although I suppose it really shouldn’t have given the correlational nature of the link between smoking and lung cancer.
You have said before that it is human nature to feel like we are in control on some level. It turns out that, in today’s world anyway – where the real killers of the past have been curbed by vaccines, antibiotics, and much better sanitation – we have a lot less control than we like to think. The sooner we (and by “we”, I mean the medical establishment), the better off we will all be.
See also James Thompson:
Psychological comments: Diet is an IQ test
People don't listen to that nonsense. Learn something instead - a good example of a positive dietary impact of health would be The Wahls Protocol that is a treatment (not a cure) for Multiple Sclerosis. One of few brain-performance optimized diets anyway; others being The Perfect Health Diet and The Bulletproof Diet. All are new by the way - from 21st centaury; since recently there has been a great, underappreciated, and not widely known progress in the field of nutrition. And they are not one-trick diets like older ones - especially The Perfect Health Diet is a very comprehensive, complete program.
Going back to the claim - take a look how just a single dietary intervention - adding Resistant Starch - significantly improved blood glucose levels:
http://www.diabetes-warrior.net/tag/resistant-starch/
Or even something much more straightforward - elimination diets that eliminates alergenes.
And if all you care is just getting thinner and having some additional muscle, then you can try John Keifers carb backloading. Created based on hormonal interaction analysis, rather than observational studies as JayMan suggests. Even with simpler Body By Science / PACE excercises, rather than a full-blown bodybuilding.
"Diets (+exercise) simply don’t work." is simply a wrong overgeneralization of "many or most diets and excercise programs don't work". But there are ones that do, even if they are in a minority on the market.
"Even the efficacy of surgery is questionable" - actually bariatric surgery has been a great success, but from the reasons other than expected - gut bacteria.
http://phenomena.nationalgeographic.com/2014/03/26/the-humble-heroes-of-weight-loss-surgery-stomach-acids-and-gut-microbes/
As for the IQ and reaction time connection - it's well known that cognitive faculties are heavily dependand on sleep, and deficit or low quality of sleep also causes other dieseases. As well as dependant on good cardioviscular system; or blood glucose levels (too high destroy neurons), and avaliability of essential fatty acids - DHA, EPA; as well as not having too low cholesterol - eg. statins may lead to a transient global amnesia. One of the claimed benefits of good diets is elimination of "brain fog".
"But when it comes to health wisdom, especially on weight, we make grand prescriptions that imply a population-wide treatment." - another obsolete 20th centaury claim. Nowadays in 21st centaury there are people who make money on individializing diets for particular person, popularized by people like Chris Kresser. If you just read a book - then you get a "population wide treatment", to get individual approach you need to contact people who do individualization of diets.
(on (among other) cancer) "It seems that it’s not necessarily anything specific to modern civilization that causes these things; it’s just that people are living long enough to die from them today" - according to Jay chemistry development, as well as industrial pollution have nothing to to with cancer?
Hey, I resemble that remark!
In "The Compass of Pleasure" (highly recommended!), David Linden points out that body weight is ~80% heritable (just like height, which also saw massive increases in Western population over the last century, presumably due to a sudeen abundance of high-energy foods). Weight homeostasis in humans is remarkably precise and powerful. Diet and exercise can produce moderate long-term weight loss, but for the morbidly obese they don't seem to do much.
That doesn't mean that intervention is futile. For example, it is known that stress interacts with the machinery of weight regulation and addiction. While stress has a large heritable component in the wild, it can certainly be affected by environmental interventions. Also, biological interventions that do produce results are those that interfere with the actual machinery of weight homeostasis, like gastric bypasses (smaller stomach = earlier onset of "satiety" signals = sustainable weight loss).Replies: @wiijy
Weight eomostasis may be a fact, but considering how much fatter people are getting, it is not clear that many people are at their set point.
As a sample size of 1, I can say that I am sure that my set weight wasn’t my former weight of 280lbs, but it might be somewhere near 220lb (6’3″).
I now get hungry at 220 whereas I didn’t get hungry while losing 2lb a week. Weight loss by cutting down refined carbohydrates, and eating much less preprocessed food.
On another point, there seems to be a desperation to make weight loss about diet+exercise. It is principally about diet. Exercise can make you feel better and your body work better, but it should be seem as orthogonal to weight loss.
Good advice, but I would add another caveat: people overestimate the impact of dietary choices on individual life expectancy and quality of life in the middle of the population. For most people, we are talking about a few years added or lost at the end of life, not about everyday fitness and pleasure for the next 30 or 40 years.
There are indeed people whose lifestyle choices are so bad that they are literally cutting their healthy life in half and there are people who are so genetically well-endowed (or internally stress-free?) that their “bad” lifestyle choices have relatively little impact on them, but for MOST people (the middle of the distribution) the impact of various diets and exercise regimens is going to be relatively small.
1. Because their existing lifestyle is not too bad anyway (the horrors of eating MacDonalds once a month can be exaggerated) or
2. Because most of us will have a mixed bag of assumptions about what is good and what is bad…some accurate, some grossly inaccurate and many about which we just dont know enough to say much…and even these assumptions will not be consistently followed in spite of the best intentions.
Less worrying about food choices may be in order in a society that lives longer than almost any previous group of humans…I am not saying go crazy with the cupcakes, but moderation and variety and walking more will do enough for most people…More activity, less refined sugar, fewer processed foods and more fresh food all seem to be good ideas. But beyond that, the returns on investment may be less than advertised.
Why not look at the experience of elite athletes in physically-demanding sports where diet and performance are linked? A lot of mixed marital artists, boxers, triathletes, ultra runners are vegan or vegetarian or close to it (adding in fish or lean meat). They tend to do a lot of tweaking of diet and usually settle in as close to vegetarian (sans diary/sugar). If this is the most efficient diet for elites athletes it would seem the ideal for every body.
@Slava: Most elite athletes have goals for their diets that are pretty different then the average person. I doubt runners habit of carbo loading, boxers yo-yo dieting to meet weigh-in goals, bodybuilders attempting to maximize post workout protein consumption, etc. would be very healthy for the average person.
Here’s an article that claims to detail Micheal Phelp’s diet:
http://blogs.wsj.com/health/2008/08/13/the-michael-phelps-diet-dont-try-it-at-home/
If your not spending a sizable fraction of your day swimming back and forth in a swimming pool, I think you’d be advised not to emulate.
Along that line, another strong predictor of poor health and shorter life is IQ. Specifically, simple reaction time. All of the poor health outcomes found, such as the ones infamously associated with obesity, stem from the fact that obesity is itself inversely associated with IQ. Indeed, one study found that when IQ is controlled, virtually all of the connection between obesity and shorter lifespan disappeared!
Maybe it’s just my imagination, but I come in contact with a lot of fat, middle-aged, MIT/Stanford/Cornell/et al.-educated scientists/engineers/mathematicians in my job. And it seems proportionate to the area (Boston). I see a lot more fat people in tech than finance. I see more fat people in finance than the hospitality.
“Eat like your grandmother cooked”
I think a large part of the problem has been the idea that everyone is the same and therefore all studies on all populations are equally valid for all populations. If individual and group genetic differences in how specific food types are processed is critical e.g. if how well sugar is processed varies by individual and group, then studies need to be collated by population e.g. a study in Minnesota might back up a study in Sweden but not a study in Japan.
If part of it is genetic and thus possibly based on adaptations to ancestral diet then eating like your grandmother cooked makes perfect sense.
JayMan wrote “Truth be told, we have no good evidence linking diet – within the range of diets that can be broadly considered “normal” (e.g., not eating dirt) – to any health outcome. ”
People don’t listen to that nonsense. Learn something instead – a good example of a positive dietary impact of health would be The Wahls Protocol that is a treatment (not a cure) for Multiple Sclerosis. One of few brain-performance optimized diets anyway; others being The Perfect Health Diet and The Bulletproof Diet. All are new by the way – from 21st centaury; since recently there has been a great, underappreciated, and not widely known progress in the field of nutrition. And they are not one-trick diets like older ones – especially The Perfect Health Diet is a very comprehensive, complete program.
Going back to the claim – take a look how just a single dietary intervention – adding Resistant Starch – significantly improved blood glucose levels:
http://www.diabetes-warrior.net/tag/resistant-starch/
Or even something much more straightforward – elimination diets that eliminates alergenes.
And if all you care is just getting thinner and having some additional muscle, then you can try John Keifers carb backloading. Created based on hormonal interaction analysis, rather than observational studies as JayMan suggests. Even with simpler Body By Science / PACE excercises, rather than a full-blown bodybuilding.
“Diets (+exercise) simply don’t work.” is simply a wrong overgeneralization of “many or most diets and excercise programs don’t work”. But there are ones that do, even if they are in a minority on the market.
“Even the efficacy of surgery is questionable” – actually bariatric surgery has been a great success, but from the reasons other than expected – gut bacteria.
http://phenomena.nationalgeographic.com/2014/03/26/the-humble-heroes-of-weight-loss-surgery-stomach-acids-and-gut-microbes/
As for the IQ and reaction time connection – it’s well known that cognitive faculties are heavily dependand on sleep, and deficit or low quality of sleep also causes other dieseases. As well as dependant on good cardioviscular system; or blood glucose levels (too high destroy neurons), and avaliability of essential fatty acids – DHA, EPA; as well as not having too low cholesterol – eg. statins may lead to a transient global amnesia. One of the claimed benefits of good diets is elimination of “brain fog”.
“But when it comes to health wisdom, especially on weight, we make grand prescriptions that imply a population-wide treatment.” – another obsolete 20th centaury claim. Nowadays in 21st centaury there are people who make money on individializing diets for particular person, popularized by people like Chris Kresser. If you just read a book – then you get a “population wide treatment”, to get individual approach you need to contact people who do individualization of diets.
(on (among other) cancer) “It seems that it’s not necessarily anything specific to modern civilization that causes these things; it’s just that people are living long enough to die from them today” – according to Jay chemistry development, as well as industrial pollution have nothing to to with cancer?
The problem with this is that traditional Western eating was mostly based on wheat flour.
And people were thin in spite of it.
And today, millions in Asia remain thin eating white rice, which is one of those dreadful refined carbs.
I have a knee jerk reaction to scorn any new bit of wisdom on diet – growing up Seventh Day Adventist is just terrible on one’s palate and one’s ability to listen to dietary advice without bitterness and resentment. I got especially jaded when I got older and realized that there really wasn’t a valid reason to subject innocent children to carob chip cookies. Whole wheat carob chip cookies.
Also, WTF was up with making us eat flaked brewer’s yeast on popcorn? Why? WHY????
As a child of the sixties and seventies I’ve seen a LOT of fads come and go. Just about everything edible has been at various times been a shortcut to death or the next miracle cure.
Ms. Moyer credits her weight loss to lowered wheat consumption whereas at her age it could have been just about any reduction in caloric intake. My very first (age 25?) attempt at weight loss involved dropping 11 pounds in 17 days by the single action of removing beer from my diet. It wasn’t losing the the grain in the beer which allowed the loss, as I continued eating all other sugary/starchy staples of my youth – bread, pizza, french fries, ice cream, etc. Such things are simply much easier when young.
Now in my 50’s, my weight will not budge without a combination of a) substantial reduction of caloric intake, and b) substantial increase in caloric output.
To Mr. Ford, a little advice – “can’t lose weight” doesn’t last forever and it’s ever so much easier to keep weight off than it is to take it off.
Also, WTF was up with making us eat flaked brewer's yeast on popcorn? Why? WHY????Replies: @Shuddh Bharatiyaan
Funny. I love the taste of carob and love Brewer’s Yeast, chaat masala and coconut oil on my popcorn.