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.
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[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?