The Drama of Nutrition

Intro

When I started this podcast/blog a few years ago, I was basically doing it as a way to kill time. I really liked listening to podcasts, I enjoyed talking to people smarter than me, and I enjoyed editing and producing the audio. I started it in grad school and found it to be terribly satisfying. The blog portion of this endeavor was mainly as a “show notes” page or summary page. Eventually the podcast portion of this site went dormant some years ago, although I keep telling myself I will revive it soon. It’s very common for me to run across someone in person or in a book or something and think. “This is fascinating. I should see if they would not mind being interviewed.” But I rarely actually reach out to people for interviewing anymore because I know I won’t have the time. Others can interpret that as I choose not to make time for doing it which is probably fair, too.

Then I got out of school and started climbing the career ladder and the blogging itself became less and less frequent. Nonetheless I always imagined this would be a place to discuss academic nutrition science, nutrition science in the news, the food industry, food safety, food chemistry, and all that nonsense. However, this post will be a little different. This is going to effectively be about stupid he-said-she-said bullsh*t, high school drama with only a passing relation to actual nutrition science, so if that kind of thing is not your bag then just skip this post.

Background

I became compelled to write this post after seeing a tweet by Nina Teicholz the other day.

This tweet links to a post that paints Teicholz as something of a nutrition policy martyr: someone who just wanted to bring capital-T Truth to the ignorant masses and is crucified for it like some sort of modern day Galileo. I don’t know much background on what exactly happened, but the Consumer Federation of America organized a conference on nutrition policy that included several panels on the topic of nutrition policy. Apparently someone over there had the boneheaded idea of inviting Teicholz to be one of the panelists.1

Who knows what happened after that. Maybe someone decided to do some actual research on her or maybe all the other panelists were insulted to even be on the same panel as Teicholz.2 Now they have two choices, both of which are sub-optimal: keep Teicholz on the panel and undermine your other panelists and possibly your organization’s reputation or uninvite her and give her perhaps the greatest marketing gimmick she has had all year. It would seem CFA chose the latter. She can now claim that the self-proclaimed nutrition elite are attempting to silence discussion and debate, and she has trumpeted this quite loudly at least on Twitter. It plays right into her narrative.

Vigorous Debate

Here we get to the meat and potatoes of this post. I don’t think Teicholz has any real desire for a substantive debate on the science, she just wants to appear that she does because it sounds good to the people who buy her books and the (misinformed) billionaires that fund her fledgling Nutrition Coalition advocacy group.

I know she cares not for any kind of scientific debate because she had agreed to come on my podcast to discuss her book in a more skeptical light then blew it up. She agreed, but then mere hours before we were to meet she told me that she would not do the interview, but that if I scrubbed my posts on her she would “feel more enthusiastic” about meeting.

teichols emails

For some context I had invited her on the podcast multiple times and was ignored each time.3 That is until Marion Nestle linked to my blog and Techolz admonished her for doing so in the comments, along with some contradicting opinions regarding my blog: it was the only serious critique of her work she had seen and even thanked me for my “good work” yet it was apparently sloppy and riddled with errors.4 I again invited her to discuss these alleged errors on my podcast to which she surprisingly agreed!5

So we emailed back and forth to nail down a time that worked for both of us. Then at literally 2:25am, a few hours before we were supposed to get together, she emails me claiming that she was too busy to meet. (She also asked me if I was going to some sort of BBQ dinner which is what that is about.) Then I said what I did above.

I think the message is pretty clear. She will not engage with any skeptics, despite the following statement in her book6:

A scientist must always try to disprove his or her own hypothesis. Or, as one of the great science philosophers of the twentieth century. Karl Popper, described, “The method of science is the method of bold conjectures and ingenious and severe attempts to refute them.”

Also around this time I heard more than just a rumor from an acquaintance at NYU that Teicholz was attempting to hire a NYU grad student to research the citations in my critique of her book. The fact that she attempted this speaks volumes. Shouldn’t she posses the studies she herself cited, and shouldn’t she be able to understand and interpret them?

Interestingly this attempt to hire someone to presumably research my critique was immediately after she agreed to come on my podcast: Feb 24, 2015. I am assuming since no rebuttal to my critique has appeared from Teicholz, no grad student took her up on her temporary employment offer. Either that or perhaps someone did but found no errors in my work.

Bottom Line

It’s pretty evident that Teicholz is not interested in debating the merits of “her” ideas. She wants no part in a vigorous scientific discussion. She does not want to engage with anyone skeptical of the ideas she writes about.

Still I am open to the possibility that people can change. If she at any point is interested in having that conversation we should have had over a year ago in Austin I welcome it. Despite the fact that she gave me the shaft that day, Nina can consider this an open invitation to have that great debate.

Epilogue

I read a piece in the New Yorker today by Atul Gawande.7 It was about science deniers. A paragraph caught my eye and made me think of the low-carb movement:

Science’s defenders have identified five hallmark moves of pseudoscientists. They argue that the scientific consensus emerges from a conspiracy to suppress dissenting views. They produce fake experts, who have views contrary to established knowledge but do not actually have a credible scientific track record. They cherry-pick the data and papers that challenge the dominant view as a means of discrediting an entire field. They deploy false analogies and other logical fallacies. And they set impossible expectations of research: when scientists produce one level of certainty, the pseudoscientists insist they achieve another.

If anyone follows the diet wars I think you can see where I am going here. I’m not about to write a treatise on this, but a few bullet points are okay, right?

They argue that the scientific consensus emerges from a conspiracy to suppress dissenting views.

  • This is literally what The Big Fat Surprise and Good Calories, Bad Calories are about. Most all other low-carb nonsense being derived from Good Calories, Bad Calories, anyway.

They produce fake experts, who have views contrary to established knowledge but do not actually have a credible scientific track record.

  • Just look at the parade of clowns that Tom Naughton in Fat Head claims are experts. What other standard-bearers do we have for the current low-carb movement? Jimmy Moore?  Zoe Harcombe? Are you kidding me with these people? Gary Taubes and Nina Teicholz have been so thoroughly discredited it’s amazing they can still pretend to be experts. Oh yeah, money. Volek and Phinney are probably the best they have. Or Kevin Hall. No wait he is a traitor because he might be publishing results not favorable to NuSI.

They cherry-pick the data and papers that challenge the dominant view as a means of discrediting an entire field.

http://carbsanity.blogspot.com/2014/06/nina-teiholz-shaister-part-i-diets-of.html

http://carbsanity.blogspot.com/2014/06/nina-teiholz-shaister-part-ii.html

http://carbsanity.blogspot.com/2014/06/nina-teiholz-shaister-part-iii-well.html

http://carbsanity.blogspot.com/2014/06/nina-teiholz-shaister-part-iv-random.html

http://carbsanity.blogspot.com/2014/06/plagerizing-plagiarism-and-plagiarists.html

http://carbsanity.blogspot.com/2014/05/no-big-surprise.html

http://carbsanity.blogspot.com/2015/02/nina-teicholz-distorts-facts-again.html

http://carbsanity.blogspot.com/2015/02/nina-teicholz-corrects-big-fat-surprise.html

http://carbsanity.blogspot.com/2015/03/nina-teicholz-distorts-fatty-acid.html

Slipp Digby discusses Teicholz’s biases

http://slippdigby.wordpress.com/2014/10/15/nina-teicholz-health-ministers-and-the-swedish-government-low-carb-diet-guidelines/

http://slippdigby.wordpress.com/2015/03/30/eat-like-an-ancient-egyptian/

And others:

http://velvetgloveironfist.blogspot.com/2015/03/nina-teicholzs-big-fat-surprise.html

http://www.huffingtonpost.com/david-katz-md/diet-and-nutrition_b_5266165.html

http://www.huffingtonpost.com/david-katz-md/were-fat-and-sick-and-the-broccoli-did-it_b_6744724.html

http://www.huffingtonpost.com/michael-f-jacobson/distorting-nutrition-facts-to-generate-buzz_b_6776024.html

http://www.foodpolitics.com/2015/02/dietary-guidelines-shouldnt-be-this-controversial/

(I might be leaving a few out…)

They deploy false analogies and other logical fallacies.

  • Like it’s going out of style. The ad hominem, the straw man, tu quoque, petitio principii, special pleading, and the good ol’ anecdotal evidence are also popular.

And they set impossible expectations of research: when scientists produce one level of certainty, the pseudoscientists insist they achieve another.

  • Indeed. Epidemiological studies are used to make the case for low carb diets, yet when they are used in favor of a more plant-based diet then all of a sudden epidemiology is not a real science, and clinical trials are the only acceptable evidence. When clinical trials are marshaled in favor of diets that are not low-carb then there is always a reason to dismiss them: The population is too small, the duration was too short, they didn’t measure the right things, the diets weren’t controlled well enough, some people dropped out, the author of the study spoke at a vegetarian conference, or one study doesn’t prove anything. I am not making any of these up, by the way. They are real excuses.

cloud

1. Not that panels like this have any real effect on policy making. It’s not like the Consumer Federation of America is an arm of the government or anything. It appears to be a private non-profit advocacy group. And speaking as someone who has attended a number of conferences like these it’s just a lot of navel-gazing, and I think an excuse for some people to get away from their jobs for a week and stay in a Hilton on their employer’s dime. Networking for the purposes of advancing one’s career is probably the the only real outcome of conferences like these. But that’s just my opinion, I could be a cynical old coot.

2. I know I would be upset if I had spent my entire career involved with nutrition policy and I get invited to speak on a panel with someone who clearly has no knowledge or education in nutrition or policy (other than cranking out a poorly researched book). I mean, imagine a different panel discussing something like foreign policy and you have a four-star general, a professor of political science, a former ambassador… and Alex Jones. Just being on the panel lends credibility to crackpot ideas.

3. If you click that reddit link to Teicholz’s AMA you’ll find links by /u/melissaf1015 that I actually think is really Teicholz herself trying her hand at astroturfing.

4. Interestingly, every time Teicholz mentions me in a comment section of a site or elsewhere she makes a number of errors about yours truly that are completely made-up, while the actual facts about me are easily found on my About page.

5. Not that it really matters, but I was actually both very excited and very nervous about the prospect. I wanted it to be a really well-done episode, so I spent a great deal of time researching and even bought some fancy new recording equipment. This had all the makings of a great podcast episode.

6. Gary Taubes unsurprisingly makes the exact same statement in Good Calories, Bad Calories.

7. As it happens, Atul Gawande unfortunately kind of, sort of (but not really) endorses Teicholz in a tweet. Shame he wasn’t a bit more discerning before tweeting her out.

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Eggs and Heart Disease

[Eggs and Heart Disease mp3]

What’s the deal with eggs?

It seems that some foods like eggs and margarine are on a perpetual pendulum with the media and, by extension, public opinion. Some days the egg is vilified as a harbinger of heart disease, while other days everything is coming up roses for the little guy. Case in point: Here is a recent article from a local Charleston news station stating

A new study suggests just three egg yolks per week can accelerate heart disease almost as much as smoking.

This article is based off a recent study from Canada published in the journal Atherosclerosis.1 Contrast this with the Harvard School of Public Health’s official position on eggs:

Recent research has shown that moderate egg consumption—up to one a day—does not increase heart disease risk in healthy individuals and can be part of a healthy diet.

So which is it? Three eggs a week is as bad as smoking or one egg per day is perfectly healthy? It cannot be both. So what should we believe?

As of now the link between serum cholesterol2 and heart disease is about as near to a capital-F Fact as you get in nutrition science.  So when you hear that eggs are really high in cholesterol compared with most other foods commonly consumed in the United States, one logical conclusion you could draw from this (if you eat a fair amount of eggs) is the following: If I stop eating eggs I will reduce my risk of heart disease. However, the waters of truth become muddier when you try to examine the actual science behind this bit of conventional wisdom.

Lucky for us my colleague Carrie Dennett did most of the leg work and found the best research available on the subject. What follows is adapted from her research.

Epidemiological Studies

  • An analysis of data from the Framingham Heart Study in 1982 was one of the first epidemiological studies to suggest that there was no significant association between egg consumption and coronary heart disease (CHD), myocardial infarction, or all-cause mortality.3
  • The “Harvard Egg Study” looked at the association between egg consumption and the risk of CHD in two prospective cohorts, the Health Professionals Follow-up Study and the Nurses’ Health Study. After adjustment for age, smoking and other CHD risk factors, there was no significant association between recent or long-term consumption of up to 1 egg per day and risk of CHD or stroke. However, subjects with existing hypercholesterolemia, cardiovascular disease, diabetes, or cancer were excluded from analysis.4
  • Djousse and Gaziano examined the association between egg consumption and CVD and total mortality among 21,327 participants from the Physicians’ Health Study I. The authors concluded that consumption of up to 6 eggs per week does not influence the risk of myocardial infarction, stroke, or total mortality in healthy U.S. male physicians.5 Individuals who ate beyond six eggs per week, however, did see an increase in CVD risk.
  • Data from the First National Health and Nutrition Examination Survey (NHANES-1) and the NHANES-1 Epidemiological Follow-up Study (NHEFS) was examined and a multivariate analysis found no significant difference in the relative risk of incident stroke, ischemic stroke, coronary artery disease (CAD) and mortality between low (1 egg/week or less), moderate (1-6 eggs/week), and high egg consumers (greater than 6 eggs/week).6 One important exception were high-egg-consuming diabetics who had twice the normal risk of CAD.
  • The Japan Public Health Center-based prospective study on cancer and CVD, which involved 90,735 men and women (ages 40-69), found no association between almost daily egg consumption and CHD incidence.7
  • Researchers in Spain looked at egg consumption among 14,185 subjects from the prospective cohort participating in the SUN (Seguimiento Universidad de Navarra) Project and found no association between the highest level of egg consumption (greater than 4 eggs/week) and the lowest (less than 1 egg/week).8

All of the above studies suggest that eggs are relatively benign and have little effect on one’s risk of cardiovascular disease. However, there would have to be at least a few that show some detrimental associations of eggs. After all, the well-ingrained idea that eggs are risky business has to be more than just a hunch, right? And indeed there are a handful of such studies.

  • Australian Aborigines were followed from 1988-89 to 2002 and it was found that consumption of 2+ eggs per week was associated with a 2.6-fold increased risk of CHD.9
  • A prospective study of 10,802 men and women in the United Kingdom found a 2.7-fold increased risk of death among subjects who consumed 6 or more eggs per week.10

However, Carrie notes in the podcast that the authors of the first paper did not collect information on fruit and vegetable intake and thus were unable to determine if there was an inverse association between high fat consumption and low intake of fruits and vegetables. Furthermore, the authors of the second paper used a food frequency questionnaire (FFQ) that was validated only for fiber intake. This means it has been shown that the FFQ they used measures fiber intake fairly accurately, but it has not been proven that it can do the same for other nutrients.

Controlled Trials

It was noted in the podcast that hyperlipidemic individuals are usually excluded from major studies like these. An exception that we discussed was a randomized, placebo-controlled crossover trial of 40 hyperlipidemic adults by Njike et al.11 Study subjects were randomly assigned to daily consumption of two hardboiled eggs or egg substitute for six weeks, separated by a 4-week washout. They found that egg consumption did not have a detrimental effect on endothelial function or plasma lipids. What was interesting, though, was that the egg substitute group showed a significant improvement in endothelial function, total cholesterol, and LDL cholesterol. Similar results were seen in an identically structured study by Katz et al that used treatment with daily consumption of either two eggs or oats for 6 weeks by 50 healthy men and women (mean age 56 years).12

Carrie also mentioned a study involving hyper- and hyporesponders13 of dietary cholesterol. A randomized crossover trial in Mexico examined the effect of dietary cholesterol from eggs.14 The subjects (30 boys and 30 girls aged 8-12 years) were randomly assigned to eat either two whole eggs or egg substitute for 30 days, with a three-week washout period. Each child was then classified as a hyperresponder or hyporesponder based on their degree of plasma cholesterol response. The hyperresponders had an increase in LDL and HDL cholesterol during the period of whole egg consumption, with the LDL:HDL ratio remaining the same. Hyporesponders had no significant alterations to LDL or HDL.

Of course now we get into even more complicated waters when we include discussions of not just total cholesterol but also LDL:HDL ratios. The previous study even mentions differentiating the small, dense LDL particles from larger, more buoyant LDL particles. There is actually a big difference between the two types, with the former more strongly linked to the heart diseases that we all want to try and avoid. But that is perhaps a topic for another day.

Choline

Carrie also brought up the fact that eggs were a major dietary source of choline. However, we were both having some trouble trying to remember what good non-animal sources of choline were available to vegetarians and vegans. Luckily Wikipedia never disappoints.15 Vegans should have no trouble incorporating some of those foods into their diet. Although, on a gram-for-gram basis eggs seem to be a good way to go, otherwise you’ll have to eat an entire pound of spinach to get a similar amount of choline that one egg’ll give ya.

Bottom Line

Eating a few eggs a week is not likely to increase your risk of heart disease, especially if you’re already healthy. On the other hand, if you have diabetes or some other metabolic disorder such as hyperlipidemia or hypercholesterolemia you should be mindful of how many eggs you are eating in a given week. You may need to limit your egg consumption to only 1 or 2 per week. In any case, discuss it with your primary physician.

  1. which is not a fringe journal
  2. the cholesterol circulating in your blood vessels
  3. Dawber TR, Nickerson RJ, Brand FN, et al. Eggs, serum cholesterol, and coronary heart disease. The American Journal of Clinical Nutrition 1982;36(4):617-25.
  4. Hu FB, Stampfer MJ, Rimm EB, et al. A Prospective Study of Egg Consumption and Risk of Cardiovascular Disease in Men and Women. JAMA: The Journal of the American Medical Association 1999;281(15):1387-94.
  5. Djoussé L, Gaziano JM. Egg consumption in relation to cardiovascular disease and mortality: the Physicians’ Health Study. The American Journal of Clinical Nutrition 2008;87(4):964-9.
  6. Qureshi A, Suri M, Ahmed S, et al. Regular egg consumption does not increase the risk of stroke and cardiovascular diseases. Med Sci Monitor 2007;13(1):CR1-8.
  7. Nakamura Y, Iso H, Kita Y, et al. Egg consumption, serum total cholesterol concentrations and coronary heart disease incidence: Japan Public Health Center-based prospective study. British Journal of Nutrition 2006;96(05):921-8.
  8. Zazpe I, Beunza JJ, Bes-Rastrollo M, et al. Egg consumption and risk of cardiovascular disease in the SUN Project. European Journal of Clinical Nutrition 2011;65(6):676-82.
  9. Burke V, Zhao Y, Lee AH, et al. Health-related behaviours as predictors of mortality and morbidity in Australian Aborigines. Preventive Medicine 2007;44(2):135-42.
  10. Mann JI, Appleby PN, Key TJ, et al. Dietary determinants of ischaemic heart disease in health conscious individuals. Heart 1997;78(5):450-5.
  11. Njike V, Faridi Z, Dutta S, et al. Daily egg consumption in hyperlipidemic adults: Effects on endothelial function and cardiovascular risk. Nutrition Journal 2010;9(28).
  12. Katz DL, Evans MA, Nawaz H, et al. Egg consumption and endothelial function: a randomized controlled crossover trial. International Journal of Cardiology 2005;99(1):65-70.
  13. Hyperresonders in this context means those individuals who have an increase in serum cholesterol in proportion to increased dietary cholesterol. Hyporesonders are those individuals that do not see such an increase in serum cholesterol.
  14. Ballesteros MN, Cabrera RM, del Socorro Saucedo M, et al. Dietary cholesterol does not increase biomarkers for chronic disease in a pediatric population from northern Mexico. The American Journal of Clinical Nutrition 2004;80(4):855-61.
  15. That’s not true. I’ve been disappointed by Wikipedia a few times.