One only has to look at the work of Caldwell Esselstyn, Dean Ornish, John MacDougall, Michael Greger, and Neal Barnard to know what food both confers health and reverses disease. A whole food plant based diet rich in fruits and vegetables, whole grains, legumes, starches, and some nuts and seeds is the way to go.
16
people know what to eat, lets stop pretending otherwise. we're a nation that prizes convenience and instant gratification over everything, including our own health.
19
Most people around the world have little or no problem “figuring out” what to eat. We have become an obese nation because we exercise no control over what, and how much, we eat. We are not the only country to be so, but we seem to have a problem accepting the truth of it.
8
The power of positive eating.
For me, healthy eating is all about what you do NOT eat, rather than what you DO eat.
I do not have a 10 Commandments of dos and don'ts, however. I simply avoid things like:
Canned foods
Fast Food (OK, I confess: I like pizza)
Junk Food
White anything
Anything containing artificially ingredients
Red Meat (Love chicken!)
Packaged Food
Dairy Products (except aged cheeses)
You would be surprised at what's left!
3
It doesn't seem very complicated. Eat food in as natural a state as possible without processing. Avoid food that comes in a box. Eat mostly plant based food. Don't drink sugared beverages. If in doubt or the research is inconclusive about a food, eat or drink it in moderation, red meats, alcohol, coffee, fat. Choose nutrients for their quality, whole grain over white etc. Exercise moderately but consistently, and move as often as possible.
Expensive, large scale studies will not take into account individual or genetic differences, not will they address issues such as poverty and lack of access to quality food sources. In addition, whether it is vegetarian or paleo, many different diets can be effective if the sources of food are high quality and unprocessed. Large scale, controlled studies with all the participants following the same diet won't reveal this.
It would be more worthwhile for these professors to work in food policy. Reducing the amount of sugar in drinks by law. Requiring access to healthy food as a public health and poverty/political issue, stop government subsidies of corn resulting in high-fructose corn syrup distorting the cost of real food. Make ethics guidelines much more stringent for research support. The field of nutrition is corrupted by special interests https://www.nytimes.com/2018/10/29/well/live/confused-by-nutrition-research-sloppy-science-may-be-to-blame.html
5
Sadly NO "diet study" can adequately compensate for the killer that is stress.
Several years ago, food started--quite literally--killing me. Due to an adverse reaction to a medication, I developed anaphylaxis to major foods. In the first throes of my illness, I lost a few dozen pounds.
But illness dogged me. I was inflamed, in agony, nearly bedridden, itching all over, so short of breath I thought I was developing a heart condition. The one night, I linked my nightly cup of tea with milk to my "restless legs" and the Benedryl I took to soothe them and I thought, "Allergy!" I removed milk from my diet.
I lost 30 pounds without trying.
Then I noticed wheat made me miserable (Celiac test: negative). Another 20 lbs fell off my frame. Then eggs. Another 20. Then the worst of all: coconut. My arthritis, a constant companion for years, quieted to a dull roar, only on the worst days. And I lost another 20.
Altogether: I lost 115 lbs.
Then the ex and his evil minions started doing their things. Creating a vast amount of stress in my life. Pulling drama, dragging me into court, using my children as weapons, making misery.
I've put on 60 lbs in the last year.
Food is not just fuel. Food is family. Food is comfort. Food is life. You can only live on a super restrictive diet for JUST. SO. LONG. Even if it makes you itch, makes you hurt, makes you fat, MAKES YOU DIE.
Stress will kill you. If stress is killing you, you might eat to ease your pain.
10
Our government has been bought and paid for by the large food "processors" of the world and it has created a nation of fat and sick citizens. Most of America's food is not food at all in the nutritious sense. It is all manufactured. "Ingredients" that are allowed in our food is outlawed in most other countries. Simply disgusting in so many ways.
9
I realize that the headline is put on by an editor rather than the authors themselves and designed to create clicks rather than to be accurate, but it really isn't "so hard to figure out what to eat." I can do it for you in a single sentence and I can guarantee you no study will ever discredit it:
Eat a little bit of many different things each meal, until you are 80% full.
Now in practice this may be easier said than done for many people...but that's a problem with execution, not with knowing what you should do. The knowing part is easy. Nobody should have any doubts about it.
31
Eat mostly vegetables, fruit, and a little meat. Exercise 30 min 3x per week. Sleep 7-9 hours per day. For your entire life. Enough with the nonsense.
58
It is not hard to figure out what to eat. It's not a mystery to any of us who are by nature obese. I was a chubby kid and an obese teenager, and suffered. I knew what to eat - and what not to eat: I should not eat large amounts of cookies, candy, bread, etc. But I had a compulsion to eat these things that made me fat. After many failed attempts, losing and regaining large amounts of weight, I've been maintaining a 90 pound weight loss for decades. I've eaten different versions of a relatively healthy diet; now I eat lots of starchy vegetables, fish, quinoa. I never eat sweets, bread or pasta, because just a little isn't enjoyable for me. The question to ask then is not WHAT to eat, but HOW to enable obese people to eat what we know we should.
8
I weigh out 3 meals a day - consisting of protein, non carbohydrate vegetables and low sugar fruit. I also weigh out my fats. I exercise 4-5 times a week and use help from a support group. After trying pills, therapy, famous advertised programs, etc. nothing else has ever worked for me. I have maintained a loss of over 75 lbs for close to 4 years. There is no magic solution for those of us with abnormal relationships with food. It doesn’t help that most convenience foods are all high sugar, high processed carbohydrates and high fat. I have to put in a lot of time to prep my food and had to virtually change my entire life. I am just so thankful that I have found a solution.
8
@Lois All vegetables have (complex) carbohydrates in them, and all fruits are predominantly sugar (simple carbohydrates). The idea that the carbohydrate molecule is evil is one of the great dietetic fallacies. Avoid processed food and excess sugar and fats. Do not avoid fruits and vegetables (and the carbohydrates therein).
8
@Lois congratulations and keep up the excellent, and hard work. Ignore those nay-sayers. Recent VALID studies show that each body handles-processes foods differently. Do what works for YOU!!
4
This is true. Make you own food. Processed and take out all have more fat, sugar and salt. The only way to know what's in your food is to cook it. I have followed weight watchers for years ( but none of the fancy stuff) and do fine. Modern food will kill you!
4
Koalas eat only gum leaves, giant pandas only bamboo, they have no diet problems at all. We do because we have a lot of choices, which is the most important and happiest part of our life. (By the way, the opening photo is one of the best I've ever seen in NYT.)
1
Rather than focus on diet studies that are hard to design and enforce, why not rely on technology. You could organise a study of a very large group over a year and have that group of defined people take pictures of what they actually eat, and periodically take bio markers. Use phones, technology including image recognition, and a big data set to derive results.
1
It's quite simple: eat what we evolved to eat. There is no obesity in nature, because it's wasteful. Extra energy goes toward power to compete or procreation; not toward making animals slow and unhealthy. Evolution has already figured this out; it produced the eye, kittens and behavior altering fungi. Until we can do that, stop. pretending we know better!
In practice: avoid sugar like the plague, eat all the vegetables you can stomach, enjoy the rest. Being hungry is miserable and unnecessary.
Develop an incredibly strong and flexible core. Knee to chest. Your internal organs will work like never before and you can eat anything, but don’t. Eat well, every bite helps, and chewing is the new “it”exercise.
2
I agree that not all nutrition research is unreliable.
I also agree that: “We also know that nuts [and] olive oil...protect against chronic disease, contrary to dietary recommendations during the low-fat diet era.”
“High-quality observational studies [many] and clinical trials [Predimed] provide strong evidence for the [long-term, hard-outcome, health] benefits” of nuts and extra virgin olive oil.
However, to be fair, where is the similar high-quality, strong observational and clinical trial evidence for the hard-outcome health benefits for whole carbohydrates over highly processed, fast-digesting carbohydrates, as the authors profess?
Answer: There simply isn’t any. Despite the political-correctness and pervasiveness of this view. Otherwise, can they or others please cite them for us, similar to the many, many datasets indicating huge outcome differences for nuts and olive oil? The authors cite is just for one 6-month trial (way too short for long-term health-effecting weight effects), with only about 130 in each tested cohort (and high drop-outs), testing only weight-loss maintenance. And that difference was extremely marginal, only about a 2-lb difference out of a 25-lb initial weight-loss. See the study.
It is a false equivalency.
3
About the only way to run these trials is to run them on folks who are incarcerated. You need total control of the subjects lives. Even then such control will be hard to get.
3
@Eric Key - A long time ago I read an article about TB treatment in a prison in the Soviet Union. The men were behind bars, for heaven's sake, so of course they all took their meds exactly as prescribed, right? Nope. There were all sorts of ways they got around the system. So I imagine an imposed diet even in prison wouldn't necessarily be followed to a tee.
2
The trick is not to listen to anyone else .
Design and implement your own diet. We all know the basics of it. Learn to make a great salad or find a fantastic salad bar. Maximize vegetables, keep meat quality, bag processed/ cured meat, reduce your salt set point, add red wine and start the fun. Of course, exercise makes all the other components work better.
I swim a multitude of strokes. Many made up, toes first is just an example.
Make eating, drinking, exercise, work, life, you’re own. Only you can FEEL what works.
6
We need single payer health insurance like Medicare for Alll. Once the government is paying for health care, it won't get lobbied into endorsing toxic diets that make food companies richer. It will have to start encouraging people to stop consuming soda, fast food, and junk from check out counter stands and to exercise regularly. Right now, there's no incentive to promote preventative health care because to many companirs get rich off of treating the sick or making them sick in the first place. This has to change.
7
It's not rocket science. Reduce the amount you intake.
Cut the sugar. A half or even 1/3 of the suggested amount in the recipe book will sweet enough, say, to make an apple pie or cookies. Try improve your taste buds. We don't need that much sugar for better taste.
I just witnessed a long line up this afternoon in front of the newly installed Carlo's Bake Shop vending machine.
Even men are in the line, which you don't see in Japan.
North Americans love overly sugared sweets.
It's no use taking a scientific approach to this issue.
TV talk/news shows have a diet talk every day for decades, and yet, any result?
1
"Why It Is So Hard to Figure Out What to Eat"
Because everyone is different.
"Why It Is So Hard to Figure Out What to Eat"
Because it is emotional.
8
Here's how I see it: If you live a healthier lifestyle, you'll be more likely to have fewer health problems and to have a longer lifespan. If you don't, the opposite is true.
To me, there's no difference between a person that lives 40 years and a person that lives 80 years, other than a unit of time.
The person that died at the age of 80 is not more (or less) dead than the person that died at 40. They will not savor the extra 40 years they got to enjoy, because once your brain dies, so to does the consciousness from which it springs. Entropy has consumed you. You no longer exist, to appreciate the extra time (or to lament the time lost, if you happen to be the person that died at 40).
I'm 47 now. If my doctor tells me I have a terminal disease and that I'm going to die within the next 6 months, I'll be afraid. I'll also probably experience some degree of suffering during the process of dying.
If I live to be 99, and my doctor tells me the same thing, I'll still be afraid, and I'll probably still experience some degree of suffering during the process of dying.
It mainly comes down to the human tendency (no matter how futile and irrational) to want to delay the inevitable. To what purpose? The end is coming. Simply enjoy the time you have, however you want, in whatever way you desire.
For me, that means eating what I want, whenever I want, in whatever quantity I desire, because I value that over delaying the inevitable.
2
I think that artists, writers, and anyone whose work is a matter of slow cumulative labor will disagree with you. A long life may not be a rational end in itself but it is instrumental to many other worthwhile things.
3
@Jason Dying isn't the problem, is it? Having a stroke and spending your final years in a wheelchair or immobile in a bed is the problem. That is the reason to strive for good health - to make whatever time you have good, happy time.
5
I'd be surprised if this book hasn't been recommended in these comments already, but In Defense of Food by Michael Pollan is a wonderful read specifically about how to eat in a world full of so many unanswered questions.
Eat Food*, Not Too Much, Mostly Plants
*real, whole, unprocessed, additive and preservative-free
1
Prescribed diets do not work. You have to change your eating habits entirely. This means more fresh fruits and vegetables, less red meat, cut out processed foods and sugar in particular. If you eat meat, best to go organic with no hormones or antibiotics.
My wife and I did that about 6 years ago, and exercise is equally important. I've gone from 182 lbs. then, to 164 now. I feel great, my blood work has greatly improved and my doctor recently said "just keep doing what you're doing."
3
While I applaud the authors' conclusions, and agree with their observations about the shortcomings of dietary research, they ignore their own glaring problems:
First, doctors are loathe to acknowledge problems that clinical trials suffer; they are not the gold standards presented here. "Random assignment," for instance, is only random relative to the variable being studied. Indeed, participants are never random, unless the authors want to pretend that people are approached randomly on the street, that the street is perfectly representative of all possible streets, and the folks approached always say yes.
Notoriously, participants do not comply with treatment protocols unless they are literally confined to a bed in a metabolic ward. Worse, this non-compliance varies by race, age, class, education, and sex. It is non-random. So the authors need to jump off the "clinical trial" bandwagon before it crashes and burns them.
Second, human culture dictates that nutritional data by their nature are messier than say, a case-control study of drug treatment. People keep error-prone dietary records, forget, lie, underestimate, fudge, all with the best intentions. They also alter their behavior once they are in a study, clinical or otherwise.
The alternative, again, is a metabolic ward with lab controlled food intake. That alternative is not realistic for estimating long term effects of real diet on health. Like it or not, we're stuck with those messy, large observational studies.
Another challenge is that, just like for medications, there is not a "one size fits all" solution for nutritional health. There are likely genetic differences that mean that mean some people will see success with a high protein diet, others with a plant based approach. Personalized medicine has become the trend in cancer care. Personalized nutrition will likely be an important approach to overall health. In the meantime, everyone wins with a whole foods approach that limits the consumption of processed foods.
2
For me, it's a matter of finding someone who knows the science, but who also has clinical experience. I have struggled with my weight since I was prescribed Paxil in the mid-90s. I gained 60+ pounds and was found to have PCOS as well...now whether the weight gain was the PCOS or the Paxil, who knows...that's the complexity of weight gains.
I lost about 20-25 lbs once the Paxil was gone....but I've yo-yo'd for another 20 lbs....and never gotten the last 20 off. I finally went back to a registered dietician who is great. Everything is straightforward....1,400-1,500 cals a day....try to walk 10k steps. Eat every few hours...and no more than 500 calories after 5:30 at night (so frontload my day). Ideally, get protein, fat, and color at each meal...and don't go too long between meals and don't eat too little because it will mess up my metabolism. Make sure I get the calories in, even if it means grabbing a danish or a burger.
Under this, I've lost 15 pounds in under 3 months....all while being able to eat at home, do take out, or be on the road....It's not sexy. It's not fast. But it is flexible and works with my lifestyle.
It is probably no more expensive to meet with a nutritionist than it is to commit to a diet program...especially if you only do follow ups every few weeks - but the personalized attention and the mix of scientific training and clinical experience has made a huge difference for me.
4
Stores crowd the cash register with candy and other junk food. Even stores such as Kohl's have candy at the check out area.
Try to find anything healthy to eat in the Pharmacy... some have stopped selling cigarettes but have added extra aisles of junk food. All of which contribute to the many aisles of remedies for the ailments resulting from eating all that junk food. Cigarette packages carry warnings. Time to put large warnings on everything with sugar. If only... everything with added sugar would glow "Danger!" in dazzling neon.
4
Please stop blaming the stores. The consumers are responsible.
2
The public mount an intensive and extensive campaign to have the Centers for Medicare..., insurance companies, & private foundations begin properly financing studies as per this article. In particular I would think the health care insurance companies would be at the forefront of valid & reliable nutrition research since such research would more than likely reduce their expenditures for both chronic & acute conditions and diseases.
1
if you are over weight then dieting is not enough. you have to exercise as well. the best way to lose weight is to eliminate sugar from your diet.
2
Agreed to all of this. Given the hundreds of billions of dollars we are spending treating obesity (soon to hit trillion I imagine). It’s critically important we spend the money on scientific research to answer diet questions.
Of particular note, recent research suggests that not all people respond the same to each diet. So we need to know who responds to what diet and what is most effective. This would be money well spent IMHO, and hopefully save many trillions of dollars over time.
2
Which all probably goes a long way to explaining why the public receives a constant stream of conflicting advice about the best dietary habits.
3
Really good commentary here. I just do what works for me and that involves a lot of vegetables, little meat and also carbs. There is some research showing that it wasn't the Neolithic meat diet that resulted in greater brain power, but the agricultural revolution's harnessing of grains that resulted in greater brain power. I'm not the picture of health weight-wise, but I have low blood pressure, low resting heart beat and do some exercise every day.
4
There is a key element in nutrition largely being ignored by all comments here in the discussion.
And it matters too.
It is not just higher intake of simple carbs and fats in the average American diet today... vs say 50 years ago. The fiber profile of our diet, in general is also quite different as well.
Why does this matter? Because fiber intake is integral to intestinal health (where a majority of our immune system resides).
Some of the metabolic health issues in the modern American diet goes directly back to poor colon health.. and that is largely driven by over consumption of simple carbs and under consumption of fiber. That is an over-simplification of a complext matter such as nutritional processing.. but it is an important component which is largely being ignored here.
8
The “research studies” are historically nonsensical. They are skewed by overt bias, pre-conceived notions, and their funding sources. The “recommendations” have been similarly unhelpful. And the hand-wringing over the so-called “obesity epidemic” has added an extra layer of fulsome ignorance. Diets don’t work in the long term for any more than a tiny percentage, and 2/3rds of those who lose, temporarily, will regain more. Been there, done that. I am presently enrolled in the National Weight Control Registry (side note: I have a lot of loose, excess skin), but I do *not* endorse any form of dietary restriction or weight loss surgery (although I have friends who have made that choice and are pleased with the results). And I have often visited the topic on my WPKN/Bridgeport CT radio program. Bottom line: the advice, the bigotry against fatness, and the belief in “studies” is actually harmful. Oh, and please leave the fat kids alone.
6
This completely ignores individual differences that have evolved recently (i.e. last 20,000 years). For example milk is highly nutritious for humans who have evolved lactose tolerance, but makes those who have not sick. The quantities of sugar that we eat are detrimental for us, but have tremendously more severe consequences for hunter-gatherers. Evolution forced by local variations in available food has undoubtedly caused significant evolution in the "optimum diet" among current American inhabitants and must be accounted for in any study about finding the healthiest diet.
5
Nutritionfacts.org is the Manhattan Project for evidence-based nutrition. The work is done. It's irrefutable that a plant-based diet has the most health benefits.
4
America needs to focus on promoting self-acceptance and intuitive eating, not anything even close to dieting. How many people have benefitted on a long-term basis from a diet? One in 20? We will continue to shorten our collective life expectancy if we are made to believe that we are not where we need to be...right now. Diets sell, but they kill too. Intuitive eating is, in my clinical opinion, the healthiest approach to altering your relationship with food.
4
I lost 150 lbs and I’ve kept it off for almost nine years. I am also a physician. When I started my diet the big question was of course was whether it should be low carb or low fat. My thought was to not argue and cut out both fats and carbs. My diet is lean protein and vegetables...and some fruit. I can guarantee that if you cut out both fats and carbs you will lose weight.
2
In my layman's opinion, excessive body weight is primarily a result of overeating. There are many overweight not only carnivores and omnivores, but herbivorous vegetarians as well.
Apart from the questions of personal income and affordability of certain foods, it is better to be a gourmet of refined taste than glutton. And remember, how one eats at the table (i.e., table manners) is not less important than what one eats.
1
The reliance on fast food meals and casual dining chains is a big part of the problem in this country. Also the so-called typical American diet leftover from the days when many people engaged in manual labor. thus needing more calories, is something Americans think of as "normal". It's not normal at all. As an older adult I have adopted vegetarian eating and almost always cook at home. It's become a hobby to find new recipes to enjoy. When I socialize with other older people and get forced into going to a chain restaurant, I can't find anything on the menu to eat except a salad. The foods have so much sodium and are often sweet. Just inedible to me. Fortunately I can still enjoy eating out at locally owned independent restaurants where the menu is geared towards more innovative fare and doesn't consist of microwaved factory food.
2
Don't even get me started on the Food Guide Pyramid. In the past it has been so fraught with politics and big business influence I can only imagine how the current administrative, who discounts almost anything scientific, will attempt to influence the guidelines. To them all preserved foods manufactured by big companies packed with powerful lobbyists will sit atop the pyramid (or in recent years compose a greater portion of the plate).
I teach medical students and when attempting to devise a nutrition curriculum using evidence I have to say our committee found very few credible published studies. We provide students with the best evidence disclosing all the limitations of the studies. I agree with the authors that we spend so much money on drug costs so why aren't we properly funding better studies? Proper nutritional guidelines would go a long way towards mitigating or even eliminating most of what ails our society- diabetes, heart disease, etc. In the meantime, I advise people to eat whole foods as often as possible.
4
There's just a few things you need to cut out to be healthy. First - no carbs. Period. Second - cut out fat. From there it's easy - just drop the remaining protein in your diet and then you can eat all that remains! Enjoy!
5
I don't think research is going to contribute much. People consume too many calories, which makes them fat. They do this because eating is really pleasurable. I am sceptical that any exhortations to eat less calories will have a lot of effect. I suspect that the only effective solution is the development of foods that taste as good as high sugar, high fat foods, while containing little of either and being low calorie.
2
@John Evan - Yes, think of what would happen if modern science found out that not having sex, or having it only rarely, would significantly improve a person's health. Do you think there would be many takers? Eating and sex were designed to be pleasurable, so that the species would continue. Going against those inbuilt urges is difficult.
3
I'm neither a doctor nor dietician, but I did shed more than 40 pounds over a two year period, and those pounds have stayed-off since 2016. How did I do it?
First, I quit drinking alcohol. I was consuming about 375ml (1/2 bottle) of wine daily. I feel I lost 20 of those 40+ pounds simply because I stopped consuming 2-3 glasses or wine per day. It was much easier than I thought, and I both look and smell better!
Second, I regulated my schedule. I started going to bed earlier (between 10-12pm, rather than 12-2am) with the goal of 7-8, rather than 5-6 hours of sleep per night. I don't know why, but I feel that going to bed and waking up at sunrise has affected how I eat and my energy level. I also eat most food before 2pm, and only eat a small meal at night. I do NOT eat after 9pm, ever. Going to bed hungry isn't all bad.
Third, I changed my diet, even though I'm NOT on a diet! I used to eat at restaurants a lot, but now I mostly eat home made, wholesome meals. I've greatly reduced the amount of meat in my diet, though I still enjoy some. I've also greatly reduced how much processed food I eat - I feel that's key. I eat-out about one or two meals per week. I clean a lot of dishes, but feel how I eat is as much a reason for my weight loss as any other.
Last time I saw my doctor a year ago, she hadn't seen me for years. She wasn't impressed by the weight loss, but after looking at my results, asked "how did you do it, how are you so healthy?" See above...
7
The sorry state of nutrition research, it seems to me, does not justify spending at any higher levels. I am so disgusted at the results of DECADES of "nutrition research" that I regard the field with dismay. Oh, so there's "strong evidence" for the benefits of "whole carbohydrates" (apparently the new term for fruits and vegetables) over "fast-digesting carbohydrates" (gussied up term for fast food). Well, thank you VERY much for this summary of 100 years of nutrition study.
Just go away, nutrition scientists. In fact, you've done more harm than good. I live in fear that some consensus is going to develop and yet another category of food will be policed and forbidden (and that insurance companies will start dictating our diets).
This whole field of study, plus the hangers-on gurus, and the acolytes who post their numbers and boast of how their doctors love them - but, oh, what size are those particles, that's key, no? - take a break. I eat my vegetables and watch my overall intake. Got it.
4
Dietary research will always be flawed because you cannot do randomized control trials in a closed environment in humans for years to assess the results. People lie about what they eat so that is why a closed environment is necessary.
Most animals, humans included, did not evolve to live in a food rich environment. Survival of the species favored obsessive eating over casual eating. Over 100 genes have been discovered that have to do with eating behavior and metabolism. Changing those genes is the best path to weight reduction (other than gastric reduction surgery to restrict food consumption and absorption ).
2
As the lawyers say, qui bono? Who benefits? Poor diet causes medical problems which may well end in early death. Why should the government try to rectify this? If you die as soon as you get social security and medicare you are reducing the government's costs. All of the social security contributions you and your employers made over the course of your life that have not been distributed to you revert to the government. Talk about a rip off!
Instead of relying on studies about nutrition (that often contradict each other) wouldn't it make a lot more sense to look to the cultures that enjoy the longest, healthiest lives? The Mediterranean diet and the Japanese diet are great examples of healthy eating patterns that have been proven by the test of time - as well as by science. In fact researchers from the University of Kiel in Germany believe that combining these diets into a 'MediterrAsian' diet "may be a promising dietary strategy in preventing chronic diseases, thereby ensuring health and healthy ageing." https://www.ncbi.nlm.nih.gov/pubmed/24069505
People want to overeat, plain and simple.
Thank you for your column.
In addition to your recommendations, I would suggest that research efforts include interviews with obese people who have managed to lose weight and keep it off for many years. Although such investigations do not constitute “clinical proof”, they can point researchers in potentially fruitful directions. I would also suggest that questions be asked about drug regimen changes as I believe that drugs can be contributing factors to weight gain.
I have struggled with weight gain all my life. Only in the past two years have I managed to gradually lose weight without being hungry all of the time. The last two years have convinced me that “conventional” dietary advice is very suspect if not plainly wrong. In addition, it makes me very angry that it took me to my 60th year of life to find a dietary and supplement regime that would help me lose weight. I don’t want future generations to experience what I experienced.
I hope that researchers like you get the funding that you need to conduct research that leads to solutions that really work.
3
A walk around a modern grocery store or meal at a restaurant tells you everything you need to know about why people are fat. Grocery stores are full of foods you should not eat. My store has about an aisle of produce, an aisle of meat. If you took everything else you should eat like whole grains and dairy and eggs, you'd have 4 aisles. Yet the store has 14 aisles.
Then go eat out and find a meal that clocks in at 400-500 calories that has a mix of fats/carbs/protein in good proportion. Most meals clock in at at least twice that, not including drinks, apps, dessert. I was at the airport recently looking for a sandwich- most were 800-900 calories, half of my calorie allotment a day as an active woman.
If you eat out a lot, you really do need to restrict yourself to half a portion and drink water. If you grocery shop, stick to the edges for most of what is in your cart.
238
@MC
Grocery stores are there to make money. Their presentation of food is largely based on what will sell best and make them the most money. If we start buying more fresh foods, then that is what will be front and center (my local chain store funnels you through fruits and veggies first, so this change does seem to be happening to some extent)
25
@Steven
My point is that you can slice and dice dieting into low fat, carb restriction and all sorts of random experiments when the reality is that knowingly or unknowingly, most fat people eat too many calories. It is very cheap and easy to overeat in the US.
I'd say I am fitter and healthier than the average woman my age and to keep my calorie count in check, I need to not eat out and to focus on fresh foods. Manipulating fat or carbs is meaningless either direction. If I go thru a time of eating out a lot (travel or work), I gain weight. If I go thru a period of cooking a lot and eating "in" consistently without buying convenience foods I drop weight.
Eating out and convenience foods are typically rich in carbs and fats, low in protein. And high in calories.
43
@MC
So, actually, manipulating fats and carbs is important. Why? Because we all have a limited supply of self-restraint (admittedly, some folks have more than others). Simple carbs (see article) do not hit the satiety center of the brain well. Thus, we need to eat more of these calories before our brain turns off the "eat" command. On the other hand, simple carbs are digested and stored quickly, so we become hungry sooner.
Yes, a calorie is a calorie. But eating simple carbs (mostly refined stuff + potatoes) makes us hungrier and more likely to consume more.
8
Check out “Forks over Knives”. All you need to know.
1
Diet research is often conflicted by bias due to funding sources and by political considerations when funded by government. For research to be effective it would need a structure of independence almost like the federal reserve system.
It is truly amazing that one of the most important areas of science as to what we should eat is in the dark ages when it comes to dietary recommendations.
This is a great article to raise such a fundamentally important issue.
35
@Joe S. Remember the hullaballoo when Michelle Obama came out with her healthy school lunches? People will eat what they want to eat and don't want to be told what to do. Most people need to learn more about good nutrition, but don't try and tell them that.
4
Here’s a strategy. Learn to re-label the feeling of hunger as positive. As an overweight child, at the age of 13 I decided I could beat this problem. I focused on reducing my intake and thinking about hunger as sign that I was successful. Has worked for years. My weight is right in the healthy zone and remains there with little change. Don’t forget to weigh yourself every day and write it down. This allows you to see what has happened. This won’t work for everyone, but has worked for me for over 50 years. Good luck.
84
@BCY123
Couldn't agree more. There is nothing wrong with feeling hungry.
5
The authors contradict themselves -- on the one hand there is little solid diet research, yet at the same time, we are besieged with life-shortening disease caused by poor diet. If the research is poor, how can we conclude that diet is shortening our lives?
Since poor diet is correlated with many other health hazards -- such as poverty -- it seems disingenuous to say that improving diet would lengthen lives. Improving lives will lengthen lives. Adding more vegetables to a low-income person's diet will not.
28
@Linda RIddell
There is nothing contradictory about these statements.
The research may be poor, but that doesn't imply that it is completely devoid of information. Certain foods are clearly associated with an increased risk of diabetes in certain individuals. Excessive salt and saturated fat is associated with hypertension and heart disease, ailments that definitely shorten life.
Where the research falls short is in informing us how to best manage our weight in a decidedly obese society.
2
All the more reason to follow Pollard’s so reasonable diet advice: Eat food; not too much; mostly vegetables.
92
@ehillesum. FYI, i meant Pollan, not Pollard.
2
@ehillesum Add to this: Prepared at home, as little processed as possible, and containing as few additives and "food-like substances" as possible.
9
@ehillesum
Mostly plants ;)
4
What we do know is that the government subsidizes the unhealthiest foods like grains and sugar, and doesn't fruits and green vegetables. So we have a world were it is cheaper to eat burgers and fries at McDonalds than make a salad at home. I don't think we need better trials to explain the explosion of obesity among the poor.
4
Excellent summary of diet-research issues.
It plays into a larger problem re: medical research. If there is no $$ to be made, it largely doesn't happen. As a nation, we vastly underfund public research. That was not always so, but the NIH and related agencies are often the first cut when we "need to trim excess spending."
I am a family medicine MD. I am not overly fond of "natural medicine," yet there are gems in that arena that go largely unused due to lack of research. Since there is no profit to be made, the funding for research rarely surfaces.
The US government needs to find a way to stimulate research into preventative and disease based medicine that pharma ignores as there is no money to be made.
Any money spent by the government will be more than returned by increased public health
99
@Steven Is there ANYBODY in Washington lobbying for prevention and health? I worked for years at pharmaceutical companies and their cafeteria food was designed to get everybody to use their drugs.....
4
The core difficulty here is not just diet research methods and procedures... the human body is an extremely complex system in which the intake of nutrients for one human can in fact be either toxic or cause physical issues and yet be benign in another human.
Genetics plays a role.
Environment plays a role
Food intake and type plays a role.
Daily living style plays a role.
Even social pressures play a role.
I have yet to see any research that covers the gambit of factors that play a role in why one human can consume an essentially "junk diet" and remain healthy (based on professional medical evaluation and testing), and another human can eat a "proper diet", exercise regularly, and still have chronic weight and health challenges.
There literally is NO one size fits all for humans where diet is concerned. And frankly, medical research seems either unwilling or unable to account for this and factor it in to their research parameters and controls.
What I am so tired of is one series of research coming to a dietary conclusion, and yet a new round of research completely undercutting and reversing prior research. This alone is a testament to the largely "junk nature" of diet research.
4
Start with natural foods. Ditch the fake foods, additives and industrial food products—especially processed sugars and starches. Eat like your ancestors. Nose to tail, wild or naturally-raised animal foods; whole vegetables, fruits, nuts and seeds; grains and beans if desired, prepared using traditional methods that remove anti-nutrients. Most people will thrive on a real food diet that doesn't emphasize sweets and treats designed to mimic processed foods. It really is that simple.
89
@d. morrison allen Great comment, Morrison!
3
@d. morrison allen
My ancestors rarely lived to 70. As far as I can tell, neither did anyone else's in Europe. So why should I follow their diet?
3
@d. morrison allen Sadly, a large part of the US and some of Canada are food deserts, where this recommendation simply cannot work. It is always about the money - who can afford to eat well/properly (read educated, mostly urban dwellers) and where groceries are sold (if it costs too much to get it somewhere, it won't be available). What really needs to happen is a decrease in processed food production, an increase in nutritional education to a significant portion of the population that for all kinds of reasons no longer knows how or what to cook in a healthy manner and affordable, healthier food choices.
4
I direct clinical trials in humans for a living. Clinical trials are hard to design and manage, despite changing just one variable.
Every food is one variable, with many sub-variables inside of it (proteins, carbs, fat, vitamins, minerals, fiber, etc.). Imagine the complexity of grouping foods for a diet trial, which leads to many simplifications that may or may not be correct. Imagine how difficult it would be for participants to stick to a diet for months. People will drop from the trial or deviate from it, and the deviation won't be random; the people that don't mind the diet will stay, the people that do not like the food or the way its prepared, or its amount will drop or deviate (many times without telling the researchers). In summary, diet trials are impossible to control, no matter how well designed.
We need a new paradigm to research diets.
142
Moreover, food trials can’t be double blind. If you set up a study on the health effects of eating eggs, the subjects will know whether they’ve been assigned to the group that eats eggs or the group that doesn’t. Unlike drugs trials, food trials can’t really use placebos
9
@Ricardo
And the largest confounding variable of all: that different people can thrive on different diets.
13
@Fourteen14:
Right-o!
The physics of pushing away from the table; the physics of hurling all those empty calorie foods out of the fridge. :-)
5
Ridiculous. We already know that everyone who successfully lost excess fat and maintained that loss did so by permanently changing their lifestyle. Columns like these perpetuate the myth that an individual can do little or nothing to achieve sustained improvement in health through diet and exercise until more research is done. The catch-22 is that there will never be a gold-standard study because what 'works' is lifestyle change. Lifestyle change doesn't lend itself to a double-blind, placebo controlled test. You will know you've done it because it takes effort to get started and maintain new behaviors until they become habits.
There are a variety of nutritionally adequate diets that provide sufficient calories for an obese person to lose weight. The right one for you is the healthy eating plan that you can stick to for the rest of your life. Likewise with exercise, there are many good exercise options. The right one is the one that you will start and continue to do with manageable and increasing intensity for the rest of your life. Not a crash diet or quick weight-loss scheme, but deliberate healthy choices in exercise and nutrition aimed at burning excess fat while building endurance along with muscle and bone density.
20
Diet trials may be inherently tricky, but looking at evolution and history is not. The data is clear: for ninety percent of human evolution, we ate wild game and fish and gathered vegetables, roots, and a few wild fruits. We didn't eat grains, dairy, or sugars, because these weren't available. And we know from looking at skeletons of bronze age people that as soon as agriculture introduced grains, legumes, and dairy as primary food sources, people's skeletons shrank and health problems became endemic. It's pretty simple: eat what humans evolved to eat.
1
@Cyntha In general, this is an approach with a lot of potential, but in fact, the actual application is going to be anything but simple. To begin with, there isn't a single "paleolithic diet;" what people ate varied dramatically with variations in local environments. Even among modern forager populations (about whom we have much more complete information than we have about paleolithic populations), something as simple as the proportion of meat/animal protein in the diet varies from almost 90% to less than 10% - and sometimes, that proportion varies seasonally as well!
I suspect that in the end, it will turn out to be less about specific foods, and more about achieving the appropriate nutrient balance (something that we still don't have comprehensive data about). And of course, the application of that information to provide dietary recommendations will have to take into account population-level differences (a bad idea to recommend ANY dairy to populations with high levels of lactose intolerance, for instance) and perhaps even individual-level variation. And it's not clear whether it will be economically feasible to feed everyone without resorting to at least some level of agricultural products, including grains.
1
@Cyntha , I agree with everything you say, but would add that since agriculture began there has been a more drastic change in the last hundred years due to long distance transport of foods, highly refined food processing, addition of thousands of artificial food chemicals and preservatives and introduction of new foods never before ingested by humans such as refined seed oils also referred to as vegetable oil, hfcs, and large amounts of refined sugar to most processed foods that make up a large portion of modern humans diets.
1
those of us who have a chronic medical condition who receive medical support regarding diet know just how lacking “dietary guidelines” can be...if you have a metabolic disease like chrons or IBS you are told that you really have to experiment with different foods to find those that don’t initiate a flare up. Diabetics given traditional carb leveling diet plans may never achieve the blood sugar control seen with carb restriction plans. Other than older data regarding vitamin deficiencies causing conditions like rickets I just don’t believe more recent diet “studies” without question regardless of the source.
5
I wonder about the effect of our diverse diets on weight, which means we no longer just eat Italian food or other ethnic foods that are emblematic of our heritage. Rather we eat a variety of ethnic foods that perhaps can affect our gut biome. In addition, how does our genomic profile affect weight gain, especially as we age. Is my body programmed to gain weight in case there is a shortage of food as my peasant ancestors may have suffered in Southern Italy. OK, I'm looking for an explanation/excuse for my weight gain. :)
2
The authors' work adds to the evidence that undisclosed deviations from research plans decreases the credibility of scientific findings. Journals can address these undisclosed deviations by better training of editorial staff or reviewers as recommended in the Transparency and Openness Promotion Guidelines (cos.io/top) and by adopting Registered Reports (cos.io/rr) to directly address the incentive to report only a biased subset of research results.
1
we need to get rid of the calorie. Calories are meaningless. Google how a calorie is measured and try to figure out how that correlates to human metabolism. It doesn't. It's total nonsense.
3
A calorie is a measure of energy. Why is that a poor unit for assessing the substances we eat to, at the most basic level, provide us with energy to keep our bodies functioning?
7
@Asher A calorie is a unit of energy. Fat it stored energy. Limiting caloric intake means using stored energy for the body's needs. No moderately knowledgeable person debates this.
You can cheat on your diet, but you can't cheat physics.
Your comment amounts to: "California is too far from New York, so we should get rid of inches, feet, and miles. That'll fix it!"
4
@Michael-in-Vegas
Of course the body obeys thermodynamics, but physics alone tells us nothing about _causation_ in a biological system.
Decades of the "calorie approach" to weight loss have been a failure, because "calories in" and "calories out" are interdependent, and both respond to types of foods, not just amounts.
2
There is a large body of scientific evidence in the nutritional field about what the healthiest diet for humans is.
Unfortunately, this diet goes against the monetary interests of large industries. These industries own nutritional research (there is little to no public funding for nutritional professionals), and as a result of self-interest these professionals churn out flawed studies. Of course nutritional professionals would deny this vehemently, but they would also be insulted at the suggestion to remove conflict of interest with food corporations. I believe they would like to do so, but self preservation means they can't. They wouldn't have jobs if they didn't work with the food industry.
In any case, this article makes it seems like the science is unsettled or confused. It isn't, it's the conflict of interest in the nutritional profession that is leading to a muddied view of the situation. Read Marion Nestle's book Food Politics for more on this topic.
3
I agree with the confounding issue and perverse incentives of the corporate actors that benefit from the current state of food, but I don’t think it’s the case that we know the right answers to all of these questions. To my knowledge, we don’t know for sure whether a well-balanced plant-based diet is better or worse than an equally well-balanced omnivorous diet. We don’t know what the optimal timing of meals is (e.g., is intermittent fasting actually beneficial to humans?). As the author mentions, we don’t know whether red meat or moderate amounts of alcohol are truly harmful. I’m sure there are many more, but these are a few that come to mind.
8
In cultures where people eat pretty much the same thing every day people tend to be skinny, as overeating is much less of a temptation.
4
Very true. Many food choices (think buffets) lead to overeating and monotonous diets reduce it.
In rich countries we have easy access to more types of food now than human beings have had in all of history.
2
@Peter Silverman Correlation does not equal causation. Eating a monotonous diet isn't the only factor driving a person's weight gain. Some cultures with fewer options haven't been inundated with the products from the west containing refined carbs, high sugar content, and loaded with soy or corn. You can look at those living in food deserts right here in the US to see limited availability to fresh produce and fruits has a much stronger impact. I think it is also fair to say that you really can't compare Americans to remote indigenous tribes. Our sedentary lifestyle burns way fewer calories than cultures who forage for subsistence.
1
It seems pointless to study "diets" when every body is individual. No one diet would ever work for everyone. The "epidemic" is, I think, obesely exaggerated. So much concern over costs, rather than working to lower the costs of health care. In fact, when the AMA declared war on obesity, it was, once again, when the cost of medical care was under scrutiny. You see, every time the costs come up, the AMA picks an easy target to distract the media and government attention. Before it was smoking, then heart disease, now obesity. Well, the very definition of obesity is totally spurious. You would do better to study the machinations of the AMA and the insurance industry, who came up with the poisonous BMI in the first place. Just as no one diet can be expected to work for everyone, no BMI can be applied to everyone. The real enemy now is technology, which has forced people into being sitting stooges rather than active independent humans. But that's not an easy target. Leave "fat" people alone. Perhaps lower the cost of exercising.
2
@Joshmo
Basically the cost of exercise is $0. It is right outside. Walking, climbing stairs, etc. The barrier to exercise is not a fancy gym or exercise togs.
6
We are searching in the wrong direction, as with so many of today's societal ills. We have an obesity epidemic, exploding, and we say, wow, suddenly people are so undisciplined and lazy!
Look to the food industry, to the packing of corn syrup into all of our food supply (read the labels) "coincidentally" happening at the same time as the start of the modern epidemic. Look at Big Sugar, that, like Big Tobacco, fights to keep it's products marketed to the vulnerable.
Let's do some medical studies about what happens to human bodies when the food supply changes, when education is unequal, when access to healthy food is denied in "food desert" neighborhoods. Let's call that "diet research."
8
@ML Thank you for your comment. We will never 'solve obesity' until we reckon with the global machine that has profited enormously as our collective waistlines expanded. It's easy to blame consumers when however the food industry is doing its best to mislead us. Look no further than the complex labels with 30 different words for sugar, and zero standards for food marketed as healthy or peddling junk science claims.
1
People eat too much. Eliminate sugared drinks. And only eat small portions
Food should not be the joy in your life
8
@Mary M
Food will always be ONE of the joys in my life. I am a full on foodee. But, at 56, I work fairly diligently to be able to indulge, which includes moderate intake, especially when looking forward to a delicious meal or going out to dine. I eat sugar and wheat in small quantities. I exercise hard, multiple times a week, and lift weights, to keep my metabolism going and my muscle mass intact. In trade, I can savor wonderful food and occasional indulgences 100% guilt free. It's liberating.
As a formerly overweight person, I am sympathetic to people who can't seem to get momentum on the weight loss track. But I am accustomed to my new way of eating and wouldn't go back to my old cycle of starving myself, being unfit, then overeating and feeling terrible about it.
Weather allowing, I'll mountain bike for 2-3 hours then mow through charcuterie. A true fair trade in my book.
18
@Mary M
"People eat too much" is a description but not an explanation for _why_ people are eating too much, nor why this has changed on a population level.
4
The truth about dieting, shall we say, is hard to swallow. Watching your calories and exercise are the magic bullet. Genetics and age also have quite a bit to do with it. I feel bad for people who spend way too much money on the latest fad.
14
@michelle
Watching refined carbohydrates is more effective (for most people) than watching calories.
2
Two observations. One of the major problems with food addiction is that you can't ever remove it from your life (for obvious reasons) like you potentially could with other addictive substances. And secondly, the human body really is calibrated to become overweight. Our ancestors survived by eating a lot when they could, and then their metabolism slowed when they couldn't. Problem is, we can now always eat. We have unprecedented access to any and all imaginable food 24-hours a day. We really shouldn't be surprised that the tendency of humans, in the face of a massive abundance of food, is to gain weight over time.
8
@BibleBeltOfSantaCruz
I so agree. If I could just give food up altogether like I did with smoking and later drinking it would be great. But diets of any kind are like going through the whole withdrawal thing over and over again. Sigh.
2
How about eating any traditional diet. If your great grandmother wouldn't recognize it, don't eat it.
3
The assumption that calories are the problem is a problem in and of itself. People must be educated that isocaloric is not the same thing as isometabolic. Translation - calories of different foods are not the same. But I do agree that better dietary research is vital. Let's stop the emphasis of prescription drugs/and lowering costs is the holy grail to good health and sending the more important message that proper diet is paramount to good health. If you eat well, generally your need of prescription drugs will be statistically lower. The fact that our health system is impacted so completely by prescription drug costs is the result of poor diet practices.
4
A Manhattan Project for nutritional science? What a poor choice of words. My guess is that this type of undertaking for nutritional science will produce a similarly explosive result that will negatively impact humanity.
People were doing fine with their diet until the government intervened and started making recommendations based on poor science, biased research, and of course, heavy corporate influence. And now America is sicker than ever. Maybe I’m being too naive, but I’ll stick to what generations of human beings have eaten (i.e., real food) instead of whatever the US government (or should I say Kellogg, Coca Cola, Nestle) tells us to eat.
9
Ask thin people what they eat..too many people go on a diet that they see on tv that shows how much weight people lost.
1
Here's a simple, memorable rule: Don't eat anything with a big marketing budget behind it.
5
The food we eat over the last 150 years (the blink of an eye in evolutionary terms) has changed dramatically and the human physiology has not even begun to adapt resulting in all of the chronic illnesses present now that were absent 150 years ago. Consider what foods you would be eating without refrigeration, long distance transportation, and commercial processing. The only food available was locally grown and raised plants and animals. Fresh fruit and vegetables were only available seasonally, Fresh animal products (meat, lard, tallow, dairy) were available rear round and provided the bulk of the energy and nutritional requirements due to the energy/nutritional density of this food source. and for much of the population, especially rural populations who were at that time in the the majority the food eaten was meat (not lean meat, but fatty meat) and full fat dairy. This energy/nutritional dense food formed the centrepiece of most home cooked meals. And all of the meals were home cooked.
6
Maybe we could start by having our government stop subsidizing grain and start subsidizing fresh produce. The obesity epidemic didn't happen because people suddenly got weak willed. Our first world dietary environment and lifestyles changed dramatically. Not only is research needed, but also an understanding that it's a social problem, not simply individuals behaving badly. US legislators, are you up for taking on Big Agriculture?
14
@Artemis Platz The government does subsidize produce growers. Human taste-buds prefer HFCS and other enjoyable things that aren't in our long term best interests: alcohol, sweets, cured meats, opiates.
It is an individual problem, however. And as a formerly obese person, this is preferably to phrasing it as a societal problem. If it's society that needs to change, then I could only passively wait for the pill or public policy to reduce my waistline. Since it was (and is) an individual problem, I could make the necessary changes and I did.
5
Even some diabetics eat sweets and some chronic lungers smoke. Yes Mrs. Calabash, there are closet eaters and closet smokers. How do you complete an accurate study without reading the minds of the participants? On the other hand the way things are going with secrecy, that may be the next step.
1
The truth is there is no interest in reducing medical costs. Our system is driven by huge for-profit pharmaceutical and medical device companies as well as for-profit (and non-profit) hospital systems. They all make more money the sicker we are. Diabetes, heart disease and immune system disorders are HUGE moneymakers. The more complications the more money is made. Obesity is a huge moneymaker --- you get diabetes, high cholesterol, and you need a knee replacement!
6
There are decades, DECADES, of data that support the value of a minimally processed, low fat, no added oil, zero animal products whole plant food diet for optimal nutrition and health. Why do you insist on ignoring this deep catalog of data and sowing doubt and confusion? It is irresponsible and it hurts people.
If you want to see quality human nutrition data then I suggest you look at the work of John McDougall, Caldwell Esselstyn, Nathan Pritikin, Dean Ornish, Michael Gregor, T. Colin Campbell, Neal Barnard and others. The issue is not confusing, everybody isn't "different". Human beings are adapted to consume plant food. We can obtain nutrition and calories from meat, dairy, and eggs but they make us sick, always. Look at the China Study, look at the Adventist Health studies, look at the BROAD study.
The answers are clear, and the answers financially threaten the meat, dairy and egg industries, as well as the pharmaceutical companies that sell billions of dollars worth of drugs to treat the high cholesterol, cardiovascular disease, cancer and diabetes caused by eating these foods. Which is why we keep getting articles that suggest or outright claim that we do not know the answer to the question of optimal human nutrition.
4
Have you ever eaten in any of the places that traditionally eat the Mediterranean diet? There are enormous amounts of added oil in that diet, and frequent use of pork and dairy in various preparations. Very little consumption of fruit.
10
@arusso I think you have illustrated the problem. Eating vegetarian *can* work for some people, but so can eating lean meats and eggs. I get most of my protein from eggs, and sorry, but I'm not at all sick and am in excellent shape. The real story is that it is simply "calories in, calories out" and there are multiple ways to achieve that balance, one of which is what you describe.
4
@arusso Thank you for writing this. You said it better than I could. For anyone who wants to look at dietary facts, follow Dr. Greger at nutritionfacts.org. The studies have been done and the results are clear. The meat and dairy and Big Ag industries are masters at obfuscation. They just need to keep people confused.
The documentary "The Game Changers" (currently on Netflix) should answer any concerns about getting enough protein on a vegan diet.
1
In 1976 as a new first grade teacher I presented a nutrition lesson. For teaching aids I brought an apple, a container of applesauce and a packaged apple pie. The conclusions of discussion were that the apple was the healthiest and the apple pie the least healthy. I don't think that has changed.
Humans learned to stave off starvation by extending scant sources of meat, vegetables and fruit by incorporating filling and high calorie grains-rice, corn and wheat. The vast majority of humans on this planet are no longer facing starvation.
Modern diet is driven by the siren song of agribusiness and corporations for quick and easy. Modern life is driven by a need to accommodate an ever increasing number of activities into every day. Modern technology eliminates the physical aspect of many occupations-to the point that we need to schedule time for exercise.
I don't think anyone can structure a study to incorporate all of those variables.
8
Eat food. Not too much. Mostly plants.
Everything else is just noise.
Follow this simple injunction from Michael Pollan and let the chips fall where they may. Live your life.
27
@KMH Even when you do this the body’s metabolism changes over time because our level of muscle decreases and muscle burns calories. Thus, we are also predisposed to gain weight as we age unless we actually reduce caloric intake.
8
@KMH
"Eat food. Not too much. Mostly plants"
Agree this is still good advice, along with Pollan's addition of
"Don’t eat anything your great-grandmother wouldn’t recognize as food,” which doesn't mean you shouldn't be adventurous and try new foods, but that additives like guar gum, high-fructose corn syrup, soy lecithin pr weird oils processed out of things that aren't really edible should be avoided whenever possible.
9
@KMH You beat me to the punch with Pollan's adage!
The media has perpetuated premature assertions about diet and health over and over again. At the same time, "body positive" rhetoric ignores the very real health consequences of being overweight. Nobody should be "body shamed," but neither should unhealthy behaviors be enabled. Food is a drug just like alcohol or marijuana. In moderation, it's fine. In excess, it's bad for you. Processed food is really not great and should be eaten sparingly if at all. Period. We should all go back to three (only if you want it) meals per day, no snacks. Emphasize variety (4 food groups, mostly vegetables). Restaurants should not serve ridiculous portions that no one in their right mind needs to eat. The KISS principle is operative here: eat in moderation, exercise, and don't focus on it 24/7.
5
@Lynn White
When I walk into my local grocery store, to their credit, fresh fruits and vegetables are directly on your right. BUT, what is right in front of us is the biggest display of cookies, donuts, cakes, bread, rolls, seasonal offerings like apple and pumpkin fritters, there is a bread slicing machine for customer use and a wall of jalapeno and cheese bagels, rolls and bread products. A bit further but in your eyes straight sight is the bakery with cakes, cheesecakes, individual cakes, goodies, cookies of every description. You can smell the sugar just like in the cereal aisle. It can be, I can see hard to resist. I walk to produce and then completely around the back of the store to avoid the area. It is done on purpose. When you walk in, the most seasonal treats full of sugar like the apple or pumpkin fritters are right on display. When you look in others wagons, amazingly there they sit. I always say, it starts in the Supermarket. I try and always have a list handy and stick with it. When the Stella Doro cookies or chips are on display at the end caps of the aisles, I snap the rubber band I wear on my wrist to focus me on what I came for. The back end of the store walls have the milk, cottage cheese, meat, fish and yogurt I came for. They have a great salad bar too near the deli which I avoid altogether. I grab salad ingredients, real ones like lettuce and carrots and avoid the deli by making a roast on the weekend and freezing portions for the week like a turkey.
1
@Concerned Citizen You are so right. We were taken down a path by some bad science and the use of weak science by Religious, Corporate and Special interest groups that want control of what you eat. To think that there is a problem eating animal products after 3 + million years of doing it successfully is absurd. When we eat like our great grand parents did, virtually no sugar, virtually no processed food and we limit the carbs to what a reasonable amount that thousands of generations thrived on, you aren't hungry, cravings go away and eating reasonable amounts of food becomes the default. Not until we became processed food eaters that started listening to governments advice did we run into problems. Keep it simple some plants and some animal products and everything takes care of itself.
1
Here's the list of specific 'diets' that work (restore health, reverse diabetes, obesity, and insulin resistance - the actual *cause* of obesity):
=Crickets=
=Crickets=
=Crickets=
So instead of trying to catch a cricket, do this instead:
DO
Learn to cook.
Buy the tools needed to help you cook easier and faster. Pressure cooker, food processor, etc.
Eat food you cook yourself (yep, including pizza and any sauce on it). All food groups: veggies, fruit, starch carbs (bread, potatoes, rice, etc) and quality protein. LOTS of fat.
Eat within a 6 to 8 hour window only - every day.
Eat until you are fully satisfied.
DON'T
Cut out any food group. You're human. Eat anything that doesn't eat you first.
Eat added sugars of *any* kind for at least 6 months (or ever). Honey, syrups, brown, white coconut - all the same. Added sugar is NOT a food group.
Count calories. Ever again.
Eat any fast or hyper-processed food-like substances. See "learn to cook" above.
Done. Your body will thank you, and you'll never diet again. The 117 pounds I lost 10 years ago (size 28 to size 7) - along with type 2 Diabetes - and never regained, will also work for you.
7
@Susan B. A. Our bodies also betray some of us in that some people do not have a well functioning satiation point and will continue to eat because they do not register “being satisfied or full.”
4
Here's the list of specific 'diets' that work (restore health, reverse diabetes, obesity, and insulin resistance - the actual *cause* of obesity):
=Crickets=
=Crickets=
=Crickets=
So instead of trying to catch a cricket, do this instead:
DO
Learn to cook.
Buy the tools needed to help you cook easier and faster. Pressure cooker, food processor, etc.
Eat food you cook yourself (yep, including pizza and any sauce on it). All food groups: veggies, fruit, starch carbs (bread, potatoes, rice, etc) and quality protein. LOTS of fat.
Eat within a 6 to 8 hour window only - every day.
Eat until you are fully satisfied.
DON'T
Cut out any food group. You're human. Eat anything that doesn't eat you first.
Eat added sugars of *any* kind for at least 6 months (or ever). Honey, syrups, brown, white coconut - all the same. Added sugar is NOT a food group.
Count calories. Ever again.
Eat any fast or hyper-processed food-like substances. See "learn to cook" above.
Done. Your body will thank you, and you'll never diet again. The 117 pounds I lost 10 years ago (size 28 to size 7) - along with type 2 Diabetes - and never regained, will also work for you.
1
When I was a small child, my working-class father brought home $70/week. On that he could support a wife and three kids. Most of the adult women were stay at home moms, bought fresh food, and prepared it from scratch. My mother shopped at the local farmers' market--on Schenectady Avenue in Brooklyn! The feminist movement opened up more job opportunities for women, but the cost of living went up at the same time--without a corresponding increase in wages--so that it took two full-time adults to support a family at the same level. Meanwhile the agribusiness found it profitable to promote convenience items so that a woman could come home from an exhausting job and open a package of junk food for dinner. And the long day at work has gotten even longer in the last decade or so.
We can't tell ordinary people that they should buy fresh foods and prepare from scratch without giving them the time to do so. And that means shorter work days for everyone, not forcing women back into full-time homemaking.
55
@Martha Shelley the RAND study, published just a couple weeks ago showed how we actually use our time each day. The culprits are the screens we stare at for as much as 6 hours per day. We humans are lazy, and we'll think of anything to excuse our own choices and behaviors. You included employers, agribusiness, feminisim, cost of living as the reason people can't prepare healthy meals for themselves. Five to Six hours per day scrolling and swiping and maintaining online personae is alot of time however.
I lost over 20% of my body weight and maintained that loss through deliberate choices to change my lifestyle. If I could do it, it can absolutely be done.
6
@Catherine
I'm not saying people can't prepare healthy meals for themselves. I telecommute on my job and prepare 3 healthy meals per day for myself and my wife. However, I don't drive to a job, work long hours there, and then have a commute home. I don't have 3 small children to attend to after work. I don't know any young mothers in paid employment who spend 5-6 hours per day on Facebook and other websites. Do you?
9
A further possible complication. It is not unlikely that relatively stable populations in specific localities may overtime adapt genetically to a particular diet that might
not serve another differently adapted population as well.
This is the first time I've seen the New York Times provide a platform for researchers to announce their work on the day on which it is published. Academics and researchers thrive on citation recognition, and the Times has just given this item a huge boost.
I'd be somewhat less cynical if this had told me shocking new things about diet research. Small sample sizes? Short time frame? Confounding with other effects? Difficulty of controlled randomized trials? We've known all those things for years.
1
Given the complexity of teasing apart dietary data, it makes sense to focus these questions on basic animal research. Certainly our rodent models have yielded significant findings in this area. I think the real problem is that these findings don’t exactly fit with our profit-driven economy, where cheap food makes the most money but yields the worst health outcomes.
1
I think part of the problem is we’ve muddied up the definition of food itself. Is commercially produced bread really bread? Are animal proteins full of antibiotics and hormones really meat?
Honest diets studies would likely show the best diets are very high in vegetables and legumes, low in animal protein and likely low in fruit. Bread is probably ok in moderation if from a natural yeast starter and the fat from cheese is probably good for you. Perhaps equally important is no reason to drink any fluids other than tap water.
What’s the problem with these results? The food industry is designed for the opposite.
4
Don’t forget that there is a huge amount of nonscientific interest in diet and nutrition that nevertheless has an enormous amount of sway on the field.
3
Further research is really irrelevant if you want to be fit and maintain a healthy amount of body fat. Regular, vigorous exercise that combines aerobic and strength building activities is 100% effective in causing good overall fitness. Anyone who embarks on a gradually more intensive exercise program and eats a sensible diet of mainly plant based, whole foods is going to get in shape. If you think a step counter and special diet foods are going to do this for you,think again. The reality is that most out of shape people have developed a very low tolerance for exerting themselves and are prone to overeating. Waiting for that magic diet or special system is just another way of avoiding the issue.
3
@Teal
And proper sleep. Dark room, no screens at night, bright outdoor light in the morning, etc, etc. Exercise, diet and sleep are the 3 pillars of a healthy life.
2
This piece identifies why their recommendation (well funded, rigorously conducted studies) will never happen. It's always, "Follow the money." The drug companies aren't going to get rich over a study that recommends that people eat a variety of healthful foods, in moderate quantities, and that they exercise as well.
3
@RMS of course not. Why would the drug industry fund trials in an area they are not involved in. These would have to be publicly funded trials.
3
@Larry Figdill Undoubtedly. But publicly funded trials are often done in conjunction with private interests - which again goes back to, "Who would benefit?"
I have to agree that research on diet is fraught with confounding realities that make it near impossible to get meaningful results. I don't pay a lot of attention to them for that reason. I have however found a way to lose weight and keep it off that I can live with.
It's my "theory" that much of the problems of being over weight are not so much eating too much but rather eating too often. You don't have to dig too deep to understand that any process in the body is a "use or lose it" situation. By having a constant flow of food energy in the gut, the process of breaking down fat is eliminated. After a while the body "forgets" how to do that and the normal metabolic process is disrupted.
I have been either right at the limit or slightly over weight for most of my life. My job puts me in front of a computer for most of the day. As much as I exercise, my weight doesn't budge.
What has worked for me is what some call "intermittent fasting". Before I had even heard of IF, I made changes to the time and frequency of my eating habits. Other than a cup of coffee, I pushed the time of my breakfast to later and later in the day. I also cut myself off in the evening earlier. During the times that I allow myself to eat, I eat pretty much what I want.
That process evolved until I settled on a regimen of eating my breakfast at about 2pm and cutting off eating at 6-7pm. The result has been a slow but dramatic reduction in weight, 25lbs or so. It works for me.
5
@J.I.M. I have been doing this now for about two months. I love it. I also eat at about 2 pm and stop at about 8:30 at night. The reason this lifestyle works I think is that it shrinks down the eating window in a way that makes it much easier to keep your caloric intake at or slightly below your caloric needs. I was actually surprised by how easy it was to implement....
1
"We continue to lack effective dietary prevention,..."
Actually, we continue to lack effective campaign finance laws; start there.
Until we implement strict campaign finance laws the makers of every gruesome variety of fat, sugar and salt bombs will own every congress person and continue waging war on our health.
6
couple of points, your nutritional needs change as does your life, what worked well in your twenties, does not work as well in your forties. I am approaching sixty have been very athletic my whole life, eat whole foods I prepare myself (mostly). Not only do your needs change , your needs are different then your buddy who is six inches taller weighs the same and works out just as hard. we are all slightly different and require different things, Small differences play out huge on a scale of fifteen to twenty years of life. So everybody is slightly different, and requires a slightly different diet and exercise program, you guess who has to do their own homework.
4
My body has found its weight. I exercise regularly and eat healthfully. Silly online BMI calculators indicated that I'm overweight. I am 55 years old. I have fabulous abs which I keep well-hidden under a generous layer of avocado and flødehavarti cheese. That is all.
19
"Study authors and the media can help by avoiding the tendency to overstate the results of weak research, contributing to public confusion."
I hope your Health reporters are reading this op-ed.
11
I agree totally, the real problem is the only source of funding for something like this is the government, we need large scale, expensive studies like we do with cancer....and is also unlikely to happen. Why? It is like the fact that the federal government has rules against funding studies into gun violence, they are afraid (not without cause) that those studies will show that easy access to guns is a major contributing factor to gun casualties, so they effectively ban the studies.
You would think it would be a slam dunk, almost every researcher into the root cause of diseases and the cost of health care tie a lot of expensive health issues back to diet and nutrition, few outside some flunkies owned by the food industry will tell you that. With the cost of medical care soaring and much of it in things like diabetes, heart disease and cancer, with obesity soaring and making it worse, which costs $$$$$, you would figure they would act.
And they do the opposite, thanks to big business. Farm subsidies go to three grains, soy, corn and wheat, that are helping feed the crisis we see with obesity and health issues, only 2% of subsidies go to produce and fruit and the like. Food industries like Nestle spend millions lobbying congress, and the pharm industry, that make a ton of money out of cancer drugs, heart drugs and the like, see lifestyle diseases as a gold mine. Promoting health eating, making health food cheap, regulating the food industry,would cut profits...qed
6
If you eat and drink ONLY real, whole food, rather than the chemical sludge that largely passes for food and drink nowadays, you will lose weight and reduce your risk for many diseases.
Before you bother responding that many people do eat only real food and are fat anyway, look at pictures of people, and how slim they almost all were, before the chemical waste industry took over our supermarkets and restaurants. Where were all of those people who you are claiming are just “naturally” fat then? Perhaps they all went into hiding just before the photos were taken?
Just stop eating garbage. Whatever it is, if our great grandparents weren’t eating it, we shouldn’t be doing so either.
7
Who needs silly studies! I just eat the same kind of food that President Trump eats. His doctor says he is healthy, and he obviously is, so let's have another round of cheeseburgers ...
But seriously, why is the Dept. of Agriculture in charge of telling us what we should be eating? Maybe the Dept. Commerce would make better recommendations, if not for America's waistlines, then certainly for its corporate bottom lines. I think I would trust a health-centered agency more. Perhaps the NIH? Meanwhile, I think I will stick to my vegan diet rich in fruits and vegetables.
4
In the absence of good, rigorous scientific studies on nutrition, these are the basic food habits my family has been cultivating:
“Eat food. Not too much. Mostly plants.”
“Don’t eat anything that your great-grandmother wouldn’t recognize as food.”
- from Michael Pollan’s book, The Omnivore’s Dilemma.
As the Houston Chronicle elaborates, “...By “food” Pollan means real food, not creations of the food-industrial complex. Real food doesn’t have a long ingredient list, isn’t advertised on TV, and it doesn’t contain stuff like maltodextrin or sodium tripolyphosphate. Real food is things that your great-grandmother (or someone’s great-grandmother) would recognize.”
Words to live by, with indulgences allowed!
11
The China Study and Dr Campbell’s work
demonstrates how to properly do nutritional studies. He’s a model researcher and available for consultation.
3
One of the most basic problems with diet trial methodology is poor experimental design. It is amazing how many published studies of any kind (SPRINT comes immediately to mind) are lacking in well-thought-out procedures and in some ways, even more amazing that the reviewers of the articles don't find the shortcomings. In the nine years I spent being educated to be a physical chemist, how many courses were available in experimental design? None. I guess it is thought that good design is intuitive: it isn't, and this article documents the result of less-than-ideal planning.
4
@David Hughes
Heartily agree with your sentiments. It begins right in elementary school. I watched in horror as kids were ‘fed’ science in kindergarten, by misinformed, well intentioned teachers, and it continued through middle school, only to be ‘rescued’ in high school. The impression I was given was that little children were not capable of processing details. Thanks to books by awesome chemists like Theodore Gray, my 14 year old son is an avid chemistry buff and thoughtful in his experimental designs, all of which are virtual and unrelated to pure chemistry. My fervent hope is that there are many parents like me who will circumvent the current education system to encourage children to learn about chemistry when young. It is the best field to dabble in to understand experimental design.
1
It would be interesting to legislate not what could be sold but what could actually be called "food," based on nutritional value.
8
@Sheri Reda I like the idea but......I guarantee the giant fake food manufacturers would get make sure that their products (Sugar Frosted Flakes, Jello etc.) would be included in the "food" category. All it takes is campaign contributions, lobbyists and a willingness to "make friends" in DC.
The Manhattan project was designed with one goal. To produce atomic weapons from scratch.
We don't need any such thing. We need people to eat moderately and exercise. If you eat fast food and potato chips while drinking beer, you're going to get fat.
If you eat lean meat, moderate amounts of whole grain food, olive oil, lots of fresh vegetables, and some fruit, and then exercise, you're going to lose weight.
There ya go. No charge.
1
Poof.
Now you live in Far Southwest Virginia, on land that you own because it’s been in your family for two generations.
You lost your job as an administrative assistant in 2010, and are living on less than $624/mo for utilities; gas; taxes, etc.
The closest store with consistent stock of fresh fruits and vegetables is over 125 minutes away, in good weather through hollers and over mountains. Winter is coming.
You have two elementary aged children you need to get to school and pick up every day, because when they take the bus-they have to get up at 5:30 am to be able to catch it at 6:20 for the two hour ride to pick up the rest of the riders and get to school.
My point is that, while your diet recipe may be factual, it may not be an option for everyone.
This is part of what those of us who do research on dietary options for rural poor populations attempt to reconcile: we may know what works best in preventing and reversing obesity and its costs, but nothing will work if it can’t be replicated in real environments in which families live and work.
18
@Ernest Montague Except it isn't that simple, as evidenced by the experience of millions of people who follow such trite advice, lose a little weight initially, and then gain it back and then some later.
7
@Ernest Montague whole grains will definitely make you gain weight, along with damaging your intestines and increasing inflammation. And we don't need to eat lean meat. Eat fat. Our bodies need it.
4
Driving though a typical LA suburb last week at dinner time I couldn’t help but notice long lines of both car and foot traffic at the fast food burger palaces. Apparently socio-economics have triumphed over any regard for healthy diet or nutrition.
4
For some reason "organic" appears over and over again in the comments. It's amusing because there is zero evidence to back up the claim that "organic" calories are somehow different from other calories. I think that people are looking for magic in many cases and "organic" just sounds cooler than "processed" to most people. Organic vegetables have never ever been shown to be healthier than those grown in a non organic manner. There's no science here , just fashion.
12
@Ross Salinger
True. And notice that “processed” is never defined. It’s just known to be something bad, like “chemicals”.
5
@Ross Salinger I don't think people are choosing organic because of calories . A calorie is a calorie no matter the type of food source. Most choose organic to avoid pesticides, herbicides, other types of chemicals used in growing non-organic foods.
3
This article pinpoints several problems with modern nutritional science. Indeed, the term "nutritional science" is very nearly an oxymoron. I attended the National Wellness Conference numerous times where the general consensus of opinion seemed to be that, like the weather changing, whatever is being recommended this decade will likely be the opposite by the next decade.
The one nit I would pick with this article is something not explicitly addressed here, but is hinted at. Namely that obesity or overweight is the cause of many illnesses. In fact, every single longitudinal study every published all show the same thing - being "overweight" with a BMI of 25-30 is associated with the best health and longevity. Even 30-35 BMI had better outcomes than the "normal" weight range of 18.5-25. How can that be if weight is the culprit?
I agree Americans have a poor diet, but put the focus on that and don't conflate high weight with poor health.
5
I like it when researchers claim that these studies are so complicated and underfunded that their results are questionable. But that doesn't keep them from recommending something. In this case, the authors tell us that exercise is great, yet exercise studies have the same problems as diet studies. Not to mention their self selective nature.
2
The disagreements in the comments uphold the author's argument. So far, I've read three "simple" solutions: "don't eat carbs", "don't eat sugar", "don't eat GMOs", all from different individuals. The variation amongst people's tried and true convictions about nutrition is exactly what the author pointed at as the 'noise' of diet culture.
5
"Mysteries of of a healthy diet"? There is no mystery to a healthy diet. Eat real food. Eat food grown in a way that does not degrade the environment. Better yet, eat food grown in a way that regenerates the soil. Eat lots of vegetabels. Only eat meat from animals raised in a healthful, humane way (in short, no CAFO). Cook the food yourself. Chopping vegetables and dancing from stove to sink is a subtle form of exercise. Eat in the company of friends and family. Eat with thoughtful pleasure, not guilt. Drink lots of water.
15
@Jackie Kim yes!!
2
@Jackie Kim Yes. I went on Weight Watchers many years ago - and decided immediately that I would not be able to "track points" and follow the other rigamarole the plan demands. So I summarized the plan to myself - eat lots of fruits and vegetables, and pay attention to your portions. Boom. The pounds came off (and have stayed off). (Being on WW on-line helped motivate me by in-putting my weight every week and getting a gold star. Whatever works, right? ;) )
5
The cerebellum is thought to be the part of the brain which governs appetite and attempts to keep us to a target weight (more likely, a target amount of fat). For healthy people, it is remarkably precise: just an extra 100 calories a day (a handful of potato chips) will make you put on 10 pounds in a year (using the rule of thumb that an extra 3600 calories leads to an extra pound of weight). Forty years ago, before the obsesity epidemic, the biological processes which assign a target weight, monitor fat levels, and alter appetite and perhaps desire for exercise worked very well. Today for some reason they are broken.
2
@Mitchell
"Today for some reason they are broken."
Yes, the question now is why, and how to we fix them.
If a small portion of a population were struggling with weight and eating healthily, you could argue individuals are making bad choices. But when a large and growing percentage of the population in many areas is struggling, there is something else going on.
What is different in the food supply, the environment, how governments direct policies related to public health, nutrition, agriculture, what's allowed in our food and what is not?
Everything from reducing recess time for school children, to more and more toxic chemicals in our bodies, HFCS, added salt, stabilizers, flavor enhancers and texturizers in our food products that weren't there 40-50 years ago, fruits and vegetables that are less nutritious due to soil depletion, monoculture, or limited varieties optimized for storage, transport and superficial appearance, along with nutritional guidelines that may have more benefit to businesses than to people.... any one or all of those things could have changed how people's brains/bodies behave.
2
Looking for better clinical trials is not the answer. Variation is just too large. What is needed instead is a method and support for individuals to determine what works for them. Telling folks what works on average is not very helpful except for those that lie on the mean. And which mean? Food that works well for one person may require an Epipen for someone else.
Unfortunately, the means to accomplish effective personalized nutrition doesn't exist. Doctors don't know much in most cases. Food companies pay the dieticians and associations to push their own profit generating agenda. I don't think much will change any time soon.
The single bright spot I see is Virta's program for diabetics.
4
Eating is quite simple. Lots, and wide variety, of fruits and vegetables, limited meat intake, eggs and dairy (if your body tolerates it/you enjoy them). Do your best to eat organic, cut out as much processed food as possible, research where your food comes from. Is this a privileged way of eating? Unfortunately yes. We need to stop focusing on diets and start concerning ourselves with making quality, natural foods available to as many people as possible.
7
The author's criticism of the design of most clinical trials investigating the relationship between diet and health appear to be well taken. Changes in personal behaviors impact mortality and morbidity prospects far more than do technologically impressive advances in medical technology. However, the authors also note that the elements of diet that can affect outcomes are incredibly complex, and that it could take decades before the results of the trial are fully realized.
The healthfulness of Mediterranean diet can be traced to that approach, as can understanding the relationship between exercise and health.
3
@MNF
The last paragraph should read; Natural experiments--applying statistical analysis to historical data-- can provide interim recommendations. The healthfulness of the Mediterranean diet can be traced to that approach, as can understanding the relationship between exercise and health.
2
Thank you, doctors. As someone who has struggled with obesity all my life, having focused primarily on the oversimplifed "calories-in vs. calories-out" approach, I'm encouraged by your article.
The latest research, slim as it may be, confirms what I've suspected for the past twenty years or so: there's a lot more going on in the body besides simple calories-consumed, calories-expended math. And while of course there is an element of "will power" involved in maintaining good weight and good health, it seems the body will do what it wants regardless of the mind wants.
And of course, the mega-food enterprises will continue to push at us whatever they want, and not what we want.
6
@Warbler
Thanks for challenging me on this. I guess I didn't articulate my opinion well. Of course, it's the math. But the point I was trying to make is that the other important factor besides calories in/out is how the body metabolizes the calories consumed. A calorie is a calorie is a calorie, and will always be. But metabolism, which is dependent on genes, age, external factors, is the evasive factor.
1
@Warbler
It actually is more complicated, because the body can do different things with calories that come in. It can burn them as fuel, or it can store them as white fat or brown fat. Brown fat is healthier. Insulin sensitivity or resistance affects how readily the body is able to burn calories. Once the energy metabolism has been deranged, insulin resistance becomes Type 2 diabetes and burning calories becomes more difficult. There are probably other hormones at play as well. What we don't understand yet are the changes at the molecular level that change the body's ability to burn calories vs. store them. For example, bariatric surgery patients often experience remission of Type 2 diabetes even before they have lost significant weight, and we don't yet know why. Nor is the role of the gut biome understood. Everyone knows someone who can eat whatever they want and never gain an ounce, and everyone knows someone who seems like they only have to look at food to gain weight. Why? We have a lot of work to do yet to understand the metabolism.
4
@Macbloom
@Macbloom
Confirmation bias - I love this new term.
Perhaps your own confirmation bias led you to believe I'm looking for a convenient answer. It seems to assume I haven't read many scientific articles. It assumes I haven't done the math over and over through the years, logging caloric consumption and expenditure, only to observe that the same caloric intake / expenditure that resulted in weight loss several years ago does not yield the same results today.
See my reply to Warbler for a further explanation.
Population studies with good epidemiological data already tell much of the story....clinical trials are simply not necessary unless you want to have finely granulated data that reveals possible interactions between controllable variables. But. Whether its Mediterranean groups; the impact of Ramadan (which mimics intermittent fasting); Seventh Day Adventists (who are vegetarians and abstain from alcohol); Rural Japanese from Okinawa, or many others, the results are always similar. Limited serving sizes, physical work, high fiber, lean protein, useful fats (from vegetables or fish), fruit (especially berries) and nuts, and limited amounts of animal fat, if any. Populations which sustain those food practices live healthier, often longer lives. Mimic much of that, if you can. And do it with as much organic produce as possible to avoid pesticides. AND COOK AT HOME!!!!
33
@PeterS
Yes, look at the diets consumed in the NatGeo Blue Zones which includes the Adventist community in Loma Linda California. There is your answer for those who will open their eyes to see.
2
@arusso Indeed, and I think one could add in a meaningful life, including spiritual life, though that is much harder to measure. But that is also the antidote to stress, which is a real killer in so very many ways.
2
...but do we really need a Manhattan Project? We already know what's "good" - lots of produce and unprocessed foods. Not eating a lot of food. I know there's always someone with a special case (the people who say, I eat 1000 calories per day and I'm still overweight!) but for the vast majority of us if you just eat an average 1500-2000 cals/day of plants/unprocessed food, you'll be thin and healthy. The fat vs carb thing is a red herring.
8
It all boils down to one simple action that should be taken everywhere:
Food Education in schools (both nutrition and preparation).
The education of kids to recognize and understand the benefits of a normal/historical human diet versus the processed diet (read sugar and salt) will have personal and communal benefits way into the future. If your mother is of a generation lacking food skills, you will learn it in school (remember home economics?).
This supports the "shop the outside edges of the super market" concept noted by others here. We live by this concept and taught our kids to do the same.
Imagine you child whining at the store for an orange rather than a Twix bar! That would be progress!
1
@Buffalo Fred
Food Education in schools (both nutrition and preparation).
But what would you teach, as far as nutrition? The USDA food pyramid? The new USDA food guidelines? Low carb? Low fat? Intermittent fasting? Eat breakfast like a king, lunch like a prince, dinner like a pauper? Mediterranean diet? Blue zone diets? Counting calories? Locavorism? Omnivorism? Paleo? Vegan? Raw food? We don't have the research and science to say for sure what the 'best' way of eating is. The popular wisdom says a 'balanced' diet with lots of fruits and vegetables and healthy grains, meats, dairy balanced with an active lifestyle is the way to go. But what is the right balance?
THAT is what this article is pointed to: because diet research is thin, we can't definitely answer any of those questions.
4
we can start with what we know with certainty. Given the epidemic of type 2 diabetes and obesity it is clear that low carb diets are effective for both.
Virta Health has effectively treated both with low-carb and high fat diets.
Type 2 diabetes is bankrupting the medical system and finally a way to reverse this which has been treated previously as a lifelong management problem and very expensive. The by-product is weight loss as well.
The science of this approach is confirmed and that would be a good place to start to improve the nation's health and reduce medical costs.
2
Research is thin because it's so difficult to quantify. Are you going to closet thousands of people in a hidden location feeding them measured portions for months? and then follow them for years to come? Probably not.
I'm 69 and I weigh daily. I do my best to stay on a plant-based diet with reasonable portions and cook most of my own food. I don't drink alcohol and limit sugar and simple carbs. None of this, of course, is quantifiable.
If I conscientiously follow this plan, and most of the time fast until noon -- I remain at my high school weight. I suffer from no chronic illness, and I appear 20 years below my real age.
And for the record I am female, 5'4", 110 pounds, and 70 years old.
Why do we need studies that can never be quantified?
3
So we are thinking our declining fitness, increasing weight and the health issues associated with them is a knowledge thing? Why isn't everyone flocking to healthy choices referenced in the essay? It is so easy to be inactive and "sometimes" foods are now part of our daily diet. With a surplus of readily available tasty food influencing "Free Will" is our biggest challenge and opportunity for a solution.
The problem lies in the medical community’s perception of each of us as one being. By this I do not mean spiritual stuff, simply that we are a collective of trillions of organisms, that along with our cells and organs form many complex systems working together. For instance, most popular diets are geared towards losing fat. But fat forms this extensive and powerful endocrine system that wields tremendous control over our bodily functions. To most people’s dismay, one gains back weight simply because, as a system it is quite greedy and protective of the territory it can occupy. So many hormones, causing cravings, shepherding sugars and fats into the adipose kingdom, that we might as well give up losing to it’s cunning strategies to overtake other systems. Fat is protective, fat is harmful. So many inflammatory cycles can be attributed to this one system. But who cares, it is biochemistry that the nutrition industry, doctors and media seems to gloss over. People are impatient.
To understand the complex systems that we are, is impossible. But we can achieve a balance by not hating what is an integral part of us and instead asking this question. Why is one system outdoing the others? Should I tame one system? Should I empower the others to outdo this one system. I don’t have answers, but asking the right questions might be a new beginning.
3
.
More diet details would be helpful, but how much more is needed ?
.
Say if ppL followed, as I mostly do, the Daily Value standards set by the feds for all nutrients,
how would the experts rate that for health benefits ?
.
1
If I eat carbs I gain weight, if I don't eat carbs I lose weight. That's the result of my diet study.
17
If a diet cannot be followed by people who signed up for a trial, doesn't that point to the likelihood it will not be something most people can or will adhere to? And in that case, is it not already a non-starter?
49
My daughter has Waldman’s disease. She can’t process fat or long chain triglycerides. In a keto crazy world we now eat fat free which means more starches to satiate. We found that small meals consumed every 3-4 hours works well. discipline is hard. Not for her thank goodness- I am struggling and gaining with this diet.
5
I agree that dietary intervention trials need improved designs, rigorous methods, and (of course) more funding. But researchers in this field should also avoid the error of defining a trial's outcome in overly simplistic ways. Diet research has too often presumed that weight loss necessarily reflects a change in health status (e.g., functional capacity, mortality) that really counts. Weight change may indicate distinct modifications of mass associated with skeletal muscle, bone, water, and lean organs. It also may indicate a modification in fat tissue. However, fat tissue has numerous functions, many of which contribute positively to successful living. Our fat tissue located under the skin, especially around the thighs and hips, frequently serves us well for energy storage and sequestration of toxic substances. Fat tissue accumulated inside the abdomen, by contrast, tends to represent metabolic threats and a source of inflammatory signals.
Will a weight-loss trial be "successful" if a participant's mass decreases in the lower limbs while it increases inside the belly? Future dietary interventions studying weight change should also report changes in body-tissue distribution. Standardized circumference measurements at the waist and thigh are a good start. A low-cost estimate more specific to internal belly fat may be the abdominal height (sagittal abdominal diameter), that is, how high the belly rises above the table.
1
I sometimes wonder if diet studies — and perhaps even this op-ed? — are not secretly funded by the american food conglomerates to keep people arguing about which diet works best or worst, when the truth is that Americans simply eat too much of everything.
Recently The NY Times showed pictures taken in the city 50 years ago and again today of the same places — look at those images you will be struck by the fact that most of the people in the pictures are thing - not skinny, just thin, normal. Crowd pictures taken back then are the same — thin people were the norm.
What changed? OK: Age Card warning: I am 70, and I distinctly remember that when I was a child candy bars sold for 5 cents, but they were also a lot smaller than the monster bars sold today — perhaps half as big. Maybe times were harder for my family then, but candy bars then were a treat. Now they line the wall of the checkout stand — the self-check area at the local store here is lined, very literally wall-papered, with candy bars of all sorts. If you sneeze one will fall into your bag.
An interesting experiment would be to take 100 Americans, move them to an island, and have them live on a carefully reconstructed diet from 1955. McDonald’s Hamburgers were just those tiny little numbers, a “regular” fries fit into one of those small paper bags, people only ate seasonal fruits and vegetables and most meals were home-cooked.
Some folks were still fat, but it was not the norm, and diabetes 2 was rare.
93
@Charles Trentelman: The BBC did this very entertainingly with multiple diets from multiple eras, and and sample size of two:
https://en.wikipedia.org/wiki/The_Supersizers...
As I recall, the only diet that made them healthier was the WWII Austerity Diet.
1
@gnowxela
I disliked that series, but it did make a point.
I note that the WWII British Rationing scheme contained foods that we discourage today. How many times are we admonished not to eat bacon, corned beef, or foods like Spam? Bacon, corned beef (which HAD to be included in one's ration), and Spam were very much on the menu. So was butter.
What was different? First, many people had jobs which involved a great deal of physical work -- that is not the case today. Second, vegetables were "unlimited", but only when they were seasonally available. One couldn't get imports. Look up "Lord Woolton Pie" -- it is really quite good. I've made it. Fruits like bananas were unavailable. Onions were largely unavailable (they had been mostly imported prior to the War).
The bread changed. People had been accustomed to white, soft bread. Bakeries were required to produce only the "National Loaf", made with wheat with a great deal of the germ and the bran left in. To eaters of whole grains it probably would taste good.
Meat was very limited, but not by weight. It was rationed by limiting it to a certain value There was a points scheme as well. One could buy legumes, grains, and even sweets with one's allocation of points. Many foods were "expensive" point-wise, and that was on purpose.
The end result is a varied, seasonal diet with a limited amount of food, but designed to provide enough calories to live. Today we fear calories and our food. That's not good.
3
The data is "thin" because there is no economic incentive (ie money) for anybody (big food, big pharma, etc.) to do any higher quality trials...period. It is naive to think otherwise....
7
Paging Capt. Obvious....No kidding? It's hard to do dietary trials the same way we do drug trials!? Astonishing! Who'd have guessed. Just more excuses from the scientific/medical establishment, a group more and more under the control of big food and big pharma. Here's something to consider: maybe drugs and food aren't the same, so maybe they shouldn't be studied the same way? And how about this: if you think a study is flawed & the outcome suspect, don't push that bad info on the public as gospel truth (eg, the 1992 Food Pyramid). For more than 100 years doctors have known that strict calorie restriction is not an effective weight loss strategy (see Josten's "Diabetes Mellitus"). And before you quote the "eat less, move more", that's been debunked as well. Exercise has minimal effect on weight loss. Yet the medical establishment & the government persistently repeat that bad advice. And when it leads to failure, it's the patient's fault, clearly. If an antibiotic failed to clear up my ear infection in spite of my having taken it as directed, it would be deemed ineffective. But when scientifically flawed, useless dietary advice doesn't lead to weight loss, the patient is to blame. And we must stop insisting there is one diet that is good for everyone. I understand the appeal of a simple approach, but food is a complex issue & so is human metabolism & real research into both is needed, not scolding and advertising slogans.
5
I didn't see much of anything in this piece about the role food industry lobbying has on the typical American diet. We know the "western diet" leads to obesity and chronic disease, and the basics about what to avoid (too much refined carbs, saturated fats, processed food). But food industries have a vested interest in shaping diet - successfully lobbying for pizza to be considered a vegetable in school lunch programs. Goldfish are "whole grains" (they're not, it's processed food). The public is snookered, and it's not just poorly conducted studies or shoddy reporting. There are active campaigns to confuse people, who will then default to their comfort foods and say scientists don't know what they're doing. Breeding distrust of science is a key step in this lobbying process.
9
Underinvestment in nutrition research will not change as long as Agribusiness and Big Pharma have their way. They would not be able to sell millions of pounds of drugs a year if we were healthy.
Our food system is broken and controlled by big corporations who are interested only in profits not health.
13
Oh, there are a lot of experts out there. After I joined a hiking club, for the first six months my hiking lunch was scrutinized and criticized. I stopped ordering food after the hike, because someone would make some snide comment about the sugar. I'm vegetarian, and many acted as if it were an communicable disease. I was asked where my protein came from, and I said I didn't know, and that is why I was so slow on my 20+ mile hikes that nobody else wanted to do.
I found, however, I had male pattern fat deposition, despite having a normal BMI. What wasn't normal was my waist-height (or waist-hip) ratio, and I was a bit surprised that none of my physicians (and I am one) seemed interested. I then lost and kept off 13 pounds, making my waist-height ratio almost normal.
We need good studies, because what is clear, without needing any p-values or confidence intervals, is that we have gotten more obese as a people. All one has to do is look. In my lifetime, adult obesity has doubled and childhood obesity has tripled. That's why our national life expectancy is declining.
We know far more about the biology of hunger; we have the ability to measure caloric intake and consumption; we have no reason not to study all aspects of diet and activity. It is truly a matter of national security when the military has difficulty filling its ranks because of obesity.
3
@Mike S.
Read up on how we (I'm vegan) obtain protein from plants, nuts, seeds! Empower yourself and others with this knowledge so that you don't find yourself being bullied with the annoying "where do you get your protein?" rhetorical questions. If you're feeling sluggish or slower than others, perhaps you need to ensure you're getting adequate B12 supplements and more of these plant-based protein sources. Bring nuts with you on hikes and incorporate chia seeds into your breakfasts.
Here is your diet research without spending money.
Eliminate Sugar.
That’s it. That’s the key.
6
@Oh My And reduce carbs because carbs turn into sugar. Moderation is key too.
Finally! Some common sense about so-called "research." All that wasted time and money.
2
I now live in Shantou, China (where Flavourful origins filmed season 1). I am obese and finally trying to do something about it... the people in the region are almost 100% thin to skinny and they credit oolong tea (in copious amount of tiny cups)... walking, afternoon naps and food that is freshly prepared with whole ingredients. They eat rice and rice noodles (which I avoid) and high fat... loads of fruit (which seems to have become a no-no on some diets). By the university there are three fruits stands where we can buy cut up fruit (fresh, for a great price). Beef is their speciality ... they enjoy pork and oysters and crabs.
Much of their diet is what we have been told to avoid. So what is the secret? The tea maybe?
1
The secret is they are eating real food and not processed food. They get their sugar from real fruit which also has fiber- so not just pure sugar and they also probably eat sensible portions and walk a lot.
9
@Connie The secret is small portions of real food. Close family ties. Home cooked food with high nutritional value. Mostly transportation by foot bringing unintentional exercise. No time spent languishing in supermarkets, restaurants (fast or otherwise), and squatting in front of the TV. Easy peasy.
2
Thanks much to the authors for pointing out both the breadth and depth of our ignorance about nutrition and highlighting key research questions going forward.
I have been astounded at the rush to embrace studies with obvious methodological limitations, particularly the lack of adequate follow up time.
Finally, the NYT is publishing high quality work and linking to a study that examines nutrition data with rigorous methodology.
What's sad is that this piece only has 28 comments - far fewer than the median number of comments that the report of a half-baked study with an n of 20 and a follow up of three weeks would evoke on these pages if it were endorsing Paleo-, Keto-, CBD- or GOOP related diets.
Also, as an aside to NYT byline writers: health scholars?
Just. Eat. Vegetables. Not complicated.
2
It's no secret: whole foods, greens, limited red meat, limited processed foods, no sugar, no GMO flour for baked goods and bread. No pesticides in our food . We all are encouraged to try to go Organic for most or all food purchases. Big Ag along with chemicals and processed foods does not make a healthy human being, especially as we age.
2
@Beverly Kronquest
There is no evidence that GMO foods are bad for us or that organic is healthier. By “chemicals” I assume you mean synthetic chemicals; of those, some are harmful and some aren’t, just as is the case with naturally occurring chemicals—and just about any chemical can be harmful in large enough quantities, including water. Also, all foods that aren’t eaten raw are processed: cooking is a process; flour-making is a process; baking is a process; fermentation is a process; and so on.
7
I lost 5 lbs easily in a week’s stint up in the mountains as an artist in residence. I couldn’t keep much food in the cabin, I hiked at least 5 miles a day. I enjoyed one big meal in the nearby town and came back with an avocado or something to eat for dinner.
A huge part of this was also being out of my natural habitat, at home with other people who stock the fridge etc. And I was in my 60’s, so shattered the “hard to lose cause of age “ idea.
Did it last ? Of course not, but it was fun while it lasted ! I exercise every day and try to watch it food wise, but it’s hard keeping a frugal food lifestyle in civilization!
1
I lost 55 lbs nearly 50 years ago. Doesn't sound like a lot, but I'm 5'1". And I never gained it back. Lost all of my pregnancy weight in 6 weeks. I've never smoked. I wear the same size clothing I wore when I was 18 years old.
And yet, I never see articles about those who have managed to keep a sizable amount of weight off over many years. Most studies are focused on diets that help one initially lose weight.
Very few people who have lost a lot of weight will keep it off consistently, over many years, without medical intervention (such as bariatric surgery).
How about doing a research study about folks like me, to see what has worked, and what hasn't, in the long run?
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@Orion Clemens You may want to sign up for the National Weight Control Registry. They do studies about folks like you (and me) who have lost weight and kept it off. It's not exceptionally rigorous, but it does generate some data and knowledge.
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@Ben
Thanks for the suggestion!
1
Diets are a multi-million dollar industry, but the reality is unsightly, we are appalled by our weight gain. Factually as humans age, they grow heavier, part of the problem is the chemicals in our bodies no longer perform. At fifty, sixty, seventy and eighty we no longer look or behave as twenty.
1
@Carol "Factually"? Whose facts? I weight the same as I did when I graduated high school in 1962 (165#) in fact my graduation suit still fits perfect. Age does not equal "Heavy". Overeating and sedentary = "Heavy". The research points to exercise as a stimulus for more and more robust mitochondria.
1
This Op-Ed is overdue. High quality nutrition and diet research is importantly underfunded. At the same time, less rigorous, or even essentially opinion based, articles and books on diet and health are published and accepted by the public as scientifically based. The lack of well done diet research has led to serious delay in steering the huge issue of treatment for obesity and other diet related conditions in the right direction. We can do better, and it is not an overstatement to say that our children’s futures depend upon it.
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Unless it turns out as in Woody Allen's "Sleeper" where the character wakes up hundreds of years in the future and finds out the scientists were all wrong and steak and hot fudge sundaes are really health foods, we pretty much already know which foods are most healthy to eat. We may not know exactly how much red meat is safe to eat each week but most experts agree that people should limit intake and replace it with fruits and vegetables. I don't recall any expert who isn't trying to sell something saying that doing so is harmful.
As to weight loss diets, there is only one truth. Any thing that severely restricts intake of foods people enjoy eating are likely to fail. Thus most diet books would only cause you to lose weight in the long term if you stuff the book in your mouth and it prevents you from only eating. The only answer is to reduce overall calorie intake and combine with exercise, which, unless you are into the training regimen of a world class marathoner, will have only a relative minor effect compared with calorie reduction.
7
in the absence of informative data: I am holding a diet trial of one participant, myself. I am doing the intermittent fasting (6:18) most days of the week. If this prevents my typical 8 lb winter weight gain, then its a winner (and an easy one). I look forward to a spring/summer spent not working off that extra weight.
7
The last time I checked the research, only 15% of **all** medical interventions have been investigated according to the so-called "gold-standard" of controlled, well-replicated research.
The foundation of all scientific research involves eliminating as many uncontrollable variables as possible.
This works very well for dead things like rocks and dirt.
There are a fairly sizable number of physicists who don't consider biology to be a real science. There is a much larger group of physicists and biologists who don't consider medicine, neuroscience, or any of the sciences of mind to be "real" science.
As Alan Wallace points out in his "The Taboo of Subjectivity," if you start by eliminating everything subjective in your studies, you may end up with a world no subject would want to live in.
3
The scientific method requires all variables to be identified and controlled for. There is no other way.
2
As a layperson trying to navigate all of this, I am frustrated by the fact that experts - actual MDs or researchers - can come to such opposite conclusions. Dr. A says I have cured innumerable diabetics by putting them on a keto diet; Dr. B says a whole-food plant-based diet has cured all of the diabetics in my office. I have opinions, but I am not a doctor. This article points to what is needed - definitive, long-term studies to clear this stuff up.
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@Josef
The cause of diabetes 2 is well known and has been for a while. People with diabetes 2 produce insulin (unlike diabetes 1 sufferers), diabetes 2 almost overwhelmingly is caused by excess body fat. Body fat interferes with how insulin works and as a result the blood sugar soars. When people lose the body fat the issues go away time and again.
A plant based diet where people lose body fat or a keto one if they lose body fat should have the same results, someone eating a plant based diet that is overloaded with fat and keep their body fat aren't going to see results.
The real questions with keto are long term, which we have no real studies of. Does it truly get rid of body fat (some studies suggest Keto users are losing more water weight and muscle mass than body fat) and more importantly what other health consequences does keto have? People love keto (talking animal protein based keto, there is a plant based version of it) because they seemingly can gorge on things like dairy, cheese, beef and so forth and lose weight and 'get healthy', ignoring they should be eating a balanced diet. Other studies are suggesting that the lowering of LDL people see with keto might be making them more at risk of heart disease (and I say might, because the studies aren't there, coming back to the original point).
3
@music observer I have been on keto almost three years. It’s a myth about the diet being unbalanced. This is a sugar free diet you eat protein and vegetables. Blood work. My HDL is 126 my LDL 100. I had a fluffy LDL test, and I have no heart issues at all even though some doctors would say my LDL is high. There is good LDL and bad LDL. MY LDL is the good fluffy kind. You can ask your doctor for this test, and many doctors don’t even know this test exists.
When I first when on keto my husband thought it was dangerous and thought it extreme until he saw I lost weight, slept better, and health improved. Well since I am the cook, he started eating keto without knowing it and dropped 30 pounds. His health improved, and he looks amazing.
1
@Oh My
You are destroying your arteries, you need to understand that. Your percieved well being is mania or hysteria because what you are eating is destroying your body.
You can lose a bunch of weight on chemotherapy, heroin, and meth also but I do not see anyone recommending these things as a healthy lifestyle.
1
What's missing in the article, and what some commenters have touched upon, is that nature provides all creatures, including humans, with strong dietary clues. I highly recommend the work of Dr. Fred Provenza, who spent his professional career studying how animals choose what they eat. If we understand nature's principles, the details fall into place - and provide sorely missing guidance to nutritional researchers. His latest book, Nourishment: What Animals Can Teach Us about Rediscovering Our Nutritional Wisdom, is a gem:
"Animal scientists have long considered domestic livestock to be too dumb to know how to eat right, but the lifetime research of animal behaviorist Fred Provenza and his colleagues has debunked this myth. Their work shows that when given a choice of natural foods, livestock [and many other animals] have an astoundingly refined palate, nibbling through the day on as many as fifty kinds of grasses, forbs, and shrubs to meet their nutritional needs with remarkable precision.
"In Nourishment Provenza presents his thesis of the wisdom body, a wisdom that links flavor-feedback relationships at a cellular level with biochemically rich foods to meet the body’s nutritional and medicinal needs. Provenza explores the fascinating complexity of these relationships as he raises and answers thought-provoking questions about what we can learn from animals about nutritional wisdom."
5
@ThinkingMatters
The problem with this is people then will assume since they crave Doritos or Taco Bell or White Castles or ice cream that their body must be telling them what to eat. Among other things, we have packaged foods today that are designed to trigger long term cravings not unlike certain drugs cause dependency on them in the brain. More importantly, human beings are subject to bombardments of advertising not to mention societal ideas that somehow eating certain foods elevates who you are, being able to eat meat with every meal, especially people who came from places where meat was associated with being rich, sways what they eat.
I can tell you that having changed the way I eat long term I find that things I once craved no longer as that appealing, and when I eat foods I used to love that have sugar in them, they taste sickenly sweet, it tells you how we get accustomed to it.
5
The article tells us that dietary studies are poor, yet claims, confidently: "Despite their greater difficulties, diet trials receive far less funding than drug trials, especially considering that poor diet is the leading risk factor for premature death." Really? We know this?
7
@Finsq
The answer is yes, we do. We know that diet is a major factor in heart disease (outside smoking), we know that diet is a major factor in cancer, because long term studies of large populations can tell us that, the way they did with smoking. Statistical analysis can factor out other potential causes and come up with correlation and causation ties. With diet, there are places in this world known as 'blue zones' where people live to be very old, and also where they don't have the incidences of heart disease and cancer you see other places. When people from these places move to places with more typical 'western' diets these days, they end up getting cancer and heart disease and the like in large percentages, which tells you it isn't genetic.
The reason for controlled studies is directly correlating things, like for example, how much carbs should someone consume , how much meat, if any, is healthy? Without those kind of studies, you get the misinformation campaigns, like the low fat craze that claims any fat is bad for you, clogs your arteries; it is like the studies that showed niacin reduced LDL so that must mean it helps with heart health..and it doesn't.
2
The two main problems in improving diets are that research in this field is dominated by epidemiologists who typically have a poor understanding of nutritional sciences. Second, with low wages and long working hours in the US, there is little hope that people can spend adequate time preparing healthy meals and dine out in health-conscious restaurants.
10
Agribusiness, packaged "food," and diet advice is extremely profitable, and these industries fund much of the dietary research.
Not surprisingly this leads to things like the low-fat/high carb advice that sold a lot of sugar/wheat/corn/processed foods and books/advice/videos while obesity and related disease increased greatly.
Some of the advice mentioned -- preferring vegetables and fruits to processed high glycemic index products and understanding that consuming dietary fat is essential to good health and maintaining a healthy weight -- has been out there for years from people like Dr. Barry Sears and others, but you wouldn't have known it from what you heard from the government and the food industry.
And there's one other confounding factor: every single person who maintains good health and fitness into middle age and beyond knows what works for them personally, and that can vary greatly. I may feel great eating meat and doing HIIT, while you may feel great going vegan and running 25 miles per week. But you have to figure that out for yourself.
65
The author's points are excellent, and, as some commentators have said, there are additional points. Diet is a difficult area to research. There's also an incentive for researchers who for professional reasons need to publish frequently to release results of tests that not only are poorly designed but based on very small samples.
1
"Few big companies stand to profit directly from dietary treatments for chronic diseases," say the authors.
I'd add to that: Many big companies actually stand to lose profits when people improve their diets in ways that ward off chronic disease-- Big Food, Big Ag, Big Pharma.
As humans, we're constantly making decisions in the face of limited evidence. We weigh the risks of choosing one path over the other--the likelihood, the gravity--and then we hedge our bets. I'm gambling on the unique kingdom that gives us both phytonutrients and fiber: plants.
13
It's interesting that even in this article there is no mention of the fact that each person brings a unique set of genetic makeup to the "research". For several years I lived with another woman who is very thin. Her mother was the same and so it her sibling. She and her sibling eat very different diets. I outweigh her by 40 pounds and probably eat quite a bit less overall. My weakness is sugar and hers is salt. I've often thought that we might make progress if we'd quit looking at obesity as a behavioral problem. Even researchers and doctors still blame the person. It's the only remaining bigotry that is acceptable. If we studied people who never gain weight no matter what they eat we might begin to understand why the opposite is also true.
42
There are studies in place right now at leading Universities about just this and how gene sequencing can alter the weight gain/loss. You also must remember that 2 sisters have one mother but also one father and both have ancestors that add to their gene pool making sisters different in this way.
4
@SAW sugar spikes your insulin and leads directly to fat storage, even in small quantities. You can confidently chalk the discrepancy up to that known fact.
1
@SAW
What you say is true, studies of identical twins show they react differently to different kinds of food elements, one person eats a couple of candy bars and their blood sugar moves slowly, another person looks at sugar and their blood sugar spikes.
And while I am sympathetic to issues with people who are obese and we need to figure out what causes obesity and how to treat it . Obesity is directly tied to a number of issues like heart disease and cancer and diabetes, and the idea of being obsese and healthy doesn't pan out, isolating other factors (like for example, smoking rates for whatever reasons tend to be higher among people who are obsese, likely socio-economic), the correlations and causation has been shown.
And while there are people who are genetically prone to being obese, statistics show that few people fall into this category. 45 years ago 15% of the population was obese, today it is 40% and growing, especially among kids. If it were genetics, this should not have changed, but it did, and not coincidentally, this trend happened along with the rise of people eating packaged and processed food and fast food as an increasing portion of the diet.
And yes, doctors still shame people who are overweight, they still come up with the old, tired "want to lose weight, push the plate away" crap that people love to say to those who are overweight....but the answer is likely in figuring out why people are obese and changing those factors.
4
Before carefully designed clinical trials can be performed, researchers need to clear up their deep cultural and learned biases and ignorance. They need to study people's eating habits across the globe, traditional and contemporary diets. They also need to understand all the edible compounds that are available to us; to understand how nutrition is impacted by how agriculture is practiced: so that we understand for example what is different between pasture raised animal meat versus CAFO animal meat, Wild fish from farm raised fish. And then on the micro level to understand that not all fats are the same and are not digested in the same way, and that some fats are not digested in the same way as carbohydrates and so on. Until these things are understood and questions are posed that don't rest on ignorant assumptions about food, metabolism, cuisine and culture, then the studies will remain flawed.
13
@NS
Most of what you are talking about has been done, diets have been studied extensively (in terms of what people eat). They also have analyzed the differences between feed lot raised animals and wild raised animals, they look at the kind of fats the animal has, its chemical composition, they look at the protein level, they also look for other chemicals that are known carcinogens as well. Studies have gotten to the point where they look at what happens when various foods are digested and what gut bacteria do with it.
The big problem is that the science behind this has not been used to create large scale, controlled studies that are needed to confirm what the causative agents are. Dr. Valter Longo at USC has done ground breaking studies on longevity and diet and on optimal diet and fasting working with animals. Among other things, his work seems to indicate that when it comes to cancer, fasting can significantly improve results of things like chemo and radiation therapy...but controlled studies are needed to see if this fully plays out with human beings. A lot of the science is there, but it is fragmented, it needs to be put together into controlled tests/studies to validate what really works.
Here, here. Let me talk about what happens because of the dearth of sound scientific information. Many, maybe millions of people who are desperate to lose weight and improve their health, are getting little guidance from medical practitioners beyond the old, "Eat less and exercise more". Many say "go low fat and count calories"... this has been the standard advice for decades, but which has miserably failed to stop the obesity epidemic and may have fueled it.
So what are people do? They turn to self help groups and gurus. They feel groups like the AHA and AMA are corrupted by special interests. So, many have turned to the latest and biggest dietary movement which is all about going low carb, no sugar and higher fat. Some doctors are on board for this, but mostly this way of eating is promoted via social media groups. Hundreds of thousands swear this way of eating is the only thing that's really worked for them. There are many, many claimed success stories. Adherents say that for the first time in their lives, they're losing weight successfully and keeping it off. But we can't escape what's lacking behind these stories is sound, verified research done under well designed and controlled studies to confirm or disprove. This must change.
28
@MimiB
Check out The Big Fat Surprise by Nina Teichholz. A very well-researched book on the origins of low-fat diet mythology. There is a good deal of nutritional research behind this that isn't well-known due, at least in part, to bias and politics in the scientific research community (which happens in many fields).
6
@ThinkingMatters
I wouldn't be so careful to rule out low fat diets, the real problem is the kind of fats. Dean Ornish has shown pretty effectively and others have similar results that a plant based diet that is relatively low in fat can help reverse severe heart disease. Dr. Ornish has moved away from the idea that all fat is bad, he has recognized that things like nuts and avocados can be healty, but in limited amounts. I haven't read 'the big fat surprise', but I wouldn't be surprised if it was someone promoting the Keto diet and saying "see, they proved animal fats are not harmful for you, you can eat a high fat/low carb diet and be healthy", and that isn't true, either (the gurus selling this know that people love being told that they can eat a ton of what they love with no consequences).
1
Thank you for raising awareness about the state of nutrition research. How can we get Congress and our national politicians to pay attention? They argue endlessly about payment approaches (M4A, private insurance status quo, etc.) that offer little promise to reduce the actual cost of healthcare vs. shifting how it gets paid for. Effective nutrition research leading to a significant reduction in obesity and T2 diabetes would save hundreds of billions in actual spending and improve the quality of life for millions.
4
It is populated by spectacular failures because most studies seem to be chasing the elusive faeries of the past century. We know what works - eating fewer calories [calories in] and expending more calories [calories out] and 'viola' - you lose weight.
For some bizarre reason we want to invest the elusive calories with faerie-like characteristics - we create magical calories - calories with wristwatches that know the time of day - calories that know where they came from and with family histories... and so on.
To lose weight you need to consume fewer calories or in layman's terms eat less - period.
"It would be like studying an intensive exercise program" - absent actually getting your test subjects to - you know - intensively exercise.
12
@SteveRR Yes, the first Law of Thermodynamics always holds. It is likely true that different diets promote or hinder the amount of calories that one digests, but ultimately
one must expend more energy than one consumes to lose weight.
6
@SteveRR
It is not that simple. Factors that influence metabolic rate can effect weight outcomes. The rate at which calories become avialable, and how quickly they run out, are also important. And total weight is not the only issue in designing a healthy diet. Indigestable fibers promote anaerobic bacteria in the gut, which reduce the risk of infectious disease, for example.
32
“faerie”, “viola”.
It is unclear that all calories are equal. Calories marked on food items are thermodynamic calories, not how much of it the body absorbs at what rate, and sheds little light on how hungry or full they make one feel (affecting future calorie consumption).
51