August 6

Minds set in concrete

16  comments

In reading through Gary Taubes’ book Good Calories, Bad Calories I came upon the following dialog that I found all too familiar. It took place in 1973 during the first hearing of George McGovern’s Senate Select Committee on Nutrition and Human Needs. A number of speakers made presentations on the adverse effects of carbohydrates on human health. British nutritional researcher John Yudkin was one of the presenters.

Yudkin blamed heart disease exclusively on sugar, and he was equally adamant that neither saturated fat nor cholesterol played a role. He explained how carbohydrates and specifically sugar in the diet could induce both diabetes and heart disease, through their effect on insulin secretion and the blood fats known as triglycerides. McGovern now struggled with the difficulty of getting some consensus on these matters.
“Are you saying that you don’t think a high fat intake produces the high cholesterol count?” McGovern asked Yudkin. “Or are you even saying that a person with a high cholesterol count is not in danger?”
“Well, I would like to exclude those rare people who have probably a genetic condition in which there is an extremely high cholesterol,” Yudkin responded. “If we are talking about the general population, I believe both those things that you say. I believe that decreasing the fat in the diet is not the best way of combating a high blood cholesterol…I believe that the high blood cholesterol in itself has nothing whatever to do with heart disease.”
“That is exactly the opposite what my doctor told me,” said McGovern.

I know just how Yudkin must have felt. I’ve had the same conversation with patients countless times.
taubesbook.jpgGary’s book is filled with accounts of low-fat advocates clinging to the low-fat hypothesis despite the lack of evidence that it was valid. In fact the evidence had been accumulating showing that dietary fat didn’t have anything to do with heart disease in particular and that it was rapidly losing its status as a risk factor for all diseases in general. The low-fat advocates tenaciously clung to any research – no matter how flimsy – showing any connection with fat consumption, especially saturated fat consumption, and disease while totally disregarding much stronger evidence that fat wasn’t the problem. Papers presenting data showing the lack of causality between fat consumption and disease or data indicating that carbohydrates might be the problem were written off as inconclusive while totally inconclusive data was not only accepted as gospel, but presented as a smoking gun.
Many of these low-fat researchers will read Taubes’ thoroughly researched book that meticulously lays out how and why they went wrong and instead of saying ‘Geez, we really blew that one,’ they’ll say his whole book is BS and if they could just get the right study they could prove to the world that they have really been right all along.
Sad but true.
Reminds me of a line from one of my favorite songs written by John Lennon:

Living is easy with eyes closed, misunderstanding all you see.*

In my years of experience I’ve always been amazed at this ability of many extremely smart people to blind themselves to the evidence staring them in the face. I read a book recently that has helped me to understand.
When MD and I were packing for Europe I rooted through my pile of unread books looking for paperbacks that would travel easily. I found a book that I had ordered a while back on the basis of a good review but hadn’t read. It was the right size so I threw it in my carry on. It turned out to be one of the better books I’ve read in a long, long time; it shed a lot of light on how people can maintain their set opinions in the face of mountains of evidence that they’re dead wrong.
The book is titled Stumbling on Happiness, and was written by a Harvard professor of psychology named Daniel Gilbert. I didn’t read the book stumblinghappiness.jpgwhen I first got it because I was led astray by the title. I – logically enough – assumed the book was about increasing one’s happiness quotient by accident, and since I’m a happy enough guy anyway, I didn’t figure stumbling onto a little more would make my life better by enough to invest the time in reading. Boy, was I wrong. The book isn’t really about happiness much at all; it’s about how the brain works to deceive us in all kinds of situations. And, au contraire to most books written by Harvard professors, this one is a real gem. It’s well written, funny, easy to read, and crawling with valuable information about how we all think. I can’t recommend this book highly enough. Get it while you’re waiting for the Taubes, and you’ll be better able to understand much of the stupidity he writes about and the stupidity you see all around you and the stupidity that we (you and, sadly, I) often exhibit oursleves.
Here is an excerpt to the point:

When facts challenge our favored conclusion, we scrutinize them more carefully and subject them to more rigorous analysis. We also require a lot more of them. For example, how much information would you require before you were willing to conclude that someone was intelligent? Would their high school transcripts be enough? Would an IQ test suffice? Would you need to know what their teachers and employers thought of them? Volunteers in one study were asked to evaluate the intelligence of another person, and they required considerable evidence before they were willing to conclude that the person was truly smart. But interestingly, they required much more evidence when the person was an unbearable pain in the ass than when the person was funny, kind, and friendly. When we want to believe someone was smart, then a single letter of recommendation may suffice; but when we don’t want to believe that person is smart, we may demand a thick manila folder full of transcripts, tests, and testimony.
Precisely the same thing happens when we want or don’t want to believe something about ourselves. For instance, volunteers in one study were invited to take a medical test that would supposedly tell them whether they did or did not have a dangerous enzyme deficiency that would predispose them to pancreatic disorders. The volunteers placed a drop of their saliva on a strip of ordinary paper that the researchers falsely claimed was a medical test strip. Some volunteers (positive-testers) were told that if the strip turned green in ten to sixty seconds, then they had the enzyme deficiency. Other volunteers (negative-testers) were told that if the strip turned green in ten to sixty seconds, then they didn’t have the enzyme deficiency. Although the strip was an ordinary piece of paper and hence never turned green, the negative-testers waited much longer than the positive-testers before deciding that the test was complete. In other words, the volunteers gave the test strip plenty of time to prove they were well but much less time to prove they were ill. Apparently it doesn’t take much to convince us that we are smart and healthy, but it takes a whole lotta facts to convince us of the opposite. We ask whether facts allow us to believe our favored conclusions and whether they compel us to believe our disfavored conclusions. Not surprisingly, disfavored conclusions have a much tougher time meeting this more rigorous standard of proof.

It takes much more evidence – in fact, it’s got to smack us in the face – for us to believe something that we disagree with at our cores. And only a smidgen of evidence to keep us clinging to our own misbegotten notions. The low-fat guys (and gals) for all the reasons that Taubes lays out are convinced beyond any doubt that reducing the fat content of the diet will improve health. I doubt that their minds can easily be changed, no matter how much contrary evidence is thrown at them.
The great physicist Max Planck once wrote:

An important scientific innovation rarely makes its way by gradually winning over and converting its opponents: it rarely happens that Saul becomes Paul. What does happen is that its opponents gradually die out and that the growing generation is familiarized with the idea from the beginning.

At least the nice thing about the low-fat-ophiles is that if they follow their own dietary recommendations the day they lose their influence may come earlier than predicted by the actuarial tables.
*If you want to hear an absolutely fabulous rendition of Strawberry Fields Forever you should get the Beatles Anthology 2 and listen to the first and second cuts on the #2 CD. It’s John Lennon doing first a demo version of the song then on cut #2 a much, much better (in my opinion, anyway) version of the song than what they ultimately came out with.


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  1. Your first Protein Power book was my first exposure to the idea that low-carb was better than low-fat. Prior to that, I’d never heard anything but the “fat bad, grain good” mantra from pretty much anybody. I hadn’t even heard of Atkins until after I picked up your book, and all of my doctors, including the current one, hold it as a matter of faith that my little to no grain or starches way of eating is going to kill me.
    I think I did a pretty good job of changing my mind in the face of the evidence, you presented the facts in a clear, readable form, without having to be smacked around. Now, whether that’s because I never really believed the low fat doctrine, or because, as a programmer, I’m used to clearly demonstrable, repeatable results as evidence of quality, I don’t know.
    I think what’s explicitly missing, though implied, in the analysis you posted is the investment, emotional, financial, or whatever, the individual has in the thing that’s being refuted.
    I had virtually no investment in the low-fat lifestyle, since it didn’t work worth crap for me, so I might have been easy to convince. I know one of the first thoughts I had was “Oh brother, another kooky diet.” Upon reading the first few chapters, though, I had changed my mind and bought my own copy, and gave the first one back to the person who’d given it to me.
    Was I easy to convince because I had basically given up anyway, or because I’m just smarter than the average joe. I’d like to think the latter, but I’m reasonably certain I’m not smarter, in general terms, than my doctor, so I have to conclude that lack of investment had as much to do with it as intelligence.
    BTW, thanks for putting this information out there, and not being afraid to defend it. When I stopped doing low-carb a couple of years ago (more because of stress and hard times than anything else, car accidents and loss of income will do that to you if you’re not careful), it was after I’d lost 40 pounds doing it. Once I stopped, I gained back all that weight and more, and of course everybody blamed it on low-carb. I agreed, of course, stating that stopping the best way of eating I’ve ever encountered was one of the stupidest things I’d probably ever done. Now that I’m back doing it right, and losing weight again, they harp on me for doing that “fad” diet again. It’s hard to keep a straight face when they do that, and I simply charge them with doing research before they make comments; I’ve passed the point where I need to convince anyone.
    Hi Brad– 
    I agree that it’s certainly the investment of time, energy and reputation that keeps people glued to an idea that has less merit with each passing day.  It’s just kind of strange because as an investment it’s throwing good money after bad.  The longer they cling to wrong ideas, the stupider they’re going to look when those ideas are ultimately shown to be invalid.

    Cheers–
    MRE 

  2. But they’re not throwing good money after bad. They know where their bread is buttered, if you will pardon the pun. A dietician who told people to avoid grains and eat plenty of fat, saturated or not, would be unemployable. An endocrinologist who got his patients off sugar and grains would run out of diabetics to bill. What would happen to big pharma without sugar? Or the dialysis industry? We’re growing corn for gasoline for crissakes — not because it makes economic or environmental sense, but because it’s yet another way to launder funds through the farm states (and Archer Daniels Midland.)
    Do you really think anyone is going to let the fact that corn is killing us get in the way of that machine?

  3. when I think of the likes of Dean Ornish and Joel Fuhrman, etc. it isn’t concrete that their heads seem to be stuck in…

  4. I was a die hard low fatter. Every year I tried to lower the fat content of my diet to an even lower level. All the while, my weight kept going up, my blood chemistry got worse and I felt terrible.
    About five years ago, my doctor gave me a copy of Taubes’ NYT article and suggested that I try low carbing. I felt that both were wrong, but I did some research and found that there was no real data that showed that dietary fat was unhealthy. There were lots of people saying so, but no evidence to base their conclusions on.
    I started low carbing and have never felt better. My weight went down, my blood chemistry improved greatly and my energy went up.
    Hi Mike–
    Don’t let that doctor escape.  Sounds like he (she) is one of the few with good sense (at least good nutritional sense) out there.
    I’m glad you’ve done well.
    Cheers–
    MRE 

  5. The saddest part about all this isn’t the self-deceit of the doctors/scientist, but the deciet that they lay upon the people. They have no way to defend themselves against this nutritional dogma. I even tell family members that their most rational course of action is to not believe anything I say, but instead to just take their doctors advice, because the way I see it the most rational thing you can do when assuming the truth of propositions in a field that is not your expertise is to just go with the majority consensus among “authorities” of that field. The only reason I can justifiably disagree about carbs/cholesterol/whatever is because I have access to, and the ability to interpret, peer-reviewed journal articles.
    Hi Neal–
    Based on my own experiences with low-carb and the nutritional establishment I never, ever go with the consensus.  It’s as true with professionals – at least nutritional professionals – as it is with group think in non-professionals: the masses are asses.
    Cheers–
    MRE 

  6. Dr. Eades I have been following a low carb diet since your Protein Power book was published. Recently while researching Prostate Cancer it seems that the medical community insists that cancer especially prostate cancer seems to be caused by a high fat diet. Is there any evidence to support that? Thank you so much for keeping these people “the medical community” on their toes.
    Hi John–
    There is the same level of evidence that fat causes prostate cancer that there is that fat causes breast, colon and all the other cancers it has been blamed for: in a word, none.
    Cheers–
    MRE 

  7. Hi Mike,
    You remind me of one of my favorite quotes from Jonathan Swift, who said that happiness is the state of being well deceived.
    There are a couple of other reasons why the lipid hypothesis has such fanatical adherents in the face of so much evidence to the contrary, why scientifically trained people ignore and deny the science that proves the lipid hypothesis wrong, a subject I plan to develop at essay length given the time. These reasons are psychological and religious, not scientific.
    First, the psychological reason. When people get up in the morning and look in the mirror, they have a name for what they see in themselves that they don’t like: fat. They then project that dislike of themselves onto fat in the environment and blame it for all the world’s ills. So fear and hatred of dietary fat is a projection of self-hatred.
    The religious reason has to do with a persistent strain of American Puritanism. According to this religious idea, virtue comes from self-denial and sin comes from self-indulgence. As George Bernard Shaw once said, people think they’re being virtuous when they’re merely uncomfortable. So being overweight is sinful because it comes from excess. Dieting, then, becomes a religious exercise in becoming virtuous, i.e., thin, through self-denial. Low fat dieting fits this mold because, as many have pointed out, it means rejecting all kinds of foods that please us. Along comes Atkins, who says: No! Becoming thin, i.e., virtuous, has nothing to do with self-denial, but with achieving satiety. For this, Atkins was attacked with all the ferocity of Torquemada persecuting heretics, for heretic he certainly was.
    The lipid hypothesis is another case, I’m afraid, where neurosis and religion trump science.
    All the best,
    Chuck Berezin
    Hi Chuck–
    Interesting theory.  I’ll be eager to read the full essay.
    As you’ll see when you read Taubes’ book, at least in the case of the scientists involved, it was more fearing to go against the herd that was stampeding off the cliff.
    Cheers–
    MRE 

  8. As the great physicist Richard Feynman put it:
    “The first principle [of science] is that you must not fool yourself, and you are the easiest person to fool.”
    This quote comes from CalTech commencement address he made in 1974 on the subject of scientific integrity. It’s also known as his “Cargo Cult Science” talk which I think, though I may be wrong, you (Dr. Mike) might have brought up before in your blog? I did a search and couldn’t find it, but it might be from your older blog format. If you haven’t you can find an adaptation of it here:
    http://music.ls.huji.ac.il/members/nachum/feynman.html
    It speaks well to what you’ve been saying about science’s ability to blind itself, or just miss the point all together.
    I’m an engineer and I have the quote above pinned to the wall of my office, just as a reminder.
    Hi Ogden–
    I’ve read the Feynman quote many times; Taubes mentions it in his book.  It speaks to something we all need to be on the lookout for: the ease with which we can all indulge in self deception.
    Cheers–
    MRE 

  9. Just got this in an email from a friend that suits this topic to a T.
    Change or add one letter in a word and give it a meaning:
    Bozone (n): The substance surrounding stupid people that stops bright ideas from penetrating. The bozone layer, fortunately, shows little sign of breaking down in the near future
    Ah, Bozone.  So that’s what causes it.
    Cheers–
    MRE 

  10. Over the past few years, I’ve been reading that there are negative health consequences from the fat in our diets when that fat is excessive amounts of polyunsaturated fats, which are highly prone to peroxidation by free radicals. It makes sense to me that there’s no reason to blame saturated fats for our current ills when the past 100 years has seen significantly decreased consumption of saturated fats and vastly increased consumption of polyunsaturated seed oils. But, some of the things I’ve read are downright alarmist about the need to eliminate polyunsaturated fat from the diet as much as possible and eat only saturated fat. To that extent, I’ve stopped buying seed oils and products made with them, but I don’t worry about the unsaturated fats in whole foods (meat, nuts, etc.) The oils I buy are virgin coconut oil, natural unrefined palm oil, butter, and olive oil. What’s your take on polyunsaturated fats?
    I avoid ALL polyunsaturated fats that come in bottles.  Polyunsaturated fats that are in their native state, i.e., as seeds, meats, plants, etc. are okay because the substances found along with them in the seeds, nuts, meats, etc. help stabilize them.  The only polyunsaturated fats I eat that come in supplement or bottled form are fish oils or krill oil and I don’t eat a whole lot of that.
    Cheers–
    MRE 

  11. Hi,
    I have an important question. For me at least. I eat a fair amount of nut butter (almond, cashew) and have tinned sardines each day for lunch (I like them!).
    Going by what I know, I am not sure if this is a good idea.
    1. The nutter butter being processed may mean more peroxides occur.
    2. The tinned sardines are not fresh, although sealed. Could those fish oils have gone rancid? hard to tell since it smells like sardines.
    regards
    col
    Hi col–
    If the nut butters are simply nuts ground into a butter it’s not much different than eating the nuts.  All the components that give the fats stability within the nuts are still there in the butter.
    You don’t really have to worry about the sardines because they’re canned fresh and kept from the air in an impervious tin, so they can’t really go rancid.
    Eat away.
    Cheers–
    MRE 

  12. So, I’ve been busy, saving the government more money and increasing efficiency. I missed your Italian vacation (I would like to compare notes, but don’t think this is the time or place). And I missed a lot of the new content content. Like this one.
    Curious to read Tabues, will wait for paperback or the library though. Commuting with hard cover tomes is a pain.
    I am curious about how it all began. Once upon a time, Banting was dieting. Somewhere around 1950 or so, it seems things changed, and we got the lipid hypothesis. Somehow, this became an idee fixe, and it must have been fairly quick. I wonder, what was at the root, and why the sudden change in the tune of the chorus. Was it fast? Is there a vast, scary conspiracy? Or is it just a simple idea (fat makes fat… everytime I think of this, I think of old school Susan Powter’s rag about Low Fat Pig), gone way out of control (I’m stilling thinking of Powter, who might be the Courtney Love of the diet scene).
    As we danced a while ago around doctoral business models, I wonder. A commenter above suggested that a physician’s incentive system is broken. I’ve been thinking a lot about that, since seeing “Sicko.” It’s not that I want an all out NHS. It’s just that I feel like we’re getting the short end of the stick, unless you happen to be very rich or employed by someone very generous (I haven’t had to test the limits of my insurance company’s generosity, but the tax payers are apparently a very generous employer). I digress. One of the foreign docs they talked to, I think in London, was doing very well for himself as an NHS doctor. I don’t know that he was typical or cherry picked, but the brief description of the incentives seemed to align the doc’s financial interests with his patient’s health interests. Ultimately, as economists, we know that incentives are what really matters. And really, I think a system that doesn’t attempt to align the two major stakeholders’ incentives is at least partially broken.
    (Of course, I say this from the point of view of a patient, not a doc or a big business (pharma / managed care / agri / insurance).)
    If you’re curious to know how it all began, the Taubes book is for you.  It will tell you in detail how it all began. 

  13. I am also going on a trip and I have a book that is just the right size for my backpack. “Protein Power”. Hummm…sounds interesting!
    It is absolutely precisely the right size.  Happy reading.
    Cheers–
    MRE 

  14. “The only polyunsaturated fats I eat that come in supplement or bottled form are fish oils or krill oil and I don’t eat a whole lot of that.”
    Good to see ya’ll back from the wilds of Europe 🙂
    The quote above got me to thinking; do you still believe supplementing with the oils is very helpful? What about the Carlsons Cod Liver oil?
    Hi Daryl–
    It depends on what the underlying diet is.  If one doesn’t eat a lot of omega-3 rich foods, i.e., fatty fish, then it helps to supplement.  If I had to take only one omega-3 supplement it would be krill oil, but I don’t have to take only one, so I take krill and fish oil at least 4-5 times per week.
    Cheers–

    MRE

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