Talking Past Each Other

I have found myself defending paleo a lot more recently.  Sometimes against the usual suspects, but also against criticism (and I use that word very loosely) from quarters I wouldn’t have expected.  I am well past trying to defend paleo to those who simply refuse to listen and especially to those whose only criticism of paleo is “I like bread”.  Where my greatest frustration lies, however, is when I hear people talking about modern humans being mismatched to their environments, to not be adapted to the food and inactivity exposures, to eating too much fake food and not enough real food, to sleep, stress, and circadian rhythms, to high glycaemic diets, to not consuming enough quality protein, etc., etc., and then having these very same people tack on the statement “oh, and paleo is a fad and totally bunk.”

Perhaps some of my frustration with this is born from a degree of agreement with them.  If I was anyone other than “That Paleo Guy” and I was looking at the most recent and increasingly common permutations of paleo for the first time, I’d perhaps come to the same conclusion however.  It would be very easy to look at some of the common blogs, the proliferation of paleo treat and dessert recipes, the starting up of commercial paleo cookie dough, and the perpetual (and mind-numbing) media stereotype of the sausage-and-bacon-eating-vegetable-dodging-bearded-Neanderthal-resembling-multi-modal-group-fitness-exerciser, and to view this “paleo diet” as something rather contrived.  Indeed, on the fringes of the movement, as is often the case on the fringe of any movement, it probably is.

But then there are a core group who are probably a bit more moderate/conservative when it comes to all things paleo.  This is the group I identify the most with.  A group which promotes real, whole foods, over and above highly processed (be it commercially processed or DIY home-kitchen processed) aggregations of ingredients made into edible food-like substances; a group which promotes physical activity patterns which involve not sitting, moving slowly with high frequency, applying some form of resistive load on a regular basis, and occasionally pushing oneself hard and fast, without getting all religious and obsessive about it; a group which promotes and respects the power of a good night’s sleep (and won’t sacrifice that just to worship at the altar of the group fitness class); a group which advocates sensible sun exposure without sun-baking and burning; a group which promotes and advocates for more human forms of social interaction (face-to-face vs. online).

The common thread through all of this is that there is nothing particularly new, novel, extreme, dramatic, faddish, or shocking about any of this.  In fact, unless I was doing all of the above in a loin cloth whilst chewing on some raw steak, all in the name of some long-lost ancestor, most media outlets wouldn’t be interested in covering any of it.

Paleo

What is PaleoMy point being, most of the moderate paleo/primal/ancestral/evolutionary biology promoters are not really saying anything that is much different from that which many in the “mainstream” are saying.  I suppose the difference sits with our “why”.  We are all largely stating the “what” and most of the “how” the same.  We (paleo) are just stating the “why” – evolutionary mismatch – a bit differently to many.  That said, is our evolutionary mismatch viewpoint really that radical?  I don’t necessarily think it is.  The Chief Science Advisor to the New Zealand Prime Minister, Sir Peter Gluckman, would perhaps say it isn’t so much a radical view point.

Mismatch: Why our world no longer fits our bodies

What is frustrating, is the amount of talking past each other that is occurring.  Some of this is born out of the paleo/primal/ancestral/evolutionary biology (PPAEB) message being in direct competitive conflict with those who have a $book/$plan/$product/$answer to the problem, that is already largely addressed in a free-to-air, open-source way by the PPAEB movement.  When you perhaps want people to listen to [your message] rather than that of those silly paleo types, it is easier to perhaps cite the most extreme and ludicrous examples from within that movement (or create your own straw man version of said movement), and show yourself to be putting them and their silly notions to bed.  For the most part, I think much of it is just plain ignorance.  I know many people who have heard of paleo, vaguely, haven’t really looked at it because it is something to do with replicating what cavemen did and “that is just silly”, and so haven’t looked at it much from there.  These people tend to rely, heavily, on the same straw man “debunking” arguments presented by others (cue reference to a TED talk where someone debunks paleo…).

As everyone has their own definition of what “paleo” is, I suppose now would be a good point to summarise my own definition of it.  To me, paleo is not about re-enactment, or about a just-so story – doing something because that is what our ancestors did.  “Paleo” has simply always been a point in time – the palaeolithic – a point in time up to about 10’000 years ago – a point up to which a good portion (not all) of my biology evolved based on constant inputs my ancestors received in the environments in which they lived.

Because of the sheer weight of human evolution which took part up to that point, and due to some of the changes that have occurred since then (particularly in the last 40-50 years), it seems like a good place to START (as opposed to finish) when trying to clear some of the signals away from the noise in our modern ecology.  Can we say that the palaeolithic was the peak of humanity in terms of health? Absolutely not.  But given that the world of 2013 seems not to be either, and that our physiology seems very confused by all the multiple inputs it is receiving, then winding the clock back a bit and stripping away some of the more recent signals before retesting them one at a time, seems to be a good approach.  Establish a good and strong baseline and test some theories from there.  Paleo (food, sleep, activity, sun, socialisation…), to me then, is not the end game, but a baseline with which to test things from and a place from which perhaps some “re-matching” can occur, in terms of the signals/inputs my physiology works best with.

Quick example.  I am of Northern European descent and have lactase persistence – I can consume dairy with no gut upset at all.  Ice cream – FTW!  But I get sinus inflammation when I do have dairy.  I only discovered this by adopting a dairy-free paleo diet and repeatedly retesting…re-exposing myself to dairy.  No dairy – no sinus inflammation.  Add dairy – sinus inflammation returns.  No grains – no gut and skin problems.  Add grains – gut and skin problems return.  I needed a good baseline from which to test these things from, however.  This is the essence of an elimination-challenge approach or something like Whole30.

Many of the common and current criticisms of paleo are not anything new and are issues which have been discussed and acknowledged within the community itself.  Chris Kresser sums it up well here, in a statement from 3 years ago…

Paleo

I too have considered a ‘name change’ – a shutting down of TPG and a move away from paleo, spurred mostly by wanting to distance myself from the paleofication brigade.  But in the end, I don’t see much of a point.  Paleo, to me, is a short-hand way of referring to the viewing of diet and lifestyle through an evolutionary lens, in order to understand where we are currently at and what we need to do.  As far as food and nutrition goes, Whole9’s elevator pitch is the essence of what a paleo diet means to me…

nutrition in 60secPaleo, as a way of eating, is also as much about what I’m not eating.  Perhaps I should call myself “That Anti-Neolithic Guy”, though that is as much fraught with interpretation problems as “paleo” is.  Yet this lifestyle that I live and promote manages to avoid the vast majority of the foods on the NEEDNT food list, as published in the New Zealand Medical Journal.  Indeed, there is only 2-3 items on that list that I personally consume (butter, coconut cream, and dark chocolate), and probably only a half-dozen all up which fall into the general category of being “paleo”.  I just replace all of the things on the NEEDNT list with real foods rather than the equally as junky “healthy” replacements suggested in that piece.

NEEDNT List

I also view “Paleo” as a short-hand for using evolutionary biology as a starting point for inquiry into human health and well-being (I should have perhaps called myself “That Evolutionary Biology Guy”).  I really love the inquisitive and collaborative nature of many of the people in this and other movements which fall under the umbrella “Ancestral Health”.  Indeed, I think a multi-disciplinary approach is the best way forward for finding solutions (something we had drummed into us as part of my Sport Medicine diploma – that you are part of a multi-disciplinary team rather than any one person being an authoritarian – a belief that was very absent when studying nutrition).  The editors of the Journal of Evolution and Health sum it up well here…

JEVO

Evolution, as an avenue of inquiry, and a multi-disciplinary approach, allows us to talk more broadly and to come at a problem from different angles to allow us to source the answer.  As an example, I hark back to a popular magazine piece examining the Paleo Diet, and some valid criticisms levelled at it by Sir Peter Gluckman:

NS GluckmanGluckman brings up two good points.  Firstly, that there is no one Palaeolithic diet to go back to – that there was lots of variation in hunter-gatherer diets.  He is quite correct here, which is why I teach my corporate groups that there is no singular hunter-gatherer diet…

HG dietsSo lots of variety in hunter-gatherer diets, but we are close to having an almost singular Western diet (the Standard Western or American Diet).  Hence why we prescribe heavy reductions in the typical Western foods and more of a leaning toward a Paleo template than a set diet. If we recognise that the SWD is not the best for us, and that modern agriculture has contrived the food supply so much that winding the clock back 40-50 years is no longer enough of a correction, it would seem we might have to go back a bit further in time to establish a good baseline.  Chris Kresser again…

Cookie cutter

Template

Gluckman, as an evolutionary biologist, mentions how we have adapted to carbohydrate in our diet by virtue of carrying several copies of a gene coding for salivary amylase – an enzyme in our saliva which helps us to digest starches.  This is true and builds on our knowledge of foods we might be best adapted to eating (mmm… kumara and yams).  But then a plant biologist can add to this discussion further by showing that some plants, such as grains, have the ability to inhibit salivary amylase (and other enzymes in our digestive system), presumably as some sort of protection system for that particular plant;

Inhibitor activity against digestive enzymes, such as α-amylase from human saliva and porcine pancreas and trypsin from bovine pancreas, of three cereal grains species were studied as potential components of nutraceuticals strengthening diabetes and obesity treatment. Significant differences were demonstrated: the highest anti-tryptic activity was found in the grain of the rye varieties studied, whereas the grain of the wheat varieties had significantly higher ability to inhibit α-amylases from human saliva and porcine pancreas. Additionally, seeds of Puma, one of the studied wheat varieties, demonstrated especially low anti-tryptic activity. Such a beneficial arrangement of inhibitors, i.e. high level of inhibitors of α-amylase from human saliva and porcine pancreas and simultaneously low level of trypsin inhibitors from bovine pancreas, indicate the possibility of the application of seeds with such properties to the preparation of nutraceuticals for people with obesity or suffering from diabetes.

By getting more people with an interest in this area talking to each other, rather than at or across each other, we can, collectively, come closer to some answers.  In the above example, starches from roots and tubers, likely good; starches from grains (particularly modern variants), probably not so much.

As a movement, we don’t have all the answers, and when something works we might not necessarily know why.  Yet we are an inquisitive bunch keen to find out why.  I suspect in many instances, we will never know exactly why something has worked the way it has, with it simply being a case of the whole is greater than the sum of the parts, be it for food or any other aspect of health and well-being.

CMJWe are, after all, talking about highly complex systems here.  Not everyone (likely the majority of people who stand to benefit) really want to know of this complexity.  Perhaps this is where we need a narrative or heuristic, which allows people to get the general idea, expedite their understanding of it all, and allow them to apply some basic principles to their lives.  The paleo narrative can be that heuristic, though I agree it can be stretched too far at times. Taleb captures the benefits and imperfections of these heuristics here…

heuristic

I want to highlight a common example of where many of us seem to be at crossed purposes in our discussions around health and nutrition – whole grain foods.

Back in 2005, the Australia & New Zealand Food Authority (ANZFA), under petition from food manufacturers, changed the definition of a whole grain as it can be used in food production and labelling.

ANZFAIn effect, this definition change allowed food companies to take a whole grain, dismantle it to its component parts, and reconstitute them as something which is nothing like the original whole grain as long as the component parts are part of the mix in roughly the same proportions, concurrently assuming that the sum of the parts are at least equal to the whole [grain].  As you can see from the screen capture above, this is because it was really only brown rice and unpearled barley (and likely whole, unrolled oats) which fitted the definition of “whole grain”, and these products were of low marketability for the food companies.  This is the rule change that allows products like Cheerios be marketed as whole grain, even though they are nothing like any of the original source grains.

Jump forward a few years and we have this entry on a blog from University of Sydney researcher, Jennie Brand-Miller;

‘Consume more whole grains is enshrined in dietary guidelines around the globe and has become something of a mantra by doctors, dietitians and nutritionists. But does the science stack up to scrutiny? When you see ‘whole grains’ on front of pack, do you assume it’s the real McCoy? Has it got everything that the original whole grain had – all the micronutrients and characteristics that make whole grains into health foods? Well, I think we are being hoodwinked. Whole grain products might have started with the germ, the endosperm and the bran of the grain, but in many cases, the finished product has been cooked, flaked, toasted, puffed and popped beyond recognition. It’s a long, long way from the grain that came in nature’s packaging…

I encourage you to read the rest of the entry as it makes for interesting reading.

More recently, Professor Jim Mann, from the University of Otago, described bread as “bags of glucose” in a talk on the Nature of Carbohydrate in the Management of Diabetes… and called into question just how much of a source of whole grains “whole grain” bread is.  Prof Mann went on to discuss the cellular structure of these products, suggesting, in effect, that high carbohydrate diets, where the sources of carbohydrate have their cellular structure broken down and destroyed (ground and refined – even when labelled whole grain), lead to a loss of glycaemic control and subsequently predispose people toward metabolic dysfunction and diabetes.

Prof Mann’s comments echo those in a recent paper on this topic;

Comparison with ancestral diets suggests dense acellular carbohydrates promote an inflammatory microbiota, and may be the primary dietary cause of leptin resistance and obesity.

A novel hypothesis of obesity is suggested by consideration of diet-related inflammation and evolutionary medicine

Furthermore, nutrition transition patterns and the health of those still eating diverse ancestral diets with abundant food suggest that neither glycemic index, altered fat, nor carbohydrate intake can be intrinsic causes of obesity, and that human energy homeostasis functions well without Westernized foods containing flours, sugar, and refined fats. Due to being made up of cells, virtually all “ancestral foods” have markedly lower carbohydrate densities than flour- and sugar-containing foods, a property quite independent of glycemic index.

Thus the “forgotten organ” of the gastrointestinal microbiota is a prime candidate to be influenced by evolutionarily unprecedented postprandial luminal carbohydrate concentrations. The present hypothesis suggests that in parallel with the bacterial effects of sugars on dental and periodontal health, acellular flours, sugars, and processed foods produce an inflammatory microbiota via the upper gastrointestinal tract, with fat able to effect a “double hit” by increasing systemic absorption of lipopolysaccharide. This model is consistent with a broad spectrum of reported dietary phenomena.

A diet of grain-free whole foods with carbohydrate from cellular tubers, leaves, and fruits may produce a gastrointestinal microbiota consistent with our evolutionary condition, potentially explaining the exceptional macronutrient-independent metabolic health of non-Westernized populations and the apparent efficacy of the modern “Paleolithic” diet on satiety and metabolism.

I challenge you to read through this paper and to listen to the Prof Mann talk and not see/hear the overlap.  It is the same ground.

The above paper references “ancestral foods” and a modern “Paleolithic” diet as a potential pathway for dietary exploration, as does this recent Australian-authored paper;

Wholegrains: Emerging Concepts, Controversies and Alternatives

Intake of wholegrain foods has been associated in large prospective cohort studies with decreased rates of diseases such as type 2 diabetes, ischaemic heart disease and hypertension. Multiple mechanisms for the protectiveness of wholegrain foods have been reported. Health authorities in western countries recommend wholegrains as one of the major food sources in a healthy diet, otherwise rich in vegetables, legumes and low-fat dairy.

However, the existing evidence for the intake of wholegrains is highly subject to confounding. Many of the results seen in the prospective cohort studies have not been borne out in randomised controlled trials or good-quality meta-analyses. The recommended intake of wholegrains suggested in some countries is well above what there is evidence for. Products labelled wholegrain have variable quantities of the intact grain and differ widely in their effect on blood glucose. Excessive quantities may add to glycaemic load, and anti-nutrients in wholegrains may have adverse health consequences. With the rate of diabetes and obesity increasing, some researchers have questioned the role of grains as part of a healthy diet.

Palaeolithic diets, those that are more in keeping with our evolutionary legacy, contain no grains or dairy, but are rich in vegetables, meat, fish and eggs, with the inclusion of some tubers. Smaller trials in animals and humans comparing a palaeolithic diet to a grain-based diet show improved metabolic profiles in the former.

This is a paper published late last year (2012) and echoes Brand-Miller’s comments from almost exactly 2 years earlier regarding the confounding of evidence related to whole grain intake, and Mann’s more recent comments regarding products labelled as whole grain having profoundly variable effects on blood glucose control.  Again, this paper also references looking toward our “evolutionary legacy” for answers and recommends more nutritious, “cellular” sources of carbohydrate such as vegetables, fruits, and tubers.  We see recognition that ancestral foods and diets are generally lower carbohydrate than standard Western diets.

The Dietary Intake of Wheat and other Cereal Grains and Their Role in Inflammation

Wheat is one of the most consumed cereal grains worldwide and makes up a substantial part of the human diet. Although government-supported dietary guidelines in Europe and the U.S.A advise individuals to eat adequate amounts of (whole) grain products per day, cereal grains contain “anti-nutrients”, such as wheat gluten and wheat lectin, that in humans can elicit dysfunction and disease. In this review we discuss evidence from in vitro, in vivo and human intervention studies that describe how the consumption of wheat, but also other cereal grains, can contribute to the manifestation of chronic inflammation and autoimmune diseases by increasing intestinal permeability and initiating a pro-inflammatory immune response.

The paleo/evolutionary biology approach is to suggest that, due to the relative novelty of grains in the human diet, we haven’t been able to completely overcome their numerous defences against digestion, which when consumed in a modern context, and in the relative large doses we get them in the modern diet, can cause us numerous health issues.  Interestingly, in one of the papers I linked to earlier, researchers are looking to exploit these very properties of grains as a novel treatment for obesity.  The suggestion is that researchers may be able to engineer plants [grains] which selectively shut down our starch-digesting enzyme, amylase, thus reducing how much carbohydrate we absorb.  If you think this sounds suspiciously like engineering “low-carb” grains, this is exactly what it is.  The only problem (not the only problem, as I see it, but the only problem for the researchers) is that these plants also disrupt protein digestion with fairly disastrous consequences.  Full paper here.

More recently, a prominent New Zealand economist has joined the nutrition debates, attacking a New Zealand food production system that is awash with Fake Food;

Why do we expect scientists and factories to make better food than Mother Nature? The fact is that nutrition science is a fledgling beast, and simply hasn’t been able to keep up with the innovation in the food industry. The whole paradigm of taking foods, processing them into their constituent parts, then recombining them in weird and wonderful ways to ‘add value’ is the stuff of mad scientists. Just as Frankenstein’s dabbling created a monster, so too has the dabbling of food scientists created Frankenfoods. There are a many examples where this scientific approach to food has gone horribly wrong; including milk formula and trans fat. There are also emerging examples where isolating food components from their natural state turns them from benign to harmful, including fructose, carotene and fibre.

So, then, from multiple quarters, we would seem to have a strong degree of convergence taking place.  Many, be it career academics, researchers, clinicians/practitioners, and lay people, are all coming to largely the same conclusions on very many areas in nutrition.  We are all perhaps using slightly different language, and there are definitely some nuances to each, but the basic skeleton is the same.  One group might talk about eating a low glycaemic index and load diet, whilst another might call this low carb.  One group might discuss omega 3: 6 ratios, whilst another might just say to avoid margarines and vegetable oils whilst eating more fish and seafood.  One group will talk about altering our sodium to potassium ratio, whilst another might say we need to eat less processed foods and eat more fruits and vegetables.  One group might describe a meal containing salmon, eggs, and vegetables coated in olive oil as Mediterranean, whilst another will call it Paleo.

Real Food

Real Food

We are all largely on the same page.  Yet for reasons of ego, perceived authority, conflicts of interest, and whatever else, we get caught up in these semi-religious debates around whose food god we should all be worshipping.  Strangely, each of our chosen deities seems to just eat real food.  We are talking past each other – talking at crossed purposes.  Nobody expects 100% agreement on anything as there is so much we just don’t know.  Scepticism and robust debates are healthy, allowing new information to be thrown into the light.  I have been to the Ancestral Health Symposium for the last 3 years – a symposium where attendees, for the most part, support a similar paradigm.  Yet even within this group there are differing viewpoints and subtle (and sometimes not) differences in approaches.  But it is largely hair-splitting.  There is no expectation that everyone will agree on everything (see the Jaminet vs. Rosedale “Safe Starches” debates as a good example).  But it would be nice to see at least some recognition and acknowledgement when we all agree on the same thing.  Instead, we have people calling Paleo a fad or fringe (and trademark infringement), academics bickering amongst themselves about who has the authority to be saying what, and a dietitian promoting a whole food-based diet whilst simultaneously making up stories about a movement that promotes largely the same thing.

Debates in New Zealand around low-carb (LCHF) diets have shot to prominence recently, with people again seemingly talking past each other and getting caught up with the label applied to the end plate of food.  The plate pictured above could be called a LCHF meal, or it could be called a Paleo meal, or it could be called a Mediterranean meal, or a Heart Foundation meal, or just a plate of real food.  Yet, without actually referencing THE SAME plate of food, these individual labels are proving divisive; like a pack of wild dogs scrapping over the same bone.

The ‘establishment‘ response to a call from the low carbers to change our eating habits is that they have reviewed the evidence for lower carbohydrate, higher protein diets (in a real food context, fat and protein often travel together), stating that they offer no advantage beyond the two years that they are predominantly studied for.  This becomes an interesting notion when I know that what the low carbers are suggesting is a diet free of processed food (including the many and varied forms of grains, which, as per above, we all seem to agree are problematic in their most modern guises) and rich in vegetables, fruits, and whole protein sources and their inherent fats.  In essence, the academic nutrition establishment seem to be suggesting that real food diets offer no advantage (for weight loss) beyond two years.

When you see what the academic research version of a low carbohydrate, high protein diet is, it becomes very easy to see the flaws and even easier to see that we aren’t even arguing about the same thing.  The following is from a recent thesis submission to the University of Otago.  The thesis itself is a tome of work, and I genuinely admire anyone who can commit themselves to such a project.  It is a huge effort and you can see how difficult it is to conduct such research on free-living humans.  I really encourage you to read the sections where the study participants gave feedback on all the difficulties they had with this diet research (some of which I think is due to inherent flaws in the study design, but then other aspects are just inherent to dealing with real humans).  The real money shot, however, is the head-to-head comparison of the foods feed to the low-fat (high-carb) and the high-protein (low-carb) groups – look at these bearing in mind all the information above on whole grain foods…

High Carb Study

High Carb Study Diet

High Protein (Low Carb) Study Diet

High Protein (Low Carb) Study Diet

I’m not going to do a full analysis of the thesis here (a whole new post in itself), but it becomes easy to see, qualitatively, that we are all discussing quite different diets even when referencing the same macronutrient terms (underscoring the futility of macronutrient-based arguments).  The conclusion from that study: “This study demonstrated that a high protein or high carbohydrate diet is equally effective for weight loss. Dietary compliance however was poor and drop out rates were relatively high.”

Instead of talking at each other and talking past each other I think it is time we started talking to each other in a way that allows us to use the same language.  It is time we acknowledged where there is common ground and to debate, robustly and respectively, areas which need threshing out further.  No singular authority has all the answers; all the practical solutions.  But we actually agree on a surprising number of areas, and we all seem to certainly agree with what ends up on our plates, for the most part – real food.  Let’s start talking about that.

BMJ: Swedish health advisory body says too much carbohydrate, not fat, leads to obesity

The British Medical Journal has been going gangbusters of late, publishing many pieces counter to the conventional wisdom.  Dr Aseem Malhotra and Dr Des Spence are amongst a couple of favourite reads of mine.

In the last few days, they have published this small piece on some of the happenings in Sweden;

An influential Swedish health organisation has recommended a diet that is low in carbohydrates but not low in fat for people who are overweight or obese or have diabetes.

The advice from the Swedish Council on Health and Technology Assessment is the result of a two year review of 16 000 scientific studies of diet.1 The recommendation contradicts the generally held belief that people should avoid foods that are rich in fat, especially those high in saturated fat.

The council, which advises the Swedish healthcare system, concluded that the scientific evidence did not support a low fat diet. Instead people should focus on reducing their intake of carbohydrates.

Fredrik Nyström, from the University of Linköping, who helped develop the guidance, recently told the local Swedish newspaper Corren that many of his colleagues had been sceptical about recommending a low carbohydrate, high fat diet. However, they changed their minds when they reviewed the scientific literature.

“It feels great to have this scientific report and that the scepticism towards low carb diets among my colleagues has disappeared during the course of the work. When all recent scientific studies are lined up, the result is indisputable: our deep seated fear of fat is completely unfounded. You don’t get fat from fatty foods,” Nyström said.

The guideline advises that meat and fish rich in fat, along with nuts and olive oils, should form a large part of a healthy diet, while the consumption of pasta, potatoes, and white bread should be reduced.

For anyone who can read Swedish, here is the full report.

 

Lustig – Fat Chance: Fructose 2.0

There is a very interesting Venn diagram near the beginning highlighting how many normal weight people are at metabolic risk (as well as how many overweight people are at low metabolic risk).  This reinforces something I have been saying for some time – being thinner than average is not a reason to be a smug skinny-fatty!

Sugar + Fat Videos

It has been a very long time since we have had the sort of week we have just had in the nutrition news.  I’m not going to rehash it all here as Mikki has already done a sterling job of that and has said the exact same thing I would have written here.  Summarised by “eat real food”.  Amongst all the hullabaloo was a great 30-minute report from Australia’s Catalyst programme on saturated fat (timely as it co-ordinated well with this BMJ piece from a UK cardiologist).  The Catalyst team have previously looked at sugar.  I think the two videos are best viewed together.

40 Years of Nutrition Research Fatally Flawed

The National Health and Nutrition Examination Survey (NHANES) is one of those major ongoing surveys from which data related to all things health and nutrition are derived. The short entry on Wikipedia summarises the aims of NHANES very well;

Findings from the survey are used to determine the prevalence of major diseases and risk factors for diseases. Information is used to assess nutritional status and its association with health promotion and disease prevention. NHANES findings are also the basis for national standards for such measurements as height, weight, and blood pressure. Data from this survey are used in epidemiological studies and health sciences research, which help develop sound public health policy, direct and design health programs and services, and expand the health knowledge.

Whilst being a survey conducted on an American population, the results from this are interpreted and referred to globally, with NZ and Australia being no exception.  It is only now, after 40 years, however, that the robustness of the survey itself and the data obtained from it, has been seriously looked at.  Keep in mind the bolded statement from Wikipedia, above, as you read this summary of this NHANES review;

The study examined data from 28,993 men and 34,369 women, 20 to 74 years old, from NHANES I (1971 – 1974) through NHANES (2009 – 2010), and looked at the caloric intake of the participants and their energy expenditure, predicted by height, weight, age and sex. The results show that — based on the self-reported recall of food and beverages — the vast majority of the NHANES data “are physiologically implausible, and therefore invalid,” Archer said.

In other words, the “calories in” reported by participants and the “calories out,” don’t add up and it would be impossible to survive on most of the reported energy intakes. This misreporting of energy intake varied among participants, and was greatest in obese men and women who under-reported their intake by an average 25 percent and 41 percent (i.e., 716 and 856 Calories per-day respectively).

Under-reporting by somewhere between 25 and 40% of total energy intake is a substantial error, especially when translated into real foods and/or the macronutrient ratios.  Under-reporting of food intake is nothing new and is part of the reason why almost any dietary survey should be interpreted with a significant degree of caution and scepticism.  Even at an individual level, people are generally not very good at accurately recalling, assessing, and recording how much they eat.

Just yesterday, as the news broke on the above story, I was reviewing somewhere in the order of 20 diet logs filled out by one of our corporate clients who had just completed a healthy eating challenge.  The following is a representative composite of most of the diet logs I reviewed;

  • Breakfast: Cereal + fruit or a fruit smoothie
  • Lunch: Soup or a chicken salad
  • Dinner: vegetables and a small amount of lean meat
  • Snacks: wholegrain crackers, low-fat cheeses, low-fat yoghurts, fruits, muesli bars

Two things really stood out when you went through the quantities reported;

  1. If this is all these people (mostly women) are eating (probably in the range of 1200-1500cals per day), they must be seriously starving
  2. Just how much sugar and refined carbohydrates are being consumed by people who believe themselves to be health-conscious and making good choices

Experience tells me many of them won’t be starving, based on the items that were left out of their food logs.  I am sure that every 2-3 days, when that hunger really kicks in, that there will be some ‘naughty little one-off treat’ which made it passed the lips, but which didn’t make it on to the diet log sheet.  A common trait across nearly every single log was that it was very idealistic, with the person who has filled it out going to great lengths to ensure that the person they knew would be doing the review (me – the nutritionist) knew that they had selected something that was “whole grain”, “low-fat”, or “lite”, or they stated the brand in such a way as to play on the health-halo which went with that brand.  In diet surveys, you get the answers that those being surveyed think you want to hear.

If we accept that this review of the NHANES data is accurate in its assessment and that such data is seriously flawed, then much of the health knowledge and food policy, which we have accepted as gospel over the last 40 years, also needs revisiting.  It needs to be tested against a new paradigm – a new yardstick.  It might well be that we need a new starting point from which to begin to base sound nutritional advice from.  Call me both predictable and biased, but I think that starting point should be one from our evolutionary history.