by Nick Taranto
Health authorities began to advise people to replace these “bad fats” with carbohydrates and processed polyunsaturated vegetable oils, including soybean and corn oils. Fast-food restaurants followed suit in the mid-1980s, switching from beef fat and palm oil to partially hydrogenated (trans fat) vegetable oil to fry their foods. Even though the USDA has since converted its food guide from a pyramid to a plate, it still communicates the idea that “fat is bad” and “carbs are good.” In fact, the new MyPlate doesn’t feature fats at all, “making it very confusing for consumers to know how fats fit into a healthy diet, if at all.”28 Walter Willett, chairman of the Harvard School for Public Health’s nutrition department, says, “The pyramid really ignored forty years of data and condemned all fats and oils.”29
Luise Light recounts,
As I later discovered, the wholesale changes made to [our] guide by the Office of the Secretary of Agriculture were calculated to win the acceptance of the food industry. For instance, the Ag Secretary’s office altered wording to emphasize processed foods over fresh and whole foods, to downplay lean meats and low-fat dairy choices because the meat and milk lobbies believed it’d hurt sales of full-fat products; it also hugely increased the servings of wheat and other grains to make the wheat growers happy. The meat lobby got the final word on the color of the saturated fat / cholesterol guideline, which was changed from red to purple because meat producers worried that using red to signify “bad” fat would be linked to red meat in consumers’ minds.30
Light continues,
Where we, the USDA nutritionists, called for a base of 5–9 servings of fresh fruits and vegetables a day, it was replaced with a paltry 2–3 servings. Our recommendation of 3–4 daily servings of whole-grain breads and cereals was changed to a whopping 6–11 servings forming the base of the Food Pyramid as a concession to the processed wheat and corn industries.
Moreover, my nutritionist group had placed baked goods made with white flour—including crackers, sweets and other low-nutrient foods laden with sugars and fats—at the peak of the pyramid, recommending that they be eaten sparingly. To our alarm, in the “revised” Food Guide, they were now made part of the Pyramid’s base. And, in yet one more assault on dietary logic, changes were made to the wording of the dietary guidelines from “eat less” to “avoid too much,” giving a nod to the processed-food industry interests by not limiting highly profitable “fun foods” (junk foods by any other name) that might affect the bottom line of food companies.31
When Things Get Complicated, We Fail
Surprisingly, the more time I spent researching and thinking about how to eat better, the more confused I became. I learned that nutrition science is still very primitive—and is a very complex and difficult discipline.
I wanted to understand on a fundamental level what and how I should be eating, but the complexity created through marketing spin, faulty science, and bad data left me overweight, confused, and stressed. Many industry insiders have intentionally overcomplicated things—and when things get complicated, we often fail.
At Plated, our Third Core Belief is: People succeed when it’s easier to do the right thing than the wrong thing. The preponderance of food marketing and complicated nutrition messages over the last forty years has left many of us baffled. We don’t even know how to determine right from wrong!
At Plated, we are trying to be deliberate and conscious as we evolve our business to make it easier to make good food decisions. Health will always be an intensely personal endeavor, but we think we can build a better, more transparent, more successful food model by sticking to our core beliefs.
Chapter 7
When Food Becomes Nutrition
One-liner: The future of food, nutrition, and health is coming. However, because nutrition science is still relatively primitive and complex, it’s easy to drive yourself crazy, so be careful.
Let me start off by saying that there are an infinite number of ways to drive yourself nuts, but doing what I did is a surefire path to obsessive compulsion, neuroses, and locking yourself in a room in a quest for “truth.” I wish I were charitable enough to say that I suffered through what you’re about to read so that you don’t have to, but in reality, my quest to get to the heart of nutrition was much more selfish than that. I just wanted to look good, feel good, and have six-pack abs. Where I wound up was locked in a hyperbaric chamber for twenty-four hours having my metabolism monitored by a team of Columbia Ph.D.s.
But there is a silver lining here, and it’s this:
I learned that at this point in human history, we do not yet have the capabilities to quantify the self to the extent needed to tailor optimal nutrition, health, and living for each and every person. We will get there soon (within the next decade or two), and in this chapter, we’ll meet some of the pioneers who are creating the road map for the quantified self. But in the interim, because we don’t have the answers, let’s not pretend like we do.
We all need to do our own research and testing to figure out what blend of nutrition, stress, sleep, and exercise works best for each one of us as individuals—there is no one-size-fits-all approach, and there are no shortcuts. But at a certain point, I found that it’s “healthier” to pull back from the brink of obsession and to return to treating food as food and not nutrition—life is just too short.
But before we get ahead of ourselves, let’s start at the beginning.
From the Marines to Man Breasts
When I started working on this book in the fall of 2015, my wife and I were expecting our second daughter, my cofounder Josh and I had been in crunch mode on the business for four years, and I was 228 pounds with 27 percent body fat. I was 30 pounds heavier than I’d been just a few years earlier in the Marines, and I realized that I felt gross for the first time in a long time. I was running a food business with the mission of making good food a reality for everyone, but I had been so focused on business and family that I had lost perspective on my own well-being.
Since high school, I had always prided myself on being an athlete, and while I was in the Marines, I consistently scored perfect 300s on the physical fitness test—20 pull-ups, 100 sit-ups in under two minutes, and three miles of running in under eighteen minutes. But here I was, 1.5 kids, a wife, and a business later, and I was well on the way to a flabby, pasty, man-breasted #DadBod.
If you have kids or know anyone who does, you know that the first few years (I hope it’s only the first few years!) are pretty insane. All my good habits (sleeping, exercising, eating real adult food, not living on a steady drip of caffeine) went out the window. I was also working sixty-, seventy-, and sometimes eighty-plus-hour weeks. I was running a business whose mission and ethos was based around healthy and sustainable eating, but I had put myself on a course for obesity and early-onset diabetes.
What the hell happened to me?
Navigating the World of Nutrition “Science”
I wanted to learn more about the science of nutrition, so I turned to the smartest expert in the field: Google. I searched “How do I learn more about nutrition?” and I hovered on the first link that I was served—the Institute for Integrative Nutrition. I clicked through and immediately became skeptical.
The institute bills itself as “the world’s largest nutrition school and certification program, empowering people to transform the world.” I signed up for the institute’s newsletter, and received a “personal” e-mail from the founder. He explained that the institute’s mission was “to play a crucial role in improving health and happiness, and through that process, create a ripple effect that transforms the world.” He encouraged me, “I want you to know that you have the strength, power, and passion to become the healthiest and happiest you’ve ever been in your life. You can overcome whatever is holding you back. Whatever it may be, you have the power to make a difference.” I felt like I had fallen into the clutches of what happens when Groupon and Deepak Chopra make a baby. The institute proclaims that it was also named one of the healthiest comp
anies in America, so if they got that right, they must be legit!1
Optimizing happiness and longevity is complex, and there are a lot of charlatans out there who conflate nutrition and getting the most out of life. My introduction to the institute is just one real, if slightly new age and hilarious, example of the conversation that surrounds nutrition science. Many of these practitioners believe fully what they’re preaching, but their wholehearted belief systems mostly ignore or only pay lip service to the real science that drives most other twenty-first-century disciplines.2
The problem is that as humans, we all eat every day. I mean, that’s not a problem more broadly—if it were truly a problem, we wouldn’t have a business. It’s a problem because we are all intimately familiar with food, and as a consequence, it is really easy to make nutritional guidance anecdotal. After all, eating is pretty important, and we tend to care a lot about what we eat. So if you’re on a strict low-carb diet, you are more likely to recommend a low-carb approach to anyone uninitiated enough to ask for your advice.
Additionally, like any discipline or industry, there are also professional pressures and expectations. Someone who studies a particular food likely has preconceptions about what he or she expects the food to do to health. A professor attempting to get tenure is under pressure to come up with fundable and noteworthy results. Researchers who built their careers on demonizing or applauding particular foods have a vested interest in substantiating their views.3
In the Marine Corps, our infantry instructors constantly talked about “human factors”—hunger, stress, sleep deprivation, extreme heat or cold—as determining more battles than bullets or bombs. It turns out when you’re tired, cold, stressed, and hungry, you don’t fight as well. Fancy that.
A different set of human factors, but human factors nonetheless, can influence how science is done. There is even a term for this—white hat bias: “Bias leading to distortion of information in the service of what may be perceived to be righteous ends.” For example, for someone who has committed her career to fighting obesity, a statistically significant change in weight, no matter how small, may be used to further a policy agenda.4
Building legitimate evidence, discussing the evidence, and using the evidence are three very different disciplines. The first two are where science can and should play the role of pushing our collective human knowledge forward. But unfortunately, when it comes to nutrition, more often than not, steps one and two get skipped, and evidence gets trundled out as dogma. Time and again, since everybody eats and since we are all looking for nutrition guidance, half-baked science gets repurposed as BuzzFeed clickbait, and next thing you know, everyone and your long-lost half sister Mildred are choking down turmeric juice cleanses.
It doesn’t need to be this way.
Do We Know What Makes Us Healthy?
Why is it that what we are advised with confidence to eat one year is so often reversed the next? We go from “Red meat is the root of all evils!” to “Eat like a caveman!” And from “Egg yolks will kill you!” to “Eat more egg yolks!” The simplest explanation for the bipolar nature of nutrition guidance is that—drumroll, please—it is just how science works.
An observation leads to a hypothesis. The hypothesis (“Egg yolks will kill you!”) gets tested, and it fails the new test. Keep in mind: Failure is always the most likely outcome in any scientific experiment. There are an infinite number of wrong hypotheses for every right one—so the odds are always against any particular hypothesis being true, no matter how obvious it might seem. Hypotheses begin their transformation into policy recommendations only after they’ve received support from a field of research known as epidemiology. Epidemiology is the study of epidemics—you probably don’t need a degree in Greek and Latin roots to solve that one. For seven decades, epidemiology has been used to find the causes of cancer, heart disease, and the other main chronic diseases that end up killing most of us.5
But here’s the rub: We have almost certainly overestimated what epidemiologic research can actually accomplish. The case of red meat and saturated fat causing heart disease is just one of many examples where epidemiology has fallen short. But it proves an important point: Trying to establish reliable scientific knowledge is incredibly hard when the research tools themselves are broken.6
The cohort study deserves much of the blame for the bad epidemiological science we have witnessed since the 1950s. In these studies, the scientists monitor disease rates and lifestyle factors (diet, physical activity, prescription drug use, exposure to stress, etc.) in or between large populations (oftentimes featuring tens or hundreds of thousands of people). These studies can cost millions of dollars and can take decades to perform fully.
Scientists then try to develop hypotheses about what caused the results. Since so much time and money is often invested, and since the diseases under observation are epidemic by definition, results generate fiendish coverage from the media. From the benefits of avocados to the dangers of caffeine and sitting at work, these cohort studies provide the only available data outside the laboratory on critical issues impacting hundreds of millions of people’s lives.
The dangerous game being played here, as David Sackett, a retired Oxford University epidemiologist, has observed, is the presumption of preventive medicine. “The goal of the endeavor is to tell those of us who are otherwise in fine health how to remain healthy longer.” But this assumes that the hypotheses and recommendations prevent rather than cause problems. Remember how we were told to eat margarine in the 1980s? Now it turns out that margarine actually causes cancer. Whoops!
Nothing illustrates this better than a classic 2012 systematic review in The American Journal of Clinical Nutrition that pretty much showed that everything we eat is associated with both higher and lower rates of cancer.7 With the presumption of “do no harm,” how clear does the data have to be before any advice is offered?
The issue with cohort studies is that no matter how well designed and how many hundreds of thousands of subjects they might include, they still have a fundamental constraint—what they call at Harvard Business School the ol’ correlation-causation conundrum. They actually don’t call it that—I just made that up. But it definitely is a conundrum.
Cohort studies can distinguish correlations between two events—that men who eat less saturated fat have less heart disease, for example. But they cannot determine causation—the conclusion that one event causes the other; that eating less saturated fat protects against heart disease. As a result, observational studies can only provide what researchers call “hypothesis-generating evidence”—what our general counsel would call “circumstantial evidence.” Testing these hypotheses in any definitive way requires a randomized-controlled trial (RCT)—an experiment, not an observational study. Not only are RCTs even more expensive and time consuming than cohort studies, but they also have the nasty habit of providing the “back” to the back-and-forth of epidemiological recommendations.8
Understanding the limitations of epidemiology is the easy part. The RCTs needed to develop bulletproof data about a lifestyle or diet change are insanely expensive and time consuming—a recent review of RCTs conducted by the National Institutes of Health put the average cost at $12 million. By randomly assigning people into a diet intervention group or a placebo group, these trials “control” for all other possible variables that might affect the outcome, like the weight or household income of the participants. This is why randomized trials, particularly those known as placebo-controlled, double-blind trials, are typically considered the gold standard for establishing reliable data about whether a diet is actually safe and effective.9
But RCTs also have limitations beyond the investment of time and money. They can’t be used to study suspected harmful effects. Imagine the uproar that would be caused by subjecting thousands of people to a diet heavy in an ingredient that is known to cause cancer. First, it would never pass an ethics review board. Second, no one would ever fund such a thing. And third, even if you cou
ld pull off one and two, you’d probably get murdered by the offspring of thousands of people to whom you knowingly gave cancer. Not a pretty picture.
And even when RCTs do get funded and approved, it’s hard to determine how the results apply on an individual level. RCTs tend to attract people who are motivated to volunteer and will follow the prescribed protocol for years. Consequently, RCTs “are very good for showing that a drug does what the pharmaceutical company says it does,” David Atkins, a preventive-medicine specialist at the Agency for Healthcare Research and Quality, says, “but not very good for telling you how big the benefit really is and what are the harms in typical people. Because they don’t enroll typical people.”10
So is there no way to study nutrition with real, hard-core, convincing science? I reconnected with one of my best buddies from college, Lance Martin, the one who had just received his Ph.D. in applied physics and bioengineering at Stanford, whom we met earlier on.
Lance explained that historically there has always been an interest in studying microbial metabolism—how different bugs metabolize things. Bugs are very trackable systems—you can grow them in a dish, knock out their genes, mess with them, and study them closely. Therefore, there’s been interest in how metabolism works in different microorganisms and simple organisms like bugs.