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How much control should the government have over our health?

How much control should the government have over our health?
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At the risk of interrupting my series on cholesterol and delaying my launch of The Eating Academy, I couldn’t resist using the events of this week to make a few points about (my views on) the role of government in our health.  If you were reading the news last week, you likely came across two (seemingly) unrelated stories:

  1. New York mayor Michael Bloomberg announced a proposal to ban the sale of sugary drinks larger than 16 ounces in New York City.
  2. The Institute for Justice (IJ) has teamed up with a Paleo blogger, Steve Cooksey, and last week filed a major, First Amendment lawsuit against the North Carolina Board of Dietetics/Nutrition in response to their charge that Steve could not give readers personal advice on diet, whether for free or for compensation, because doing so constituted the unlicensed, and thus criminal, practice of dietetics.

Full disclosure: about a year ago I met Bob Ewing, the Director of Communications for IJ, a non-profit law firm serving under-represented clients in cases typically involving protectionism, freedom of speech, eminent domain, and other basic rights.  I could write a ten-part series of why I think IJ is the second-coolest non-profit ever formed (second to Nutrition Science Initiative, or NuSI, of course).  Since first meeting Bob over a breakfast of scrambled eggs and bacon last year, I’ve had the privilege of not only meeting many of his brilliant co-workers, but also the founder of IJ, Chip Mellor, who has led IJ for 21 years and five trips to the U.S. Supreme Court.   IJ is a collection of some of the most mission-driven, intellectually rigorous, brilliant, and ethical folks I have ever met.  I’m honored to call Bob a friend and to have him and his colleagues serve as role models for the type of culture we strive to create at NuSI.

 

Soda restriction in New York

At the surface you might think I’d applaud the announcement of Mayor Bloomberg.  After all, few people outside of Gary Taubes and Rob Lustig would argue harder than I do about the harm to our health brought on by the nutritional weapon of mass destruction (NWMD) known as sugar (sucrose and HFCS).  On one level, I do appreciate the intent of what is being done in New York – attempting to create an incentive to change human behavior for the good of our health.

However, I have a fundamental problem when tactics precede strategy.  I have an even greater concern when strategy is formulated in the absence of correct information when such information is knowable.  As a fan of military history and business history I will always acknowledge, appreciate, and continue to study the role of strategy in the absence of complete information.  This is the essence of human survival and achievement.  However, the reverse condition – strategy and tactics that ignore knowable information – is root cause of some of the greatest military, business, and human health tragedies.

When NuSI is formally launched, I will spend much time explaining how we will translate our very clear mission – reducing the economic and social costs of obesity and its related diseases – into a strategic and tactical approach.  However, anyone who spends even 30 minutes with me knows my position on this.  Correcting the human health problem requires, first and foremost, correct information. I’ve made this point before, but I want to reiterate it.  A few months ago I wrote a post about the study published in the Archives of Internal Medicine claiming a link between red meat consumption and increased mortality.  Please look at it if you have not done so.  The exact same day this study was published, the same group of authors, from the same prestigious university that starts with the letter “H” published another article in an even more prestigious journal, Circulation, claiming a link between sugar-sweetened beverages and heart disease.

While I, and many others, believe the authors drew the incorrect conclusion in the first study and the correct conclusion in the second study, neither study proves anything.  Perhaps the most important thing one can glean from their simultaneous publications, yet disproportionate media coverage (the red meat story was on the front page of every major newspaper, while the sugar story went virtually unnoticed), is the role the media plays in our beliefs of what constitutes a healthy diet.

While I certainly believe there are far more compelling data, using actual controlled experiments and much more convincing epidemiology, to implicate sugar, I’m still not convinced the New York strategy is a good one.

It’s not clear that the conclusion that “sugar is bad” was arrived at with any greater rigor or scrutiny than the conclusion “red meat is bad” was formulated.  If the government creates a policy to limit consumption of sugar, (I won’t actually address the merits or efficacy of the proposed approach to do this in New York), will red meat be next? What about fat, in general?

At the risk of sounding like an anti-government person, which I am not, how good is their track record on this topic?  How good is their track record on other topics?

Assertion 1: Every American should own a home, even if they can’t afford it.

Assertion 2: Turning corn into ethanol will be good for the environment and reduce our dependence on foreign oil.

Assertion 3: Financial derivatives will reduce, rather than concentrate, risk in financial markets.

This list is longer, but you get the point.  Each of these hypotheses led to significant policy changes, all of which have done far more harm than good.   I’m not suggesting the government should be impotent and refrain from creating policy, but too often the policies created are reactionary, politically motivated, and not grounded in high quality data.

While I personally agree on the toxicity of sugar, I think the government should spend its money and political capital on ensuring the science in support of my belief is validated.  Then, and only then, can we have a discussion about the policy implications.

 

The case of the Steve Cooksey, the Paleo blogger

After being diagnosed with diabetes, and nearly dying of its complications, Steve did his own research and learned that the high-carb/low-fat diet his doctors recommended may not have been the “best” choice for him.  He adopted a low-carb “Paleo” diet and lost about 80 pounds, freed himself of his medications, normalized his blood glucose, and claims to feel healthier than ever.  Like many of us who have experienced the virtues of carbohydrate restriction, he believes a well-formulated low-carb diet is the simplest, cheapest, and most effective way to treat diabetes.

Of course, as you know, this goes against the conventional wisdom promoted by most licensed dietitians and physicians who advocate a high-carb/low-fat diet and, if necessary, medication to lower blood glucose.

In December 2011, Steve started a Dear Abby-style advice column on his blog to answer reader questions.  In January 2012, the North Carolina Board of Dietetics/Nutrition informed Steve that he could not give readers personal advice on diet, whether for free or for compensation, because doing so constituted the unlicensed, and thus criminal, practice of dietetics.

The State Board also told Steve that his private emails and telephone calls with friends and readers were illegal.   Violating the North Carolina licensing law can lead to fines, court orders to be silent, and even jail.

Win or lose, the fact that IJ has become involved in this case should be reassuring to us all.

 

Free speech

An obvious theme in this case is that you don’t need the government’s permission to give someone ordinary advice.  What Steve and others are writing about is part of a nationwide movement of people using the Internet to take responsibility for their own health, and to help inspire others to learn more about health and improve themselves as well.  Occupational-licensing laws should not be used to censor and silence these people and shut down their dialogue.  These laws do not benefit the public. They benefit traditional medical hierarchies.

 

The practice of medicine versus advice

The key First Amendment question asks: 

When does the government’s power to license occupations trump free speech?

According to Steve and IJ, answering that question depends on the context of the relationship between the speaker and the listener.  For example, when someone visits a doctor in a doctor’s office, the government has a much greater interest in regulating the doctor’s advice because patients typically surrender much of their personal judgment to the doctor. And there are certain things only a doctor can do, such as authorize a prescription or perform an operation.

But, all Steve does is give advice based on his personal experience to people who want to hear it.  Willing speakers and willing listeners embody the essence of free speech.  When someone asks an online advice columnist for advice — especially if the columnist has made it clear that he or she is not a licensed professional — the government has little, if any, standing in regulating that advice.  No one thinks that Steve Cooksey is a licensed dietitian or that asking him a question creates something analogous to a doctor-patient relationship.  (Even in my case, as a California-licensed medical doctor, advice that I give via this blog doesn’t create an actual doctor-patient relationship with my readers.)  When the government treats ordinary advice between laypeople as a crime, then it has outlawed a form of communication that is as old as language itself and the First Amendment does not allow that.

Although Steve’s advice should be constitutionally protected whether or not it’s good (the whole point of free speech is to enable people to search for the truth on their own terms, not the government’s), it’s a good idea to keep in mind that following Steve’s advice is not “crazy.”  Steve tells people to give up grains and sugars. I am still waiting for one shred of meaningful evidence to prove to me that this is harmful advice.  Steve, effectively, tells people what to buy at the grocery store and order at restaurants. In other words, Steve’s advice is pure speech, just like you could get from any number of books on the market (and it’s probably better than what you’d find in most books on nutrition).  There is a big difference between telling someone to eat eggs instead of toast for breakfast and performing surgery on them or prescribing medication to them.

 

Controversies need dialogue, not censorship

Giving the government the authority to censor speech is particularly dangerous where there are real controversies. Right now, the Paleo/low-carb diet is a source of public and scientific controversy. Those with a stake in the status quo may succumb to the temptation to use the censorship of advice as a way of dominating the debate and preventing people from putting controversial ideas into action, ideas that are perfectly legal to put into action.

The Internet has made it possible for millions of people to question the medical status quo and learn from each other in a historically unprecedented way. The censorship of advice should not be used to squelch the flow of valuable information across the Internet between willing speakers and willing listeners. The government should not be allowed to scrub the Internet like this.   Plotting terrorist attacks through Facebook and proposing people change their nutrition on a blog are not the same thing.

A little over 30 years ago, a French academic named Robert Faurisson wrote a book denying the Holocaust.  A number of such books, of course, had been written before and have been written since.  However, what really left an impression on me in this particular case was that Noam Chomksy, a Jew, openly defended the book and Faurisson’s use of Chomsky’s essay, Some Elementary Comments on The Rights of Freedom of Expression.  Chomsky defended this, in essence, by saying that he disagreed with everything Faurisson had written, BUT because of his belief in the First Amendment, he supported the right of the author to write the book openly and freely.

Just as Dean Ornish (a medical doctor) and Colin Campbell (not a medical doctor) have the right to tell us that eating fat and animal products is the root of all human health woes, so too does Steve Cooksey have the right to tell us the opposite, and have a dialogue with those willing to engage.

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About the Author:

Peter Attia, M.D., is the co-founder and President of the Nutrition Science Initiative (NuSI), a non-profit based in San Diego, CA. He received his B.Sc. from Queen's University in Canada and his M.D. from Stanford Medical School in California. After his surgical residency in general surgery at Johns Hopkins he worked as a consultant at McKinsey & Company. He founded NuSI with scientific journalist Gary Taubes in 2012.

Discussion

  1. George Henderson  June 6, 2012

    I’d like to be the first to say, Right On!
    You put it very well indeed.
    I’m always skeptical when researchers say “more research is needed”. I mean, they would say that wouldn’t they?
    But in this case, more research sure would be appreciated.

    (reply)
  2. lorraine  June 6, 2012

    Thank the goddess for IJ.

    While I suppose Bloomberg’s heart is in the right place, this is a perfect example of the problem of potential confounders when observing a population. Living in the NYC area, New Yorkers are basically in revolt on the invasive government angle, and the mayor and his supporters are all over the news with the health angle. He did the same with cigarettes. I go to NY a lot and I don’t think there’s anywhere safe to smoke anymore, even outside. But New Yorkers are historically one of the healthiest populations in the US, before the cigarette ban, and before the soda ban. And some data indicates they have greater longevity than the average US citizen. Is it because they can’t smoke (and now have to buy soda in multiple smaller units instead of one big one)? Or is it because they walk everywhere, they walk everywhere really fast, they have a high stimulation environment, they don’t take any crap, or they make a lot of money which gives them access to health care? Who knows? That’s the point, who knows?

    As for Steve Cooksey, I have less faith in the good intentions of the folks behind that one. I always suspect the workings of PCRM or something similar behind this kind of stuff. Speaking of which:

    Assertion 4. Trans fats to replace saturated fat in restaurant fryers.

    (reply)
  3. David  June 6, 2012

    Firstly, you write so well – it is clear and concise. I am very envious.

    What happen in Australia is that some studies, in particular RCT or high quality observational studies need to be done before any policy is done. I’m sure a similar process happens in the States.
    More importantly, there are processes to ensure that the policy changes actually make a difference and a lot of data is gathered when policies are enacted.
    I hope the banning of sugary products have such processes (albeit hard to truly attribute and changes in health in the short-term to the policy).

    In a way, the change of policy can be used as a sort of: socialist-communist state-wide experiment of human subjects. And they can compare their results in a ‘single-arm cohort’ study.

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  4. Hoboken411  June 6, 2012

    Peter – appreciate you took the time to share this important message.

    I’m astounded at how “afraid” large entities have become now that the people are waking up. It’s insane!

    I’m getting similar kick-back from my readers (I don’t run a low-carb blog, but created a low carb section). They are so threatened by the strong conviction I have for the profound health benefits of living low-carb. But the confirmation bias they have makes them deeper opponents of my stance on the matter.

    This whole debate, along with government meddling is going to reach a tipping point, and I’m fearful of where it might take us next.

    (reply)
    • Peter Attia  June 6, 2012

      It’s all the more reason to stand strong. I could be next. You could be next.

  5. David Nelsen  June 6, 2012

    What’s wrong with corn ethanol, other than say:
    1. Gives worse gas milage.
    2. You have to plant, water, fertilize, pesticide and then harvest it.
    3. Truck it to a distillery and ferment it, then add benzene to get rid of the water.
    4. Take it by truck again to point of use.
    Never has so much energy been used to get so little in return.
    5. On the bright side, corn for ethanol is probably better than having humans or cattle eat that same corn.

    I am a chemical engineer by training and this amount of waste and resource diversion offends me. Just because you can do something doesn’t mean you should do something.

    I agree that Bloomberg has put the cart in front of the horse. Without good science, every group can claim something is bad (Fat, Sugar, etc.) and the one who wins is the one who yells the loudest. The media just goes along for the ride (Gary Taubes not with standing). Keep fighting for truth and honesty (the Feynman ideals). I end with 2 of his quotes:

    The first principle is that you must not fool yourself and you are the easiest person to fool.

    The idea is to try to give all the information to help others to judge the value of your contribution; not just the information that leads to judgment in one particular direction or another.

    (reply)
    • Peter Attia  June 6, 2012

      Geee, when you put that way…. One more point I’m sure you’ll like. Straight from the USDA, no less: Each gallon of ethanol produced from corn requires 368 gallons of fresh water.

    • Barkeater  June 9, 2012

      Not to veer too far off the health point, ethanol has another horrible effect. E10 gasoline degrades rapidly (less than 90 days) and attracts water like crazy. Automobiles have sealed gas systems and tend to go through gasoline pretty fast, so the problem is not noticed much there. But, boats and many other applications have vented tanks and use gas sporadically with long storage periods. The old advice to store gasoline tanks full is now a terrible idea for winter (or summer) storage. The nearest non-ethanol gas available to me is 50 miles away (only three sources in my state; $4.75 per gallon). Stabilizer products have been proven to be nearly worthless for E10 (despite their claims – there may be some obscure ones that help, but how to guess which ones? Most do not work). The cost in added maintenance to drain tanks is bad enough, but I and others have wasted a lot of money on repairs and experienced hours of poor running equipment thanks to ethanol. Ask any boat motor mechanic or snowmobile afficianado — ethanol gas has been a curse since the middle of the last decade.
      On top of the 368 gallons of water Peter mentions. Great example of phenomenally stupid policy that, once implemented, practically cannot be rooted out.

    • Jeffrey of Troy  June 9, 2012

      Assertion 1: obvious idiocy

      assertion 2: even a cursory investigation of known facts would have made it obvious that it was a bad decision.

      assertion 3: an obvious lie (On a related note: if someone insists proven lies are true for decade after decade, will you continue to believe the person has good intentions?)

  6. colby  June 6, 2012

    Dr. Attia, have you seen this? Every time I do, I cringe:

    http://www.youtube.com/watch?v=Fyj2N-AspqU

    (reply)
    • Peter Attia  June 6, 2012

      It’s true. Sucrose = HFCS.

  7. KevinF  June 6, 2012

    So many ironies and interconnections and reverberations here it makes my head explode. The only reason Steve Cooksey has to be troubled to make his dietary case is because government dietary meddling based on bad science corrupted society’s views on what to eat 40 years ago. And now a more narrow faction of government is meddling to try to block people from overconsuming something that they’re FORCED TO SUBSIDIZE.

    And meanwhile the Public Choice aspect seeps all through this — always some cadre of special interests who’re really motivated to engage in rent-seeking while the population at large is too preoccupied with life to pay attention. We subsidize corn farmers and protect sugar producers then try to figure out how to legislate away the effects of eating corn and sugar; we intrusively license every little sub-industry that can buy off a state legislator for the sole purpose of stifling competition, whether for dietitians in North Carolina or interior decorators in Arizona.

    And lest anyone praise New York’s initiative, I suggest we first better learn Michael Bloomberg’s opinion of saturated fat. (First they came for the trans fats, and I didn’t speak out because I didn’t eat Crisco. Then they came for the salt …)

    (reply)
  8. Alan  June 6, 2012

    I propose a ban on Mayor Bloomberg instead. Who is this nut? Why not instead propose a ban on the sale of alcoholic beverages in any amount larger than a pint? The only thing that Bloomberg consistently opposes is free will. What if I have a large family and wish to buy a 32 ounce sugary beverage in order to split among my several children or to dump into a punch bowl at a party? Human purposes and wills are infinitely variable. For the record, however, I fear the sugary beverage and would never serve it to a minor child of mine. But that is not for some guy who happens to be Mayor to determine.

    (reply)
    • Johna Till Johnson  June 10, 2012

      In all fairness, Alan, the ban proposed is only in certain venues (eg movie theaters)–there’s no way you’d buy a 32-oz container THERE to dump into a punch bowl at a party. Selling larger volumes of sugary drinks in, say, grocery stores would still be permitted under the Bloomberg ban.

      That’s not to say that, as a New Yorker, I agree with the idea. I kind of like the fact that he’s proposed it, because it draws attention to the dangers of sugar. But I think it’s serious overreaching and should be stopped.

  9. Frederique  June 6, 2012

    Sadly, Mayor Bloomberg is missing the point. While soda is an obvious source of sugar, and as such has a role in promoting weight gain, obesity, diabetes, I think there are other less obvious sources of sugar that may be more worthy of, maybe not regulations or bans, but at least information and education.
    What I mean is that if I choose to drink soda, I know I am getting a lot of sugar. Much like if I choose to have ice cream, or dessert, I am consciously making the decision to ingest sugar. (Children may not be capable of as conscious a decision, but adults certainly are.)
    However, if I buy a sandwich, a soup, a salad, any savory dish, I do not expect to be ingesting any sugar. Yet, there is sugar in the bread (In the US, people have been misled into believing that sugar is necessary for the yeast to work when making bread), there is sugar in the salad dressing (again, in the US, cooks are taught that sugar is necessary to offset the vinegar in a dressing), and there will be sugar in my mayonnaise dressing, in my sauce, etc… The salad may have candied pecans (sugar), dried cranberries (again, sugar), etc….

    So, if we were to help people regulate their sugar consumption, it seems to me it would make more sense to give full disclosure as to which foods have actual sugar (fructose).

    BTW, I was not impressed either with Mayor Bloomberg’s initiative, mostly because my first thought was what if the next item they decide to ban is butter, or whole milk… At least here, I feel his policy will not get in the way of my plan for health.

    (reply)
    • Alexandra M  June 6, 2012

      This morning I saw an ad for Miracle Whip mayonnaise that claimed, “It’s actually quite sweet…” So they’re not even hiding the sugar anymore, they’re actually promoting it. And yesterday the endcap at the grocery store was loaded with chocolate Cheerios: “More whole grains than any other ingredient! May reduce risk of heart disease!”

      *heavy sigh*

    • KevinF  June 7, 2012

      Not to worry Alexandra, per their web page,
      “One delightful serving of Chocolate Cherios has 9 grams of sugar and is a heart healthy choice for your whole family.”
      See? It’s HEART HEALTHY!

    • Peter Attia  June 7, 2012

      Very good point. I *totally* forgot about “heart healthy” foods.

  10. Ash Simmonds  June 6, 2012

    Reminds me of The McGovern Report – “we don’t have the luxury of time to find the truth before making policy…” – http://www.youtube.com/watch?v=xbFQc2kxm9c

    (reply)
    • Peter Attia  June 6, 2012

      Ash, funny you should use this quote. I’m giving a lecture at UCSD in 2 weeks on the ethics of dietary recommendation. This point is featured.
      By the way, the lecture is at 4:30 on Wednesday June 20 at UCSD School of Medicine in the Medical Teaching Facility, Room 175. I believe it’s also open to the public, if any readers are local and want to come.

    • jw  June 8, 2012

      Please videotape and link to this speech, it would be much appreciated. (Bonus points for a podcast and slide set…)

      Thanks in advance.

  11. Travis Koger  June 6, 2012

    Here is an interesting take on Bloomberg’s ban on sugary drinks, http://www.guardian.co.uk/commentisfree/2012/jun/05/big-soda-ban-michael-bloomberg-struggle

    So what about no-sugar drinks. I assume that these are also banned?

    100% agree with you on the censorship of these policies Peter.

    And on the same day this story was also in the headlines. http://www.guardian.co.uk/world/2012/jun/05/michelle-obama-disney-channel-advertising

    (reply)
    • Carol J  June 6, 2012

      There were some stipulations on the drinks being 25 calories or less per 8oz serving – so no ‘diet’ sodas (and some other types of drinks) would not be included. So you could order a 32oz ‘diet’ soda, walk over to the fountain and fill it with whatever you wanted… it’s nuts.

      The money and effort on this ban could have been put to so much better use… Mayor B should have tried to ban HFCS and then let the corn industry, politicians and PUBLIC get a load of that controversy!

  12. Colleen  June 6, 2012

    Next Dear Abby will be shut down because she provides advice that only a licensed clinical social worker or psychologist or the like can provide. Since the government has taken a position on “healthy eating”, I think Steve Cooksey’s speech is the highest order political speech entitled to the most protection under the constitution. As for Bloomberg, I think this is the wrong approach. Educate people and they can make their own decisions. Me thinks Bloomberg relishes too much the government control. (Interested to hear about IJ, now back to cholesterol – thanks for the blog, it’s a public service).

    (reply)
    • Laura  June 6, 2012

      Reading about the attack on Steve Cooksey made my blood boil, so I came here to comment. I can’t say anything better on his behalf than what Colleen says here. Amen!

      Doc, thanks for the heads-up on this threat. The price of freedom is eternal vigilance!

    • Jan  June 7, 2012

      Danged right, Colleen. Let people make their own decisions. At 62, I do NOT need a (democrat) Mommy to ‘help me’, or a (republican) Daddy to coerce me.

      I’ll make my own decisions.

      I am so happy that I can now educate myself without the ‘help’ of an overpriced institution of ‘higher education’, whatever that has come to mean. With that comes the warning to take all internet info with a hefty help of skepticism. That’s what learning SHOULD be.

      Go get the facts, as far as possible and make your own decisions. That’s freedom. But with it is the responsibility to spin on a dime when it turns out that the facts really don’t support your conclusion anymore.

      Kinda like in Tim Minchin’s incredibly funny and erudite “Storm”. (Peter, this is an order: Go see it on youtube – no really, you need to see it

      Cheers!

      Jan

  13. Nikhil Hogan  June 6, 2012

    You guys should check out the Surgery Center of Oklahoma, they’re the only free market hospital I can think of that doesn’t take Medicare or Medicaid and is wildly successful.

    (reply)
    • Ryan V  June 6, 2012

      Hey ty for the information.

      Free association leads to success in the human population.

      I feel a shift coming towards freedom via reason…less government…more truth.

  14. Joshua  June 6, 2012

    I’m liking you more and more Pete! I love the IJ & I love the work you’re doing to present an alternative dietary viewpoint. After reading your cholesterol series, I feel like I owe you money or something.

    With regard to this post, the clincher for me is that the government is absolutely schizophrenic with regard to its dietary guidelines and support for the processed carbohydrate industries. On one hand it says eat less fat, and on the other hand it helps Domino’s fund an advertising campaign as part of some kind of cheese initiative. If you’re going to take my money, don’t spend it on crap like this!

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  15. JK  June 6, 2012

    I really appreciate your discussion of this topic. I’m currently in a Masters program for Public Health, and these issues are at the forefront of our curriculum. As you can imagine, I meet with much resistance from my academic cohort (especially since my focus is obesity). I know you experience the same stigma for challenging the status quo in the medical community, so it is great to read your work!

    That being said, any advice for me after graduating? I’m somewhat disheartened, as the last thing I want to do is go to work for an organization promoting the same old tired obesity lines.

    JK

    (reply)
    • Peter Attia  June 6, 2012

      Find an organization to join that shares your view of what is right and your passion and commitment to make a profound impact. These issues WILL change, once enough people are fed up with the current system and demand accountability and excellent science. There are roles for everyone: the public, the providers (e.g., doctors, RD’s), the government. We need “good” people at all levels.

  16. Trisha Eldridge Gilkerson  June 6, 2012

    Well written post and I totally agree! I am anxiously awaiting the next cholesterol post!

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  17. JK  June 6, 2012

    Thanks for the words of encouragement, Peter. Maybe I’ll have to hightail it to San Diego after I graduate… :)

    JK

    (reply)
  18. Constance  June 6, 2012

    I have a tiny quibble here. You talk about the government doing those three things that didn’t work out so well but in reality, it was lobbying, corporatism disguised as the government and a Republican party made up of sociopaths and people with borderline personality disorder. Backed by an electorate that watches Fox propaganda exclusively.

    I think the Bloomberg thing is ridiculous and I think most state protectionism of “professionals” is disgusting.

    (reply)
    • Peter Attia  June 6, 2012

      I agree about the point of lobbying, but this is a bipartisan issue. Both sides of the aisle supported the laws that enabled the mortgage debacle. If anything, it was a Democratic Congress that pushed through the ethanol bill in late 2007. My point is, both sides are equal involved in this.

    • Joshua  June 6, 2012

      I agree that the Republicrat party is pretty disgusting, but I also feel the same way about the Demoblicans.

      One thing to think about Constance is – if the government had less power, there would less reason for corporations to toady up to legislators for special favors. The grain industry is a great example – farm welfare bills have always had big bipartisan support.

      I don’t bother to advocate for no government at all, but all governments are subject to rent seeking from the powerful and connected. The only way I know of to systematically reduce the impact of that cronyism is to reduce the ability of government to grant those kinds of favors.

      Dr. Attia – I apologize if this got too far off subject.

  19. Jeff D  June 6, 2012

    At the moment, I’m not too concerned about the rhetoric, and so long as it remains just that, I’ll remain not too concerned. And given that carbohydrate addiction is our country’s primary export, I’m not convinced that this idea has legs.

    The danger comes when municipalities and state governments realize that a tax is just as good as a ban from a political standpoint, and a good moneymaker to boot. So they tax the carbs, and then tax the fat, and of course the alcohol, and soon enough we’ve taxed pretty much everything there is to eat. Which we do anyway, so lets just raise the sales tax and get it over with. We’ve got to fund the corn subsidies somehow.

    Or maybe Nebraska retaliates with a ban on bagels. Dr. Davis would approve I’m sure.

    (reply)
  20. Constance  June 6, 2012

    Sorry, I forgot to mention how much I enjoy your blog and it’s clearly written and understandable information.

    (reply)
  21. Adam  June 6, 2012

    There is a very frustrating problem with your website that aggravates me a great deal…

    You only post once a week.

    I mean, I know “supporting your family” and “having a career” is important and all, but I think I speak for everyone here when I ask you to please find a 25th hour in your day to blog more!

    What a thoughtful, reasoned, and erudite response to yet another political issue turned media frenzy turned Jon Stewart monologue on the Daily Show (ok that part was hilarious).

    The fact that Mike Bloomberg got it “right” this time in regards to sugar doesn’t negate the fact that his ability to do this means either he or some other uninformed politician will ban saturated fat next.

    As Andre Agassi once said, “Information is Everything”. er, wait…

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  22. Claudia  June 6, 2012

    Excellent post, as usual. Somewhat related: Gary Taubes’ New York Times article on salt. You can read it here:

    http://www.nytimes.com/2012/06/03/opinion/sunday/we-only-think-we-know-the-truth-about-salt.html?_r=2&smid=pl-share

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  23. Bob Beasley  June 6, 2012

    Peter,
    Thank you so much for sharing your advice…er, uh I mean personal experience :) It’s going to take many people like you to continue to point out that “The King has no Clothes”.
    Bob Beasley, RN

    (reply)
    • Peter Attia  June 6, 2012

      I think I can at least see the King’s underwear, though…

  24. Alexandra M  June 6, 2012

    Very well written indeed! I completely agree: getting something “right” (the attention to sugary beverages, not the ban) for the wrong reasons is worse than useless. As several people have pointed out, if action like this can be taken against one food, other (irrationally) vilifed foods could be next. Like bacon, heaven forfend.

    And soon, salt. Michael Jacobson of CSPI has already written the usual blather in a letter to the NY Times in response to Gary Taubes’ excellent column on salt intake recommendations, published Sunday.

    http://www.nytimes.com/2012/06/06/opinion/salt-in-your-food-the-effects-on-health.html

    (reply)
  25. Ryan V  June 6, 2012

    Peter do you know Tom Naughton? Your article today reminded me of him…

    I like it when freedom and truth collide.

    (reply)
    • Peter Attia  June 6, 2012

      Not personally, but through email.

  26. Elenor  June 6, 2012

    Tom Naughton — writer, director, and total wizard of the fantastic documentary “Fat Head” (available for free on Hulu and Netflix) — actually was invited to speak to a conference put on by Congress’s Office of Research Integrity on why more and more people are ignoring doctors, nutritionists and government health agencies and turning to blogs and social media for health and nutrition advice. (Of course, he ended up speaking to a mostly empty room, cause they didn’t really MEAN it! But he has posted his speech for us to see.)

    Search YouTube for this title: Crisis In Nutrition IV – Vox Populi

    Also, to get a great introduction to how and why “scientific” studies can be (and are) often completely wrong, search YouTube for his talk: “Science For Smart People.”

    (reply)
  27. Joe  June 6, 2012

    Just a note to say that I hope your next chapter on cholesterol is coming out soon. VERY soon!

    It’s your fault, Doc! You have us on pins and needles!

    Thanks!

    (reply)
    • Peter Attia  June 6, 2012

      Wow…who would have thought…It might be next week, or possibly the week after. Use this week to re-read the previous ones and get ready to tackled another big problem…what to make of HDL???

  28. Joe  June 6, 2012

    I’ve read your cholesterol articles so many times already that I’ve had to go out and buy new eyeglasses, yes, with a stronger prescription!

    The hardest part (so far) about dealing with your series is finding a doctor who even knows what “NMR” and “LDL-P” mean, much less even getting the test done. I don’t like knowing more than my doctor knows about something. It’s discomforting!

    I’m 71 years old, my TC is 265, my TGs are 94, my HDL is 64, so while my TC is “high,” and my LDL-C is “high,” (161) my HDL/TC ratio is very good, as well my TG/HDL ratio, and my LDL is “Pattern A,” which is also good (or so I hear). But I don’t yet know if I’m discordant/concordant, or what my LDL-P number is, so I need to get an NMR. ASAP. I’ve lost ~ 85 pounds in the past year or so, so I’m thinking that may be having some effect on my numbers too.

    On with the series, Doc! Millions of your readers are hoping it resumes soon. Like next week, at the latest.

    Pretty please?

    And thanks again for the great information, Doc!

    (reply)
    • Peter Attia  June 6, 2012

      I thought everyone would be delighted by the “break” this week…

    • Maryann  June 6, 2012

      Great post, Peter. I was very suprised and disappointed to see the name-calling by my classmates. No doubt, this class is comprised of republicans, democrats, libertarians, liberals, consevatives, etc. I hope that people will show respect for each other by refraining from insulting attacks on classmates. It was probably unintended…but it was nonetheless directed at some of us. Lets focus on what we all have in common, and concentrate on learning. I do believe that the success of NuSI depends on people from all political orientations working together.

  29. Joe  June 6, 2012

    No way!

    It would be like visiting the rest room at a Pavarotti concert while the Fat Guy is still singing!

    Encore! Encore! Encore!

    (reply)
  30. RGB  June 6, 2012

    If the issue that Bloomberg has brought out is to “control” the obesity epidemic in his city (and the country?), I think it is important to observe what is truly between the lines…$$$$ money! Corporate America is demanding that profits rise and costs decrease. So, get in line people and do your corporate duty, keep the costs of health care down — while profits soar. Bloomberg, afterall, is a billionaire. Remember the tobacco industry being subsidized by the government while, at the same time, we’re told of the ill-effects of smoking — by the govenment? United States of America, Inc.
    Keep up the battle, Dr. A.
    Thanks for what you are doing.

    (reply)
  31. steve  June 6, 2012

    HDL is definitely in the news, but I hope you cover saturated fats influence on LDL particles; it seems many who go low carb find that there level of LDL particles and LDL-C move up tremendously. May have to due with absorption or synthesis by way of excess burden on the liver, but this is only conjecture by me.

    The amazing thing is that cigarettes are not banned. Pretty clear about that one. Why not? The revenues from taxing them is an important source of income for the States- at least that is my guess.

    (reply)
  32. Shirley  June 6, 2012

    As a nurse educator, I struggle with trying to get people to research things for themselves. I give out many books that raise the questions of status quo. People keep saying the obvious: “If you cant trust the Am. Heart Association and the Amer. Diabetic Assoc. who can you trust?” Then I go into my story of Ancel Keyes and the biased science that everybody bought into. Then they start rolling their eyes and saying conspiracy theory……. I keep on though with more info from different sources saying the same thing. The sad part is, I believe we are growing our own diabetics with the school meals of pizza, french fries and lots of carbs. USDA is an organization formed to benefit the farmer and until the schools get off of that free ride, they will not have a say about what the schools can serve.

    (reply)
    • Peter Attia  June 6, 2012

      Keep up the good work, Shirley. We will be mocked for a long period of time.

    • Laura  June 7, 2012

      Heh heh. I’m thankful that, even long before I went low-carb and counter-CW, my son absolutely refused to eat school lunches and insisted he take a packed lunch. Maybe his biology hadn’t yet been sufficiently corrupted, so he could tell that the school lunch stuff is largely, uhm, junk?

  33. Roger Butler  June 6, 2012

    Peter,
    First I would like to state clearly that I absolutely concur with you that Steve Cooksey must be supported. I like the fact that you did not mount an unqualified libertarian case that people should be allowed to publish absolutely anything but carefully set out why it is important that people should not be constrained from honest seeking and distributing information and opinions of certain sorts.
    I am not sure how helpful your tactics versus strategy line is, surely any responsible adult seeing a child about to run across a busy road would use whatever tactics they could to stop her and then maybe subsequently petition the local authority about implementing a road safety strategy. I am similarly dubious about your assertion that, “strategy is formulated in the absence of correct information when such information is knowable.” Surely the issue here, certainly in relation to carbohydrate, saturated fat, and salt, is that there is honest disagreement amongst experts as to what constitutes correct information: and can anyone ever be sure she has complete information?
    I think a case can be made that a public discouragement of sugar consumption can be defended whilst similar action against red meat cannot – i.e. I would maintain that the situation in these two cases is clearly different, unless there are some facts I am unaware of. In the case of sugar, as I understand it, absolutely no one is suggesting that sugar is an essential element of the human diet and that anyone will become ill or have their lives endangered by ceasing to consume it, or so much of it. On the other hand, when it comes to red meat and saturated fat there are clearly differences of opinion amongst those highly qualified in relevant disciplines, including you.
    Of course your post opens up any number of questions that cannot really be pursued here such as the nature and purpose of democratic government, the shortcomings of many of the current systems of representative democracy, and the influence major food and pharmaceutical corporations have in public life.

    (reply)
    • Peter Attia  June 6, 2012

      Hmmm, I’m not sure I see the analogy of the child crossing the road. The best available evidence (if a kid is hit by a car, it’s bad) suggests immediate action (i.e., tactics). I’m talking about decisions to go war, to created policy, to tell someone to eat X and not Y.
      Remember – sometimes you have to act without knowing information. Other times – you have the “luxury” of pursing knowable information, but you elect not to. This is the crime, in my opinion.

  34. Catherine  June 6, 2012

    lol–I see you now being called “Taubes’ new partner in crime” in the blogasphere, so you COULD be next.

    (reply)
    • Peter Attia  June 6, 2012

      Is that a good thing or a bad thing?

    • Joshua  June 7, 2012

      I’d say it’s a good thing. Who wants to go with the flow when you’re getting close to the waterfall?

    • greensleeves  June 8, 2012

      It’s a bad thing Peter; Gary’s stalkers will soon be here in your comments with all their usual tactics – questioning your medical degree, accusing you of lying about your weight and swimming, attacking your family and perhaps even harassing you when you travel with fake social messages.

      Remember, as Dr. Guyenet stated just yesterday, the alternate hypothesis is long dead and buried. High insulin makes you lose weight, not gain it. Fat people are just lazy liars. This is now the prevailing belief, and I hope you are prepared for their full-scale assault. Mockery will be the least of it. (sigh)

    • Peter Attia  June 8, 2012

      Whew, thank goodness it’s settled. Now we can shut down NuSI and keep telling people to eat less and exercise more.

      I appreciate the warnings and sentiments, but I don’t see a choice. Besides, it’s not about ME. It’s not about GARY. It’s not about Dr. G. It’s about those who are sick and unwell because bad science and misinformation have run amok. Does it hurt my feelings when people say nasty things to me? Of course. Will it be upsetting if/when the things you suggest happen? Sure. But if I only think of myself, I’m already doomed to fail. If I keep my eye on the ball…trying to change the world…it may be more tolerable.

  35. Debbie  June 6, 2012

    I agree with Bloomberg’s soda size ban. Remember, he’s not banning soda, just the sale of certain sizes in certain places. Like you can’t sell cigarettes and booze everywhere. What’s wrong with that? He’s DOING SOMETHING, probably something he CAN, given the market driven forces/politics against all of us. We can worry about slippery slopes, if it ever comes to that, later, which is unlikely given the size of the mountain to be scaled -

    (reply)
    • KevinF  June 7, 2012

      Will you still agree when he next bans something you like as opposed to something you dislike?

    • greensleeves  June 8, 2012

      Kevin, I love beer. But it’s been illegal to buy and sell certain large sizes of beer in NYC for about 80 years. This has hardly reduced New Yorkers to serfs in a North Korean prison. Why aren’t you agitating about the beer? Do you even live in New York? They voted for Bloomberg 3 times you know; they seem to like his approach. Why can’t New Yorkers have the government they chose? No one is forcing you to live there. :)

      A second note, to Peter: is it necessary to be a Libertarian to be low-carb? I am turned off by Libertarian politics, honestly, and am quite dismayed to be slammed with it when I just want to learn about health when I come here. Do you plan to write often about Libertarianism?

      I don’t mean to be cranky ;) just honest. Thanks for listening.

    • Peter Attia  June 8, 2012

      Hmmm, let’s see, I’ve written 30 posts in 6 months. How many have irked your anti-Libertarian sentiments? Oh, one. Gosh, sorry for that. Is it ok with you if, say, 3% of MY blog posts are about a topic you don’t like. Wait. I have a solution. Just like the New Yorkers who choose to live in NY, you can choose to read (or not read) the blog. I don’t mean to be cranky… :) … just honest.

    • greensleeves  June 8, 2012

      LOL! I appreciate your humor here, Peter, thanks.

    • Peter Attia  June 8, 2012

      I appreciate yours!

  36. Brandon Taylor  June 6, 2012

    Peter,
    this isn’t realted to the article per se, but I’ve been struggling to find a definite recommendation on your website, Ben Greenfield Fitness etc.:
    how ardently should someone on low carb (particularly someone who is ketotic) avoid convential soy sauce. I’ve avoided it because of the soy (though i know it is distinct from tofu etc.)and wheat. But if it were used as home once and a while or in a dish at a buffet would that be okay? Or should avoidance be akin to that of vegetable oils like soybean oil?

    Thanks,
    Brandon

    (reply)
    • Peter Attia  June 6, 2012

      For some, like me, who really seem to thrive on a diet free of gluten, I avoid soy sauce. In the “big picture,” though, it probably doesn’t play a huge role in modest consumption for some/most people (assuming one isn’t drinking it all day long).

    • Maryann  June 7, 2012

      In “The New Atkins for a New You” by Westman , Phinney, and Volek, they recommend “a minimun of a half a teaspoon of salt each day. You can do this with salt itself, a couple of cups of salty broth, or a measured amount of soy sauce.” (p 19). We use Kikkoman gluten-free soy sauce, which we found in Shop-Rite. Hope this helps.

    • greensleeves  June 8, 2012

      Hi Maryann!

      I used to use the gluten-free soy sauce, but lately I’ve found this coconut product called “aminos” at Whole Foods. It tastes even better than the gluten-free soy, and I now I use it in place of soy sauce all the time. I was surprised by how much I liked it. Maybe you will too.

  37. George Henderson  June 7, 2012

    I’m really having trouble making up my mind on the sugary drinks, because I feel I’m only getting one side of the story.
    Can someone write a closely-argued and fully-referenced blog on why sugary drinks might be good for me and why I should start to drink 16-oz cokes?
    A sort of “safe sodas” position.
    Then, and only then, will this debate get started.

    I am being a little bit sarcastic.
    But who knows?
    And yes, I am aware of Ray Peat.

    (reply)
    • KevinF  June 7, 2012

      Ha, I’m not going to put that on MY blog. But, I have read of officials at Coca Cola excusing themselves by saying hydration is good and important, and tasty beverages encourage hydration, and so therefore soft drinks are good and healthy. And got to admit he has a solid point — dehydration WILL kill you a lot faster than heart disease or diabetes. Lord knows how our ancestors ever survived before Coke was invented.

  38. George Henderson  June 7, 2012

    Good point Debbie. Presumably the city licenses these particular outlets as it licenses liquor outlets or gun stores, and does in fact have the right and responsibility to impose restrictions, above and beyond that of federal government.
    Your freedom to dump garbage on the kerb or park where you want is also dependent on Bloomberg’s whim.
    And if you live in another city, it doesn’t even affect you, unless the person you vote for decides to try the same thing.

    (reply)
  39. Greg  June 7, 2012

    Peter,

    Enjoyed reading your article immensely as it reflects my own personal beliefs. I’ve also enjoyed your columns up until this point greatly, but as a science undergrad with social science graduate work, I enjoy the change of pace with this piece. So…unlike some of your other posters, I enjoyed this departure. To be honest, while I majored in physics and biology, my later work and personal reading has been along the lines of political science, economics, finance, literary theory, philosophy…so you get the point; I like to put the science in some greater social context. Foucault’s “Birth of the Clinic” informs much of the work of nutritional science to be honest. In any case, I didn’t expect a reference to Chomsky in your blog this week, but I was pleasantly surprised.

    Finally, back to your posting– I was horrified when I first heard of the case regarding the Paleo blogger. I’m glad to hear that there is a group such as IJ and that they are taking up his case. Also, my first reaction to the NYC ban on sugar was to cringe. My reaction hasn’t changed. There is so much wrong here.

    (reply)
    • Peter Attia  June 7, 2012

      I was such a Chomsky fan in college I actually applied to transfer to MIT just so I could take his linguistics classes! Unfortunately, I didn’t get my financial aid application in on time, so I would have needed to pay full price, and decided not to transfer…

    • Mark  June 7, 2012

      Hi, Peter.

      I went to grad school at Harvard. I tried to register into Chomsky’s course at MIT (Harvard and MIT students are allowed to cross-register for certain classes), but I was too far down on the wait list.

      I’m a big first amendment guy, and I’m even a card-carrying member of the ACLU. So, I agree with what you write here as it relates to the facts which you’re presenting. Still, I can’t help but suspect that there is more to this Cooksey case than we are aware of, and that additional facts will present themselves as this thing gets litigated. My suspicion is that this is the case, and that the private correspondence between him and the readers may have been presented as something other than opinion.

      I’m not familiar with regulations as they relate to medical licensing, but I am familiar with how this has been applied to securities law (which is my specific field of expertise). Nothing precludes you as an unlicensed individual from starting a blog similar to this one, which would give out investment tips or advocate for a specific type of portfolio management or investment strategy. Even if the government knew your intent was to solicit clients (whether paid or unpaid), you could carry on. Otherwise, this would be prior restraint, which would be unconstitutional. Once you cross the threshold from general advice to specific advice or portfolio management to individuals, you’re practicing without a license — even if with the “I’m not a licensed professional” caveat. There is case law for this. Individuals’ sites have been shut down after it was determined they were offering advice without a license.

      Because we aren’t privy to the emails or private correspondence in this case, we have no idea of knowing the full story here. Assuming he wasn’t dishing out medical advice, the government’s case has no merit.

      What are your thoughts on the government’s role in regulating general medical advice from homeopaths, spiritual healers and other types of quacks? At what point should the government intervene, or should they intervene at all?

    • Paul Sherman  June 7, 2012

      Mark,

      I’m Paul Sherman, one the IJ lawyers representing Steve Cooksey. You raise some important questions in your post and so I wanted to respond.

      A lot of people have the default assumption that there should be some constitutional distinction between generalized advice and individualized advice. But the Supreme Court has never said that such a distinction exists, and part of the purpose of bringing this lawsuit is to demonstrate that that proposed distinction conflicts with basically everything else the Supreme Court has ever said about the First Amendment. In other words, if you’re allowed to write a detailed book about something, you should—generally speaking—be allowed to convey the same information or opinion to people on an individualized basis.

      As for Steve’s speech specifically, part of the point we’re trying to make is that it simply doesn’t matter what Steve was saying in his emails. The Board of Dietetics/Nutrition is only interested in Steve’s speech to the extent it deals with what food people should eat. Our position is that Steve has the right to say whatever he wants to another adult on that topic, whether it’s presented as fact, opinion, or advice; whether he does it for pay or for free; and whether or not it takes into account the listener’s individual circumstances. In any of those cases, it’s all just speech on a topic that people have discussed freely for as long as there’s been language. Steve has a right to say it and, equally important, his adult listeners have a right to hear it, consider it, and then accept or reject it.

      One of the things that makes investment advisers different from Steve is that, very often, investment advisers engage in lots of non-speech conduct. They may, for example, have the power to actually handle your money and make investments on your behalf. Regulating that sort of conduct by a fiduciary raises no First Amendment issue. But if I tell Peter that, as a reasonably young investor with a long time before retirement, his investments should be all stocks—or that, to avoid impending financial catastrophe, he should be invested entirely in gold—that’s just speech, and I should be allowed to say that without having to get a license from the government.

      Finally, it’s worth stressing that IJ is not arguing that as soon as the First Amendment is implicated, the government automatically loses. As I’m sure you’re aware, that’s not how First Amendment law works. We’re arguing that the First Amendment is implicated by any restriction on advice, and therefore the government has to meet a heavy burden of showing that the restriction it has imposed is necessary to protect the public and no broader than necessary to serve that goal. For some types of extremely high-stakes advice—e.g., medical or legal advice, perhaps even some kinds of investment advice—the government might be able to show that the consequences of bad advice are so extreme and irreparable that only licensed experts can safely give individualized advice. But under the First Amendment, that should always be a case-by-case inquiry, and there’s no reason to believe the government can meet that burden when it comes to nutritional advice. The government can certify experts on the subject of nutrition, who can then advertise their government-conferred credentials, but it can’t give them a monopoly on the subject matter.

    • Peter Attia  June 7, 2012

      Paul, thank you so much for the very insightful overview of the nuances of this case and, as importantly, the First Amendment.

    • Travis Koger  June 7, 2012

      Thanks Paul for the detail on the legal arguments on this.

  40. Steve T  June 7, 2012

    Dr Attia,

    I’m a new fan – I just found your site this past weekend and I love it. Regarding Mayor Bloomberg, I’m surprised nobody mentioned that he celebrated “Donut Day” the same day as he defended the ban! Don’t for a minute assume that he gets it…

    (reply)
  41. Dan  June 7, 2012

    Off topic, but wanted to share what I think is some success with becoming keto-adapted…

    I’ve been on low-carb <40-50g for 5-6 weeks with a refeed each week. Based on some of what I've read here I'm trying cutting out the refeeds…been <30g C last 3 days (incl fiber) and <120g P.

    I did a 45 min trail run tonight and felt great. For the day I had 2T MCT + 1T coco oil in my coffee, then 6oz beef, 3 eggs, an avocado, and a little cheese for lunch…then my run at 6:15p. I wasn't hungry, I wasn't tired, I had consistent energy through the run. I'd say it was a zone 2/3 effort with some spikes on the hills.

    So that's pretty sweet. I have to be getting keto-adapted or I should have felt like crap. Oh, and I did my weekly Big 5 lifts yesterday.

    And I had probably 2-3t of salt today too..

    Thanks for all the info and inspiration!

    (reply)
    • Johna Till Johnson  June 10, 2012

      Hey Dan:

      Tell us more about your workout regime. I recognize the “Weekly Big 5″ after having just purchased the Body by Science books… but how often do you trail run? How far? Do you do anything else? What’s your workout schedule like?

      Inquiring minds want to know…. (and thanks for posting!)

  42. C Wolf  June 7, 2012

    I thought we learned that Prohibition didn’t work?

    So, the billions in farm subsidies go to 3 crops and a few huge agricorps, making sugar/processed carbs cheap. Then the USDA says the Standard American Diet is 69+% processed carbs. So, one city banning larger cup drinks (will quart bottles still be sold?) will fix the issue?

    The USDA 2010 guidelines spec 100% whole grains as a relatively small % of the plate by volume. Name one government agency whose food service complies with that.

    No question obesity is a complex issue with huge public health consequences. Go to WalMart and watch people checking out. Go to Old Country Buffet and watch them eat. Invest in fat buggies. :)

    (reply)
  43. Joshua  June 7, 2012

    This made me laugh – it makes you look like you’re your own biggest fan. In case something spontaneously fixes itself – the post I’m looking at says it was posted by Peter Attia.

    (reply)
    • Peter Attia  June 7, 2012

      Hmmmm…strange… I typically don’t post comments to myself. Takes too much time. I usually prefer to just text myself.

  44. Travis Koger  June 7, 2012

    Did you lot see this article/study?

    http://archpedi.jamanetwork.com/article.aspx?articleid=1171936

    Is it also providing more backing to the notion that body weight is not all about thermodynamics? Interesting read.

    (reply)
    • Peter Attia  June 7, 2012

      I think the big problem with this study this study is the number of confounding variable. The differences in parental education levels and income are significant. I can only image the differences in dietary patterns. While I realize this was the point of this study, it calls into question some other methodological shortcomings that may interfere with interpretation.

    • Travis Koger  June 7, 2012

      Agree. I would have thought that it definitely adds to the question of is thermodynamics the only factor though… even if the study is clearly flawed. It continues to amaze me how some ‘scientists’ can ignore what is pretty well staring them in the face.

  45. Mark Jacobs  June 7, 2012

    Peter,

    Thank you so much for your input. I am not a “no government” person either. I am however a fan of very limited government and firmly believe that it is not the function of government to dictate health policy. The USDA food triangle certainly is an example of bad policy, and the awful unintended consequences of a much less healthy population.

    (reply)
  46. dullgeek  June 7, 2012

    My only gripe with this post is that you seem to start from the assumption that if sugar can be rigorously proven to be the poison that you believe it is, then the government would be justified in controlling it. Even if “sugar is bad” is thoroughly concluded, I’m not sure that I think that the government should be intervening in my decisions about what I consume.

    I have been off carbs since Jan 1 (New Year’s resolution). So I’m a believer in your thesis. But I’m generally of the opinion that we are better off when we can each run our own experiments for what works best in our own individual circumstances. That requires that the government not make laws enforcing their limited view.

    IMHO the public policy implications are independant of the rigor of determining that “sugar is bad”. Regardless of sugar’s badness, I think the public policy should be simple: Your body is yours. The government will have no say in what you consume. Be careful. Good luck.

    Or have I misread your position?

    (reply)
    • Peter Attia  June 7, 2012

      Yes, you’ve missed my position. I’ve made no assertion whatsoever about what the government should do — if anything — even in the presence of perfect information. I certainly have my ideas, but I have not presented any of them here. Maybe another time.

    • dullgeek  June 7, 2012

      This is one of the comments that raises my concern:

      I think the government should spend its money and political capital on ensuring the science in support of my belief is validated. Then, and only then, can we have a discussion about the policy implications.

      I already have an opinion on the policy implication, and it is independent of the results of the science. Until my consumption imposes negative externalities on non-consenting third parties, it is none of the business of the government what I consume. $0.02.

      Sorry for hijacking the thread. I’ll stop now.

  47. Marilyn  June 8, 2012

    A lightweight comment here: I have a theory that all the laws and regulations that need to be made have already been made, and now there are a whole bunch of politicians out there who need to feel useful — to feel like they’re “doing something” — so they’re coming up with all these idiotic, no-good “new” laws and regulations. In my opinion, the most useful thing lawmakers could do would be to go back over the law books and expunge the old ones that we no longer need.

    (reply)
  48. Catherine  June 8, 2012

    “How much control should the government have?” (none, but then I am a Paulite)

    Since I don’t anticipate having much control over this, I choose to receive my health care in the shadows (even though I am in in excellent health) I choose physicians that do not enter my data into a computer and execute lab work privately. Depending on what happens with the health bill, I have made plans to get yearly physicals / care in Jordan or maybe Singapore. Insurance companies look for any excuse to raise your rates, and I would like to keep my HSA / high deductable catastrophic care rates affordable. I’m happy to pay cash and keep my involvement with the government to a minimum.
    I want to be the client, I want to pay for a physician’s advice but have complete control of my decisions. (and I am willing to pay for that, and travel)

    (reply)
  49. Lee  June 8, 2012

    Well said. You are such a thoughtful and intelligent writer–I love your blog posts. I would love to find a doctor like you in my area!

    (reply)
  50. steve  June 8, 2012

    @Paul: I believe this all has to do with whether Cooksley is dispensing medical advice. Many bloggers are asked about specific health issue, thyroid problems,etc; and many bloggers respond with specific recommendations such as taking iodine,selenium, etc and have links to Amazon for ordering these vitamins, etc, many of which for specific conditions might worsen them. Seems to me in this case the giver of advice may be practicing without a license, and harm may result.
    If no medical advice is dispensed, there is no call for the government to be involved. Yes, case specific.
    Regarding Bloomberg: He is just trying to address, however,poorly, an escalating public health crisis. I am all for anyone doing what they want to themselves so long as I do not have to pay for the consequences of their behavior. Unfortunately, that is not how society works. We all pay for those who engage in such behavior. It is a tough issue with a slippery slope.

    (reply)
  51. Alex Carvalho  June 8, 2012

    I’m with dullgeek. Keep the government out of my menu. Even if (maybe specially if…) I decide to eat poison. And as much as I believe your post was truly justified, I just hate that your series on cholesterol was interrupted as I’ve been really looking forward to each additional posting. Keep it up!

    (reply)
  52. Tom  June 8, 2012

    Right wing anti-government zealots should realize there would be NO food labeling if Republicans had their way. Put that in your pipe and smoke it.

    (reply)
    • Alex Carvalho  June 9, 2012

      If there were no compulsory food labeling, food companies would still be free to label their products if they so wish. They could even come up with voluntary industry standards for labeling, which could end up being more relevant, useful and meaningful to consumers than those dictated by government. Consumers who care about knowing what they’re eating would give preference to brands that disclose the information. Consumers who didn’t care could keep buying undefined goo, maybe at a discount price. We neither need the nanny state to impose food labeling standards nor to tell us what to eat.

    • Jeffrey of Troy  June 9, 2012

      @ Alex C

      Civilization requires laws, regulations, and – to fund the enforcement of the laws and regs – taxes, no matter how much you find the phrase “nanny state” reinforcing.

    • Alex Carvalho  June 10, 2012

      @ Jeffrey of Troy

      I fully agree with all the roles that you attribute to government as a condition for civilization, and I even allow for a few others such as national defense. This would be a proper state. Unfortunately most governments have extended their reach much beyond, transforming themselves in monster nannies (yeah, I do find this expression reassuring…). I find individual choices about food to be an exclusively private matter. No nannies, please (oh, I used it again…).

      Freedom and truth are friends, not enemies. Only free agents can point their fingers at lies and blow a whistle as Dr. Attia does around here.

    • KevinF  June 10, 2012

      There’s some pretty obvious common ground here. Government SHOULD do things that help markets to be transparent and that enhance information available to consumers — in order to combat asymmetric information problems in markets. Governments should NOT (as a general principle, but with unavoidable exceptions) do things that limit a consumer’s choice to buy whatever they want to buy.

      Another way to view that is that governments should use their power to improve MARKETS themselves, rather than to protect producers or get all nanny-state about baby-sitting consumers.

      Seems to me that’s so obvious everyone of most political stripes should get it — I’d think Republicans should embrace food labeling and Democrats should recognize that banning extra large drinks that people want to buy is going too far. Perhaps that’s too much to ask though.

  53. walid  June 9, 2012

    Hi Pete, can you please suggest a good source of information on the scientific method. I think getting a good understanding of this important topic is essential for me to appreciate your arguments in this blog

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    • Peter Attia  June 10, 2012

      Hmmm…this is a great question, and I’ll need to think about it. I was very fortunate to learn most of what did about the rigors of science from my mentor at the NIH, Dr. Steve Rosenberg. His book, The Transformed Cell, was perhaps the most influential book on me during medical school, along with the work of Richard Feynman. For starters, get a copy of The Transformed Cell. If I can think of others, I’ll let you know. Perhaps others have some great ideas, too.

    • Peter Attia  June 11, 2012

      Walid, upon further reflection, here are some other recommendations:

      1. Reading books on the philosophy of science — Francis Bacon, Kuhn, Popper, Robert Merton — and memoirs and essays of good scientists — Medawar, Feynman, Bernard among others — is a good place to look.

      2. For pure science 101, Beveridge’s Art of Scientific Investigation, which dates back to the late 1940s, I think.

  54. Jeffrey of Troy  June 9, 2012

    Many of you are expressing a love of both truth and freedom; this is confused. In reality, they are in serious conflict.

    By accepting freedom as the highest good, you preserve not only the freedom to tell the truth, but also the freedom to lie; in actual practice the freedom to lie inevitably becomes the requirement to lie. (The truth upsets the schemes of the liars, who use their ill-gotten gains to manipulate the situation in their favor.)

    If civilization and justice are to be restored/persist, freedom must be subjugated to truth, always and everywhere.

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    • Pushback  June 9, 2012

      And then people like you will arbitrate the “truth” and subjugate us to it. Thank you very much, but I prefer freedom. I will evaluate evidence, weigh by my own personal priorities, and make my own choices.

  55. Jeffrey of Troy  June 9, 2012

    Most people will not actually get two of the smaller size; they – like Truman – accept the reality of the world with which they are presented.

    I expect this limit on the size of soda-pop will actually reduce diabetes and obesity in NYC.

    If they try to ban fat, we can cross that bridge when we come to it.

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  56. Jeffrey of Troy  June 9, 2012

    Yes, eliminating the subsidies to wheat, corn, soy, and sugar would be better than bans and taxes. However, that is Congress – the US Gov (often erroneously referred to as “the Federal Gov”; actually, the system of gov is federal, the US Gov is not federal).

    Bloomberg is taking action that he – as mayor of NYC – can.

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  57. Catherine  June 10, 2012

    “I appreciate the warnings and sentiments, but I don’t see a choice. Besides, it’s not about ME. It’s not about GARY. It’s not about Dr. G. It’s about those who are sick and unwell because bad science and misinformation have run amok. Does it hurt my feelings when people say nasty things to me? Of course. Will it be upsetting if/when the things you suggest happen? Sure. But if I only think of myself, I’m already doomed to fail. If I keep my eye on the ball…trying to change the world…it may be more tolerable.”

    Which is why you have so much respect and support!

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    • Peter Attia  June 10, 2012

      Thank you, Catherine. Very kind of you to say.

  58. Michael Andreula  June 11, 2012

    I couldn’t agree with you more Peter. The government needs to help fund large scale tests to determine what is the correct way to eat. We should all rally around this cause!

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  59. Ken MacKillop  June 11, 2012

    I agree with the gist of this post, Peter. That said, a highly related case in point comes to mind.
    I am a huge admirer of Gary Taubes, and a big skeptic of Robert Lustig. They seem to share a common hypothesis — that the not-only sufficient, but likely necessary pre-condition of modern (insulin-related) diseases is excess fructose consumption. I believe Gary is working on a related new book (and maybe Lustig, independently, also?).
    I am skeptical of this entire hypothesis, in the sense that I do not believe excess dietary fructose is a NECESSARY pre-condition to modern disease(s). Nevertheless, I think Taubes and Lustig (while overreaching to different degrees) are both probably on to something important. But Lustig is after government intervention. While I sympathize with some of his reasoning for this, I vehemently oppose this course of action, not least because (I think) he is probably partially and fundamentally wrong in his hypothesis. This is reminiscent of the diet-heart theory, and its terrible aftermath that is still sickening our society. Lustig is a ZEALOT, and has not learned adequate self-skeptical discipline IMO.
    Richard Feinman has commented extensively along these lines of skepticism of Lustig. I had all of the same thoughts prior to reading Feinman’s blog posts. But I am not a blogger, and Feinman says it well enough — notably, unlike Lustig (who continually gets basic technical facts in support of his argument wrong), he is a biochemist as well as a long-standing activist in the related diet politics.
    For an alternative pre-condition hypothesis (to that of fructose), I recommend Michael Rose’s (55theses.org). In short, it involves the genetic interaction of aging and diet (and carbohydrates in general) — this is a subject that Rose is arguably a world-class expert in. Rose modernizes (by offering up-to-date scientific support for) the earlier theory of Cleaves and Campbell, in my view. They included not only sugar, but refined carb’s in general (e.g. flour, beer) in their thesis.
    Aside from Feinman, Lustig’s violation of the principles suggested in your post seem little commented upon. He is much-too-much lauded and too-little criticized, methinks.
    Also, I might mention that I noted early-on a likely connection (via the AHA) between George Bray (a real historical bad actor, IMO) and Lustig, who has mentioned Bray occasionally in connection with his research. This brings up the fructose-as-scapegoat for starches-in-general concern of Feinman — I independently had the same thought. This is the seedy, political, funding-related side of all this nutrition stuff — not to be ignored, I suggest.

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    • Peter Attia  June 11, 2012

      Ken, I hope I haven’t suggested that fructose is necessary and sufficient to induce insulin resistance and obesity. I don’t believe either. I do think, for many people, it’s the cornerstone of the problem, for reasons discussed already. I don’t know Rob Lustig very well, but I do know him personally. Despite his critics (Rob and I do not agree on several points, including the implication non-fructose sources of dietary glucose that I believe are “bad”) I think he knows more about fructose biochemistry than people give him credit for. You are correct that Dr. Lustig will have a book out, probably by the end of the year. Gary has finished a remarkable article on sugar, which should be published soon, as is working on a book on the same topic.

  60. Mike H  June 11, 2012

    I smell a libertarian!! I bet you get a bunch of hate for this post. I know I always do when I say stuff like this. Great post, though :)

    What you say about them possibly outlawing saturated fat is especially scary, I believe they are doing this in Denmark.

    (reply)
    • Brian  June 12, 2012

      Not really, but close :-)
      There’s now a tax on ALL fats in Denmark and this is probably not a very good idea.
      BUT a suger tax is also being implemented this summer and that is a step in the rigth direction. This sugar tax is applies sugar in the form as tablesugar, syrup, glukose but also foods with added sugars in them. This is one way of doing it but I would prefer a labelling of the product with a sign on the front saying SUGAR ADDED instead, then people could make their own choises, Taxes is not the way to control behavior.

      Unfortunantly we have a doctor Arne Astrup in denmark, highly regarded in some circles and he is an old school selfproclaimed nutrition guru hating all saturated fats and recommending healthy carbs and counting calories as the ultimate solution.
      (He is one of the architects behind the Letigen pills – banned after a few years use after several deaths (mix of caffeine and ephedrine))
      Yesterday I heard that a large danish medical company – Novo – is soon to reveal their latest invention. A new pharmeceutical that supressess hunger and therefor “cures” obesity… this is supposed to be their new money maschine – they have some insulin patents that is to expire soon (Novo is one of the largest manufactures of insuline and other diabetic products world wide)

  61. Aaron  June 11, 2012

    This is a great post Peter. I’m more or less with you on this issue: I think more research needs to be done before policy can be effectively deliberated, and I think spending government funds on this research is sound policy. I do have a lot of red flags about the IJ however. Nowhere on their website do I see critiques of corporate control/concentration of power. Without such critiques and without effective challenges to private power the IJ risks becoming a “uselful idiot” for private interests whose own agendas may be worse than a government agenda! Keep up the excellent work.

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  62. LynneC  June 12, 2012

    Do you see a distinction between banning cigarette smoking in public places and banning the sale of supersized soft drinks? And if yes, what is the distinction?

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    • Peter Attia  June 12, 2012

      I do see several distinctions.

  63. Eric  June 13, 2012

    Nothing makes for a good libertarian like studying nutrition and its history.

    “Of all tyrannies, a tyranny exercised for the good of its victims may be the most oppressive. It may be better to live under robber barons than under omnipotent moral busybodies. The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end, for they do so with the approval of their own conscience.”

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  64. Nan  June 13, 2012

    Government should help educate, provide funding for further studies, etc., but bans don’t work–just look at the gross failure of drug laws. A much better step than an all out ban would be a large label on the beverage packages giving the nutritional information. Won’t help everyone, but would help many.

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  65. Margaretrc  June 15, 2012

    @Walid, Tom Naughton has two video presentations, each one hour, that are really good fast summaries of the scientific method, particularly as it applies to nutrition and pharmacology. I used to teach science, and of course the scientific method was the core of my lessons and I would have happily used either one to reinforce what I was teaching. I believe both are available on you tube or at his site. They are “My Big Fat Fiasco” and “Science for Smart People.” No doubt the books Dr. Attia recommended are excellent sources, but if you want a quick primer that covers the main talking points, these are it.
    Dr. Attia, excellent post, as always. I couldn’t agree more.

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  66. Margaretrc  June 15, 2012

    @LynneC, banning cigarette smoking in public places protects people who don’t smoke from having to be subjected to something that, at least, they don’t like and at most may be seriously harmful to them. (Some people like my husband can have asthma-like attacks triggered by cigarette smoke nearby.) Banning supersize drinks doesn’t really protect anyone, though it does inconvenience those who choose to over consume added sugar and thus hurt themselves. One keeps people from hurting others with their personal choice, the other tries (we’ll see how successful it is) to protect people from themselves. Big difference.

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    • jw  July 11, 2012

      Headline:
      “Chestnut eats 68 hot dogs to win” (Nathan’s hotdog eating contest)

      So, let me get this straight: drinking a zero calorie, 32 ounce Diet Coke is illegal, but eating 20,000 calories in ten minutes is celebrated by the entire city?

      (BTW, since this is Peters’s site, that was approximately 1,500 grams of carbs in ten minutes, or what he eats in a month…)

    • Peter Attia  July 11, 2012

      Hilarious calculation!

  67. Tom  June 27, 2012

    The government already has an immense amount of control over our health, through the administration of its food and drug policy. Everything else, including Mayor Bloomberg’s attempt to limit soda, pales in comparison. The difference is that Bloomberg’s attempt is overt, while the real control is covert, and exerted through the campaign coffers of Cargill, Archers Daniels Midland, the other big agribusiness giants, and big pharma.

    Both Bloomberg and Cooksey are being attacked because in an infinitesimally small way, they challenge this control. Granted, in Bloomberg’s case, the challenge might be clumsy, but because of our wonderful Supreme Court, we can be virtually guaranteed that “people” like Coca-Cola, Pepsi, Archer Daniels Midland, et al will exert their “speech” in the form of millions of dollars so that Bloomberg will have to do the same thing Cooksey is doing – shut up.

    I discovered your site in a biking forum. Wow! I’m just glad you’re publishing in CA, and not in North Carolina!

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  68. jw  September 25, 2012

    Hopefully this is not too political, but it was the headline on the Drudgereport just now:

    http://townhall.com/columnists/kyleolson/2012/09/23/complaints_mount_against_michelle_obamas_new_lunch_menu

    Complaints Mount Against Michelle Obama’s New Lunch Menu
    By Kyle Olson
    9/23/2012

    In Wisconsin, high school athletes are complaining about not getting enough to eat each day, due to the skimpy new school lunch menu mandated by the United States Department of Agriculture and First Lady Michelle Obama.

    The story we published earlier this week on that subject is unfortunately not unique. Students across the country are complaining about the new school lunch regulations.

    Perhaps the real motive is to starve students into slimming down. Just ask students in Pierre, South Dakota who, too, are in an all-out revolt.

    “I know a lot of my friends who are just drinking a jug of milk for their lunch. And they are not getting a proper meal,” middle school student Samantha Gortmaker told Keloland.com.

    Despite the fact that the new regulations have increased the cost of a lunch 20 to 25 cents per plate, it’s not pleasing students.

    Some are throwing away their vegetables while others are adapting to the rules by becoming industrious. In New Bedford, Massachusetts, students have created a black market – for chocolate syrup. The kiddie capitalists are smuggling in bottles of it and selling it by the squeeze, according to SouthCoastToday.com.

    Nancy Carvalho, director of food services for New Bedford Public Schools, was quoted as saying that hummus and black bean salads have been tough sells in elementary cafeterias. That means even smaller children are going through the day fighting hunger pains, which can never be considered a good thing.

    One government official tried to put the blame on the students.

    “One thing I think we need to keep in mind as kids say they’re still hungry is that many children aren’t used to eating fruits and vegetables at home, much less at school. So it’s a change in what they are eating. If they are still hungry, it’s that they are not eating all the food that’s being offered,” USDA Deputy Undersecretary Janey Thornton was quoted as saying.

    Ms. Thornton just put her finger on the problem. The government is trying to impose a new diet that children are not accustomed to. It’s not reasonable to expect them to either eat what the government deems healthy or go hungry.

    Many will opt to go hungry, and that’s the government’s fault.

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  69. jw  February 28, 2013

    FWIW, Michelle Obama in today’s WSJ:

    http://online.wsj.com/article/SB10001424127887323884304578328682206937380.html#printMode

    Summary – less sugar (OK), more fruits, less fat (hmmmm….)

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