Blog | Tuesday, December 13, 2016

Of plate, state, and the calculus of hope


In my customary purview, nutrition, public health, and disease prevention, I have had cause to lament periodically the apparent hegemony of Newton's third law. For every silly action we've taken over recent decades to address the effects of badly constituted diet on weight and health, we have appended an opposing, but comparably misguided reaction. Believe it or not, this pertains to the high drama of our current political situation, too.

Let's start with our plates; the state of the State can wait.

In principle, and famously, we had advice some decades ago to reduce our intake of dietary fat. For purposes here, we need not belabor the relevant provisos: the advice originated with studies showing the advantages of the high-fat Mediterranean diet. So, really, it was advice to reduce our intake of saturated fat from the usual sources. The message got mangled as it was passed along, just like in a game of ‘telephone.’ The idea that all dietary fat should be cut, while genuinely favored by some, was actually a distortion of the original mainstream message, but took on a life of its own.

Be that as it may, nobody with any actual expertise- not proponents of eating low fat, and not opponents of eating low fat- ever advocated for low-fat junk food. The original idea was to reduce dietary fat intake by swapping out the salient sources in the prevailing diet- fatty meats, processed meats, processed dairy, fried and fast foods, snack foods- for foods naturally low in fat: vegetables, fruits, whole grains, beans, and lentils, for instance. And, where that was actually done, rates of heart disease and premature death were slashed, and life expectancy extended dramatically. It just hasn't played out that way in America.

No one worth listening to ever said: just eat Snackwells, and all will be well. But, of course, that, or something much like it, is just what the makers of Snackwells, along with every other version of low-fat junk food, implied. And since they implied it with all of the resources of “Big Food” at their disposal, they implied it to great effect.

How great? Well, intake of all the best, natively low-fat foods changed almost not at all in the U.S. over the past 40 years. For that matter, total dietary fat intake never even went down. Rather, fat only ever went down as a PERCENTAGE of total calories, because total calorie intake has gone up, driven mostly by, you guessed it, low-fat junk, laden with added sugar and refined carbohydrate. Total fat intake, actually has trended up over recent decades, it's just that total calorie intake has gone up even more. That is the legacy of the “low fat” era in America. As they say in the old country: oy, vey.

Then, to make matters worse, Newton's third law kicked in. Apparently, human nature shares an affinity for it with all the rest of nature. Perhaps it's because it is so much easier to say, “I was wrong,” than to admit, “I DID wrong.” What's the difference?

If the low fat message simply “was wrong,” then we got bad advice, and can scarcely blame ourselves for following it. If we had actually cut fat, and gotten fatter and sicker- we may have been given bad advice, but what we did, we did well. That's the kind of admission we seem inclined to make: I was wrong, but I was misled.

Far harder, it seems, is this: the advice was fine, but I bungled its implementation horribly! This confession, unlike the other, leaves us little space to avoid a self-indictment of gullibility, nincompoopery, and/or fundamental incompetence. That's a very bitter pill to swallow, so apparently, most of us spit it out.

Instead, we claim: It's not that we implemented advice to cut fat (and, really, saturated fat) moronically; rather- the advice must have been wrong! Much easier to lay the blame there.

But it's just not true. In the U.S., we did, indeed, apply advice about dietary fat as moronically as possible: we conflated saturated fat with total fat; we never reduced our intake of fat anyway, nor even our intake of saturated fat more than trivially; and we added low-fat junk food. If anyone can legitimately claim surprise that THIS formula didn't vanquish obesity and chronic disease, I will give up my day job and become a hula dancer.

So we took the easy way out. We blamed the advice, rather than our monumentally stupid response to it- and then surrendered ourselves to Newton's third law. It was, obviously, time for some equally silly, but opposing reaction, like: cutting carbs. And so we did, bungling it every bit as badly as the “cut fat” message that preceded it.

Whatever the merits or demerits of Atkins' platform, it's only fair to note that he never advocated for low-carb junk food, any more than Keys ever advocated for Snackwells. But at the Atkins' Diet heyday, low-carb junk food is just what we got- and it has stuck with us ever since.

Nor were those sequential boondoggles enough to cure us of our Newtonian proclivities. We have since welcomed the advent of non-GMO junk; gluten-free junk food; “no longer made with high-fructose corn syrup” junk food; and probably other varieties I'm overlooking.

And that brings us, however tangentially, from the state of our plates, to the state of our Union. For, as opposed to Nate Silver, it may be that Isaac Newton correctly predicted the outcome of this election.

It is rather ironic that a population of allegedly thinking Homo sapiens behaves so much like the native inertia of celestial flotsam. Ironic, but apparently true.

The past eight years represented a remarkably progressive action in American politics. Those personally disappointed, for whatever valid reason, by their trajectory during that span, were presumably invited to express that disappointment with an equal, opposing, and by the reasoning of many of us, regressive, reaction. So here we are.

As with our plates, it is convenient and expedient to blame any personal disappointments on the bluntness of the action, rather than all the subtleties of context and implementation. The Affordable Care Act, like a car with no wheels, was designed to “fail,” by those wanting it to do so. The administration of the past eight years faced relentless obstructionism, and if we are honest- racism, too. And, of course, the Obama era began in the gaping hole of the Great Recession. There is a limit to how “good” getting back to ground level can ever feel, relative to reaching actual heights- no matter how monumental the climb out of the depths actually is.

Whether the topic is the content of plates, or the status of our State, physics itself seems to stipulate that an uninterrupted sequence of forward steps is little less than unnatural. But equal and opposite need not mean equivalent and self-canceling. When you run, you push against the ground, and the ground pushes back; but the ground stays put, while you move. Progress is possible.

In spite of it all, the objectively measured quality of the typical American diet has improved over recent years, albeit it little, and slowly. But it's progress just the same, and maybe the only kind the third law allows. And perhaps what's true of dinner is true of our democracy.

As for Newton, he bequeathed us other gifts too, like calculus. Conjoining that to the third law, I wind up with the calculus of hope. Progress is possible, even likely, but not likely ever to be linear. In accord with the rest of nature, human nature too is disposed to a meandering path of actions and reactions.

Here's to progress, in all areas, accordingly.

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.