Tuesday, December 9, 2014
Best diet? Look beyond the beauty pageant
Can we say what diet is best? Well, not on the Today show.
A study published this week in Circulation: Cardiovascular Quality and Outcomes purportedly compared an array of “popular” diets and found that, despite a whole lot of marketing claims and clamor, none was demonstrably better than another, and none was particularly good.
The study, predictably, has been generating a lot of media attention. This is common to almost all high-profile diet studies and almost always comes to my attention, given the professional lens through which I view the world. This case was different, however. I wrote the editorial that accompanied this article, so I have known about the study in all of its particulars since long before the media embargo lifted. Presumably for that reason, I was asked to opine on the Today show.
As I said on TV, this study does indeed suggest that almost all of the “my diet can beat your diet” claims are a product of salesmanship, not science. Consider the huge number of diet books that have been popular over the yeas, every one of which telling you why it is the best. Obviously, that can't be true about all of them. It isn't even true of any of them.
And if the 576,228 (or so) fad diet books we've had so far have failed to provide the Holy Grail of dietary salvation, what, really, is the likelihood the 576,229th will do so? Let's just go with: not much.
As I noted in my editorial, the new study actually provided only a very narrow window to the never-ending dietary beauty pageant. The researchers compared 3 variations on what they themselves called “carbohydrate restricted” diets: Atkins, South Beach, and the Zone. The fourth contestant was Weight Watchers, which is now more about improving food choices overall, but historically has been about using points as a surrogate for calories.
My assessment of the study, it's strengths, limitations, and implications, is fully developed in the editorial, which the journal has generously made openly accessible here, so I won't revisit all of that. Suffice to say the findings of the research indicated that data and diatribe diverged widely. The data did not really back up the claims and clamor underlying any given diet.
Would this still be true if the window were much wider, examining the full expanse of diets competing for our attention, and our cash?
Yes, it would. I know, because I have been obligated to look through those larger windows. I did so while writing the 3 editions of my nutrition textbook, examining for the newly released third edition, and with the help of my co-authors, nearly 10,000 scientific publications. Yes, it was just as painful as it sounds! But it sure did provide the bird's eye view.
I was obligated to do much the same on a smaller scale to write an invited, peer-reviewed paper entitled, “Can we say what diet is best for health?”
So, can we say what diet is best for health and weight control?
Let's start with a bracing dose of honesty, then come back to that question. If you are reading this, you must be literate. If you are literate, you should be able, despite the crap you learned in high school, to read the writing on the wall. The wall says: Grow up!
Anyone with half a wit knows that a get-rich-quick scheme is almost certain to be a scam. But in our culture, that same, generally sensible person reaches for his or her credit card every time a get-thin-quick scheme comes along.
If that includes you, then: Grow up! There is no magical pixie dust for getting to health, any more than for getting to wealth. Treat the two the same, and acknowledge that time, effort, and commitment are required in both cases. What worthwhile thing in your life happens with no allocation of time or effort? Why should health or weight control be different?
They aren't. Grow up about it.
Now, back to the question: Can we, in fact, say what diet is best, for health, and weight control?
Yes, by looking beyond the beauty pageant. Look, for instance, to the Blue Zones. These populations around the world live longer and better than the rest of us, because of what they have in common. They eat diets of food, not too much, mostly plants; they exercise routinely; they don't smoke; they sleep enough; they are not ridiculously stressed out; and their social connections are strong. Feet, forks, fingers, sleep, stress, and love are the 6 cylinders in the engine of lifestyle as medicine, and they are firing on them all. As a result, they often live to be 100, then go to sleep one night, and just don't wake up. Folks, that's how it's done!
But the Blue Zones are also noteworthy for their diversity. In Loma Linda, Calif., they are vegans. In Costa Rica, their diet includes eggs, dairy, and meat. In Ikaria, Greece and Sardinia, Italy they practice variations on the theme of Mediterranean diets. In Okinawa, Japan, a traditional plant-based, rice-centric diet produces the same outstanding results.
In all cases, the theme is the same: real food, not too much, mostly plants. Or put even more generically: wholesome foods, in sensible combinations. Unlike us here in the U.S., if it glows in the dark by some contrivance other than bioluminescence, they don't eat it!
Why choose low-fat or low-carb, when there are good and bad sources of fat, good and bad sources of carbohydrate? Why choose between low-glycemic and low-salt, when a diet of wholesome foods results reliably in both? Why choose between the quantity of calories and the quality, when the best way to control the former without perennial hunger is to improve the latter? Why choose any dietary dogma at all?
No, looking at the never-ending parade of quick-fix contestants, we cannot say which diet is best, because none is. But looking beyond the beauty pageant, to a vast expanse of evidence and the compelling, real-world examples of the Blue Zones, we certainly can say what theme of eating is best for both health and weight control. Wholesome foods in sensible combinations. No highly processed, willfully addictive, glow-in-the-dark junk. Food, not too much, mostly plants.
I guess for a culture eager for the winner of the swimsuit competition, that theme just isn't sexy enough. But folks, it's the real deal. And there is beauty in it, because a theme leaves wiggle room. A theme means you can choose the variation on the theme that you, and your family, like best. A theme means you can choose your preferred way to love food that loves you back.
Can we say what diet is best? Yes, in fact, we can. But only if we grow up, get real, and look beyond the beauty pageant.
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.
Contact ACP Internist
Send comments to ACP Internist staff at firstname.lastname@example.org.
- Why can't we easily clean our stethoscopes?
- Show your work--what my algebra teacher taught me
- We need an Ebola test with perfect negative predic...
- Doctor, do you suffer from Glory Day Syndrome?
- Causal opacity
- Knife dancing
- Sometimes, 'sorry' is all it takes
- Whole grains and half-witted notions
- A second vaccine against pneumonia recommended for...
- The absence of evidence is not the same as evidenc...
Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.
And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.
Controversies in Hospital
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).
db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.
Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.
David Katz, MD
David L. Katz, MD, MPH, FACP, 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.
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.
Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).
David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.
Reflections of a Grady
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.
The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.
Technology in (Medical)
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.
Peter A. Lipson,
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.
Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.
World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.
Other blogs of note:
American Journal of
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.
The Public Library of Science's open access materials include a blog.
One of the most popular anonymous blogs written by an emergency room physician.