The USDA Dietary Guidelines can stay wrong longer than you can stay healthy

With the recent publication of the Scientific Report of the 2015 Dietary Guidelines Advisory Committee (DGAC), I am reminded of this quote attributed to the famous English economist John Maynard Keynes (1883 – 1946):

The market can stay irrational longer than you can stay solvent.

Why do I like this quote so much?

Because for a long time, it’s the same idea I’ve had about the USDA’s Dietary Guidelines, and the latest “scientific” report from the DGAC has not altered my opinion in the least.

Here’s my corollary:

The USDA Dietary Guidelines can stay wrong longer than you can stay healthy.

In my mind, our situation with regard to dietary guidance is (unfortunately) much like what happened with the financial crisis of 2008. We don’t have a single crash like the financial collapse of 2008, but an ongoing, slow-motion, accelerating health crash as our rates of unhealthiness and chronic disease such as diabetes continue to rise dramatically.

The worst part of the financial crash is that the economists who failed to predict the crash steadfastly continue to refuse to admit they were wrong—even after all the devastating evidence clearly shows otherwise.

This stubbornness has given rise to the growth of Behavioral Economics as an antidote to the Efficient Market Hypothesis (theory) that prevailed before the 2008 financial crash. The Efficient Market Hypothesis postulates essentially that the markets are always right.

If you want to see what I’m talking about, watch this NOVA PBS program from 2010 called Mind Over Money http://www.pbs.org/wgbh/nova/body/mind-over-money.html.

Here’s a brief description of the program:

Mind Over Money
Can markets be rational when humans aren’t?  Aired April 26, 2010 on PBS

Program Description
In the aftermath of the worst financial crisis since the Great Depression, NOVA presents “Mind Over Money”—an entertaining and penetrating exploration of why mainstream economists failed to predict the crash of 2008 and why we so often make irrational financial decisions. The program reveals how our emotions interfere with our decision-making and explores controversial new arguments about the world of finance. In the face of the recent crash, can a new science that aims to incorporate human psychology into finance—behavioral economics—help us make better financial decisions?

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Introducing the Figure Out Food app

Hello blog readers, it’s time to introduce to you my new crowdfunding campaign to raise funds to build the Figure Out Food app.

Here’s the link to my Indiegogo crowdfunding page (for those that want to get right to it):

Figure Out Food: Eat what works!

A clip from the campaign page will let you know what this is all about:

Figure Out Food is a mobile app to help you figure out what to eat to be healthy and how to tell if it’s working. No diets or medical tests required. It connects what you eat to specific signs of health so you learn what actually works for you, not what experts claim or one-size-fits-all diets say should work for you.

The app gives you an easy and effective way to measure your health after eating so you can tell whether what you are eating is working for you, and, over time, build your own personalized diet. It puts you back in control of your diet and health.

The ideas behind the app have been in the works for a long time. You could say it all started back in the late 1990s when I first started reading about low carb eating, but it really started coming into focus when I wrote this in 2002:

Doctors and other self-anointed health and nutrition experts keep telling us what to eat and why. They tell us eating the “right” foods will make us healthier and help us to live longer and avoid diseases. They tell us eating the “wrong” foods will kill us. They speak in broad terms and specific scientific terms like HDL/LDL cholesterol levels, triglycerides, and blood pressure measurements.

It has all always left me shaking my head in confusion. What should I really be eating to be healthier? And how would I really know if I am doing it right?

It used to be four basic food groups in balance, then it was low fat and super low fat, then the food pyramid, now high-protein and low carbohydrates—aaaggh! How is anyone supposed to know what is the right way to eat?

Because of the changing scientific and medical opinions about optimum nutrition, I decided to take a personal and empirical approach. I decided to figure out the connections between what I ate and how I felt, in a very specific, subjective, but important way. I wanted to connect the missing dots between recommended foods and bad foods and how I felt after eating them, and to correlate my feelings with better health. Much of my research was accidental and sometimes painful, but ultimately helped me learn the connections between eating and feeling. I call it Eating Awareness.

My Eating Awareness gives me the knowledge of knowing how my body will be affected by the specific types of foods I eat. For example, I know that eating a bowl of ice cream will soon after make me thirsty, warm my body temperature, urinate, and feel drowsy. While the ice cream feels good going down, the thirst soon afterwards is a clear sign that the ice cream threw my body’s hydration out of balance. This is not good. Thirst is an important sign to become aware of in reading your body’s reactions to the foods you eat.

These ideas evolved over the past decade into what I now call Figure Out Food.

So check it out and please support the project if you can.

It’s time we changed our view of nutrition and health and learned how to eat what really works for each of us.

Thanks!

Health Now

Causing Health, Not Preventing Disease

What is health?  low risk factors? longevity? absence of disease?

People talk about health and good health all the time, but they seem to assume you know what they mean. Why eat a good diet? to be healthy of course, but just what does that mean? Lower my risk factors so I don’t get some disease in the future?

Nope, we seem to talk all around it, but never pin it down, what we really mean by health. Health is the goal, the ultimate outcome. It’s why we eat “right” and exercise. We need to focus on health first and understand it and what causes it instead of worrying so much about meaningless risk factors.

Perhaps there’s a better way to understand health than the tired old definitions from the chronic disease prevention model.

I want to know what health is, and how to get it today, don’t you?

Redefining Health

You cannot live by risk factors and health markers. They are not reliable ways to gauge your health. We all live in the present moment, not in the future.

Apparently, our model these days is to worry about getting chronic diseases. To reduce our chances, we follow guidelines and rules put out by public health organizations that are supposed to lower our risk of getting these diseases down the line.

But what about right now? How do I live a full, healthy, vibrant life right now? Why don’t the public health authorities tell me how to live healthy right now?

Risk factors don’t make me feel better, no matter how low they are. I still fall asleep after lunch and don’t have the energy I used to. Sometimes I get moody and don’t always get good quality sleep.

Public health organizations are focused on chronic disease prevention, not day-to-day, present-day health and wellbeing. They say they are but they really aren’t. They tell you to lower your risk factors and lose weight. Like that’s supposed to make me healthy today.

I want to know what health is—and how I can achieve it today.

Risk factors don’t work to produce health today.

But we don’t even know what health is. No one ever defines what health is in a way you can understand and makes sense.

Having low cholesterol is not the definition of health. Having low or normal blood pressure is not health.

You know what good health feels like, intuitively, but doctors and health researchers don’t focus on these soft qualities that are most important to you, like how much energy you have in the afternoons, how good your mood is most of the time, or how well you can focus and concentrate on whatever you need to do.

Isn’t it time we defined what good health really means? And how to get it?

The chronic disease prevention paradigm we’ve lived under for the past 40 years says eat this, not that, exercise some and you’ll prevent yourself from getting chronic diseases like cardiovascular disease and diabetes.

But how does that give me health today, right now?

I want health today, health right now, Health NOW!

How can I achieve that? Is there a way? What if we took our focus off of preventing chronic disease later and put our focus on achieving good health right now, today?

Can we do this?

Yes, but in changing the goal from “preventing disease” to “good health now,” we’d have to define what “good health” or “health” means.

No one ever seems to define what health or healthy means.

Except in terms of absence of disease, which makes not a lot of sense.

What does healthy mean to you? That you can do all the things you want to do? That you have no physical restrictions or illnesses or injury?

We need a more pragmatic way of defining health, one that does not depend on medical tests or prevention models.

We can look toward the nascent quantified self movement where people use devices to measure all sorts of things about themselves, from heart rate to sleep quality to calorie counts to steps taken to what comes out the other end.

But step counting and all the other metrics don’t tell you if you are healthy.

No, what we need is a more general reference frame to test ourselves, to rate our own health because we know when we feel good, right? I know I do.

We need a way to capture that, not all these metrics that really don’t mean a lot, no matter how much data we collect or how many fancy graphs we can make from the data.

So, not only do we need to define health, since no one really has, but we also need a simple way to measure health, that anyone can do at anytime, without fancy tests or gadgets.

We don’t understand how to achieve health now, in the present moment, because we’ve been focused on the future and preventing disease.

It’s time we changed our perspective and focused on achieving Health Now.

I want Health NOW, not some time in the future when I don’t get some disease. How does preventing future disease help me feel better now? It doesn’t. Only feeling good health now, right now, makes me feel good right now.

This is a paradigm shift that is needed. From the prevention paradigm built on epidemiology to Health Now. See my Health Now page for a table of differences between the old Prevention paradigm and Health Now.

Health Now becomes health in the next moment and on into the future. By focusing on what makes you the most healthy right now, you take care of the future while giving you optimal health now. Unlike the prevention strategy where how you feel right now is less important than keeping your risk factors and health markers within normal ranges.

Health is not the sum of risk factors and health markers.

Health NOW is what you want; it’s what I want; it’s what you should want—not low risk factors.

The idea is to shift our thinking and health creation strategy away from prevention and toward health.

It’s about: Causing Health, Not Preventing Disease

And it starts with reclaiming your Plate from the USDA.

They try to tell you what to eat to be healthy or what they believe is healthy. See their ChooseMyPlate.gov website for the color coded monster.

It’s what you’re supposed to eat. So “my plate” is really what the USDA wants you to eat, supposedly that will make you healthier by preventing chronic disease in the future.

But once you shift your paradigm to Health NOW, you see that you have to reclaim your plate and make it truly your plate, not what the industry-influenced USDA wants you to eat.

When you do this, you become responsible for your own health and wellbeing, so you decide to investigate and experiment to see what really makes you feel healthy.

But even before you start experimenting with your diet, you have to know what healthy is.

So we need to define health in a simple way that everyone can understand and intuitively measure without doctors and medical tests.

How do we do this? We learn to listen to our bodies and what they tell us. They are always giving us feedback about how we’re doing, if only we’d learn how to listen to the signs.

This is what I’m working on, and what Figure Out Food is all about:  the process of learning how to listen to your body.

10 Ways to Radically Improve our Dietary Guidelines

After 35 years, isn’t it time we had better Dietary Guidelines?

A vision for better dietary guidelines that actually work

2015 Dietary Guidelines Advisory Committee (DGAC)
These are not the Dietary Guidelines you’re looking for . . .

In the above photo, you can see the 2015 Dietary Guidelines Advisory Committee (DGAC) meeting in September 2014. They have been finalizing their draft recommendations to go into their final report. Their charge has been to review the last guidelines, from 2010, to see what, if any, changes are needed for the 2015 guidelines, based on any new evidence they deem important.

I’ve watched many of their meetings, which are available online, and come away unimpressed. Is this the best we can do in the 21st Century?

A little personal history might be in order here. I never wanted to learn about nutrition or food. I wanted it to all just work. I wanted the Dietary Guidelines to work, to make me healthy so I could go on with everything else in life I wanted to do, like ride bikes, work, play, watch TV, and travel.

I Want to Believe
I wanted to believe in the USDA Dietary Guidelines

What I found, however, in the early to mid 1990s, was that following the USDA Dietary Guidelines didn’t actually work that well for me. I had large energy swings, and was hungry and thirsty all the time. Following the Dietary Guidelines turned me into a prediabetic, with unstable blood sugars and raging thirst.

After a couple of years of this, I thought: “this can’t be right!” How can I feel so terrible if eating this low-fat, high fruit and vegetable, food pyramid diet is supposed to be making me healthy?

That’s when I started looking for alternative advice on how food was supposed to make me feel, and how it was supposed to work to make me feel good and healthy.

The landscape for alternative nutrition advice was pretty slim in the mid 90s, but eventually I found the key to unlock my current passion about nutrition. I read the book Protein Power, by Drs. Eades. Finally, it started making sense.

I realized that nutrition is less about what you eat than all the spaces in-between, how your body operates and functions on what you feed it. Nutrition is less about eating than how you feel. Learning to connect what you eat to how you feel is the key.

To make a long story short, ever since, I’ve been keenly interested in nutrition for my own personal self-interest. I feel that I’ve had to learn so much about nutrition, not because I wanted to, but because much of the official dietary advice just didn’t seem to work for me or give me the promised and expected results.

On this journey, I’ve read so much and thought so much about what’s wrong with our current Dietary Guidelines and what could make them better. It’s time to share these thoughts.

10 Ways to Improve our current Dietary Guidelines

Here are ways we could radically improve our Dietary Guidelines.

1. Faster, constant updates and revisions

Why in the world does it take the DGAC two years to review the evidence—just to see if anything has changed since the last guidelines?

An update every 5 years is just too long and too slow. We live in the internet age of constant updates. Five years might as well be a century as far as all the new things we have to learn to deal with in that time.

We need constant updates and revisions since our food environment changes every day with new products, new scientific results, and even more choices about what exactly to eat every day. We can’t wait five years for an update.

2. Feedback Mechanism needed

What do you do when the Guidelines don’t work? What do you do then? What’s Plan B? And how can you let the USDA know their advice isn’t working? (Besides waiting another three years for them to open up the public comment window and give selected persons just under three minutes to give oral testimony?)

Dietary Guidelines are rules, similar to software, in that they are programming inputs to your body, what to eat, to produce health. When your software or apps don’t work, you can submit bug reports and enhancement requests. We need similar ways to report problems and issues such as side effects and adverse events.

Something like the UK Yellow Card scheme would be a nice way to provide feedback:  https://yellowcard.mhra.gov.uk/

The Yellow Card Scheme now supports the reporting of all suspected problems or incidents to all healthcare products, not just suspected side effects to medicines

3. Personalized Guidelines instead of one-size-fits-all

Why can’t the Dietary Guidelines be customized for each person and perhaps different situations? Each of us is different, unique, unlike everyone else.

You are not like everyone else. You live in your own environment with your own special history. Why should you eat the same as everyone else? Why should that even work?

We need to move beyond the one-size-fits-all mentality and customize dietary patterns for each person, that are suited to each person’s specific needs, characteristics, history, and circumstances.

4. Teach me how to tell if what I’m eating is working

We need testable Guidelines. Teach me how to tell if what I’m eating is working and making me healthier.

Teach me what eating right and wrong feels like, so I can tell on my own—what to look for and notice and be aware of, and how to fix it. Don’t just tell me what to eat and assume it’ll work! All too often your past advice hasn’t worked, leaving us stuck not knowing what to do.

Teach me the process of using diet and nutritional knowledge to improve and promote and restore health, in a holistic (and not so reductionist please), round-trip way so I understand it is not just about eating but also digestion, absorption, metabolism, and excretion—and overall how my diet makes me feel.

How can I tell if my diet is making me healthier, every day, every meal? I’m not interested in risk factors and medical tests, but in measures of well-being and everyday performance and functioning: real health you can feel and use and makes life better today, not some vague promise of a longer life or diseases prevented.

Wellbeing is functional health – that you feel good and can perform all the ways you need to and want to. Optimal wellbeing and health is something you should have now and all the time.

5. Sharing Dietary Experiences – Crowdsourcing what works

Instead of all of our dietary experiences being scattered across myriad nutrition forums and blogs, why don’t we have a way to collect data on what works for people?

Haven’t we realized that the Dietary Guidelines are a giant observational experiment that we should be collecting data on? An experiment that unfortunately has probably caused the huge rise in obesity and an even bigger epidemic of what I call “unhealthiness” that includes metabolically damaged normal weight and under-weight people.

Why isn’t there a way to measure how well your diet is working and be able to share that with others that share similar characteristics, to develop patterns and allow analytics to find trends and related effects?

Why aren’t we using the power of the internet, mobile devices, big and small data, and social networking to crowdsource better dietary guidelines for the 21st Century? Dietary Guidelines that actually work, instead of what experts tell us every five years should work.

6. Focus on health first instead of diet 

One of the 7 Habits of Highly Effective People is “Begin with the end in mind.”

Just what is the goal of the Dietary Guidelines? Health, right? So why don’t we start there and work backwards to see what gets us there, instead of listening to experts tell us to “eat this, not that” with the vague promise that it’ll lower our risk factors for chronic diseases and may contribute to a longer life.

Focusing on health means knowing what health is. How can you eat a healthy diet if you don’t know what health is? For a new way to look at health, see my Health Now page. Health is more than the absence of disease and low risk factors; it’s feeling good, everyday. It’s feeling good all day long, not falling asleep after lunch.

7. Make some Dietary Guidelines APPs already

Where are the Dietary Guidelines apps in the age of smartphones?

Dietary Guidelines should be app-ified by now. The USDA’s SuperTracker food tracking web site is not good enough in the smartphone age. We need apps. Isn’t this obvious?

The Dietary Guidelines are a relic of a pre-personal computer, pre-internet, pre-web, pre-mobile phone, pre-apps age. Isn’t it time they joined the future?

We need 21st Century Dietary Guidelines:  open, fast, constantly updated, do-it-yourself, relevant, personalized, customized, individual, dynamic, responsive, evolving, tailored, and tested.

8. Grade yourself properly DGAC

The DGAC considers “what works” to mean what works to get people to follow their guidelines—not what actually works to make us feel better and healthier, because these two things are not necessarily the same.

Stop using adherence to your possibly fatally flawed guidelines as a measure of what works. We may not be following your advice because experience tells us it doesn’t work. If people are not adhering to your advice, take a deep look and ask why.

9. Stop blaming the victims when Guidelines don’t work

Perhaps it’s not us, it’s you (DGAC).

Most of us are not that stupid to keep trying a dietary plan that doesn’t deliver the promised and expected results. And some of us don’t have a choice:  SNAP (food stamps), National School Lunch Program, VA Nutrition and Food Services, etc.

The DGAC seems to be composed of experts who believe that it’s all our fault (the public) for not listening to their “correct” advice, that we’re all just too lazy and gluttonous to follow their expert recommendations and guidelines. So they blame us instead of looking at what they might be doing wrong.

10. USDA should stop serving two masters

The Dietary Guidelines are officially a joint effort of the USDA (United States Department of Agriculture) and the DHHS (Department of Health and Human Services).

The USDA serves two constituencies. They are supposed to promote the US agriculture industry, and as half of the sponsoring organization for the Dietary Guidelines, they are supposed to promote public health. But what if these two goals come into conflict?

Perhaps we should just have HHS develop the Dietary Guidelines, but then who’s to say they wouldn’t be just as industry-influenced as they are now?


Let food be thy medicine . . .

When are the Dietary Guidelines supposed to work? If I follow the Dietary Guidelines—like taking medicine—when should I feel the effects? and what/how should I feel? what benefits should I notice/see? When? Today? Week? Months?

The entire Dietary Guidelines process and paradigm is old-fashioned. It tries to prescribe food as medicine (which is good), but it’s not customized to each person’s unique needs, with no feedback mechanism or process to tell if it’s working, with no measuring stick, and no alternative treatments (different diet plans) to try.

Dietary Guidelines seem to be built on the Doctor-Patient Prescription (Rx) model—but without individuals (us) knowing how to determine efficacy of treatment—and no feedback mechanism when things go awry. Instead of the prescription model, we need a feedback-driven process of what works and doesn’t.

Dietary Guidelines do not tell you what to look out for (signs and symptoms) to indicate whether your diet is working or not. It’s like saying, here, take this medicine forever, or at least the next 5 years, till we update our advice again—and if you have problems, side effects, adverse effects—tough, not our fault, you must be doing it wrong because we’re the experts, we have evidence, and we cannot be wrong!


Conclusion

After 35 years , we can do better than what we’re getting from the DGAC. We desperately need to.

What it takes is a new way of looking at health, of defining health, that moves us completely away from the past 40 years of prevention paradigm thinking, to what makes us optimally healthy today, not long into the future.

In my next post, I will start laying out how exactly we, together, can create the 21st Century Dietary Guidelines we need—by focusing on health first.

Low fat diets “probably not a good idea”

I came across a wonderful WSJ op-ed article today by Nina Teicholz, author of The Big Fat Surprise.  Here’s a tweet she sent about it with a link to the piece:

It reminded me that I had watched the very same DGAC meeting she mentions in the above article, where the vice-chair, Alice Lichtenstein, makes some remarkable comments about whether low fat diets are good and still recommended by the Dietary Guidelines Advisory Committee.

The meeting in question was the 2015 DGAC Meeting #5, day 1, on 16 September 2014, http://www.health.gov/dietaryguidelines/2015-binder/meeting5/index.aspx

In this clip, vice-chair Alice Lichtenstein says “low fat diets are probably not a good idea” and that “they induce dyslipidemia” and that they switched their message way back in 2000. Who knew?

The full meeting video is available online (this clip starts at 04:35:15):  http://videocast.nih.gov/summary.asp?File=18613&bhcp=1

And if that wasn’t enough to blow you off your chair, Frank Hu, also on the 2015 DGAC, followed a few minutes later, saying “People keep on saying that we are still recommending low fat diets which is not the case” (clip starts at 04:37:39):

It’s all part of the Subcommittee 2 Dietary Patterns, Foods and Nutrients, and Health Outcomes presentation on Saturated Fat and Cardiovascular Disease, given by Frank Hu. This presentation starts at 04:14:00. The fascinating discussion on whether low fat diets are still recommended or not was started by Miriam Nelson (in the Q&A) at 04:33:10.

The takeaway?  Low fat diets are over, so last century, but apparently the message hasn’t really gotten out to all of us.

But they still say we should reduce our saturated fat intake, although their own draft conclusion statement says that higher saturated fat intake as compared to carbohydrates is not associated with CVD risk. I don’t get it.

Here are the draft conclusion and implication statements, so you can read them yourself:

sfa.and.cvd.6 sfa.and.cvd.7 sfa.and.cvd.8 sfa.and.cvd.9

It’s ugly watching the sausage get made.