Some weeks ago I got a call from a reporter.1 This reporter had just attended an event called “Politics of the Plate: The Evolution of American Food Policy” presented by Real Clear Politics that included Nina Teicholz and Adele Hite. You can view the event below, but the gist of the event was that the US government’s nutrition policy is bad, it has been based on bad science for years, it advocates a low-fat/high-carbohydrate diet, is anti-fat, and has contributed to the rise in obesity and many chronic diseases we see today.
According to this reporter, the event was compelling enough that he or she wanted to write a piece on it and kind of examine the merits of our nutrition recommendations.2 I was told the piece would be published about a week after our conversation, but as of this writing many weeks later it has not come out. Perhaps I was successful in convincing the reporter that Teicholz and Hite did not know what they were talking about. Or maybe the senior editor of the news outlet didn’t feel it was something that needed to be published. I don’t know. But what I’d like to do here is give something of an expanded version of what I told the reporter.
[Link to the video on Real Clear Politics]
I’m going to get into the merits of the arguments in a moment, but before I do I would like to spend several paragraphs on one logical fallacy I have encountered often when I engage the work of popular low-carb authors and increasingly when the more zealous low-carb adherents engage with me: the false dichotomy.
One employs the false dichotomy when there is little evidence for their position, but there is another position for which there is even less evidence (or there is good evidence against the other position). If the charlatan can convince their audience that these are the only two positions available then their job becomes much easier. All they need to do is poke some holes in the opposing position, and then the charlatan’s position is accepted by default – the charlatan doesn’t even need to provide positive evidence for their own position. In other words, reduce the spectrum of positions, of which there may be countless, to only two, and make sure the opposing position is a rather weak one.
Okay, that last paragraph was perhaps too abstract. Let’s talk about something more concrete. What I see very, very often among proponents of low-carb diets is that there are essentially only two diets out there to follow: the low-fat/high-carbohydrate diet or the high-fat/low-carbohydrate diet. When low-carbers are asked why one should follow a low-carbohydrate diet, often they begin by telling you that a low-fat diet is bad. Nina Teicholz does this in her recent book The Big Fat Surprise: Why Butter, Meat, and Cheese Belong in a Healthy Diet. You might think that the book is a collection of evidence for butter, meat, and cheese being healthy, but it is not. The bulk of the book is dedicated to pointing out how and why a low-fat diet might not be healthy. Very little ink in the book is actually dedicated to making the case for butter, meat, and cheese.
This is actually a pretty smart move on her part, since not a lot of evidence exists that butter, meat, and cheese are healthy. So instead of trying to show legitimate evidence in favor of her position, she reduces the spectrum of diets in the world to essentially low-fat or low-carb and pokes holes in the low-fat diet, hoping her readers accept her low-carb position by default.3
This logical fallacy is also used by the young-earth creationist community. If you follow that issue at all you will notice that the cornerstone of the creationists’ argument is not “Let me present all the scientific evidence suggesting that our deity created life and the universe…” But rather their argument is “Here are some possible inconsistencies with evolution by natural selection…” Now of course creationists can try to poke all the holes they want in evolution, but doing this does not make the scientific case for why young-earth creationism is true. They still have all their work ahead of them.
I feel like I need a picture to break up the wall of text.
Teicholz also employs this tactic when trying to create a bizarre crusade against the USDA. For decades official dietary guidelines have consistently recommended a diet that is 1/3rd fat. A diet that includes ~33% calories from fat may not be considered a high-fat diet, but nobody in their right mind would call this a low-fat diet. No one, that is, except for hyper-dogmatic low-carb proponents like Teicholz. You see, since there are only two diets in existence, and the USDA does not recommend a high-fat/low-carbohydrate diet, it must therefore be recommending a low-fat diet.
Although this kind of argumentation is clearly based on flawed reasoning it seems to be quite effective at both convincing the less-skeptical among the audience and at rallying the troops for the ridiculous anti-government crusade du jour. I have criticized false and misleading statements by low-carbohydrate proponents like Teicholz and Taubes on this website, and I have also made evidence-based criticisms other places online such as Reddit. I am always accused of both following and promoting a low-fat diet.4 It never fails. Nevermind that there is no evidence of this promotion because I have never advocated such a diet; if I point out dishonesty by low-carbers then I must follow a low-fat diet. There is no alternative.
For those too busy to read the long-winded explanation above, I will sum it up as I did in an earlier post: Many LCHF proponents reduce the multiplicity of diets that exist in the world to a low-fat or high-fat dyad. This is overly-simplistic and creates a false dichotomy, which only benefits people interested in deception.
Adele Hite Wants to Change the Dietary Guidelines
If you watched the above video, you’ll notice that Adele Hite is not a big fan of the dietary guidelines. She blames the guidelines for the rise in obesity over the last several years as well as a major contributor to chronic diseases such as heart disease, diabetes, and cancer. She has written a manifesto on her website, complete with a letter-writing campaign where you can print a pre-written letter by Hite and send it to the USDA.
In Hite’s blog post she says the letter “is not a call for low-carb, high-fat dietary recommendations,” but it kind of is. She criticizes what she says are plant-based recommendations, and lists a series of “specific recommendations” that she takes issue with because they are apparently anti-fat and too focused on carbohydrates. By the way, I’m pretty sure these “specific recommendations” are straw men (another logical fallacy!), because I can’t find them anywhere in the full 95-page document of the 2010 Dietary Guidelines for Americans. At least not in the specific wording she uses.
As an aside, I doubt very highly that the Dietary Guidelines for Americans have any meaningful influence over our food consumption. I don’t have any evidence to back this up, but neither do I think Hite or Teicholz have any evidence to the contrary. I bet you dollars to donuts that you could do a man-on-the-street style interview and grab 100 random people and ask them questions about the dietary guidelines like
- According to the Dietary Guideline for Americans, how much folic acid should a woman who wishes to become pregnant consume daily? Answer in micrograms, please.
- According to the Dietary Guideline for Americans, persons aged 51 years or older should consume no more than how many milligrams of sodium per day?
- According to the Dietary Guideline for Americans, pregnant or breast-feeding women should consume seafood ranging from ______ oz to ______ oz per week?
…and NONE of them would know the answers. I bet you could even repeat the experiment with actual medical doctors and you wouldn’t do much better. Besides most of the guidelines are so freaking vanilla that I have a hard time understanding why anyone would be against them? Who could possibly be against recommending a variety of vegetables? Who could be against recommending physical activity? Only people with personality disorders that need attention.
In the video Teicholz says that the guidelines are aggressively influential and she makes ridiculous claims like the NSF and the NIH will only fund research that conforms to the guidelines, ALL nutritionists must conform to the guidelines, ALL doctors must use the guidelines to educate their patients, ALL the Health and Human Services programs are required to abide by the guidelines, school lunch programs must conform to the guidelines… methinks there is a teensy bit of exaggeration going on. I could explain why these claims are ridiculous, but this post is long enough as it is.
Apparently this plate is the worst thing to happen to public health since cigarettes.
In any case, Hite makes some claims in her manifesto that have actual citations. If you are a follower of the blog you know how much I love citations. Let’s dive in!
The DGA have contributed to the rapid rise of chronic disease in America.
In 1977, dietary recommendations (called Dietary Goals) created by George McGovern’s Senate Select Committee advised that, in order to reduce risk of chronic disease, Americans should decrease their intake of saturated fat and cholesterol from animal products and increase their consumption of grains, cereal products, and vegetable oils. These Goals were institutionalized as the DGA in 1980, and all DGA since then have asserted this same guidance. During this time period, the prevalence of heart failure and stroke has increased dramatically. Rates of new cases of all cancers have risen. Most notably, rates of diabetes have tripled. In addition, although body weight is not itself a measure of health, rates of overweight and obesity have increased dramatically. In all cases, the health divide between black and white Americans has persisted or worsened.
From the video
Right off the bat, before we even check any sources, Hite is shown to be a hypocrite. How? I’ll tell you. Hite discusses supposed increases in chronic disease since the DGA have been introduced, arguing that “the DGA have contributed to the rapid rise of chronic disease in America.” She also makes this same case in the video with the fancy graph she had made at Kinkos. To break this down a bit: Event happened (dietary guidelines); then some other things happened (increased disease, allegedly); therefore the event caused the things.5 In case you can’t tell this is the post hoc ergo propter hoc fallacy. Some might know it better as “correlation does not equal causation.” Its use is often criticized by people who know the difference between spurious correlations and causes. People like Adele Hite.
Now let’s get into the claims and the evidence. Since the DGAs were introduced…
Claim: The prevalence of heart failure and stroke has increased dramatically.
Facts: Hite cites the Morbidity and Mortality: 2007 Chart Book on Cardiovascular, Lung, and Blood Diseases. Don’t know why she doesn’t cite the more up-to-date 2012 chart book, but it’s the one I’m going to use. According to the report, heart failure has pretty much stayed constant since the 1980s, with a slight increase for blacks over the years. She is right about stroke, though, at least partly. Prevalence of stroke rose quite a bit up until 2008 when it started declining. But there’s a lot of data in the chartbook that was not mentioned. Why? Because it doesn’t fit nicely into the story Hite is trying to craft. For example:
- The death rates for cardiovascular disease have dropped precipitously since 1980. [chart]
- The death rates for stroke have fallen since 1980. [chart]
- Age-adjusted death rates for coronary heart disease have plunged. [chart] This remains true even when stratifying by race. [chart] [chart]
- Hospital case-fatality rates for acute myocardial infarction have plummeted. [chart]
- Hospital case-fatality rates for heart failure have dropped like crazy. [chart]
- Hospital case-fatality rates for stroke have sunk dramatically. [chart]
- Age-adjusted death rates for stroke have cratered. [chart] Again, this remains true when stratifying by race. [chart] [chart]
Now if Hite wants to blame the DGAs for an increase in stroke prevalence (which she has no business doing in the first place, considering the evidence) then she must also say that the above improvements are also due to the DGAs.
Claim: Rates of new cases of all cancers have risen.
Facts: Her evidence for this is a decade-old publication on cancer statistics.6 The way Hite words that claim you might think each subgroup of cancer (lung, brain, colorectal, ovarian, etc.) have all risen, but this is not the case. Incidence of most cancers has dropped, but if you average all the cancer incidence over the past several years they have risen very slightly as a whole. It seems that the substantial increase in lung cancers skews the average upward. Although, if you look at cancer death rates they have all decreased slightly. Technically correct, but potentially misleading.
Claim: Rates of diabetes have tripled.
Facts: According to the cited source, the total number of persons with diabetes has tripled – not the rate.7 Technically incorrect, but I’ll let this one slide.
Claim: Rates of overweight and obesity have increased dramatically.
Facts: Absolutely true.8 Well, at least obesity rates have increased dramatically. Overweight actually has remained pretty stable through the years.
Claim: All available data show Americans have shifted their diets in the direction of the recommendations.
Facts: This is a juicy one that needs unpacking. This is kinda something that has been batted about on all sides of the nutrition spectrum for several years. Hite cites another old statistics report based on self-reported dietary intakes from 1971-2000.9 Here’s the low-down on that and similar reports: Since 1971 (and even earlier, I’m sure) Americans have been steadily eating more daily calories. In terms of macronutrients we have been eating more of everything. More CHOs, more protein, more fat.10 Thing is we have increased our CHO intake more than we have increased our fat and protein intake, which means that if you look at the relative changes in macronutrient intake we will have narrowly increased our percentage of calories from carbohydrate, and narrowly decreased our percentage of calories from fat and protein. Then what happens is people like Teicholz, Hite, and anyone else with a moneyed agenda claim that the DGAs forced Americans on a low-fat diet which has caused a rise in obesity, diabetes, and all that which is extraordinarily misleading because TOTAL FAT ACTUALLY INCREASED & TOTAL CALORIES INCREASED. This highly relevant context is left out to hornswoggle an unskeptical audience. Don’t be deceived.
Claim: Current choline intakes are far below adequate levels, and choline deficiency is thought to contribute to liver disease, atherosclerosis and neurological disorders. Eggs and meat, two foods restricted by current DGA recommendations, are important sources of choline. Guidance that limits their consumption thus restricts intake of adequate choline.
Facts: Almost entirely false. The source for this claim is a review article on choline.11 An article funded by the American Egg Board if you were curious. The article kinda says that intakes among women are suboptimal. According to the paper the Nurses Health cohort has intakes of about 411 mg/day which is not quite the recommended 450 mg/day. But the eggs and meat statement is preposterous on two levels. One, the current DGAs don’t restrict eggs or meat. In fact they explicitly recommend an increase in egg consumption and lean meat consumption. Secondly, choline is widely available in plant foods as well. In fact the article mentions soy flour as having one of the highest concentrations of choline, along with quinoa and wheat germ.
Claim: In young children, the reduced fat diet recommend by the DGA has also been linked to lower intakes of a number of important essential nutrients, including calcium, zinc, and iron.
Facts: Again, the DGAs do not recommend a reduced fat diet, unless your idea of “reduced fat” is simply “not extremely high in fat.” Further, the study she cites for this claim actually makes the case that lower fat diets are actually healthy for children! From the conclusion: “Lower fat intakes during puberty are nutritionally adequate for growth and for maintenance of normal levels of nutritional biochemical measures, and are associated with beneficial effects on blood folate and hemoglobin.”
Claim: DGA guidance rejects foods that are part of the cultural heritage of many Americans and indicates that traditional foods long considered to be important to a nourishing diet should be modified, restricted, or eliminated altogether: ghee (clarified butter) for Indian Americans; chorizo and eggs for Latino Americans; greens with fatback for Southern and African Americans; liver pâtés for Jewish and Eastern European Americans.
Facts: Nope. At least not explicitly.
Claim: Recommendations to prevent chronic disease that focus solely on plant-based diets is a blatant misuse of public health authority that has stymied efforts of researchers, academics, healthcare professionals, and insurance companies to pursue other dietary approaches adapted to specific individuals and diverse populations, specifically, the treatment of diabetes with reduced-carbohydrate diets that do not restrict saturated fat. In contradiction of federal law, the DGA have had the effect of limiting the scope of medical nutrition research sponsored by the federal government to protocols in line with DGA guidance.
Facts: Nope. At least Hite provides no evidence for these absurd claims. Plus the DGAs even explicitly say that “plant-based sources and/or animal-based sources can be incorporated into a healthy eating pattern.”
Claim: The science behind the current DGA recommendations is untested and inconsistent. Scientific disagreements over the weakness of the evidence used to create the 1977 Dietary Goals have never been settled. Recent published accounts have raised questions about whether the scientific process has been undermined by politics, bias, institutional inertia, and the influence of interested industries.
Facts: For fuck’s sake. Here Hite cites Gary Taubes’s Good Calories, Bad Calories and Teicholz’s The Big Fat Surprise. How many times must we revisit the lies??
Claim: Two recent meta-analyses concluded there is no strong scientific support for dietary recommendations that restrict saturated fat.
Facts: Actually the only one of the two cited studies is a meta-analysis; the other is a review article.12,13 The meta-analysis has been widely misinterpreted to suggest that saturated fatty acids are harmless, but that’s not the case. As we all know some saturated fatty acids are basically benign, like those found in coconut and other tropical oils. Typically the short and medium chain fatty acids. But the data from that paper show that the longer chain fatty acids definitely increase the risk of heart disease, especially stearic and palmitic acids which are the most abundant in animal fats. http://i.imgur.com/H72g1eP.png The only one that appears to decrease risk is margaric acid, a synthetic fat found in margarine. Even when you pool all the saturated fatty acids the net effect is an increased risk of heart disease, although a modest one. All the polyunsaturates, however, were shown to decrease risk of heart disease: http://i.imgur.com/e7lJ6PL.png http://i.imgur.com/YfC1qMx.png
The review article also gets misinterpreted, willfully it seems. It states that replacing saturated fatty acids in the diet with polyunsaturated fats has been conclusively shown to reduce the risks of CVD. It also says replacing saturated fats with carbohydrate offers no real benefit. However, low-carbers like Hite and Teicholz take that last result and make the leap to “saturated fats are good” or “restricting saturated fat is bad.” It is truly deceitful.
Claim: Federal dietary guidance now goes far beyond nutrition information. It tells Americans how much they should weigh and how to lose weight, even recommending that each American write down everything that is eaten on a daily basis.
My sarcastic response: How dare they?? This is clearly an attack. The horror… The horror…
Claim: This focus on obesity and weight loss has contributed to extensive and unrecognized “collateral damage”: fat-shaming, eating disorders, discrimination, and poor health from restrictive food habits.
My response: The government is responsible for fat-shaming now? The USDA caused eating disorders and discrimination because they recommended incorporating more fruits and vegetables? I can’t imagine that demonizing carbohydrates and vegetable oils would cause any kind of eating disorders, though.
At the end of the letter Hite ends with such vague and nonspecific recommendations that no matter what the committee actually decides you would have real difficulty making the case that Hite’s precepts were not followed. Seriously… have the recommendations apply to all Americans; expand nutrition research; include traditionally nourishing foods; are directed towards health and well being; are clear, concise, and useful… I mean, unless the committee recommends a diet of used tires and uranium and does so in an 800 page report written in pig latin, I imagine Hite will have difficulty proving that the USDA did not do just as she instructed.
There may indeed be a case for modifying the current dietary guidelines, but Hite and Teicholz make a bad case based on logical fallacies and the willful misinterpretation of nutrition science. Let’s hope that the people tasked with actually creating these recommendations rely on evidence instead of nonsense.
1. A reporter, by the way, that writes for a legitimate news publication. It wasn’t like Bubba’s Food Blog or anything.
2. I’m keeping the identity of the reporter vague for a couple reasons. First, on the off-chance that he or she still is planning on publishing something I don’t want to scoop them. Secondly, I know from firsthand experience and secondhand knowledge that the more zealous of the low-carb bunch can be rather cruel, and I wouldn’t want the reporter to experience any of that just for speaking to me.
3. She also hopes her readers will assume that a low carbohydrate diet necessarily means a diet high in butter, meat, and cheese, even though the few studies she cites in favor of a low carb diet often use vegetarian sources of protein and plant-based fats in the low-carbohydrate groups.
4. Amusingly, very often I also get accused of being brainwashed by the government and/or being a paid shill for Big Vegetable. I wish I was kidding.
5. In case you want to argue semantics with me and say some crap like ‘she said CONTRIBUTED not caused,’ then I say that’s a distinction without much of a difference. Webster defines contribute as ‘to help to cause something to happen.’
6. Jemal, A. et al. Cancer Statistics, 2005. CA. Cancer J. Clin. 55, 10–30 (2005).
7. CDC – Number of Persons – Diagnosed Diabetes – Data & Trends – Diabetes DDT. at <http://www.cdc.gov/diabetes/statistics/prev/national/figpersons.htm>
8. Products – Health E Stats – Overweight, Obesity, and Extreme Obesity Among Adults 2007-2008. at <http://www.cdc.gov/nchs/data/hestat/obesity_adult_07_08/obesity_adult_07_08.htm>
9. Wright, J., Kennedy-Stephenson, J., Wang, C., McDowell, M. & Johnson, C. Trends in Intake of Energy and Macronutrients — United States, 1971–2000. (National Center for Health Statistics, CDC, 2004). at <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5304a3.htm>
10. Ford, E. S. & Dietz, W. H. Trends in energy intake among adults in the United States: findings from NHANES. Am. J. Clin. Nutr. 97, 848–853 (2013).
11. Zeisel, S. H. & da Costa, K.-A. Choline: An Essential Nutrient for Public Health. Nutr. Rev. 67, 615–623 (2009).
12. Siri-Tarino, P. W., Sun, Q., Hu, F. B. & Krauss, R. M. Saturated fat, carbohydrate, and cardiovascular disease. Am. J. Clin. Nutr. 91, 502–509 (2010).
13. Chowdhury, R. et al. Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk: A Systematic Review and Meta-analysis. Ann. Intern. Med. 160, 398–406 (2014).