Navigating your way through nutrition wars

Imagine that you observe a conversation between a few knowledgeable folks discussing their views on hot nutrition topics. They are professionally involved in these matters; they are researchers, clinicians, doctors, professors, influential bloggers, published authors etc. You start reading their exchange in hope to pick up nuggets of wisdom to apply to your own situation. Things start out cordially, and you look forward to gaining valuable insights. All goes well until one of those points of contention comes up. If you ever observed such an exchange, you’ll identify them easily. How much protein? Is there such thing as too much fat? Do calories matter? Is there metabolic advantage to fat vs. carbohydrates? Dietary guidelines… cholesterol…  OK, the list itself can go on forever. You got the idea.

(Image courtesy of Jack Moreh)

Next thing you know, cordial exchange turns into duel. Probably relatively polite at first, with some sarcasm sprinkled throughout. Then irritation takes over and mutual accusations fly. Lines of divide are drawn, audience breaks by two camps which add their comments, likes and memes. Both sides start lobbing links and charts at each other, proving their points and debunking those of opponents. If you observed this kind of exchange, what you are going to realize at this point is:

1. You’ve seen it before. This same exchange, with insignificant variations.
2. You’ve seen it many times.
3. Charts and links cited by both sides in support of their arguments are all familiar. Each and every exchange on this topic repeats them over and over.
4. No one ever changed their opinions as a result of an argument of this kind. This is not an exchange of valuable information; this is a battle in which both sides defend their precious beliefs amounting to religion. CICO folks will throw grenades at CIH folks, and vice versa. Each side will deploy all kinds of tactics intended to win an argument; straw men, red herrings, misquotes, quotes out of the context, distortion of the opponent’s words, data cherry-picking, and when patience wears thin – primitive insults.
5. You are not going to learn anything from this shootout, not any more than you learned from all the previous ones.

This last point is the most frustrating, if you are simply looking for help in solving your practical problems. You, unlike them, are not invested in any particular theory. You, unlike them, don’t get paid for confirming or debunking any of the theories. Your well-being, unlike theirs, is not affected by the victory or a loss of this or that hypothesis. Your interest is only your own health, and shouldn’t you be able to count on these good folks’ help with your problems? After all, this is their profession, and this is what they presumable set out to do when elected it. Yet you have distinctive feeling (and rightly so) that in all this back and forth you and your problem matter very little. And so you are left with this nagging question: how on earth are you supposed to chart your course if these pros can’t agree on anything? After all, status quo doesn’t work for you – you are not slim, fit and healthy (or you wouldn’t be even interested in these topics). Most astonishingly, nor is entire population of the continent – yet so many professionals refuse to admit that there is a problem with their “evidence-based approach,” opting to put blame on YOU instead; It’s you who doesn’t follow their recommendations, you see. Never mind that you honestly tried to keep low fat diet. Never mind hours wasted in gym. And let’s not even mention that if the whole population can’t follow the guidelines, then the guidelines must not be very realistic – that is if we even assume that they are not erroneous.

This part is what shocks me the most. I mean, can’t they see that their theories have very little to do with real life experiences? How can they ignore this glaring fact? The whole colossal failure that the diet paradigm is should have had the doctors up on arms – yet they continue protecting status quo. Granted, with some notable exceptions that dare going against the mainstream. I wish there were more of them, but hopefully the tide is turning – their numbers grow. But I digress.

I had a very interesting exchange recently that I want to share with you, as much as possible considering that my counterpart did not explicitly agree to be named outside of the group where the exchange took place. Neither did he object when I asked, but I’ll err on a side of caution and courtesy. I’ll just mention that he is a notable name in academic research field in one of the leading European universities, with decades of studies and countless publications under his belt. The conversation that got my attention included a few folks questioning his traditional dietary approach and his defense of it. Very staunch defense. Seeing stubborn refusal to acknowledge any problem with current mainstream position and rather arrogant lecturing tone, I became really interested in this phenomenon, and wanted to try and find out as much as I could about this stance.

Before we get to the conversation itself, I’d like to pause for a second and remind about some earlier posts where we touched on the theme of nutrition wars, entrenched positions and stubborn defensiveness when faced with opposing views. I believe they’ll provide useful background:

Calories, Macros and Weight Loss

Zealotry in Nutrition

When can you believe the studies?

All caught up? On to the conversation itself.

Vadym Graifer: Dr. XYZ, reading through this exchange, I want to ask you an honest question. First, background from which the question originates. I am a pragmatist and empiricist who got dragged into nutrition-related topic, as many others did, by weight and health problems. Many years of trying various approaches finally took me to a solution: combo of low carb, fermented foods and intermittent fasting. 95 pounds lost, diabetes reversed, other related health problems solved, in maintenance and in the best shape of my life. With that, to the question itself:

As a researcher in this field, doesn’t it bother you that so many people (I’d like to say overwhelming majority) can’t relate to and benefit from recommendations originating from a mainstream research? Don’t you find it worrisome that so many find the solution to their problems doing something other, and often directly opposite, than what you guys recommend? Do you have a feel sometimes that your field became rigidly defended by people who got entrenched in their paradigm and reject any flexibility in their views, public good be damned?

As I rewrite and re-tweak a blog post sharing my experience in navigating murky waters of confusing research in highly specialized field, I’d appreciate your “view from other side of the fence,” so to speak.

Dr. XYZ:  Thank you for asking. To give some background, you can look me up on the *** website. My background is in clinical and public health nutrition and I’m not a dietitian, but I am fascinated by the phenomenon you describe and that is why I’m engaging with this thread.
You seem to have found your own path after trying and failing with other conventional approaches, perhaps through dietetic help. The end result is that you have lost a lot of weight and feel tons better. I’m not surprised, because that is the desired end goal through weight loss. How you got there is fascinating (Can’t get rid of impression it was an academic for “freaky” – V.G.). It clearly works for you.
On this Facebook thread are several people who have made a similar journey and these are the folk I have been engaging with to try and understand the phenomenon.
Whereas in clinical nutrition, we have worked hard to improve nutrition support through the application of scientific research, clinical trials and improvements in practice, it is basically to a captive audience of patients. It doesn’t work so well in the community because there is little control over what people eat, how they live their lives or how they remain motivated to improve their nutrition given the limited help of clinicians and dietitians (See how we move in direction of blaming the patients? – V.G). The food industry is very often profoundly unhelpful because it marches to a commercial drum and has a brilliant supply chain which means that if I want a fresh salt beef sandwich at 3 in the morning in London, I can just go out and buy it. Whether it is good food is quite another matter!
Now to my “bother” and my observations from this side of the fence. The ketogenic diet movement and other diet movements are plagued by folk who push rubbish science in support of their claims. It is very poor stuff in relation to the quality of what pertains in the field of clinical nutrition. The evidence base is often very anecdotal and remains unpublished as a coherent scientific narrative. When I have engaged to ask simple questions I’m often roundly abused for my pains. I’m told that “testimony” trumps science (which is considered flawed, venal, corrupt etc.) and that I don’t know what I’m talking about and other more ad hominem stuff. There are also an awful lot of very angry people who do not trust people like me, any further than they can throw me. They feel let down by nutrition science, doctors, dietitians and government guidelines which don’t seem to help. I’m not surprised because guidelines are guidelines, not “how to do it guides”. You can observe this process at play in this thread quite clearly.

It reminds me of the current enthusiasm for FODMAPS in treatment of IBS except in one respect. There, I can have a civil discussion of the evidence but in this arena it is all rather sweaty and rude. I know that I can be annoying but really, do people have to be this rude?
1. “get the f*ck off my page. You don’t know that the f*ck you are talking about.”
2. “He represents the academia I left as you can see for good reason. I have no intention to return and become dummified.”

So I’m bothered because the science is poor and “positive studies” cannot be questioned objectively, it seems to me. I’m also bothered because the “Keto Movement/Revolution” is carrying all before it, eating clinical professionals alive and on the basis of some really dodgy polemic and data. (Once again notice how what bothers good doctor turned from the problem with their research to problem with those who lost hope and started fixing things themselves? How dare they, without our credentials and not having published their work! – V.G.) Medicine has not been clean in its relationship with pharmacotherapy so there is good reason for complaint but honestly, do two wrongs make a right? I can think of no academic nutritionist who regards the “Keto Movement” in a good light and for similar reasons to mine. Having said that, if you were to seek help from a dietitian or nutrition-knowledgeable doctor and told them that you were following the keto diet and fermented food, they would most probably be glad to work with you to help improve where necessary (Sorry doc, but many found very different reception from their health practitioners, ranging from reprimands to refusal to treat them any further – V.G.). I know several academic nutritionists who are using or investigating KD in different settings and in an orderly way, a process which should lead lead, we hope, to better evidence-based treatments.
There we are. You asked me politely for my opinion and I’ve given it. I hope it helps in fostering understanding.

Vadym Graifer:  thank you for taking time to construct thoughtful reply. You don’t have to recruit me into “let’s be civil” numbers as the poisonous tone in these exchanges is one of biggest turn-offs for me, no matter which side deploys it. I also appreciate that you understand where the anger comes from; in most cases it’s directed toward those who insist on dismissing peoples’ findings as “anecdotes.” Mind you, when communities (I use the term loosely) of thousands and thousands improve their health going against what “official science” recommends, and are repeatedly told that they don’t understand… well, what do you expect them to do, go against their observations and experiences? BTW, to elaborate: I am not exactly keto, just a low carb. I am far from overly strict in food composition or fasting protocols, rather on a “gentle” side of things. The only strict line I keep is no junk food or engineered concoctions – real food only.

If I may, I’d like to drill a tad more on this:
Seeing this divergence between what you good folks research, find and report on, and what “revolting masses” do and report on, do you feel that at some point youi’d better stop debating them and telling them their science is flawed, and use your formidable resources and knowledge to find out what it is that heals them? Help them put the science together, so both sides would benefit? Wouldn’t it do a lot of good for public, for them and for you? After all, you can’t possibly deny the results many of them (us) achieve by doing what many of you don’t recommend to do?

Dr XYZ: Vadym Graifer thank you for those polite and thoughtful comments. My ability to change things in this arena is very limited. I will ponder what you have told me.

In a few hours after this exchange doctor withdrew from the group where the exchange took place. I am not holding my breath to say honestly.

Unfortunately, this attitude is not a rarity. I see it everywhere in scientific community. In other comments, this same doctor lectured his opponents about lack of published papers – even though it’s almost a common knowledge now that his colleagues actually prevent contradictory research from being published. When told about it, doctor demanded evidence, which was promptly provided. Taking an offense at the term “gatekeepers,” doctor stopped this line of conversation. See the pattern?…

It really amazes me that those who are supposed to get intrigued by new and effective ways to solve the diabesity problem get irritated by them. Instead of studying the phenomena and researching it, they dismiss it and attempt to relegate it to the status of pseudo-science. I am not naive, I perfectly understand where this attitude is coming from. Everything they taught and preached is being threatened.  Their career was built on that, their reputation depends it remaining true. They will defend it to the bitter end. You could see it in the parting words of the good doctor: “Calorie is a calorie. Any diet will be slimming or fattening depending on energy deficit or excess.” Ugh.

So, back to our dilemma. If you are trying to chart your own course, how helpful exchanges between warring sides are and how to use them constructively? They can help you structure your steps. You can define various approaches, read up on personal experiences and try to determine what helps folks with circumstances similar to yours.  There is an awful lot of collective experience amassed by now that is being shared between those who, for the first time in their life, managed to stop their relentless weight gain and related diseases and reverse them. It’s not always easy to untangle – the task of separating sound advice from drivel is far from trivial. And yet, it’s doable. Seek out doctors that went against mainstream. Don’t trust them blindly either. It’s your health – be smart and careful, verify what you read by comparing to other experiences, start slowly, move step by step and observe how things work for you. Get a feel that you are on your own? Don’t let it frustrate you, take it as an exciting prospect of becoming a master of your own health. Many made this journey, so can you. It’s exciting and rewarding.