Nutritionism, orthorexia, and metabolic syndrome as disease du jour

This is the first of what I hope to have as a series of mini-essays on these related topics. If you’ve been following my posts under the Nate Silver tag I’ve certainly been obsessed with weight loss and eating and simultaneously very skeptical of most, if not all, of the nutrition information. I happened to see Michael Pollan on Colbert which triggered a new source of my thoughts based on reading some of his books/articles, specifically In Defense of Food. Nutritionism and orthorexia are two concepts Pollan expands that match, at least partially, the thoughts I’ve been having.

I’ll start by answering why I’m obsessing about these topics. All the posts about my own weight loss activity were not directly triggered by orthorexia, but my own “scare” with obesity and “disease”. I was mildly obese and had been for some time. I’d managed reasonable weight control when I lived in California and could get plenty of outdoor exercise but once I moved to this less favorable clime I became more of a couch potato and definitely advanced to the low end of the obesity scale. With my recent semi-fanatical weight loss program I’ve moved out of the obese definition and almost am even out of the overweight category.

I didn’t finally begin to address my condition out of vanity or shame or some general sense that losing weight would be a good thing (which I knew but didn’t respond to). Nor was this due to it being easier, now that I’m retired to focus on the problem, both having the time for intensive exercise and the circumstances (not traveling) to better control my diet. No, it was triggered, as is often the case, by a health scare, a blood test in my annual checkup. A decade ago when my cholesterol levels and blood pressure were found to be mildly elevated my doctor gave me a choice: meds or lifestyle changes. At the time I knew addressing lifestyle changes wouldn’t work as I’ve done that before (for instance, when I spent two years training for a triathlon) and knew I needed to have complete focus to be successful at weight control, something I couldn’t do while simultaneously living the Silicon Valley intense working lifestyle. So I took the easy way (and technofix), meds, and they worked.

But this time, with a new out-of-range blood test, the recommended med (metformin) looked very unattractive to me (in general I think meds are a bandaid and addressing the underlying issues is a better approach). So given my life circumstances had changed and thus lifestyle change focus was possible that is the route I took. Naturally with my focus on fitness I took the time to “study” (in a soft sense) as much as I could about nutrition and its relationship with “disease”. Being fully capable of reading real science articles, plus being a believer in sound evidence-based science, I quickly concluded most of the nutrition information is, if not wrong, or, at least not based on science. Plus quickly one learns there is a strong element of attitude, even politics in most “advice”. Being fat is considered a moral lapse and so in a modern Calvinist way the nutrition scolds have declared nutrients (and, of course, corporate interests) the villain, the same way the stern religious types have declared war on sex.

Pollan sums up much of this attitude in his ideas, in particular:

We are becoming a nation of orthorexics: people with an unhealthy obsession with healthy eating.

and

Maybe it’s time we confronted the American paradox: a notably unhealthy population preoccupied with nutrition and diet and the idea of eating healthily.

At the same time I’ve been obsessed with food in another way, from the culinary aspect. I love to cook and do a reasonably good job of it. In all my copious free time to be reading I stumbled onto the latest rage in cuisine, that of the “scientific” approach, as partly exemplified by America’s Test Kitchen (my new favorite TV show and books) and also Molecular Gastronomy and such books as What Einstein Told His Cook.

So this puts me in a strange position, simultaneously wanting to do lots of cooking of tasty, but fattening foods, with these new techniques and needing to severely reduce my caloric intake to accomplish weight loss, truly a bipolar frame of mind. It is in this context that my ideas have been forming.

Perhaps Peter Reinhart’s Whole Grain Breads represents this spread. Whole grains are one of those icons of the nutrition freaks. Somehow anything white (i.e. white flour) is evil even though whole wheat flour (magically good) is just 90% white flour. It’s not additives or even substances in white flour, it’s what has been removed. But Reinhart’s approach is mostly aimed at the culinary side, how to make bread that tastes better. The migration of bread from its wonderful “primitive” state to WonderBread (tasteless factory food and bad for you) is something the artisan baking world (and me) is attempting to reverse. But it is almost coincidence that the use of whole grains (to improve taste and pleasure of eating bread) overlaps with the nutrition scolds since their ideas are silly and Reinhart’s ideas (better tasting bread) are solid.

So closing this introductory essay I want to comment on the trigger that got me going on the weight loss: diabetes (specifically type 2) and more broadly metabolic syndrome. Even though I recently contributed to the American Diabetes Association (triggered by my chance meeting with Sterling Cleveland, a really cool guy walking across America to raise money for it) I actually don’t believe “diabetes” (at least type 2) really is a “disease”. Now, note I’m not saying people (like me) don’t have elevated blood glucose. And I’m not saying that isn’t a bad thing (it is). What I’m saying is this is just a “disease” defined only by a particular bit of blood chemistry. Diabetes (and the alleged, (not proven) connection to obesity is the disease du jour (fad) and as such is way over-hyped. Medical researchers and even more so research scientists resist these labels. In the same way that “heart disease” and “cancer” don’t really exist (too vague, the actual conditions are more complex and subtle and specific). What is happening is that people are taking many complex and individual conditions and lumping them together and putting a label on them. The worst of this is the non-existent “metabolic syndrome” which is way too large an over-generalization and therefore totally useless as something to base action on.

And all this ties back to Nate Silver, with his emphasis on the ideas of causation, correlation, and association, in looking at real data. What the hoard of studies have done is show that people who have specific health issues, mostly older people (like me), have these issues in clusters (hyperlipidemia, hypertension, and hyperglycemia) and then they jump to the conclusion (unjustified by facts) there is a connection (metabolic syndrome) and then jump to the even less justified conclusion these are tied to obesity which is then tied to food. I think this is a poor understanding of the science, but more importantly just an attitude (mostly leftie) that is hostile to the “western diet” (if there really were such a thing) or in short being hostile to corporate food. Now corporate food lobby provides lots of opportunity for criticism, but McDonalds is NOT the cause of my health issues, any more than the cigarette companies were when I smoked. What the lefties are doing is blaming someone else rather than themselves. Yes, fast food companies and cigarette companies are pushers, but I’m the one who chose my addictions. We are weak (actually programmed that way by evolution) and do over-indulge. Food, of any type, is not evil (any more than sex is); it’s inappropriate consumption that is.

And to reverse those addictions requires reason and evidence, not political or attitude responses. That’s why I reject so much of the nutrition “establishment” and also the diabetes lobby (and yes, it’s a lobby too, just as much a the beef producers are).

In rejecting diabetes as a “disease” I do not, however, reject the underlying but more complex issues. I do believe hyperglycemia poses a risk to me of neuropathy, in particular degradation of my retinas. And losing my sight would be worse than dying of a nice rapid heart attack. When I first started taking statins I read lots of research articles and concluded that the case against cholesterol as the cause of some particular coronary problems was tenuous; in short, it was an association, not a causation. So were drugs that alter my blood chemistry (which they did) actually providing me any health benefits (I’m alive so many would say yes, I say there is no evidence of benefit since we can’t run the test of a clone of me that didn’t take the drugs) – that was a question the real science didn’t answer, but the popular POV was all to happy to jump to conclusions.

So all this connection of all these “diseases” (a too-vague idea to be useful for addressing “real” health issues) to obesity (mine and other people) and nutrition is, a bridge too far. The facts just aren’t there. So this has just become an attitude (and often a very self-righteous one) and a dogma. I reject all dogma and in this area there is plenty to go around. But, at the same time, excess body fat isn’t good. Evolution programmed us to seek high calorie foods, which was fine when they were scarce, so there is a connection to modern technology, basically making too much and too many high calorie foods easily available.

So closing the circle while I’m intrigued about reading Pollan’s ideas, especially about nutritionism and orthorexia (a new term for me, but one that totally fits the inchoate ideas I’d had about this area) I also know I’ll mostly disagree with him since after denouncing nutritionism and fad diets and such, he, of course, proceeds to come up with his own (this seems to be something all these writers do, denounce everyone else’s ideas as fads while simultaneously claiming they’re the one seer of truth – a little too close to the way religion works for me not to reject all of them).

My obsession with the statistics and Nate Silver is my peculiar and techie way of addressing the practical issues of weight loss. Anyone can loss weight using any combination of diet and exercise. The specifics don’t matter. All the “advice” is just opinion. It is simple, you must consume less calories than you burn – less food, more exercise (what you eat for breakfast and when is irrelevant). Any program that results in a net daily calorie deficit will cause weight loss. BUT, while we (and me, specifically) are good at loss, we’re terrible at keeping it off. Our bodies have a conspiracy against our willpower and as willpower subsides the body’s desires prevail.

This time in my life I not only intend to lose weight but to never regain it. And for me that means science – lots of measurement (and understanding that measurement, how many dieters have obsessed over how scales work as much as I have) and constant monitoring and developing critical metrics that allow me to correct for my inevitable backslides (as my recent vacation was) immediately.

So weight loss is simple: eat less, exercise more and accurately measure.

And so is weight maintenance: detect real gains (not the very high noise hiding the signal) and respond immediately.

So as I read Pollan (while grinding away on my exercise machines) I’m going to use that as focus to further elaborate these ideas.

About dmill96

old fat (but now getting trim and fit) guy, who used to create software in Silicon Valley (almost before it was called that), who used to go backpacking and bicycling and cross-country skiing and now geodashes, drives AWD in Wyoming, takes pictures, and writes long blog posts and does xizquvjyk.
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