Monday, May 16, 2011

Nutrition Science: An Oxymoron?

         I used to think that only a fool could experience much confusion about food and nutrition.  When I went to medical school, back in the days of leeches and wooden needles, nutrition was briefly covered in the biochemistry course.  Beyond that, it was pretty much, “Mmm, food good.  Eat food.” And, of course, “Fat people have no impulse control.”  This came from my freshman roommate, himself a skinny guy who went on to become a skilled and apparently compassionate bariatric surgeon.
         I’ve spent my life thinking that the equation was pretty simple.  If the number of calories taken in exceeded the caloric cost of running the body machinery, excess calories were stored as fat.  Weight loss occurred if we expended more calories than we had taken in, and weight gain occurred in the opposite circumstance.  Good nutrition meant taking in the right quantities of available “healthy food.”
         Now I’m beginning to see that food isn’t an easy or straightforward issue at all.  Perhaps all calories are not equal.  Perhaps all food is not equally good for us.  Perhaps even the “healthy food” that’s available isn’t so healthy, at least for the people who eat it.  For the economy? Maybe so.
The movie Food, Inc. seems to say that we’re guided by advertising and availability to eat what we eat because that’s where the money is for food and agriculture interests.  The once-hallowed FDA Food Pyramid of my youth seems to have been the result of a political process involving lots of lobbying by folks who wanted to be sure we continued to eat what they were being paid to produce – thus the heavy focus on grains.  Apparently, neither nutritionists nor health authorities had much to do with its production, though it has a profound effect on health.
         Individual voices stand out, sometimes out of proportion to the actual proven value of their message.  Gary Taubes’ article, “Is Sugar Toxic?” (NY Times, April 13, 2011) reiterates the story of nutritionist Ancel Keys from the University of Minnesota. Keys was such a strong proponent in the 1970s of his idea that dietary fat consumption was the best predictor of heart disease that he was able to discredit the equally-probably ideas of England’s John Yudkin, along with Yudkin himself.  Yudkin had argued that sugar consumption was linked directly to both the triglycerides of heart disease and the insulin levels of type II diabetes.  Keys’ powerful personality led to widespread acceptance of ideas about fat and heart disease that may have led us to adopt even more harmful high-carbohydrate diets to avoid fat.
         I’m reminded of the Gary Larson cartoon in which a shark in the water near a beach cups his fins around his mouth to yell, “Bear, Bear!!” as panicked bathers stampede into the water to escape.
         Casting caution to the winds, I have boldly asserted that I will wade into the morass of dietary information and sort out scientifically proven ideas from those that merely seem sensible.  In the process, I’ll identify those ideas without a shred of supportive evidence, and those that fly in the face of good sense.  When I’m done with that, it’ll be clear how we should all eat, and I’ll just jot it down and then we can get back to worrying about bigger things, like where Obama was born and whether autism causes global warming.
         Or not.
         Chris Mooney’s article on “Made-up Minds,” published originally in Mother Jones and excerpted in “The Week” (May 20, 2011), reminds us that reasoning is inseparable from emotion. We all tend to pull friendly information close and push threatening information away.  The fight-or-flight response, he says, applies not only to predators but also to information itself.
         What’s that mean?  It means that emotion may not have much bearing on scientific conclusions, but it certainly colors those conclusions to which we give credence, and those we’re willing to talk up.  We accept evidence that supports our views, and reject evidence that doesn’t.  In fact, we often reject as experts those whose conclusions, however well researched, don’t fit our pre-existing views.
         That’s a little awkward.  Does that mean that I can’t make an unbiased analysis of popular writing, looking for its scientific backing?  Will I filter out the stuff that doesn’t agree with my biases, even if it’s well-researched, and even if I think I’m being wonderfully even-handed?  Does that mean people shouldn’t trust me, either? Will my recommendations be just another set of biased ideas, based on that fraction of the literature that supports biases that I already have?
         Yeah, maybe. I’ll be authoritative, but not a “final authority.” I’m a seeker, an inquirer, an asker of questions.  When I present an idea as true, I really think it is.  Remember, however, that my pronouncement and $4.00 will get you coffee at Starbucks.  In other words, my idea is just that -- my idea, however well-spoken.  Even my objective judgments are difficult to separate from emotion, from my urge to affirm that the universe really does look the way I think it should look.
         Trust and verify.

Sunday, May 15, 2011

Fat is Not a Character Flaw

        My sister and I have spent our adult lives getting fatter.  Neither of us wanted to do that, yet over the years we’ve accumulated enough extra fat between us to build a couple more people. 
Now I’ve lost about 70 pounds on a healthy eating program, and I feel good.  She and her husband have been eating on this same program, and have each lost substantial weight, enough that people are noticing.
         We talked about how easy this program has been, and how completely unaware we were that this is possible.  I once had the desperate feeling that I was doomed to continue inflating, since no matter what I did I continued to gain weight.
Since starting the program, I’ve thought repeatedly that it’s appalling how easy it has been for me to lose weight, bring down my glucose, and bring down my blood pressure.  Appalling because I didn’t know this was possible, didn’t know how to do it, didn’t know how to get direction from medical people anywhere.  Appalling because in my anesthesia practice every day I see people who are overweight, hypertensive, on oral hypoglycemics for early type II diabetes, and on cholesterol-lowering medications.  Appalling because I think that’s largely  unnecessary.  And appalling because almost nobody seems to know how to make a difference, yet.
         The program that worked for me, lowering blood pressure and blood glucose in the bargain, was the Ultralite program ( The Ultralite people at have a program that works, but in my experience it’s marketed so casually that it’s very difficult to hook people up with it.
I’m now certified as a practitioner for that program. The program is certainly effective, and people who are doing it are pleased with the results.  People learn not only how to lose weight, but how to eat for the rest of their lives to keep the weight off. Why haven’t I recruited a gang of clients, if I think this is such a great program? 
 Two reasons. The program is expensive, and it’s hard to get patients started with other practitioners on the mainland. I think it’s too expensive for many of the folks for whom I’d like to make it available here on Kauai.  Why is it expensive? Mostly because it’s practitioner-supervised, and because it uses a proprietary snack between meals in addition to lots of “real” food.
When people who don’t live here ask about the program, I find it’s hard to get people started with practitioners in other locations, even though people on the mainland might be best served by someone in their own area.  Sure, I could be the practitioner for these people.  I can coach on the phone (the life coach training, you know), but there are a limited number of people for whom I can do that. I’m still practicing full time as an anesthesiologist, and I live in a time zone that’s as much as six hours dislocated from parts of the US.
         Are there other approaches?  In truth, none that I’ve tried. But the ideas on which the Ultralite plan is based are not secret and not proprietary.  They are increasingly general knowledge.  Several people seem to be speaking to the same ideas as those used to create the Ultralite plan – people including Dr. Walter Willett from Harvard, Dr. Steven Gundry (, Isabel de los Rios (The Diet Solution, available on the internet), Gary Taubes of “Good Calories, Bad Calories,” and an increasing chorus of others.  All these people seem to be saying that the whole “low-fat” conversation has been a journey off the path, and that the biggest issue with our current way of eating is the preponderance of sugar and high-carb, high-glycemic processed food.  This deserves much more discussion in future articles.  For now it’s sufficient to say that many of my prior ideas about food and nutrition seem to have been all wet.
         My sister and I also talked about the differences between the medical model and the coaching model.  In the medical model, something is wrong and we’re here to diagnose it and fix it.  Find a problem, prescribe a solution.  Pills work for high glucose, for high blood pressure, and for high cholesterol.  They don’t do much for excess weight, but there’s always weight loss surgery if you’re heavy enough to qualify.  I believe that weight loss surgery for most people, by the way, is one of the most inadvisable moves anyone ever can make.  It literally consists of making yourself sick for the rest of your life in order to lose fat.  That’s healthy?
         Coaching (as in life coaching) takes a different approach to issues than does medicine. To coaches, people are whole and complete and have within them all the resources to create the lives they want.  People want help in discovering and developing these resources.  Coaches don’t fix, and don’t give advice.  But they do help people tap their own inner wisdom, learn new ways of being and doing, and create different lives.
         So being fat isn’t something to fix, and it’s not a character flaw.  It is, for most of us, the predictable result of the choices we make and the way our bodies work.  Fat is simply the energy store that accumulates in a body skilled at gathering and storing energy in times of plenty in order to survive times of famine. In my own experience, even when I thought I was eating “healthy,” I was still making choices that directed my body to accumulate fat.  Increasingly, there’s information available that allows me (us) to make different choices.
         Each of us has within us the ability to direct our actions, channel our instincts, and create the best lives of which we’re capable.  
         Over the next few months (years?) I’ll be looking at what we know about food, and what we think we know.  More than 30 popular diet books and a couple of internet programs are piled by my chair right now. I’ll look at places where people pretty much agree, and where they don’t.  I’d like to see a website with a simple eating plan to which I can refer people, one geared to empowering people for the rest of their lives instead of harvesting money, one with straightforward discussion of issues. 
We will change the world’s conversation about food, and about fat.