Expert Dietary Guidance: Gasoline on a Fire?

Let’s ignore, for expediency sake, electrical fires. They are a case apart, an exception to the prevailing rules. Much the same is true for highly prescriptive, condition-specific diets, such as low protein intake for kidney failure, or a ketogenic diet for control of intractable seizures. There are always exceptions, but they don’t obviate the rules.

The rules of fire fighting, as they relate to the fires most people encounter most of the time, are pretty clear. Drowning such fires is generally a good idea. Foam from an extinguisher might be ideal, but water is reliably good. So say the rules.

Espousing such rules, any given expert might say: if your foot, or potato, or box of tissues catches on fire, aim a hose, spray some water, and put it out. Maybe you didn't really even need “expert” advice to know this. Arguably, the same could be said for eating more vegetables.

In any event, that’s the expert advice. It’s not very controversial. It’s not even provocative. It is, however, correct.

It just so happens, however, that your circumstances are conducive to garbling the message. For example, you may be pumping gas when the memo comes in, and all you really hear is: aim hose, spray. You think: I’ve got a hose, I can do that!

Or, maybe, Exxon-Mobil intercepts the message before you ever get it, and converts it to: “aim hose, put out fire!” They don’t specify a gasoline hose, but the image accompanying the pithy advice shows exactly that. Let’s call it subliminal misdirection.

So, your potato does catch fire, you spray gasoline instead of water on it, and your house burns down. No, Virginia, you don’t get to blame the charred ruins on the expert advice!

I am not aware of this problem in fire fighting; but it is just the problem we have in using diet to fight chronic disease, control weight, or promote health. It is just the problem we have with expert dietary advice, and the absurd volumes of generally self-serving noise about all the ways it has gone wrong.

No, Americans are not fatter and sicker because we followed flawed expert advice. I am not saying there were no flaws in expert advice; there were, are, and always will be. Humans don’t do perfection; not in nutrition, or any other realm. There are always flaws. But all that means is we can’t let unattainable “perfect” become the enemy of attainable “good,” and in the hands of the pragmatically prudent, it doesn’t.

What I am saying is: we are fatter and sicker not because of those inevitable flaws in expert advice, but because we NEVER followed expert advice, not any flavor of it, in the first place.

Given the intensity of misguided criticism at this particular juncture, in the immediate aftermath of the Dietary Guidelines release, I will repeat that: Americans NEVER followed expert dietary advice in the first place. Period.

For all the clamor about the harm done by “low fat” advice, the bracing reality could not be further removed. Those populations around the world with genuinely “low fat” diets that are, more importantly, comprised of wholesome foods in sensible combinations- count among the world’s healthiest, longest-lived peoples. This is by no means evidence that diets NEED to be low in fat to produce both longevity and vitality, but it certainly IS evidence that a diet that is optimal in its composition and happens to be low in total fat can be among the means to just those enviable ends.

Advice to lower fat intake in the U.S., flawed though the advice may have been, could have led us to a Blue Zone. Instead, it led us to Snackwells. And to reiterate bluntly a point I’ve made before: no nutrition expert EVER said: “just eat Snackwells, and everything will be fine.” Snackwells, of course, are a convenient flag-bearer; they stand for every variation on the theme of low-fat junk food.

No expert ever said it; but that’s what we did. That’s what we did because we heard what we wanted to hear. It’s what we did because Big Food got in the game, and manipulated us. Whatever the reasons, the historical record is clear: we garbled the message.

It’s even worse than that. For the most part, we didn’t even REPLACE questionable, high-fat foods with at-least-as-questionable low-fat foods. The national trend data suggest that our intake of fat stayed pretty constant; even our intake of saturated fat, about which even more silly noise is being made, stayed about the same. What did we do? We ADDED tasty low-fat junk foods to everything we were already eating.

Imagining you could find a nutrition expert benighted enough to have thought that substituting low-fat junk for high-fat anything could confer advantages, and I think you would have trouble finding one, we’ve just raised the bar. You now need to find a nutrition expert with their head so far…well, never mind…that they thought merely ADDING low-fat junk without reducing anything would magically produce vitality and weight loss. They will be riding a unicorn.

Failing to find any such expert, because they are fictional beings, we come to the main point. The noise being made about egregiously flawed, expert dietary guidance has nothing whatever to do with expert dietary guidance. In some cases, as with my own response to the 2015 Dietary Guidelines for Americans, it’s about what politicians have done with the reliable work of scientists. In most cases, it’s about someone encumbered by ulterior motives, a deficiency of relevant expertise in their own right, or both, misconstruing the results of what we have DONE for the results of what was ever recommended. They are as different as water and gasoline.

Before wrapping up, I need to note that this is by no means limited to advice about cutting dietary fat, or saturated fat. It pertains just as much to all other expert advice, addressing gluten, fructose, meat, carbs, and so on. When Atkins made his meteoric rise, he was advising people to eat less carbohydrate foods, not to eat LOW carbohydrate brownies; those hadn’t been invented yet. They were, in short order, to exploit the popularity of his message- just as the Snackwell inventory was invented to exploit the popularity of Keys, Castelli, and later on, Ornish and others. This is not a partisan concern; it’s not limited to any given dietary faith. It’s generic: we never, as a population, followed with fidelity ANY “expert” dietary advice. We translated it all into gibberish and new varieties of junk food.

Those feeding on it now to propagate messages about meat, butter, and cheese; or saturated fat; or the irrelevance of calories, are doing us all a disservice. They are, intentionally or otherwise, propagating the great diet fallacy of the past half-century.

They are blaming bad expert advice no one ever followed for the mess in which we find ourselves.

The flaws in genuinely expert advice about diet are analogous to: this hose versus that hose; this water pressure, versus that. Spraying gasoline instead of water is a problem at a different level altogether. That’s the problem we have, and need to contemplate- by the light of the glowing embers that used to be our house.

-fin

David L. Katz, MD, MPH, FACPM, FACP, FACLM

Director, Yale University Prevention Research Center; Griffin Hospital
President, American College of Lifestyle Medicine

Founder, The True Health Initiative

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