Tuesday, January 17, 2017
What we know about diet, and why time is of the essence
As a year of particular assaults on everything anybody thinks they know about diet and health, including if not particularly the science underlying the Dietary Guidelines for Americans, winds down, it's inevitable to reflect on what anyone truly knows about diet, and how we know it. The merchants of doubt, profiting handsomely from the status quo and perpetual confusion, would have you think no one knows much of anything, so enjoy some Coke with those fries.
I disagree. We are, emphatically, not clueless about the basic care and feeding of Homo sapiens, and I think that would be vividly clear to all but for time. Time, it turns out, is of the essence.
To explain what I mean depends on a thought experiment, and I ask for your indulgence here; it's just a bit macabre.
Imagine that, heaven forbid, you or a loved one is the victim of a gunshot wound to the abdomen or chest, be it the product of a bullet gone astray, or one willfully targeted. There are far too many of both flying around our culture, but that's a topic for another day.
First responders show up promptly to find you crumpled on the ground, bleeding profusely, surrounded by hysterical family members. They do what they do, and rush you into an ambulance, family in tow, and speed off to the closest hospital, which fortunately for you, has a Level One trauma center.
They burst through the emergency department doors, with you on a gurney soaked in blood, rushing to the operating room, where a top notch surgical team is scrubbed and waiting.
But before they get there, you and this entire, frantic entourage are intercepted in the corridor by a raised hand from a calm, imposing figure in a white coat.
“Just a minute,” he (it could be she) says. ”Why the hurry? I am Dr. Reni Gaid Jeanyus. I am here to point out the folly of this rush to judgment.
“I am guessing you don't know about the literature debating whether this scalpel or that scalpel is best; it's intense! You may not have dived into the roiling controversies regarding the use of mosquito versus alligator forceps, to say nothing of the Rochester Pean versus the Rochester-Carmalt for hemostasis. And this is just the tip of a foggy iceberg. Clamps? Don't even get me started!”
Sensing the growing restlessness of your paramedic team, Dr. Reni (these types are, for some reason, always ‘Dr. First Name’ rather than ‘Dr. Last Name’) puts a restraining hand on your gurney. No one is going anywhere until the peroration is done.
“As I was saying,” he says, “the debates are all but endless, and I- and perhaps ONLY I- know what they really mean! There is no proven value in trauma surgery at all.
“The whole thing is a scandal; a conspiracy, orchestrated by the tired old forces of the status quo. The Trauma Surgeon Mafia is in on it, of course; as is the Royal Order of OR Nurses. Naturally, The Surgical Scalpel Society and the International Corporation of Unnecessary Surgical Instruments have skin in the game. And, of course, all concerned are aided and abetted, as ever, by the Federal Authorities.
“I tell you it's shocking! Do you realize that there are NO randomized trials comparing the benefits of prompt trauma surgery to, say visualizing goat cheese? Or counting the hair follicles on your fourth toe? Or schmearing rutabaga marmalade on your nipples? None!
“Fortunately for you, though, I happen to have with me several jars of Dr. Reni's Rutabaga Marmalade- which, by the way, goes beautifully with that goat cheese- available for those actively hemorrhaging at the bargain price of $24.99 a jar. Credit cards are OK, but I prefer cash. Personal checks work, but only when signed in blood, and I'm not sure you have any left …”
This scenario is, of course, absurd. Were there to be such a Dr. Reni, he would be intercepted by security, and escorted off the premises. If he did manage to trouble you and your family, you would promptly push past him to the operating room, and rightly so.
But why do we know that “alternatives” to trauma surgery are absurd? Are you drawing on your expert knowledge of the topic? Can you cite the relevant randomized, controlled trials? Can you refute the claims about debate over clamps, scalpels, and forceps? Isn't it possible that the conventional wisdom is all wrong, and visualizing goat cheese might have worked just fine?
The answer to all this is: duh. It's perfectly obvious that when people are shot and bleeding out, if expert hands don't do expert things to stop that bleeding and repair the macerated vital parts promptly and expertly, those people die. You, in that corridor, might well die in the time it took to hear this huckster's case.
As implied at the start, this is not about bullet holes or trauma surgery. My point here is that the only difference between this scenario and what we know about diet and health is time. Bullets kill us fast; diets kill us slowly. Tobacco kills slowly, too, by the way, and that fact has been exploited in the prevarications of Big Tobacco for decades.
If the timeline between what we eat and its diverse effects on health were as instantly vivid as the effects of a gunshot, there'd be no place for the agents of pseudo-doubt, pseudo-discord, and pseudo-confusion.
Don't get me wrong; there is legitimate doubt and discord, too. There is still a LOT to learn about a lot of details. Nobody really knows the optimal level of most micronutrients. Understanding of how best to personalize diets based on biometrics, anthropometrics, and genomics is still nascent. And, of course, there is no truly decisive, 100-year-long randomized trial involving tens of thousands to say what diet is “best” across an entire lifespan for longevity as well as vitality.
But as Dr. Reni would point out, there is no single, decisive randomized trial to prove that some particular sequence of particular surgical instruments is best for patching a hole in your chest, either. That's a poor argument for parking yourself in the corridor and bleeding, with or without marmalade. Arguments that divert you from the profound benefits of a diet comprised principally of minimally processed vegetables, fruits, whole grains, beans, lentils, nuts, seeds, and plain water for thirst are comparably unjustified.
Variations on the theme of good diets foster vitality and longevity, and fortuitously, redound to the benefit of the planet as well. Alternatives that do just the opposite prevail. This would all be perfectly clear to everyone were the causal pathway better matched to human perception.
The truth about broccoli, beans, and bratwurst is about as clear as the truth about bullets. It's just slower.
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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