Saturday, August 17, 2013

Hilde Bruch Quote

"Looking at obesity without preconceived ideas, one would assume that the main trend of research should be directed toward an examination of abnormalities of the fat metabolism, since by definition excessive accumulation of fat is the underlying abnormality. It so happens that this is the least work has been done." - Hilde Bruch

Tuesday, May 10, 2011

The Bad Cholesterol Myth

Here is a succinct statement from a researcher about the so-called "good" and "bad" cholesterol (hat tip: Richard Nikoley).

The bottom line: LDL is a delivery mechanism.

"What our study found was that the more LDL-cholesterol, the so-called 'bad cholesterol' you had in your blood, the better you built muscle with resistance training. LDL is not "bad," it is an essential physiological component of our blood that does a job, and, we need to back off calling it 'bad cholesterol.'"

Thursday, May 5, 2011

The Robert Lustig Diet?

I get a number of inquiries, both through the search engines and in person, regarding Dr. Lustig, and what diet he recommends. The following is not the “Lustig Diet” per se, but it is what he and the University of California, San Francisco Center (UCSF) for Obesity Assessment, Study & Treatment (COAST) recommends.

From Sugar: The Bitter Truth:

We write this on the back of a matchbook. It’s just as simple as you can make it. We have four things we teach the kids to do, and the parents.

1. Get rid of every sugared liquid in the house. Bar none. Only water and milk. There is no such thing as a good sugar beverage. Period.

2. Eat your carbohydrate with fiber. Why? Because fiber is good. Fiber is supposed to be an essential nutrient and we can talk later if you want, after the cameras turn off, as to why fiber is not an essential nutrient – because the government doesn’t want it to be. Because then they couldn’t sell food abroad.

3. Wait 20 minutes for second portions, to get that satiety signal.

4. Finally, buy your screen time minute for minute with physical activity. That’s the hardest one to do. If you play for ½ hour, you can watch TV for ½ hour. You want to watch TV for an hour? Play for an hour. That one’s a hard one.

We follow our patients every three months. Here’s my question: does it work? What do you think? Yeah, it works.

In sum:

1. Eliminate sugar-sweetened beverages.
2. Eat carbohydrates with natural sources of fiber
3. Wait 20 minutes for second portions
4. Buy screen time with physical activity, minute for minute.

Tuesday, May 3, 2011

Are a balanced diet and moderation really the answers?

I can’t tell you how many times I have heard from one of my colleagues in nutrition tell me “everything in balance and moderation.” Virtually any time we start talking about what constitutes a healthy diet, they invariably tell me it’s all about eating a balanced diet and eating everything in moderation, even if it’s unhealthful.

As someone who cannot eat cookies in moderation, or smoke cigarettes in moderation, this advice drives me up the wall. When we’re talking about smoking, we try to get the smoker to quit, we don’t tell them cigarettes are good in moderation. If it’s the cigarettes that are giving us lung cancer and it’s the sugar, refined, and easily digestible carbohydrates that are making us fat and sick, why is it copacetic to prescribe these foods, not only in moderation, but as part of a presumably “balanced” diet.

There’s also this notion that if we restrict our consumption, and say, try to eliminate a six-soda-a-day habit from our diet, we’re going to be more likely to give in to our cravings, than if we moderated our soda drinking and allowed for one can of soda per day. This study seemed to demonstrate that people who restricted carbs craved them less than people who ate them in “moderation.” This makes intuitive sense, does it not?

I quit smoking about 15 years ago. I used to smoke a pack of cigarettes a day. Now I don’t even give it a thought. Even when all my friends are doing it and everyone around me is smoking. I haven’t had a cigarette in 15 years, but by the logic of dietitians, I should crave cigarettes more than if I practiced balance and moderation and cut down to five cigarettes a day for the last 15 years. 

Likewise, I don't eat sugar and sweets, but still attend the office birthday gathering that includes a supermarket sheet cake. I don't have any cake. Does that make me some sort of freak? Sort of. People are somewhat bemused by my abstention and I think it makes them question their own behavior and I'm silently judging them. Well, I'm not.

I have a strange feeling that if I continued to smoke five per day and managed to cap it at five, which I would argue would have been excruciatingly difficult on a daily basis, I would have much greater cravings for a cigarette today. In fact, if I had any inkling at all to light up, it would be a greater craving than what I now experience having eliminated them. Yet this is what we are telling fat people to do. Don’t eat the entire pizza, fatty. But don't deprive yourself, either. Just have one slice and savor those bites. Or, perhaps I should give myself that piece of cake because otherwise I will want that piece of cake so badly that I will give into my cravings, and wind up in a food coma under an overpass on route 128.

It’s actually quite ludicrous. Perhaps the lean dietitian doesn’t have cravings for carbs the same way someone who is morbidly obese does and telling someone to feed their habit, but only in small doses, is torturous for many people. I for one find little more ironic than the “Fun Size” snickers bar.

In other words, I would rather go through the pain for a week or two and kick my habit and not have to give it much thought, if it all, for the rest of my life, rather than walking a tightrope of balance and moderation on a daily basis.

A common response to telling people to eat a more ancestral diet is that they "just can't live without" fill-in-the-blank-sugary-doughy-starchy-goodness (cookies, cake, pie, pasta, bread, candy, soda, bagels, etc). I thought this was the case myself years ago. Giving up "an entire food group" [1] is daunting at first, but after you give it up for a while, amazingly, you don't miss it. To go back to cigarette smoking, during the first few days of quitting, all I could think about was having just one cigarette and that I could never live without nicotine. But, as it turns out, the things we just can't live without, we can live without, so long as we live without them. Keeping them in our lives in moderation is a recipe for disaster for many people.

When I ask dietitians and dietitians-in-training what constitutes a balanced diet, they generally tell me that it’s 60% carbohydrate 25-30% fat and 10-15% protein.

One of these things is not like the others, Can you tell which thing is not like the others...By the time I finish my song?

Let’s go to Walter Cronkite circa 1964: ‘Well folks, there are still a few states that have yet to report the results, but we can safely say that the election is still up for grabs at this point. The American people are “balanced” in their decision for who is going to be inaugurated in January. Lyndon Johnson currently holds 61% of the popular vote while Barry Goldwater sits comfortably at 39%.’

I’m sure if you check the archives, this is not exactly the way it went down in the newsrooms.

This happened to be the largest landslide in American presidential-election history.

If our “balanced” macronutrient diet represented three candidates running for president, carbohydrates would represent the largest landslide in presidential history.

Also, the macronutrient group we eat the most of also happens to be the only non-essential category of the three.

We can live without dietary carbohydrates, yet they dominate the current US recommendations for consumption. What’s wrong with this picture?

Quality of the diet dictates quantity of the diet so the worst thing the government could have said, and the cruelest joke they could have played on the public (it would be funny if it weren’t so tragic) was to encourage a decrease in the quality of the diet while prescribing a conscious reduction in the quantity as well.

Think about an Atkins diet for a moment. An induction diet generally consists of - eating to satiety - meat and vegetables. It encourages adequate protein consumption, high fat consumption, and cholesterol consumption, all of which are essential components of the diet.

The promulgation of a low fat, low cholesterol, low calorie, diet, has undoubtedly done us more harm than good. The subtext has always been about moderation and (energy) balance. Problem is, it doesn't work.

Almost all of the research that has been done in the last fifty years has been conducted in the context of a low fat diet for heart-health and weight-loss so it seems that we have some catching up to do.

Something that Jeff Volek mentioned in an interview with Jimmy Moore is that when we're long gone we will look back at the last 30 years of nutrition as the dark ages because people will realize we missed the boat by putting so much effort into low fat and really ignoring the concept of carbohydrate restriction.

Dr. Eades noted much of this in a blog post entitled Last gasp of the dark ages of nutrition. In it, he cites quotes from the New York Times and Wall Street Journal telling us that it’s all about counting calories, and then goes on to dismantle this notion and how the conventional wisdom views everything with a biased lens.

Eades also points to a an illuminating quote by the physicist Max Plank, who said, “A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die and a new generation grows up that is familiar with it.”

The sad reality is we may be reaching a breaking point where our healthcare system can't sustain this level of obesity and diabetes and not only are the opponents dying out, but the population at large seems to be getting sick, fat, and dying as a result of their recommendations.

Well, almost there, guys. We’re getting closer and closer to the breaking point as the obesity epidemic and diabetes epidemic - to name two - increase unabated while you admonish people for their lack of will power.

So let's get some fresh blood in there. Let's put a few new cars on the road and be sure to ‘kick the tires’ of the low carbohydrate hypothesis. But the important thing is to allow the low carbohydrate vehicle out of the garage and put some miles on it so we can properly evaluate it.

[1] This phrase turns out to be nonsense, but this is how dietitians like to pooh-pooh an Atkins or Paleo diet - grasping for straws at this point - remember when these diets gave us heart disease, cancer, obesity, diabetes? Turns out when we lose this "food group" we lose the diseases as well. But check out this article, Paleo Diet: Caveman diet draws grunts from nutritionists (hat tip to Angelo Coppola at Latest in Paleo #13), subtitled: Avoiding entire food groups is a mistake, critics say. Perhaps, grains shouldn't be considered a food group when they weren't consumed for more than 99% of our existence on earth as a species? Are cookies a food group?

Wednesday, April 27, 2011

High Fat Diets: The Sweet Deception

Robert Lustig was recently interviewed by KQED and had this to say:

How do you get diet induced obesity in a rat? People say put them on a high fat diet. Garbage.
You can't get a rat to eat a high fat diet...unless you add 20% sucrose to the diet. Basically you're giving them cookie dough.
But if you give them lard they won't eat it. They actually lose weight on that because that's the Atkins diet for them. It's not palatable. They don't like it and they actually lose weight and their metabolic parameters improve.
The only way to get an animal; a rat, monkey, or any other animal, for that matter, to eat a high fat diet is to lace the fat with sucrose.
So the question is: which is doing the damage, the fat or the sucrose in that case? And the answer is both.

In a recent post entitled Diabetic nephropathy and the lost Swede at Hyperlipid, Peter links to a recent paper in PLoS which demonstrated a partial reversal of diabetic nephropathy in mouse models.

“These studies demonstrate that diabetic nephropathy can be reversed by a relatively simple dietary intervention,” conclude the authors of the paper.

Peter goes on to cite a Swedish paper - that the recent paper above did not cite - which demonstrated a reversal of renal failure by a low-carbohydrate diet.

While the PLoS study neglected to mention the Swedish paper, they referenced a 2007 paper entitled A high-fat, ketogenic diet induces a unique metabolic state in mice.

Bottom line for these researchers? “These data indicate that KD [Ketogenic Diet] induces a unique metabolic state congruous with weight loss.”

The diets were:

1) Control, or, Chow (16.7% fat, 26.8% protein, 56.4% carbohydrate (6.5% sucrose))
2) High Fat (45% fat, 24% protein, 35% carbohydrate (17% sucrose))
3) Ketogenic Diet (95% fat, 5% protein, 0% carbohydrate)

Wait, so which one is the “high-fat” diet, again? “High-fat” is 45% fat, while KD is 95% fat. It has been mentioned before at this blog, and warrants mentioning again: in science, you need well-defined variables.

When researchers compare a low-carbohydrate diet to a low-fat diet, what constitutes “low” depends on which team of researchers you ask. There is no well-defined number or percentage. Also, invariably, when the diets are compared, the low-carbohydrate diet is ad libitum, which is a fancy way of saying “all-you-can-eat.” The low-fat diet is restricted in calories, but more often than not, the researchers do not make this distinction throughout their articles. These are just a couple of examples to the limitations of the current definitions, and there are more, to be sure.

With a “high-fat” diet which happens to contain 162% more sucrose as a percentage of carbohydrates compared to the chow, perhaps the researchers and the people reporting the results should mention something about this? Considering when the researchers remove the sucrose and add fat (i.e., the ketogenic diet), the problems magically disappear, it just might warrant mentioning, and might bring into question the quite liberal use of the term "high-fat" in this context.

While Dr. Lustig and I can agree that we think it’s garbage to claim that we induce obesity by feeding mice, or humans for that matter, a “high-fat diet,” it seems we part ways regarding why the mice eat less on a ketogenic diet (i.e., a  high-fat, little-to-no-carbohydrate diet) and also regarding what is doing the damage. Lustig thinks its sucrose and fat? A little bit odd coming from the guy who said “It ain't the fat, people.” Perhaps I'm picking nits, but doesn’t this imply that you need to feed a human both sucrose and fat to induce damage? (I would also like to address the idea that the KD is not “palatable” and the absurd implication that dieters eat less out of boredom that many researchers, academicians, journalists, physicians, and authors alike invoke, but will save it for another post. To keep you “satiated” in the interim, here is a great post by Dr. Eades on the subject.)

In other words, if we had two arms of a randomized controlled trial (RCT):

1. 2500 kcal: 90% Fat; 10% Protein; 0-1% CHO
2. 2500 kcal 0-1% Fat; 10% Protein; 90% Sucrose;

Would both of these groups lose weight and improve their metabolic parameters? Let’s say prior to baseline they have an average BMI of 32, and they have been relatively weight stable in the past 6 months eating:

2500 kcal: 30% Fat; 10% Protein; 60% CHO (about 20% sucrose)

As Lustig has said, a calorie is not a calorie, and calories can be isocaloric, but not isometabolic.

In other words, the second arm of the RCT is taking in 90%, or about 2250 calories of sugar, and 1125 calories of fructose. This amounts to about 281 grams. Lustig has said to shoot for less than 50 gm.

Why would the fructose be particularly damaging? After all we’re talking about “fruit” sugar. How can something in fruit be bad for us? Sugar is natural. Have we just refuted the idea that sugar is toxic, poison, and evil?

As Gary Taubes pointed out in a recent interview on NPR, and Paracelsus (not sure if it was on NPR as well) in the early 16th century, the effective dose makes the poison.

One of the points biochemists will make is you can’t just say that something is natural.
A metaphor is I could lean on you and apply a gentle pressure for 10, 20 minutes, an hour, it’s not going to do you any harm. But if I take that same amount of pressure and condense it into a split-second, then I’m hitting you in the arm pretty hard, and it hurts, and I’m going to cause swelling and pain, etc.
And that’s what we’re doing when we consume these sugars in this quantity and especially in liquid-form, it’s like we’re hitting the liver with them, and the liver responds by going “ouch,” and turns it into fat and becomes a little insulin resistant, and then the rest of the body becomes insulin resistant, and over the course of months or years, you end up quite likely with this problem called metabolic syndrome, and all of these chronic diseases stem from there.

As Dr. Lustig pointed out in an interview with Jimmy Moore:

Basically, if you look at the stereoscopic model of fructose, you can’t even imagine how it can stay together as a ring. It’s going to fly apart almost on contact and that means that that reactive ketone group that’s in the fructose is going to react with just about any protein around and it’s going to contribute reactive oxygen species, which ultimately cause vascular damage. That’s basically you down the road to cardiovascular disease. If you’ve let that fructose get past your liver, you’re screwed.

We shouldn’t let researchers, or journalists, or professors, or anyone for that matter, off the hook when they implicate a “high-fat” diet in causing, or even curing, an ailment, without them making the distinction that a “high-fat” diet is a “high-fat-high-sugar” diet in this context.

It could be likely that the increase in sugar is the driver of disease, while the “high-fat” content is along for the ride. The results of the 90% fat ketogenic diets certainly seem to make a case for it.

Thursday, April 21, 2011

The Russian Literature Paradox

And in knowing, that you know nothing, makes you the smartest of all. - Socrates

When I was attending Gary Taubes’s lecture at Tufts University, there was a fair amount of “audience participation.” I mean this somewhat facetiously because I was practically the only individual taking part.

Taubes would present a slide and a quote by someone in the field of nutrition and he would ask the audience of predominately nutritional science students and professors to raise their hands if anyone had heard of the quoted person.

“Who here has heard of Louis Newburgh?” Crickets. I would sheepishly raise my hand.

A few slides would go by. “Anyone familiar with Carl von Noorden?” Hay bale drifts through the room. My hand goes up. "You don't count; you read my book," quipped Taubes. Fair enough.

But I think there’s an important lesson in this.

I have been taking a distance (read: online) clinical nutrition course in which there is a great deal of discussion on the message boards. Each week, a group of two or three students post a question related to the week’s course topic. Gestational diabetes, carbohydrates and diabetes, metabolic syndrome, childhood obesity, bariatric surgery, saturated fats, and so on. And virtually every week, my opinion runs counter to at least 90% of the students.

Seemingly, it should be relatively easy to dismiss the lunatic with the tinfoil hat (it's comfortable, okay?) as a charlatan, but something odd happens en route. I’m the one presenting the science, the history of nutrition, and the observations that refute the claims of the vast majority. This goes off like a fart in church. Everything popular is wrong? Maybe.

Some people in the class are somewhat supportive, but most, at best, are condescendingly back-patting and thanking me, in their best Dr. Oz impression, for “kicking the tires.” This is what Oz said to Taubes during his appearance. In hindsight, Taubes said that he should have responded: ‘well, Dr. Oz, I'm not sure kicking the tires makes a damn bit of difference after you've totaled the car,’ (his other shelved rebuttal allegedly was ‘the jerk store called, and they’re running out of you’) though he also conceded that this would have been edited out, along with his explanation of the complications of cholesterol, and why he declined having a cholesterol test if they weren’t going to do a comprehensive panel, like the one he ended up getting.)

Others in the class claim that I’m introducing “a totally new science” to health and nutrition and that I should start my own special field. Go home and get your shinebox, Bob.

But here’s the rub: I am introducing science - not a ‘totally new science’ - science, into a field that seems to be actively avoiding it. I'm also just bringing up historical information regarding nutrition and it feels like many people think I'm coming out of left field.

I'm seen as a crackpot by the class when I bring up names like Louis Newburgh, Carl Von Noorden, Hugo Rony, Jean Mayer, Julius Bauer, Ancel Keys, John Yudkin, George Mann, George Bray, George Cahill, Eugene Du Bois, Francis Benedict, et al.

If this were a graduate level physics course (and this is something Taubes illuminated in his lecture), if I brought up names like Plank, Einstein, Tesla, Faraday, Heisenberg, Bohr, Curie, Feynman, Volta, Hubble, Fermi, et al., everyone would know who I was talking about, what they accomplished, and their contributions to the field.

In physics, if you didn't recognize these names, you would be laughed out of the field. In public health, you're mocked if you do.

If I polled the class on the recognition of the twelve names in nutrition and weight regulation I mentioned, how many of these people would they recognize? These people are pioneers in the field, yet we’re not taught very much, if at all, about them. I think it would be helpful.

I happen to know the names of guys like Rony and Bauer and their contributions to the field. For the most part, I know them because Taubes knows the names, too, and included them in articles like The Soft Science of Dietary Fat, What if It’s All Been a Big Fat Lie, The (Political) Science of Salt, and wrote books such as Good Calories, Bad Calories and Why We Get Fat.

It doesn’t make me smarter than anyone that I’m the only one in the lecture hall of 200 people to pass the Taubes test, but I would argue it makes me more informed. And one of the limitations to nutrition as I see it, is that if you really want to have a full understanding of obesity, for example, you need to be familiar with endocrinology, metabolism, weight regulation in animals, anatomy, clinical treatment and trials of obesity in humans, anthropology, exercise physiology, reproduction, cell biology, and have a familiarity with the relevant research, epidemiology, and clinical trials, and the list goes on. It might take a few lifetimes to achieve this.

But it doesn’t absolve the field from trying to learn the basic sciences and have at the very least a cursory understanding of the aforementioned topics. Instead, when I invoke biochemistry and endocrinology in the regulation of adipose tissue in my class, or when I tell them that the brain can run predominately on ketone bodies, they respond that I have “interesting opinions.” It’s the science! I’m not making it up!

This brings me to the latest podcast (episode 76) by Robb Wolf and Greg Everett at The Paleo Solution.

Robb was wonderfully agitated by the following question:

6. Brain Function without Dietary Carbohydrate

Craig Says: My girlfriend is a very recent graduate of nursing school and has been very helpful in my transition from a fellow vegetarian to a “things-with-a-face eater.” But she is very hesitant about my adoption of the Paleo diet mostly based on her contention that the brain cannot function properly without complex carbohydrates such as pastas and rice.  I’ve been 98% paleo for the last two months with a few slips into ice cream hell.  Can you give me a medical explanation that will help me in this battle?  She will not join the meat-eating bandwagon but has definitely reaped the benefits of switching our diet to entirely whole foods.  She is complete agreement with this aspect of Paleo nutrition but can’t understand the low-carb effect on the brain and other important bodily function.  Thanks for being such an accessible and reliable scientific resource.

So Robb dusts off his 4th edition of Stryer’s Biochemistry (I happen to have a copy myself so I think that makes us beaker-brothers or something nerdy - or perhaps we’re just both interested in science - which seems to be such a rarity in the field of nutrition, that it appears peculiar that we would have science textbooks?) and goes to town: the human brain can run predominately on ketone bodies during relative caloric, or carbohydrate, unavailability.

But it, too, brought up a larger point, which is very much related to the previous one about nutritionists having no understanding of the history of the field; they have virtually no understanding of the science behind nutrition as well.

It is valid to point out that physicians receive little to no nutrition training. Chris Kresser was just pointing this out in a podcast with Jimmy Moore. Why listen to your doctor when they have so little training in nutrition? Good question.

But what of the registered dietitians? What are they learning? I happen to be completing my didactic program requirement in dietetics, and feel free to have a look for yourself of the course requirements. There are science courses, to be sure, but it doesn’t seem to explain my experience with dietitians and dietetic students. It is safe to say that most of them don’t understand the biochemistry, endocrinology, biology, physiology, and organic chemistry, for example, at a level where they can explain relatively pedestrian mechanisms of action. To be fair, I was recently trying to work out a problem related to organic chemistry, and turned to an expert in the field, who subsequently asked if I had indeed passed organic chemistry in college. Passed? Yes. Grasped? No. But I’m trying and will continue to do so until I can at least speak the language.

I try to make it a point to surround myself with people who are smarter than me; people who often will tell me that I’m wrong more often than I’m right. Criticism is far more useful than praise. This is how you grow. To remain stagnant is to ignore the voices questioning your methods and results and never seeking alternative explanations or questioning your own ideas. The public health authorities are phenomenal at this.

I don’t think most dietetics students make this kind of effort. What Richard Feynman called “a specific, extra type of integrity that is not lying, but bending over backwards to show how you are maybe wrong, that you ought to have when acting as a scientist.” And “this is the responsibility of scientists,” (perhaps dietitians and public health authorities are immune), “certainly to other scientists, and I think to laymen.”

In fact, most people I know don’t seem to be making the effort, or claim that they just don’t have the time. That’s why I think people like Lalonde, Kresser, Taubes, Lustig, Wolf, et al. are so invaluable, and unfortunately, so rare.

Wolf, later in his diatribe, posited a couple of questions: Why aren’t the nursing and medical students reading the textbooks and scientific literature and questioning the conventional wisdom? And why is the convention wisdom what it is when it seems to run counter to science?

I think it’s because the foundation and core principles of public health operate as a political institution. It may be fair to say that the opposite of science is politics, i.e., politics is anti-science. And this is coming from a blogger who studied political science (an oxymoron, perhaps?) as an undergrad.

Robb also mentioned that he was “mean” to his conference attendees - at a hospital, addressing the medical staff - during a recent presentation and asked them basic biochemistry and metabolism questions; and they could not answer them correctly. And maybe half the people were present to tell Robb what he was saying is wrong.

Sounds a lot like Taubes, his lectures, and his point about the dearth of understanding of one’s own field. Yet these same people in the audience of a Taubes or Wolf lecture are the ones discrediting the lecturer and dispensing the dietary advice; while Gary and Robb are relegated to “kicking the tires.”

Another point that Robb illuminated was The Russian Literature Paradox.

If you run into a PhD in Russian Literature and tell them you read Crime and Punishment, and get into a discussion about Russian lit, and the PhD rattles off names like Alexander Blok, Sergei Yesenin, Anna Achmatova, Marina Tsvetaeva, Osip Mandelstam, Boris Pasternak, Joseph Brodsky, Vladimir Mayakovsky, Ivan Bunin, Vladimir Nabokov, Mikhail Sholokhov, Mikhail Bulgakov, Andrey Platonov, Vassily Grossman and Aleksandr Solzhenitsyn, (I had to look up just a few of these names!) perhaps you should defer to this man’s opinion. It doesn’t mean that his convictions are necessarily true, but it most likely means that he is more informed and has a better grasp on the subject. And perhaps you should educate yourself on the subject before you join the discussion.

With nutrition, everyone eats, therefore everyone is apparently an expert in nutrition. Everyone has an opinion, and anyone who has lost more than three pounds in their life (about 99% of the population), feels that they can instill their wisdom upon the masses to great fanfare.

Problem is, even the supposed experts in nutrition can't tell you who the nutritional European and American equivalents to Nabokov, Dostoyevsky, Gogol, and Chekhov are, but boy are they are willing to commentate and pontificate with great resolve.

With Russian Literature, most people are wise enough to heed the advice of Mark Twain: “It is better to keep your mouth closed and let people think you are a fool than to open it and remove all doubt.”

With nutrition, every Tom, Dick, and Harry - and seemingly every public health authority - has no problem opening their mouths and removing all doubt.

In other words, the "experts" in the field of nutrition do not understand nutrition. Therefore, anyone who can rub two brain cells together can contribute to the field.

Meanwhile guys like Gary Taubes, Robb Wolf, Chris Kresser, Chris Masterjohn, Kurt Harris, Stephan Guyenet, Petro Dobromylskyj, Michael Eades, Robert Lustig, Eugene Fine, Eric Westman, Steve Phinney, Jeff Volek, et al., are having collective aneurysms on a daily basis and at some point, I believe, we are all going to realize that engaging the "experts" in a dialogue is like playing handball against the drapes.

I feel like I speak for the bloggers, physicians, and researchers above in a collective message to the public health authorities, channeling my inner-Will-Hunting: “I’m sorry you can’t do this, I really am, because I wouldn’t have to fuckin’ sit here and watch you fumble around and fuck it up.”

I try - and I think this is a common thread among the aforementioned bloggers, writers, researchers, and physicians above - to treat the field of nutrition like a science, because that’s what it presumably is. And I think a significant part of the reason for the massive health problem we have is that it’s not treated as such.