It has been a while since I've blogged about nutrition. My last post was on the dangers of centenarians and Blue Zones narratives on longevity where I explained the pitfalls regarding reasoning from tail extremes. As you may have guessed from my earlier posts on nutrition. I'm a data guy, not a biology guy. Conversely, my only credentials with respect to nutrition and medical science, are the type of credentials that I as a data guy want to urge you not to take all too seriously, especially for the reasons I described in my previous blog post.
I have a complicated health history. Partially genetics related, partially related to bad lifestyle and diet choices and partially related to bad advice and poor judgment by medical professionals. I had my first CV event at age 24 and had some close calls since then. Now, 23 years later, I'm still alive. A lot has happened in that 23 years, at some times things got worse, and I could point at some suspect variables for that. Sometimes things got better, andalso for that I have some theories on what variables contributed to that, and it would be easy to just look at the numbers and declare myself a guru, using my survival as justification. I have no aspirations of obtaining guru status, but more importantly, the esential point remains that much of my continued survival is undoubedly stupid blind luck. That is, I could be right and my survival might be less due to blind luck, or I might simply be a lucky bastard who terribly wrong about why he is stil alive. Base point is, you can't know how many people might have used the same strategies for health improvement that seem to have worked for me and died. In fact, there exist mirror images of me. People who were sick. Did the exact oposite of what I believe has kept me alive, and are 100% convinced that doing that is what saved their lifes and made them better.
So on to what prompted me to write this blog post. I recently watched this video where vegan guru, Dr. Garth Davis (MD), author of the book Proteinaholic starts of a talk about (low-fat low protein high carb high fiber) plant-based diet with an amazing four minutes and forty-four-second long intro about alternate facts.
Unfortunately, however, after the great intro, the guru did as gurus always do. So he spent the rest of the twenty-two-minute long talk proving that he didn't really care all that much about facts, or actually that he didn't quite understand the concept of false certainty about facts.
Some claims from the video:
- Carbs don't make you fat, fat does
- Butter causes heart disease
- Red meat causes cancer
- Hot dogs are as bad for you as cigarets
- Vegans live longer and have less heart disease
- Fruit is fantastic for you
- There is a fiber deficiency in this country
- You need half a kg a day of calcium
- You can get half a kg a day of calcium from eating a salad.
- Having iron deficiency is good for you
Let's assume Dr. Davis meant half a gram instead of half a kg, so we will let those slide. There is one interesting gem in the talk that I think is a predominant form of bias in nutrition, whatever school of nutrition you look at.
Dr Davis points out one study where vegans did worse than other groups, only to then point out those vegans were getting too little fiber and might be eating vegan Oreos. What he, however, failed to look at was that the same reasoning might actually apply to the contrasting group. All the low-X groups, where X can be anything from fat or carbohydrate to meat or salt, seem to share this one narrative.
Basically unless you filter (no, not adjust) for eating total crap, it is useless to compare diet X to diet Y. You can't recognize that one group of vegans was eating a crappy vegan diet that included Oreos and then fail to consider that in other studies the meat eaters might be consuming their meat at Wendy's or McDonald's washed down with half a liter of soda. Failing to do so, basically is one of the ways how alternate facts are hatched. And looking at the list of facts that Dr. Davis provides us with, seems he isn't exactly immune from the thing he accuses so many others of.
Other forms of bias sneak into his talk as well. Again fallacies we see repeated by many camps. Referring to industry sponsorship of studies from one side yet failing to account for industry sponsorship of studies from other types of industry. One group will refer to studies sponsored by the egg or meat industry telling us all real science shows us just how bad cholesterol is for us. The other group will refer to studies sponsored by the pharmaceutical industry and the vegetable oil industry, telling us real science shows us cholesterol is harmless at worse and could possibly prolong your lifespan. Both groups are equally justified to point out COI, but both groups are also highly negligent at failing to take in to account the COI contained in the people conducting the contradicting studies.
Now let us forget about low fat versus low carb for a bit. Let us forget about vegan diet versus an omnivore versus a meat-based diet for a bit and let us look at why I personally disagree with Dr. Garth Davis the most. It's not fat vs carb. Its not vegies vs meat. It certainly isn't the eccological impact of diet choices. My main issue with Dr. Davis's alternate facts are his views on Protein vs Fiber.
As Dr. Davis tells us, it is very much possible to get enough protein on a vegan diet, so I won't argue with that. Just that the person who he refers to as an example of vegans not being protein deficient actually seems to get almost half of his calories from protein. Not exactly the macro split Dr. Garth Davis is advocating. Not exactly the high fiber diet he is advocating either.
So why look at fiber versus protein? Well, partially they seem to have similar effects on metabolism. Eat a lot of solid food sourced fiber and you will be less likely to overeat. Eat a lot of solid food sourced protein and again you will be less likely to overeat. Combine either with restricting either fat or carbohydrates and the effect will be the strongest. So basically if your sole goal is to lose weight, then a low-fat low protein high carbohydrate and high fiber diet should have comparable effects to a diet high in fat and protein but low in both fiber and carbohydrates. There could be a reason why the mythical health effects of fiber are practically non-existing in studies from places or times not touched by the obesity epidemic. Fiber keeps us from overeating. Overeating causes obesity. Obesity causes adverse health effects. These are all real facts, but strangely facts that are hardly looked at when looking at the mythical health effects of fiber. Does dietary fiber have any beneficial health effects apart from its attenuation of our tendency to overeat? Well maybe. Are there any actual studies showing us this is the case? Not to my knowledge.
Now let's look at protein. As Delgado's meal plan shows, if you want more than just weight loss, protein is really important. Where protein, like fiber, helps to keep you from overeating, other than fiber, it actually helps to protect lean body mass while losing weight and, when combined with strength or muscle growth geared resistance training, it actually helps to gain the right type of weight. Muscles instead of fat. Are there any negative side effects of protein? Well, if you have kidney disease or are extremely lean, then, yes, you may want to watch out with protein. If you don't? There are a lot of alternate facts floating around in vegan circles telling you there are, most prominently of cause The China Study. Funny thing though, if we look at the actual data of this book that claims animal protein is the cause of so many illnesses, the longevity figures that people like Garth Davis like to bring up actually shows a positive association between animal protein (and meat, cholesterol, and saturated fat).
So why care about body composition? Well contrary to popular belief, obesity isn't about weight. Obesity isn't about BMI. In fact, any study that records visceral fat levels seems to show that BMI, when adjusted for VAT is actually protective of chronic disease mortality. Those studies that compare BMI to other simple metrics such as the Conicity, Waist to Hip ratio and Waist to Height ratio consistently show that BMI is a worse risk marker than each of the alternatives. Thirdly, once you have CVD (and yes, CVD is the leading cause of death, even amongst vegans), low LBM convincingly becomes a risk marker that dwarfs high body fat as far as actual mortality is concerned. So in short: A high LBM is a just as important risk attenuation as low body fat is. And (pending data from larger IRB firewalled studies) this is likely a rather conservative statement. In order to attenuate risk, it is a good idea to lose fat and gain (and most definetely not lose) muscle. Serious protein intake and resistance training seems a reliable strategy for achieving that.
So my hypothesis basically is:
LBM matters. Replacing fiber with protein (in a high RT context) is beneficial
Want to do it the vegan way? Fine, it's perfectly possible. Not sure about the potential adverse of an animal protein animal-fat free diet but still want to have a ethical diet or afraid of meat? Consider entomophagy. The ecological impact of locally bred insects per gram of protein tends to be significantly lower than many plant-based protein sources. especially the low calorie and high fiber sources and plant-based foods that need to be transported from across the ocean.
As for alternate facts. The biggest issue isn't facts versus lies but facts versus hypothesis's posing as facts. Nutrition has a lot of those. I write speculative fiction as a hobby and for me, fiction writing is the place where we can simply make facts from some wild hypothesis. Where induction is a powerful tool to create powerful narratives. Science should be different. In nutrition though, unfortunately, it is not. I often jokingly refer to nutritional science papers as my favorite sub-genre of speculative fiction, but in fact, it isn't a joking matter.
You see above, I pose my view as a hypothesis, not a fact. A lot of the alternate facts in nutrition are actually interesting hypothesis's. Many though are not. Fat will make you fat even though (as some LC advocates point out) vegetables won't make you green. And yes, carbs will make you fat as well. Protein and Fiber will help you from overeating, and most likely protein would be the better option between those two for lean body mass reasons.
As for any of the X causes Y facts, have a good look at this old blog post of mine. Alt facts are a real issue. Gurus debunking one set of alt facts only to produce their own shiny and new pile of alt-fact nonsense is an even bigger problem though.