COMMENTARY

Brawn, Brains, and Grains of Truth

David L. Katz, MD, MPH

Disclosures

April 03, 2014

In This Article

Tales to Wag the Dietary Dogma

In modern public health nutrition, we have a faction long contending that animal protein is the devil in the details of our diets. We now have another saying that wheat is making us fat, yet another contending that grains are making us stupid.[5] In the context of mounting evidence that not all saturated fat is created equal,[19] and that we can replace it (with sugar, starch, and trans fat) and wind up worse off,[20] a commentary in the British Medical Journal[21] attempting to absolve it has prompted a predictable war of words, with competing armies facing one another under banners of saturated fat as unredeemed sinner and misunderstood saint.[22]

And let's not even get into sugar as toxin,[23] fructose as poison,[24] and whether calories count.[25] Suffice it to say that those passions all run just as high.

Is this really where we want to be? Haven't disparate visions of God caused the world enough grief that we don't want disparate visions of dinner to do the same? If any of the world's religions is correct in all the details, then all of the others must be wrong -- and countless people have both killed and died throughout history thinking it so. If any of the prevailing, mutually exclusive theories about diet[26] is correct, then all of the others must also be wrong. Should choosing a meal really require choosing a Messiah?

Couldn't the proponents of low-carb eating acknowledge that jelly beans were part of the problem, but pinto beans not so much? The vegans have important arguments about the treatment of our planetary cohabitants, sustainable eating for a population of 7 billion, and planetary stewardship -- but if anything, these get lost when they fail to allow for the fact that game and fish figure in the diets of some of the world's longest-lived, most vital peoples. We could have been right about reducing saturated fat intake and wrong about what we ate instead.[23]

We could agree that eating real food, close to nature, rich in nutrients, and also that eating exclusively plants, would be far better than the typical American diet and would occupy ground common to the disparate theologies of food.[27] We could, and if we did so, we might devote more of our energy to getting there from here -- rather than berating one another for differing notions of exactly where "there" is. We have spent literally decades doing just that, and have paid an excruciating price in years lost from life -- and life drained from years.

There are valid and evidence-based elements in Dr. Perlmutter's argument.[28] We should, of course, eat less sugar and refined starches; more plants directly from nature; more nuts and seeds; and for those inclined, lean meats from animals comparably well fed. We should exercise and get enough vitamin D. And those who are sensitive to gluten should of course avoid it, just as those with peanut allergies should avoid peanuts.

The trouble with such a platform is that it does not make for a sexy, provocative title or best-selling book. Perlmutter's book[5] invokes a scapegoat to garner best-selling sex appeal, but in so doing, it selectively cites the literature, ignores the weight of evidence, and sacrifices its validity.

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