Don’t listen to anyone, including me.

The latest link passing around my Facebook page leads to an article about “the feeding-tube diet“—a woman who had her doctor insert a feeding tube so she could get wedding ready.  Why don’t you write about that? more than a few of my friends asked.  And I suppose I have some thoughts on it, mostly having to do with the fact that we’ve got a society as a whole that’s taught us to set arbitrary ideals for ourselves and then make ourselves miserable in the pursuit of the supposed happiness that we’ll feel once achieving said goals.

When picking through the New York Times’ health section, however, I noticed this little gem of a segment that most people seem to have overlooked: A Room for Debate piece entitled, “Do We Need More Advice About Eating Well?”

Good question, New York Times.

The different debaters raise various points—some that no amount of information is useful if you’re unable to apply it (ie, for those living in “food deserts” or for those without enough time and resources to prepare healthy meals),  some that deeply ingrained behavioral patterns prevent us from applying the knowledge we do pick up, and some that we still don’t have quite enough information available (ie, what type of sugar food contains or whether foods are genetically modified). 

Then famed registered dietician (yup, you can get famous doing anything) Marion Nestle argues, “Of course Americans need more information about eating well. Otherwise we wouldn’t have an obesity problem.” She explains the problem: “People are bombarded with conflicting advice, much of it from sources with a vested interest in selling particular foods, supplements or diet plans. Nutrition studies tend to focus on single nutrients, making their results difficult to apply to real diets.”

Which, I suppose, is what I see the most of at our gym—I mean, we’re a luxury club with spa services and state-of-the art equipment.  There’s a summer’s farmers’ market a stone’s throw away, a Whole Foods and Trader Joe’s within walking distance, a few less pricey grocery options also within range, plus an abundance of CSAs and the like.  And, let’s be honest—if you can afford the gym’s monthly fee, you can probably afford some or all of the above.  Living in a food desert is not an issue.  So we have a lot of people who struggle to apply the knowledge they have and rebuild their habits, in part, because, it’s hard to make sense of all the information out there.

Eventually, though, we have to figure out what works, who to listen to, who not to, and so on.  How else do you make headway in this whole “getting healthy” thing?  When reading the latest advice, you may need to do some further research—or at least look at the advice with a grain of salt.  Here are some rules of thumb I came up with to help decipher all the health hubbub:

1) Keep it Simple, Stupid
Michael Pollan coined the term “nutritionism” to talk about our culture’s fascination with nutrients rather than whole foods—ie, avoid carbs, avoid saturated fats, B vitamins give you energy, etc. A larger part (if not the majority) of nutrition research and reporting focuses on the effect of specific nutrients on the body.  Except nutrients in foods come packaged together with other nutrients, which will invariably affect how they act in our bodies—thus, a banana is not one giant potassium pill, nor is a salmon simply a swimming conduit of omega-3 fatty acids.  If you follow every bit of advice out there—Should I eat fat?  Should I not eat fat?  Is fruit bad for me because of all the sugar?  You’ll never be able to eat, because every week we get new research that contradicts old research.  Chances are, if you focus on eating a variety of whole foods—things that recognizably came from a plant or an animal—you’ll meet nutrition and nutritionism guidelines—if not by this week’s standards, then by next week’s.

2) If at all possible, find the original research.
Yes, journal articles can be monstrous to read.  Usually, though, even the abstracts can give you a better idea of how to interpret the results of the research, and those come fairly boiled down.  Yoni Freedhoff illustrates why going to the source can be beneficial both here and here.  Both blogs talk about news coverage of recent research—the first about a study that supposedly shows that chocolate makes people thinner, the second that white rice causes diabetes.  The two articles received a lot of press when they appeared, but the actual studies were fairly shoddily done.  The chocolate study was simply the result of 975 men and women filling out questionnaires about the frequency with which they eat certain foods, to help with looking at the non-cardiac impact of statin drugs.  The study only controlled for fruit and vegetable intake, mood, saturated fat intake, and amount of activity.  They looked at the average BMI’s based on how frequently the person supposedly eats chocolate each week, and voila:  Chocolate makes you thin!  …Except it doesn’t, actually.  People with low BMIs more readily admit to eating more chocolate than their heavier peers, but at best that shows correlation, not causation (and even then, self-reporting regarding diet is fairly unreliable research).  I’m not going to go too much into the white rice study here, but it’s the same idea—the research actually doesn’t support the lofty claim that the media presented.   But how sensational is the headline, “White Rice May Increase Risk of Diabetes in Asian Populations , But Because Researchers Missed Some Major Control Factors, More Research Is Needed”?

3) Ask if there’s money to be made from a health claim.
And who’s offering the advice.  If the Dairy Council funded a study on calcium, the reports may be skewed to get people to drink more milk.  A new “super” food or nutrient means more supplements, more ways to modify existing processed foods to make money (eg, yogurt with added fiber), more magazines filled with special recipes using said ingredient.  It’s hard for big business to make more money off of “Eat more whole fruits and veggies” than they already do, but fiber and antioxidants and vitamin XYZ can be packaged and sold.

4) Consider how the advice relates to your great-grandma’s life experience.
Assuming Great Grandma lived a long and healthy life.  If not, think of another relative who lived a long life in a previous century.  Do you think they avoided butter like the plague?  Probably not, but she may not have used an entire stick to cook collard greens for dinner, either, because she didn’t have a Publix down the street to buy another pound block from; she had to wait for the stuff her (or her neighbor’s) cows produced.  Did she drink a chilled glass of pomegranate juice every day? Once again, likely not, but maybe she had access to better quality fruits and vegetables that afforded more nutrients.  We often talk about eating foods that our ancestors would recognize as food to avoid processed junk, but think about health advice and consider how it relates to what we know about those living before nutritionism and heavy food processing: ie, people have been eating bread for centuries, but maybe not the quantity or form that we see it in today.  If they got by without living entirely gluten-free, chances are you might as well—but you may be better off not eating it in the jumbo quantities we do today, and try to keep it out of foods that don’t need it, because maybe your system is getting overloaded from the excess.  Perhaps more simply, be especially wary of all-or-nothing nutrition advice—you need this supplement or avoid this food altogether.  Instead, consider it as a way of looking at moderating your diet in certain areas or looking for deficiencies in others.

5) If you decide to try to make a change based on diet advice, allow yourself time to get out of the “honeymoon period.
Psychologist-types discuss this phenomenon called “cognitive dissonance,” which basically amounts to how humans respond to conflicting feelings and emotions.  The best way I had a professor explain it to me once was if you’re on the fence about buying something, then you buy it, your brain will change how your perceive the purchase so you think that you really wanted it—basically, to help you overcome the ambivalence that came with spending the money on something you felt only so-so about initially.  When you jump into a plan—say you decide Omega 3 fatty acids seem pretty cool, so you’ll buy one of those expensive-ass bottles of Fish Oil Supreme pills from the local Vitamin World, or say you decide that those chicks in Skinny Bitch seem to know what’s going on, so you’ll try being vegan even though cow was your favorite food for the previous 20-odd years of your life—you’re initial reaction to making that commitment will likely be to look for ways to prove that you made the right decision.  You may even encounter the placebo effect, where whatever you think is a problem will get better simply because you want the nutrition change to make it better.  Now, I’m not saying you can’t trust that the healthful change will be more healthful—eating more vegetables will likely make you poop better, and you may enjoy organic produce more than the factory-farmed stuff.  Just remember, if you follow the advice, your brain probably wants you to feel like it’s working.

Weeding through health news headlines can feel overwhelming, particularly because there are pieces of wisdom amidst everything.  In general: take all of it with a grain of salt (But not too much.  You don’t need that much sodium.)

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6 thoughts on “Don’t listen to anyone, including me.

  1. I really like (and can relate to) the section about cognitive dissonance. I have a “shopping problem,” let’s say, so this helps explain why I have so much trouble returning things. (That’s how they get ya.) I never thought about how this applies to foods, too. Hm and wow. Thanks for opening that door of analysis, Kat.

    • Kat says:

      I suppose I’m just assuming– never seen any specific research on it– but it’s definitely what I feel like I see when I talk to people. Of course you’re gung-ho about this diet, you know? You don’t want to jump into restricting all grains or all animal products or whatever without feeling like it’s a good idea.

      You know, I read somewhere once that if you try on clothes, your much more likely to buy them because your brain has already latched on to the thought that you own them.

  2. ltverberg says:

    Nice article! I totally agree, especially about looking more carefully at the original research. You’re so right about correlation vs. causation, and at what the study controlled for and what it didn’t. Good point too, about shopping and cognitive dissonance.

    One thing I’d add is that mediocre results often get inflated by the media. Say that a paper shows that eating peaches is associated with slight decrease (6%) in heart disease. The headlines will read, “Peaches Are Key to Cardiac Health.” Later, someone will repeat the study and see a 3% difference. The news will say, “Peach Health Myths Debunked.” The actual data might not change much, but people *love* black and white conclusions.

  3. ltverberg says:

    Nice article! Good point about shopping and cognitive dissonance.

    I especially agree about looking more carefully at the original research. You’re so right about correlation vs. causation, and at what the study controlled for and what it didn’t.

    One thing I’d add is that mediocre results often get inflated by the media. Say that a paper shows that eating peaches is associated with slight decrease (6%) in heart disease. The headlines will read, “Peaches Are Key to Cardiac Health.” Later, someone will repeat the study and see a 3% difference. The news will say, “Peach Health Myths Debunked.” The actual data might not change much, but people *love* black and white conclusions.

    • Kat says:

      Read the white rice article! You’ll find it interesting–that’s exactly what the article says. There was a study done of white rice consumption and how it links to type 2 diabetes. It showed a possible slight increase in diabetes rates for Asian populations (although, once again, there were control group problems), but not enough to be significant. It was all over the news that white rice causes diabetes, though.

      • Interesting about the rice study – I’m not surprised. People love to boil things down and exaggerate conclusions. I’m aware of it in my writing. If I say, “some scholars cautiously hypothesize that X was true in the first century”, everyone who quotes me in a blog will say “X was true in the first century.”

        It’s not that all research is null and void if not every control was done. That would be impossible. But it’s good to know the strength of the original data, by looking at the primary sources. One thing that always worries me is when a result is barely statistically significant. When I was in grad school we had a saying: “If you have to use statistics, it’s probably not significant.”

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