Thanks for taking on the subject of nutrition. I am interested in nutrition that may lead to better quality of life/functionality as human longevity is extending. While morbidity and mortality are important outcome variables, I would like to understand more about nutrition and quality of life, over the lifecycle.
I’ve been substack bombed today. I’ll have to peruse this later because when I saw that trans fats were bad all I could think was “trans fat phobic” 🤦🏻♂️
Dr. McCormack, appreciate your effort here. Definitely some worthwhile information to ponder. I will admit confusion over vegetable oil (canola, corn, soybean, sunflower seed, etc) not being considered an ultra-processed food. A simple google image search of the term "vegetable oil processing plant" would be sufficient for most, but if that is not enough, feel free to read a brief overview of vegetable oil processing.
I studied physics for several years and have had a long career in computer programming, with a specialty in predictive analytics. I'm also, as my Substack profile says, a "grumpy old mansplainer". This said, my impression is that diet and nutrition do play important roles in our health, but much of the advice given to us on these matters by so-called experts seems to be rather contrived, often influenced by politics, and not based on rigorous scientific research.
In his 1973 film "Sleeper", Woody Allen made fun of the constantly evolving nature of food fads and fashions, as in this scene in which two scientists in the year 2173 are discussing the dietary advice of the late 20th century:
"You mean there was no deep fat, no steak or cream pies or hot fudge?" asks one, incredulous.
"Those were thought to be unhealthy," replies the other.
"Precisely the opposite of what we now know to be true."
The NOVA Food Classification scheme is so anti-scientific that it can't be allowed to play a part in any rational argument! Is there really nothing better? Consider:
--Remaining agnostic as to the current idea that seed oils are the literal work of the devil, how can "vegetable oils" possibly be considered "minimally processed"? They are doused with hexane, degummed, bleached and hydrogenated! What meaning does "processed" have if this doesn't count?
--Bread, cheese, and canned vegetables are in category 3 (processed), but the act of placing them on top of each other and calling it "pizza" moves it into the worst category. Hamburgers are treated similarly--beef (including ground) is in category 1 but place a bun (category 3) on it, and somehow it becomes highly processed.
--Two out of the ten examples of highly processed foods are infant formula, and they are listed first. Formula is indeed highly processed! But when it's placed first and second on the list, you can see a political bias in action.
One other way to guage the effects of UPF is through natural experiments where a country's market suddenly opens up to such products. Another way is to factor in how physicians see their patient's health change based on their dietary pattern change. And finally, looking at nursing homes and prisons and other closed systems where there is some more consistent food group ratios.
Nursing homes... Food comes out of frozen packs. Or out of cans. Occasionally you can see a salad leaf or a fresh fruit in what is served. But forget your daily "5 portions of fruit or vegetable."
I wonder how all the residents don't end up with vitamin and mineral deficiencies. Or maybe they are but not one checks?
I don't know why the "Mediterranean" diet is so highly advocated. Define precisely what that means. The Japanese diet is the most healthy, especially if you look at the general population.
The reason the so-called Mediterranean diet is highly advocated is because it consistently produces favorable results. The question is, why? Here is the answer: "The Mediterranean diet is low in arachidonic acid and rich in healthy fats such as monounsaturated fats found in extra-virgin olive oil (EVOO), nuts and omega-3 fatty acids from fish, which has been shown to lower the risk of inflammation, heart disease, cancer, diabetes and obesity, and other degenerative diseases." https://advancedmolecularlabs.com/blogs/news/new-red-meat-study-controversy
Another question. Why is it important to consume a diet low in arachidonic acid? (1996) "Excessive signaling of arachidonic acid (AA) metabolites has been associated with various chronic degenerative or autoimmune diseases, and intervention with the metabolism of AA is widely employed therapeutically in these afflictions. In essence, AA is the most biologically active unsaturated fatty acid in higher animals. Its concentration in membranes and its magnitude of effects depend on its amount, or that of its precursors and analogues, in the diet. The tendency of the field of nutrition to ignore the role of dietary AA will optimistically be reversed in the future." https://pubmed.ncbi.nlm.nih.gov/8642436/
Well, the future has arrived and arachidonic acid intake is at an all time high almost everywhere in the World. Unfortunately, government agencies, recipients of the public trust charged with protecting and improving the public’s food, and scientific bodies, supported by public funds and charged with assessing and improving the public’s health, completely ignore the results of contemporary methods of feeding oilseeds to livestock.
As far back as 1919 E.V. McCollum issued this warning: “Seed mixtures, no matter how complex or what seeds they are derived from, will never induce optimal nutrition. The only successful combination of natural foods or milled products for the nutrition of an animal are combinations of seeds or other milled products with sufficient amounts of the leaves of plants.” Excerpt from 'The Newer Knowledge of Nutrition'. https://www.google.com/books/edition/The_Newer_Knowledge_of_Nutrition/jndUnd5xX5wC?hl=en&gbpv=1&pg=PA2&printsec=frontcover
More recently, Norwegian animal science researchers wrote, "It should be technologically easy and fairly inexpensive to produce poultry and pork meat with much more long-chain omega-3 fatty acids and less arachidonic acid than now, at the same time as they could also have a similar selenium concentration as is common in marine fish. The health economic benefits of such products for society as a whole must be expected vastly to outweigh the direct costs for the farming sector." https://pmc.ncbi.nlm.nih.gov/articles/PMC3031257/
Eating five doughnuts a day would be bad for me just because it will make me obese...
I always get baffled by the "no sugar added" labels. And then when you read the small print you find out that it's full of honey or some other "fully natural" sugar.
Although observational studies likely are the best that can be done - practically - in large scale nutrition research, this approach is nevertheless notoriously weak. Confounding, recall bias, non-causitive associations, overstated conclusions/implications, and other issues plague this research. John Ioannidis - if I remember correctly - has addressed this in the past. So what ever you do, consider nutritional research with focused skepticism - and include a pinch of salt...
Healthy salt - Morton Lite Salt - a Na + K salt blend that I use for all my salted foods...
Also some years ago, the book Food Politics by Marion Nestle was useful to me. I believe she still publishes in this realm. I would be interested in a take on her spiel by our Sensible Medicine writer.
I tell my patients, first and foremost, about portion control. Then, from a CV perspective, to eat like Mediterraneans more often than not (it reflects the very few diet RCTs that I feel are…ahem….worth their salt).
Beyond that, I suggest (borrowed from one of my colleagues) they minimize what they eat that comes out of a bag, can, or box. And to peruse how many items on an ingredients list that they can pronounce.
I find “diet” guidelines to be like any other medical/scientific guideline in the 21st century: completely devoid of nuance in the pursuit of simplicity and ease of adoption. And quite often with some undeclared conflicts of interest besides.
I am also looking forward to this series of articles. It sounds like it may vindicate the advice I gave to patients over forty years of medical practice: Eat what you like. Food has virtually nothing to do with health and disease. If you are unhappy with your weight, eat less. I have often found that those who advocate various diets are not very well informed on the subject of digestion and absorption of nutrients---one of the most well worked out areas of human physiology. The demonization of sugar in recent years is a sure sign of such ignorance.
Thanks Jim. More nonsense has been written on nutrition than any other subject on earth. Vinay Prasad posted a video on Sensible Medicine several months ago where he and an internist were giving a presentation to a group of medical students and/or residents. I can't remember the topic but it had nothing to do with diet and the first question in the Q&A was about the effect of diet on whatever they were discussing. Dr. Prasad said "I don't know" and asked the internist "What do you eat?" He replied "I eat what tastes good." He went on to say that one of the staff doctors--a cardiologist--was very fussy about his diet and was practically a vegetarian. Then he stated that he had been at a dinner and sat at the same table as the cardiologist's wife and watched her slug down large quantities of beef and potatoes with lots of butter and gravy. When he asked why she didn't follow the same diet as her husband, she replied that she was an oncologist and spent most of her time seeing people who did everything "right" and still developed cancer.
I recall your quote! Of course we addiction folks really had to do a lot of nutritional work especially for our low bottom drunks - but we also advocated the judicious use of ice cream for cravings for obvious reasons. Some of my patients even after decades of recovery tell me that their ice cream fix was as important in early sobriety as their meetings were. I’m also a fan of sensible medicine!
Interested and looking forward to the rest. I tend to ignore the nutrition headlines and try to look at how foods fit into the wider landscape. I’m wary of ultra processed foods and foods with a lot of added sugars mostly because they are developed and over-sold by large corporations that in my opinion do immense harm ecologically and economically. I’m quite sure that added sugars are an addictive substance coaxing me to pay money to companies that don’t have my welfare in mind. So I think it’s possible much of the hype and emotionalism is not about nutrition alone, but about Americans’ suspicion that we are being exploited, rather than fed. And my own suspicion only grows when I see the graph of how much UHP food different countries consume, with the US heading the list. While the analysis of the nutritional evidence is intriguing, the economic and environmental context is always going to be important to me.
Very interesting so far. Although this article is directed at the food enemies through the decades, we should also note that there are stars that also have been made by possible questionable evidence. Currently, protein has been named a champ. The definition of adequate protein has been expended and food companies are responding like they did with food enemies.
Well, this explains my dear friend bringing a large Tupperware of plain, cold chicken breast chunks to the last luncheon I hosted, and choking it down alongside the Neapolitan pizza, asparagus, green salad, and berries I had provided. :)
Thanks for taking on the subject of nutrition. I am interested in nutrition that may lead to better quality of life/functionality as human longevity is extending. While morbidity and mortality are important outcome variables, I would like to understand more about nutrition and quality of life, over the lifecycle.
I’ve been substack bombed today. I’ll have to peruse this later because when I saw that trans fats were bad all I could think was “trans fat phobic” 🤦🏻♂️
Dr. McCormack, appreciate your effort here. Definitely some worthwhile information to ponder. I will admit confusion over vegetable oil (canola, corn, soybean, sunflower seed, etc) not being considered an ultra-processed food. A simple google image search of the term "vegetable oil processing plant" would be sufficient for most, but if that is not enough, feel free to read a brief overview of vegetable oil processing.
I studied physics for several years and have had a long career in computer programming, with a specialty in predictive analytics. I'm also, as my Substack profile says, a "grumpy old mansplainer". This said, my impression is that diet and nutrition do play important roles in our health, but much of the advice given to us on these matters by so-called experts seems to be rather contrived, often influenced by politics, and not based on rigorous scientific research.
In his 1973 film "Sleeper", Woody Allen made fun of the constantly evolving nature of food fads and fashions, as in this scene in which two scientists in the year 2173 are discussing the dietary advice of the late 20th century:
"You mean there was no deep fat, no steak or cream pies or hot fudge?" asks one, incredulous.
"Those were thought to be unhealthy," replies the other.
"Precisely the opposite of what we now know to be true."
The NOVA Food Classification scheme is so anti-scientific that it can't be allowed to play a part in any rational argument! Is there really nothing better? Consider:
--Remaining agnostic as to the current idea that seed oils are the literal work of the devil, how can "vegetable oils" possibly be considered "minimally processed"? They are doused with hexane, degummed, bleached and hydrogenated! What meaning does "processed" have if this doesn't count?
--Bread, cheese, and canned vegetables are in category 3 (processed), but the act of placing them on top of each other and calling it "pizza" moves it into the worst category. Hamburgers are treated similarly--beef (including ground) is in category 1 but place a bun (category 3) on it, and somehow it becomes highly processed.
--Two out of the ten examples of highly processed foods are infant formula, and they are listed first. Formula is indeed highly processed! But when it's placed first and second on the list, you can see a political bias in action.
One other way to guage the effects of UPF is through natural experiments where a country's market suddenly opens up to such products. Another way is to factor in how physicians see their patient's health change based on their dietary pattern change. And finally, looking at nursing homes and prisons and other closed systems where there is some more consistent food group ratios.
Nursing homes... Food comes out of frozen packs. Or out of cans. Occasionally you can see a salad leaf or a fresh fruit in what is served. But forget your daily "5 portions of fruit or vegetable."
I wonder how all the residents don't end up with vitamin and mineral deficiencies. Or maybe they are but not one checks?
I don't know why the "Mediterranean" diet is so highly advocated. Define precisely what that means. The Japanese diet is the most healthy, especially if you look at the general population.
The reason the so-called Mediterranean diet is highly advocated is because it consistently produces favorable results. The question is, why? Here is the answer: "The Mediterranean diet is low in arachidonic acid and rich in healthy fats such as monounsaturated fats found in extra-virgin olive oil (EVOO), nuts and omega-3 fatty acids from fish, which has been shown to lower the risk of inflammation, heart disease, cancer, diabetes and obesity, and other degenerative diseases." https://advancedmolecularlabs.com/blogs/news/new-red-meat-study-controversy
Another question. Why is it important to consume a diet low in arachidonic acid? (1996) "Excessive signaling of arachidonic acid (AA) metabolites has been associated with various chronic degenerative or autoimmune diseases, and intervention with the metabolism of AA is widely employed therapeutically in these afflictions. In essence, AA is the most biologically active unsaturated fatty acid in higher animals. Its concentration in membranes and its magnitude of effects depend on its amount, or that of its precursors and analogues, in the diet. The tendency of the field of nutrition to ignore the role of dietary AA will optimistically be reversed in the future." https://pubmed.ncbi.nlm.nih.gov/8642436/
Well, the future has arrived and arachidonic acid intake is at an all time high almost everywhere in the World. Unfortunately, government agencies, recipients of the public trust charged with protecting and improving the public’s food, and scientific bodies, supported by public funds and charged with assessing and improving the public’s health, completely ignore the results of contemporary methods of feeding oilseeds to livestock.
As far back as 1919 E.V. McCollum issued this warning: “Seed mixtures, no matter how complex or what seeds they are derived from, will never induce optimal nutrition. The only successful combination of natural foods or milled products for the nutrition of an animal are combinations of seeds or other milled products with sufficient amounts of the leaves of plants.” Excerpt from 'The Newer Knowledge of Nutrition'. https://www.google.com/books/edition/The_Newer_Knowledge_of_Nutrition/jndUnd5xX5wC?hl=en&gbpv=1&pg=PA2&printsec=frontcover
More recently, Norwegian animal science researchers wrote, "It should be technologically easy and fairly inexpensive to produce poultry and pork meat with much more long-chain omega-3 fatty acids and less arachidonic acid than now, at the same time as they could also have a similar selenium concentration as is common in marine fish. The health economic benefits of such products for society as a whole must be expected vastly to outweigh the direct costs for the farming sector." https://pmc.ncbi.nlm.nih.gov/articles/PMC3031257/
Is weight ever taken into account?
Eating five doughnuts a day would be bad for me just because it will make me obese...
I always get baffled by the "no sugar added" labels. And then when you read the small print you find out that it's full of honey or some other "fully natural" sugar.
Wondering if similar examination of alcohol and exercise literature would produce the same skepticism with current recommendations??
Nina Teichholtz has done a lot of work in this area along with Zoe Harcombe.
Although observational studies likely are the best that can be done - practically - in large scale nutrition research, this approach is nevertheless notoriously weak. Confounding, recall bias, non-causitive associations, overstated conclusions/implications, and other issues plague this research. John Ioannidis - if I remember correctly - has addressed this in the past. So what ever you do, consider nutritional research with focused skepticism - and include a pinch of salt...
Healthy salt - Morton Lite Salt - a Na + K salt blend that I use for all my salted foods...
Also some years ago, the book Food Politics by Marion Nestle was useful to me. I believe she still publishes in this realm. I would be interested in a take on her spiel by our Sensible Medicine writer.
Looking forward to the rest of this series.
I tell my patients, first and foremost, about portion control. Then, from a CV perspective, to eat like Mediterraneans more often than not (it reflects the very few diet RCTs that I feel are…ahem….worth their salt).
Beyond that, I suggest (borrowed from one of my colleagues) they minimize what they eat that comes out of a bag, can, or box. And to peruse how many items on an ingredients list that they can pronounce.
I find “diet” guidelines to be like any other medical/scientific guideline in the 21st century: completely devoid of nuance in the pursuit of simplicity and ease of adoption. And quite often with some undeclared conflicts of interest besides.
I am also looking forward to this series of articles. It sounds like it may vindicate the advice I gave to patients over forty years of medical practice: Eat what you like. Food has virtually nothing to do with health and disease. If you are unhappy with your weight, eat less. I have often found that those who advocate various diets are not very well informed on the subject of digestion and absorption of nutrients---one of the most well worked out areas of human physiology. The demonization of sugar in recent years is a sure sign of such ignorance.
I like your style!
Thanks Jim. More nonsense has been written on nutrition than any other subject on earth. Vinay Prasad posted a video on Sensible Medicine several months ago where he and an internist were giving a presentation to a group of medical students and/or residents. I can't remember the topic but it had nothing to do with diet and the first question in the Q&A was about the effect of diet on whatever they were discussing. Dr. Prasad said "I don't know" and asked the internist "What do you eat?" He replied "I eat what tastes good." He went on to say that one of the staff doctors--a cardiologist--was very fussy about his diet and was practically a vegetarian. Then he stated that he had been at a dinner and sat at the same table as the cardiologist's wife and watched her slug down large quantities of beef and potatoes with lots of butter and gravy. When he asked why she didn't follow the same diet as her husband, she replied that she was an oncologist and spent most of her time seeing people who did everything "right" and still developed cancer.
I recall your quote! Of course we addiction folks really had to do a lot of nutritional work especially for our low bottom drunks - but we also advocated the judicious use of ice cream for cravings for obvious reasons. Some of my patients even after decades of recovery tell me that their ice cream fix was as important in early sobriety as their meetings were. I’m also a fan of sensible medicine!
Interested and looking forward to the rest. I tend to ignore the nutrition headlines and try to look at how foods fit into the wider landscape. I’m wary of ultra processed foods and foods with a lot of added sugars mostly because they are developed and over-sold by large corporations that in my opinion do immense harm ecologically and economically. I’m quite sure that added sugars are an addictive substance coaxing me to pay money to companies that don’t have my welfare in mind. So I think it’s possible much of the hype and emotionalism is not about nutrition alone, but about Americans’ suspicion that we are being exploited, rather than fed. And my own suspicion only grows when I see the graph of how much UHP food different countries consume, with the US heading the list. While the analysis of the nutritional evidence is intriguing, the economic and environmental context is always going to be important to me.
Very interesting so far. Although this article is directed at the food enemies through the decades, we should also note that there are stars that also have been made by possible questionable evidence. Currently, protein has been named a champ. The definition of adequate protein has been expended and food companies are responding like they did with food enemies.
Well, this explains my dear friend bringing a large Tupperware of plain, cold chicken breast chunks to the last luncheon I hosted, and choking it down alongside the Neapolitan pizza, asparagus, green salad, and berries I had provided. :)