The Drivers of the Herd, Part 17
The NuSI Guys, Part 7, Dietary Trends, Part 1
Slide 3 http://vimeo.com/45485034
In the previous video I shared with you my commentary on this presentation by Dr. Peter Attia. In that one I mainly focused on his take on the history of diet-heart. In this one I’ll be concentrating our focus on just a few things he said at the beginning of this video. Have a listen.
Slide 4 Attia: “If you look at another data base, the FAO database, so this is the Food and Agricultural Organization, they give you an even more granular breakdown of what happened over that same period of time, which is that grain consumption specifically increased by 39%, the consumption of butter and eggs fell by about 38% and the consumption of all animal products fell by 13%. So we can certainly take comfort in knowing something, which is when the American people were told to do something, they actually did it.”
“When the American people were [asked]* to do something, they actually did it.” Is that true? Did an increase in grain consumption and a fall in fatty animal food consumption coincide with increasing rates of obesity?
* Attia: “told”
Slide 5 Notice two things here. First, observe that the left graph is based on information from NHANES. More on that in a moment. But do you remember what he said about another data base?
Slide 6 He made reference to a data set from the Food and Agricultural Organization. I wanted to know from where he was getting this information.
Slide 7 Nutrition Science Initiative: Introduction and Overview. September 2012. Accessed Dec. 17, 2013 at http://www.givewell.org/files/conversations/NuSI%20overview.pdf
I looked at NuSI’s fundraising document at GiveWell.org to see if a source was provided there since none appeared in Attia’s video. Here’s what I found. Look at the lower left.
Slide 8 Nutrition Science Initiative: Introduction and Overview. September 2012. Accessed Dec. 17, 2013 at http://www.givewell.org/files/conversations/NuSI%20overview.pdf
There you see it references an unspecified document from the “U.S. Food and Agricultural Organization”.
Slide 9 http://eatingacademy.com/nutrition/the-straight-dope-on-cholesterol-part-I
Do you remember how we saw what a careful and serious person Attia is?
Slide 10 Nutrition Science Initiative: Introduction and Overview. September 2012. Accessed Dec. 17, 2013 at http://www.givewell.org/files/conversations/NuSI%20overview.pdf
I find it strange that a serious person would try to get away with referencing an organization that does not exist. There is no such thing as the “U.S. Food and Agricultural Organization”. Google it for yourself. There is a United Nations Food and Agriculture Organization. I couldn’t find any documents of theirs specific to the United States that could back up this assertion.
Slide 11 Mann, J., et al. "FAO/WHO scientific update on carbohydrates in human nutrition: conclusions." European Journal of Clinical Nutrition 61 (2007): S132-S137.
If you want to know what the FAO says about carbs, they created a pretty conventional statement about how carbs have no special role in promoting obesity.
Slide 12 They endorse healthy carbs, as any responsible health professional should.
Slide 13 They also recommended that carbs contribute up to 75% of the calories in your diet.
Slide 14 Nutrition Science Initiative: Introduction and Overview. September 2012. Accessed Dec. 17, 2013 at http://www.givewell.org/files/conversations/NuSI%20overview.pdf
Attia’s claims were also based on NHANES data.
Slide 15 Archer, Edward, Gregory A. Hand, and Steven N. Blair. "Validity of US Nutritional Surveillance: National Health and Nutrition Examination Survey Caloric Energy Intake Data, 1971–2010." PloS one 8.10 (2013): e76632.
NHANES data is based upon self-reported dietary intake. I’ve said over and over again in these videos that self-reporting is not a reliable way to ascertain true dietary patterns. NHANES in particular was recently demonstrated to be highly flawed for this reason. Looking at the entire history of NHANES, these researchers determined that reported energy intake was often not physiologically [plausible]. The NHANES data is clearly unreliable.
Slide 16 These researchers found that fat in particular was underreported by NHANES participants. This discredits Attia’s argument.
Slide 17 So what about Attia’s assertion that Americans got heavier despite following official dietary recommendations?
Slide 18 p.13. McGovern, G. "Eating in America." Dietary goals for the United States of America. Report of the Select Committee on Nutrition and Human Needs. US Government Printing Office (1977).
If we want to assess that claim, we’ll need to first understand what the dietary recommendations have actually looked like. This is the list of goals prepared by the first report of the McGovern panel on nutrition in 1977. I’ll treat these as representative of official recommendations in general because for the most part they are and because this document is so widely condemned by low-carbers. I’m going to draw your attention to just a few recommendations. First, in number 1, you can see that they advised an increase in the consumption of whole grains. That doesn’t read “refined grains”. Number 3 says that Americans should reduce their fat consumption, particularly their saturated fat consumption. And number 6 says Americans should cut back on sugary foods. Dr. Peter Attia is implying that Americans actually did all these things. Is he right?
Slide 19 First, if we want to understand what has caused people to get heavier in America, we’re going to have to look at the period in which people started getting heavier. Attia and the other low-carbers want you to believe this all started in the late ‘70s when Americans cut back on animal products and started eating more grains. The graphs Attia uses to make this point show increasing obesity through the ‘80s and ‘90s. But this is a form of cherry picking.
Slide 20 Rose, David. "Global warming stopped 16 years ago, reveals Met Office report quietly released... and here is the chart to prove it." Mail Online (UK Daily Mail) 13 Oct. 2012. Web. Accessed 5 Jan. 2014.
To show you why, I’ll use a different example to show you how deceptive graphs like Attia’s can be. This was a story run by the UK’s Daily Mail. They used this graph to claim that global warming stopped 16 years ago. Let’s pretend for a moment we are ignorant of the fact that the oceans and even the clouds are important heat sinks not accounted for in air temperature readings. Let’s forget the details of climate change for now and just focus on this graph. Notice they chose to begin their graph in 1997. Within the time period they’ve chosen, it does seem that temperatures are no longer rising.
Slide 21 http://www.metoffice.gov.uk/research/climate/seasonal-to-decadal/long-range/decadal-fc
But if you look at a graph showing a larger sampling of data, you can see that they were highly selective about what they chose to show you. I have boxed in the region shown in the previous graph. The Daily Mail graph started with a spike in temperatures around 1997. Ignore that and you can see that within the random effects of a complex system like the climate, it looks a lot less like global warming is stopping.
Slide 22 Komlos, John, and Marek Brabec. "The trend of mean BMI values of US adults, birth cohorts 1882–1986 indicates that the obesity epidemic began earlier than hitherto thought." American Journal of Human Biology 22.5 (2010): 631-638.
In the same vein, it is essential that we understand that Americans didn’t just start getting heavier in the 1980s. This very important recent paper added a great deal of support to what many researchers had suspected: Americans got heavier throughout the twentieth century. This paper has many wonderful graphs which I will not reproduce here. But this quotation tells you what you need to know. BMIs definitely began increasing after World War I. BMI’s also surged after World War II. Obesity didn’t suddenly start rising in the ‘80s. This is unsurprising if you read the commentary in the McGovern report.
Slide 23 p.9. McGovern, G. "Eating in America." Dietary goals for the United States of America. Report of the Select Committee on Nutrition and Human Needs. US Government Printing Office (1977).
Here you can see that obesity was considering a serious and growing problem in the 1970s. This document is filled with statements of concern over obesity and suggestions for how to fight it. So what do we see in dietary trends if we look at a larger time frame?
Slide 24 p.13. McGovern, G. "Eating in America." Dietary goals for the United States of America. Report of the Select Committee on Nutrition and Human Needs. US Government Printing Office (1977).
Attia implies that Americans reduced their fat intake. Practically everyone who has researched this topic knows the problem with that belief.
Slide 25 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5304a3.htm
Wright, J.D., et al. “Trends in Intake of Energy and Macronutrients --- United States, 1971—2000” MMWR Weekly. Centers for Disease Control and Prevention. February 6, 2004 / 53(04);80-82
While the percentage of fat in the diet may have slightly decreased over the period he selected, the absolute amount of fat did not. If anything it increased. The reason fat declined as a percentage of calories is because Americans ate more calories, and this was definitely not what we were asked to do.
Slide 26 p.13. McGovern, G. "Eating in America." Dietary goals for the United States of America. Report of the Select Committee on Nutrition and Human Needs. US Government Printing Office (1977).
Attia says Americans ate more grains, as requested. But that’s not what Americans were asked to do. We were asked to consume more whole grains. Did we?
Slide 27 Cleveland, Linda E., et al. "Dietary intake of whole grains." Journal of the American College of Nutrition 19.sup3 (2000): 331S-338S.
No, we did not. Only a very small fraction of the grain products consumed in the US during the ‘90s, for example, were whole grains. Americans ate more junk and this shouldn’t be news to anyone.
Slide 28 Wells, Hodan Farah, and Jean C. Buzby. Dietary assessment of major trends in US food consumption, 1970-2005. US Department of Agriculture, Economic Research Service, 2008.
Over that time period, Americans drastically increased the added sugars we consumed. This is not something we were asked to do.
Slide 29 Bleich, Sara N., et al. "Increasing consumption of sugar-sweetened beverages among US adults: 1988–1994 to 1999–2004." The American Journal of Clinical Nutrition 89.1 (2009): 372-381.
Here is a portion of another table that makes this point. Americans consumed far more sugar-sweetened beverages since the ‘80s.
Slide 30 Wells, Hodan Farah, and Jean C. Buzby. Dietary assessment of major trends in US food consumption, 1970-2005. US Department of Agriculture, Economic Research Service, 2008.
And while we did reduce our consumption of animal fats except for fatty cheeses a little, we more than made up for that with other added fats. All these add empty calories that do little if anything to promote overall health. The major benefit to added oils is that they tend to displace animal fats in the diet. Since vegetable oils tend to lower cholesterol and animal fats tend to raise it, this is a good trade, even if it still leaves us far from a truly healthy diet.
Slide 31 http://www.cnpp.usda.gov/Publications/FoodSupply/FoodSupply1909-2000.pdf
Gerrior, Shirley, Lisa Bente, and Hazel Hiza. "Nutrient content of the US food supply, 1909-2000." Center for Nutrition Policy and Promotion, U.S. Department of Agriculture. 2004.
Returning to my point that Americans were getting fatter since World War I, not just since 1980, we will look at graphs showing food supply data over most of the twentieth century. It’s true that these data are not a perfect reflection of actual consumption, but we have no better alternative as far as I am aware.
Slide 32 Attia says butter consumption fell. This is true, but as I said, you can see this was more than offset by other added fats.
Slide 33 We can see here that while egg consumption has fallen along with red meat consumption, poultry consumption has increased dramatically. Why not blame the increase in obesity on chicken?
Slide 34 Whole milk consumption has fallen a great deal, but cheese consumption has also increased, especially through the years that interest Dr. Attia.
Slide 35 Moss, Michael. "While Warning About Fat, U.S. Pushes Cheese Sales."The New York Times 6 Nov. 2010. Web. Accessed 5 Jan. 2014 at http://www.nytimes.com/2010/11/07/us/07fat.html
This has not been an accidental trade-off. Our government promoted cheese to us.
Slide 36 Notice that as Americans have gotten fatter over the twentieth century, that supposedly most fattening of starches, the white potato, has trended downward through it all.
Slide 37 Now let’s consider grain consumption during the previous century. Grains are represented by the broken line. Total grains in pounds have mostly fallen over the twentieth century, with the upturn in the ‘80s and ’90s to which Attia referred not translating into Americans meeting even the very pathetic whole grain recommendation in those days of one serving per day. This is a good moment to recall that Daily Mail graph of global temperatures. If we look over a longer time span, we see that the portion he selected did not give us an accurate sense of the broader trend.
Slide 38 As a percentage of energy, grain consumption has fallen over the last century, as has dietary fiber consumption.
Slide 39 Meanwhile, our absolute intakes of protein and fat have increased whether we are looking at the last century or the last 30 years. It’s no wonder we’ve gotten fatter.
[Wondering about food wastage? I’m discussing trends here, not absolute intakes. Please see Figure 5 of Jeffery, Robert W., and Lisa J. Harnack. "Evidence implicating eating as a primary driver for the obesity epidemic." Diabetes 56.11 (2007): 2673-2676.]
Slide 40 The USDA researchers who prepared this document called the increase in fat consumption since 1970 “disturbing.” Dr. Peter Attia, on the other hand, would like to see us eating a lot more fat.
Slide 41 Nutrition Science Initiative: Introduction and Overview. September 2012. Accessed Dec. 17, 2013 at http://www.givewell.org/files/conversations/NuSI%20overview.pdf
Let’s go back to that one NuSI graphic. Notice in the middle it says that total animal protein consumption has fallen as a percentage of calories.
Slide 42 Wells, Hodan Farah, and Jean C. Buzby. Dietary assessment of major trends in US food consumption, 1970-2005. US Department of Agriculture, Economic Research Service, 2008.
But look at this. We can see that meat, poultry, and fish in the food supply have [collectively] actually increased by over 20 pounds per person. By weight, eggs fell by only about seven pounds. The drop in eggs was more than offset by increases in meats.
Slide 43 Larsen, Janet. "Peak Meat: U.S. Meat Consumption Falling." earth-policy.org. Earth Policy Institute, 7 Mar. 2012. Web. 24 Dec. 2013. <http://www.earth-policy.org/data_highlights/2012/highlights25>.
The Earth Policy Institute also shows a graph that gives a different impression from the one Attia gives. Only recently has meat consumption relented from its long post-World War II surge, a surge that coincided with increasing BMIs.
Slide 44 Wells, Hodan Farah, and Jean C. Buzby. Dietary assessment of major trends in US food consumption, 1970-2005. US Department of Agriculture, Economic Research Service, 2008.
Let’s go back to this table. It showed us that vegetable oils displaced added animal fats in the diet in the US. I said this wasn’t ideal but it was an improvement for heart health. Let’s shift our discussion now to trends in diet and heart disease.
Slide 45 Goodman, D. S. "George Lyman Duff memorial lecture. Cholesterol revisited. Molecule, medicine, and media." Arteriosclerosis, Thrombosis, and Vascular Biology 9.4 (1989): 430-438.
It is no coincidence that that switch was accompanied by a dramatic drop in deaths from heart disease. Look how steeply heart disease deaths increased from 1920 to 1960. You can see why good people like Ancel Keys were concerned.
Slide 46 “Coronary-artery Disease.” Editorial: Lancet 2: 1123, 1955.
An editorial appeared in The Lancet which expressed alarm at this increase, also seen in the UK. “All cardiologists whose experience goes back thirty years or more seem to agree with the vital statisticians that the higher mortality-rates reflect a real increase in coronary-artery disease, and also that young people, below the age of 40, are now affected much more often than formerly,” they wrote. So what dietary changes accompanied that surge in heart disease?
Slide 47 Friend, Berta. "Nutrients in United States Food Supply A Review of Trends, 1909-1913 to 1965." The American journal of clinical nutrition 20.8 (1967): 907-914.
You can see how dramatically meat and dairy consumption increased over that time period in this table. Meanwhile people were eating fewer potatoes and cereals, and all the while added sugars held steady.
Slide 48 Danforth Jr, E. "Diet and obesity." American journal of clinical nutrition 41 (1985).
The switch away from carbohydrate during the heart disease epidemic is illustrated by this graph as well.
Slide 49 Gortner, Willis A. "Nutrition in the United States, 1900 to 1974." Cancer Research 35.11 Part 2 (1975): 3246-3253.
You can see the same thing here. Carbohydrate consumption actually fell as heart disease deaths rapidly increased. Potatoes and sweet potatoes consistently fell out of favor over this time. Cereals were consumed less, too. But dairy, meat, and especially eggs became far more popular. This paper has several very informative graphs. Look at them and you will see that while heart disease claimed lives in ever greater numbers, sugar consumption showed practically no increase. Don’t let these ideologues get away with revising history. Americans experienced this tragic epidemic just as they traded their starches for meat and eggs, and sugar had little to do with it.
Slide 50 Drewnowski, Adam, and Barry M. Popkin. "The nutrition transition: new trends in the global diet." Nutrition reviews 55.2 (1997): 31-43.
We now understand that this change in the American diet was just one example of how food supplies are affected in countries experiencing a transition from poverty to wealth and industrialization. Industrialized animal food production delivers cheaper animal foods. This is plainly visibly in this graph. Cheap, nutritious, environmentally sound starches are consistently traded for fats, sugars, and animal products. This paper reproduced this graph.
Slide 51 And it originated this one. Fat consumption has historically been closely tied to income. This is the nature of the nutrition transition. This is apparently a fundamental aspect of human nature that we all intuitively understand.
Slide 52 p.10. Wood, Thomas Barlow. The national food supply in peace and war. The University press, 1917. Google Books.
This preference was understood far before anyone came up with the phrase “nutrition transition”. Here is an author back in 1917 commenting on this very dynamic. As incomes rise, bread is discarded in favor of meat. Please read this slide.
Slide 53 What We Eat. Author: Lucille Williamson and Paul Williamson. Source: Journal of Farm Economics, Vol. 24, No. 3 (Aug., 1942), pp. 698-703.
Here are authors in 1942 expressing their intuition about this. “One is more likely to leave a piece of bread for the garbage man than to discard a tender piece of steak.” We all understand that bread is cheaper than steak. It’s this difference in how we value these foods that is destroying our health and the planet’s health.
Slide 54 Those same authors commented in 1942 that in the poorest countries more than 80% of the diet came from starches.
Slide 55 Spengler, Joseph J. "Aspects of the Economics of Population Growth: Part II."Southern Economic Journal (1948): 233-265.
This economist in 1948 provided us with a very valuable table demonstrating this association between animal foods and income.
Slide 56 Here is the top of his table. Countries are ranked by income per worker so the United States was on top. At the right you can see two columns showing the percentages of the diet from animal foods and from cereals and potatoes. In this top portion of the table we are seeing animal foods at around 40% and starches at around 35 or 40%.
Slide 57 Aspects of the Economics of Population Growth: Part IIAuthor(s): Joseph J. SpenglerSource: Southern Economic Journal, Vol. 14, No. 3 (Jan., 1948), pp. 233-265
At the bottom of the table you see that animal foods get as low as single digits, while starches reach as high as 90% of the diet. If you read this paper, the author asserts that such diets were nutritionally inadequate but that is a separate matter. These countries were poor and their diets were concentrated on too few crops.
Slide 58 Bennett, Merrill K. "International contrasts in food consumption." Geographical Review 31.3 (1941): 365-376.
The world used to be mostly poor but it wasn’t mostly fat. The world used to be fed primarily by carbs. This is a very fascinating map. I hope you’ll study it and think about it. If we agree that obesity is a global problem and if we agree that it is a problem that has been getting worse, then we have to understand that this problem has come upon us as we have all shifted away from unrefined carbohydrates and toward animal foods.
Dr. Peter Attia says he has a strong interest in cholesterol. So do I. That’s the topic in the next three videos.