Who Will Win the Diet Wars?
An age-old battle continues in the modern era
The recently published article in the Lancet on sustainable and health diets (#EATLancet) provoked the usual intellectual brawl on social media. Insults were hurled, honor and integrity were questioned, and ad hominem attacks were of course used with reckless abandon.
Where is all this going? Will we debate forever what we should eat? Will this struggle ever find resolution? The public looks on and sees physicians and scientists swearing at one another and wonders about these questions, probably with increasing cynicism each day. They are not aware that science has always been this way, but that will be as true tomorrow as it was before the EAT-Lancet report was published.
Ideological battles seem rarely to find resolution. There are today still those who disbelieve in dinosaurs or even the idea that the earth is round. This has not prevented humanity from making real progress toward a better world.
What, then, will be the outcome of the diet wars?
The Tao Te Ching states that, “compassion in attack brings victory, and in defense, invulnerability.” I believe that those who embrace this teaching will learn what truly matters about diet and nutrition, and will ultimately prevail in the contest for the hearts, minds, and appetites of people all over the world. That is how 4th generation warfare works, which explains why the United States military, despite being what it is, hasn’t conclusively won a major conflict since World War II. This is a war for hearts and minds, and one side can lose every single battle and still win the war, provided they are the most persuasive. These are times in which propaganda goes a long way, but in which tangible results go even further.
I saw a great deal of propaganda in the last week. I saw many people commit logical fallacies that I believe confuse not only themselves but others. I believe that when we truly care about the truth more than anything else, and most importantly more than our fragile egos, we clearly state our arguments without resorting to propaganda or illogical thinking. People are very quick to insult one another in ideological arguments. If you want to get clear of this nonsense, you should take the time to read “Nonsense,” by Robert Gula (HT Jim Otteson for recommending this book to me). The history of science and of medicine is riddled with rivalries between individuals and schools of thought in which even outright physical violence was sometimes employed. Tensions in the world of medicine are apt to run high simply because the stakes are, truly, life and death.
Why is compassion the key to victory?
Only when we are truly compassionate do we see what actually helps our patients.
Only when we are compassionate do we see what in fact harms patients.
Only when we are compassionate can we perceive our own flaws.
I reached this conclusion only by reading medical history.
Many physicians are familiar with the story of Ignaz Semmelweiss. Semmelweiss was a Hungarian physician who was notoriously adversarial toward those who did not accept his premise that hand-washing was life-saving. He demonstrated conclusively that physicians, by not washing their hands, caused infections that killed countless young mothers in Europe. Today, this is universally accepted as true. Yet Semmelweiss was at the time criticized by everyone, including luminaries like Robert Virchow. We still learn about Virchow in medical school . Even the greatest physicians and scientists can get things wrong, apparently. As Otto Warburg and Max Planck agreed, “science advances one funeral at a time.”
One recounting of the story of Semmelweiss, in Harold Hellman’s, “Great Feuds in Medicine,” included an anecdote that few have heard and that I consider instructive to anyone engaged in the 4th generation warfare surrounding nutrition. A Polish physician (whose name escapes me) read Semmelweiss’s work and immediately recognized its validity. He promptly took his own life by jumping in front of a train. He understood that his actions, however well-intentioned, had caused his patients to suffer and even to die.
Physicians rarely talk about the psychological burden that errors and poor outcomes place upon us. We don’t like to think about it and the public certainly doesn’t like to hear that the people they entrust their health to occasionally, if ever, make mistakes. Yet the history of medicine is riddled with mistakes that have cost countless patients their lives. Without a doubt, much of this has been in the form of bad dietary advice. Imagine if tomorrow Chris Kresser had a change of mind and decided to be a vegan. However preposterous you find this premise, the reality is that clinicians change their minds about many things.
Clinicians who do not, in my experience, are the most dangerous.
The example of rate versus rhythm control is instructive in this sense. Not long ago, physicians debated whether we should control irregular heart rhythms with powerful drugs. Some said that all we should do was lower the rate. Others said that we should force the heart into a “normal” rhythm. Enforcing normality might seem like a good idea, but one mentor of mine in medical school estimated that this effort to enforce a normal heart rhythm killed more Americans than died in the Korean War.
The same physician told me, “one day, you’ll wake up in your bed and realize, ‘that’s how that patient died.’” In some cases, what you realize is how your actions led to the patient’s demise. I purposely avoided procedural specialties because I knew I wouldn’t cope well with such burdens and I am grateful that, to this day, I can think of no serious adverse outcome that arose from my action or inaction. Yet such events are inevitable, especially in our over-burdened healthcare system. I did not have to practice long to see this happen, with lethal consequences.
Physician suicide is a growing problem. Undoubtedly, physician suicide is being driven in part by the unacceptable conditions in which we are left to practice by our government and by private interests, particularly the monopolies of the insurance, hospital, and drug corporations, who have deeply corrupted American medicine. But it is also driven in part by the fact that when we make mistakes, we get to live with them. If Chris Kresser ever changes his mind and decides to be a vegan, he will have to cope with the guilt of having given the opposite advice for years. The same goes for Joel Kahn, who recently debated Chris on Joe Rogan’s podcast, or any physician who provides lifestyle advice. We get to live with the consequences of what we advocate. I believe this is a greater driver of physician burnout, depression, and, ultimately, suicide, than we acknowledge.
The difficulty of grappling with our own mistakes is enough, without the jeers or animosity of our adversaries saying, “I told you so.” As tempting as it is to ridicule the opposition, I do not think it serves anyone well. This is why I believe compassion will change the world of nutrition far faster and more positively than the current atmosphere of hostility. When I read the kind of comments provoked by the EAT-Lancet report, on both sides of the aisle, I ask myself, “would Gandi have written that? Martin Luther King? Dietrich Bonhoffer? Abraham Lincoln? The Buddha? Jesus of Nazareth?”
I suggest those who wish to change the way the world eats read things like, Letter from a Birmingham Jail (MLK), The Dhammapada (The Buddha), The New Testament (Jesus), The Cost of Discipleship (Bonhoffer), or The Story of My Experiments with Truth (Gandhi). The legacies of each of these authors merit pages in history books, whereas most physicians and scientists warrant mere footnotes, if that.
We must be ever mindful of the fact the stakes of our work are life and death. We will all make mistakes in what we advocate for and against. It is hard enough to be honest with oneself about one’s mistakes, without the condemnation of others and the censure of our colleagues. From a practical standpoint, I find that ad hominem attacks and logical fallacies in arguments tend to reinforce bad ideas, rather than resolve conflicts in our thinking.
I began my career with a typical, partisan mindset with regards to nutrition. I did not buy the conventional wisdom that a plant-based diet was a cure-all. On the contrary, in my own case and in the cases among many of my family and friends, I found a variety of other diets led to improved performance and greater well-being. I was surprised to find patients living into old age without special diets. It is easy to say that this is mere chance, but the longer I practice, the less I believe that one lives to 90, let alone 100, by chance. The yearly risk of death at age 80 is approximately 9%. Yet I routinely meet 90-year-olds who have made it that far eating whatever they wanted.
This impressed upon me the primacy of the environment in determining health or disease, rather than what we eat. I hope that all clinicians, including even the most stalwart partisans in this conflict, readily acknowledge that people are still managing to make a wide array of diets work for them. There can be no debate that hunter-gatherer peoples like the Inuit and Eskimo can live to old-age reliably on their traditional diet, which looks nothing like the Mediterranean diet. Likewise, the native Okinawans or Kitavans eat generous portions of carbohydrates, and relatively little saturated fat.
To me, one of the most important questions to answer when approaching dietary counseling is, what is my goal? Longevity? Feeling well? Happiness? Often, I find these goals run at cross-purposes, for better or for worse.
Did you know that the word “diet” actually means lifestyle or way of life? Depending on which source you use, of course. Not long ago, dietary choices were so limited that diets were uniform in a localized time and place. Only with the advent of agriculture did humanity suddenly possess a surplus of food, and therefore the luxury of picking and choosing what they ate.
What can explain this discrepancy? To me, the answer lies in the foundations of evolutionary theory.
The quantity and quality of food available in nature is dependent upon environmental conditions that ultimately are a function of the geological (and therefore electromagnetic) activity of the earth in concert with the activity of the sun. The archeological data suggest that ancient humans ate animal protein and fat almost exclusively to survive ice ages. Likewise, in the relatively warm period in which we live, carbohydrates and plant foods are abundant. I ask you, what would a winning evolutionary strategy be for the massive fluctuations in food availability we see on earth? To wire your metabolism to prefer one macronutrient over another? Or to yoke your metabolism to environmental conditions, so that when it is cold and all you have is fat, you burn fat, and when it is warm and sunny, and carbohydrates are on the menu, you burn carbohydrates?
When you change the conditions of existence, you change how you exist. Life on planet earth is adapted to local, seasonal diets.
I was shocked when my friend, Charles Van Rees, an ornithologist at Tufts, told me that deer will eat baby birds or bird eggs when given the chance.
Nature abhors a vacuum and will take what it can get when it comes to food. Nature loves a free lunch. And you really think you’re supposed to just eat meat or plants? You think it’s even worth talking about diet without first talking about the environment?
Darwin wrote about how bird beak size and shape varied with food availability, which is ultimately a function of climate, which is of course a function of geological and solar activity. Our ancestors adapted to eat whatever they could get their hands on. The literature could not be more clear — metabolism is determined by environmental factors.
What we do with what we eat depends upon the signals we receive from our environment. In light of this fact (pun very much intended), how can we presume to offer guidelines on what people should eat that do not simultaneously address these factors?
Local, seasonal diets are what organisms on planet earth have been selected for, because only recently have any organisms been able to break this trend. Those local, seasonal diets varied dramatically based on geological and solar activity. Those organisms that relied on one food source over another died out in the ice ages, or the intervening warm periods. Those that could burn whatever was available were selected. This is why mammalian metabolism can be radically altered by cold — this is not a hormetic effect.
I have had the pleasure of living in some extremely cold places. I have worked in Bemidji, Minnesota (negative 30 degrees last New Years, when I arrived) and Portland, Maine (single digit temperatures at least two months of the year). In remote areas, people tend to have two sources of heat — typically gas plus some kind of wood heat (pellet stove or wood stove). Why? Because if one failed, your pipes would freeze and you would die. Adaptability is the hallmark of dominant animals on planet earth and humans exemplify this perhaps above all others. I no longer accept dietary maxims that ignore environmental variables. Just as we employ different sources of heat based on the weather, so our metabolism employs different substrates based on environmental conditions.
What happens when you put diesel fuel into a gasoline engine? Did you know that the oil you use to lubricate your car’s engine should be chosen to match the temperature of where you live? Why would biology be any different? If you live in an environment of extreme cold, why would your body do well eating carbohydrates? If you live in an environment of extreme heat, why not eat carbohydrates? If you live in a blue-lit, microwaved cubicle and sleep in a high-rise, and never see the sun, what are you supposed to eat? How does your body regulate its metabolism without being able to sense its native electromagnetic environment? Is this why we are seeing unprecedented rates of modern diseases despite a pristine environment (at least in the United States) and a rapid expansion of the healthfood section of the grocery store?
I routinely meet geriatric patients who eat pizza, drink beer, and have avoided medical care of any kind for their entire lives. I call it “The Redneck Paradox” — the fact that many rednecks eat complete garbage day in and day out and somehow are more robust than the average college student or young urban professional. For a long time, I saw the people who didn’t pay attention to their diet as outliers, rather than facts that did not fit the theory that diet is the primary determinant of health. Today, having looked at the data on how light affects biology, I think the incongruities between how well people eat and how sick they become are simply proof that it is not diet that matters most, it is the electromagnetic environment in which we live.
I am further convinced of this by the fact that, over the course of my career, I have become close with luminaries of both conventional and alternative medicine. I will not disclose personal details, as of course that would be improper, but I can honestly tell you that many of the people most ardently hawking supplements or ridiculing fad diets are, themselves, falling apart long before their time.
They puzzle over why.
I do not.
Light shapes life.
How is it shaping yours?
Thank you for reading.
If my work has inspired, enlightened, empowered, or in any other way helped you, I hope you’ll share it with those you care about.
I am on a mission to teach people what it means to live a healthy life — that can’t happen if people like you don’t spread the word.
You can enroll in my online wellness course at live-healthy.com.
You’ll find me on twitter, facebook, and instagram as @StillmanMD.
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