Confessions of a Dietitian: Let's Discuss The Science.

When most people find out that I study nutrition, the typical response is: "cool! So you, like, write meal plans? Can you make me one?" I usually smile and joke about my phantom hourly rate, but underneath my cajoling facade a sadness prevails.

My dear, friendly meal-plan seekers, I would love to aid you in your quest for a better diet but first I need you to hear me out. Nutrition is a rapidly evolving field filled with many interesting things to know and many questions to be answered. It seem the public perception of nutrition only exists within the realm of trendy food blogs, daytime talk shows and Biggest Loser competitions. As I prepare to graduate with my masters in Nutrition Diagnostic, I hope that I might create a career and an ongoing dialogue about the complexities of nutrition physiology and help to champion a better understanding of the field as a serious branch of science. 

Sure, I know the public is (dare I say: starving) for new factoids about the Paleo diet and the wonders of Kale and Turmeric. I of course enjoy kale just as much as the next person! First, however, let me regale you with my knowledge on mega-dose regimens of Vitamin B1  for the management of diabetic micro-vascular complications. I spent around 5 months researching this topic and believe in its potential to help reduce the burden of the some $245 billion dollars spent on these issues in 2012. Or, if that doesn't interest you, let me engage your imagination on how very little we truly know about all of the ways nutrients interact with our bodies and how our bodies interact with nutrients. I've spent the last two years attempting expertise on this topic and still, I have to admit, I am far from understanding it all. This will be my lifelong work. Join me on this journey.

I love my field, and I want to engage others on its many branches of knowledge. Most importantly, I want to spread the idea that: to know about nutrition is to know about ourselves. To become acquainted with our physiology, our biology and even our spirit. To venture into a field of study with twice as many questions as answers and very few absolutes. And to be okay with that. 

Of course, a field with very few absolutes may very well be at the root of a public desire for the ideal meal plan, so I don't blame or shame the requests of the public for guidance. I will happily offer you some of that, but I also want to make another point about the inherent issues in conducting and analyzing nutrition research. There is truly a deliberate denial and downplay of important existing evidence in nutrition. For years, the science of nutrition hasn't seemed to get anything right. I am continuing to learn why this is and all of the factors at play in why nutrition science is unable to establish good consensus, but I have some theories. 

Within nutrition science there exists what I refer to as a cycle of evidence dilution. One might call this a dilution of the truth-or at least the strongest version of it. From what I can gather, the cycle of dilution of nutrition research is really an insidious tactic used by Big Food to prevent good evidence from becoming best practice. The cycle of evidence dilution basically asserts that if opposing evidence cannot be eliminated, it must be shrouded in doubt. 

So how does doubt create an inability to achieve optimal nutrition absolutes and recommendations? The cycle is achieved by the deliberate design of studies which downplay the results of previously published on a given topic that threatens the food industry. Any study that has the potential to provide evidence directly conflicting with the interests of food industry (say, sugar is strongly linked or even causes diabetes and other chronic disease) is often immediately counted out by a similar study showing the opposite conclusion. We have seen this in the media: eggs are bad, now they're good. Sound familiar?  Journalists without expertise in nutrition or even research read abstracts and conclusions and report the findings searching for that new lead on nutrition to keep the public confused. The cycle continues.

What is truly insidious however about this tactic is that the cycle takes advantage of the well-intentioned efforts of nutrition organizations attempts to advocate for strong evidence in providing the public with recommendations. You see, studies published in opposition to new information inevitably place the burden of evidence on those trying to generate new ideas about nutrition. One of the more recent examples of this is in regard to the debate on sugar, carbohydrates and saturated fat. Public health trend lines for diabetes and other chronic diseases have been climbing at a steady rate for the last 50 years and are not abating. During this time, research has revealed very little conclusive evidence about the causes. How is it that a public health issue of such enormous implication has not been linked to any specific causative factors with any certainty? In fact, national nutrition guidelines such as the Dietary Guidelines for Americans are only now beginning to lift the ban on dietary fat and cholesterol (see work by Gary Taubes for a complete review), albeit cautiously and in spite of plenty of good studies that provide physiologically-based evidence for the causative link. 

This is where the cycle comes into play. Guidelines are intended to be evidence-based for reasons that are obviously justifiable. However, in lieu of "strong evidence", such as in the case of endless contradictory research findings, changes to the prevailing nutrition rhetoric are difficult to make. Truth in the literature becomes diluted. Again, this cycle places the entire burden of evidence on new information being generated and very little burden on those fighting to maintain the status quo of nutrition: low-fat, ignore sugar and focus on physical activity. 

For a complete detailing of the food (and especially sugar) industry's plan to subjugate research implicating it in the current epidemic of chronic disease, it is best to refer to those who have done the best work: Dr. Mark Hyman and Dr. David Ludwig are a few of the pioneering researchers who I have followed in my attempt to unravel the science of what aspects of the diet really make us sick. These individuals are not in fact low-carbohydrate imperialists imploring the public to swear off bread and birthday cake. Instead, they continue on their quest to help the world think more critically about how our bodies actually work. There are legitimate explanations, from a physiological and biological perspective for how sugar and excess carbohydrate causes disease ranging from the widespread dysfunction of critical hormones like insulin as well as the process of inflammation and nutrient deficiency rendered by unhealthy Western diets. 

I truly believe, that it is only through examining nutrition science critically, gaining an understanding of physiological drivers of chronic disease and asking the right questions about nutrition that we can begin to help care for the many sick individuals inhabiting our world. So, sure ask me about a meal plan, I'd love to help, but first, lets discuss the science.