Saturated Fat is Not Bad for You and Cholesterol Doesn’t Cause Heart Disease: An Exemplary Case for More Humility and Open-mindedness in Health-Related Research

It is very difficult for us human beings to admit we are wrong. We live in a culture that focuses on individual ego. The “health industry” is saturated (pun intended) with loud, dogmatic celebrity doctors and nutrition experts, who live in a world of absolutes and extremes. Unfortunately, nutrition is not a science of absolutes. The complexity and variability of the human response to nutrition lends itself more to humility and introspection than celebrity and pontification. How does this relate to the falsity of the lipid hypothesis (i.e that saturated animal fats elevate blood cholesterol levels, which in turn causes heart disease)? This hypothesis has been perpetuated by those who have stubbornly adhered to and benefited from these false principles and refused to consider alternative theories largely to avoid admitting they were wrong.
The questionable and fairly unscientific development of the lipid hypothesis has been well chronicled in many works such as Gary Taube’s Good Calories, Bad Calories, Tom Naughton’s documentary Fathead, and numerous peer-reviewed publications. The body of literature discrediting this hypothesis, and supporting the health benefits of a high-fat, low-carbohydrate diet (even with high cholesterol intake) is now substantial (1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12). A growing number of individuals (nutrition experts, medical doctors, health professionals, and educated “lay” people) have rejected the low-fat, high-carbohydrate nutritional advice. Yet, this hypothesis continues to drive national health recommendations, clinical practice, and public health policies. The purpose of this writing is not to repeat the science demonstrating that the current hypothesis is wrong, that information is readily available in other places, such as the references I’ve cited. Instead, the purpose is to point out the ridiculousness of the situation. The whole argument is like a petty spat between you and your spouse or significant other. At some critical and terrifying point during the argument, you realize you were wrong, and worse yet, your partner has proof of it. You can’t give in and admit you were wrong. What then? Would you be discredited in every former and future argument? Would you appear inferior?
The important point is not that everyone should eat a low-carbohydrate, high-fat diet, and that in-turn low-fat, high-carbohydrate diets should be demonized. The point is that A LOT of people would benefit greatly from an alternative diet to that recommended by the USDA, AHA, and ADA, yet they are denied this option because prominent individuals in the medical and scientific communities refuse to accept change and admit defeat. As educators, clinicians, practitioners, and scientists, we need to be able to admit we are wrong. Personally, we need to have the humility and open-mindedness to accept challenging viewpoints. As a society and discipline, we need to be less critical of those who change their mind on a topic or admit they are unsure. This is a sign of intelligence, not stupidity.

The Expanding Pie

The theory of the expanding pie comes from the business world, and describes a shift in the mindset about how negotiations are made. In a nutshell, the theory states that instead of fighting over a small, single pie (a situation in which as one person gets more, the other person must receive less), both parties should work together to create a bigger pie (now there is room for everyone to be satisfied). This mentality fosters a less competitive and more collaborative approach. The first time I was introduced to this topic was in the context of dance during a conversation about the meaningfulness of each artist’s contribution to the whole. Lately, I’ve been thinking a lot about how this theory relates to nutritional science. This is kind of what the nutritional science pie looks like right now:

 

As with many things- politics, sports, religion- we feel the need to categorize and become a partisan supporter of one “camp” or way of thinking. This has become alarmingly true in nutrition. The competition between nutritional “camps” means that as one exerts its superiority, the others must be crowded out and discredited. As those who support the USDA Guidelines exert their superiority, the influence and incorporation of other nutritional theories into the clinical and public health spheres must be demoted. Here’s what the pie could look like if we adopted less of a war mindset towards nutritional science:

The pie now becomes an ever-expanding pie that supports and gives equal opportunity to new information and alternative theories. The human species demonstrates great genetic and phenotypic variability, and because of this demands an individualized approach to nutritional design (as discussed in previous blog posts). An expanding pie model can facilitate such individualization because it provides a greater number of tools (dietary theories) to meet the needs of an individual. Although I have my own personal dietary preferences and ideas on the optimal human diet, I wonder if fighting for one diet against other diets is the right approach. Instead, perhaps a more inclusive approach to nutritional science might better meet the varied needs of the human species.

Individualized Nutrition: The (Distant) Future of Nutrition

One of the ways I like to present material in my nutrition courses is through what I term “question-based learning”.  I apologize to all my colleagues who are experts in pedagogy, I’m sure there is a more accurate description for this teaching method, and I’m also sure I didn’t invent it.  Anyway, I will pose a question to the class and allow for individual thought, then small group discussion, followed by a class-wide discussion in effort to come to some reasonable response to the question.  Let’s give it a whirl…

Is there one dietary pattern that would suit the needs of all people?

At this point I would mention to the class that they must be able to justify their answer; although this is a closed question, the answer must be grounded in something.  The good part about being in a classroom is that we all learn from each other due to the dialogue.  My greatest hope with this blog is that it would inspire you to have these discussions with others.  Here are my thoughts on this question.

The answer is clearly no.  First of all, food is a key part of culture, and there are so many cultural backgrounds in the United States that there are bound to be many different suitable dietary patterns.  People also have different preferences and take different medications, both of which influence dietary needs.  Furthermore, you easily find two people who have a similar dietary pattern, one with numerous co-morbidities and the other living complication-free into their 90s.  If you looked at all people in their 90s, I also doubt that they all ate about the same thing for the previous nine decades.  I had a great discussion with a man – Springfield College alum – who is 94.  He asked me, “so, what should I eat”?  I told him “I think you’ve figured it out”.

Next point: “suit the needs” is vague; does this mean maintaining a certain body weight?  Reducing cancer risk?  Moderating blood pressure, cholesterol, or inflammation?  Performing well at a sport?  Each of these situations might have a different outcome with the same dietary pattern.

Another reason I say “no” to this question is that our dietary needs probably change over time.  So, whereas a certain pattern might serve us well in adolescence, the same pattern might become inadequate, or not-ideal later in life.

So, I’m sure some of you are getting frustrated that I have simply created a straw-man here and am just spouting off to have a reason to avoid grading essays.  Not so!  It is important because the answer to this question affects the vantage-point from which we approach nutrition.  If the answer to this question is clearly “NO”, then why are we continuing to place our money and resources toward creating more blanket recommendations?  Is it the best use of time and money for the USDA to continue with the Dietary Guidelines for Americans in the current format?  The same question could be asked of many major organizations.

I think we are at the point where we need a better approach. Even if we all agree that there is no “perfect diet” for all people, that still leaves people to say “ok, then what should I do?”.  Though trial and error might be the only reasonable approach, this is easier said than done for most people.

Picture this: you walk in to your primary care physician’s office, provide a small blood sample, and within a short period of time you are presented with a detailed outline about the dietary pattern that best suits you.  I am aware that some systems like this are in existence.  But do we really have reasonable accuracy with this method?  Do we have definitive research about the long-term outcomes RESULTING FROM a dietary pattern (notice the all-caps; not “associated with”, RESULTING FROM)?

As nutritional scientists, we owe it to the public to do better.  We owe it to the public to use our resources in the best way we can to confront the issues we are here to confront.  Is it going to be a simple blood test?  Is it an algorithm? Maybe we just don’t have the information or technology we need at this time to provide individualized nutrition – but we should at least make that clear.  The point is, we need to make progress toward the end of individualized nutrition.  Maybe providing individualized nutrition with reasonable accuracy will never be possible; but I am certainly not willing to continue walking down the dead-end road that is blanket nutrition.

Nutritional Problem Solvers: Explanation and Justification

Hello from Springfield College and welcome to the nutritional sciences blog.  We recently announced the launch of our nutritional science program , and have gotten a great response!  We will be welcoming our first class of students starting in the fall of 2013.  This program is an outstanding fit at the College; it dovetails perfectly with our mission, and with our current academic programs.  Importantly, the program comes at an important time in America – a time where the focus on nutrition is greater than ever, yet there is more confusion and controversy than ever.  This led us to realize that we desperately need educated, motivated, creative thinkers to meet America’s nutritional needs.  As we like to say, “Great ideas are born here” – and we are confident that our new program will generate leaders in nutrition – NUTRITION PROBLEM SOLVERS.

Now, I’m pretty sure I didn’t coin that phrase – nutrition problem solvers – and I don’t know who did.  The idea has certainly created a lot of excitement around here; not the least of which was a recent article in Business West where George O’Brien discusses our new program and the idea of a nutritional problem solver.  I have gotten a lot of comments about this phrase and thought it would be a great topic for the first blog post.  In essence, what is a nutrition problem solver, and do we really need this right now?

I think the “do we really need this right now” is probably the best place to start.  To address this point, I’ll pose a series of questions to you – shouting answers is optional, depending on how interested you are in looking crazy in front of your computer screen.  Is there a nutrition crisis in America?  Do you pay more attention to what you eat now than 10 years ago?  Do you think government regulation is the only way to positively impact the nutrition environment in the U.S. (i.e. banning nutrients like trans-fats, or limiting the maximum size of a soft drink that you can buy, or mandating calorie posting on restaurant menus)?  Are the dietary guidelines for Americans based on a non-bias review of solid scientific evidence?  Should big-agriculture be able to genetically modify seeds used to feed us but not allow scientists free access to these seeds for research about the potential impact on our health?

There are probably another hundred questions I could pose; and as the list grew, so too would the support for the idea that we do “need this now” – nutritional problems solvers.  We need a new-wave of trained nutrition professionals who are going to make a meaningful impact on the future of nutrition in America.  The new program at Springfield College will strive to create these nutritional problem solvers: people who understand nutrition from a scientific and social perspective, and can critically evaluate available information to progress our knowledge and practice.  A lot of the things we are doing with nutrition in America right now simply aren’t working.  In my opinion, one of the biggest crossroads in nutrition today is personalized nutrition.  We know there is no one perfect diet; I think just about anybody you ask would agree that there isn’t one single diet that would work for every person.  Yet we are still pushing for blanket recommendations.  Why?  Probably because it is easier to do.  Even though we could pretty much all agree that it isn’t effective, we do it because it is the easier alternative to personalization.  We need to do better – we need to address this problem.  (More about this topic in my next blog post “Individualized Nutrition”).  Nutritional problem solvers will take on challenges like this and make progress.

Throughout this blog I will take an approach to nutrition similar to what is done in the “Applied Nutrition” course that I teach here at SC.  When I arrived here I was asked to teach the course.  I said “sure, what is that?”  To me, applied nutrition, in the truest sense, would be me taking the class to the dining hall and eating.  Although that might earn me great ratings on my course evaluations, I decided not to take that approach.  What I did was create a course all about critical thinking in nutrition.  The purpose of the course is to give the students the skills to evaluate information in nutrition to provide their clients, patients, and athletes an informed response to the hottest topics in nutrition.  I would like to take such an approach with this blog.  The purpose is not to display my personal opinions, but to generate thoughts, ideas, solutions, comments, etc. about important topics in nutrition.  I would love to hear from you and hope you will consider adding your opinions in our comments section.

Thanks for reading; I hope you will consider sharing this blog address with a friend, or better yet, a future nutritional problem solver!

Richard J. Wood Ph.D.

Director – Nutritional Sciences Program, Springfield College

rwood@springfieldcollege.edu