Monday, November 28, 2016
How dieticians can save the world
I was honored, and genuinely delighted, to take the stage at FNCE 2016 (the annual meeting of the Academy of Nutrition and Dietetics, for those who don't know the lingo) with Dr. Walter Willett of Harvard, and Kathleen Zelman of WebMD, our session moderator. Kathleen was fresh from her speech, earlier the same day, as this year's recipient of the Academy's prestigious Lenna Frances Cooper Award.
As for Walter, the most published and cited nutrition researcher in history, he needs no introduction to anyone nominally tuned in to matters of food and health. I will simply note two things. First, this was, in a sense, the “Walter and Dave Show, part 2”, as he and I co-chaired a conference last fall on the same theme: the common ground of healthful, sustainable eating. That conference was sponsored by the not-for-profit Oldways, which advocates for “health through heritage.”
The one other thing I will say about Walter is that I respect and love him almost like a father. Only those who know how much I love and respect my actual father will appreciate just what that means. Moving on.
Walter provided a thoroughly evidence-based review of the fundamentals of healthful, sustainable eating, reprising the themes laid out at the Common Ground Conference a year ago, and updating the case with studies published since. I followed with a discussion of how we can be so prone to perpetual, pseudo-confusion in the first place when the relevant evidence is so abundant and so clear.
In particular, I talked about how scientists can seem like they disagree even when they agree far more; how a whole sequence of mono-nutrient fixations have been converted into nutrition boondoggles spanning decades; how the harms of sugar were not discovered by some currently best-selling diet book author last Thursday, but rather have been salient for years; and how utterly appropriate the recommendations of the 2015 Dietary Guidelines Advisory Committee were, before politicians adulterated them under the influence of lobbying, or bullying, if there really is any difference.
We are not clueless about the basic care and feeding of Homo sapiens. On the basis of massive aggregations of science, even mean applications of sense, the global consensus of diverse authorities from many relevant fields, and the experience of whole populations over generations, a diet emphasizing minimally processed vegetables, fruits, beans, lentils, whole grains, nuts, seeds, and water preferentially for thirst, is unassailably right for people and planet alike. So it is, and so we said.
During the Q&A that followed our brief presentations, a dietitian in the audience asked what to me seemed a beautiful, and refreshingly humble question: what can dietitians do better to help advance the public understanding of the fundamentals just discussed?
My part of the answer was that we only have the strength, or even the volume, to get anything meaningful done, if we are unified. If genuine understanding of the common ground of health-promoting, sustainable eating is to become common knowledge, it must do so courtesy of common cause.
Why? Well for one thing, we live in a massively noisier world than anyone before us has ever known. It's almost shocking to me to hear myself talk about the “pre-Internet” portion of my career to young colleagues, but there actually was such a thing! I miss it, to be honest.
Now, though, we are all irrevocably caught up in the endlessly amplified echoes of every opinion, expert and more often otherwise, courtesy of the blogosphere and social media. If our best understanding of eating well is the signal we hope to transmit, the challenge of doing so rises directly with the volume of static it must overcome.
Accordingly, those of us who have relevant expertise, and truly do mostly agree, must lead with that message. All too often, it is our native tendency to do otherwise.
It's our tendency because we are human, and all want to talk about “the thing“ that matters most to us, be it passion, priority, or pet peeve. But there are two salient problems in this domain. The first is that non-experts also have their passions, priorities, and pet peeves related to nutrition, and in cyberspace, they can readily broadcast those in the guise of facts, their lack of relevant qualifications generally undeclared, and routinely overlooked. If actual experts, dietitians and others, broadcast a comparable scattershot of disparate opinion, how is the public to know what's what, let alone who's who?
While there is plenty of room for variation among the prioritized particulars any one of us might favor, the basic theme of eating well for longevity, vitality, and the sake of the planet is simply not negotiable. Experts know that, and can both help the public know it, and distinguish expertise from impersonations of it, by reaffirming it every chance we get. Non-experts, hoping to be heard in the cyberspatial din, need to subordinate reliable, time-honored, evidence-based understanding to titillation and provocation. Experts can afford to do the opposite.
That does not preclude the appendage of personal priorities. Maybe you think artificial sweeteners are the absolute worst. Or maybe you think they are much preferable to sugar. Maybe you want to make a case for including dairy in the diet, or maybe, for excluding it. Maybe you think sodium gets too much attention, or maybe you think, not enough. Maybe you are convinced that artificial dyes and flavorings contribute to behavioral disorders in children, or maybe you consider that evidence inconclusive. Maybe you are all about gluten, or GMO foods, or resistant starch, or the microbiome.
By all means, tell the world, but to use a food metaphor, tell the world where the common cake ends, and your bit of favored frosting begins. If our commonality is the cake, and our differences relegated to the icing, we can have that cake, and serve it, too.
I meet very few, if any, dietitians who don't agree with the proposition that diets and health would improve (in the U.S. and other developed countries) with more vegetables, fruits, whole grains, beans, lentils, nuts and seeds and water in the place of almost any other beverage almost all the time. Over the years, however, I have met many who tended to talk much more about some narrowly bounded, personal priority, than the expanse of common ground we share.
The result of that is the obvious: the public doesn't know we agree nearly as much as we do. Deriving the impression that no two nutrition experts agree or hold the same opinion for more than 20 minutes at a stretch, the public learns distrust of us, if not disgust with us, which opens the door wide to a never-ending parade of fools and fanatics with something to sell.
We have the strength to change prevailing diets and health for the better only in unity. If we collectively defend the fundamentals of healthful, sustainable eating, and then append our personal priorities, whatever they may be, we can be the change we hope to see in the world, and stay true to ourselves as well. We can be greater than the sum of our parts, yet still part over given particulars as inclined.
The answer was intrinsic to the lovely, humble, generous spirit of the question. We can each take the most effective stand in support of our personal priorities for health if we do so resolutely, consistently, and emphatically on the common ground we share.
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.
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