Positive Health Update, Physician Nutrition Education

Bob Crowther (68) highlights further lowered health risk factors during the past twelve months along with quotations from a recent opinion article about nutrition in The Journal of the American Medical Association (JAMA).

Encouraging Health Status From Lifestyle Choices

Senior Yoga Mobility
In
Hanumanasana

2013 
Making Progress 
In
Upright Forward Split

Demonstrating
Whole Body Range Of Motions, Limitations
Of
Muscles, Joints, Connective Tissues

 Seeking 
to
Improve
 Extending Legs Forward & Backwards
Raising Torso Towards Full Upright Position
 Shoulder Mobility, Having Arms Up Straight 


During 2018 -2019

• This Asana Is Included During Each Evening Yoga Session
• Yoga Blocks Are Used Often To Facilitate My Movements
• Have Been Experiencing Decreasing Lower Back Mobility Limitations 
• Enhancing Pelvic Girdle, Spinal & Shoulder Girdle Muscle Flexibility

Remaining focused on my daily yoga activities during this past year have contributed to the positive health outcomes I share below.

Fourth Annual Meeting With Dr. Jarrod Faucher
(Geriatric Specialist, St Vincent's Hospital)

[127.7 POUNDS]

Since March (2016), after reviewing my first blood and urine assay data in approximately 9 years, I significantly modified daily nutrition habits and made better and more informed food selection decisions.

As a consequence, both 2017 and 2018 lab assay data reflected improved health outcomes from the daily lifestyle choices I made.

My 2019 April 26th conversation with Dr. Faucher provided an opportunity to inquire about various evaluation numbers including data from four assays of blood samples after fasting 15+ hours (a urine sample analysis was not deemed necessary). 

MY FOCUS

This past year I remained relatively healthy, free of any illness, and only began experiencing nasal congestion during the two weeks before our meeting.

I was able to further enhance various health indicator values realized during the past two years without taking any prescribed medications, vitamins or supplements from: 

[1] two a day (morning, evening) yoga sessions in my condo

[2] adding hiking to my yoga, walking as physical activities of choice

[3] preparing most meals at home from nutrient-rich, high quality food sources to obtain proteins, carbohydrates and fats

 CONSEQUENCES OF ADDRESSING
 POSSIBLE
 HEALTH RISK FACTORS:

• Maintained Weight in 120's  
• Lowered Heart Rate, Maintained High Blood Oxygen Level
• Decreased Systolic Blood Pressure (Best In 4 Years)
• Reduced Triglycerides Value 
• Lowered LDL Cholesterol, Increased HDL Cholesterol
• Improved Cholesterol/HDL Ratio (Lowest To Date)
• Good Glucose, Electrolyte (sodium, potassium, chloride) Values
• Likely Enhanced Immune Protection  
• Limited Dupuytren's Contracture Mobility Impairment

By:

• Eating real food, restricting consumption of processed sugars in various forms and moving my body (yoga, hiking)
• Consuming mostly plants (vegetables, fruits, grains, seeds, legumes, spices, herbs), some seafood, occasional dairy and meat
• Limiting daily salt intake, drinking water at each meal & throughout the day
• Daily preparing own food, consuming small portions at each meal
• Monitoring weight daily, keeping (incomplete) food logs
• Receiving flu, pneumonia, recombinant shingle vaccines
• Having regular dental cleanings, good daily dental hygiene practices
• Stretching palms each day multiple times

I intentionally ate more during the past twelve months yet maintained a desired weight range to enable more challenging yoga whole body mobility. 

For several years I have commented on various nutrition topics - sharing information from various sources (personal, articles and books) - most recently in January, February and March. 

These posts may have influenced my friend Arno Tilles, MD to share a link to a published report on medical nutrition education in the April 9, 2019 issue of JAMA.
[My conversations with Arno on yoga fitness, nutrition, overall health and wellness topics over many years have been appreciated, valued.]

I have cited some of the author's words for your consideration.

TITLE
Nutrition Education In Medical School, Residency Training, and Practice
by
Stephen Devries, MD 
Walter Willett, MD
 Robert O. Bonow, MD

FIRST PARAGRAPH

"Nutrition education in medical school is rudimentary, at best, and limited for the duration of graduate medical education for many specialties. Requirements for meaningful nutrition education in all phases of medical training are long overdue."

FOUR REASONS

 Why Nutrition Education Deserves Special Attention:

[1]

"A 2018 report by the US Burden of Disease Collaborators identified poor-quality diet as the leading cause of death in the United States. The prevalence and cost of diet related diseases are predicted to climb if left unchecked."

[2]

"There is a renewed interest in a shift in health care from disease management to health promotion and prevention, areas that physicians will find difficult to adequately advance without a solid foundation in clinical nutrition.

[3]

"Patients are barraged by information on diet and health from the media, and physicians need to be knowledgeable in this area to help patients interpret and act on the confusing, and often contradictory, nutrition messages in the public domain." 

[4]

"There is increasing attention on the wellness and self-care of residents and fellows. Lessons learned by physicians-in-training about clinical nutrition might not only serve to improve patient health, but also have the potential to enhance physician self-care through greater awareness and knowledge of the dietary influences on well-being. This knowledge in turn can help make physicians more effective counselors."

SOME OBSERVATIONS

'Beginning with medical school, the time devoted to nutrition is limited, with an average of 19 total hours over 4 years, and is focused largely on biochemistry and vitamin deficiency states. ... Following medical school, nutrition education during the 3 or more years of graduate medical education is minimal or, more typically, absent."

" ... both residency and fellowship training ... lack a requirement for physician-in-training to learn about nutrition or diet. Similarly, requirements for nutrition education are lacking in speciality training programs

AND

The authors make a case that " ... guiding patients to make dietary changes is a team effort and can include appropriately trained dietitians, nutritionists, nurses, health coaches, and chefs. ... currently, most physicians do not have enough education in nutrition to contribute meaningfully to that team."

"Problems related to poor-quality diet and obesity are the result of many complex personal and societal factors that extend far beyond the the influence of physicians and hospitals. But physician visits are ideal opportunities to reinforce the message that attention to nutrition and lifestyle are critically necessary for optimal health and that medications alone, however important, will rarely be sufficient. Importantly, adequately trained physicians also may be stronger and better-prepared advocates for public policy that addresses the underlying causes of poor nutrition and food insecurity."

SUGGESTIONS
[1]

"The most useful approach to including meaningful nutrition education into all phases of medical training is not to consider nutrition a new unit in curriculum but, rather, to integrate concepts related to nutrition within the existing content. In this way nutrition can be more appropriately understood as a vital, practical determinant of health rather than an isolated discipline." 

[2]

"Physicians and health care organizations can collectively begin to emphasize their seriousness about nutrition in health care by practicing what they (theoretically) preach ... At minimum, a consensus to align food served in medical training programs and conferences with the Dietary Guidelines for Americans would be a welcomed approach."

LAST PARAGRAPH

"An emphasis on nutrition is not only good medicine, but is also becoming sound economics. As new value-based models for payment of medical services take hold, financial incentives in medicine will increasingly align with prevention-oriented services, and among them should be a greater focus on nutrition."

FUTURE WELLNESS ROADMAP

Daily lifestyle choices made these past years as a senior will continue during 2019 into 2020 and undoubtedly contribute to the relatively good health, mobility I now enjoy.

Share your reactions to my comments. 

#BobCrowther #Nutrition #Yoga

Yoga, Nutrition: Evaluating Fast Foods

Bob Crowther (68) cites multiple sources about a recent study led by Megan A. McCordy focusing on fast food variety, portion size, dietary energy and micronutrients including sodium of entrees, desserts and sides over 30 years.

MAINTAINING A LEAN BODY EATING REAL FOOD

Enhancing Spinal Mobility

Full Lotus Variation
The Yoga Loft
 (2017)
PHOTO BY PATTY TREMBLAY

Demonstrating

Joint Mobility

&

Supple Lower Body Muscles 
With
Limited Spinal, Back Range Of Motions 

My ongoing lifestyle focus emphasizing both yoga mobility and nutrition have led to positive health outcomes as I continue to age - celebrating today my 68th birthday.

Maintaining a lean body as a senior has been facilitated by making better, more informed daily food choices than during past decades (in my 20's, 30's and 40's.)

Weight loss in preparation for reconstructive thoracic surgery enhancing my breathing at 50 in 2001 was maintained afterwards - in part by changing poor eating habits. 

Decreasing consumption of fast foods including drinks with high concentrations of sugar was one significant behavioral change I made. 

I recall lowering various health risk factors by changing my nutrition in the years following my surgery and before my introduction to Ray Hoyt and the hatha yoga classes he taught in Webster & Dudley, MA.

History Of Fast Foods

Fast Food Nation

Eric Schlosser

The public was introduced to the negative health impact, consequences of the fast food industry in Eric Schlosser's book (Fast Food Nation) first published in 2001, again with Afterword in 2012. 

Two years later Micheal Moss published Salt Sugar Fat - providing details behind the CEO decisions, science and branding of processed foods by the Big Food Industries.

2014 Publication

Despite these publications and disclosures, fast food companies have thrived as the rise in obesity and diabetes throughout the US has continued. 

An
 UPDATE ON FAST FOODS 
[LESS HEALTHY TODAY]

In my February, 2019 post I shared some highlights of THE TRUTH ABOUT FOOD by David Katz - including his perceptions of an ideal nutrition, his warnings about the ongoing lies perpetuated by Big Food including their Fast Food selections.

Given this history, I was not surprised reading the New York Times article by Tiffany Hsu with the title: Bigger, Saltier, Heavier: Fast Food Since 1986 in 3 Simple Charts - one of many brief publications citing data from a February, 2019 study published in Journal of the Academy of Nutrition and Dietetics.

Hsu and other reporters named below* share some details of the study led by Megan A. McCrory and health science colleagues (Allen G. Harbaugh, Sarah Appeadu and Susan B. Roberts) affiliated with Boston University and Tufts University.

ARTICLE TITLE

Fast-Food Offerings in the United States in 1986, 1991, and 2016 Show Large Increases In Food Variety, Portion Size, Dietary Energy, and Selected Micronutrients

BACKGROUND 

The average amount of total daily calories from fast food increased from 4% (1977-1978) to 11% (2007-2010)

10 FAST FOOD Chain Menus Examined

• Arby's, Burger King, Carl's Jr.
• Dairy Queen, Hardee's
• Jack in the Box, KFC
• Long John Silver's, MacDonald's, Wendy's

SOURCE OF DATA OVER 30 YEARS

[1] Data were obtained from the Fast Food Guide in 1986 and 1991 and from online sources in 2016.

[2] Authors examined 1,787 entrees, side dishes and desserts from the 10 chains.

[3] During this time, there was a 226% increase in the variety of items in these three categories - approximately 23 new items per year. 

ENTREES ... increase in:

• portion size: 13 grams/decade (39 grams)
• energy (kcalories): 30/decade (90)
• sodium: 4.6 percent daily value/decade (approximately 14%), up from 27.8% to 41.6%
• calcium: 1.2% DV/decade

DESSERTS ... increase in:

• portion size: 24 grams/decade (71 grams) 
• energy (kcalories): 62/decade (186)
• sodium: 3.6% DV/decade
• calcium: 3.9% DV/decade
• iron: 1.4% DV/decade

       [4 of the ten restaurants had increased calcium and iron]

SIDES (like chips, soups, French fries)

• relatively stable portion size
• energy (kcalories): ~14/decade increase (42)
• sodium: increase from 11.6% to 23.6% of recommended DV

STUDY CONCLUSIONS FROM ABSTRACT

"These results demonstrate broadly detrimental changes in fast-food restaurant offerings over a 30-year span including increasing variety, portion size, energy and sodium content."

"Research is needed to identify effective strategies that may help consumers reduce energy intake from fast-food restaurants as part of measures to improve dietary-related health issues in the United States." 

Additional Information

FAST FOOD Consumers:

• On any given day, approximately 37% American adults under the age of 20 and 45% young adults (20-39) (Josh White)

• Consumption of an average entree and side was near 40% of a 2,000 calorie daily diet (average of 767 calories). (Jeff Gelski)
• Adding a caloric beverage increased this percentage to 45-50%.

• Most of the new menu items over the years have tended to be less healthy than the regular items (David Disalvo)

AND

. About 40% of American adults (50 - 74) through 2015 to 2016 are obese - up from 13% in 1960 to 1962 and 23% in 1988 to 1994. (Gary Stern) 

. The "frequency of eating away from home is positively associated with increased risk from chronic health conditions like hypertension, obesity and insulin resistance." (Gary Stern)

. Obesity is now the second leading risk factor for disability in the United States (Susan Perry)

Selected McCrory Responses
 to
 Questions From Gary Stern
[I have edited wording of some questions] 

[1] Why are fast-food items getting larger? -" ... It's a bargain, and you get a lot of food for a relatively small amount of money. ... Perhaps the healthy food demand hasn't gotten big enough for the fast food restaurant to respond to."

[2] Why listing of food calories isn't having more impact? - "It is having a small impact. There was one study ... that compared changes in calories from 2008 to 2015 ... there was a decrease if about 9 calories ... The problem is that nine calories is not enough."

[3] Why is menu labelling having minimal impact? - "There are many possible reasons: 1)People look at the numbers and don't know what that means, 2)People may ignore numbers, 3)They are having some impact since most of these restaurants offer salads."

[4] What's the effect of increasing sodium and calcium levels of fast food items? - "It varies by individual, but for a lot of people, high sodium contributes to high blood pressure, which puts people at risk of strokes and dying. Stroke is one of the top 10 causes of death in the U.S. and high blood pressure contributes to stroke and heart disease."

[5] Target audience who dines out at fast food chains? - "I'd say for the most past, the audience consists of many college students, lower-income people, and people who are on the run and just like the food"

[6] What recommendations for people who dine at fast food chains? - " ... try ordering the next size down ... if they go with a friend, try splitting an order of french fries ..."

[7] Why aren't salad, vegetarian dishes or plant-based burgers more popular? - "I think in general people don't go to fast food for healthy stuff. One main reason they choose to eat what they eat is it tastes good ..."

[8] Have fast-food eateries offered right to order half or one-third portions at one half the price? - "Usually when they offer smaller portions, its more expensive. When they offer smaller portions, it must be the same bargain for the customers." 

[9] Is there anything the study didn't cover? - to paraphrase: the study did not examine combo meals, it focused on individual menu items

McCrory QUOTES

"Given the popularity of fast food, our study highlights one of the changes in our food environment that is likely part of the reason for the increase in obesity and related chronic conditions over the past several decades, which are now among the main causes of death in the U.S."  (David DiSilvo, Tara Law, John White)

"Despite the vast number of choices offered at fast-food restaurants, some of which are healthier than others, the calories, portion sizes, and sodium content overall have worsened (increased) over time and remain high." (David DiSilvo)

"We need to find better ways to help people consume fewer calories and sodium at fast food restaurants." (Susan Perry)

"We would like to see more changes, such as restaurants offering smaller portion at proportional prices." (Susan Perry)

The investigators "hope their study will bring greater awareness about the health risks associated with frequent consumption of fast foods." 

MY TAKEAWAY

This report by McCrory and colleagues further reinforces my daily decisions these past years to prepare meals at home: eating real food, mostly plants, without the excess levels of salt, sugar and fat found in the heavily processed fast food selections.

*Sources & Affiliation: Jeff Gelski (Food Business News), David DiSalvo (Forbes), Susan Perry (MinnPost), Chase Purdy (Qurtz), Tauren Dyon (UPI), John White (Kotatv, Gray News), Dennis Thompson (HealthDay), Tiffany Hsu (NYT), Gary Stern (Food & Drink), Tara Law (Time)

Do share your thoughts with me.

FUTURE FOCUS

I anticipate providing an update on my health status after meeting in late April with my Geriatric Specialist.

#Bob Crowther #Nutrition #Yoga

Yoga, Nutrition & "THE TRUTH ABOUT FOOD"

Bob Crowther (67) attributes current yoga mobility to daily nutrition choices made, notes the influence of Michael Pollan among other authors writing, speaking about food and shares topics presented in the David Katz book, THE TRUTH ABOUT FOOD. 

BETTER MOBILITY WITH GOOD NUTRITION

Variation Of  "Spiderman"
In
 THE YOGA LOFT
PHOTO BY PATTY TREMBLAY

 Effective Asana To Prepare For Other Movements
(Upavistha, Compass Pose, Forwards Splits)

 Demonstrating
Whole Body Joint Mobility
&
Lengthening 
Of Muscle and Connective Tissues 

Limitations
 Raising Torso to Upright Position

ACKNOWLEDGING
 YOGA & NUTRITION CONTRIBUTIONS OF RAY HOYT 

MY CURRENT
&
STILL EVOLVING NUTRITION CHOICES 
Mostly Organic Selections

Meals I have prepared daily during the past two months have included the following ingredients among others in various combinations, at times enjoyed raw or heated with olive and avocado oils:

• Broccoli, brussel sprouts, dried and frozen mushroom species, leek, onion, red & yellow peppers, green and yellow beans, rainbow carrots, avocado, sauerkraut, squash (butternut, yellow), baby zucchini, cherry tomatoes

• Blueberries, raspberries, blackberries, apple varieties, goji berries, medjool dates, pitted dates

• Grains have been eaten in different forms: as Ezekiel cereal, different compositions of granola, muesli, grain and seed blends

•  Lentils, and over ten types of beans including black, adzuki plus occasional thin bread slices (quinoa  organic amaranth + quinoa, protein) 

• Mixed raw nuts (almonds, brazil nuts, cashews, hazel nuts, pecans, peanuts, walnuts), seeds (chia, flax, hemp, pepitas, sunflower) along with cocoa nibs, at times dark chocolate with high cocoa content ... also have eaten natural peanut butter at times

• Spices including basil, ground cinnamon, ground ginger, oregano, parsley, rosemary, rubbed sage, thyme leaves, ground turmeric

• Dairy consumption was limited to an organic egg at one time, infrequent addition of some cheese (teaspoon) to a meal of mixed vegetables

• Wild salmon (teaspoons at one time), sardines and frozen sea scallops along with vegetables

• The limited, infrequent meat consumed - usually only one or two teaspoons added to vegetables - have included grass fed bison, organic chicken, turkey preparations 

• Water, coffee and/or tea with no added sugar, dairy were enjoyed with my meals; one bottle of Kombucha but no wine, beer or hard alcohols  ... infrequent drinks (chocolate mocha) or a pastry were available at the Booklovers Gourmet in Webster, MA

My food selections reflect the influence by the journalist, author Micheal Pollan from reading his informative books including The Omnivore's Dilemma, Cooked, In Defense OF Food. 

FOOD RULES (Michael Pollan, 2009)
Eat Real Food, Mostly Plants, In Small Amounts

CONCISE
64 GUIDELINES
A GEM!

Michael Pollan has enlightened the public on food, nutrition topics over decades through his books, diverse articles including the microbiome and many interviews.

Authors also informing my food choices:

• Investigative reporting by Michael Moss that led to the publication of Salt Sugar Fat (2014)

• Mark Hyman's clinical experiences with nutrition for 35 years contributed to the value of his 2018 book: FOOD WHAT HECK SHOULD I EAT?  This informative, accessible resource is reader-friendly: a well organized presentation about our different food categories, providing useful consumer guidelines, available healthy options. 

This author, book was introduced in my March 28, 2018 yoga blog.

Hyman identified what we know, what we do not know about 12 different food categories - noting health & safety considerations, presenting useful options for public consideration.

Having been educated further on making more informed, healthy food choices by Pollan, Moss, Hyman and other authors over many years, it was encouraging to have the opportunity to read David L. Katz writing about known food truths and identifying perceived lies, seeking in his words "the whole truth".

I mentioned Dr. Katz, his most recent book in my January 28, 2019 post - the author being a subject of conversation with a friend attending a Primary Care Physician Convention in Boston.

THE TRUTH ABOUT FOOD
Why pandas eat bamboo, and people get bamboozled

I have highlighted various sources (his education & research, interactions with colleagues and vast publications from many authors with diverse backgrounds) that collectively have influenced the author's perspectives about the distortions, misrepresentations, fallacies, lies and a/the truth re: food, nutrition and related subjects he writes about - at times quoting at length his own words. 

My approach in expanding on the original TABLE OF CONTENTS was deemed necessary (1) to better identify, communicate the diverse, interesting and informative topics included in a book of 752 pages lacking an INDEX. 

EMPHASIS  OF BOOK  (691)

"The particular emphasis of this book is mostly on the truths that directly address the scourges of chronic disease and premature death in developed countries that have good choices but routinely make bad ones"

Katz continues: Calling the book "the truth about food relevant to the burdens of chronic disease and premature death in developed countries that have good choices but routinely make bad ones" seemed rather inelegant to both me, and my publisher. So, "the truth about food" is a proxy for that."

" ... the whole truth about food is a global truth, spanning deficiency and excess, choices and choicelessness."

ABOUT THE AUTHOR
Notable Selections:

• MD from Albert Einstein College Of Medicine (1988)
• MPH from the Yale University of Public Health (1993)
• Residency training in Internal Medicine, Preventive Medicine/Public Health
• Founding Director of Yale-Griffin Prevention Research Center
• Author of 15 books, ~ 200 articles, Textbook Chapters including Nutrition In Clinical Practice, 3rd Edition
• Radio, TV Appearances, Accomplished Conference Speaker
• Founder/President of the TrueHealthInitiative

Research Approach (578)

Katz has: "(1) relied on good, unbiased methods to defend against the biases of researchers alike;

(2) always required that funders defer study management and interpretation entirely to the research team;

(3) always required the right to publish the results, whether favorable to the funder or not; and

(4) limited our studies to those of genuine interest to us for reasons we could express and defend clearly."


 Sources Of Funding (578)

Katz has received financial support from "federal agencies, not-for-profit foundations, and industry"

"We- the researchers- and the funders, too, have been "biased" every time. We have never run a study without caring about the outcome, and wanting a particular outcome is bias."

Katz on "What Science is for" (579 - 580)

"Science is where knowledge extends, not where it begins."

"Science is a method, a set of tools, and the most powerful we know, for answering hard questions that do not yield to casual observation and common experience." 

"Science for all its marvels, depends on sense" ... "the global consensus of experts ... rely on" [science and sense]

Katz cites Tom Nichols multiple times (73, 86, 95, 476) emphasizing the importance of expertise when addressing nutrition, food topics

The author notes "that most physicians are still very, poorly trained in nutrition. But The 'MD' after one's name tends to convince others, and maybe even one's self, that you are an expert in all matters of health. ... doctors with no expertise in nutrition are all too often willing to offer expert opinion."

The author acknowledges (598): 

"Sure, experts can be wrong. And, it's even possible that the global consensus of experts can be wrong, although that's relatively rare in science. And it might even be possible for experts to be "all wrong," although that's vanishingly unlikely, since it's hard to become an expert without actually knowing something, and experts, in general, allow for uncertainty every step of the way."

What Katz Eats (108 -109)

 "... I am not a "vegan" per se. My diet is vegan on many days, and it is made up of wholesome, whole plant foods- vegetables, fruits, whole grains, beans, lentils, nuts, seeds and plain water ... I do not eat mammals at all ... I do ... include some animal foods in my diet.

My wife's *French Mediterranean-inspired cuisine ... makes selective use of cheese, and an occasional use of plain yogurt ... I eat a bit of both ... [cheese consumption has] shifted from bovine sources to goat and sheep in deference to the environmental and ethical issues in the mix.

I eat poultry rarely and reluctantly. ... it is locally sourced, organic, and the birds lived in a free-ranging, cage-free life. Eggs occupy a small place in my diet ... selection to free-roaming, cage-free, well treated, local birds.

... I eat less fish than I used to ... we are very careful about sustainable sourcing. I eat seafood ... careful about the sourcing ...

So, I am not a vegan. But all my sympathies are."

* See pp. 701 - 703  + RECIPES (706 -735) 

NOTE: The author provides brief comments, variations of what to eat in different sections of the book (15, 314, 330 - 331, 360, 442, 678)

Author's Ideal Nutrition
(679 -680)

Katz expands on Micheal Pollan "food, not too much, mostly plants" and offers what seems to him "a quite good, working definition of "best diet for health"":

"dietary patterns associated with the best health outcomes ... are variations on a common theme, ranging from quite low to quite high in total fat, and from moderately low to quite high in carbohydrate, and across a narrower range in total protein ...

 ... always sharing an emphasis on whole, wholesome, minimally processed vegetables, fruits, legumes, whole grains, nuts and seeds with plain water as the preferential answer to thirst-combined in balanced, sensible variety in patterns that are often time-honored and informed by heritage and cultural practices, such as traditional Mediterranean and traditional Asian diets. 

Such diets may or may not include dairy, fish, seafood, poultry, meat and/or eggs- but when these are included, they make up a modest portion of the diet in the aggregate ... tend to be minimally processed, and obtained from animals ... fed a native diet of wholesome plant foods and provided plentiful space for exercise."

Such diets often leave room ... for wine and chocolate, in moderation ... healthful beverages ... tea ... coffee ... but exclude, mostly or entirely, all hyper-processed foods and beverages ... sodas, sports drinks ..."

Other Factors
 Informing Author's Nutrition Viewpoints
(Longevity, Environment, Doubt)

Longevity Related To Nutrition (659)

THE BLUE ZONES

Katz (659):

"We have the real-world evidence of the Blue Zones populations telling us that the longest-lived, healthiest populations  on the planet all consume whole grains routinely. Whole grains figure prominently in variation of the Mediterranean diets, Asian Diets and vegetarian diets."

Dr. Steve Osofsky (682)

Katz: "I was doing all I could to extend the lives of the very creatures busily destroying the planet"

Katz: a part of his standard email signature as of November, 2016 (681)

"As I learn ever more from environmental experts, I find that our debates about diet for human health are apt to become moot very soon. The impact of our prevailing diets on the planet is fast becoming the only thing that really matters. There will be no point in debating diet for human health on a planet no longer hospitable to human habitation- and we ae blithely, and blindly, blundering in that very direction."

Bertrand Russel Quote (13, 670)

"The whole problem with the world is that foods and fanatics are always so certain of themselves, and wiser people so full of doubts."

Katz: "In the company of the wisest, the most thoughtful, most expert and knowledgeable people I know- I have many legitimate doubts about about many details of nutrition."

See

 Marion Nestle (Food Politics)

FDA 

Has Been Compromised Since Inception

[Public vs. Business vs. Political Interests]

FORWARD  (3-10)
Mark Bittman Comments (3 - 4)

NOTE
The Twelve Truths Of Diet (5)

The Five Attributes of Reliable Truths (6)

The Five Warning Signs Of Insidious Lies (7)

Face of Truth, Mask Of Lies? (8)
See 10 Comparisons

TABLE OF CONTENTS (9)

PROLOGUE: SIMPLE, JUST NOT EASY (11- 28)
Katz Quotations

" ... this is NOT a "how to" book ... there is no value in knowing "how to" if you do not know "what to." (11 - 12) ... "We must know how we know it. We must know why we know it ... to deny alternatives to it." (21-22)

"The truth about food is stunningly simple. It's the lies that are complicated." (12)

"Humans knew perfectly well what to eat since long before anyone devised ANY dietary intake assessment, let alone a placebo-controlled, double-blind RCT." (24)

"Lies, damned lies and statistics paint over the truth until it is hidden from view." (27)

"My intent here is to point out what is obvious at the level of sense, and then confirm it with science. The truth about food is on trial. You be the judge." (27)

Part 1: Lies  (29-35)

Chapter 1: Lies (37-245)

Citing Comments Of Author's Plan (40)

[1] ... I will provide what I hope is a reasonably complete inventory of the kinds of lies you are likely to encounter

[2] Then, I will explain each in general terms, and illustrate each with real world examples

[3] It is possible to offer a counter-claim to a falsehood that is, in turn, another falsehood. 

Logic, however, applied correctly, leads always to reliable and generalizable conclusions.

Katz prepared "A catalogue of common and important lies (and fallacies) about diet" (42)

I Identify The 25 Topics Listed By The Author 
Read Katz Example and Reality Check, Additional Comments 

About Time
(43 - 49)
[There is substantial uncertainty about the effects of essentially all foods and/or dietary patterns on health and weight]

Absence of Evidence Equals Evidence of Absence
(50 - 56)
[We can say something is false because we lack definitive evidence that it is true (or vice versa)]

AWARENESS EQUALS EXPOSURE
(57 - 61)
[News about any given toxic exposure is routinely interpreted as if the exposure is new]

BAD BEDROCK Fallacy
(62 -67)
[A valid argument can begin with a false contention]

CELEBRITY EQUALS EXPERTISE Fallacy
(68 - 73)
[Being famous for anything means being expert in everything (and especially nutrition)]

Doubt About This, Proves That Fallacy
(74 - 80)
[If I can raise doubts about the merits of your case, it proves my case]

EATING BREAKFAST EQUALS EXPERTISE FALLACY
(81 - 87)
[Any kind of experience with food equals nutrition expertise]

False Equivalence Fallacy
(88 - 96)
[All opinions expressed about nutrition are of equal merit]

Katz: 

Critical of Nina Teicholz investigative reporting, position of history re: nutrition studies (83)

See

THE BIG FAT SURPRISE

FOOT ON FIRE Fallacy
(97 - 106)
[Advances in our understanding of nutrition, and in ways to study nutrition, require us to renounce everything we knew before]

Mental Mission Creep- and the Menace of Frenemies
(107 - 117)
[If the case is valid, any argument in support of it can help]


ONE-SIZE-FITS-ALL SCIENCE FALLACY
(118 - 131)
[Writers untrained in nutrition, epidemiology, or research methods are qualified to tell us what nutrition studies mean]

READ
MICHAEL MOSS

Opinion Equals Expertise Fallacy
(132 - 139)
[Any opinion about nutrition is tantamount to expert opinion]
See Nichols: Experts can be wrong, their advice ignored

Katz: 
"The idea that every opinion about nutrition is the same as a genuinely expert opinion is, obviously, nonsense." (134)

"Admittedly, there are differences of opinion among even legitimate experts in nutrition." (135)

Mistaking Part for Whole Fallacy
(140 - 144)
[Whatever effect is attributed to some part of a food reliably tells us about the effects of that food]


Repetition Equals Reliability Fallacy
(145 - 154)
[Hearing some assertion about diet and health often enough is a reliable indicator that is true]

Revisionist History
(155 - 162)
[New, altered versions of history are reliable]
Katz is sensitive on this topic


NOTE
MARION NESTLE
food POLITICS

Conflicts Of Interest Discussed

Ripple-Free Pond Fallacy
(163 - 170)
[The effect of a given nutrient, ingredient, or food on health or weight can be understood independent of context]

SCIENCE OBVIATES SENSE Fallacy
(171 - 191)
[A scientific "answer" is always an inconvenient truth]

Straw Diet Deception
(192 - 197)
[Any diet study reporting that "this' diet beat "that" diet is reliable]

Theory Over Reality Fallacy
(198 - 206)
[A theoretical concern (or claim) may be used to dismiss established effects]

Tiny Parachute Fallacy 
(202 - 213)
[A study that fails to show the benefit of a diet or lifestyle intervention proves that intervention is ineffective]

Too Easy (Quick, Good, etc.) To Be True
(207 - 213)
[Being overweight or unhealthy can all be blamed on the right scapegoat, and fixed with the right silver bullet]

Toxic Telephone
(214 - 227)
[A message can be repeated multiple times and keep its integrity]

Unchanged Mind Equals Chained Mind Fallacy
(228 - 237)
[If you fail to change your mind about nutrition whenever the latest headlines say you should, you are dug in, stuck in the past, and rigid]

What's In A (Diet) Name?
(238 - 245)
[Any given diet study may be interpreted reliably based on what the assigned diets are called]

Cultural Currents and Currencies
(241 - 245)
[Our culture makes sense and is the way things ought to be]

 See
 Michael Pollan
Omnivore's Dilemma

Note
 Pollan's comments (130-131) On Joel Salatin and PolyFace Farms

[Pastoral, Perennial species, Polyculture, Solar energy, Local Market, Diversified, Biological, Local fertility, Chicken Feed]

CHAPTER 2: STATISTICS (246- 282)

The inclusion of this topic by the author is welcomed and significant: statistics is a important tool used by research investigators involved in nutrition studies.

Katz highlights, with examples, how statistics applied to nutrition has been used in positive and negative ways.

  Of Bad Apples, Good Baloney, and Culled Cherries

Bad Apple Fallacy (269 -272)
[If fault can be found with any particular nutrition study on any given topic, it tarnishes all studies] 

Chapter 3: DAMNED LIES (283- 306)

Katz:

 "The worst of all lies are damned lies- the willful deception for the sake of profit and personal gain." (283)

" Of course Big Food lies to us about the harms of big food!" (287)

See comments on BIG Ag, Big Food, Big Media, Big Publishing (288 - 298)

Part 2: TRUTH (307-308)

Chapter 4: The Truth  (309 - 667)

Katz Catalog of Dietary Truths lists 68 +1 topics (311-313)
 None of them appear in TABLE OF CONTENTS  (page 9)

I List The 48 Topics Katz Provides Truth About:
(note some topics are included in others)

For each topic, Katz includes an introductory section - bottom lines, up top-, provides comments and a list of citations by him, others - in some cases, the author suggests Additional Reading of Potential Interest.

Adaptation (317- 324)
author notes biological adaptation of our species

Food Addiction (325 - 332)
"eat wholesome food in sensible arrangement" (331)

Algae (333)
mentions powder from Spirulina as whole food ingredient

Calories (334 -351)
Yes, "Of course they count!" (334- 335)
see Table: activities, calories expended (340 - 341)
note 
comments relationship calories, hormonal responses (344) 
  Insulin comments (345)
missing word, second paragraph (348)

Chocolate (352 - 355)
about cocoa
note benefits with 60% content
antioxidant nutrients (flavonoids), stearic acid 
magnesium, fiber, arginine (nitric oxide precursor 
correct error: see to seen (352)

Cholesterol (356 - 366)
Cites 2015 Dietary Guidelines
optimal (plant based diet) will be low in cholesterol
see comments on Eggs (364)



Coffee (367 - 369)
"concentrated source of antioxidants" 
 "has anti-inflammatory properties"

Cooking Oils (370 - 383)
identifies oils used by 7 individuals (377)
comments on canola oil, olive oil
Note 
Soybean, Coconut, Canola Oil References (382-383)
 Dr. J. Thomas Brenna 
recognized as authority of fatty acids, health effects

The Cost Of Nutritious Food (384 - 391)
 not always more expensive, see comments

Dairy (392 - 412)  
 mentions DASH diet (to lower blood pressure)
 advises against Raw Milk
 seek alternatives to Butter (Olive Oil)

also see (668) comments on Dairy
See 
Mark Hyman book FOOD (76 - 93)

Dieting (413 -420)
encourages Lifestyle Changes

The Environmental Impact of Diet (421 - 425)
 a major concern of the author
notes Miriam Nestle book Soda Politics (423)

Watch DVD

Also
See Consumer Reports 
 on
 Meat Contamination 

October, 2018 Article


Read John Tickell book
 KISS THE GROUND 
for a more inclusive discussion on this topic 

Dietary Fats (427 -448)
note comments on Ancel Keys (428)

see informative omega discussion 
(Omega-3, Omega-6)
Omega-3 fats lower inflammation 

eat nuts and seeds for Omega-3

Saturated Fats
limit highly processed foods of any kind including meat and dairy, fast food to achieve low intake of saturated fats

olives and avocados for monounsaturated fats

Plant (seeds, nuts, algae), Seafood sources
suggests limit 

Katz critical of Nina Teicholz

Fish (449 - 458)
Mentions sustainability, environmental issues
John Robbins' book Food Revolution
See
Mark Hyman FOOD (94 - 110)

FODMAPS (459- 461)
"fermentable oligosaccharides, disaccharides, and polyols"
"are diverse sugars, and sugar-like compound"

Fortification (462 -467)

Fruit (468)
Many benefits, negative (kids junk food)
also see: sugar (625), lectin (510)

Gluten (469 - 476)
Comments on potential risk factors eating grains for some
for most people, grains can be eaten 

Glycemic Measures (Index; Load) (477 - 482)
Distinguishing
Index: food raising blood sugar level
Load: concentration of sugar in food

GMOs (485 - 496)
Katz supports technology used

 Legal, political concerns of others, unintended consequences of this technology are not addressed by Katz

See Marie-Monique Robin for another perspective on GMOs


Junk Food (497 - 501)
see 
 Michael Moss Salt Sugar Fat



Truth about Kid Food (502 - 506)
'Big Food' products unhealthy for children
see composite (20): 2017 new cereal marketing

Kombucha (507)
fermented tea with yeast and bacteria
little scientific evidence of benefits 

Lectins (508 - 512)
not an issue for most people

Another Perspective 
Steven Gundry Book

Macronutrients (513 -540)

Fats (514 - 518)


Proteins (518 - 532)
Plants a source of protein

see 
 comments on sarcopenia in adults (528)
T. Colin Campbell views on protein 
vs.
 Ancel Keys perspectives (529)


Carbohydrates (532 - 535)
Plants are mostly carbohydrate

Note:
diets low, high in total fat and relatively low, high in total carbohydrates can be good, bad or in-between

"All carbs are SO not created equal!"

see North Karelia Project references

See
 Gary Taubes
  Good Calories, Bad Calories 

Meat (541 - 558)
 see comments on Paleo
challenges Paleo assumptions about quality of meat then, now

No alternative, nuanced view on meat, dairy, fish in this section
also see comments on meat (678)

Read
Joel Salatin Book

Alternative Guidelines
To
 "Big Food" Meat Production 

Microbiome (559 - 563)
places emphasis on healthy foods, not microbiome
 note author Hadza tribe in Tanzania perspective

See
British Author
Alanna Collen (10% HUMAN)

HUMAN MICROBIOME PROJECT
I commented on the Collen book in my April 19, 2018 yoga blog
Nutrient Supplements (564 - 569)
eat real food, selective use when required

Nutrigenomics (570 - 575)
a young field of science
evaluating
single nucleotide polymorphisms variations

Nutrition Research (576 - 582)
Katz identifies his research and industry funding sources
yet
the history of nutrition science, studies subject to different interpretations of personalities, politics, industry & government

Nuts (583 - 584) 
include them in meals
rich in
 unsaturated fats, protein, minerals, antioxidants, fiber

Obesity (585 - 587)
read brief comments

Organic Foods (588 - 592)
Organic does not mean nutritious
note health, environmental benefits

Personalized Nutrition (593 - 596)
use common sense

Protein (597)   
also see Macronutrients comments 
replace animal protein with plant protein
protein increases insulin release
excess protein is converted to fat 

Salt/Sodium (598 - 604)
decrease consumption
eat foods in sensible combinations

Soy (605 - 608)
"use as component of a balanced diet"

Sugar Substitutes (Artificial Sweeteners) (609 -620)
see Table Sugar Substitutes (612 -613)

Sugar (621 - 628)
see comments
 on Katz's nutrient profiling system NuVal (623)
rejects sugar is poison, fructose is toxic
beware of stealth sugar
Challenges 2014 meta-analysis (628 -630)

Note
 John Yudkin, Investigator
Contemporary Of Ancel Keys

Superfoods (639 - 640)
misleading branding also see comments (668)

Tea (641 -642)
white, green, black varieties
antioxidant presence varies for each

TMAO = Trimethyamine-N-oxide (643 -644)
associated with
 meat consumption (protein l-carnitine)
eggs (choline found in lecithin)

see Mark Hyman comments in FOOD (64)

Veganism (645 - 652)
Katz cites WHAT THE HEALTH Documentary 
Acknowledges the positive benefits from this diet yet
expresses some caveats, its promotion

Documentary highlights funding conflicts of interest 
(with Big Food, Big Ag, Others)

 Anderson & Kuhn (2017)
Promoting Vegan Nutrition

Katz also  mentions documentary (59)

Water (653 -654)
needs related to
temperature, humidity, activity, body size

Whole Grains (655 - 662)
for most, health benefits from eating them
Note
 David Perlmutter, MD
Perspective 

Wine (663 - 665)
in moderation for pleasure

Other Truths (666)
Google Katz for info on topics of interest

 Recommended Sources About Nutrition Truths (667)

Katz names individuals and sources he follows

True Health Initiative Newsletter
Harvard Health Letter
Center for Science in the Public Interest
WebMD
Tufts University Health & Nutrition Letter
AND
The Vegan RD
Politico's Morning Agriculture
ScienceDaily Nutrition News
ConscienHealth

CHAPTER 5: NOTHING BUT TRUTH  (668-669)

CHAPTER 6: THE WHOLE TRUTH (670 -698)

See Author's Comments On:

The Right Way to Be Wrong About Diet

AND
The Right Way to BE Right About Diet
a thought experiment
Plus Alternative Facts

What we know

How we know it 

The Sad Reality: Knowledge Isn't Power

Holes in The Whole truth: Leaving Room for The Unknown
See comments about T. Colin Campbell, The China Study

The Whole Truth: of Science, Sense, and Solidarity

The whole truth: 

is the child of not just science, but also sense

the whole truth is modest, and allows for doubt

EPILOGUE: FREEDOM!

FROM THEORY TO PRACTICE, AND BEYOND ... (699-705)

If I ran the zoo

From theory to practice ...

RECIPES (706-749)
Author's wife "provides a sampling recipes from Cuisinicity"  

Summative Bibliography
Recommended Sources
[I have added page citations by Katz in this book of some authors listed below] 

• David A. Kessler (12), James Hamblin (3, 96, 106, 191, 512, 556, 694, 696), Mark Bittman (3-4, 366, 411), Michael Moss (28, 67, 162, 189, 245, 348, 351, 398, 409, 501, 619, 634), Michael Pollan (169, 390, 467, 530, 539, 562, 604, 694), Monica Reinagel (71), Stephan Guyenet, Yoni Freedhoff
• Berkeley Wellness, Blue Zones (79, 95, 106, 144, 190, 206, 240, 381, 456, 494, 539, 540, 555, 608, 636, 651, 661, 693), Center for Science in the Public Interest, Cuisinicity (2, 109, 375, 705), EAT Forum, Eat Drink and Be Healthy, Food Revolution Network, FoodTank, Harvard Health Letter, Oldways, The True Health Initiative

PLUS

Noteworthy Scientific Articles (737 - 749)

CONCLUSION (751- 752)

"There are various foods that might be good for us, but bad for that of the planet - such as fish from depleted fisheries, seafood from denuded oceans, and game animals from the world's vanishing wild places."

THOUGHTS

On 

THE TRUTH ABOUT FOOD

The author has exposed both lies and identified truths on a wide range of food, nutrition topics - providing informed perspectives and a wealth of resources to consult: from individuals, organizations and publications.

 The two chapters on STATISTICS and DAMNED LIES were accessible through examples cited by the author - effectively communicating information to better understand the ways food and nutrition information can be obscured, manipulated  

 Recommending KATZ Book, Sharing Some Perspectives

• A more expansive, inclusive alternative to the TABLE OF CONTENTS as presented on page 9 would have been appropriate. As written, it does little to identify the topics under consideration and it detracts from the authors presumed goal of both communicating and accessing information clearly, easily - this was not my experience 

• Likewise, the absence of an INDEX was inexplicable and diminished the book being easily consulted as a future resource - I used over 120 yellow Post-it, index cards to mark, to find different topics ... admittedly frustrating given my interest in the food, nutrition subjects addressed by the author 

• Additional editing of the book to make it more concise would have avoided the repetition of topics without compromising the content, intended message of the author 

Also

The history of nutrition science, the role of Ancel Keys, contemporaries plus competing political, health and business interests then and since is far more complex than presented by the author in different sections of this book based on other authors I have read

 [I look forward to reading the original Keys Seven Countries Study, the White Paper Katz published via the TrueHealthInitiative with colleagues, and written commentaries of others to access, attempt to evaluate their various viewpoints]

Investigative reporting on historical and contemporary nutrition topics - those without David Katz background, expressed expertise - have and continue to make important contributions to educate the public and should be evaluated on their merits without ad hominem attacks

Final Thoughts

Katz (415) wrote: "The only way to manage weight and health over timelines that truly matter is to master permanent lifestyle changes."

I take satisfaction knowing the daily nutrition focus, food choices during my senior years undoubtedly have contributed to the relatively good current health status being experienced, maintaining a comfortable weight in the 120's.  

Through my yoga and nutrition lifestyle focus, I have become quite good at listening to my body - appreciating the important connection of my yoga mobility with the foods I consume.

Thank You Ray Hoyt!

Share your thoughts.

#BobCrowther #Nutrition #Yoga