Low fat – another nail in the coffin

So here’s an interesting study: «Effects of a lifestyle intervention in metabolically benign and malign obesity.«

From the intro:

In the last few years it has been shown that metabolically healthy obese (MHO) individuals comprise roughly 30% of obese people and 10% of the adult general population [1– 5]. In addition to having insulin sensitivity that is similar to non-obese individuals, MHO individuals have lower liver fat content and lower intima media thickness (IMT) of the common carotid artery than obese insulin-resistant (OIR) individuals [6].

A group of German researchers put 262 non-diabetic people on a 9 month lifestyle intervention. The intervention was of the traditional (insane) type:

Counselling was aimed to reduce body weight by ≥5%, to reduce the intake of energy from fat to <30% and particularly the intake of saturated fat to ≤10% of energy consumed and to increase the intake of fibre to at least 15 g/4,184 kJ (1,000 kcal). Individuals were asked to perform at least 3 h of moderate sports per week. All participants completed a standardised self-administered and validated questionnaire to measure physical activity and a habitual physical activity score was calculated.

262 participants entered the study. Of these, 43 were normal weight and 116 were overweight. The remaining 106 were obese.

The point of the study was to see how this lifestyle intervention affected people with different insulin sensitivity (IS). The obese individuals were (BMI≥30.0 kg/m2) were grouped, based on their IS and IS was estimated from an oral glucose tolerance test (OGTT). Those with the best insulin sensitivity were labeled metabolically healthy obese (MHO, n=26) while those with poor IS were labeled obese insulin-resistant (n=77, OIR).

More from the intro:

Data about the effects of lifestyle modifications specifically in MHO and OIR populations are sparse: two small studies implemented energy-restriction diets for 12 weeks and 6 months in women [8, 9], and one a 6 month exercise intervention programme, also in women[10]. All three studies showed an improvement in cardiovascular risk profile in OIR, but not in MHO, women, despite similar weight loss [8–10].

So apparently traditional dieting does not do much for 70% the obese people. Anyway, weight loss was unimpressive as always with these strategies. The obese insulin resistant lost 3,3kg and the obese metabolically healthy lost a whopping 2,4kg of the average starting weight of 100kg. Remember this is 9 months of dieting. The difference between groups was not significant and the total body fat loss in the MHO didn’t even reach statistical significance.

However, fasting glucose (5.42 – 5.26 vs 5.07 – 5.17) and insulin (91.43 – 77.10 vs 38.33-39.70) both decreased more in the insulin resistant obese (there was a non-significant increase in both in MHO). This is perhaps not surprising as they had a much higher baseline level in both factors. Insulin sensitivity (OGTT) improved in the OIR group, but decreased (non-significant) in the MHO. Homeostatic model assessment (HOMA) also showed a decrese (2.98- 2.44) in the OIR group and an increase in the MHO group (1.16-1.23). Liver fat was high in the OIR and also decreased a bit in this group.

None of the cholesterol markers were interesting, but the authors noted that:

Unexpectedly, there was a small reduction in HDL-cholesterol levels in both groups. However, this was statistically not significant, indicating that these changes are not clinically relevant.

The end results show that despite a small weight loss, traditional calorie reduction can improve several markers of insulin resistance, but only if you are very resistant. And even though insulin sensitivity improved in the OIR group, their end level was still only 9,3 wheras the baseline level in the MHO group was 17,5.

The study illustrates that traditional lifestyle treatment only works (marginally) if your metabolism is really messed up. If not, there is little to gain from this strategy, and the study indicates that it might even make things worse. Though unfortunately not the final one, this is another nail in the coffin for traditional lifestyle treatment and a good reminder that overweight and obese people are a pretty heterogenic group that may respond quite differently to similar treatments. So don’t mess around with this nonsense. Go paleo instead.

The authors weren’t that impressed with the results either, writing:

«For MHO individuals, the option of a lifestyle intervention seems to be less effective if the target is to improve insulin sensitivity, although it may positively affect non-metabolic causes of morbidity and mortality in obesity, such as cancer and traumatic incidences. For OIR people, a lifestyle intervention clearly has positive effects. However, their insulin sensitivity remains very low even after the intervention compared with the MHO group, which indicates putative inadequate protection from type 2 diabetes and cardiovascular disease.«

And their solution to the problem? Drugs:

Thus, an early pharmacological treatment of obese insulin-resistant people, additional to the lifestyle intervention, may be considered as an appropriate therapeutic approach.

Science and religion

He held forth on a great range of topics, on some of which he was thoroughly expert but on others of which he may have derived his views from the few pages of a book at which he had happened to glance. The air of authority was the same in both cases.

Roy Harrod about John Maynard Keynes 

Science is what scientists do. It is difficult to find a better definition of the word. No one agrees completely on what methods and rules should make up science. But there are still aspects of science that are generally agreed upon and that make more sense than others. One goal, if not the only goal of science, is to find facts and explain the world as it really is. Science is searching for truths rather than lies and untruths. Interestingly, a whole field of intellectuals work and live as scientists without actually having a clear definition of the word science. But it is not given that we need a strict definition. We generally know what people are talking about when they say something is true or false. Our language often works perfectly fine in conveying such vague ideas “truth.” Leaving out deeper philosophical considerations, words like truth, reason and fact actually make sense to most of us. It is true that the earth is round (or more correctly closer to an oblate spheroid) and it is false that the earth is at the center of our solar system. Natural selection is a fact and so the creation of all living beings by a god is a lie.

Dean Ornish
Whenever I write about many of the “scientists” in the field of nutrition, I often feel compelled to put the word “scientist” in quotes. I know they work as scientists, but are they following scientific principles? Are their results, scientific results? Is, for example, Dean Ornish a scientist? Is his work focused on finding truths and facts based on logic and reason? Because it seems to me that he disregards a great deal of data when he comes to his conclusions and that he has a great ability to cherry pick and interpret any cherry picked data to fit his existing world view. This makes many of his conclusions wrong, and many have argued correctly that he is in fact wrong about many things.

Ornish works as a scientist, even if he has not always followed agreed upon principles designed to filter out the truth. Should I then disregard anything he says? No, of course not. That would mean to disregard basic aspects of human nature, one of which is our great ability to screw things up. We all do, but unfortunately, some more than others. Thus, I have to consider anything Ornish has to say. This does not, however, mean that he has earned my trust.

Ornish is just an example here, and is in no way unique in his field. Scientists regularly work in unscientific ways. As Thomas Sowell puts it:

The ignorance, prejudices, and groupthink of an educated elite are still ignorance, prejudice and groupthink… 

Although scientists should always put new theories to the test and assess their validity, this is not always done. Ideas are often accepted more on the basis of resonance with peers than empirical verification. In fact, as Sowell puts it, scientists act just like the rest of us:

If they are simply people who are like-minded in general, then the consensus of the group about a particular new idea depends on what that group already believes in general- and says nothing about the empirical validity of that idea in the external world. 

The fact that ideas are wrong does not mean they can’t be accepted by a great many people, and even sometimes by the majority of people. The ideas of Hitler, Lenin and Mao for example, was and are still accepted by millions as being very good ideas indeed, despite their lack of logic and empirical testing. The belief that humans are cured of illness because needles are jammed into immeasurable magical energy points or that homeopathy makes any sense at all, are also beliefs with numerous followers despite being completely devoid of reason. Religions, as the prime example, gather millions of followers without being in anyway rational.

By no means does working as a scientist or working in a scientific field mean that you are a reasonable person. Religion is in many ways the opposite of reason as it usually requires a lack of, or disregard of reason to exist. It is then difficult to understand how someone can work as a scientist or in a scientific field and at the same time believe in a higher power when there is absolutely no evidence for the existence of such a higher power.

An important part of science is the falsifications of hypotheses. Not every theory needs to be falsified, but many theories will be nonsensical if they cannot be falsified. The existence of a god cannot be falsified, that is, one cannot prove that there is no god. That, however, does not make the existence of a deity any more plausible. Although the existence of a god cannot be falsified, we do know enough about the human psyche, the history of the earth and the universe and the history and evolution of religions to say that any of the proposed gods are extremely unlikely to exist. I will not do the whole discussion of why religion is nonsensical. Others have done so before and have done so far better than I ever could. I can, however, recommend and refer to writers such as Sam Harris, Richard Dawkins, Christopher Hitchens and Daniel Dennet. (Here is a short talk by Dennet, and while at TEDs, make sure to also watch Dawkins talk on militant atheism.)

Writing critically about religion is going to hurt many people’s feelings. Religion is personal. It is at the core of the identity of many, and challenging religion is challenging who people are. But religion is a part of human existence. It affects us personally and as a society, and most importantly, there is no reason to think that religions are benign or that they do not affect the wellbeing of humans negatively. So religions should be discussed and I am taking the side of the critic.

Isn’t it enough to see that a garden is beautiful without having to believe that there are fairies at the bottom of it too? 

Douglas Adams
Although Norway is one of the least religious countries in the world, I am afraid that the recent atrocities in Oslo, which turned out to be a one man crusade against both democracy and Islam, will make it even harder to publically being critical towards religion. Suddenly one fears being grouped with such lunatics. But falling silent is not a good response. Nothing has changed, but being the critic still has its dangers. Ayaan Hirsi Ali, for example, has written some wonderful literature and is an extremely intelligent person, but she is also openly criticizing Islam and has thus been forced to live large parts of her life in hiding and under protection. There are many like her and openly criticizing religions, especially Islam, can often be a death sentence.

Even in countries like Norway where freedom of speech is a virtue held high, being publically critical of religion is severely frowned upon and like in so many other countries, blasphemy has long been a crime. Norwegians in general are naïve people and are often so afraid of stepping on any toes that we are willing to sacrifice even a freedom of speech to avoid it. Monty Pythons “Life of Brian” was originally banned in Norway. When finally released a few years later it was with an NC-18 rating and a text on the cover explaining that Brian was not really Jesus.

Religion, and any other unsubstantiated beliefs, should be put under the same scientific scrutiny as a scientific claim, or any claim at all for that matter. Reason and objective analysis tells us that religions greatly differ in their ability to make as many people as possible as happy as possible. Thus some religions must be characterized as better than or worse than others and some thus pose greater threats to our well-being than others, despite all being equally devoid of reason. To say that one religion by nature is better or worse than others is perhaps the greatest tabu. It is still a reasonable conclusion.

In “The Moral Landscape – How Science Can Determine Human Values”, Sam Harris argues that if our goal is to maximize the well being of humans, then religions fall severely short of science and reason. In particular, religions are horrible moral guidelines. This, of course, will strike many as odd, given that they believe religion to be the only place to look for moral guidance. Writes Sam Harris:

For nearly a century, the moral relativism of science has given faith-based religion – that great engine of ignorance and bigotry – a nearly uncontested claim to being the only universal framework for moral wisdom. As a result , the most powerful societies in on earth spend their time debating issues like gay marriage when they should be focused on problems like nuclear proliferation, genocide, energy security, climate change, poverty, and failing schools.

In his “The year of living biblically” experiment, A.J. Jacobs attempted to follow all the rules of the Old Testament (view his talk on TED Here). This proved an impossible mission, as it would have made him into a murdering lunatic. He did however give some of the rules a try, such as not shaving the corners of his beard, stoning an adulterer, not sitting in a place where a menstruating woman had sat and only wearing clothes made from the same fabric.

Religion does undoubtedly not originate from reason or science, but from the lack of it. There is thus no way religion and science can coexist in a person without being at conflict with each other. Says Sam Harris about the oft perceived unproblematic uniting of religion and science:

…this is based on a fallacy. The fact that some scientists do not detect any problem with religious faith merely proves that a juxtaposition of good ideas and bad ones is possible. 

Francis Collins
How then should we respond when a person like the director of the National Institutes of Health, physician-geneticist Francis Collins, described by the Endocrine Society as «one of the most accomplished scientists of our time», head of the Human Genome Project, goes religious, publishes a book about his strong faith in the Christian God and claims that science points to the existence of God and that God himself does not need an explanation since he is beyond the universe? 

When Collins, in 2006, published “The language of God” the result was remarkable. Rather than being an intellectual suicide, he continued as before and received praise for his attempt to reconcile and unite science and religion (or rather Christianity). Collins probably has more responsibility for biomedical and health related research than any other person on earth. He is controlling an annual budget of more than $30 billion, and yet he believes God created the universe some 14 billion years ago, that breaking God’s moral law will lead to the estrangement from God and that Jesus is the solution, that God created evolution and that a virgin gave birth to the son of God and that Jesus was actually resurrected some 2000 years ago.

The insanity of all of this is overwhelming. You can see it live here, and you can see him make an ass of himself for Bill Maher here.

According to “The Diagnostic and Statistical Manual of Mental Disorders» (DSM-IV), published by the American Psychiatric Association, delusion is a “false belief based on incorrect inference about external reality that is firmly sustained despite what almost everyone else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary.”

According to this definition Collins is delusional. The fact that others around him also firmly sustain this belief does not make it less delusional, although most scientists are not religious.

The problem here is not so much that Collins is delusional but that the system allows him to be delusional in the position he holds. Would he still be in his job had he been a devout Muslim or Hindu? Of course not. Because the religion he happened to fall upon was a type of Christianity approved of by a majority, no one much cared that Collins would take the texts of the bible as certain proof just as he would laboratory observations.

Most any time someone is critical towards religion, opponents invariably bring up the “but-why-does-it-matter-that-some-people-are-religious «argument and the «they-are-not-hurting-anyone» argument.The quick answer is that, although they may not be directly hurting anyone with their belief, there is no reason to think that religious belief is benign. Religions are without reason, and Collins will and do argue falsely and irrationally when discussing religion while arguing rationally and logically when discussing many scientific matters. That affects people.

“So he found God and faith. Good for him?” Yes perhaps, but bad for us. Because it means that he is willing, in some respects and circumstances, to put aside reason and logic and believe in farfetched ideas despite all the evidence pointing to the contrary. Collins judgment cannot be trusted.

A person’s private beliefs should not keep him from a public position, but Collins is an advocate of profoundly anti-scientific beliefs, and it is reasonable for the scientific community to ask him how these beliefs will affect his administration.

Steven Pinker

It is reasonable to ask why Collins was not fired from his position when he turned Christian when he definitely would have been fired had he claimed to believe in Thor or Zeus.

Being open to the possibility of a intelligent higher power is in itself not that big of a threat to reason. On can for example be open to the possibility that such a power started what lead to the known universe. This cannot yet be disproved, but it still makes no sense. Why choose to believe this over non-theist explanations? But if a person believes that the universe was created by any of the already know gods, that belief comes with a package called religion. A package containing farfetched beliefs in magic rituals, nonsensical moral laws and a whole range of extra beliefs that flies in the face of logic. This is what Collins do when he assumes the universe is created by the christian god and he must also then accept and buy into (which he admittedly does) the other parts of the christianity package.

The fact that we do not know something is no reason to conjure up a god as an answer. In addition, the belief that a god created the universe may take away the curiosity and incentive to try and figure out, using science, what actually did start it all. In this way religion is corrosive to science.

Science is also corrosive to religion. There are far more atheists and agnostics amongst the highly educated and especially those educated in the natural sciences, then amongst the general public. Religion is corrosive to science and reason. Of course we cannot leave important decisions about future human flourishing and well being, like for example that of how to use embryonic stem cell research, in the hands of a devote Christian or Muslim. Religious people will often believe in a soul, no matter how unlikely the existence of such a thing might be, and they will also believe that embryonic stem cell research is wrong simply because writings from a primitive Bronze Age community are interpreted to mean that an almighty god says it is wrong. No logic or reason required. It is simply wrong. When Francis Collins was appointed head of NIH, the Times featured a story where many prominent scientists spoke up against it. Writes The New Yorker:

Steven Pinker, a cognitive psychologist at Harvard, questioned the appointment on the ground that Collins was “an advocate of profoundly anti-scientific beliefs.” P. Z. Myers, a biologist at the University of Minnesota at Morris, complained, “I don’t want American science to be represented by a clown.” 

Collins, who founded the BioLogos Foundation dedicated to «the integration of science and Christian faith,» sees no conflict between science and religion and believes that God is outside of time and space, or put in more reasonable terms, nonexistent. In his work to unite religion (Christianity) with science he undermines and mocks the very key concepts of science he should be representing. 

My beloved science and me

I am no expert on anything, except perhaps on being me, of which I have an entire lifetime of experience. I don’t know much about biochemistry, about anthropology, anatomy or physiology in general. I got through my entire low quality typically Norwegian education in sport sciences almost completely without taking notes (it’s difficult to listen to a lecturer, think, and take notes at the same time) and without top scores. I have a terrible memory and often read my own blog to learn new things. In fact one of the reasons I started writing things down here was simply to have a place to put down my thoughts so that I could find them again. I am no expert and no one reading this blog should make the mistake of considering anything here expert advice.

But I like science. The reason is that I’d just like to know the truth. I am not interested in believing and the only way to find truth, as far as I know, is to use science. We all start out as scientists and we all know how to use science when we are born. From day one we are doing our very own n=1 study. What happens when I eat this? What sort of reaction do I get when I pull this down? The results are recorded in neurons and we test and test and test.

After a while though the brain starts living a life of its own, and we believe things not tested, we suppose and assume and depend on rational guidance to not lose touch with reality.

The urge to believe is strong. Superstition, which is one of those evolutionary obstacles on the course to rationality, is a good example of this. You wore your blue shirt to that meeting that went just perfect, and when it is time for a new meeting there is an urge to yet again pull out the same shirt, because it might be that the shirt matters. Another great meeting and the likelihood of a different shirt being worn to an important meeting gradually diminishes. Athletes engaging in competitive sports seem particularly prone to superstitious thoughts.

Superstition still makes perfect sense in light of evolution, as most things do, but luckily we can fight even evolution. Our irrationality can also be blamed on evolution. Believing that the stars are fires on the eternal hunting grounds of the afterlife or that somehow everything is linked to a carpenter being nailed to a piece of wood for saying people should just try to get along, is believed because our brains have evolved little protection against these sorts of thoughts. But this lack of an irrationality force field can make the search for truth difficult.

I am no expert, but I’d still like to know the truth and I fight the propensity to believe every day. That being said, I don’t think you have to be an expert to understand the general theme of healthy living. Much of it makes perfect sense and much of the rest requires a strong belief held despite the nature of the evidence.

Eating foods found in nature and not those invented by humans makes a lot of sense. Not accepting this requires some faith. Eating animals also makes a lot of sense as most data suggest it to be wise, while not eating animals requires belief in something other than nature (if you ask a vegan he might say he believes in nature, but that’s just self delusion. He believes in his self delusion).

Grains worry me. Admittedly I haven’t looked at the data on this subject very thoroughly. It seems to me the data arguing against grain intake is not that strong. I would have liked to have some RCT’s and some more anthropologic data from hunter gatherers. But the data are strong enough to have me worried, and strong enough to make grains nothing more than an occasional exception to my diet.

In all likelihood you do not have to eat a low carb diet to be healthy. Anthropologic data has shown us that humans can and do live as hunter gatherers on a relatively high carbohydrate diet without being plagued by the diseases of civilization.

I feel there are two important notes shat should be made regarding optimal diets. Firstly, although humans can thrive with good health on high carbohydrate diets, this does not exclude the possibility that we can thrive even more and improve our health more by replacing some of the carbohydrate with fats and protein. The Kitawans were healthy, but could they have been healthier? Secondly, although the evidence clearly indicate a natural, Paleolithic like diet with minimal grains, plant oils and processed foods as the optimal diet for maximal health, as a (wannabe)scientist I cannot take this to mean that we will not find an even better alternative. I am, and have to be, open to the possibility that we in the future might grow meat in the laboratory that far exceeds the nutritional quality of any natural meat, that we may make genetically modified foods that should replace natural foods or that we in the end will compose our diets of highly processed even plant based foods which might be the best human diet ever achieved. Technology is cool and the speed of scientific progress is astounding. I can’t wait to see what the future will bring. For now though, natural paleo like diets are our best alternative.

Science like most human endeavors is also affected by fashion and trends. There are even scientific journal with names like “Trends in molecular medicine” and “Trends in cell biology.” The latest environmental fashion is climate, which seems to be changing rather more than most people like it to. It’s a fashion though, and I dislike the reduced focus on other major environmental disasters. Physics has string theory, which has been all the hype for some time. Paleo is a trend in nutritional science and I think leptin perhaps is losing its popularity.

Strangely, it took a fashion designer (my wife) to give me a good scientific analogy for the changing of trends and how we perceive them. Fashion is after all both defined and plagued by ever changing trends. She proposed that trends are like the ever moving tectonic plates, but there is always a constant and stable core. Sometimes we get caught up in the ways of the plates and forget about the core.

The important thing to remember about trends in science is to not confuse popularity with importance. A new and exciting theory can shift our focus like a pair of boobs passing through the vision of a human male, but its importance must be questioned.

I sometimes think that as a scientist I should be open to anything. If new data emerge from good methods they should be accepted despite any of my previous certainties. I also think that not all things need to be studied. We do not need to do a scientific study to find out if it is dangerous to jump out of an airplane without a parachute, because common sense, a well developed human ability, predict the outcome of these actions and tells us what the result might be.

Unfortunately, this view – the conviction that some things need not be tested because rationality and common sense dictate them to be true – can also be used to halt science. This has happened in some scientists who do not think any more dietary trials are necessary because we already know fat is fattening. Or that no more trials of physical activity to treat obesity are necessary because we already know exercise makes us thinner. It is common sense and regarded as established as gravity.

So we need to have an open mind, albeit not so much that our brains fall out, the prime example being alternative medicine which in all aspects apart from a deity seems equal to religion.

Nutritional science like any science is a mental obstacle course where the true way is along a rope that is not spanned high in the air, but only just above the ground. It seems intended more to cause stumbling than to be walked upon.*

*Franz Kafka

New dietary guidelines – the fairies are rejoicing

Nonsense, n; That which is not sense; spoken or written words which make no sense or convey absurd ideas; also, absurd or senseless action.

I am writing nonsense, but it is because no sense within my mind will answer the purpose. 

Hawthorne (1871) 

All around are heated discussions and angry tweeters, heads are being slammed on desks, palms being slammed on faces (preferably ones one) and Einstein’s definition of madness is being quoted frequently.

Ladies and gentlemen, I give you the new and updated dietary guidelines.

Someone once said that science pretends to be more reasonable than it is, and so ends up being more unreasonable as a consequence. I am more inclined to replace science with scientists.

There is so much to be said about dietary guidelines and I am sure much will be said in the near future. I will not go into details and argue what statements are sound and supported by science and which are not. But I do find the entire process very interesting and I wonder if a time comes when people will look back at this while giving themselves a good facepalm and thinking, “What the hell were they thinking?” I can’t wait till the future gets here.

I was at the Norwegian Health Directorate yesterday to get a copy of the new national guidelines and to hear what the perpetrators had to say. As expected, they served fruit and bad coffee. It was interesting to hear how the authors boasted about the foolproof methodology they had used. How only the best information from the best sources, like the World Health Organization and the World Cancer Research Fund, was used. It got me thinking how remarkable it is that in some peoples mind, as long as the methodology is good the conclusion is equally good. But good methodology does not translate into good science. It might help, but in the case of WCRF report, for example, it clearly did not. I checked, and it is full of arbitrary mess ups like translating correlation directly into causation, not to mention its use of thermodynamics and its cherry picking articles and miss referencing.

The Norwegian guidelines were neatly divided into 13 simple, easy to follow points (loosely translated):

1: Diet should be primarily plant based and contain lots of vegetables, fruit, berries, whole grain and fish, and contain limited amounts of red meat, salt, added sugar and energy dense foods.

2: It is recommended to maintain a balance between energy intake and energy expenditure.

3: Eat 5 portions of vegetables, fruit and berries a day.

4: Eat minimum 4 portions of whole grain products each day.

5: Eat the equivalent of 2-3 dinner portions of fish per week.

6: It is recommended that low fat dairy products be a constituent of the daily diet.

7: It is recommended that one chooses lean meat and meat products and limit the intake of red and processed meat.

8: It is recommended that one choose plant oils and margarines.

9: Drink water.

10: Limit intake of added sugar.

11: Limit intake of salt.

12: Supplements might be necessary to ensure nutrient intake for parts of the population.

13: A minimum of 30 min of physical activity per day is recommended.

There you have it. The recipe for good and healthy living. The diet should be plant based. I know there are humans in the world and even small societies that do live on a primarily plant based diet and who seemingly are in good health. But in no way does this imply that a plant based diet is healthier than one animal based. It doesn’t even prove that a plant based diet is healthy, just that it might be possible. Of course the guidelines are not based on anthropologic evidence, but on a fear of animal fat and meat. It is not based on scientific data supporting a link between the intake of animal fats and disease, but on a completely irrational fear that fat might be deleterious to health, a fear created by a wonderful combination of a scientific field consisting of people who have forgotten what science is but who are still constantly cheering each other on in close cooperation with media and marketing interests.

The one vital part missing in the dietary guideline picture is what we do when the brilliant foolproof methodology gives us a conclusion. This is not when we rest on our laurels, but the time for some actual science to take place. This is when we have to check if the conclusion makes sense in light of what we know from all the different areas of science.

There is no evidence of this last part taking place in the guideline process. But the guidelines are not worthless. In fact a good and scientifically sound way to base your diet and lifestyle would be to use the guidelines in the following way:

Mind the advice about cutting sugar as well as the advice about exercising. Don’t mind the fish and the water and the vegetables, do the complete opposite of the rest:

– Diet should be animal based.

– Grain intake should be minimal

– Butter and animal fats should be substituted for plant oils and margarine.

– Do not pay attention to energy intake and expenditure,

and remember to get enough salt.

Intermission – religion and science

Some thoughts on the brink of a new year. An intermission in the exercise for fat loss rambling was at its place.

There are people in this world, quite a few people, who would let their children die in the hands of a holy man rather than have them live by the hands of a doctor. A holy man is trusted at the expense of logic and reason and without taking into account the human minds ability for imagination and self-deception. The doctor is disregarded because to the layperson he operates in a field as difficult to understand or more so than a religion with simple answers.

A holy man, be it priest, mullah, shaman or other is trusted because he is there, unlike the scientific paper(s) or the lines of reasoning that might, in the presence of sufficient schooling and training, convince people otherwise. 

In the health store the poster tells us that the vitamin C supplements can cure our colds. It might be right even though Linus Pauling was made a laughing stock claiming so, but that’s not the point. The poster is there, unlike the scientific papers or biochemistry textbooks undermining the claim. It is there with bright colors, a friendly smile and a promise it would be so nice to believe in.

We humans are prone to base our beliefs and understandings on the closeness of the source of information. Of course we are. Education and religion show a negative correlation. In areas where education in increased religion is decreased. When the textbook is slammed on your desk with the incentive to learn its contents the information is there whether you want it or not. The availability of good information make the esoteric unnecessary. This is not to say that any religious person is less smart or wise than the atheist, the human brain is more complex than that.

As frustrating as it is to see religions firm grip on virtues I hold high like those of reason, logic and skepticism, it is also very understandable. The holy man is there.

When your doctor tells you to reduce your saturated fat intake he does so because the information that he relies on is there. It is there in the local medical journal and it is there in pharmaceutical statin commercials sent to him.

Albeit, closeness of information is not all it takes, but I believe it to help more than it may seem. The doctor is unlikely to being swayed just by being shown a meta-analysis from Kraus, by being told the story of Ancel Keys or by some of Ravnskovs marvelous statistics. Just as a devout christian is unlikely to cast away his beliefs when listening to the evolutionary biologist.

But, the presence of good information is likely to sow seeds of uncertainties. I know from my own experience that my present views are the product of constant drops of information leading to uncertainties not to be left unexplored.

When someone close lose weight by eating fat and the results are there and clear in my face the impact is stronger than simply having heard of a similar episode somewhere. Of course, we can train ourselves to be more or less open and skeptical and the training can reduce the effect of the distance of the information. But, before we are properly trained to investigate information for what it is, irrespective of its closeness, distance matters. The commercial poster beats the journal, and the priest beats the scientist by being there.

My conclusion and solution to all of this is to keep being up in peoples faces. Be there. Talk to the doctor and the priest and your friends, write a blog, write a letter and spread seeds of potential knowledge. Admit to it when proven wrong and yield when a better argument is presented, but don’t keep your knowledge to yourself.

A scientist’s dilemma

I would like to consider myself a scientist – or at the very least a man of science. I do science for a living, although admittedly I don’t actually know what science is.

When I talk to people about nutrition, whether in person or in front of a class, I make an attempt at presenting nutrition from what I believe to be a scientific standpoint.
But there invariably comes a point during my rambling monologues when the listeners who aren’t sleeping realize that my advice on nutrition is roughly the opposite of what everybody else say, the opposite of what their textbooks says and the opposite of what the government recommends.

Eat fat,” I say, “preferably saturated fat. Butter is great. Avoid sugar and eat proteins. In fact, just make sure that most of what you are eating was also once eating something. Don’t eat grains, at least no wheat. If you don’t like seafood you might want to supplement with omega 3.” You get the picture.

At this point, a hovering hand usually catches my attention.

Are you telling us the government is wrong?

Yes, that is correct,” I think to myself. But I don’t say it.

Instead I try my best at working around question and feeling very much like a greased up politician I effectively avoid the question by saying something about how scientific results are often disagreed upon, how it takes time to change scientific paradigms, how textbooks are slowly updated, how science is not immune to the ways of money and how even scientists rarely admit to being wrong even though the evidence calls for it.

But, what I would like to say is, “Yes, that is correct.” In fact, what I would like to say that it is hard to be more wrong than the official guidelines.

I dodge the question, because I know I will lose credibility by asserting myself. Claiming to possess a knowledge that has escaped most everybody but me will drive my audience away and luckily so. It is after all a sign of healthy skepticism in my audience.

If I succeed in getting across the message that even the government might get it wrong, there invariably is a follow-up question.

Who then should we listen to?”

Me,” I think.

But I don’t say it.

Instead I talk about how, if you really want to know the truth, if you really want to know about nutrition and health, you have to read. You have to read and study and accumulate your own knowledge. Only then can you make sensible decisions about whom to listen to.

If however, you don’t want to spend your time learning about nutrition and navigating the maze of confusing information, you’ve got three more or less sensible choices:

1. You can trust your experience and the experience of those around you. A lot can be learned from listening to the body, cleaning out the senses and having a keen eye for the obvious. Humans however, are prone to deceiving themselves.

2. Find any random person or organization that promote a dietary strategy and follow it. This strategy is commonly used in religion and judging by the number of religious people around, I would say it’s an easily followable approach.

3. Don’t give a crap and eat whatever you want to eat.

I hate that there are no better options. When asked about whom to trust I would like to give people a name. Preferably the government, as it should be their responsibility to make correct and important knowledge available to the public. But I can’t give a name. In truth, the only option for those who really seek the truth is to find it themselves.

And how bloody ineffective it all is. But as I claim that those who should be trusted can’t be trusted there is no way people will or should blindly trust me.

And who’s to blame for this sticky situation? Much of the blame lies with scientists; the very group of people I would like to consider myself a part of.

Scientists have disagreed far more than the evidence permits. They have been led by money, fame and feelings and are in general guilty of being just like ordinary humans.

I do not think nor hope that the day comes when I can teach a nutrition- and health approach that everybody agrees upon. After all, the progress of science rests entirely on disagreement. But it should be possible to agree about the important issues. It is possible, but agreement honors us with its absence. And in the meantime everything is so much more difficult than it has to be and the obvious question poses a dilemma where there should be none.

The death of a theory

If I haven’t seen further than others it’s because giants were standing on my shoulders« – Richard Feinman quoting Hal Abelson quoting his roommate. 

I’ve been reading a fantastic book lately. Lee Smolins “The trouble with physics – The Rise of String Theory, the Fall of a Science, and What Comes Next.” The book is exactly as great as the title sounds, although admittedly, I only understand a fraction of it. Lee Smolin discusses string theory, how is came to be the leading theory in theoretical physics and how it might prove to be one of the greatest dead ends in the history of science. I’m by no means qualified to discuss theoretical physics, but as always when reading science my head draws parallels to my own area of research. String theory, as the leading theory in theoretical physics, does have a lot in common with the leading theory in obesity treatment, the low fat theory.
There is little doubt that the “low fat diet for weight loss” theory is a theory that should have been rejected a long time ago. There are good reasons it should be rejected. It only indirectly addresses the physiological causes of excess fat storage. And because it only indirectly addresses the real problem, it only works temporarily.

«They will devise numerous articulations and ad hoc modifications of their theory in order to eliminate any apparent conflict.» – T. Kuhn

In the near future the low fat theory might be considered one of the greatest blunders in health science. At least, it has the potential to be considered as such. Some theories have been shown to be near immortal and this is definitely one of them.

It is easy to draw parallels between the low fat theory and string theory. String theory is an attempt to unite different aspects of physics, general relativity and quantum mechanics, into one great unifying theory, a complete theory of nature. It is based on simplicity and beauty, but what seems intuitively logic is not necessarily logic at all.

Before Keppler, the planetary orbits were thought to be circular. A circle is beautiful and symmetric and it seemed logic that this was how the planets moved. And yet, observations showed the planetary orbits to be elliptical. The low fat theory is also intuitively logic. Fat contains much more energy than other nutrients of the same weight and excess energy is stored as fat. Thus eating fat in excess makes the body store fat in excess. Fat from foods makes fat in the body. It is simple, beautiful, logic and wrong.

String theory, like the low fat theory, does not have a good track record as far as theories go. It started as a simple theory, and many people think that a theory that incorporates all of physics should be simple. But there were fundamental problems with string theory right from the start. In order to get it to work on paper a lot of dimensions had to be added (the 3 dimensions we are used to, were by far enough), new and unobserved particles were invented and the theory had to be background dependent to work when the whole point was that it should be background independent. It also made few predictions and proved close to impossible to falsify by experiment. A theory has to be falsifiable, because only by opposing repeated attempts of falsification does a theory evolve into truth.

«A nice adaptation of conditions will make almost any hypothesis agree with the phenomena. This will please the imagination, but does not advance our knowledge.» – J. Black

Still, string theory survived. It survived because it was constantly added ad hoc additions and because conditions were constantly changed. Now, this is a normal scientific process. Few theories are perfect when they emerge. The question is, how many conditions can be changed and alterations be made before the theory should be replaced by a new one?

Like the string theory, the low fat theory needs to rest on several assumptions in order to survive. The low fat theory is based on the belief that energy intake and energy expenditure are independent factors. Little scientific data support this, and it is not possible to consider the body to be a closed system. It is also based on the assumption that we can all control our energy intake and expenditure by will. Low fat diets don’t work in the long run. Upon discovering this we can change the theory or consider it faulty. Because it didn’t work, modifications were made; People are lazy, have poor self control, exercise too little and so on. None of these assumptions are justified. They are often not given directly, but disguised by the fact that they are logical consequences of the theory.

Both the low fat and string theory were the leading theories in their field for a long time and in many ways still are. Other theories, even better theories, has constantly been placed in the shadow and were given little financial support. People who worked on alternative theories to string theory were automatically outsiders, low in the field’s hierarchy, just like the researchers working on low carb diets was given less attention than they deserved.

This is painful for many who have invested years and even decades of their working lives in string theory. If it is painful for me, imagine how some of my friends who have staked their whole careers on string theory must feel. Still, even if it hurts like hell, acknowledging the reduction ad absurdum seems a rational and honest response to the situation. It is a response that few people I know have chosen. But it is not one that most string theorists choose.”  – Lee Smolin

Although there’s still some hope for string theory, there is none for the low fat theory. We’ve tried it. It didn’t work. We are getting fatter than ever. Often the scientific standards themselves are reduced in order to keep these gargantuan theories alive. Intentionally or not, the result of this is sometimes the death of science itself and the people considered scientists are no longer scientists in the true definition of the word. The death of a theory is replaced by the death of science.

It doesn’t take an expert
There are usually no sides in science. Sometimes people ask me; what do you believe in/ who do you believe to be right or what dietary method do you teach? The way I see it the only correct answer is that I don’t believe anything. I know what some of the facts are. I can make some calculated guesses on what is less certain, and there is a lot I don’t know. Of course, I cannot actually give this answer. People need substance, and as soon as I mention carbohydrates, I’m on the low carb side. But there are no sides. Science is not a battle between teams, it is a unified search for truth.

The reason that mathematics invented the idea of proof and made it the criterion for belief is that human intuition has so often proved faulty– Lee Smolin 
Basic scientific principles are not difficult to understand and they are independent of scientific subject. When scientific standards are reduced, any lay person can see the faulty logic. Tom Naughton is being accused of writing about things he does not have the authority to write about. But, he does know what he is talking about, much more so than many of the experts in the field. You do not have to be a nutritionist or even a scientist to address the core problems related to basic scientific principles. A beginners mind easily spots the obvious flaws. Diabetes means you can’t handle dietary carbohydrates, yet a doctor may easily tell you to cut fat from your diet after diagnosing you. The doctor’s mind is that of an expert, clouded by experience.

«…insist that we should change the rules of science just to save a theory that has failed to fulfill the expectations we originally had for it. – Lee Smolin

Why aren’t we all fat?

I have noticed that there is one argument used in the nutrition debate that is used by both the low carb and the low fat community (in this context, dividing it into two sides make perfect sense). The same argument keep flying back and forth but I feel it is rarely given the response it deserves.

It goes something like this; “If carbohydrates make us fat, why aren’t all the people of the world, like many Asian people, who live on high rice diets, fat?”

For the record, I am fully aware that the composition of a traditional Asian diets is debated and that a general shortage of food may protect against any harmful effects of a high carb diet. The above argument is a poor argument for another more important reason.

In the low carb world the same argument is used, often in a form resembling the following; “Eating fat cannot make us fat. Because, if fat made us fat, why aren’t all people who live on regular high fat diets, like the Inuit or the Masai fat?”

This argument (and all similar) is easily refuted. Part of the reason these arguments are fallacious is that they rely on an unstated assumption, an assumption we cannot make. A causal factor may affect us differently and may only end up in full blown disease in predisposed individuals. We are not genetic copies. If we were all clones, finding causal factors would be so much easier (there is a reason twins make for popular study subjects). But we’re not. We respond differently to the same stimuli and only by being clones would we all be able to react similarly.

Smokers have a greatly increased risk of lung cancer, yet many smokers smoke their way through long lives with no cancer.

Still, the causal factor is still the causal factor. Insulin and glucose drive fat storage in all of us. Some of us however have counter regulatory mechanisms that may overpower the fat storing effects causing us to remain lean. The above arguments rest on the assumption that we are genetic copies. We’re not.

Ok, I realize the clone analogy is stretching it a bit. After all, as members of the same species we are very similar and we may easily all respond similarly to the same stimuli. But the truth is that the arguments do rest on the assumption that we will respond in the same way and the danger is that the assumption will be used to discard a theory when responses differ.

In some studies of low carb diets the results have been less than expected. My experience is that many of these studies are also easily criticized, but that doesn’t really matter. It also doesn’t matter that studies using body weight may not detect large alterations in body composition. What matters is that the cause for a disease does not necessarily make everybody exposed to the causative agent, sick. Carbohydrates may easily be the main cause of excess fat accumulation in fat cells even if not everybody who eats great amounts of carbs gets fat. We cannot simply reject a theory that points to carbohydrates as the main cause of overweight just because there are people who don’t get fat in the face of plentiful carbohydrates.

«If any and every failure to fit were ground for theory rejection, all theories ought to be rejected at all times.» – T. Kuhn 

Imagine a disease spreading through society and everything points to a virus as a cause. Then some people argument that the virus cannot be the cause of the disease, simply because there are people being exposed that does not get sick. It makes no sense.

On a similar note, the fact that you can lose weight by starving yourself (eating less energy) does not in any way contradict a theory pointing to carbohydrate as the causative agent.

The simple and undeniable fact is that many high quality studies of low carb diets have illustrated the diets efficiency in reducing weight. It makes perfect physiological sense and even evolutionary perspectives support it. These results cannot be rejected simply because someone loses weight by eating less energy. The results still stand. Getting them to fit with results from energy restriction studies is a matter of physiology, not theoretical science.

So, although carbohydrate restriction does not always give the expected positive results, this is not ground for theory rejection. On the other hand, when low fat diets have never given the long term results the theory predicts, this is ground for rejection. Treating overweigh people with low fat diets is a prime example of treating a symptom, the fat stores, rather than treating the cause of the fat storage. Because this is a strategy focusing on a symptom is will not work long term. Science supports this. Low fat diets simply do not work long term. We must reject the theory and try something else.

Is there a chance that such observations have already been made but ignored because, if confirmed, they would be inconvenient for our theorizing?” – Lee Smolin