The Importance of Eating Together - ​Cody C. Delistraty - The Atlantic

On the one hand, the topic of this article would seem to be nothing more than common sense.  Folks that eat together are happier and healthier.  This is not new news.  On the other hand, this article shows how difficult it is to "know" anything about the complex animal we call "humans".

http://www.theatlantic.com/health/archive/2014/07/the-importance-of-eating-together/374256/

"After my mother passed away and my brother went to study in New Zealand, the first thing that really felt different was the dinner table. My father and I began eating separately. We went out to dinners with our friends, ate sandwiches in front of our computers, delivery pizzas while watching movies. Some days we rarely saw each other at all. Then, a few weeks before I was set to leave for university, my father walked downstairs. "You know, I think we should start eating together even if it's just you and me," he said. "Your mother would have wanted that." It wasn't ideal, of course—the meals we made weren't particularly amazing and we missed the presence of Mom and my brother—but there was something special about setting aside time to be with my father. It was therapeutic: an excuse to talk, to reflect on the day, and on recent events. Our chats about the banal—of baseball and television—often led to discussions of the serious—of politics and death, of memories and loss. Eating together was a small act, and it required very little of us—45 minutes away from our usual, quotidian distractions—and yet it was invariably one of the happiest parts of my day."
"Sadly, Americans rarely eat together anymore. In fact, the average American eats one in every five meals in her car, one in four Americans eats at least one fast food meal every single day, and the majority of American families report eating a single meal together less than five days a week. It's a pity that so many Americans are missing out on what could be meaningful time with their loved ones, but it's even more than that. Not eating together also has quantifiably negative effects both physically and psychologically."

This is where the trouble begins.  There's not anything quantifiable about the data the author cites.  This is not good science.  It's just correlation, which does not imply causation.  For example, it's long been known that wealthy people live longer than the poor.  What is not known is why - do they choose better lifestyle variables?  Probably.  Which ones matter?  No one knows.  I'd guess that on the whole they eat better food, smoke less, and sleep more/better.  Guessing is just a small first step in science.

"Children who do not eat dinner with their parents at least twice a week also were 40 percent more likely to be overweight compared to those who do, as outlined in a research presentation given at the European Congress on Obesity in Bulgaria this May."

OK, but why?  Answer:  we don't know.

"On the contrary, children who do eat dinner with their parents five or more days a week have less trouble with drugs and alcohol, eat healthier, show better academic performance, and report being closer with their parents than children who eat dinner with their parents less often, according to a study conducted by the National Center on Addiction and Substance Abuse at Columbia University."

Fascinating correlation.  I'm glad I eat with my family almost every night thanks to my wife's focus on this matter.  But this correlation does not tell us anything about prediction or control, which is what science is about.

Bittman's Great Summary

This one was so compelling, I'm reposting it.  It is foundational material in my book.

"The study controlled for poverty, urbanization, aging, obesity and physical activity. It controlled for other foods and total calories. In short, it controlled for everything controllable, and it satisfied the longstanding "Bradford Hill" criteria for what's called medical inference of causation by linking dose (the more sugar that's available, the more occurrences of diabetes); duration (if sugar is available longer, the prevalence of diabetes increases); directionality (not only does diabetes increase with more sugar, it decreases with less sugar); and precedence (diabetics don't start consuming more sugar; people who consume more sugar are more likely to become diabetics).

The key point in the article is this: "Each 150 kilocalories/person/day increase in total calorie availability related to a 0.1 percent rise in diabetes prevalence (not significant), whereas a 150 kilocalories/person/day rise in sugar availability (one 12-ounce can of soft drink) was associated with a 1.1 percent rise in diabetes prevalence." Thus: for every 12 ounces of sugar-sweetened beverage introduced per person per day into a country's food system, the rate of diabetes goes up 1 percent. (The study found no significant difference in results between those countries that rely more heavily on high-fructose corn syrup and those that rely primarily on cane sugar.)"

http://opinionator.blogs.nytimes.com/2013/02/27/its-the-sugar-folks/?_php=true&_type=blogs&_r=0

This article references a study (linking in the article) that is about as good as it gets in health science. Bittman's summary is spot on - until he gets to his politics, which I could do without.  Coercion hasn't worked well at all with regards to food and health.  I say let's try cooperation.

Sugar and Government Joined at the Hip

The industry's tactics—similar to those used by Big Tobacco in downplaying the adverse health effects of smoking—were explored by Gary Taubes and Cristin Kearns Couzens in the 2012Mother Jones investigation "Big Sugar's Sweet Little Lies." But this latest report draws on some newly released documentssubmitted as evidence in a recent federal court case involving the two biggest players in the sweetener industry: the Sugar Association and the Corn Refiners Association (the trade group for manufacturers of high fructose corn syrup). 

The report details companies' plans to bury data and to convince consumers that sugar is "fine in moderation." It also shows how trade groups hired independent scientists to cast doubt on studies that show the adverse affects of sugar consumption—and strategized to intimidate scientists and organizations who didn't tow the industry line.

http://www.motherjones.com/blue-marble/2014/06/sugar-industry-tactics-to-make-your-food-unhealthy

Examples of their "fine work" follow in the article.

What the sugar industry did is almost as bad as what the federal government has done - first they empowered these groups by putting them on government working groups as "expert witnesses."  Second, they pushed the shoddy science of low fat.  

What's the difference?  If you do the work you could figure out that the sugar industry and the government are doing us wrong, but because the government is over-reaching, the sugar industry was able to employ the government to do its dirty work.  Further, the government used its power to remove funding to force all kinds of institutions to comply with it's faux guidelines.  We could escape the sugar industry's deceptions if not for the coercive influence of the government.

So are the sugar guys guilty?  Of course.  Almost as guilty as the government, which is not going to play the other side of the fence and act outraged - OUTRAGED I TELL YOU - as it prosecutes the sugar industry for ... working with the government.

Next thing you know, the government will sue the diabetics that are wrecking the health care system for eating what the government said they should.

Correlations Are Awfully Interesting

Did you know that fat ingestion causes cancer and heart disease?  Well, not only that, but crude oil imports from Norway cause an increase in death due to drivers crashing into trains in the US.
Here's the proof:  Tyler Vigen Spurious Correlations

http://www.tylervigen.com

This guy's page of correlations is how dietary advice is largely reported - folks get money to test for correlations, and report their findings.  When the information is interesting, or uninteresting, reporters make it into a story, usually by pretending that correlations mean more than they do.

Why are we stuck with this sort of immature science about diet and health?  Why don't they conduct more expensive and definitive studies?  Cost and complexity - both are so high such studies may never be done.  Medicare and Medicaid - designed to provide needed care to the poor and elderly - is eating the federal government, and leaving politicians with very little of other people's money to spend.  As the demand on these medical care systems grows the incentive to create feasible studies that yield usable information will increase.  

Experts, Expert Opinion, and Science - May They Never Meet

Dr. Eckel describes himself as “a scientist and professing six-day creationist and a member of the technical advisory board of the Institute for Creation Research…” Many scientists are religious. This is not to question Dr. Eckel’s religious beliefs, but to question his ability to think scientifically. He believes there is scientific proof that the world was created in six days and that evolution does not exist. This should at least raise eyebrows when the co-chair of an influential panel charged with giving scientifically sound dietary advice has a financial conflict of interestand proselytizes for beliefs that are anti-scientific.

Practice guidelines affect both public policy and medical practice. We should expect professional medical organizations—like the American Heart Association—to examine all the evidence relating to diet and heart disease risk.

The American people should be able to trust that only impartial scientists write guidelines. We should be confident that those experts are not working to advance corporate interests and that they do not espouse beliefs that are well outside the scientific mainstream. An avowed creationist who consults for a food lobby hardly seems an appropriate choice to fulfill these criteria.

For the last several decades, the AHA has promoted a low-fat high-carbohydrate diet as a cornerstone of heart health. It has taken a very public position that saturated fats are a major driver of heart disease risk and the mounting tide of evidence that this is dead wrong must put them it in a very uncomfortable position. And yet a fundamental requirement of science—as opposed to propaganda—is that when evidence that contradicts a hypothesis is replicated over and over again, that hypothesis must be abandoned.

http://www.thedailybeast.com/articles/2014/05/22/the-heart-association-s-junk-science-diet.html

This writer is very confused.  She says we should be able to trust that only impartial scientists write guidelines.  There is no such thing as an "impartial scientist", and if there were, there would be no way to identify one.  Further, the scientific method is very clear about the problem with truth - people.  The point of the scientific method is to remove the influence of humans on determining what is or is not true as regards scientific inquiry. 

She says we should be confident those experts are not working to advance corporate interests, but come on - how will that happen?  Many of them are, and it's ridiculous to think that we can figure out which which is which.  We should look at experts and politicians and corporations and their products and perform due diligence - including considering the opinions of "experts" who will judge everything created by any corporation as being a bad thing.  

As for this assertion, that we should be confident that they [scientists] do not espouse beliefs that are well outside the scientific mainstream, that's another laugher.  If that was the criteria for trusting a scientist, we might all still believe the earth was flat and that the sun revolved around us.  But it is also just an extension of the writer's underlying confusion - that we lay persons should be able to trust all knowing, all caring and all loving experts with our health, since we're all too stupid to sort out our own self interest and they practically were put on the earth to help us and ignore their own self interest.

There are no simple answers and there is not likely to be a solution that will remove from our plates the job of figuring this stuff out for ourselves.  

Good science can be executed by idiots with bad intentions and crazy beliefs.  Bad science is often the result of caring and highly informed people with great intentions.  The underlying assumption of the scientific method is that we cannot trust humans.  

Let the buyer beware.  The AHA has little to do any longer (and it may have never had anything to offer in that arena) with helping you keep your heart healthy, but that is not new news and has nothing to do with who their experts are.  It's a result of, or the cause of, the AHA's refusal to acknowledge how little we have proven by science about diet and health; and the AHA's assertion that it knows what is good/bad for heart health; and the AHA's refusal to admit to being wrong when there is now plenty of evidence that contradicts the AHA's advocacy of a low fat diet.

The AHA is just another institution gone wrong, of which there are plenty of other examples, and the idea - prestigious and influential institutions which are found to be self serving vice purposeful - is one of the less surprising discoveries in this time.  Raise your fist and be thankful that we have equal access to information, and need no longer be dependent on experts and institutions.

Correlation or Causation?

To summarize, back in the 80s and 90s, because scientists had noted a correlation between estrogen replacement therapy and a decreased risk of heart disease, many women were put on estrogen replacement by their doctors.

Twenty years later, a controlled randomized study showed that in fact, estrogen replacement was very bad for heart disease! Oops.

How could a mistake of this magnitude occur?

It turned out that women of higher socioeconomic status who were more interested in their health (or better positioned to do something about it) were much more likely to ask for or agree to take estrogen than poorer women who had less access to health care.

And while on the surface it may have looked as if hormone replacement therapy reduced a woman’s risk of heart disease, in fact, it was a woman’s socioeconomic class that actually predicted that risk.

Middle and upper class women were less likely to suffer from heart disease – despite the fact that more of them were on hormone replacement therapy, not because they were on hormone replacement therapy.

http://www.precisionnutrition.com/research-review-fish-oil-prostate

Filed under "epidemiology has a 100% track record - it has always been wrong."

Why We Got Fatter During The Fat-Free Food Boom

"In an informal survey, we asked readers of The Salt if they bought packaged food labeled as fat-free during the fat-free marketing craze. 76 percent said yes, and 70 percent told us they ate more refined carbohydrates and sugars as a result."
http://www.npr.org/blogs/thesalt/2014/03/28/295332576/why-we-got-fatter-during-the-fat-free-food-boom?sc=17&f=1001

This is another telling of how the government intervened in the diet of americans, and killed many, based on immature science, good intentions and arrogance.  If folks could sue the government, the settlement would be far larger than the tobacco industry settlement as so many more were killed and sickened.

Just Another Observational Study

"Drinking more than four sweetened beverages a day, especially diet soda, doesn't appear to be good for one's mood, a study by the U.S. National Institutes of Health found.

"In a study of more than 200,000 older adults, those who drank more than four cans of soda a day had a 30 percent greater risk of depression than those who consumed none. The same amount of fruit punch was tied to a 38 percent higher risk, according to research released today by the American Academy of Neurology. The risk was even greater for people who consumed diet drinks, whether soda, punch or iced tea.

The study, one of the first to look at sweetened beverages and depression, doesn't explain the connection, so it's still unknown how the drinks may be tied to mental health, said Honglei Chen, one of the study's researchers. One theory is that the drinks have been linked to diabetes and obesity, which in turn can lead to the mood disorder, he said."

http://www.bloomberg.com/news/2013-01-08/sweetened-drinks-linked-to-depression-in-u-s-soda-study.html

We didn't need another observational study, but these things get funded so they do them.  The study can't answer the important question:

Does drinking soda/diet soda make you depressed?

Because the answer very well could be that depressed people drink more soda of any type to make themselves feel better.

However, there's a good reason to think that drinking this stuff does in fact make you depressed, because the best model for depression is based on inflammation as the cause.  In other words, the same chronic inflammation that is caused by a diet that features high blood sugar spikes, high chronic insulin levels and systemic chronic inflammation causes depression in some or many of those on this diet.  

Ever see a depressed person socking away avocado?  Lard?  Or bacon and eggs?  More likely, they are eating cookies or other sweets (processed foods made from wheat, soy, HFCS, and omega 6 laden industrial "vegetable oils"), along with their cola (diet or otherwise).  

Eat meat, vegetables, nuts and seeds, little fruit or starch, no sugar/wheat.

More Exercise, Less Mortality. "?"

""Exercise may be as good as drugs for heart disease, diabetesDec. 14, 2013 at 2:01 AM

Dec. 14 (UPI) -- A meta-analysis found exercise may be as effective as drugs in helping patients with strokes, diabetes and heart disease, British and U.S. researchers say.

Researchers at the London School of Economics and Political Science, the Harvard Medical School, Harvard Pilgrim Health Care Institute in Boston and Stanford University School of Medicine in California conducted a meta-analysis of 305 research projects involving 340,000 patients diagnosed with one of four diseases: heart disease, chronic heart failure, stroke or pre-diabetes.

The researchers compared the mortality rates of those prescribed medication for common serious health conditions, with 57 studies involving 15,000 volunteers enrolled in exercise programs.

The findings, published in the British Medical Journal, found medication worked best for those with heart failure, but physical activity was at least as effective as the drugs which were normally prescribed for borderline diabetes, heart disease and might be better for stroke.

Although exercise seemed to be more effective than drug interventions in stroke rehabilitation, and diuretics seemed to be more effective than exercise interventions in heart failure treatment, these findings should be interpreted with caution given the scarceness of data and the different settings involved, the researchers wrote in the study.

Despite research suggesting regular physical activity could be "quite potent" in improving survival odds, but until more studies are done, patients should not stop taking their medications without taking medical advice, the researchers warned.""

These study results are very interesting.  The confounders:  What type of exercise?  How did they control for factors such as: those who eat the worst, highest carb diets, will feel the worst and will have the greatest inflammation, and so will likely exercise least.  IOW - the study would not detest that perhaps those who work out more often are the ones who already eat better than those who do not work out.  

In my experience, exercise if of minimal benefit if one's interest is simply fat loss.  To get the fat off your belly, you have to change how you eat.  But exercise is GREAT if you want to feel better, live better, and absolutely essential if you want to have a chance to end this ride on your own terms.

This abstract was forwarded to me by Dr. Lowell Gerber, you can learn about his fascinating cardiology practice here:

www.youngerleanerme.com

Science, Diet, Health, Cognitive Dissonance, Opinion and Humility

Dr. Mike Eades of Proteinpower.com is blogging again and that's good for me, I have learned quite a lot over the years from his blog.  If he's overly contemptuous from time to time, he's also very skilled at teaching the scientific method as applied to health and diet.  There were a couple of posts that completely changed how I see human metabolism.  Thanks Mike!

In this post, he discusses the challenges in the business of helping people sort out dietary right from dietary wrong.  The title - Eat Less Move More and Die Anyway - points to the oft cited formula for how to change the world's predicted health care disaster (if everyone is sick, you can't pay for all the necessary meds and care).  The benefit of this simple approach is it is not intimidating - you might think "anyone can do this, even me."  The downside - the science that is available indicates that moving more and eating less does not help you dodge those nasty terminal endpoints of life that we would like avoid so that we can live long enough to die in our beds (as we used to say when I was a Patrolman trying not to get killed in the line of duty).  At the link above he details a 9 year study which proved fairly convincingly that a low fat, low calorie intervention with moderate exercise was not effective at combatting the diseases of civilization.

Not that you would have heard about that 9 year study, because if they mentioned that, they'd have to start saying things like "we never really knew whether low fat, low cal was good for you or not, but we were sure hoping it would be.  Sorry about all your dead relatives and all those meds you are taking to help with hypertension, gout, and diabetes."  As to that point, one might be concerned that government health care authorities made recommendations that may be killing us, and may be making us sick and at the same time enormous consumers of the medications that sick people get in this country, AND that those recommendations were not proven by science.  The implications are immense, but that's another discussion.

Nor were you likely to have heard about these studies, which could have changed the debate all by themselves (these quotes are also from Mike Eades' blog):

"A couple of years ago, Ron Krauss, as mainstream a researcher as you could find and holder of all sorts of academic credentials, started thinking that maybe saturated fat wasn’t the demon everyone thought it was. He dug up all the studies he could find looking at whether or not saturated fat actually did cause heart disease. He put all these studies together in a meta-analysis, and got it published in the prestigious American Journal of Clinical Nutrition (AJCN). The article, titled Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease, came to the following conclusion:

there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD. More data are needed to elucidate whether CVD risks are likely to be influenced by the specific nutrients used to replace saturated fat.

"And, as if to rub salt in the wounds of the lipid hypothesis folks, Krauss published another paper in the same issue of the same journal looking at a nutrient that often replaces saturated fat.

"This second paper, titled Saturated fat, carbohydrate, and cardiovascular disease, concluded

there are few epidemiologic or clinical trial data to support a benefit of replacing saturated fat with carbohydrate. Furthermore, particularly given the differential effects of dietary saturated fats and carbohydrates on concentrations of larger and smaller LDL particles, respectively, dietary efforts to improve the increasing burden of CVD risk associated with atherogenic dyslipidemia should primarily emphasize the limitation of refined carbohydrate intakes and a reduction in excess adiposity.

The point Mike Eades is grinding on is the abuse of the mantle of science by the combination of the "gurus" and the science journalists, who should know better than to simply babble on about the results of studies that, almost always, can't show cause and effect, but are treated as if they do.

You can see the resulting cognitive dissonance here, where Forbes reviews the book Grain Brain:
Some in the nutrition and medical communities take issue with Perlmutter’s premise and prescription. Several critics, while not questioning the neurological risks of a high-carb diet, have pointed out that readers may interpret his book as a green light to load up on meat and dairy instead, a choice that has its own well-documented cardiovascular heart risks.

“Perlmutter uses bits and pieces of the effects of diet on cognitive outcomes — that obese people have a higher risk of cognitive impairment, for example — to construct an ultimately misleading picture of what people should eat for optimal cognitive and overall health,” St. Catherine University professor emerita Julie Miller Jones, Ph. D., told the website FoodNavigator-USA.

If it is so dangerous to load up on a meat and dairy based diet, which of course is not what low carbers typically advocate, why can't they show one single intervention study in which people eat that way have poor mortality results?  Answer - because when people are put on a diet like that they don't get sick.  The thing that's not there can be ignored by those who still believe what has never been true.

Science is supposed to be about conflict, because the scientific method is fundamentally about the human condition.  Humans are not good at doing truth.  Humans are subject to all kinds of bias.  Being a scientist does not cure one from being human.  Thus, the first response to all scientific efforts should be to think "that's BS, how could they prove that?"  Perversely, we consult scientists and ask them their opinions as if that's the same as the scientific method.  Things that scientists say are judged authoritative.  This leads to the "You are an idiot and I'm a genius" argument that is all over the web, in which a person grades their own homework and tells the world how they know the science like no other.  It is certainly tough to get a blog audience by saying, "gee, we don't really know, but this is what I think".  When science is conclusive - drop an apple, it falls, debate about gravity over - we don't have much to fight over.  The presence of web-fighting about something is evidence of weak science.

Because the science of diet and health is so immature, humility will serve one well.  Rather than pretending to know what isn't known, I think it's more useful to focus on what works - for yourself, for your clients, while continuing the search for truth.  Human nature gets in the way of this approach, ego demands we proclaim our intellectual victories and pummel the ignorant authorities proved wrong daily, but that's the struggle of being human.  As it seems to be for Mike Eades, it is hard for me not to feel contemptuous and angry about folks who should know better, who hold positions of authority in government and as industry leaders, who say "this is true" when, based on the scientific method they claim supports them, "this may or may not be true."

What I think, and what has worked for me, is that excess blood sugar is the worst thing one can do to oneself if the goal is to avoid early decline, physical and mental degeneration, and the diseases of civilization.  The best way to regulate blood sugar is to avoid destroying your body's ability to regulate it for you.  The body has an ancient mechanism that works well when not bombarded by too much of the agricultural monsters we produce for ourselves today (primarily sugar and wheat, with industrial seed oils playing a role via enhanced inflammation). You will die one day, I will die one day, the point is what do you get to make of the days you have before that terminal end point?  The sick have fewer choices, and the sick take choices away from the ones that they love.  Striving for thriving health is the shizzle, I think, if shizzle still means what it did the first time I heard that ten years ago.  My conjecture may not work for everyone.  My conjecture has quite a bit of supporting evidence in the scientific literature but is far from proved true (although NUSI.org may be able to do something about that before I reach my terminal end point).

You can test this conjecture on yourself with ease.  If you restrict carbs with a well formulated high fat, moderate protein diet, does your blood sugar regulation improve?  Do you have less hunger?  Can you start to win the battles with your food obsessions?  Does real food begin to taste better?  Do your aches and pains feel less achy?  Are you sleeping more soundly?  Is your belly getting smaller?  Has the government stopped recommending foods that used to make you fat, lazy and sick?  (Just kidding on that last part, that's not going to happen anytime soon because they haven't exhausted their ability to try to prove what they said was proven 40 years ago).

So don't take some blogger's word for it, or some person's word for it who has a PHD after their name.  Do the experiment on yourself, the results can be (if the experiment is done correctly) more significant than a lifetime of expensive science performed by folks who you never met.

Pseudo Science

Can a teacher get in trouble for talking out of school?  Let's hope not.  This professor's critique is, in my humble as ever opinion, spot on.  I'm glad someone will say it from the "inside".  I recommend the full article.

The apparent self-interest that is driving research in this field is not limited to raising students to merely follow the herd. The subjective data yielded by poorly formulated nutrition studies are also the perfect vehicle to perpetuate a never-ending cycle of ambiguous findings leading to ever-more federal funding. The National Institutes of Health spent an estimated $2.2 billion on nutrition and obesity research in the 2012 fiscal year, a significant proportion of which was spent on research that used the pseudoscientific methods described above. The fact that nutrition researchers have known for decades that these techniques are invalid implies that the field has been perpetrating fraud against the US taxpayers for more than 40 years—far greater than any fraud perpetrated in the private sector (e.g., the Enron and Madoff scandals).

When anti-science rhetoric occurs at a Kansas school-board fight over creationism, we can nod our educated heads in silent amusement, but if multiple generations of nutrition researchers have been trained to ignore contrary evidence, to continue writing and receiving grants, and to keep publishing specious results, the scientific community as a whole has a major credibility issue. Perhaps more importantly, to waste finite health research resources on pseudo-quantitative methods and then attempt to base public health policy on these anecdotal “data” is not only inane, it is willfully fraudulent.  

Edward Archer is a research fellow at the Arnold School of Public Health at the University of South Carolina. He recently coauthored a PLOS ONE article on this topic.

http://www.the-scientist.com/?articles.view/articleNo/37918/title/Opinion--A-Wolf-in-Sheep-s-Clothing/

What Is "Doubly Labelled Water"?

Water is pretty cool stuff. It keeps you hydrated, helps you flush waste materials from your body, and when combined with healthy muscle glycogen levels from a high-carbohydrate diet, makes your muscles look nice and full and vascular and all-round swole.

But the physiological usefulness of water hardly ends there.

If you take some water, partially or completely remove the hydrogen and oxygen and replace them with the elements deuterium and oxygen-18, you end up with what is known as doubly labeled water.

At this point you’re no doubt thinking, “Why on Earth would you do that to water?”

Because the use of doubly labeled water has proved itself to be a rather nifty way of measuring energy expenditure in free-living humans (and animals). And it offers a greater degree of accuracy than the aforementioned energy expenditure formulas. 

http://anthonycolpo.com/why-you-cant-trust-nhanes-or-gary-taubes-robert-lustig-to-accurately-report-calorie-carbohydrate-fat-intake-trends/

In spite of AC's deeply held belief in the significance of immature science, I think this is a helpful description of what doubly labelled water is, and what it does.

It's a powerful tool to understand the interplay between caloric intake and expenditure, and how they interact with differing macronutrient intakes and differing individuals.

BMJ: We Missed the Mark on Sat Fat

This is a great read, I highly recommend you read the whole piece.

"The aspect of dietary saturated fat that is believed to have the greatest influence on cardiovascular risk is elevated concentrations of low density lipoprotein (LDL) cholesterol. Yet the reduction in LDL cholesterol from reducing saturated fat intake seems to be specific to large, buoyant (type A) LDL particles, when in fact it is the small, dense (type B) particles (responsive to carbohydrate intake) that are implicated in cardiovascular disease.4

"Indeed, recent prospective cohort studies have not supported any significant association between saturated fat intake and cardiovascular risk.5 Instead, saturated fat has been found to be protective. The source of the saturated fat may be important. Dairy foods are exemplary providers of vitamins A and D. As well as a link between vitamin D deficiency and a significantly increased risk of cardiovascular mortality, calcium and phosphorus found commonly in dairy foods may have antihypertensive effects that may contribute to inverse associations with cardiovascular risk.6 7 8 One study showed that higher concentrations of plasmatrans-palmitoleic acid, a fatty acid mainly found in dairy foods, was associated with higher concentrations of high density lipoprotein, lower concentrations of triglycerides and C reactive protein, reduced insulin resistance, and a lower incidence of diabetes in adults.9 Red meat is another major source of saturated fat. Consumption of processed meats, but not red meat, has been associated with coronary heart disease and diabetes mellitus, which may be explained by nitrates and sodium as preservatives.10

"The notoriety of fat is based on its higher energy content per gram in comparison with protein and carbohydrate. However, work by the biochemist Richard Feinman and nuclear physicist Eugene Fine on thermodynamics and the metabolic advantage of different diet compositions showed that the body did not metabolise different macronutrients in the same way.11 Kekwick and Pawan carried out one of the earliest obesity experiments, published in the Lancet in 1956.12 They compared groups consuming diets of 90% fat, 90% protein, and 90% carbohydrate and showed that the greatest weight loss was in the fat consuming group. The authors concluded that the “composition of the diet appeared to outweigh in importance the intake of calories.”

"The “calorie is not a calorie” theory has been further substantiated by a recent JAMAstudy showing that a “low fat” diet resulted in the greatest decrease in energy expenditure, an unhealthy lipid pattern, and increased insulin resistance in comparison with a low carbohydrate and low glycaemic index diet.13 In the past 30 years in the United States the proportion of energy from consumed fat has fallen from 40% to 30% (although absolute fat consumption has remained the same), yet obesity has rocketed."

This one is a mind blower, as I have read the NNT was 100, whereas baby aspirin is 40.  It's much worse than that:

"A meta-analysis of predominantly industry sponsored data reported that in a low risk group of people aged 60-70 years taking statins the number needed to treat (NNT) to prevent one cardiovascular event in one year was 345.20 The strongest evidence base for statins is in secondary prevention, where all patients after a myocardial infarction are prescribed maximum dose treatment irrespective of total cholesterol, because of statins’ anti-inflammatory or pleiotropic (coronary plaque stabilising) effects. In this group the NNT is 83 for mortality over five years. This doesn’t mean that each patient benefits a little but rather that 82 will receive no prognostic benefit.21 The fact that no other cholesterol lowering drug has shown a benefit in terms of mortality supports the hypothesis that the benefits of statins are independent of their effects on cholesterol."

http://www.bmj.com/content/347/bmj.f6340

It's MAGIC!

The ubiquitous recommendations for health and wellness include such recommendations as reducing salt/sodium intake, keeping saturated fats to no more than 10% of total caloric intake, and of course "moving more and eating less".

Strangely, none of these things is likely to be helpful to most folks, and yet, many folks do all of these things on the thought that "There must be a reason why so many people tell me to do this. They have a PHD, they must know what's best, its magic to me but they must know."

It's the presumption that someone out there knows the answer which drives this kind of behavior. It's what led me to go "low fat" for a few years, which also led to a monster fat gain, which led to me finally deciding I had to figure the food and fat thing out.

In the past, it was not unreasonable to assume that other people would "know" the important things. It probably made sense to do what your doctor told you to do. Doctors back in the day had access to much information that you didn't have access to, and a vast depth of training and experience. They also had many fewer tools to work with than they have now, so they likely knew the ones they had very well and had seen the results of using that or those tools many times.

That's all different now. You can know as much as your doctor about your individual situation, in many cases. You can take responsibility for your own circumstance. You no longer need believe that the voice of authority is right, at least not for your situation. You don't have to treat health and diet recommendations as if they are the magic elixir, distributed by those who know the dark secrets.

Let's take the case of salt/sodium for an example. If you have a blood pressure problem, and you reduce your salt intake, you may notice a reduction in blood pressure. There's quite a bit of evidence that reduction of blood pressure results in better health. So if you reduce sodium intake and your blood pressure numbers improve, voila, you've just proven that sodium reduction is a worthy pursuit. Of course, about 80% of those who have high blood pressure can control this problem by carb restriction, and in that case, can eat all the salt they want to. Either way, you choose your intervention and you get the results based on your own judgment of cost/benefit.

What if, on the other hand, you don't have a blood pressure issue? Strangely, the authorities will still tell you to reduce your salt intake. This is not because they can prove that reducing sodium intake will make your life better, this is because much of the information we hear about salt and such is "public health science." That is, it is intended to address the needs of and health outcomes of populations. From the public health perspective, if you tell 1000 people to reduce sodium intake and 500 comply, and of that group 100 get a benefit, that's a win. In other words, they don't really care if you or your family or anyone you know will benefit from the recommendation, because they are on a mission from god to change health statistics for a population, so they make recommendations that may or may not help you. These recommendations are promulgated because the "scientists" entered their assumptions about the recommendation in question along with estimation of compliance and estimates of the theoretical benefit of the recommendation. If their computer model calculates (based on their assumptions) that the recommendation in question will "save" thousands of life if implemented in our population of 300+ million - Yahoo! Another public victory!

Isn't that great!?!

Vaccinations are a variance on this theme. If you give enough kids a vaccine, one or more will die as a result of a reaction to the injection. If you are the parent of the dead child, it will be cold comfort to know that in theory thousands of lives, or hours of suffering, were "saved" by the vaccination of the masses.

In short, "public health" and the science that this discipline draws on is not focused on you, your circumstances or your individual interest. Knowing that, I'm stunned at how many people labor under the misinformation that this field so skillfully distributes.

The point is "don't trust the experts." If they say it is true, try it and measure the result.
If there is no change, don't assume this is some magic that should guide your life based on your faith that the government scientists must know more than you know, and must be faithfully interpreting the results of the science they work with.

Test it! If eating whole grains makes your blood sugar skyrocket, don't believe it when they tell you that whole grains "break down more slowly in the gut and therefore have a lower glycemic load." If you don't have a blood pressure problem, don't worry about salt intake. If you try carb restriction and your gout, your blood pressure, and your lipid profile improves, tell them they can go suck it when they say you need to eat 11 servings of grain each day. If you are eating a mountain of fat every day (as I do) and your blood lipids look good, you feel good, you perform well, you sleep well, your hunger is minimal to non-existent (most days I eat by habit and routine, and almost never for hunger), your waist is small (or getting smaller), then have a good laugh when they tell you to cut the red meat and animal fats and graze on vegetables 24/7; and pray for their eventual enlightenment (hopefully before I die so I can say "I told you so").

By the same token, if you can suck down bread like there's no tomorrow, and you look feel and perform just like you want to, more power to you! There's no one on the planet who's smart enough to question something that works for you - assuming it does.

And that's where this narrative gets tricky, because we often accept compromises based on our belief that they are "normal." I see people daily who think their aches and pains are normal. They think "well everyone else is taking statins and BP meds, that doesn't mean anything, it's just part of aging and boy aren't we lucky that these great meds are available and my insurance company will pay for them." They wrestle with heart burn daily but "so does everyone else in their family." I see people who think their expanding waistline is just part of getting older. I see people getting dental work who just think it's great that the dentist can remove and replace teeth with minimal pain. I see people who think osteopenia is just "aging bones" and don't question the recommendation to eat calcium. I have come to believe that all of these issues are not normal, and when I confront one I will fool around with diet until I can find a solution. This has been successful in eliminating several chronic conditions that I thought were just "normal" or part of my own genetic defects - IBS, having my nasal passages close each night (how well do you sleep when you nose is stopped up from a cold? How would you like to feel that way every night?), or having such high levels of knee pain that I was taking 800mg of ibuprophen three times daily.  I have fixed all of this and more, so yes, I'm a believer.

In other words, if you don't think something is wrong, how likely will you be to change? You will just bravely suffer on, hoping the meds don't ever stop working. And of course, this is another reason why the public health authorities make recommendations as they do - they don't think you are smart enough to figure out what's wrong or what to do about it.

I would hope that most of those who are reading this "won't be that guy/girl" who's too ignorant to know what's wrong and what to do about it. Find a solution, take action, be persistent. Magicians are fun but I don't recommend that you take their advice about diet and health.

Quack of the Century and Why You Shouldn't Take "Vitamins"

This is partly why I say "If you can't tell a difference, there is no difference."

It makes the most sense to eat in a way that helps you look, feel and perform your best. If that doesn't help you to live to 80 ... well, you'll have a good ride while you are here! No one knows yet how to make the best odds for living to 80, so "make each day count" is as smart as following expert advice on longevity.

Here's a long article about vitamins and health. I am posting the most relevant parts, but the whole thing is a good read if you have curiosity about how the science of diet could go so far wrong. http://www.theatlantic.com/health/archive/2013/07/the-vitamin-myth-why-we-think-we-need-supplements/277947/

Excerpts:

On October 10, 2011, researchers from the University of Minnesota found that women who took supplemental multivitamins died at rates higher than those who didn't. Two days later, researchers from the Cleveland Clinic found that men who took vitamin E had an increased risk of prostate cancer. "It's been a tough week for vitamins," said Carrie Gann of ABC News.
These findings weren't new. Seven previous studies had already shown that vitamins increased the risk of cancer and heart disease and shortened lives. Still, in 2012, more than half of all Americans took some form of vitamin supplements. What few people realize, however, is that their fascination with vitamins can be traced back to one man. A man who was so spectacularly right that he won two Nobel Prizes and so spectacularly wrong that he was arguably the world's greatest quack.


Although studies had failed to support him, Pauling believed that vitamins and supplements had one property that made them cure-alls, a property that continues to be hawked on everything from ketchup to pomegranate juice and that rivals words like natural and organic for sales impact: antioxidant.
Antioxidation vs. oxidation has been billed as a contest between good and evil. The battle takes place in cellular organelles called mitochondria, where the body converts food to energy, a process that requires oxygen and so is called oxidation. One consequence of oxidation is the generation of electron scavengers called free radicals (evil). Free radicals can damage DNA, cell membranes, and the lining of arteries; not surprisingly, they've been linked to aging, cancer, and heart disease. To neutralize free radicals, the body makes its own antioxidants (good). Antioxidants can also be found in fruits and vegetables -- specifically, selenium, beta-carotene, and vitamins A, C, and E. Studies have shown that people who eat more fruits and vegetables have a lower incidence of cancer and heart disease and live longer. The logic is obvious: if fruits and vegetables contain antioxidants -- and people who eat lots of fruits and vegetables are healthier -- then people who take supplemental antioxidants should also be healthier.

In 1994, the National Cancer Institute, in collaboration with Finland's National Public Health Institute, studied 29,000 Finnish men, all long-term smokers more than fifty years old. This group was chosen because they were at high risk for cancer and heart disease. Subjects were given vitamin E, beta-carotene, both, or neither. The results were clear: those taking vitamins and supplements were more likely to die from lung cancer or heart disease than those who didn't take them -- the opposite of what researchers had anticipated.

In 1996, investigators from the Fred Hutchinson Cancer Research Center, in Seattle, studied 18,000 people who, because they had been exposed to asbestos, were at increased risk of lung cancer. Again, subjects received vitamin A, beta-carotene, both, or neither. Investigators ended the study abruptly when they realized that those who took vitamins and supplements were dying from cancer and heart disease at rates 28 and 17 percent higher, respectively, than those who didn't.
In 2004, researchers from the University of Copenhagen reviewed fourteen randomized trials involving more than 170,000 people who took vitamins A, C, E, and beta-carotene to see whether antioxidants could prevent intestinal cancers. Again, antioxidants didn't live up to the hype. The authors concluded, "We could not find evidence that antioxidant supplements can prevent gastrointestinal cancers; on the contrary, they seem to increase overall mortality." When these same researchers evaluated the seven best studies, they found that death rates were 6 percent higher in those taking vitamins.
In 2005, researchers from Johns Hopkins School of Medicine evaluated nineteen studies involving more than 136,000people and found an increased risk of death associated with supplemental vitamin E. Dr. Benjamin Caballero, director of the Center for Human Nutrition at the Johns Hopkins Bloomberg School of Public Health, said, "This reaffirms what others have said. The evidence for supplementing with any vitamin, particularly vitamin E, is just not there. This idea that people have that [vitamins] will not hurt them may not be that simple." That same year, a study published in the Journal of theAmerican Medical Association evaluated more than 9,000 people who took high-dose vitamin E to prevent cancer; those who took vitamin E were more likely to develop heart failure than those who didn't.
In 2007, researchers from the National Cancer Institute examined 11,000 men who did or didn't take multivitamins. Those who took multivitamins were twice as likely to die from advanced prostate cancer.
In 2008, a review of all existing studies involving more than 230,000 people who did or did not receive supplemental antioxidants found that vitamins increased the risk of cancer and heart disease.
On October 10, 2011, researchers from the University of Minnesota evaluated 39,000 older women and found that those who took supplemental multivitamins, magnesium, zinc, copper, and iron died at rates higher than those who didn't. They concluded, "Based on existing evidence, we see little justification for the general and widespread use of dietary supplements."
Two days later, on October 12, researchers from the Cleveland Clinic published the results of a study of 36,000 men who took vitamin E, selenium, both, or neither. They found that those receiving vitamin E had a 17 percent greater risk of prostate cancer. In response to the study, Steven Nissen, chairman of cardiology at the Cleveland Clinic, said, "The concept of multivitamins was sold to Americans by an eager nutraceutical industry to generate profits. There was never any scientific data supporting their usage." On October 25, a headline in the Wall Street Journal asked, "Is This the End of Popping Vitamins?" Studies haven't hurt sales. In 2010, the vitamin industry grossed $28 billion, up 4.4 percent from the year before. "The thing to do with [these reports] is just ride them out," said Joseph Fortunato, chief executive of General Nutrition Centers. "We see no impact on our business."

How could this be? Given that free radicals clearly damage cells -- and given that people who eat diets rich in substances that neutralize free radicals are healthier -- why did studies of supplemental antioxidants show they were harmful? The most likely explanation is that free radicals aren't as evil as advertised. Although it's clear that free radicals can damage DNA and disrupt cell membranes, that's not always a bad thing. People need free radicals to kill bacteria and eliminate new cancer cells. But when people take large doses of antioxidants, the balance between free radical production and destruction might tip too much in one direction, causing an unnatural state in which the immune system is less able to kill harmful invaders. Researchers have called this "the antioxidant paradox." Whatever the reason, the data are clear: high doses of vitamins and supplements increase the risk of heart disease and cancer; for this reason, not a single national or international organization responsible for the public's health recommends them.