Dietary Pseudo-Confusion: of Fire and Rain

As some of you have likely noticed, I have been in full battle mode since the release of the official 2015-2020 Dietary Guidelines for Americans. The reasons for my crusade are a matter of public record, so I won't belabor them here.

I will note, however, that some of my respected colleagues have gone the other way, emphasizing what's good about the guidelines, and what's similar between them and the excellent Dietary Guidelines Advisory Committee's report that preceded them, and on which they were supposedly -- ah, if only! -- to be based. Said colleagues have tried to talk me out of my turret.

However, I find little to no comfort in arguments that the official guidelines are substantially like the scientific report that informs them. To put it in honest -- if unfortunately harsh -- terms, the Pentagon on the afternoon of Sept. 11, 2001, was substantially -- even overwhelmingly, by any measure of volume or mass -- like the Pentagon of Sept. 10, 2001. But all that mattered to any of us, of course, were the differences.

So, too (for me, at least), the dietary guidelines. Important elements -- both what was said, and how -- were blown away. That's an assault, a violation, no matter the acreage. We are left with something altered, and adulterated, and blighted.

I have gone on to argue that the blight of that sabotage -- whether seemingly contained in scope or otherwise -- is pernicious just the same. Long before the dietary guidelines were released, the advisory committee's report was not just disparaged, but disparaged as the "government's bad advice." But the committee is not the government. The author of the gripe was either ignorant of that or willfully disingenuous about it; I don't presume to know which. Either way, it set the stage for this: Whatever winds up being wrong with the dietary guidelines and the process underlying them extends to the Dietary Guidelines Advisory Committee's report, because they are both versions of the same "government advice." The proximity of one name to the other certainly fosters that perception, and abets that argument.

But it is a false argument. The scientists, though commissioned to advise the government, are fully independent of it. Their report asserts what they judge to represent the weight of evidence in the service of public (and appropriately this time, planetary) health. The official dietary guidelines are, indeed, a government product, and assert only what politicians think we ought to do about what public health scientists actually recommend.

One consequence of all this is that food industry elements prevailed over scientists, and are now celebrating their victory in a flurry of marketing distortions. Since this is a triumph of short-term profits over the long-term interest of people and planet alike, it is a pyrrhic victory if ever there was one. But our cultural myopia seemingly obscures the writing on the cliff face off of which we are marching.

Another is the propagation of a cottage industry in dietary pseudo-confusion; seemingly, consternation and hand-waving helplessness are all the rage. If, after all, dietary guidelines are so very much in question, how much does anyone really know about healthy, sustainable eating? Is there any real expertise? Are there any real experts? In particular, if experts can point out the deficiencies in the judgments of other experts, and if every last proposition can't be traced back to a p-value from a randomized, controlled trial, are we not obligated to run up the white flag and declare rather hopeless cluelessness about the basic care and feeding of Homo sapiens?

No, we are not.

I have said before that you are confused about diet -- the fundamentals of eating well -- only if you want to be. Despite a recent spike in the volume of distracting noise, I still feel exactly that way. Sorry, Vox.

No, we are not clueless about the basic care and feeding of Homo sapiens. And no, we don't need randomized controlled trials to answer every question. (Although, frankly, we have plenty of them -- a fact routinely overlooked or refuted, again as a product of either ignorance or ulterior motives.)

If we did need a randomized controlled trial for every clue attenuating our cluelessness, how on earth could we ever put out a fire?

In fact, let's take it back a step. Given the paucity of peer-reviewed papers on the topic, how can we know anything about fire and rain in the first place?

It appears that lightning often starts forest fires. It appears that lightning strikes, tinder ignites and some swathe of California, New Mexico or Australia burns to the ground. But applying the kind of thinking that seems to prevail in nutrition these days, we must concede this is all just so much observational data, and therefore unreliable. This is not clear evidence of cause and effect. It is merely an association, "proof" of nothing.

Perhaps thunderstorms merely serve the proclivities of arsonists, who like the cover of all that windy mayhem. Maybe lightning is just an innocent bystander to arson, every time.

Or, maybe thunderstorms are a supernatural diversion so that Satan, his minions or maybe good angels who know the value of regenerating the forest can set all ablaze with photon torpedoes from their eyeballs. Minimally, we must concede we have failed to disprove it so far.

And as for the rain: It does appear to put fires out. But what a rash, rush to judgment it is, applying that observational epidemiology to fire trucks and fire hydrants. We have no proof that rain puts out fires. Maybe under the cover of rain, toads or earthworms, well ... whatever.

Surely we can only know that lightning starts fires and rain puts them out when such feeble observations are put to the test of real science: randomized, controlled trials. Surely, we cannot presume to put out fires with water not having compared it to placebo.

And of course, even if we did the hard and necessary work of actually proving that lightning can start fires and water can put them out, we would have many more questions left to answer. Applying, again, what passes for rational thinking in the realm of modern nutrition, we are obligated to profess knowing far too little to do anything with what we know until all such questions have been answered, at great cost to the average taxpayer (or self-serving billionaire).

What is the requisite dose of rain? Is there some number of drops per square foot per second? Is cold rain or warm rain more effective? What about the interactions of rain with every different variety of vegetation or type of wood?

As for our presumptuous applications: Have we even bothered to test every possible level of water pressure in a fire hose? Have we compared hard water to soft, a hose of this caliber to a hose of that caliber, and all those other possible calibers, too? If not, surely we are forestalled from using water to put out fires. Surely, we know far too little for such brash impertinence, and know it far too shakily into the bargain.

But then again, it all does seem to work. And it sure does seem as if a lot more houses would burn to the ground if we didn't use what we thought we knew about fire and water.

Science is, irrefutably, the best means for answering most questions. But sense is the best reason for asking them.

We might ask, "How many angels can break dance on the head of a pin?" and allocate the entire budget of the National Institutes of Health to the answer. But no semblance of that answer, and no state-of-the-art methods, could vindicate an enterprise so badly misdirected at the start.

With all due respect to my counterparts and colleagues, many seem inclined to treat nutrition just this way. There is a massive confluence of science and sense regarding the fundamentals of healthy, sustainable eating; the randomized trials that have not been conducted do nothing to negate it.

I am rather confident about the basics of feeding Homo sapiens sustainably and well for reasons rather more basic than an entire career devoted to the science of that very issue. I am rather confident because science best answers what sense asks. I am confident because James Taylor is not alone.

I, too, have seen fire, and I've seen rain.

David L. Katz, MD, MPH, FACPM, FACP, FACLM, is the director of Yale University's Yale-Griffin Prevention Research Center, which he founded in 1998, and current president of the American College of Lifestyle Medicine. He earned his Bachelor of Arts from Dartmouth College in 1984, his medical degree from the Albert Einstein College of Medicine in 1988 and his master's degree in public health from the Yale University School of Public Health in 1993. He completed sequential residency training in internal medicine and preventive medicine/public health. He is a two-time diplomate of the American Board of Internal Medicine and a board-certified specialist in preventive medicine/public health. He holds two honorary doctorates. Dr. Katz has published roughly 200 scientific articles and textbook chapters and 15 books, including multiple editions of leading textbooks in both preventive medicine and nutrition. Recognized globally for expertise in nutrition, weight management and the prevention of chronic disease, he has a social media following of well over half a million. In 2015, Dr. Katz established the True Health Initiative to help convert what we know about lifestyle as medicine into what we do about it, in the service of adding years to lives and life to years around the globe.