Blog | Monday, March 25, 2013

Better diet? Bigger picture!


A study just published online in the New England Journal of Medicine demonstrates a reduction in both chronic disease and premature death with adoption of a Mediterranean diet. This has some journalists opining that we now have evidence of a benefit we did not have before. Actually, that is untrue. We have long had evidence of the disease-fighting, death-defying potential of a well-practiced Mediterranean diet.

The new study has longtime proponents of the Mediterranean diet crowing as if this now proves it is the best diet going. That, too, is untrue. While an attempt was made in the new study to compare the Mediterranean diet to a healthful low-fat diet, participants in that group didn't really cut bad fats out of their diet. They mostly just kept eating a typical Western diet, which we already knew was bad. That the Mediterranean diet was better than the typical, prevailing diet of industrialized countries is yesterday's news. Those who want today's news to be that the Mediterranean diet has been proven superior to other truly good diets will need to wait until tomorrow, or longer. We had previously lacked any good head-to-head comparisons of "best diet" candidates, and we still do.

My colleagues who advocate for healthful low-fat eating have been quick to note that the comparison group in this trial was not it. But they may also go too far in defense of preconceived notions if they refuse to acknowledge that based on the evidence we have, a good interpretation of the Mediterranean diet is likely to be just as good as veganism for human health, if not necessarily as good for the planet and our fellow species.

What shakes out of all of this is the perennial tendency to find the patterns we are seeking, while missing the forest for the trees. Do we know what single dietary pattern is best for human health? We do not.

Do we know what fundamental theme of eating is best for human health? We certainly do -- as surely as we know that pandas should eat bamboo, and koalas should eat eucalyptus, and for many of the same reasons. Do we know how great the benefit of lifestyle as medicine could be? We do indeed, if only we could get the right medicine to go down. And no, more spoons full of sugar would not be helpful!

We have plenty of relevant science. We also have our common sense, although we tend not to apply it very commonly where diet is concerned. And we have, if we are willing to take in the view, an opportunity to see the (whole) elephant in the room.

Science, sense and elephense

(This poem was originally published in the online supplement to: Katz DL. 2011 Lenna Frances Cooper Memorial Lecture: The road to HEaLth is paved with good InVentions: of science, sense, and elephense. J Acad Nutr Diet. 2012 Feb;112(2):313-321. The audio link to the 2011 Lenna Frances Cooper Memorial Lecture is available here.)

Where the perils that threaten
prevail and surround-
it's not in small parts
that solutions are found.
There can be cause to love reduction
But I see the menace in its seduction.
In saying so,
I intend no provocation
Of this worthy congregation-
I just have this predilection
For review, and redirection.
And my fervor lies in finding means
to answer the right question;
Not in seeking foot of emperor
to practice genuflection!
So while I, too, profess compliance-
(In the company of giants)
With the tried and true of science-
I allow for some defiance:
Skiers race
An avalanche, a flight
That's make or break;
Would it count as
Defiance to say
There's no science
To indict a particular flake?
A river swells to
Cresting; its banks devolve
To mud. There's no science
To say that no science
Can say which sandbag
Stops the flood.
When with steadfast equanimity
We have parsed all plausibility
When to our telomeres we're diced
And from their bits, genomes respliced-
We may agree it is terrific
To be robustly scientific-
But lest we're muddled in denial
we must concede the best-run trial-
Though potentially inspired
Is still in tribulations mired.
For while to build a better sandbag,
we might design a RCT;
That we're wet and need a levee,
is on display for all to see.
We need science for microscopes
We need science for telescopes
But let's acknowledge, my friends
That the view decides the lens!
And while perceiving complications
may be something like reflex
A job may be hard instead of easy,
yet still be simple, not complex.
In this mad view, there's method,
whatever you may think-
For while it's true, I do see elephants-
they're only very rarely pink!
Through the trees to the forest,
we must all strive to perceive
When we do, we can't tarry-
We'll get no reprieve
We'll have miles to go, to get out
of the wood
And turn WHAT we all know,
into HOW to do good!
With utensils in hand
To carve up the beast...
We might pause to consider:
On what parts we feast?
Trees and forest;
View and lens-
Knowledge and power
Science and sense:
What road
We ought to choose
At the fork twixt
Win, or lose-
Could just come down
To views; and seeing
Past parts...
To whole elephense.
My friends, from the start
it was my intention
To make the case for good invention
for where there's a will
There's a way to be paved
So the health of our families
Can be righted, and saved.
And I'm confident
We can all escape our doom-
If we'd just see the elephant
Here in the room!

David L. Katz, MD, FACP, MPH, FACPM, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care. He is a board certified specialist in both Internal Medicine, and Preventive Medicine/Public Health, and Associate Professor (adjunct) in Public Health Practice at the Yale University School of Medicine. He is the Director and founder (1998) of Yale University's Prevention Research Center; Director and founder of the Integrative Medicine Center at Griffin Hospital (2000) in Derby, Conn.; founder and president of the non-profit Turn the Tide Foundation; and formerly the Director of Medical Studies in Public Health at the Yale School of Medicine for eight years. This post originally appeared on his blog at The Huffington Post.