President's Desk, October 2015
David L. Katz, MD, MPH

Standing With Friends

Before I launch into the focus of this month’s column, bear with me for a brief promotional message about the American College of Lifestyle Medicine. Be sure to read the Spotlight article below- exciting developments, indeed. I look forward to seeing you in Nashville come November 1 as we kick off Lifestyle Medicine 2015- if you haven’t registered yet, please do!

I am proud that the American College of Lifestyle Medicine expressed public supportfor the work of the 2015 Dietary Guidelines Advisory Committee when their 572-page report was first issued.  I am proud that we have reaffirmed that support now that the work is encountering predictable abuses from the usual suspects.  The scientists comprising the DGAC are friends, indeed, to lifestyle medicine.  They are now friends in need as well.

Over recent days, the work of the DGAC was excoriated in the British Medical Journal, and then subjected to scrutiny before Congress which apparently resembled something like a circus.  We have, unsurprisingly, learned that behind all of this mischief are those constant perils to public health: profiteering, self-interest, and politics as usual.

All of this might be understandable if the DGAC had suggested anything truly radical.  Invoking the weight of evidence, however, they did the very opposite.  This language is directly from the report’s executive summary:

The overall body of evidence examined by the 2015 DGAC identifies that a healthy dietary pattern is higher in vegetables, fruits, whole grains, low- or non-fat dairy, seafood, legumes, and nuts; moderate in alcohol (among adults); lower in red and processed meats; and low in sugar-sweetened foods and drinks and refined grains. Additional strong evidence shows that it is not necessary to eliminate food groups or conform to a single dietary pattern to achieve healthy dietary patterns. Rather, individuals can combine foods in a variety of flexible ways to achieve healthy dietary patterns, and these strategies should be tailored to meet the individual’s health needs, dietary preferences and cultural traditions. Current research also strongly demonstrates that regular physical activity promotes health and reduces chronic disease risk.

Many factions, including our own at ACLM where passions run strongly in favor of plant-based eating, might wish for a bit more of this, or a bit less of that.  But admittedly, these conclusions are temperate and sound, evidence-based and eminently reasonable.  How can they even be made to seem controversial?

People tend to speak quite indiscriminately about “consensus,” generally telling us about its absence.  Some of these people are scientists, from whom we expect precision and fidelity to the operational implications of definitions.  When they tell us there is “lack of consensus,” we are invited to believe they have data.  But they don’t.

Of course there is lack of universal consensus on any topic; all that requires is for someone, no matter how misguided, to disagree.  I don’t think most of us care about that.  Most of us take consensus to mean the prevailing interpretation of people with the requisite aptitudes and expertise to do the interpreting in the first place. 

We also, I suspect, have some quantitative threshold in mind, whether or not we have situated it with numerical clarity.  If, for instance, 99% of all experts agree about dietary guidance, or climate change for that matter, and 1% disagrees- would that be “lack of consensus”?  Most of us, I suspect, would say no; that sounds more like consensus to us.  That’s not proof that the consensus is correct- that’s a different matter entirely; it’s just proof that it exists.  If 99% doesn’t do it for you, how about 99.9%?  At some point, a majority becomes enough to qualify as a consensus.

But in this day of the blogosphere, the 1%, or the 0.1%, have no trouble making noise.  If they fortify one another’s noise in an echo chamber, they may seem to be the tip of a non-existent iceberg.   In other words: if I assert that we lack consensus, and several folks come along to say -“hear, hear!”- we may leave our audience with the impression that there are thousands more just like us who feel the same.  But it’s also possible that we are all there is.

Second, there is a serious problem with the prevailing definition of “research,” a term I see used routinely by bloggers, many untrained in research methods.  The term is used routinely to mean: I searched for sources that affirmed the opinion I owned at the start.  In the case of our litigants, such research would be: I talked to several people who agree the cow is mine!

This is not research; it is canvassing.  The true work of research when testing a hypothesis requires allowance for the result you don’t want.  When reviewing accumulated evidence, it requires comparable attention to sources whether they conform to your hopes, or oppose them.  Along with expertise, alas, such stipulations about research seem these days to be on life support.

Third, and finally, there is what we might call the “lens” problem.  Some perfectly legitimate scientists and accomplished researchers seem prone to overlook the parable of the blind men and the elephant, and the dependency of the lens on the view.  An electron microscope is a very powerful tool, but of little use when assessing hurricane damage to a coastal town.  A huge telescope can help us peer into the distant space and time of the universe, but helps not at all when screening for skin cancer.  So, too, expertise in, say, cell biology might allow for erudition about lipid metabolism, yet cause one to overlook other parts of the elephant in the room- or the dietary pattern in the Blue Zones.

The alleged discord currently roiling the world of nutrition as it pertains to populations in (principally) industrialized countries stunningly reduces to this: one side recommends our diets should be comprised principally of vegetables, fruits, whole grains, beans, lentils, nuts and seeds with lesser amounts of other items and nothing hyper-processed that glows in the dark, for the sake of our own health, and that of the planet; the other side says we should eat more meat, butter, and cheese.

There is, of course, a patina over this fundamental divide, in the form of many nits related to this fatty acid, and that; this variety of sugar, and that.  The picking of such nits is then somehow transmogrified into a fundamental “lack of consensus” about, apparently, anything- and uncertainty about whether it would be healthful to eat more spinach, or sausage.

We are by no means clueless about the basic care and feeding of Homo sapiens, and we well know that diet is a centerpiece of lifestyle as medicine.  On that basis, we stand with the DGAC, currently, friends in need.  Thus far this alliance is not enough to overcome the forces of profit-driven discord.  But it’s a start, and the True Health Coalitionis a global army coming together at our backs to help advance the mission.  We can lose a battle, and win the war.

For now, I am proud that we have chosen to stand with our colleagues in public health nutrition.  I would say that we have taken a seat with them at the same table, but we all know that, like “more meat, butter, and cheese,” more a bad idea!