OC 2/3/23

Ingestion questions

Ingestion questions

Up front, I confess that I am very skeptical of our health care system. Not because I know anything better. Far from it. I’ve never studied medicine, and I’ve got enormous respect for those who have—it’s a damned difficult field requiring a great deal of time and devoted study. People who come out of med school ready to practice medicine have paid their dues, investing gobs of time, effort, and wads of money. Apart from that, the current U.S. health care system may be the best there is in the world. It’s certainly the best one we’ve got.

That said, I’ve been following the discussions among a subset of dissidents and critics of the current medical system and its recommendations regarding diet. For me it began with reading Gary Taubes’s Good Calories, Bad Calories some 15 years ago now, a book that goes into great detail describing the breathtaking lack of science behind the most common health advice, recommendations, and treatments—particularly with regard to weight, metabolism, and diet. The short version of the story is that there was never more than flimsy evidentiary support for the low-fat diet as a public health recommendation. But the government recommended it anyway, with the force of federal regulations implemented as the food pyramid in the 1980s. It is applied as the declared healthy diet at all institutions where the federal government provides or subsidizes food: public schools, hospitals, nursing homes, military bases, the prison system, etc.

While Taubes wasn’t a physician, he used his natural science background to trace the paper trail of the medical recommendations. He has become something of an historian of the science, as he says, especially of the so-called diet-heart hypothesis: the proposition that eating a diet high in fat leads directly to obesity and heart disease. The main body of evidence supporting the hypothesis consisted of epidemiological data from population surveys, which is to say, asking people what they had eaten in the past, and then assessing their health now to determine correlations. A major weakness, of course, is that most of us can’t accurately recall what we have eaten over the course of weeks and months—especially not in terms of servings, pounds, and ounces. A much better type of evidence would come from limiting test-subjects’ diets and observing their health markers over time, as they either worsened or improved: some type of controlled trial.

Another factor in the low-fat diet becoming the standard health recommendation was the force of personality of several respected, accomplished medical researchers who had adopted the diet-heart hypothesis out of conviction that it made so much sense that it absolutely had to be right. These were the types of researchers who managed to leverage their academic positions to exclude research work that contradicted their own. One in particular—Dr. Ancel Keyes at the University of Minnesota—was especially effective in stamping out competing research.

Taubes has traced the competing theory—that obesity, heart disease, and other health problems are caused by the insulin response to carbohydrates in the diet—back to dietary recommendations from the early 19th century. He also described how the low-carb diet has had a long history, even when the mechanism behind it was poorly understood. Earlier generations of physicians in Europe and America would recommend patients with weight problems cut back considerably the amount of bread and potatoes, rice and sweets they ate as a means of slimming. Patients commonly reported back with improvements in their health, often beyond just weight loss.

And they still do to this day. Many of the practicing physicians who have themselves become low-carb and ketogenic diet proponents were converts who did so after they had experienced problems with weight—until patients came into their offices greatly improved after trying some version of carbohydrate restriction.

The medical establishment (a term now over-used to the point of meaninglessness in our political squabbles) still mostly sticks to what they have always recommended, even as they have eased off the militancy about it. In some areas of academia and government, the low-carb or ketogenic diets have gained grudging acceptance—and the criticisms of the low-fat approach’s scientific shortcomings have been acknowledged. Part of it is conviction, still, in many cases. Part of it is the path-dependency that takes over large institutions. Add in the effects lobbying from vested interests who see their market share at stake and you can appreciate that existing policies are very difficult to turn around, even if everyone were to agree on what the science establishes.

As a non-specialist observing all this, it is of course difficult to figure out quite what to believe. The case made by the low-carb proponents seems very strong, or at least their criticisms of the status quo seem very persuasive. But it would be foolish to think the science describing how our human physiology works is complete, to believe the competing theories aren’t each fraught with numerous weaknesses. So what can an individual do?

In the case of diet, at least, the individual can conduct an experiment on her- or himself to see if carb reduction is feasible and whether it results in the promised benefits. Unlike taking prescription medicines, changing your own diet is less risky—at least for a short period of days or weeks. And then you can determine where to go from there.

For anyone interested in the practical description of what’s involved, here’s a link to a presentation by Dr. Eric Westman, who has been helping people apply the diet at Duke University for almost 20 years, after picking up the baton from Dr. Atkins who made the treatment famous several times. Although his intro is about the online academy he offers through his university, his presentations are available for free on YouTube for do-it-yourselfers. He really isn’t selling anything as a requirement for the program to work.

I’ve got a bit more to say about this than I’d expected, as it turns out. So I’ve probably got some more postings on this to scratch this itch. Also, because I think it’s worth telling about, since I’ve found it helpful personally—presented in the spirit of a free tip if anyone happens to be interested, in the chance that it might be something someone finds useful, helpful, or interesting.

As for the terminology, the diet I am talking about is referred to variously as the low-carb diet, the ketogenic diet, the Atkins diet, or carb restriction, carbs being one of the three major dietary nutrient categories: carbohydrates, fats, and proteins. There is no one single form of the diet, but central to all its interpretations is a very limited intake of carbohydrates. The amount of dietary fat and protein consumption is mostly not limited, although proponents are generally skeptical of vegetable oils, preferring butter and other animal fats as nutritious.