DIETARY SCIENCE – OR RELIGION?

         I haven’t written a useful word in the past two weeks.

         Why is that significant?  Because I took an entire income-free two-week period to write.  I promised myself that by the end of that period I’d have a basic website in place, with the basics of an eating program that I’d distilled from the writings of others.

         The period ends today. Today there’s no website, and no distillation.

         Among other things I did instead of writing was to be Grandpa Mike for a few days in Sacramento.  I spent three days with my wonderful granddaughter, and with my much-loved son and his amazing wife.  Yes, I’m at the time in my life when it’s clear that at some future moment of reckoning, I’m more likely to wish I’d spent time with my granddaughter than to wish I’d spent time writing down my thoughts about an increasingly complex set of issues that seem to defy solution.

         And I moved.  I moved from my bachelor condominium near the hospital to a house 20 minutes away, in the Wailua Homesteads.  I moved to begin sharing a house and creating a home with the woman I will marry.  I moved with some trepidation to a house that’s been her family home for 38 years, a house she bought and built with her husband, who died in 2007.  I moved despite plenty of advice from relatives and friends warning me that it would be difficult to create “our” home in a house that’s been “her” home or “their” home.  Three weeks into the process of living in the same house, I have a rapidly-deepening appreciation of her strength, her adaptability, her willingness to embrace change, and her love -- and an even-greater ability to listen to well-meaning advice without incorporating it into my life.

         Lest it appear that I frittered away my research time entirely, I hasten to point out that I devoted the entire return flight from Sacramento to Honolulu to reading and taking notes on Gary Taubes’ Good Calories, Bad Calories, a 2007 book from a science journalist who examines the [lack of] science behind the low-fat diet recommendations of the past 30 years, and the [overlooked] science suggesting that “carbohydrate-rich foods are inherently fattening, some more so than others, and that those of us predisposed to put on fat do so because of carbs in the diet.” (Taubes' account of his appearance on Dr. Oz's show in March)  Moreover, he argues in his subsequent book Why We Get Fat, it’s almost certain that the same foods that make us fat are the foods that cause heart disease and diabetes and cancer – the diseases associated with obesity.

         In short, Taubes says that much of what we think we know is wrong, or at least not proven, and the advice that we fatties should eat less and exercise more is at least inadequate and maybe completely misguided.  He charges that organized medicine, the public health establishment, the food industry, and the government have succumbed to the urge to simplify a complex scientific situation so much that it’s no longer possible to meet the scientific obligation of presenting evidence with relentless honesty. We have created, he says, an enormous enterprise dedicated in theory to determining the relationship between obesity, diet, and disease. In practice, however, the enterprise is dedicated to convincing everyone involved, especially the lay public, that the answers are already known and always have been – “an enterprise, in other words, that purports to be a science and yet functions like a religion.”

         Taubes took five years to write this first book.  Perhaps it’s not surprising that in two superficial weeks I wasn’t yet ready to write, especially when I spent most of that two weeks allowing myself to be distracted by other aspects of my life.

I’ve said that I love to take complex ideas, churn up and digest all the underlying information, and make a distillation of my own ideas – that’s why I enjoyed medical teaching so much.  And I’m beginning to see here that I’ve bitten off a much bigger chunk than I imagined. The more I learn, the more I see that I don’t know.

If I’m to make a difference in the food conversation, I’ll have to get busy churning and digesting.  I hadn’t planned to be overtaken by such an irresistible inquiry while still working full time and in the midst of profound life change, and I don’t have in place a structure that accommodates that sort of intense work on top of everything else.  This will be an interesting challenge…

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.

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 (www.ultralite.us). The Ultralite people at Transformations.com 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 (www.drgundry.com), 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.

Agreement and moving on

Yesterday my wife and I reached agreement on distribution of property, clearing the way for a divorce decree by the end of the month.

It's been almost two years since she first said that she wanted our marriage to be over.  What once seemed a simple process became more and more complex and protracted as suspicion of withholding assets and anger about past issues was stirred into the mix.  I began to think we'd never be free of each other, though clearly we each wanted to be.

Now that's about to be over.  Neither of us ended up with all the assets we wanted. I'll give up a big chunk of the retirement savings for which I've worked, and I'll also put a great deal of cash into retiring a debt that I once dismissed as unimportant.  In addition, I'll contribute half of the boatloads of cash necessary to refinance the house with its underwater mortgage and put it in her name. And a few other things.

We'll each have what we have, and we'll move on.  Intact.

The irony here is that the mistakes and bad decisions that led me to a failed marriage have also been part of the path that's left me living in Hawaii, doing a job I really like, and living a life that I love. In the midst of sadness, I've never been happier.  If I'd eliminated any of the mistakes, I might not be here.  There's lots more to say about why life is good, and today isn't yet the day to say it.

By the way, as part of our agreement I have taken down all the divorce-related video cartoons. Letting go, moving on...

And by the way, I've lost almost 70 pounds as of this morning.  And I feel great.