Most Drs I know have NO idea of the basics principles of statistics. They just repeat things, eg “fat is bad, a healthy diet has a base of >=50% grain”.
When you ask them where they get that from, they tell you they read it while in school (in the 90s), from a book that was edited in the 70s, that took it from a study conducted in the 60s, that is just an appeal to P-hacking.
Doctors just repeat advice given by national boards. These organisations are a bit slow, but still update their advice every few years, and these are heavenly reliant on statistics & research.
Just read Harvard's nutritional advice pages, they are exactly what a doctor will tell you.
The problem is nutritional science is highly unreliable. And the main reason is, that it's incredibly difficult.
Lots of the generic advice given is based on large scale studies over long years of population in the advice against red meat etc. But there are just too many variables. Which is why they keep changing their advice, however they thoroughly understand statistics.
Also the main focus has been on risk factors instead of understand in the mechanisms behind certain things, partially because the mechanisms are just so darn complicated.
Cigarettes was pretty clear pretty fast, they resorting to hiding the research, it was much more difficult to obfuscate it.
With practical matters putting a man on the moon it's easy to figure out who's wrong and right.
Not all NutScis work for the national boards. But those that do are bombarded with lobby.
> The problem is nutritional science is highly unreliable. And the main reason is, that it's incredibly difficult.
Science is --if the proper protocol if followed-- never unreliable, at best the scientific conclusions change often. Science is ALWAYS difficult, or it would not be science but mere common sense.
> national boards [...] are heavenly reliant on statistics & research.
So how come there's soooo much difference between countries? Canada recently started to advice against milk, but the US still promotes it. To me this shows the power of lobby is very stronger in these boards.
What's the source for that?
The "make water your drink of choice" replaces a reference to milk in the previous recommendation.
From the guidelines :
"Vegetables, fruit, whole grains, and protein foods should be consumed regularly. Among protein foods, consume plant-based more often.
Protein foods include legumes, nuts, seeds, tofu, fortified soy beverage, fish, shellfish, eggs, poultry, lean red meat including wild game, lower fat milk, lower fat yogurts, lower fat kefir, and cheeses lower in fat and sodium." (Italics mine)
But there are risks of deficiencies in a meat & dairy free diet. I've people close to me had b12 and iron deficiencies who cut out those because of modern diet ideas.
Especially B12 is a big one, and if you don't supplement it's almost impossible to get on a diet without dairy or meat. It's also full of many other nutrients. So recommending milk doesn't sound so crazy to me, even though I agree the milk lobby is a known powerhouse in many countries.
B12 is produced by bacteria in dark soil, and water soluble; so found in surface waters. Now we and most livestock drink treated water, so no more B12 in the water. Hence I supplement. The B12 that's in meat, eggs and dairy is typically also supplemented to them in their feed.
There might be issues with contanimated milk, but milk in itself doesn't seem to have much negative substances in it.
Lactose intolerancy is annoying for those who have it, but doesn't seem to have much consequences. Kale also has similar effects.
A main thing is the hormone content.
> Lactose intolerancy is annoying for those who have it
I believe we all have it to some degree. And LI is the default, it is just some europeans who became better at digesting lactose.
All food comes with downsides. I'd say for us humans the least downsides can be found in fruits and tender green leafs, which is what the diet of the other primates (yes humans are biologically classified as primates) predominantly eat in their natural habitats.
Apart from science and research, there's also common sense: no other animal consumes milk after their (if mammal) weaning stage.
Kind of strange you are going all the way back to primates. The last 200.000 years we've evolved to eat 60-90% of our kcals diet of animal based food.
The last 10.000 - 15.000 years we moved more to agriculture, mainly grains and rice. Which is not that long but allowed us to be better adapted to grains and other plants.
Overall the body seems to be very good at processing different kinds of food. From meat, dairy, eggs to plants. In these debates all sides invest too much in their moral positiion and have to resort to very complicated logic that doesn't have any backing in research but makes sense for them with a few graphs and 1 or 2 principles that they think define are the base of human health.
Meat & dairy come with its issues, but so do plants. They contain lots of antrinutrients blocking nutrient intake (which is main reason why iron is spinach is not taken up well). And plants are much less nutrient dense and are harder to digest. It's the vegans & vegetarians that need to supplement, which says something.
He shares some facts on dairy, that's all.
> The last 200.000 years we've evolved to eat 60-90% of our kcals diet of animal based food.
Evolution is not that fast. We can "adapt" in that time (like the lactose tolerance), but not evolve to live of different foods. Evolutionists seems to agree.
> Overall the body seems to be very good at processing different kinds of food. From meat, dairy, eggs to plants. So people engrained too much in these debate resort to very complicated logic that doesn't.
Short term yes. Long term no. Primates are already omnivores. They eat bugs and rarely hunt. So its not far off. Dairy after weaning stage is a new thing.
> It's the vegans & vegetarians that need to supplement
Source? B12 is already discussed in this thread. Apart from that D maybe? Because we left our original sunny habitat. Otehr than that I dunno. See what the keto fans are recommending in supplements :)
From Credit Suisse Foundation in 2015: 54% surveyed doctors falsely believed eating cholesterol-rich food raises blood levels of cholesterol. Concluded: "Clear example of the level of misinformation that exists among doctors."
> Just read Harvard's nutritional advice pages
Haha. The Economist: A researcher at the University of California uncovered documents from 1967 showing that sugar companies secretly funded studies at Harvard University designed to blame fat—not sugar—for the growing obesity epidemic
Medicine is also very very large and very fuzzy when you step out of the time tested knowledge. Reading pudmed is surprising. Everything is statistical and there's always a paper contradicting a previous one.
A more appropriate typo I haven't seen in a while. I'd definitely read pudmed.
(For those with English as a second language, "pud" is a folksy abbreviation for "pudding".)
You could follow the paper results as written.
But everything is statistical and youre and individual.
Isn't there a better way?
The reason why is much simpler: in virtually all cases, if you don't bother to see a doctor, you won't die. Doctors aren't killing people at such high rates that most of us should already be dead.
This is the reason discourse on this site is going down the toilet.
Would you ever go to a dentist with crooked teeth or a physio with scoliosis?
It’s a shame you don’t play by your own rules, because then we wouldn’t have to read your idiotic spew.
By all means, go get scammed. Go buy books and fall for the mythos and appeal to authority.
That didn't go well - the way covid sceptics were treated by the Cathedral was not nice.
It's rather like software engineering, but with lives/health at stake.
Although your use of the phrase "the Cathedral" doesn't lead me to believe you're very grounded in reality yourself.
Your second is just raising the temperature without adding any real value, hence the downvotes you appear to be getting.
Hacker news is weirdly populated by people with no grounding in reality on very specific topics, like this and the MOND bullshit people spew in all physics discussions. I think it's an unhealthy obsession with being contrarian mostly.
You see the phrase "the Cathedral" flung about a lot. I take this as a fairly solid indicator of ESR-fellating big-L Libertarians.
It's worth remembering the definition of skeptic as stated here:
"a person who questions the validity or authenticity of something purporting to be factual.".
But COVID discussions tend to be extremely black and white, with no place for a middle ground.
The comment about skeptics serves only to keep that black and white picture, which is one reason for downvoting.
I think the comment I replied to would've been much more valuable if it specified which groups of COVID skeptics they're backing up. As it stands, it's just playing apologetics for crazy people.
It would be far healthier for discussions to separate skeptics and obviously crazy or idiotic. Those are two very different groups.
As it should be, because they were dangerous idiots coming away with stuff that would have made a Victorian-era quack patent medicine seller blush.
No, Stoney McDooberson, smoking weed will not protect you from COVID.
"BuT BiG PhArMa Is TrYiNg To KeEp EveRyOnE SiCk WiTh VaCcInE cLoT sHot! BuY hOrSe WoRmEr InStEaD!!!"
Yeah, who do you think makes the horse wormer? Hint - not a naturopath.
Were they dangerous idiots?
It was the screaming racist Qanon anti-vaxxer maniacs that were pushing the "lab leak" idea, and they turned out to be entirely wrong too.
I stand by this. The current debate is around a modified strain escaping from a lab, but even if that's laid to rest, how would we rule out a leak of an unmodified virus?
I find it embarrassing that everyone took so long to point out the obvious: whether it was a lab leak is impossible to disprove.
You can use it in humans, but in a far smaller dose than you'd expect. It works quite well as a dewormer in humans too.
It does precisely fuck all against COVID or any other sort of virus.
Solid gold against intestinal parasites though.
The history of nutrition claims seems to be full of failures (e.g. "butter is bad, substitute with margarine" -> "margarine is bad", "fat is bad" -> "carbs are bad"). From someone who is ignorant of Nutrition research I have always wondered if the main issue is that the best research is not communicated because it is not convenient for business or government. So although some researchers are aware that current advice is likely to be harmful, they don't have the power to change the messaging.
1. This kind of research is difficult to execute because there are too many confounding variables. You can never get clear isolatable results. There is no such thing as "good" and "bad" that applies to a large population in all contexts. This may sound like a drawback, but in a way this is great for researchers because it creates an infinite amount of studies you can run and publish, and nobody can ever tell you that you're wrong, because there is no clear answer. You'll never be out of work. If industry tells you "we need a study that shows X" there's almost certainly a way to design a study in such a way to get result X.
2. Research must be published. No matter what your results or experimental assumptions and constraints are, as a researcher you must "sell"  your research and present it in the best light. That's what your career is all about. Citations. Similarly, as a reporter you must write articles that attract views, so you must sensationalize research, even if the original publication was clear about its shortcomings. These perverse incentives create vicious cycles, not just in nutrition.
There will always be a new fad "superfood" like pomegranate or acai berry, because there is some farmer's collective that needs to pump their crop into the headlines.
There will always be mass injection of bad stuff into the food chain, such as HFCS, because heavily subsidized crops produce an oversupply to be dumped. (Have you ever noticed that "corn" is never on lists of FDA allergens?)
There will always be hucksters and snake-oil salesmen (the bad kind; real snake oil is known to indigenous tribes to have healing properties). Dr. Oz and infomercials will need to push supplements and "the latest research" because they have a bill of goods to sell you.
My family was caught up in every fad diet throughout the 70s and 80s, and we suffered as a result. There was never any reason for us to eschew eggs and their yolks, or butter or full-fat milk. There were plenty of reasons for us to avoid drinking water with massive doses of fluoride. My father is a scientist who knows the environmental dangers of radiation, asbestos and other lab chemicals, yet he tacitly approved of the onslaught of crap which we routinely purchased from the corner grocery store.
That consensus dietary recommendations change frequently is itself a myth.
* Wine (separate articles than alcohol)
* The "superfood" of the month.
* The "fat eraser" food of the month
* The "perfect diet" of the year
And the fact that somehow people don't seem to notice the constant trend and still take them all so seriously.
We need to run randomized clinical trials to tell if drugs work. We’d need the same to make any definitive conclusion about the impact of diet.
But the problem is unless say, cancer treatments, where an effect is obvious after months, the impact of diet can take decades to show up.
Can you run randomized clinical trials for decades? Not really.
So you do non-randomized, observational, retrospective studies that have so many holes in them you question the effort spent doing them.
That’s why we’re in the state we are.
There is a caveat. Most science, even when high calibre and delivering clear results, doesnt reliably predict wwhat individuals should do. It only speaks to an average across the population. Individuals have unique responses, which can vary by degree and also by direction. The gold standard is always careful experimentation on a case by case basis. This phenomena is more apparent in diet science where dissecting causation and elaborating mechanism is particularly difficult. Many studies are narrow in scope, with short duration, and applied to limited demographic types... limiting generalisability. Larger, longer studies in more natural contexts produce results that often conflict, presumably because of factors we don't fully understand.
So my two cents would be to remember that results of studies are not always true for individuals, annoying as that is.
If you're serious about change you'll need to experiment.
I think the tension is that that are errors in both directions here. Sure - some people will have worse results than optimal because they followed advice meant for the "average" person when they have unique body chemistry. But on the contrary many people who think they are unique will shun advice for the "average" person and have worse results.
My hunch is that more people make the second mistake than the first.
The first problem is that this isn't always obvious. You can't substitute all leafy greens for spinach, there aren't many good non-milk non-fish sources of calcium, not all nuts and seeds have the right amount of vitamin e. It's quite hard to balance everything even when you're tracking individual foods, and it makes for some very strange meals.
The second problem is that a lot of the important nutrients are coming from foods that are otherwise calorie-dense or have other problems. Citrus fruits are sugary, milk and nuts are fatty, uncooked spinach can cause stomach trouble. It's not necessarily bad to eat calorie-dense food, but it does make things less forgiving when you're trying to eat at a calorie deficit to lose weight.
It makes me wonder if maybe I had long-term deficits in some of these nutrients and just didn't know.
The half-litre of milk is one of the many things you could try. You could also eat 100g of poppy seeds, 5 cups of cooked lentils, or a kilogram of cooked kale. The point is that it's genuinely very hard to eat enough calcium, and that's only one of the nutrients that need to be juggled.
> it's genuinely very hard to eat enough calcium, and that's only one of the nutrients that need to be juggled.
Ive found that eating a variety of food stuff, and not hyper optimising for one nutrient goes an awfully long way towards hitting all of those goals. If you followed my suggestion above, you've likely hit your calcium, iron, vitamin A and C nutrients for the day out of ~700 calories leaving an average person 800-1200 calories leftover to burn on whatever they want to!
> The Reference Daily Intake (RDI) used in nutrition labeling on food and dietary supplement products in the U.S. and Canada is the daily intake level of a nutrient that is considered to be sufficient to meet the requirements of 97–98% of healthy individuals in every demographic in the United States.
Due to individual variations you may need less. So falling short of the RDI isn't necessarily a problem.
Edit: Consider what the RDI for calories would be. If it meets the requirements for 97% of people, then it must be a quantity sufficient for some people with very high metabolism. So eating RDI-calories would likely make a significant amount of people obese.
Macros are no replacement to studies with actual food sources. It's a way to trick you.
Edit: [CORRECTION] Asian women have high osteoporosis. I misremembered. This was a terrible example.
Also interesting https://en.wikipedia.org/wiki/Osteoporosis#Prevention
>yet Asian women have no problems with "low calcium" diets (low dairy/meat).
Asian diets (particularly in Japan) are very fish-heavy.
No, this is not a thing, please don't spread misinformation.
What if we have innate cravings for ALL of the essential nutrients, and what if we keep eating until we get enough of them?
Hence, rather than avoiding bad things in food, the ultimate quest in the nutrition space should be to understand what foods we need to prioritise to get the nutrients we need to be satiated and thrive!
That’s definitely an overreach. Here’s how I might have put it:
What if we have a sense of “craving” for a broad-based and long-term level of adequate nutrients, and what if we tend to keep eating towards that general goal?
[the subsequent paragraph, minus the exclamation point]
Really? If my wife started feeling better due to a dietary change that goes against what doctors say I would be delighted!
Would you prefer that you wife keeps feeling shitty, but hey, atleast she is following the advice of "professionals"?
The N=1 where N=1 got better is all that matters! Because that N=1 is you or your wife!
On the satiety page  him and another scrape MyFitnesPal diary entries and uncritically label diaries where the intake exceeded desired calorie amounts as having low satiety, and vis versa. It somewhat ignores that people may have not logged all of their food for the day; I would have expected to see controls for that, and maybe ensuring the data was coming from regular loggers instead of incidental ones. The actual method of analysis is not well-described.
Again, when claiming to be driven by data:
- In the Holt paper, there are 41 people are broken down into 6 groups, so ~11 people per group
- When you look at the the analysis, the SEM can correspond ~25-30% of the mean value; when you consider this to be ~11 people, when the I score for popcorn was 154 +/- 40 the veracity/reliability of the data for founding all of his arguments starts to become challenging
- The Holt data uses a scale looking at six different qualitative factors of the food/eating experience and constructs a score from this and satiety perception after 2hrs and uses bread as a baseline
- A lot of his graphs are missing proper labels
- Many have lines where the data's source is poorly indicated
- He uses nebulous terms such as satiety and hunger without it being effectively operationalised (or having a meaningful scale)
- The "The Optimising Nutrition Satiety Index" graph omits most of the labels and does not provide the data
- The same graph uses a linear correlation, but has a curved line and does not provide a p-value
- I managed to perform a partial reconstruction through. I found their SI data  and hovered over a lot of data points (found 26 of them which took a fair bit of time - you can't export it) and combined that with the Holt data. My graph approximates theirs relatively well 
- From my tentative analysis from a one tailed Pearson, I found: n=26, r=.631, r2=0.399, p<0.001, 95% CI (0.370, 1)
- I'm a bit sceptical that their r2 is in fact 0.6031 when the one I found was 0.339. I wonder if they are using the r value which I found to be 0.631.
- To be sympathetic and assuming the r was misstated (and my r would change with additional data), they have managed to demonstrate a moderate significant correlation with reasonable effect size, between Holt's measure and their own.
- However, Holt's uses a significantly different methodology to his, and to that end I fundamentally question if they are measuring the same thing as to justify his claims, such that the correlation could be co-incidental.
- I don't think it would be unreasonable to expect meaned data from ~11 people (and 41 data points) to have some form of relationship with data from 9000 (or 587187 days of entries).
- A majority of the article relies on the reader to look at a graph and draw an inference (without labels or meaningful information
- Interestingly the Satiety-Hunger axis is reversed on their simple diagrams compared to what the analysis uses
I think that when they consider themselves to be data analysts, the analysis has to be of a high-standard. Sloppy presentation, communication, withholding of data/methodology, reliance on one or two articles to substantiate claims (often times very old articles) generally leaves a lot of room to question their findings/claims.
1 - https://optimisingnutrition.com/satiety-index/
2 - https://public.tableau.com/app/profile/marty.kendall7139/viz...
3 - https://postimg.cc/sBbnQZ70
I sometimes feel like in the past, previous generations had a good signal-to-noise ratio; but the signal was tainted by commercial (or today I learned: religious) interests and bad scientific methods. (I'm thinking of fossils/climate and tobacco/health). For a while the quality of the signal improved, but so did the noise floor. And now we're in the situation that quality information is theoretical available for everyone (thank you internet), but (for a lay person) it became very hard to discriminate from bad (or tainted) information: Is that influencer/blogger selling me a new diet because they think it's a great idea? Are they paid/incentived to do it? Or do they actually know what they're talking about?
Maybe everyone had that impression in a certain age; I'm not above that.
Obviously that could be said about this article was well; but since it aligns with my belief I'm biased to think it can't be totally wrong. Now am I falling for anti-SDA/industry propaganda by someone who (maybe subconsciously) has an axe to grind (noise), or is this this well researched advice that I can follow (a clean signal)?
Even wiki has this info:
>> Diet may be a modifiable risk factor for the development of Alzheimer's disease. The Mediterranean diet, and the DASH diet are both associated with less cognitive decline.
So for you the protein doesn't seem to be a huge concern in the big picture.
The most protein dense food is red meat. And the most complete an amino-acid panel.
So basically increase your meat intake.
As a carnivore myself i eat around 1kg of beef a day
I've only heard of such high protein diets in bodybuilding forums.
Evidence that protein requirements have been significantly underestimated
Rajavel Elango 1, Mohammad A Humayun, Ronald O Ball, Paul B Pencharz
PMID: 19841581 DOI: 10.1097/MCO.0b013e328332f9b7
A high protein diet (3.4 g/kg/d) combined with a heavy resistance training program improves body composition in healthy trained men and women – a follow-up investigation
Relatively high-protein or 'low-carb' energy-restricted diets for body weight loss and body weight maintenance?
In fact modern focus on protein is another myth based on superstition.
Protein is the only macronutrient that was shown to increase child height. Fats and carbs do not seem to have an effect on child height.
It's a known phenomena that when eg Japanese parents move to US their children grow taller than their Japanese peers, even though both parents are Japanese.
Obviously it's hard to say if protein is the only cause in this, it could also be others. Some people "blame" growth hormones in milk, no idea if that has any merit to it.
But the point is: nutrition DOES affect child height to a certain degree, not just the genes of the parents.
Children born during that time or just before the war were not shorter than their parents.
While excessive protein is well known to simulate muscle growth, there are no indications that it is good for long-term health. And one still builds muscles with just 60 gram of protein per day, it just takes longer. One gets 60 gram of protein when eating enough potatoes to get 2500 kcal.
Surviving and thriving are very different things. Even obese people could be told to have survived, because they live long years; yet, they leave many on the table.
> And one still builds muscles with just 60 gram of protein per day
Only untrained individuals can do that. Most of the population with just 6 months of training will easily hit the wall with less than 10% of calories coming from protein.
Then there were experiments some from over 100 years ago that showed that athletes at the top level can still improve their performance eating 60-65 gram of protein on average per day for over a year.
Then consider junk vegans who eat mostly potato chips. They do have health issues, but those can be attributed to consumptions of too much empty calories from heavily processed seed oils, not any kind of protein deficiency.
We should be careful not to talk past each other. In your previous comment you talked about muscle growth and muscle building. I took it to mean strength building, the one people do in the gym. Hence my comment on untrained individuals and the amount of protein required to build muscle. Anyone who would like to improve their strength and hypertrophy should better be careful to eat enough proteins.
No activity in the nature demands as much strength as the weight training activities in the gym. A small amount of protein may suffice for natives of Papua New Guinea.
As a side note, muscularity might mean different things. A lean individual showing muscular definition might be considered muscular, yet it doesn't mean that they have big muscles or that they are strong. In a similar manner, someone who looks big might look big because they have favorable fat distribution in their body. They may not be strong.
> athletes at the top level can still improve their performance eating 60-65 gram of protein on average per day for over a year.
Yes they can. They are probably mid-distance runners, not strength lifters. Not all types of sports demand high protein intake.
I am not aware of modern studies that contradicted the conclusions there. Basically even with 60 gram of protein per day one can still maintain and improve muscular volume and strength. It just takes a lot more time compared with consuming 120-200 grams per day that are recommended by modern sport diets.
It's known that bodies of children can "compensate" in later periods for the lack in previous periods. This is most noticable in gymnasts who relatively more often experience a delay in puberty due to their extreme training regiment, but if they stop the body "catches up".
Author proposed using sound scientific research rather than superstition to analyze diet and nutrition. Maybe he’s shilling for his blog or whatever, but it didn’t seem overt.
The narrative around the development of dietary guidelines bears repeating. This mythology recently killed someone I cared about, a chemist and engineer well capable of analyzing the data, but who couldn’t overcome the fear of fat and salt.
No, he only distances himself of fat-based keto. He is a low carb/keto fanatic. He jumps to conclusions from MyFitnessPal data and hand picked things (like the "1997 satiety index"). And seems to be doing mostly experiments on himself. This is garbage.
It makes me sad these kind of unscientific fads pop up constantly on HN.
It seems the main point of the article is that “official” dietary guidelines are a crock, and that real dietary science is coming along.
Out of all the info, I’m inclined to try to find some kind of moderate position — more leafy vegetables and whole grains, non-factory farmed fish/meat, less sugar, minimal ultra-processed junk. With that, cook tasty food for my family and friends, have a great time together, and never worry about dietary science again.
(1) adjust energy intake and expenditure to achieve and maintain a healthy body weight; (2) eat plenty and a variety of fruits and vegetables; (3) choose whole grain foods and products; (4) choose healthy sources of protein (mostly plants; regular intake of fish and seafood; low-fat or fat-free dairy products; and if meat or poultry is desired, choose lean cuts and unprocessed forms); (5) use liquid plant oils rather than tropical oils and partially hydrogenated fats; (6) choose minimally processed foods instead of ultra-processed foods; (7) minimize the intake of beverages and foods with added sugars; (8) choose and prepare foods with little or no salt; (9) if you do not drink alcohol, do not start; if you choose to drink alcohol, limit intake
Can you expand on this please?
Someone I know went on the keto diet like it was a religion, and I'm concerned about their long-term health.
The ones that stuck hardest were, on one hand, fears of cholesterol and sodium; on the other hand, the twisted embrace of both fruit and “sugar-free”; and on the gripping hand, the mortal fear of being fat / the holy grail of being thin.
This led to “healthy” meals of barely seasoned steamed chicken breast and broccoli, with fat/sugar-free oatmeal cookies and a bowl of fruit for dessert. Which led to fairly obvious malnutrition, wasting away, lack of resilience, etc.
We’d go out for Mexican or Vietnamese dinners sometimes, and it was fascinating to watch this picky eater ravage a big plate of cochinita pibil or gà nướng.
Paleo is for fad chasers who don’t understand ketosis.
So importers had seeds which they couldn't sell anymore. The solution? Let's market them as superfoods …