Episode 99: The Ethics of The Dietary Guidelines And Food Politics In America With Adele Hite

Thanks for joining us for episode 99 of The Ancestral RDs podcast. If you want to keep up with our podcasts, subscribe in iTunes and never miss an episode! Remember, please send us your question if you’d like us to answer it on the show.

Today we are excited to be interviewing Adele Hite !

Adele Hite is a Ph.D. candidate in communication, rhetoric, and digital media at North Carolina State University, as well as a Registered Dietitian with a master’s in public health nutrition. Her work encompasses the rhetorical and cultural studies of food politics, nutrition science, and public health; science-based policy controversy; and the ethics of dietary guidance.

Information abounds about what foods to eat and not eat in what we learn from conventional nutrition experts. But did you ever wonder what the basis is for this dietary guidance that forms people’s views about food and America’s public health policy?

Adele Hite joins us today to discuss what she’s learned throughout her research and experience about the effects of the Dietary Guidelines and food politics. Adele also shares insight into the state of nutrition knowledge and what the future holds for the Dietary Guidelines and public health policy.

Here are some of the questions we discussed with Adele:

  • What got you interested in studying the Dietary Guidelines?
  • What’s your perspective on whether or not people are actually are following the Dietary Guidelines?
  • Do you think that the Dietary Guidelines are having an actual damaging effect in real-time, or do you feel like it’s mostly the overall changes in the food environment that have led people to eat a different way?
  • You say that there are many oversimplified narratives about nutrition, health, and “the obesity crisis” that deserve more critical examination. What are some of those narratives that you find to be the most pervasive?
  • Do you think that there is a theory that explains the bulk of what causes obesity? If not, why is it so hard to figure out what’s causing it?
  • What’s your opinion about the state of nutrition knowledge?
  • What have you learned in the last several years of doing this deep dive research that either surprised you, was unexpected, or ended up actually changing your personal beliefs?
  • What is your experience been as a dietitian who is not supportive of the Dietary Guidelines as they currently stand? Do you have any advice for listeners who don’t know how to blend their dissension with their career?
  • What is your hope for the future of the Dietary Guidelines and public health policy in general?

Links Discussed:

TRANSCRIPT: 

Laura: Hi everyone. Welcome to episode 99 of The Ancestral RDs podcast. I’m Laura Schoenfeld and with me as always is my cohost Kelsey Kinney.

Kelsey: Hey everyone!

Laura: If you don’t know us, we’re Registered Dietitians with a passion for ancestral health, real food nutrition, and sharing evidence-based guidance that combine science with common sense. You can find me at www.LauraSchoenfeldRD.com and Kelsey at www.KelseyKinney.com.

We have an awesome guest on our show today who is going to be sharing her research about the ethics of the Dietary Guidelines and the food politics rhetoric that drives our nation’s food choices. I’m so happy she’s joining us. She’s a friend of mine and I think you’re really going to enjoy this episode.

Kelsey: If you’re enjoying the show, subscribe on iTunes so that you never miss an episode. While you’re there, leave us a positive review so that others can discover the show as well! And remember, we want to answer your question, so head over to theancestralrds.com to submit a health-related question that we can answer or suggest a guest that you’d love for us to interview on an upcoming show.

Laura: Before we get into our interview, here’s a quick word from our sponsor:

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Laura: Our guest today is someone who I consider a personal friend. Her name is Adele Hite. She is a Ph.D. candidate in communication, rhetoric, and digital media at North Carolina State University, as well as a Registered Dietitian with a master’s in public health nutrition. Her work encompasses the rhetorical and cultural studies of food politics, nutrition science, and public health; science-based policy controversy; and the ethics of dietary guidance.

Welcome, Adele! We’re so glad to finally have you on the show.

Kelsey: Yeah!

Adele: Thanks so much for having me. This is terrific!

Laura: It’s very strange. I feel like you and me have such a long history. I don’t know when you met my mom, but I think I met you in 2011 because you were finishing your program at UNC and I was just starting mine and we had our mom in common. That was six years ago at this point. Now you’re off at NC State and hopefully finishing your dissertation at some point this year.

Adele: Soon, yes.

Laura: That’s the hope. I know you very well. I know your back story very well, but I don’t know if our listeners do. If you don’t mind to just tell us your story in a nutshell and then just what got you interested in studying the Dietary Guidelines since they’re quite the beast.

Adele: The shortest answer to that is your mother, Laura, because she’s the one who told me about it. She swears that it’s not true, but I actually remember the exact moment that it happened. She went, well you do know that there’s these Dietary Goals that happened before the Guidelines. And I was just like, what?!

That got me started down that whole rabbit hole of the McGovern committees. There’s a lot of talk about how there was this moment in 1977 where the Dietary Goals were created, but the McGovern’s committee had really been playing around with the issues of nutrition and where nutrition fit in the political picture for almost the entire decade of the 1970s.

This fits in with my own personal story because I became a vegetarian in the 1980s, in the early 1980s. I got a copy of Diet For a Small Planet and I read it and I believed every single word. I really thought that I was doing the very best thing for my body, for the world, for the global hunger, and all of these issues in addition to being a college student and being a little bit on the rebellious side. And this was my way of sort of pushing back at my parents’ meat and two vegetables sort of lifestyle. It worked great when I was in my 20s, but the older I got, the less successful this particular eating pattern was for me.

I think this is a very common thing is that we think that we found the one perfect diet. And it is perfect for a while, and then it’s not anymore. Instead of rethinking our diet, we look for a lot things outside of ourselves that we want to blame.

Here I was gaining weight and not feeling well on a low calorie, low fat, vegetarian, home cooked, all the things that it was supposed to be, and not doing well. I eventually through some research, and reading, and basically giving up dieting for a long time, I stumbled across the Mike and Mary Dan Eades Protein Power and it resonated with some things that some healthcare providers had been telling me. When I tried it, my body felt very right on it.

But even with that, I still sort of felt like I was the problem, like I must have this weird metabolism and that’s why that best diet ever didn’t work for me. But then when I started working with Eric Westman at the Duke Lifestyle Medicine Clinic, I met a lot of people whose story was very, very similar to mine. I realized that it wasn’t me and that there wasn’t just one path to good health, which is what we’ve been told, the only path to good health, the only path to prevention of chronic disease was to eat this low fat, low calorie plant based diet.

Seeing person after person come through the clinic who were really trying to be healthy, not everybody was, but most of these people had been dieting and trying to work to a healthier state through dietary changes for a very long time. To see their struggle match my own, I realized that there was something really wrong with the system and something wrong with what we’d been told.

That’s how I ended up sort of following this down the strange path through back to school to become an RD and the MPH program that, Laura, you were in; and then nutrition epidemiology which I thought was going to give me answers to why we had this disconnect between biochemistry and public health practices, but it didn’t; then into communication and rhetoric and digital media because I did realize that some point that we were dealing with politics and not with science.

Laura: That’s funny, you would think nutrition epidemiology would be the complete middle man between biochemistry and public policy, but apparently not.

Adele: That is what I thought and I thought it was going to give me the answers. The longer I studied it, it was sort of like this bad relationship. You’re dating someone and you’re like let me just change myself a little bit more and see if this works out, and let me just change myself a little bit more and see if this works out. I kept thinking it was me. I’m like well you’re just being really dense about this and when they tell you divide this continuous variable like French fry consumption or salt consumption up into quintiles or quartiles, and that doesn’t really make sense because it’s not like something dramatic happens in between French fry number four and French fry number five. I just kept thinking, well you’re just not wrapping your brain around this. Then finally I realized as you do in any dysfunctional relationship, I was like it’s not me, it’s you nutrition epidemiology. You’re messed up and I have to go. That’s what happened.

Laura: That’s so funny. I know that you’ve been doing this stuff for years and there’s been a lot of things that you’ve learned and maybe some myths that you’ve busted or myths that you had that you realized weren’t accurate.

I think one of the common myths that I hear from the Paleo community and even just I guess as an RD and going through UNC I think this was one of the main assumptions as well, that the Dietary Guidelines were perfectly fine and that they’re not the problem because nobody listens to them anyway. I don’t know if the Paleo community would say that they’re not a problem, but I don’t think most people think that the Dietary Guidelines really impact anybody and they’re not really the best way to change what’s going in this country.

What’s your perspective on whether or not people are actually are following the Dietary Guidelines?

Adele: I think we all first have to admit that we don’t really know what people eat. I think that’s the main thing. But there are other parameters that we can look at. We can look at what people tell us that they eat. Even that doesn’t represent what they actually eat, it certainly represents what they think they should be eating. It certainly represents what they wish they were eating. It represents what I like to call the dietary imaginary. It is their sort of idealized idea of a healthy diet.

In that regard, the NHANES data and The Nurses’ Health Study data tell us that, yeah, even if people aren’t in real life actually following it the way that they say they are, certainly they know what a healthy diet consists of. In terms of food availability, the shifts in food availability certainly reflect dietary guideline precepts. We’ve increased the amount of flour and cereal products that are available and we’ve increased the amount of vegetable oil that’s available in the food supply. Increases in meat, and dairy, and butter, and even increases in sugar are not that dramatic compared to the increases in flour, and cereal, and vegetable oils.

I think the other things that we have to understand that an attempt to follow the guidelines is not necessarily going to result in actually meeting the Dietary Guidelines goalposts. We have to understanding that there’s a real body involved.

We have on the one hand, and this is one of these things that just really gets on my nerves, we have mainstream nutrition experts that are claiming victory for over the past 35 years we’ve seen trends in lower blood pressure, we’ve seen trends in lower cholesterol, and we’ve seen reductions in heart disease mortality. These experts will say, look, people have followed the Dietary Guidelines and reduced their intake of saturated fat and cholesterol and that’s why all these wonderful healthful things have happened. Then they turn around and say but the increase in diabetes and obesity is related to the fact that individuals don’t follow the Dietary Guidelines and they just eat too much.

Here’s my take is I don’t care which way you want to say it, but you can’t have it both ways. You can’t claim the good stuff for the Dietary Guidelines and then blame the bad stuff on individuals. It removes the notion that when you did the things like remove saturated fat or remove cholesterol form the diet… What are those in real foods? Well that’s meat, that’s eggs, that’s cheese, things that satiate and nourish us. Maybe that’s what caused people to start eating more food because they’re trying to recapture those nutrients that were lost when we took those other things out of our diet. But they just completely disconnect those things and that really bothers me.

Laura: I know that my mom, one of the reasons she’s super interested in the Dietary Guidelines is because of the way that they inform a lot of the policies for childcare facilities, and school lunches, and older adult care facilities.

Do you think that the Dietary Guidelines are having an actual damaging effect in real-time? Or do you feel like it’s mostly the overall changes in the food environment that have led people to eat a different way?

Adele: I think it’s a combination. And I think a lot of it is rhetoric, I think a lot of it is discourse. I think this this something that I’ve learned in my program that I wasn’t really thinking about last time when I was looking at nutrition epidemiology.

I think your mom is very right in it’s changed our intake of essential nutrition without a doubt because it’s moved that priority, which was our priority in feeding the public for many years was just to make sure everybody has adequate essential nutrition. That moved off the agenda and was replaced by a focus on preventing chronic disease.

But unfortunately I what happens is a lot of times when you’re try to prevent chronic disease is you end up causing nutrition deficiencies that would actually help prevent chronic disease. Particularly in terms of feeding pregnant women and feeding small children, I think what we’re doing is setting up long term health repercussions that don’t have anything to do with chronic disease per se, but have to do with nutrient deficiencies that occur during pregnancy into childhood that we’re then battling against for the rest of our lives metabolically.

We don’t know a whole lot about this yet, but I think we’re going to find in the future that epigenetic effects are really critical and those have to do with a fetus being malnourished in terms of mostly inadequate protein. I think that’s really, really critical and we know that about 40% the young adult female population gets inadequate protein, and those are the people having babies. And what does that tell us about those babies?

Laura: That inadequate protein, is that based on the RDA for protein? Or What is defined as inadequate?

Adele: Sadly it is based on the RDA and the RDA is woefully low. The RDA is the minimum needed to prevent sort of overt diseases of deficiency. That’s not the minimum needed to create another body inside your own. I think it’s really, really critical. I think the RDA for protein is far too low and I think that’s borne out by the fact that across populations and across time if we have more protein than that available to us, we eat it. It’s probably about half of what it should be.

Kelsey: Can you tell our audience what the RDA is right now for protein?

Adele: It’s right around 50. It’s a little bit lower for women and it’s a little bit higher for men. But it’s about 50 grams of protein per day.

Kelsey: Wow.

Adele: What we’ve seen across time and across populations is that we eat more like in a range between 70 to 100 grams. The range is based on body size. If you’re a smaller person, you need less protein.

I think the critical aspect of this and the thing that gets forgotten, you hear (speaking of those myths) oh American’s eat plenty of protein, we don’t need to worry about protein, American’s eat plenty of it. Nobody is thinking maybe we eat plenty of protein because our bodies require plenty of protein so we eat until we get plenty of protein. It’s not like Americans go, I’m going to make sure that I get plenty of protein today! Maybe they’re doing that now because you really it being pushed more, but I don’t think that that’s actually something that we set out to do consciously. But our bodies set out to do it and they don’t tell us about it. Our bodies are pretty intent on getting adequate protein and I think that’s borne out by these across time and across population figures for protein intake.

Laura: I just can’t believe that so many young women would be not even getting 50 grams of protein a day. That’s like 10% of calories on a 2,000 calorie diet. It’s just amazing.

You say that there are many oversimplified narratives about nutrition, health, and “the obesity crisis” that deserve more critical examination. What are some of those narratives that you find to be the most pervasive?

Adele: I think the overarching one is that the Dietary Guidelines have nothing to do with the changes that we’ve seen in American’s health. Here’s where I get that from; we know that people have increased their caloric increased in the past 35 years by about 150 – 200 calories on average. But nobody can explain why except to go back and say that you as an individual are doing something wrong. We hear fat people eat too much. But then that raises the question of what is too much and why? Do fat people just not care? I mean we just don’t care! We’re just going to eat all the food! That doesn’t make a lot of sense.

Why would as a population like in ’78 we were okay? But in ’85 all of a sudden we were like to hell with thinking about how we look or what our health is like! We’ll just eat whatever we want! Something changed and the DGAs were a part of that.

I think another thing is this idea that we eat more food because food is cheap. What else has changed in the environment? Well, we have this big income disparity. Maybe people have to eat cheaper food because people relatively speaking have less money now than they used to have. We know that the cheapest food in the grocery store are the highly processed grains and cereal products. Those are the cheap foods.

We instituted this really radical notion and I don’t mean radical in terms of dietary changes. I mean radical in terms of we divided the world of food up into food that is good that you should eat and food that is bad that you are a bad person if you eat. That’s the radical part. The diet itself, not so much. Although it wasn’t the diet that I would have picked.  But dividing the world of food up into these sorts of categories, it’s actually very sort of like religion, it’s dogma.

Prior to that really the idea was eat food that gives you adequate and essential nutrition, and then we really actually had public health guidance that said this, eat whatever you want after that. Can you imagine if a public health person said that nowadays, like how crazy that would sound if we said make sure that you get adequate essential nutrition and that your body is fully nourished and replete with everything that it needs, and then you can eat whatever else you want. You’d be just carried away, tarred and feathered, and rode on the rails out of town. But that’s how we used to talk to people and it really does make me wonder if we changed something dramatically with our relationship to food as well as in our bodies when we divided the world of food up into good food and bad food.

I think that this idea of essential adequate nutrition is really part of that because one of the things that we see is when people are not adequately nourished with regards to essential nutrients, they do have a tendency to eat foods they don’t need, consume more sugar, consume more refined carbohydrate, consume more alcohol because our bodies are in sort of a state of weakness and desperation maybe even. We’re just consuming to be consuming at this point.

Laura: I think from a clinical perspective a lot of times when I have clients that crave sugar, there’s two things that are typically going on in their diet. One is the protein question. A lot of my clients that don’t eat enough protein, once their eating higher protein diet, and we’re not talking about anything like insanely high. We’re talking about maybe 10 ounces of some kind of protein food a day total. All of a sudden they don’t have the sugar cravings anymore and they’re just like I don’t understand. They thought they just had poor willpower or that they ate too much sugar and that’s why they craved it, which certainly makes if a little harder, but it was really more about that they weren’t getting enough protein. Then in the more Paleo minded clients, a lot of times those are ones that aren’t eating enough carbs for their activity levels.

Adele: Right.

Laura: If they’re eating enough whole food carbs, and fruit, and maybe some sweeteners too, maybe some sugars in there, they don’t actually crave it. I think a lot of these cravings that the average person has for sugar, and salt, and the packaged foods, that kind of thing is because they’re not getting actually the basic needs that their body has. The body is like well sugar is a really quick way to get the carbs that I need and if you’re not getting enough protein you tend to need more carbs.

It’s just like you said, people have this belief that they’re getting enough protein and if they have a sweet potato a day, that’s enough carbs. It’s just interesting how much misinformation exists everywhere in nutrition. I feel like you maybe feel that same way that the information is not actually that solid.

Adele: Oh yeah. I think that this is one of the other real issues with the whole sort of nutrition discourse. The whole landscape is that we swing from one extreme to the other. The reality is we don’t know much about much of it. Our most solid foundation in terms of knowledge is in the essential nutrition department. Steven Zeisel at UNC found some time in the past thirty years another essential nutrient, which is the one your mom studies, choline. Forty years ago, we didn’t consider it essential. Now we understand that for some people in some points in their lives, it is absolutely an essential nutrient and you have to get it from your diet because your body doesn’t make enough of it.

It’s these gaps in our knowledge that I think have gotten wider and deeper because we’ve been so focused on trying to create these links between diet and chronic disease, which I just want to point out to everybody out there listening, the only way that we have been able to make any claims about diet/chronic disease relationships are through observations studies. They are never cause and effect. They are always association. They’re hypothesis, they’re theories. This goes from the low fat people to the low sugar people.

I don’t care which way you’re looking at it, you’re talking about epidemiology. Are there better and worse ways of using epidemiology? Absolutely. But we can’t make those relationships through experimental trials, or we can’t make them very well through experimental trials because you’re always going to have these specialized circumstances and specialized populations. People who participate in clinical trials are different from people in the general population. If you’ve ever been in a clinical trial, you know this. It’s not easy to be a participant. It requires a lot of you.

It’s sort of ridiculous to say that we know much of anything about diet and chronic disease links. We know that alcohol and liver disease, we feel pretty good about one. And we feel pretty good about the sugar and cavities or dental caries relationship. It sounds a little weird to say this because people are like, cavities! It’s so superficial. But I think that link is actually a lot more interesting than it seems on the surface because there are so many other things that we are beginning to learn that are associated with dental caries; higher levels of heart disease, and ulcers, and all of these other things. But it’s not just the sugar. It’s the sugar interacting with the bacteria in our bodies and other things like that.

Again, blaming these single nutrients for long term chronic disease, it’s a red herring. It’s misleading and I think it just really lends itself toward this sort of dogmatic approach to health where you have a shiny little talisman that you carry. I only eat gluten free food! I only eat local food! I only plant food! You think your little shiny good luck charm is going to save from eventually being dead, and it isn’t. Let me just be blunt about this. You’re going to die and it’s not necessarily going to be because of yiour food.

Laura: I think with chronic disease in general, it’s a little tough because there’s so many different ideas about too much of certain foods or not enough of certain foods or certain nutrients that leads to those chronic diseases. But I feel like obesity is one of those that the general nutrition expertise in this country really pins on the whole eating too much and not exercising enough, like the eat less/move more approach to weight loss.

I know there’s been a lot of research done in the field of obesity in epidemiology and more of a physiology approach. When you’ve looked at this, do you actually think anyone knows what causes obesity? We’re not talking about gaining 10 to 20 pounds or something, we’re talking about actual obesity where it’s BMI above 30, significant metabolic factors involved as well. Is it just about people are eating too much and not exercising enough? Do you think that there is a theory out there that explains the bulk of it? If not, why is it so hard to figure out what’s causing it?

Adele: You said something really interesting in there which is not just obesity but obesity and metabolic factors. I think that’s the first part of the conversation we have to tease apart which is that there’s more than one kind of obesity. Even with regards to high BMIs, there’s more than one kind of obesity.

The first two patients that we saw at Duke Lifestyle Medicine Clinic had two very, very different kinds of obesity. One gentleman was probably about as big around as he was tall and he really had no metabolic issues. He had joint pain because of his weight and part of his reason for being with us was to lose weight so that he could have, I forget whether it was hips or knees operated on. That was one kind of obesity. Our next patient was a man who was sort of normal looking from about mid chest up, but then had a big belly. He was on a bagful of medications and had all kinds of metabolic issues going on.

Those were very, very different kinds of obesity. The kind that the first patient had, yeah, eventually it’ll impact joints simply because of body mechanics. Other than that, this is not a metabolic issue. That may very well be an eat less, move more kind of situation. We put him on a low carb diet and it worked great, but we probably could have put him on… low carb diets do work to lower caloric intake. You can’t point your finger and go “well it was the carbs” in this case because calories get reduced as well.

What we saw in clinic over and over again is that when you took carbs out of people’s diet, they didn’t increase their other foods dramatically, unless it was women, as you pointed out, who weren’t eating enough protein to begin with in which case they would start eating more protein up to a point and then it would stop. Once they became sort of protein replete, it would just level off.

I think we first have to tease that apart. There’s metabolic issues, and you don’t have to be obese to have them, that are associated with obesity. But then we have to ask do the metabolic issues cause the obesity, or does obesity cause the metabolic issues? Observational studies don’t tell us that.

I don’t think that we know specifically what causes those metabolic issues. Personally, I don’t think that obesity causes metabolic issues. I think metabolic issues cause obesity. I think I can make that assumption because we see thin people with diabetes. I’m not talking about type 1. We see thin people with type 2 diabetes and not everybody who is obese becomes metabolically dysregulated.

If there’s a cause and effect, one of the things that is true about cause/effect situations is that the cause should equal the effect. Every time you have an obese person, you should have metabolic dysregulation. If you have metabolic dysregualtion, you should have obesity. We don’t have that.

I think first of all we need to focus on the metabolic dysregulation, and I think there’s culprit underneath it all, and there’s a lot of nuance to this that I think we’ve looked too long at lipid factors and we need to look at insulin. This is another situation where it was simply a matter of sort of the fate of technology that we were able to measure cholesterol easily and so we focused on it and it became our biomarker of choice. We’re still not able to measure insulin sort of quickly and easily and therefore it’s frequently ignored. But you can see by the way that I’m presenting this that this is not we found the best biomarker and that’s why we use it. No, we had an accident of technology happen and that’s why we use it.

These sort of coincidences are not us deliberately choosing the best way to think about the human body. I think that insulin has been overlooked and it’s probably part of a larger more complicated picture. I don’t think it’s simply, and nothing is simple when it comes to the human body, but we just have focused on a particular set of biomarkers because we could measure them. But that doesn’t mean they are the most important ones.

Laura: I feel like you’ve been in so many different educational environments related to nutrition, and health, and biochemistry, and epidemiology, and all that. What’s your opinion about the state of nutrition knowledge? I know science in general there’s a lot of things that we feel very confident that are scientific fact. To be fair, most science is still theoretical until disproven essentially. But do you feel like there is much that we actually have factual knowledge about when it comes nutrition? Or do you think most of it is just untested theory that could easily be debunked if you dug into it?

Adele: With regards to diet/chronic disease relationships, I think most of it is theory. I don’t know how much of it will be debunked, but it is theory because that’s the only way we can establish it currently is through a methodology that is really very, very weak, very weak, so weak it’s just not going to hold up under close scrutiny at all.

We are never able to reproduce these observational diet/chronic disease relationships in experimental settings. We just simply haven’t been able to do it. There’s all kinds of excuses for that, but the realty of it is that this may not be something that we can ever prove on a population wide basis.

This brings me back to something that I think is just, it’s been overlooked. I’m interested in how we end up down one path rather than another. I told you the cholesterol versus insulin story and that’s a matter of technology. Back when we were sort of trying to figure out what the best diet to prevent chronic disease was, the initial question was not what’s the best diet to prevent chronic disease? The initial question was do we have enough science, period, to determine whether or not there’s a link between and chronic disease? There’s a question that happens before the which diet is the best diet and that is there even a way to know what diet is linked to chronic disease?

There was a pretty prominent theory at the time, Roger Williams is sort of the mastermind behind this about biochemical individuality, which is that we are all so different from each other along all of these different parameters that the idea of having a…and it sounds ridiculous when I say it…we have one diet for all adults over the age of two that is meant to reduce your risk of every single chronic disease that we know of. Doesn’t that sound just ridiculous? It sounds absurd on the surface. How is it that we could have one diet for all humans that fixes everything? It makes no sense.

When Roger Williams was coming along with his idea of biochemical individuality, on the other hand we had people like Ancel Keys and Yudkin had different theories about these sort of one size fits all diets. Roger Williams was just sort of a quiet..he’s a biochemist. He’s much happier in the lab than arguing in front of a congressional hearing and things like that. He just didn’t push his agenda. But at the same time, his agenda also did not fit into a political agenda which was we are going to fix everything with one diet. His approach required nuance, and it required paying attention to individuals, and it required thinking about these complex systems in complex ways. That is the antithesis of a public health agenda.

It got sort of left by the wayside, but I highly recommend reading his book. It’s written by a biochemist, but it’s actually very, very readable to anyone who’s interested in these matters, especially if you’re a dietitian because like you just said, we don’t have a lot to hang our hats on otherwise. But the theories behind his book I think are extremely valuable. He says the kinds of things that you’re finding in clinic which is that if you’re not replete with the things that your body actually needs, it’s more problematic with regards to consuming foods that you don’t need.

Laura: What’s the name of his book?

Adele: It’s called Biochemical Individuality and his name is Roger Williams.

Laura: Great. We’ll link to that in the show notes so people can check that out if they’re interested.

You’ve obviously been studying this topic for years. I know that from my interactions with you, it seems like your perspective on the Dietary Guidelines, public health, chronic disease, that kind of thing has changed.

Adele: Yeah.

Laura: What have you learned in the last several years of doing this really deep dive research that either surprised you, or was unexpected, or ended up actually changing your personal beliefs?

Adele: I came into this at first thinking that the low fat diet must have had a lot of science behind it and a reduced carbohydrate diet didn’t so that my goal was to go out and create that science. Well, my first lesson in Amanda’s class, my first year in that program was that the low fat diet didn’t have a lot of science behind it. That was my first lesson. Then the next lesson was that there weren’t any real good ways to acquire this information, that really the science was not up to the task that we were sort of putting to it.

Then I was really wondering well then how did this idea of the low fat, low calorie, eat less/move more notion become so embedded in our national consciousness as well as our policy, and healthcare education, and all of that?

What I found that really surprised me is the role of politics in it. By politics I don’t just mean McGovern and the Dietary Goals. I mean the role of women. Women were at the heart of The Nurses’ Health Study which is what a lot of these initial forays into nutritional epidemiology were built on were those studies. They picked the women for The Nurses’ Health Study, the picked this group to follow because they were compliant, because they were educated, and because they were health conscious.

You’re talking about a way that women are socialized to food that became then a part of the scientific process. I thought that was so fascinating. They didn’t pick people who didn’t care about their health, or didn’t care about how they looked, or otherwise just were sort of random eaters. They picked a group of people that they knew were socialized to complying with rules that they were given. To me this is just fascinating.

Dietitians as a 97% female population, dietitians. So we are again socialized as women and as dietitians to follow rules which makes us very different from say doctors who are socialized to think independently. When we get into that area with I’m a dietitian, how do I go against the Dietary Guidelines? Do you think that doctors think that way? If they felt that a different diet was better for their patients, they would just say so. They would have no compunction about going against our national health policy. They would just offer another diet. The socialization of women is really central to how all of this got impacted.

Race is critical to it. The simple fact that we don’t recognize metabolic dysfunction in African American people because we look at them through a lens of how metabolic dysfunction occurs in white people and it doesn’t occur the same way in black people. So we go well you’re not really metabolically dysregulated, you’re just fat.

The example is if you have insulin dysregulation, in white folks there’s a tendency for that to cause low HDL and high triglycerides. In a lot of black people and in some other ethnicities, you don’t see that lipid dysregulation. But those lipid dysregulations are markers for metabolic syndrome. If you don’t have them, they go well you’re not metabolically dysregulated, you’re just a lazy glutton. Then when these same individuals end up with a metabolic disease, diabetes or heart disease later on, they go well it’s because well it’s because of your obesity. It wasn’t because of your insulin or something like that because you didn’t have these other markers.

That’s straight up to do with race because we didn’t study these populations. Now that we’re starting to study these populations and see things differently, we’re still just getting this sort of dug in entrenched notion, umm, well, we don’t really need to look at those things because those populations are not our populations of concern. That’s tragic and pretty horrible that that’s also a reality.

Laura: Yeah, that makes sense. You had mentioned a few ago that dietitians tend to be rule followers and afraid to step away from what the national policies are for nutrition. I know we both, and I should say Kelsey as well, being dietitians we’ve seen that not only in our education but in people who contact us for advice.

There’s a lot of people out there that even though they know different information and they’re exposed to some of this ancestral health kind of stuff, or low carb, or whatever they’re looking at, they’re still afraid to go against these Guidelines because of the potential for repercussions in their career. What is your experience been as a dietitian who is not supportive of the Guidelines as they currently stand? Do you have any advice for listeners who don’t know how to blend their dissension with their career?

Adele: Yeah. In terms of my own experience, it was kind of painful, but I was beating my head against the system. When my PhD program in nutrition epidemiology sort of imploded on me, a lot of that had to do with the questions that I was asking about the Dietary Guidelines. I was taking a direct aim at them.

For RDs in practice, your responsibility is to your clients and your patients. Your responsibility is not to the Dietary Guidelines. Period. Exclamation point. End of story. You don’t have any responsibility to those policy guidelines at all. There’s no requirement that an RD be part of or adhere to AND principles or DGA principles.

In fact if you look at the ethics that the AND puts out, they assert that you should number one personalize the diet to the patient.  You should do that and whatever that means. You use your clinical judgment to do that. The other thing is that you should know the science. Again, you’re using your clinical judgment to apply the science to a particular individual, not a statistical entity. This is a real person in your office that you have to deal with.

The RD ethics also say that we have to acknowledge that there are legitimate differences with regards to interpreting the science. I think that that’s where our clinical judgment comes in, our clinical experience comes in, and also something that I want to point out to everyone that I hope makes them feel better, something called standard of care. Standard of care is defined as providing healthcare in accordance with the standards of practice among the members of the same healthcare profession. This is where we feel as RDs like that’s where we’re going to get in trouble because the standards of care for RDs are like so and we’re practicing differently.

Well, I’m here to tell you by virtue of your podcast and the community that you represent, Ancestral RDs, that’s a standard of care. To compare a dietitian who practices that sort of care to a dietitian who practices vegetarian and vegan nutrition, that’s not the same standard of care. We have a community that has its standards for caring for patients and the vegan and vegetarian RDs have a different community and a different standard of care.

I think that anytime you have clinicians that come together around a particular practice or intervention to treat particular patients, they create. Standard of care is not a guideline, it’s not written down. Standard of care is a practice. I think that we can feel good about knowing that we are part of a community that has standards of care with regards to our patient population that we treat as a community. I think we have to keep that in mind.

I also have to say that the AND is beginning to shift its position. There was a suggestion from the Academy that the DGA not consider saturated fat a nutrient of concern. All of our jaws collectively dropped when we saw that. But if we wanted to reclaim legitimacy for our profession, and I think that’s what that was a move for, is to reclaim that legitimacy and to say we’re not just sort of mindless followers of the DGA, we need to follow the science.

Here’s the other thing that we need to do, okay, read Roger Williams, treat your patients as individuals, and then this is key: collect data. Track, track, track. The AND would love for its RDs out there to do that and then share the information with them. They haven’t made that really easy to do just yet, but if we do it in our community, in the ancestral health RD community and we can show….so despite what you read on the internet, the plural of anecdote is data. It really is because where do you think all this data comes from? All of the data that we collect from the Nurses’ Health Study, from The Women’s Health Initiative, from the Health Professionals Follow Up Study, all of these studies come from individual bodies. That’s an anecdote.

What we need to do is we need to collect and track our interventions with our clients and patients and show how the things that we do with them are leading to health improvements along specific measurable parameters. And we can include things like quality of life, we can include things like hunger and energy levels. It doesn’t have to be the same old fashioned weight and lipid levels.

Laura: I know, people just love the numbers because they’re so much easier to measure and have more statistically analytical type data.

Adele: And those are good and I’m not saying don’t track those. I’m saying in addition to that, because that’s not all there is to our lives. We’re not just nutrition eating machines. We have a social life where we want to go out and eat. We have busy schedules and cooking these fabulous meals all the time isn’t always possible.

What are the ways that we can help people teach them how to eat, teach them how to be adequately nourished in ways that fit into their lifestyle and help them reach the goals that they have for themselves? We need to put this all together in a picture about a person and collect that data, and then track, and track, and track. And then share that with our professional organizations so we can say, look, we’re having success this way.

Because the truth of the matter is when I was working with the Academy up in Washington D.C. and actually spending my days looking up dietitian interventions and how they impacted health, one of the reasons that it was really, really difficult to justify paying registered dietitians for obesity interventions is that we don’t data that supports that this is helpful.

Kelsey: Right.

Adele: If we collect it as ancestral health nutritionists and we show that oh yeah, it is helpful, but not the way the Dietary Guidelines say it’s helpful, then we have a really, really powerful tool.

Laura: Right. It would be so cool to have some kind of app that you could put that data into and even maybe have self-reporting happening with the clients. I feel like when you’re in the trenches as a dietitian doing the work, it’s almost like you have some much that you have to do to make sure that you’re giving correct information to your patients that the idea of then figuring out how to do effective tracking and analysis of it is just so much extra thought. I could imagine that a lot of people wouldn’t be super motivated to do that even though it would be really helpful.

Adele: I have some good news for you.

Laura: Oh good!

Adele: I have some good news for you. There is a team up in Canada right now that are putting together an app that does exactly this.

Laura: Sweet!

Kelsey: Cool!

Adele: On the surface it looks just sort of like your basic fitness app. You plug in your calories in, you plug in your food, you plug in your activity levels, how much water you drank, all the rest of that stuff. The beauty part about this is it’s got two wonderful features. One is that it interfaces with a provider app so that the input that the patient is giving can be shared with the provider automatically. It’s almost like a health record between the patient and provider. That set up can be established.

The guys who are creating this are trying to create it so it is really, really low impact on the provider so that it integrates well with all of the rest of the information that you’re collecting about a patient and things like that. It’s not like some separate thing that you have to do.

The other beautiful part about this is that the guys building this are these data wiz’s. While the patient interface platform sort of doesn’t look like all that, behind that platform is this giant interlocking data system where they can put together all of this information in so many different ways and look at different parameters and track them differently.

One of the things that they’re really interested in doing is sort of grouping people by common features. You know as dietitians that the body of a post-menopausal female is very different from the body of a child bearing age female or a 20 year old active male. These are different bodies. And in fact probably different places in the world, and different socioeconomic levels, and different access to different environments whether food, or activity, or whatever, all of these are ways that we could cluster people and go, what works for these kinds of people in these circumstances?

You could find a way to help people sort of find their similar folks and what ways of eating or interacting with the environment or whatever are working for those people under those circumstances. That way as your body changes, as your circumstance change, you can migrate from group to group and begin to see different dietary patterns that might work at different times and places.

This is the kind of nuance that we need. These guys are working on it and I’m so fascinated with it. This is one of the things that I want to study going forward. Their ultimate goal is to upset the applecart and democratize nutrition so that this information is available to you and to the public in general so that you can begin to make far more nuanced decisions about the people that you see in front of you.

Laura: It’s almost like creating an app that gives you clinical experience in a very short amount of time.

Adele: Yeah, I think that that’s actually that’s a really brilliant way of putting it because it’s using the power of big data to not to make sweeping generalizations, which is how we’ve been using big data. Everybody is average! I mean that’s so not true. But it’s using the power of big data to do the opposite, to say how can I find the most particular nuanced individualized way of looking at you without having you have to do trial and error, trial and error, trial and error sort of indefinitely. Yeah, I think that’s actually a really smart way of thinking about it. It is like a big batch of clinical experience behind the scenes.

Laura: Right, it’s a faster way of not having to work for 20 years and see thousands of people and then decide okay, when I’ve seen someone like you, this is what worked.

Adele: That’s actually really smart.

Laura: Thanks, Adele! We have one last question for you for our interview today because I think a lot of what we talk about when we talk about public health policy, and health guidance, and standard of care, and all that is kind of frustration with how things are and irritation about well this was all this political stuff going on that caused this to happen and now we’re kind of not able to steer the ship in another direction. But I do think that there’s been a lot of changes like you said about saturated fat change with the Academy of Nutrition and Dietetics. We’ve seen some small changes in the overall discussion.

What is your hope for the future of the Dietary Guidelines and public health policy in general? Do you have any ideas about how they might change for the better? Should they be abolished and just start from scratch, or not have any sort of public health policy? Do you have any thoughts about where the future could head?

Adele: I think it has to do with just what we were talking about. I don’t think the Dietary Guidelines are going to go away on their own because that is a giant system that is self-perpetuating. It’s great for nutrition scientists to have them there because they can say, oh look, we fed people this healthy diet and their bodies didn’t do what they were supposed to do so they are lying sacks of nonsense.

It’s really powerful for nutrition scientists because it keeps them in the role of expert. It’s really powerful to the food industry because it allows them to say, look, we made these healthy foods for you! And when you get sick of them, look, we made some unhealthy foods over here and you can be bad and eat these foods! The food industry wins either way. Nutrition scientists and experts win either way. The only people who lose are the public.

I think what’s going to really happen is that we’re going to make them irrelevant. We’re going to start collecting our own data on our own bodies, and this group up in Canada are going to help us put all that data together, and the Dietary Guidelines are simply just not going to be relevant to anybody expect the food industry and nutrition experts. They’re eventually going to figure out, okay, you’ve been saying for years that nobody listens to you, well guess what, nobody really is listening to you. That’s what’s going to change.

Basically if you think about it, the Dietary Guidelines were instituted when computers were mainframe IBMs housed in universities. They were these big giant things that required a room and a dozen people to operate. Now we carry more powerful computers around in our pockets. The world has changed around these Dietary Guidelines. The Dietary Guidelines have not changed. I think that we’re going to continue to see more of that same thing where the world changes around the Dietary Guidelines and they become less and less relevant to any human being who is interested in relationships between diet and health. They’re going to become sort of like, you could still go in downtowns in small town America and see hitching posts for horses for a very long time. They’re going to be like that. They’re going to be an artifact. They’re going to be an antique. They’re going to be something for us to point at and sort of snicker.

Laura: Remember when…?

Adele: Yeah, remember when people thought that was a thing? They may persist for indefinitely because they do serve these other purposes for these other groups, but they’re not going to serve that purpose for individuals. When I am going through the grocery store line or something like that and the cashier is there rolling their eyeballs as someone is buying stuff and going on about how they’re trying to be gluten free, and this free, and that free, and blah, blah, blah, and the poor cashier is just standing there with this blank look on their face. I come through and I’m like, yeah, I know how you feel. They’ll look at me and say the same thing every time, but isn’t everybody’s body a little different? That’s what they say. So people know this. You just have to give them permission to know it. That’s what I think is our job is that we need to give people the permission to know this.

Laura: Nice. I like that. Adele, it’s been awesome. I always enjoy having conversations with you. This is our first recorded one, maybe not the last. If our listeners are interesting in hearing more of what you have to say about nutrition and public health, where can they find you?

Adele: I have a blog or as my kids call it, a blob, called Eathropology. It’s like eat and anthropology together squished together because that’s what I think we’re really looking at. We talk a lot about food, and this food and that food, but we’re really talking about behavior. We’re talking about eating. That’s what I try to pay attention to in my world is thinking about this process of how we go through our lives. We have to eat and eating is central to who we are as humans. What does that mean to us when somebody tells us that there’s one diet to rule them all? How does that interact with our eating bodies?

Laura: Nice. We’ll link to that in the show notes. I know I’ll always be keeping an eye out for when your book comes out. You have to write a book at some point.

Adele: I do, I do.

Laura: You can’t get out of it! We really enjoyed having you on, Adele. Thank you so much for your time. We wish you the best with your dissertation. I hope that goes well.

Kelsey: Yeah.

Adele: Thanks so much. This was so much fun. Thanks for inviting me to do this. I love talking to you. Those were great questions for me to think about and try to work my way around.

Laura: Nice.

Adele: Yeah, let’s stay in touch.

Laura: Take care, Adele. We’ll see everyone here next week.

Adele: Okay, bye.

 

Disclaimer

This podcast is not designed to and does not provide medical advice, professional diagnosis, opinion, treatment or services to you or to any other individual. Through this site and linkages to other sites, Laura Schoenfeld and Kelsey Marksteiner provide general information for educational purposes only. The information provided in this podcast, or through linkages to other sites, is not a substitute for medical or professional care, and you should not use the information in place of a visit, call consultation or the advice of your physician or other healthcare provider. Laura and Kelsey are not liable or responsible for any advice, course of treatment, diagnosis or any other information, services or product you obtain through this site.

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Welcome to The Ancestral RDs Podcast!

Laura Schoenfeld and Kelsey Marksteiner, your favorite Ancestral Registered Dietitians, will teach you everything you need to know about ancestral nutrition and lifestyle to optimize your health - without stress or unnecessary restrictions!

Comments

  1. Luc Tremont says

    Thanks so much for having Hite on your show. She’s thoughtful, provocative, provides well-reasoned arguments, and she speaks in lay terms. Her assertion that RDs who buck the DGA can rely on their own professional sub-culture to defend their standard of care, however, doesn’t even hold up to mild scrutiny. What Hite argues, in essence, is that if a particular RD can convince enough other RDs to his/her POV, then there’s a valid community to create a standard of care. This is validity conferred by popularity, and that’s just nonsense on its face.

    She mentioned vegetarian and vegan RD communities as having defensible standards of care for their clientele. And while it is, in theory, possible to be healthy on these dietary plans, they require extreme care and lots of supplementation (especially vegans) to be successful, which is not a standard that any RD should encourage. RDs should promote the easiest possible diet to maintain that’s consistent with optimal (or at least, acceptable) health.

    I believe Hite is quite right when she says that (a) the observational studies on which prescriptive guidelines are based are too weak to warrant strong guidelines in the first place, and that (b) it’s impossible (or even unethical) to create clinical trials to validate the observational studies. It logically follows, then, that any claim of a standard of care based on the DGA or its underlying science is simply a mirage. That’s why RDs should feel free to flout the DGA in the event of a challenge to their practice, not because they can point to some group of RDs who believe as they do.

    • Adele Hite says

      Hi Luc,

      I think you make a very good point about how RDs should feel free to flout the DGA because the scientific underpinnings are too weak to justify those guidelines in the first place. That is true enough. But in the clinical setting, the legal definition of standard of care is not whether or not there is “official” guidance that should or should not be followed, but “the level and type of care that a reasonably competent and skilled health care professional, with a similar background and in the same medical community, would have provided under the circumstances.” The legal system is more interested in what similarly trained professionals do than in what the science does or does not say. In other words, in a legal challenge, an RD is held to a standard of care as practiced by her peers. My point was that, in this regard, the more peers we have, the better off we are.

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