Yves here. While the exhortation to have all doctors receive some nutrition training sounds all well and good, perhaps the advocates should take a look at what passes for nutrition science and get back to me. There is painfully little in the way of good underpinnings due to the dearth of solid studies. It takes very long-duration efforts with frequent and accurate reporting. The ones that are the most solid have nurses as the sample group. Most people lie about what they eat and how much they eat.
A related issue is that what I have seen from my limited contact with those who have degrees in nutrition is enough to make one be leery. Look at the food provided by most hospitals. Those menus are created by dietitians. My mother was fed things that I would have refused to eat, like turkey on white bread, pasta with red sauce, canned sweetened fruit and breakfast cereal (and I don’t mean oatmeal).
One of my sisters in law got a Master’s degree in nutrition science. Perhaps things have changed since then, but she said there were two types of programs, one for people who intended to go work for one of the major food companies and figure out how to make better fast food and junk food, and the other focused on health outcomes. The problem with the latter is I have no idea what she learned. For instance, she got pregnant after she finished her degree. Her doctor told her she needed to eat more protein. She told me she started eating cheese daily to do that.
Cheese is a very inefficient way to get protein. An ounce of hard cheese (and she was eating hard cheeses) is 54 calories of fat v. 32 from protein. And she was already chubby when she got pregnant, so it wasn’t as if she needed to increase her own body fat level.
Another is faddishness in diet advice, a result of the fundamental difficulty in performing good studies. Wine in moderation is good for you! Any alcohol is bad for you! Coffee is bad for you before it became good for you. At least tea seems always to have been good for you….except if you consume it British-style, with milk.
Now I did run into one exception, but he had been found by what I called the sports mafia, a group of doctors and highly skilled trainers who worked mainly with pro athletes, Olympic contenders, and the few normal people who found them out for rehab. Remember that athletes as well as bodybuilders eat for their sport. There are real stakes here, hence some attentiveness to what works. Diet fetishists might remember The Zone fad, which was designed for distance performers like runners and long-ish to long distance swimmers (The Zone does work but you have to run your life around it and most give up). Similarly, pizza is a very suitable for soccer players right before competing, it turns out, due the timing of caloric uptake after eating.
The professor in question taught nutrition at Ohio State and also practiced medicine about half time, and ran diet experiments on cooperative patients. His patter included having a patient with total cholesterol of 400, but he was not worried about her because her HDL was 300.
When I was in his lecture (about 20 people, I was the only non-trainer), he called out, “Does anyone here have cookies?” One woman sheepishly put up her hand. She had a small pack of some sort of supposedly healthy cookies. He asked her to bring it to him.
He said, “I guarantee that the second or third ingredient will be hydrogenated fat.” It was number three.
He continued, “It’s a preservative. It keeps the cookies from going bad. That stuff is so removed from food that if you put a pound on your counter, in a year it will be unchanged. Even cockroaches won’t touch it. ”
Admittedly this is anecdata, but I have not seen anything written by purported nutrition experts to make me change my generally dim view.
By Nathaniel Johnson, Assistant Professor of Nutrition and Dietetics, University of North Dakota and Madeline Comeau, Medical Student, University of North Dakota. Originally published at The Conversation
On television shows like “Grey’s Anatomy,” “The Resident” and “Chicago Med,” physicians seem to always have the right answer.
But when it comes to nutrition and dietary advice, that may not be the case.
One of us is an assistant professor of nutrition and dietetics; the other is a medical student with a master’s degree in nutrition.
Both of us understand the powerful effects that food has on your health and longevity. A poor diet may lead to cardiovascular disease, diabetes, obesity and even psychological conditions like depression and anxiety. Diet-related diseases are the leading causes of death in the U.S., and a poor diet is responsible for more deaths than smoking.
These health problems are not only common and debilitating, but expensive. Treating high blood pressure, diabetes and high cholesterol costs about US$400 billion per year. Within 25 years, those costs are expected to triple, to $1.3 trillion.
These facts support the need for physicians to give accurate advice about diet to help prevent these diseases. But how much does a typical physician know about nutrition?
The deficiencies in nutrition education happen at all levels of medical training.
What Doctors Don’t Know
In a 2023 survey of more than 1,000 U.S. medical students, about 58% of respondents said they received no formal nutrition education while in medical school for four years. Those who did averaged about three hours of nutrition education per year.
That is woefully short of the goals set by the U.S. Committee on Nutrition in Medical Education back in 1985: that med students should receive a total of 25 hours of nutrition education while in school – a little more than six hours per year.
But a 2015 study showed only 29% of medical schools met this goal, and a 2023 study suggests the problem has become even worse – only 7.8% of med students reported 20 or more hours of nutrition education across all four years of med school. If this is representative of medical schools throughout the country, it has happened despite efforts to bolster nutrition education through numerous government initiatives.
Not surprisingly, the lack of education has had a direct impact on physicians’ nutrition knowledge. In a study of 257 first- and second-year osteopathic medical students taking a nutrition knowledge quiz, more than half flunked the test. Prior to the test, more than half the students – 55% – felt comfortable counseling patients on nutrition.
Unfortunately, this problem is not limited to U.S. medical schools. A 2018 global study concluded that no matter the country, nutrition education of med students is insufficient throughout the world.
Bringing Nutrition Education Back
Even though evidence suggests that nutrition education can be effective, there are many reasons why it’s lacking. Medical students and physicians are some of the busiest people in society. The amount of information taught in medical curricula is often described as overwhelming – like drinking out of a fire hose.
First- and second-year medical students focus on dense topics, including biochemistry, molecular biology and genetics, while they learn clinical skills such as interviewing patients and understanding heart and lung sounds. Third- and fourth-year students are practicing in clinics and hospitals as they learn from physicians and patients.
As a result, their schedules are already jammed. There is no room for nutrition. And once they are physicians, it gets no better. Providing preventive care including nutrition counseling to patients would take them more than seven hours per week – and that’s not counting the time they would have to spend on continuing education to keep up with new findings in nutrition science.
On top of that, the lack of nutrition education in medical schools has been attributed to a dearth of qualified instructors for nutrition courses, as most physicians do not understand nutrition well enough to teach it.
Ironically, many medical schools are part of universities that have nutrition departments with Ph.D.-trained professors; those academicians could fill this gap by teaching nutrition to medical students. But those classes are often taught by physicians who may not have adequate nutrition training – which means truly qualified instructors, within reach of most medical schools, are left out of the process.
Finding the Right Advice
The best source of nutrition information, whether for medical students or the general public, is a registered dietitian, certified nutrition specialist or some other type of nutrition professional with multiple degrees and certification. They study for years and record many practice hours in order to give dietary advice.
Although anyone can make an appointment with a nutrition professional for dietary counseling, typically a referral from a health care provider like a physician is needed for the appointment to be covered by insurance. So seeing a physician or other primary care provider is often a step before meeting with a nutrition professional.
This extra step might be one reason why many people look elsewhere, such as on their phones, for nutrition advice. However, the worst place to look for accurate nutrition information is social media. There, about 94% of posts about nutrition and diet are of low value – either inaccurate or lacking adequate data to back up the claim.
Keep in mind that anyone can post nutrition advice on social media, regardless of their qualifications. Good dietary advice is individualized and takes into account one’s age, sex, goals, body weight, goals and personal preferences. This complexity is tough to capture in a brief social media post.
The good news is that nutrition education, when it occurs, is effective, and most medical students and physicians acknowledge the critical role nutrition plays in health. In fact, close to 90% of med students say nutrition education should be a mandatory part of medical school.
We hope that nutrition education, after being devalued or ignored for decades, will soon be an integral part of every medical school’s curriculum. But given its history and current status, this seems unlikely to happen anytime soon.
In the meantime, those who want to learn more about a healthy diet should meet with a nutrition professional, or at the very least read the 2020-2025 Dietary Guidelines for Americans or the World Health Organization’s healthy diet recommendations.
Many thanks for this article. I agree with Yves Smith’s assessments and anecdotes up top. I also have listened highly, highly skeptically to MDs and their ideas about nutrition.
Yet: For many years, most of my adult life before transferring to the Undisclosed Region, I relied on a chiropractor / kinesiologist as my main doctor. (Natch, this got tougher to do under Obamacare, because the data bases don’t recognize chiropractors as MDs.)
My chiropractor has always been nutrition-conscious. When I was in my late twenties, around 1984, he was on the “warpath” about soft drinks. And I pretty much haven’t had any sweetened soft drink since. It was only later that MDs started trying to explain to their patients that Coca-Cola is diabetes in a bottle.
More recently, when Covid appeared in the U S of A in February 2020, he sent out a list to his patients. It is the vitamin and supplements list that many of the commentators will recognize: C, B complex, zinc, vitamin D3. Some herbals.
As to vitamin D, I recall the vogue about 15 years ago among MDs for vitamin D tests — on the assumption that it is the “anticancer vitamin.” Well, that was all wrong. Yet it is effective against Covid.
Here in the Chocolate City, I regularly question my doctor and my pharmacists about Covid and Long Covid. The Undisclosed Region is lucky — there isn’t much of either these days.
I asked the head pharmacist why he wasn’t seeing Long Covid, when in contrast it is so common in the U S of A.
He gave the almost stereotypical Piedmontese answer: “Because Americans eat badly.”
And this post explains why: Lack of training of those in medical care. Prejudices among nutritionists. Lack of time in the overburdened U.S. health-care system to sit down with a patient and wean him from Big Gulps and Doritos.
“Life on Earth is an Antenna Tuned To Sunlight”
https://youtu.be/ZnkQSjKwH-M?si=i4dlDfeJS04aXihv
We are being starved of full spectrumed light. I have seen young people run from shadow to shadow in order to avoid the sunlight!
There is definitely a lot of contradictory advice out there, but maybe the answer is just to keep things simple and don’t over complicate it. Seems to me that eating whole foods and avoiding processed and fast foods, and doing everything in moderation would be a very good start. Too much of anything is generally not good, even water.
That being said, this isn’t easy for a lot of people when one locally locally grown tomato at a farmer’s market can run you a couple bucks or more but a box of mac and cheese at the dollar store is $.69 or so.
When industrial ag can produce cheap but unhealthy calories at scale for low margins, putting the healthy producers out of business, at some point we’re going to have to ban certain types of industrially produced food if we really want a healthy populace.
eat real food, not too much, mostly plants. Try to avoid vices as much as you can (we are all fallible)
This advice pre-dates Pollan by decades with some support from studies (but good studies are few and far between) and anecdotes….for example the median Japanese person consumes an unholy amount of sodium per day, but apparently other aspects of Japanese diet/culture negates/muffles the negative effects of sodium.
Excellent advice. It is sugar, salt, and saturated fats that make manufactured food palatable. Read the labels. Real food looks like real fruit, real vegetables, and real animals (if you’re not vegan). There is protein in plants, you just have to prepare beans/lentils/etc.
Almonds and other nuts are ready protein and fiber. Fiber is essential to a well-regulated gut.
The problem is the processed food industry has developed cheap, easy to store ‘food’ that is ‘tasty’, nutrient free but calorie rich. Hence widespread obesity.
The Japanese also follows what’s called the 80 percent full (hara hachi bu) rule, https://health.clevelandclinic.org/dont-eat-until-youre-full-instead-mind-your-hara-hachi-bu-point. If Americans can’t eat better then perhaps they should eat less crap by following that rule.
What’s really shocking about the Japanese diet is how expensive fruits can be, like depending on the season apples can cost as much as 2 dollars a piece. There’s a really strong possibility that I will be moving there later this year, and I am quite worried about how that will impact my diet. I don’t really cook, but it’s super easy and cheap to eat healthy in Taiwan even when exclusively relying on takeout food. There’s a shop just 20 minutes on foot from my house, that sells rice boxes for around 4 to 5 dollars, and you get one meat (done sous vide style as in fancy steaming) plus 4 different kinds of lightly stir fried/steamed veggies. You can find this kind of shop easily in Taiwanese big cities.
Resident of Japan, native of Ireland here. One thing that surprised me here is that in Japanese hospitals the meals that patients are be served are prescribed by the doctor as part of the treatment, something I never heard of in Ireland.
Regarding the price of fruits, yes, apples can be expensive. Bananas, mikan (satsumas) tend to be much more reasonable in price, but fruit does tend to be more of a luxury item here. Melons and pears can also be ridiculously expensive.
When I first moved here, one of the biggest mistakes I made financially was trying to eat the same things as I was used to from home rather than learn how to eat the Japanese way. Japanese supermarkets have a wide variety of produce, but the standard parts of the Japanese diet are going to be much cheaper. Also, even if you don’t cook, it can be possible to eat healthily even eating regularly in restaurants, like you do in Taiwan. When you get here I recommend fining a good teisyokuyasan (定食屋さん）which will serve rice, miso soup along with a main dish and a couple of side dishes of veg. Most places offer takeout service/delivery service also.
Many years ago I had a Japanese roommate here in Dublin. I’d assumed at the time that all Japanese had very healthy diets, but she seemed to subsist all the time on the monthly box of snacks her mother sent her from Osaka, and packaged noodles from the Chinese supermarket. Her exercise consisted of walking to the pub for pints of Smithwicks. I keep in touch and she is now in her 40’s, but people regularly think she is under 30, a picture of glowing health despite not changing her diet or exercise regime much as far as I can see. The key secret seems to be that like so many Japanese, she is very frugal, and the only thing she overdoes is beer.
While Japanese love their junk food, they always seem to me to be far less sugary than western snacks. And there are usually plenty of fairly healthy options in kombinis, even among all the junk. As you suggest, the standard local restaurant basic set meal in Japan can be relatively inexpensive and pretty healthy, once you avoid the deep fried chicken and octopus balls.
They do like their junk but it is definitely not as sweet. Having gotten used to the snacks here, I find when the chocolate bars I used to love from home are far too sweet. It also tends to come in smaller portions than you would be used to in the West.
Also the soft-drinks have no sugar for the most part. While they do have Coca-Cola etc, the majority of the drinks on sale in the convenience stores will be various varieties of non-sweetened tea which also has to be a contributing to the superior health outcomes.
Yeah, when in Rome, eat like the Romans do. I’ve actually been to a couple of 定食屋さん in my travels to Japan, but I’ve always gotten the unhealthy meat/croquette options (not fish), and the vegetable servings were always on the smallish side, but thanks for bringing this up since it is a very legitimate option.
My current thinking is I would live in an area with an abundance of supermarkets so that I can cycle through different 素材 s from different places on different days, if there are 定食屋さん, Ootoya, etc, the better so I would not get bored easily. Right now, I’ve located two stations in the Kansai area where there’s 10 supermarkets in a 1 km radius (I am not planning to drive nor am I going to get a bicycle), so they will be my first ports of call when I arrive later this year.
If you know of any places with an abundance of supermarkets (within walking distance) and easy access to nature in the Kansai area, please feel free to share ;) I am going to be working from home, so commuting is not going to be an issue.
Yes the unhealthy options are very tasty. Tonkatsu is my particular vice :-)
I’ve lived in the Kanto region almost all of my time here. I’m afraid I don’t know the Kansai region very well at all, so unfortunately I can’t be much help there.
Can’t argue with a good Tonkatsu, and my absolute favorite place is actually in Osaka. That’s not the reason I decided on Kansai though ;)
The very first step to be taken by an average American is just to cut everything in half. Don’t worry about what is on your plate…just eat only half of it. The rest can come later.
Bingo! As my cardiologist says (holding two cupped hands closely together) “eat this much food”.
Could the problem be that under our system of Inverted Totalitarianism makers of highly-processed industrial “foods” have been able to suppress funding for research on nutrition because it would be bad for their profits? When I look at the shelf space devoted to sugary soda-pop, salty chips, and frozen entrees it’s unsurprising that there’s little research expended on whether eating this crap has negative impacts on our health.
In contemporary America, unlike the Undisclosed Region, it requires the luxuries of time and money to live in a place where one can avoid these highly-processed foods. My life-partner and I are able to prepare and eat whole foods, mostly from local farmers and our garden. We consume pasture-raised meats, wild-caught fish, locally-produced cheese, and bake with flour grown and milled nearby. We avoid added sugar and season with moderate amounts of sea salt.
Our preferred beverage is water from our community well located on a nearby mountain, filtered through 5-stage reverse-osmosis — although we also enjoy minimal-intervention wines from producers who we actually know. Our entire county has also banned franchise and chain restaurants — we do not have so much as a Starbucks within an hour of our home, so even grabbing a coffee involves a familiar face working the roaster.
Rather than properly deal with nutrition, they –read the food industry and the pharmaceutical industry– have decided that, come what may, the real solution to poor nutrition, diabetes, and obesity is to market drugs like Ozempic (and like). Google the latest news re: “Elon Musk and Bernie Sanders agree on one thing: Ozempic”
Thanks. If most of us knew as much about nutrition as we do about Batman, we’d all be a lot healthier.
The trouble is, everyone is a nutrition expert in their own mind now. They “know” what they read on Facebook, CNN, USA Today, or one of the clickbait science news websites (where “we finally know” the answer about some “eerie” or “shocking” or “bizarre” phenomenon multiple times per day). Doctors are just as bad as any other non-specialist in giving advice that is often wrong and usually impractical. And it doesn’t help that the advice often flips according to the latest studies. Remember when coffee was bad for you and red wine was good? Uh-oh, not any longer!
If you want dietary advice, see a nutrionist/dietician. Your “primary care physician” in particular is not a good source, since the “primary” part of their role is insurance company gatekeeper, with limited minutes in which to get patients in and out and code up the paperwork churned out by the crappy IT system that the practice uses.
I’m always surprised by the apparent managerial capture of the medical system up to and including private medical practices, through the vehicle of computer-aided bureaucracy (the bureaucrat is the one being aided, not the doctors/patients). I assumed doctors would be more adverse to their profession being micromanaged. These medical networks should really be air-gapped from the corporate ERP systems before the SAP-ization of healthcare system chokes the life out of it.
The ones who are get weeded out. See Pierre Kory losing his license. This sends the message to those who otherwise might be inclined to push back against micromanagement
Yes, it’s not that desirable to have MDs be dispensers of nutrition advice; for one thing they are overworked and hard to get in to see, for another they are very expensive.
That said, there are a lot of bad nutritionists/dieticians out there, many still peddling the party line they were taught years ago, or just with little depth to their knowledge, it’s a crapshoot whether a person will get a good plan from them or not.
Unfortunately we are the gatekeepers of our own wellness and we have to put in the effort to learn about it and keep up with evolving science.
There is a lot of profit in sick care; not so much in health care. Perhaps that is why nutrition is not a sub-specialty in medicine, like orthopedics, dermatology, or cardiology.
So, where DO the doctors get their dietary recommendations from if they’re not trained? Why, the same place Yve says – the world health organization, who’s just a lobby for the highest bidder.
My experience has been, time after time, that doctors minimize diet in favor of prescription drugs (statins, blood pressure meds, insulin). I have come to believe that most doctors do not believe patients have agency/ability to modify their own behavior, thus they do not believe in the efficacy of nutritional counseling. Also, many PCPs in my opinion are very siloed and are not taking in new information outside of their field of specialty (see Covid precautions and lack thereof).
Good points, but the obscene, confiscatory prices of BigPharma provide very powerful disincentives to alter the status-quo. And the US as a country, spends 17-19% of GDP on so-called health care. Compare that with other OECD countries, who spend nearly half of that and have much better health indicators.
Having a modern, comprehensive health system, while regulating price-gouging by BigPharma would be very helpful, but no “political will” to do so in Congress. This is to be expected when political bribery has been formalized and institutionalized.
In how many countries are doctors well versed in nutrition? As far as I know, medical students in every developed country are too busy to afford to learn a new field, and there is a shortage of nutrition faculty and textbooks. However, that does not mean that other countries are facing the same health crisis as the United States. If that is the case, then making doctors more knowledgeable about nutrition is not a prescription for America’s woes. In my opinion, Americans would live healthier lives if their children were taught in school to stop drinking soda instead of water and eating fast food on a weekly basis.
“Americans would live healthier lives if their children were taught in school to stop drinking soda instead of water and eating fast food on a weekly basis.” It would be easier for children if vending machines in their schools did not sell soft drinks, and if the commonest (and most popular) fare in the cafeteria line were not chicken nuggets and processed frozen french fries. When I was in school (eons ago of course) there were no vending machines at school. Of course, the cafeteria served mostly hamburgers and hot dogs, but many of us packed a sandwich from home.
Big Ag and Big Food control “nutrition science” in the US, whether it’s taught to children, doctors, or moms.
At the risk of sounding unkind, my primary care Doc doesn’t seem to know much bout anything, and I don’t think he has read anything about medicine since 1992.
yes….considering whose driving the bus….Big Ag & Big Pharma…..and so here we are.
I used to be in charge of an Alzheimer unit. I often questioned the dietitian about the unhealthy diets. Her response was that her hands were tied. She had to follow the prescribed dietary algorithm. Like orange juice on every lunch and dinner tray. Oh please …..
At the time, I was into Ayurveda, which is a 5000-year old healing system based entirely on different and unique rules of nutrition. Ayurveda helped me and my daughters obtain and maintain perfect weight and helped me get rid of chronic migraine headaches.
Thanks very much for this article.
In my experience there are a few US based MDs who have taken it upon themselves to learn basic nutrition, but only a few. The sometimes contradictory information, misleading info by the USDA, and a plethora of fad diets leads to confusion and/or apathy for many.
A form of traditional Mediterranean diet seems to be the best for me: lots of fresh veg, especially leafy veg like collard greens, chard, spinach etc. Freshly-made salad dressings with EVOO of course, no processed canola and other inflammatory veg oils. Minimize white flours, processed carbs and sugars. Lots of legumes like lentils, garbanzos, beans etc. Fruit, but no fruit juices (fiber mitigates blood sugar). Alcohol in moderation only, (1-2 glasses of red wine with evening meal) Eliminate processed meats, especially those with nitrite/nitrate. Eat lean meat in moderation. Eat oily fish like sardines, mackerel etc.(high omega 3 etc.) with low mercury, and minimize high-mercury fish. Eat cheeses and high-fat dairy in moderation. Nuts, especially Brazil, Macadamia, pistachio, almonds etc are also good nutrition and for LDL/HDL balance. Maximizing fiber is huge: LESS than 10% of US folk eat enough fiber in their diets. https://nutrition.org/most-americans-are-not-getting-enough-fiber-in-our-diets/
And of course some sort of physical exercise is essential.
I have lowered my glucose and A1C level, lowered cholesterol, my BMI is in the healthy range, BP is in range, and I am generally fit for a person of my age. I am also lucky.
Some people swear by the Ketogenic diet, or variations of this, but I found them too extreme and I have good results by following the above diet.
On most things diet related, I have learned from Dr. Robert Lustig and others. https://www.youtube.com/@RobertLustigMD
The problem for many is that they have no time to properly plan and prepare healthy food. Fast food, processed food, take-out, etc. is infamous in the US. It is cheap, convenient and addictive. This goes perfectly with the extortion racket that poses for a health care system in the US. A nation of obese, hypertensive, diabetes-stricken, folks require huge amounts of medications etc. And since BigPharma can legally gouge people, there is little if any incentive to change the status quo. I don’t hear anyone talking about meaningfully addressing the health crisis in the US.
Nutrition science is the prime example of bad statistics. They’re based on observational studies, rely on self reported measures by the study participants, and leave out many important confounding variables, either by choice, or because it’s impossible to understand everything about a participant that could affect their health outcomes. Even if you only rely on RCTs, they are incredibly hard to run properly in a comprehensive, large sample size environment. Most studies cannot be relied on for real world activity.
https://www.youtube.com/watch?v=KDY7XYmb6nI
Nutrition science is entirely unreliable | Don’t trust the New York Times Well section
mmmm, maybe. Depends on the nutritionist, I think. I know a man, yes an anecdotal story, who received the big “C” diagnosis 10 years ago, took directions and treatments including chemo from a very skilled oncologist, and also found a highly regarded nutritionist and took their recommendations for diet. The oncologist wasn’t opposed to nutritional advice – can’t hurt, might help. Man and his wife tossed out all the processed food in their pantry, tossed out the sugary stuffs like sugar-pops breakfast cereals, took to buying locally grown veg at the local farmers’ market, etc.
The man is still here 10 years later. As his oncologist said, can’t hurt, might help.
adding: before you dismiss observational studies out of hand, remember that in the old sailing days the British navy carried Lime Trees aboard for fresh limes as a source of vit. C to prevent scurvy in the sailors. / ;)
https://health.mil/News/Articles/2022/01/10/The-British-Limeys-Were-Right-A-Short-History-of-Scurvy
adding, adding: vit D is added to milk to ward off rickets in the young who drink milk; vit A is added to milk to ward off night blindness and other health issues in the young who are the highest consumers of milk.
There’s a reason for these vit additions.
No mention of “food deserts” not just lack of grocery stores, but large chain mega stores wherein obtaining healthy produce et al are a real challenge, even to the most knowledgeable. With the Kroeger/Albertson merger soon to become an even larger problem – thank Lina Khan at the FTC who is doing her best to prevent this from happening. After the election, anticipate an abrupt politically engineered departure. With Whole Foods schlepping up many of the local and regional natural foods markets, it became a national company only to be purchased by the Amazon as a white knight to avoid a hostile takeover from an even worse corporation. However, this was essentially the demise of a national level food chain dedicated to natural foods.
And I almost forgot, we can add the mega-merger of Kroger and Albertsons to that. More consolidation, less choice, and more price-gouging! Things will get worse, before they get better (or is that too optimistic?)
I have had constant battles with the dietitians at the long term care homes that I have to interact with on behalf of someone else. Unfortunately, I have lost most of the battles even for topics that are already beyond controversy. To me it seems like they are more focused on corporate liability than on what is good for the resident. The doctor on the file doesn’t even try to engage in any discussions about diet, but is helpful on other matters on most days. This is all happening in Canada, where the healthcare system seems relatively sane.
For myself, I have a generally clean diet since meeting an excellent naturopath/ayurvedic doctor over a decade ago. He is absurdly good at helping me re-balance when I need it (my diet took a hit during the pandemic). The solutions are straightforward and make sense. He is also very good at diagnosing imbalances, even when there are no clinical symptoms. Ayurveda and Traditional Chinese Medicine have approaches to diagnosis that work well when done right.
I recall someone I knew a couple of decades ago saying that their doctor had told them they could lose their license if they advised on nutritional matters. I am sure the doctor said that, but I am not sure it was true.
A theme that has come up for me is that doctors have a profound skepticism/scorn for anything that they didn’t learn in their own training. My personal experience is that they don’t even ask questions…they simply dismiss things. Change comes very slowly in the medical profession. In some conversations, I have had to put my credentials on display to even get a conversation going. My own family doctor told me that she encountered issues in hospital while helping her father, and she is a physician!
I really, really feel for people who have no one to advocate for them. There are a lot of them.
Good stuff. I recommend Colin Campbell (The China Study)–a guy who was raised on a dairy farm, then supervised that largest-ever study of the connection between diet and health. He now tours the country promoting a vegan (whole foods, plant-based) diet.
Videos (Netflix): “What the Health” (how big food conspires to make us sick), “Forks over Knives” (more whole foods, plant-based success stories), Even Arnold Schwarzenegger, Jackie Chan and James Cameron produced “The Game Changers” about world-class athletes going vegan.
For a start, try pcrm.org,..recipes and strategies for adopting a good diet. Your taste buds adapt (as when going from whole to skim milk) and that unhealthy stuff you couldn’t do without becomes distasteful.
I heard an interesting podcast many years ago where they actually debunked the China Study. Apparently you can’t really compare vegans/vegetarians to meat eaters because there are too many confounding factors– vegan/vegetarians tend to be more health consicous in general: they are more active/outdoorsy, smoke less, drink less, etc.
So someone did a study betwen Mormons and Seventh Day Adventists since both religions require members not to drink/smoke/do drugs… but Seventh Day Adventists are also told to become vegetarian.
When the did the studies determining which group was “healthier”, turns out the meat-eating Mormons came out ahead.
I do think CAFO/non-organic meat can be a huge problem. But sweeping generalizations claiming everyone would be healthier if they were vegetarian isn’t necessarily true.
Are you being serious? Colin Campbell is a fraud, he intentionally misrepresented the China Study to support his preexisting hypothesis. I recommend reading the China Study itself, not the book by Campbell. It shows the exact opposite of how Campbell presents it.
As a retired Dietitian that mainly worked in school lunch, I am very disappointed in the American Dietetic Association’s embrace of the corporate food system as they give the association so much money no one can be critical of these players. While I was middle management, the upper management at USDA and state administrators thought processes were that school lunch should serve modified fast food (low salt and fat foods) to get the kids to participate. Commodity foods are sent to food processors to make chili, spaghetti sauces, pulled pork, chicken nuggets etc. My district did offer many fresh vegetables and fruits but, over the years the made from scratch entrees and breads were replaced with fast type frozen foods. The 40,000 students we served a day thought they were getting a nutritious meal. Site level staff no longer have preparation skills and staffing ratios push school lunch programs to frozen foods as made from scratch foods take more employee hours. I believe the loss of Home Economics where the basics of food preparation and nutrition principals has had a detrimental effect since at least the 1990’s. Sadly, the district I retired from has succumbed to corporate management and has really deteriorated with poor food quality and very poor morale as those remaining used to be proud of the good things the department did.
Don’t be too hard on them. Every human institution is as corrupt as hell, and the people at the top got there by climbing over the bodies of their rivals.
Adding my 2 cents here. A few years back there was a diet called the “Cave Man Diet”. It called for avoiding anything that a cave man would not recognize as food. Or in other words, eat as close to nature as you possibly can. Lots of fruits & vegies, avoid processed foods. It let you give in to temptation once in a while, but get back to basics as soon as you can.
The quip about soda being “cancer in a can” really caught my attention. Some of the most obese people I know consume several cases of diet soda on a weekly basis.
I suspect (but can not prove) that fresh frozen vegies are better than canned. Read the labels.
Yes, flash-frozen real vegetables maintain nutrient content (vitamins & minerals) better than canned (cooked) vegetables.
federal and local tap water regulations and food safety regs. are woefully outdated. I would not consume the water used in canning.
At the very least, it is a reasonable hypothesis that at there is a much higher chance of excessive nitrates (rural farming) in canned food given all the water used.
The “cave man diet” does make sense if you want to learn how humans fed themselves and evolved. But you need to factor in the control of fire which changed everything.
Raw beans, rice, and wild grains are a few of the natural foods that humans can’t digest. However, the control of fire allowed these and other foods to be cooked and opened up food sources new to humans with the then unknown benefits of killing bacteria and other harmful organisms.
Socrates had this figured out eons ago before capitalism inserted itself between our collective mouths and the food supply:
“let food be thy medicine and medicine by thy food.
That NYC folks blame gluten, in their hyper-processed, herbicide dessicated, bromated GE monoculture/ CAFO diet & immediately killed whatever microbiome they were pouring so much Organic Catskill avocado, guava, mango, pineapple & reduced cruelty artesian bovine somatotropin; cage free, pasture raised sturgeon roe & they still haven’t learned to tip the guy who delivers their sodium flavored weasel noodles; leads me to believe, “How To Serve Man” just might be a cookbook & Impossible pink slime is PEOPLE? If we question genetic literacy project, Hillary’s sending drones!
Yeah, I know, but it’s a nice way to consume protein.
The same thing can literally be said about salt. The audience is left wondering: is hydrogenated fat particularly bad for you? Whether cockroaches will eat it or not is not particularly relevant
Salt, as a preservative or not, is necessary for mammalian life. Hydrogenated fat, not so much. / ;)
Yes, witness mountain goats scaling absolutely insane rock faces to find salt licks.
As a mountaineer in the Pacific Northwest I have directly witnessed a mountain goat lick a climbing partner’s pee puddle to get at that salt.
China Study changed my life. Dr Campbells focus is on the heart, coronary diseases. This book fixes Yves lament, it doesn’t lack for tons of data, is a very long-duration effort, with frequent and accurate reporting. There is a companion book called “Prevent and Reverse Heart Disease” written by a cardiologist from the Cleveland Clinic named Caldwell Esselstyn. The two met while working on diet research from different angles. The books definitely go together. One is research, the other is practical advice and empirical studies based on that research. As in, Dr Esselstyn took on 10 or 15 patients, all who had been given death sentences due to their advanced heart disease, and he turned them all around, long term, with a whole foods only, low fat, no meat diet. Hard to believe until you read the books and see it put in practice (I practice it on myself!). Im a guy who’s relatives on both sides are littered with deadly sudden heart attacks in their 50 and 60s so I take it very seriously. I also myself just got diagnosed with AFib at age 60, so the genetics are pushing back against me. But I dare say, knock on wood, I’m healthier than every other male my age that I know. Not even sick (except for covid once) for the last 15 years since I started the “China study” diet. No stuffy noses even.Then again, maybe I’m just lucky to have a strong immune system. How would one know? The China Study and Dr Esselstyns project give strong evidence. I often wonder if the Afib emerged with an assist from covid.
I’m sorry but you do not understand. There is no such thing as good data in nutrition. It is impossible to do accurate, large sample, long duration studies. You can’t recruit a big and diverse enough sample who will report accurately (as in meal and snack journals with quantities of what they consumed) for a long time. The # of dropouts creates sample bias. So I am skeptical of anyone who says they have good data, as opposed to useful indicative data.
Even professional dietitians can give poor/outdated advice. Good books include Callie Means, Robert Lustig, Mark Hyman, and Tim Spector. The ADA and AHA are sponsored by vested interests, and so are many of the journal articles and schools (or hired school leaders, who serve as consultants). For real progress, remove vested interests from public health, and educate everyone. Instead of subsidizing commodity crops, treated with pesticides and wrapped in plastic, subsidize local organic farmers. Do not let food stamps be used for sugary or sugar substitute drinks, which increase hunger.
Personally, eat real food, mostly home cooked, with limited or no added sugar and many fruits and vegetables. It takes 2-3 wks for your taste buds to adjust. If emotional or addictive attachment is substantial, (likely for many) addiction style mind-training can break the emotional/addiction, teaching you to develop an aversion to junk – your mind likes feeling better and the brain signals change, so it works far better than willpower. (Judson, The Hunger Habit) Once your metabolism readjusts, usually in weeks, you are not chronically hungry and the cravings go. Just reading Chris Van Tulleken (Ultra-processed People) might help too – once you know what these additives are and how they work, you think twice.
If you can afford it, go organic-when-available, preferably not wrapped in plastic or grown with a lot of plastic. Not sugared yogurts and granolas, even if organic, and avoid refined (white) carbs. For meat, milk and eggs, go for pasture raised poultry, and 100 percent grass fed beef/dairy. Livestock fed pesticide and plastic-laden junk food, antibiotics and full time stress in feedlots/dark-warehouses are not healthy and should be avoided as feasible. Skip ultra-processed foods with factory or chemical plant sounding additives. Yes, it takes time and money but you feel better in 1-3 weeks and save both health and medical costs. Before long, the ultra-processed junk tastes weird and sugary junk like artificially sweetened syrup. If you are on medication, consult your physician – watch your glucose and blood pressure closely and be ready to wean off medications in a day to weeks or months.
A patient of mine I hadn’t seen in awhile came to me with high cholesterol. She told me a year ago she saw her MD and endocrinologist because of her low blood pressure. They both told her to eat potato chips. She told me she liked potato chips so she didn’t mind but now she has high cholesterol. I was astounded that was their recommendation. At the very least, they could have just told her to put a pinch of sea salt/electrolytes into the water she was drinking. There were many ways to address this but they BOTH chose the way that caused harm.
Gastroenterologists of course ironically seem to be especially ignorant about diet and up until recently would deny there was any connection between diet and people’s GI symptoms. Covid seems to have changed things somewhat and now gastro docs are recognizing MCAS, SIBO, etc. and the corresponding diets necessary to address these conditions.
People do need individualized nutritional/dietary recommendations. Genetics such as ApoE can play a large role. Most PCPs do not have time for this nor the knowledge. Licensed naturopathic doctors get extensive nutrition training but also do not have time to go over detailed diet diaries with patients. Many conventional dieticians still push artificial sweetners and low fat diets on everyone. Their information seems to be stuck in the 80’s. Holistic nutritionists tend to be the best option. The program a nutritionist has gone through will hugely influence their recommendations. I personally would never send patients to someone still recommending nutrasweet/splenda, diet soda, etc…
The healthy potato chip equivalent is nori sheets! Delish and similar mouth feel.
Nori is one of my favourite discoveries since moving to Japan. Especially Korean nori, which is a bit saltier than the Japanese variety. I have it with almost every meal! It especially goes brilliantly with rice.
Late to this, but indeed, for all sorts of reasons, the ‘science’ of nutrition is enormously confusing, and much of this comes down to poor training of doctors and the vague educational status of ‘nutritionists’. Some of the problem comes down not just to medicine, but poor epistemology in many branches of nutritional science (for example, it was a common paradigm up to recently to assume that the health effect of food was simply the additive impact of the individual nutritional components, which is self evidently untrue). Its amazing to think just how little we know about the microbiome, despite how important it is for everyone on the planet, and the fault for much of this is the bunkering of specialisms within science.
For many years I’ve read up on nutrition science at multiple levels (from primary sources to ‘influencers’) and tried to find reliable sources of information, and I’m not sure I know any more now than anyone else.
Yves is quite right to say that the cutting edge is probably in sports nutrition, although there are complicating factors here – a healthy food for a high level athlete may not be healthy for a regular person. An example is eggs, which seem to be a highly nutritious and safe food for active people, but unhealthy for those more sedentary. Its interesting that some athletes thrive on what should be considered quite unhealthy foods. One source I follow is Nic Verhoeven, who has an outstandingly interesting YT channel (Physionics), but eats ice cream every day, much to the horror of his followers.
Even so called ‘common sense’ advice can be misleading. Michael Pollen talks about not eating what your grandmother wouldn’t recognise as food. But my maternal grandmother died aged 35 from anaemia resulting from a vitamin B12 deficiency, so I’m not sure that’s particularly good advice for me. Another ‘common sense’ thing which is untrue is that we should eat like our ancestors. Ask any archaeologist what our ancestors ate, and they will tell you there was probably more variation in the past than now – some societies were pretty much vegans, some pretty much full time carnivores or piscivores, with multiple levels between (including highly seasonal variations). It doesn’t really tell us anything.
When it all boils down, the simplest advice seems to be to consciously not eat too much (which seems to be the Japanese secret), avoid processed food as much as possible (and this includes ‘traditional’ processed foods like pickles and preserves and jams), eat as wide a variety of fruit, veg, beans, nuts, grains and legumes as possible, and go easy on animal products unless you are a power athlete. Most of all, just enjoy food, don’t get into the trap of treating it as fuel.
I have found the NOVA food classification system to be helpful:
https://ecuphysicians.ecu.edu/wp-content/pv-uploads/sites/78/2021/07/NOVA-Classification-Reference-Sheet.pdf
Very late to the party, but:
Well worth the read about the NOVA classification and ultra-processed food:
Ultra-Processed People: The Science Behind Food That Isn’t Food.
Discussed here.
And from first-hand experience, medical students are not taught human nutrition very well. But more importantly, they are seldom aware of how the Great American Food System has failed the entire population. It is easy to preach about proper eating, but food deserts are very real. Everywhere, including inside the modern American supermarket.
There’s at least one doc pissin into the wind here. At some point The Holy Algorithm led me to https://www.youtube.com/@pradipjamnadasmd, for which I am grateful. Pradip is a cardiologist in Orlando, his videos are mostly just recordings of informal talks he gives to other doctors on the subject of Taking. This. Stuff. Seriously.
I trust him not only because he isn’t selling anything at all, not only because he acts like a class traitor (preventing heart disease means he doesn’t get paid to treat it, after all…) but I also trust him because he’s willing to give an hourlong talk on a subject like advanced glycation endproducts, which is just a pile of bad news that no one (myself included) wants to hear. Roasted nuts, BAD, seared steak, BAD, grilled broccolini, BAD, reheated leftovers, BAD, butter, hoooy boy is that ever BAD. Not that I dislike poached fish and steamed veggies, but the thought of eating predominantly raw and low temperature or moist cooking for the rest of my life is depressing.
That’s the problem with good nutritional advice; a lot of people stand to lose money from it, and hardly any money to be made from it. If I pressure cook a few potatoes and carrots in my Instant Pot, that’s money Frito-Lay didn’t make selling me the myriad processing and marketing “value adds” of a potato chip. Instant Pot made some money, but they seem to have hit the total addressable market ceiling now that everyone has one. They’re literally trying to sell Star Wars themed Instant Pots now, which is about as clear a sign of desperation as anything. Clearly not a sustainable revenue stream, as we say these days.
Yves is quite right about both doctors education and the state of the art nutrition. I spent years trying to get my father, a very well educated and respected MD, to improve his diet. I tried especially hard once he began to have heart issues. It was difficult to convince him because none of the studies were that great and he was generally able to find some flaw. As he got older he did start to come around cutting out the junk, but unfortunately it was too late and he died of complications due to his heart failing. As a result I’ve spent quite a bit of time going over the “nutritional science” and there are several challenges to the task.
First people are different, not only their genetics, their life style, their history, but also in their environment. All of which play a role. For example, it is well recognized that pulsed EMF from a cell phone can open Voltage gated Calcium channels (VGCC’s) which are involved in all sorts of cell signalling. It is likely genetic factors, mineral deficiencies and history of exposure aggravate this issue. This sort of exposure is going to impact how people respond to toxins or nutrients and is never considered in studies.
Then there is the problem that the source of food and how it was grown can impact its nutritional qualities and level of contamination, which are almost never consider in these studies. I was quite disappointed to learn recently that my Organic cinnamon from Costco was contaminated with lead, though somewhat relieved to see it was well down the list of most contaminated cinnamon products. How is it we are just discovering these sort of issues? We don’t even account for the most obvious issues so how do we expect to understand the more subtle ones? My base case is that corporate intervention improves profit at the expense of nutrition. So for example I prefer to bake my bread from heirloom wheat such as Red Fife, which has a higher protein content so better rise and likely nutrient level yet because of its lower yield is harder to find.
Motivation of the researchers is also obviously a consideration not only in how the studies are conducted, but how there results are reported or if they are reported at all.
My response has been for the past ~ 20 yrs I have been eating a plant based, organic or better yet, locally produced, or even better yet, out of my garden or from my friends and neighbors. The strategy has been to spend the money on the best quality foods and hope that I can avoid having to spend even more on doctors and so far it has paid off as I have yet to have gotten even the flu over that time without resorting to any pharma products. That said I also immediately treat any soar throat with a saturated salt gargle, followed by after an hour or two if no improvement with a Listerine gargle, and since 2020 after an hour or two of no improvement with ~1% povidone iodine spray such that I have yet to go to bed feeling ill. I also get plenty of sleep, exercise and sweat everyday. I usually get outside for at least an hour rain or shine as I think IR exposure is just as important and UV. I also try to regularly consume an adaptogen, usually mushrooms, as well as some fermented food. I love nori sheets as a snack and find along with homemade kale chips to be one of the most nutritious/calorie snacks (though less so the ones from sources like Costco fried in oil pack in plastic). Especially like nori since I use real salt which has no iodine added.
If you have extras in your garden, which is common this time of year around here, you can use a dehydrator to easily turn them into chips. You just need a mandoline slicer and after dried store them in ziplocks in a cool dark area. I like to spritz them with olive oil and a dash of salt just before eating. Its surprising how good they are even after a couple of months. This time of year I heat my house with my dehydrators, making veggie chips, apple chips, fruit rolls, and dried blueberries. My go to snack to replace the potato chip craving is hot air popped organic popcorn. Even organic cost very little by the bucket, stores months if well sealed and takes only a minute to prep. For salty buttery sense I use nutritional yeast and salt, for more umami substitute the salt with Soy, Tamari or something like Worcestershire sauce. For barbecue flavor spritz with your favorite chili sauce or powder. I like Jalapeno, with a little honey. For more of a candy substitution, I use a dusting of cinnamon with a spritz of honey. Note while it can be quite nutritious popcorn still has plenty of calories and be careful nutritional yeast can be grown on all sorts of ag waste so make sure your source is reputable.