Contrary to claims, Virta has not “reversed diabetes”.

Not tolerating carbohydrate is a pathology. If diabetes has been reversed, glucose tolerance should be restored. If glucose tolerance has not been restored, then LCHF is no different paradigmatically than symptom management with pharmacotherapy.

That disease reversal requires a test with carbohydrate does not imply that a high carbohydrate diet should be resumed for more than a few days, if a low-carbohydrate diet is the preferred means to achieve disease reversal.

That disease reversal requires a test with carbohydrate only implies that a brief demonstration of carbohydrate tolerance is necessary to demonstrate disease reversal.

A few days of carbohydrate at reasonable calorie intake will not compromise glucose tolerance if disease reversal has been achieved. If it does, then disease reversal has probably not been achieved.

Since Virta has not verified disease reversal in the manner explained above, it cannot be said that the Virta study has achieved reversal of diabetes. This is well-understood by the Virta scientists, and it is still unknown why their study has not incorporated this evaluation.

(Originally posted January 10, 2018 on Medium: https://medium.com/@kevinnbass/the-data-do-not-support-the-idea-that-the-low-fat-dietary-guidelines-caused-the-obesity-epidemic-687e382894ed. Copied in full to Patreon September 21, 2018, with sporadic additional commentary as noted in the text.)

According to Dr. David Ludwig and many others endorsing the Low Fat Dietary Guidelines Caused Obesity Story (including Dr. Robert Lustig, journalists Gary Taubes and Nina Teicholz, and others), the Dietary Guidelines for Americans (1980) caused Americans to reduce fat consumption, increase carbohydrate to compensate for the reduction in fat, and become obese.

This occurred because, according to the story, carbohydrate is uniquely obesogenic: carbohydrate consumption is said to stimulate appetite and food intake. And, because carbohydrate consumption increased as a result of the dietary guidelines, the dietary guidelines can therefore be said to have caused the obesity epidemic. The conclusion: if we change the dietary guidelines Americans will eat fewer carbohydrates, and the obesity epidemic will be solved; in short, to regain our health, we must to return to the Lost Lower Carbohydrate Dietary Guidelines Golden Age.

I believe that a substantial range of data demonstrate that this story is incorrect and not even plausible from the point of view of a well-informed human behavioral ecology. However, for the time being, I will focus simply on refuting a core claim, namely that in response to the Dietary Guidelines for Americans, fat consumption was drastically reduced. I will demonstrate here that this claim is directly contradicted by the available evidence, namely that released by the Centers for Disease Control and Prevention (CDC) and United States Department of Agriculture (USDA). I know of no available evidence that supports this core claim of the story.

Although I have characterized the position that I will be providing evidence against, before proceeding let us focus on precisely the words used by the proponents of the story in question. I will focus on the claims of Dr. David Ludwig, in part because of his influence, in part because his statements are representative of the widely held narrative. But mostly, I will admit, because he told me I am wrong.

But unless I have made some fundamental error in my dozens of hours spent in front of Excel spreadsheets, poring through, organizing and re-organizing, and thinking about the data, then I am not wrong. I do not rule out the possibility that I have made such an error. Much stranger things have happened in science, to more gifted individuals.

Therefore I’ve no ego in this. But, I will argue against what I interpret as a popular myth, based upon a long and careful assessment of the data. I hope if someone has a different interpretation that they feel equally certain about, they will do the same in turn against me.

Onward.

That’s a misleading statistic, Kevin. If we’re to look at trends, then total fat vs total carbs is more relevant — and that point is clear (it’s been the processed carbs). For a more complete review, see my pieces JAMA or CNN, linked here: https://t.co/GMriOyh8U7https://t.co/104Ap8D74H

 — @davidludwigmd

In providing these quotations, I will reference the above article, as well as the CNN and JAMA articles that Dr. Ludwig has provided as support for his claims in that original article.

Quotation from the original article that started this discussion:

Source: https://medium.com/@davidludwigmd/genetic-study-supports-carbohydrate-insulin-model-of-obesity-327d84be6d2b

(It is worth noting that Stephan Guyenet [Twitter: @whsource] has written an interesting rebuttal to this post of Dr. Ludwig’s, here: http://www.stephanguyenet.com/interesting-new-genetic-study-on-insulin-secretion-and-body-mass/. – KB 09/21/2018.)

It is worth noting here that Dr. Ludwig considers the “low-fat diet craze” a central point of contention, and indeed, as we shall soon see, the causal factor of the “flood” of processed carbohydrates that he believes is responsible for the obesity epidemic.

Now, let us take a look at the relevant quotation from the CNN article that Dr. Ludwig references in his tweet:

Source: https://www.cnn.com/2016/10/05/opinions/debate-low-fat-diet-ludwig/index.html

Here Ludwig cites unreferenced figures (>40% to ~30%) that I shall soon show are at odds with known facts. Perhaps more important, however, Ludwig causally links the replacement of fats with carbohydrates to “surging rates of obesity and diabetes”. Once again, we see how pivotal the notion of “low-fat” is to Dr. Ludwig’s explanatory schema — and how dramatic he considers the shift from the traditional American diet to the post-1980 low-fat diet to be. As we shall see, however, low-fat was neither causal in the increase in calories, nor was fat indeed reduced; fat increased after the guidelines were released.

Let us finally look at the relevant quotation from the Journal of the American Medical Association (JAMA) opinion piece that Ludwig referenced in his tweet:

Source: https://jamanetwork.com/journals/jama/article-abstract/2564564

Again, we find an unreferenced “30%” figure, as well as the claim that this 30% figure was caused by the dietary guidelines. The 30% figure is demonstrably untrue; the claim of causation by the guidelines is both unestablished and unreferenced, and I believe does not hold up to scrutiny when compared to the behavioral scholarship that is presently available to researchers.

What do the data say? We will begin by using USDA ERS data. USDA ERS data are obtained by USDA. USDA surveys food producers and compiles these records to estimate the total production in a country, county, city, etc. There are dozens of survey types, covering many types of food producers. USDA tries to capture data from all major food producers. USDA ERS supply data is considered a good proxy for consumption, though it cannot easily take into account waste. Because of this, calorie estimates per capita are often higher than what is actually the case. This is an important limitation of USDA data. However, USDA data are generally regarded as representative of food consumption trends, even as the number of absolute calories may be substantially lower.

With these caveats, let’s take a look at USDA supply data on fats and total calories.

As we can see, supplied calories from fat has consistently increased since 1910; they have not been decreasing relative to America’s traditional diet; they have been increasing; arguably, fat calories supplied increased at a faster rate post-1980 than before. This is not consistent with Ludwig’s claim that fat was reduced after the release of the Dietary Guidelines, nor with the claim that fat was higher before the guidelines.

Indeed, immediately after the guidelines were released, we actually see a small spike in fat calories supplied, the opposite of what we would expect if Ludwig’s hypothesis were true.

To remind ourselves of Ludwig’s claim that fat decreased, let us revisit his quotation from JAMA:

Note that Ludwig is correct that total calories have increased. Indeed, this increase, according to USDA and as we shall see, has largely been driven by an increase in fat calories — not carbohydrates.

Let us now take a look at the percent fat of total calories changes:

Although there is indeed a decline in fat calories as a total % of total calories, note how modest this decrease is, from 41% to 37%, or a 4% decline. Yet, this 4% decline in fat calories is claimed to account for the obesity epidemic.

Is this a plausible theory?

(Note, as a percentage of total calories, the increase in fat calories from 1980 to about 2000 (seen in the previous graphs) does not translate into an increase in fat %. This is because carbohydrate calories during the 1980–2000 period are increasing at an even faster rate than fat calories.)

Note, moreover, that by the year 2010, fat calories % was actually higher than in 1980. If Ludwig’s theory were true, we might therefore expect for carbohydrate intake to have decreased to levels below that of 1980. However, we can see that this is not the case:

Here we can see that carbohydrate intake in 2010 was still much higher than in 1980, and had only decreased modestly from its height in 2000 — despite a record high in fat intake (and, correspondingly, obesity).

Finally, let’s take a look at food categories and see what these have been doing over the past 40 years.

And here’s the whopper: over the past 20 years, fats have been the only major food category to increase. Everything else has gone down. Calories up, obesity up.

Perhaps most worrying for Ludwig’s thesis is that USDA reports a slow decline in calories since 1909, then a sudden sloping upward starting in the 60s and 70s.

The sloping downward makes sense: people are doing less physical activity and consume fewer calories. But the sudden increase in calories starting in the 60s and 70s needs to be explained. And it can’t be by Ludwig’s theory.

Now, it might be argued that food supply data do not adequately show real consumption trends. Let us therefore look at data from the CDC, obtained through the National Health and Nutrition Examination Survey (NHANES). NHANES, like USDA ERS, estimates food consumption, but through a different method: consumer surveys. I prefer USDA data, and I am not alone. It is objective. NHANES data reflect aspirations and what people believe they should be doing, rather than what they are doing. Multiple studies have shown that consumers underestimate total calories consumed — and especially fat. Obese people underestimate more than lean people.

Nonetheless, we will look at the NHANES data, and as we shall see, it too tells a different story than Ludwig’s. Let us start with total fat calories reported:

As we can see here, consumers actually reported an increase in fat calories just after the Dietary Guidelines were published. This contradicts Ludwig’s (and others’) claim that a decrease in fat calories caused people to eat more carbohydrates, becoming obese.

Moreover, if fat grams are increasing, then according to Ludwig, carbohydrates should be decreasing. Yet, according to NHANES data, carbohydrates went up dramatically:

Why carbohydrates went up is anyone’s guess. But it wasn’t driven by fat going down.

Now, what makes less sense is that even as fat in the food supply went up over 200 calories per capita according to USDA, reported fat only increased slightly. While this goes against Ludwig’s thesis, I don’t have a explanation that I am confident about for why this should be.

One possible explanation is that all of this added fat is in the form of cooking oils in restaurants. Because the cooking oils are thrown out after they are used, presto, consumers eat the same amount of fat, but more fat in the food supply is recorded. This is supported by the USDA data, if we take soybean oil to be the principal form of added oil in cooking oil.

For this explanation to work, we would need to see at least *some* decline in other sources of fat in USDA data to compensate. This is because if people are increasing their fat intake through restaurant-fried foods (if only modestly, i.e. much less dramatically than USDA would indicate), they would need to decrease their other sources of fat intake.

We see something like this in the USDA data. People consume less margarine, less tallow, less red meat, more chicken. Balanced out, people would seem to be consuming an uncertain amount more vegetable oils, and an uncertain amount of fat from other sources.

Another explanation is that as people get fatter, they progressively underreport their fat intake. This is supported by the findings of several papers. One, published in the International Journal of Obesity, reports particularly striking results, with an increase in underreporting as the obesity epidemic increases, with obese individuals underreporting more often than non-obese individuals. A screencap of the abstract:

This article may incidentally also explain why carbohydrate and calorie consumption seem to be going down in NHANES, even though the obesity rate continues upward only slightly slower than in previous years.

Finally, let’s look at the NHANES data reported as a % of fat — not total quantity.

From 38% to 34%, despite an increase in total fat. A far cry from >40% to nearly 30%, which is Dr. Ludwig’s charge. This change literally consists of a few grams of fat per day, causing the obesity epidemic. Again, note that the total fat calories are identical in 2010 to those in 1980. Only the total calories have changed.

Wrapping up. As food for thought, let’s look at China, perhaps one of the most dramatic cases of an explosive and sudden obesity epidemic in the known record. What does China teach us?

(Macronutrient figure adapted from Wan, 2017. Diabetes data from Shen et al, 2014; overweight/obesity data from WHO.)

(And to answer the pre-empt the question: no, it’s not because of an increase in sugar. Sugar consumption in China has remained incredibly low and stable for the past half century.)

To nutrition afficionados in these days, such graphs may strike some as confusing, even bizarre. In part, this is because a lot of us have been taught that carbohydrates cause obesity. But again, epidemiologists have known for generations that the nutrition transition accompanying industrialization classically looks like China’s — with the attendant diseases.

People deserve to know the truth. The truth goes deeper than anything presented by the low carbohydrate advocates. And it is much more complex than anything I have presented here. But only with the truth can we solve our present crisis of obesity and chronic disease.

The low-fat-caused-obesity story is a myth, and one that needs to die. Will Dr. Ludwig help us put this myth to rest? We can hope. The sooner we can come to an agreement, the sooner we can solve the present crisis — which is one of far greater significance than merely health, as Dr. Ludwig has written — and help the many people who struggle with their weight and their health.

In the meantime, for an in my opinion excellent overview of what many obesity researchers do think makes us fat, I recommend obesity researcher Kevin Hall’s recent article, “Did the Food Environment Cause the Obesity Epidemic?” http://onlinelibrary.wiley.com/doi/10.1002/oby.22073/full

I look forward to comments and criticisms.

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As an MD/PhD student, my passion is for communicating the cutting edge of medical science and fighting misinformation. If this post is of use to you, please consider donating to my Patreon account. Your contribution will make a significant positive impact, and I will be greatly personally appreciative.

You can sign up as a patron at my page, here.

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You can find me on Twitter at @kevinnbass.1 LikeChris (cp_elevated)Thank you so much for this post. It’d be interesting to look outside the US as well. We know obesity is a global epidemic but does that mean every country implemented diet guidelines that caused the fattening up of their own citizens? I find Gary Taubes’ theories are very US-centric, though I haven’t read all of his writings.

“Eat like your ancestors. Go Paleo like your caveman forebears. Eat in an evolutionary way. Cut gluten—our ancestors didn’t eat wheat—and gain your health back. Intermittent fasting—like hunters who haven’t yet caught their prey—maintains lean muscle mass but shreds fat: it’s how we were evolved! Whole30: 30 days of eating like evolution wants us to!”

We are told over and over that if we “just eat like our ancestors,” we will attain optimal health.

But what if this is a popular myth, an ideology that romanticizes the past, and what if the diets that propose that one eats in this way are based on mythical constructions of that past?

I disagree that we should “just eat like our ancestors.” Here’s why.

1. What did our ancestors actually eat? Knowing what our ancestors ate is possibly as difficult or more difficult than nutrition science itself. For instance, it was long thought that our ancestors never consumed grains. We now know that grains were regularly and almost universally consumed during the entire record of the Paleolithic to which we have access:

(From: “Plant foods and the dietary ecology of Neanderthals and early modern humans“)

2. Which ancestors to look at to eat like? What our ancestors have eaten has changed radically and rapidly over time. A brief look at the history of the European diet over the past one or two thousand years demonstrates this clearly. (For example, see: https://en.wikipedia.org/wiki/Medieval_cuisine.) The wide variety of documented dietary strategies in the anthropological and archaeological record does likewise.


(Credit: Jen Christiansen, Scientific American)

3. What timeframe is most important for evolutionary change? Recent evidence suggests that recent evolutionary change could be the most rapid. (For more, see: “Recent acceleration of human adaptive evolution“.)

4. What are our goals? Our ancestors were optimizing for fecundity not longevity, and within certain resource and/or time constraints. Many of us are optimizing for long-term health, and we have far fewer resource constraints. Our ancestors were looking to stay alive and maximize survival reproduction. They didn’t have their eyes on how they will maintain health into their 70s, 80s, 90s, or even 100s, because most of them did not expect to make it to those ages. Today, we face the real possibility of living that old—especially if we maximize health and minimize our rate of aging early in life.

It is true that industrialization and what might be called the post-industrialization of the food system has been a catastrophe for chronic disease risk. And starting with whole foods is likely to be the best starting point for creating a diet. But that’s the end of it.

After that, a better approach is to look at populations that have the characteristics we want—say, maintaining a healthy weight and being healthy for as long as possible—and try to determine what features of these populations explain these characteristics. Using animal models, well-designed observational studies and wherever possible randomized clinical trials in modern populations, we then test our ideas. If our ideas hold up to these tests, we incorporate our findings into recommendations. If they don’t, or if they have intolerable downsides, we try to explain why we got things wrong.

Logical, science-based. No romanticization of a past that we reconstruct in our imaginations involved. No conspiracy theories necessary. Modern health science incorporates all evidence in a critical way to come to conclusions. That is why modern science is better than the Paleo paradigm or so-called ancestral health.

We still must tailor the recommendations to our own life situations. Only we as individuals are can adapt the science to what feels best and healthiest for our own bodies. But we need to keep our minds open to what the cutting edge of hard, critical science can contribute to that quest for personal optimization. It isn’t always–or even often–what the Paleo gurus would have you believe.

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As an MD/PhD student, my passion is for communicating the cutting edge of medical science and fighting misinformation. If this post is of use to you, please consider donating to my Patreon account. Your contribution will make a significant positive impact, and I will be greatly personally appreciative.

You can sign up as a patron at my page, here.

===

You can find me on Twitter at @kevinnbass.

It was two months since I had last stepped into a Jiu Jitsu gym. A white belt having started training 6 months ago, spar after painful spar I had been getting absolutely DECIMATED. It was demoralizing. While I had played plenty of sports as a kid, I didn’t have a martial arts or wrestling background except for Tae Kwon Do, briefly, when I was 10. I hadn’t even watched much UFC. But I had always admired martial artists and loved, loved, loved the movies. And I had always wanted to be like that. But until a fellow MD/PhD student, who also happened to be a Brazilian Jiu Jitsu (BJJ) brown belt, started rotating in our lab, I hadn’t known how to start. So when we got to talking about BJJ, I immediately asked him if I could visit his gym with him.

As I said, the learning curve was steep. I didn’t know what a triangle or an arm-bar were. While I came to the gym 2-3X/week to learn, getting tossed around like a ragdoll was humbling. Demoralizing, really. And day after day, it just hurt. Then graduate school started becoming intense.

If I had to cut gym time to 1X/week and would feel like I was stagnating, could there be a better way? Yes: convincing the wife to become my daily training partner. Each and every morning, 7 days per week. I taught her some grip breaks and submissions. She was hooked. So, rather than give up, I bought some mats. I bought a heavy bag to drill on. I bought a Swiss ball for the same purpose. And I started getting serious about kettlebells. Here is the completed project, also known as my bedroom:

(The desk and the chair have since been jettisoned. And before the break, we were drilling on four mats. I also have a few more kettlebells: they’re my babies.)

So when I dropped into the gym two months later, I came to CRUSH. And crush I did. When drilling on my own, the rough outline of the whole game had started to become clear in my mind. Repeatedly I drilled takedowns, submissions, positions, transitions, escapes, sweeps. As the venerable Mr. Miyagi had once said:

I trained everything.

It translated. I was landing submission after submission. Oh, I was still eating my humble pie. But much of the time I wasn’t. Ten pounds heavier, I felt stronger. And more flexible. And comfortable with the basic positions. I was still somewhere at the bottom of the pile, but I wasn’t at the bottom of the bottom. I had become a decent, solid white belt.

This would all be a cool story if it hadn’t come at a price. And come at a price it had. You see, just a few days earlier, my temperature had started slowly increasing…

After smashing and getting smashed, I limped home, my body broken but my spirit victorious, and I went to sleep. And I woke up to this:

And this:

On a good day, I might look something like:

I had never seen a resting heart rate pattern overnight like that before.

So, the next day I ambled about, hardly able to move. I felt my temperature spiking further, and probably not very intelligently, I rode my bike home, burning hot and with a terrible body flu.

I slept. And the next morning, I woke up to see:

Things were really… heating up.

That’s not the worst of it, though. This temperature spike was on the background of an overall trend downward of temperature (probably related to a decline of total calorie intake and expenditure, as I am actively cutting intake in order to lean out). Here is what things look like relative to the trend over the past 30 days, not the past 3 months:

Almost a 4 degree spike over the average of the previous 30 days!

One thing I noticed starting about a week ago: No overt symptoms. But I felt just… dissatisfied. Upset. Not at ease. Somewhat depressed. No other symptoms. Just “under the weather”.

I was feeling the illness mentally that I could only see on my Oura ring, and which I was only to experience a full 5 days later physically.

Did this subclinical illness progress into a full-blown flu by overstressing my body during training? Or did the stress cause another infection to be superimposed on top of the first?

The relationship between exercise and infection has been studied formally. Two reviews (here and here) each suggest that while moderate exercise is immune system-boosting, strenuous exercise is to be avoided. One review even suggested that training through unresolved illness could be a trigger for chronic fatigue syndrome, a notoriously poorly understood illness. Another study suggested that a drop in antibodies–which fight off infections–occurs acutely immediately following exercise. This makes sense, because cortisol also spikes after exercise, and cortisol is a potent immunosuppressant.

Takeaways:

  1. We are sometimes ill and don’t even know it.
  2. If you’re running a fever and feeling run down, laying off the training might be a good idea. Well, duh. But sometimes training makes me feel better. Now I know to think twice: if my temperature looks OK, do it. If I am running high, lay off.

Bonus: What about eating and illness? We have all experienced appetite loss with acute illness. Does this have any adaptive function? We have some preliminary answers to that, though it may depend on what kind of infection one is dealing with. In mice, survival from bacterial infections were shown to be highly responsive to glucose intake. Here is how mice responded when injected with Listeria bacteria:

Basically, they stop eating when infected, consistent with the evolutionarily preserved “sickness syndrome.”

But does this serve any real purpose? What happens when you force-feed the mice who stop eating? As it turns out: they die.

As always consult a medical professional when making treatment decisions. But it may be the case in certain infections where one loses one’s appetite or one feels a little less inclined toward physical activity, it might be a good idea to heed those signals: they might be there for a reason.

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As an MD/PhD student, my passion is for communicating the cutting edge of medical science and fighting misinformation. If this post is of use to you, please consider donating to my Patreon account. Your contribution will make a significant positive impact, and I will be greatly personally appreciative.

You can sign up as a patron at my page, here.

===

You can find me on Twitter at @kevinnbass.

1. The Role of Medicine by Thomas KcKeown
McKeown's book had an extraordinary influence on the discussion of what we now call the "social determinants of health." The central argument of The Role of Medicine was that the vast majority of improvements in health through the 20th century have not been due to medicine--but due to social factors promoted by reformers, activists, and philanthropists. Although his hypothesis that nutrition undergirded much of the gains in 20th century health is now usually disregarded for one favoring cleaner water supply, McKeown's arguments are persuasive and they haven't been entirely set aside by many prominent social scientists. McKeown's enduring legacy is in having shown that the epidemics that had hitherto plagued civilization were not defeated by antibiotics or vaccination--but by improved environmental factors. (This does not mean that antibiotics or vaccination are not useful or have not helped--it just means that the majority of progress in the reduction of mortality was not made by use of them.)

Some recent counterarguments to McKeown claim that, in fact, statins, antihypertensives, and open heart surgery have made similar progress in recent years as McKeown's environmental revolutions made at the turn of the 20th century. Both views are likely right: historical developments in medicine are likely overblown, yet rapidly advancing medical technology is likely to make such feebleness a thing of the past. Yet still, for improving our countries' health environments, much work remains to be done.
2. Bad Science by Ben Goldacre
In this riveting book detailing quackery both within medicine and outside, Goldacre takes a scalpel to bad science and in doing so, lays open both the underbelly of the modern medical-industrial complex and suggests a better way. Goldacre while inclined almost to polemics at times provides a necessary corrective to Whiggish tendencies to falsely regard modern medicine or the quackery that stands against it as the solution to our health problems. Often, in terms of effective treatments, we are on our own. And that fear, not the effectiveness of quacks or of medicine, is probably why we run headlong into the open embrace of the reassurances of modern medicine or of the quacks who decry it. If we choose the more difficult path, it does not have to be this way. Most of us won't.
3. The Omnivore's Dilemma by Michael Pollan
The book that self-deluded quacks and shills alike can agree is, at the least, fairly well written, TOD is possibly one of the greatest books written about food in our generation. Covering different styles of eating, from the industrial to the agricultural to the hunter-gatherer, Pollan eviscerates the madness of the modern food system but tries to search for a middle-ground between the reckless ingenuity of man and the maddening and sometimes inhospitable vicissitudes of nature. Monsanto is, as always, singled out as a monster, spawning a cottage industry of green activists mistakenly obsessed with the toxic threat of pesticides to the purity of our food--and of a simpler way of life. Wendell Berry's quixotic and imaginary vision of a life of community based in agrarian values laid out in Culture and Agriculture features strongly. Pollan is a master storyteller but often places a folksy, modernity-anxious ideology ahead of science in his quest for coherent narrative. The Omnivore's Dilemma, more than any book, started my journey into the world of food. May people enjoy it and take it seriously, but not too.
4. In Defense of Food by Michael Pollan
Responsible for bringing the concept of nutritionism to modern consciousness (at least in book form), in this work Michael Pollan coined the now famous phrase, "Eat food, not too much, mostly plants." Food in this sense is meant in opposition to what Pollan calls "food-like substances," which are ingestible food-like items that are industrially produced but "would not be recognized by your grandmother" as food.

Like TOD, this text is shot through with modernity anxiety and a deep mistrust of established authority--an enduring theme in the genre, and of course, in American literature as a whole. But what will endure from this book is the idea that food when eaten is experienced--not studied. This concept would have a major influence in encouraging eating guidelines to abandon a focus on macronutrients, food groups, calories, etc., starting with Brazil and now Canada.

Whatever its flaws, this book can only be regarded as a masterpiece of the genre and a bedrock of progressive health culture.
5. Good Calories, Bad Calories by Gary Taubes
Largely responsible for putting hormones on the map in the popular discussion on nutrition, Taubes's impact has matched if not exceeded Pollan's, with Taubes's tendrils of impact spreading in popular culture as rapidly as Pollan's ideas are affecting government policy. Where Pollan may have impugned corporate America and the misplaced Mandarin musings of misguided researchers in a modest if sternly disapproving register, Taubes scribbled wild conspiracy-mongering screeds against the machinations of ambitious but illegitimate scientists who apparently tricked their colleagues into believing that blatantly cherrypicked research was not a grand farce. Except Taubes's claims in this respect were not true, as detailed in a recent white paper. These ideas continue to be perpetuated endlessly by conspiracy mongers and increasingly seedy participants (many of whom have extensive disciplinary records at the hands of health boards) in the keto community.

Ah, so something nice to say about GCBC. Well, it was right in saying that calories are not the end-all, be-all. Food quality is. However, Pollan said as much, so the real question is one about carbohydrate. Taubes was possibly partly right about carbohydrate but probably mostly not. The ketogenic diet may have important longevity and/or cancer treatment implications and may have caused the discovery of more than a few important metabolic regulatory steps.

I remain mostly convinced that Taubes was the master of not letting the facts get in the way of a good story. GCBC should be seen as a character study in how a brilliant mind can go wrong--akin to Newton's dabbling in alchemy or Einstein's obsessive rejection of the empirical implications of quantum mechanics--albeit at a likely lower register. As plant-based diets gain increasing popularity, Taubes's work will continue to provide the gunpowder to the counter-barrage, and mostly lacking justification. A few of its major contentions, that metabolic function can be undermined by certain kinds of foods, might be lasting in their implications, influence, and truth--in large part through the experimental verifications of David Ludwig, a Harvard professor and a Taubes spiritual (if not actual) low-carber-in-crime.

As a person, I cannot help but very much like Gary Taubes. As a science writer, I cannot help but write things that are not positive.


Professor Timothy Noakes is well known in the world of science. His work has played an important role in the world of sports science. He has published more than 400 scientific articles–a remarkable and unusual feat of scientific productivity. He has earned both a medical degree and a doctor of science and received a remarkable number of accolades.

Tim Noakes is also a kook.

In 2014, for instance, he wrote a tweet suggesting a defense of Andrew Wakefield stating that the CDC was behind a conspiracy to cover up a link between vaccines and autism. https://en.wikipedia.org/wiki/Tim_Noakes 

Also in 2014, Noakes recommended that a woman wean her baby onto a low-carbohydrate diet and became embroiled in a nearly 4-year hearing by his country’s health professionals organization. https://en.wikipedia.org/wiki/Tim_Noakes

Tim Noakes rejects that LDL causes cardiovascular disease, a central lynchpin of modern medical science. https://en.wikipedia.org/wiki/Tim_Noakes

Correspondingly, he rejects the use of statins and has a long history on social media of suggesting that statins are harmful, and of endorsing the work of fringe figure and LDL denialist Uffe Ravnskov. https://twitter.com/search?l=&q=statin%20from%3Aproftimnoakes&src=typd&lang=en&lang=en

Noakes has been known to claim that not eating carbohydrates prevents or cures cancer on multiple occasions. (Carbohydrate restriction may help treat some forms of cancer, but research is still in the preliminary stages.) Noakes also endorses the view, rejected by the large majority of professional obesity researchers, that insulin resistance precedes and causes obesity. https://twitter.com/ProfTimNoakes/status/941026898091618304 …

Although Mendelian Randomization experiments suggest that high insulin secretion can precede obesity, such experiments suggest that only about 1-10% of obesity is explained in this way. http://clinchem.aaccjnls.org/content/64/1/192?ijkey=130c91dd6dcb0c60817738f98872ba7465543ea1&keytype2=tf_ipsecsha

Demonstrating the (unfortunate) weakness of present scientific capacity, Noakes in an editorial misinterprets this paper and indicates that he believes that it demonstrates the causality of insulin resistance for obesity. It does not. The most reasonable interpretation is that whatever Noakes’s past scientific performance, old age has likely not enhanced his abilities. Likewise, he seems at ease musing over extreme positions before a following that is not well trained to evaluate these positions.

In response to a thread that I posted on Twitter about Noakes, Jacques Rousseau, a longtime critic of Professor Noakes, sent the following very interesting link to a legendary debate that Noakes was involved in: https://twitter.com/JacquesR/status/1088902639134355456

In it, Noakes guaranteed the audience that a low-carbohydrate diet would make one immune to cancer, dementia, and diabetes. Learning this, I just had to listen to the entire debate.

As I was doing my laboratory work, I listened. Here is a point-by-point account.

At almost 20 minutes in, Noakes denied that saturated fat raises LDL. This is false, as Mensink and hundreds of studies have shown: https://apps.who.int/iris/bitstream/handle/10665/246104/9789241565349-eng.pdf. It is difficult to believe that a scientist could say such a thing. One of the only conclusions to be drawn is that he has not actually read the relevant research.

Just at 20 minutes, Noakes also claims that polyunsaturated fats are inflammatory. This is not supported by the evidence which shows that in humans polyunsaturated fats are either neutral or anti-inflammatory. Although theoretical considerations would cause people to think that polyunsaturated fats might be inflammatory, human studies have shown that these theoretical considerations have not been borne out. Yet they persist, apparently in Tim Noakes, who dismisses evidence in favor of them. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4424767/

(It is true that weight loss will reduce systemic inflammation, so one can have low inflammatory markers on a high-saturated fat diet. Likewise, one can also have high inflammation on a polyunsaturated fat diet if one’s body weight is high. Body weight and in particular body-fatness is the dominant determinant of the body’s inflammatory state, and if cutting added oils helps to reduce body fatness, good. But on an isocaloric basis, the research points overwhelmingly to oils being neutral or positive on inflammation. That is why when people lose weight, their systemic inflammatory markers decrease. When they gain weight, these markers increase. This is because being overweight is stressful on the body’s cells.)

Back to Noakes. Between minutes 20 and 50, there is much hand-waving but little actual evidence. By 50 minutes, it’s conspiracy theories: MRC and NIH won’t fund trials to test his ideas because they know he is right and want to prevent discovery of a cure for cardiovascular disease, cancer, diabetes, dementia, etc. After his claim that you won’t get dementia, diabetes, or cancer if you don’t eat carbohydrates, he then says, “Those diseases did not exist until we started eating the highly processed foods.”

This is in fact false. Dementia was documented since the beginning of recorded history: https://www.ncbi.nlm.nih.gov/pubmed/16442123.Cancer has also been documented in 1.7 million hominid ancestors: https://www.sajs.co.za/article/view/3566. (And of course “cancer” was coined by classical Greek physician Hippocrates. Oops.)

Many prehistoric animal fossils with tumors have been discovered, e.g.: https://www.sciencedaily.com/releases/2016/12/161208121323.htm So yes animals got tumors before the advent of McDonalds. (Another such report comes from Erwin Ackerknecht’s 1982 introductory chapter to his book on the history of medicine.

Diabetes is different. First documented in Egypt or India about two thousand years ago, diabetes mellitus has been remarkably rare throughout human history in the West, with physicians living in the grain-based Roman Empire rarely encountering the disease: https://en.wikipedia.org/wiki/History_of_diabetes. Some scholars have even maintained that diabetes was not first definitely documented in the West until after the middle ages (source: chapter from Burkitt and Trowell’s 1981 edited volume). This is probably because the degree of energy excess and food-processedness is indeed unprecedented today compared to the past.

Nearer the end, in response to people upset about the expense of his diet, Tim proposes that we should not be eating meat at all, but the guts, the bones, and the brain of the animal instead. He suggests that this approach will solve the problem and make his diet affordable to the poor.

An appropriate ending to this thread. Thank you for reading.

(This post is based on my January 25th, 2019 Twitter thread, here: https://twitter.com/kevinnbass/status/1088933196341960704.)

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As an MD/PhD student, my passion is for communicating the cutting edge of medical science and fighting misinformation. If this post is of use to you, please consider donating to my Patreon account. Your contribution will make a significant positive impact, and I will be greatly personally appreciative.

You can sign up as a patron at my page, here.

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You can find me on Twitter at @kevinnbass.

1. The desire for total self-reliance leads to the belief that one can and should have a competent opinion on everything;

2. The belief that one should have a competent opinion on everything leads to a lack of nuance, since having an opinion on everything requires a massive oversimplification of every subject. An insistence on discarding nuance is therefore an insistence on oversimplification;

3. Resistance on the part of experts to the insistence on oversimplification directly challenges and denies the values of total self-reliance. Nuance, given the finitude of the human mind, makes those values impossible from a practical point of view;

4. The insistence on nuance when particularly strong is thus viewed as intensely existentially hostile. Therefore, all that is nuanced must be weasely and corrupt; it doesn’t get to the point, which is what self-reliant regular, straight-talking people do;

5. The subtleties of expertise are therefore viewed as in fact alien, authoritarian, arrogant, deceitful, and above all, malevolent. This is fertile ground for the invention of the Conspiracy Theory;

6. The intense feelings of distrust that arise from this experience of expertise, and the new conspiratorial ideas about experts which validate these feelings, even perhaps intensify the desire for total self-reliance, restarting the cycle anew from #1;

7. The conclusion: expertise must be seen as empowering for people to be converted from the sometimes paranoid, frequently hostile worldview of total self-reliance.

They must be integrated into a new community and experience an improved sense of belonging and purpose and self-determination. This community is cannot be seen as alien but complementary–replacing what was sought in what can sometimes only be called cult-like online communities.

It’s a lot to ask for, but in my opinion… behind the wild and frequently irrational forms of argument is really a radically different mentality with a radically different worldview and set of goals.

I’ll say again, none of this is evidence-based, clearly, so that nobody calls me out on this. This is just speculative introspection that I totally made it up. But I have a desire to make sense of things, to oversimplify when I don’t have the knowledge, too. So I did that here…

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As an MD/PhD student, my passion is for communicating the cutting edge of medical science and battling misinformation. If this post is of use to you, please consider donating to my Patreon account. Your contribution will make a significant positive impact, and I will be greatly personally appreciative.

You can sign up as a patron at my page, here.
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You can find me on Twitter at @kevinnbass.

Want to write a best-selling pseudoscientific diet book? Look no further. Follow these tried-and-tested rules, and you too are guaranteed to have your very own pseudoscientific diet book best-seller.

1. Pick a calorie-dense, commonly over-consumed food;
2. Invent or cherry-pick evidence to demonize ingredients in such calorie-dense, commonly overconsumed foods using scientific-sounding jargon;
3. Recommend not consuming such toxic ingredients;
4. Enhance and “knit together” the above effect by tying the above facts into an emotional narrative commenting upon contemporary prevailing political, social, moral, or cultural concerns.

That’s it! But how does this work?

Now here’s the payoff that will allow you to understand the psychology behind your next best-selling pseudoscientific diet book.

People following these rules will lose weight by cutting the most calorie-dense foods, not because they are trying to cut calories, but they are trying to cut “toxins”. Because people are cutting toxins and not calories, they are doing two things, one POSITIVE with respect to one’s self-understanding and sense of personal efficacy. And the other NEGATIVE with respect to forbidden foods. The first thing they are doing is:

a.) Losing weight that was not one’s responsibility (the food was toxic, not merely caloric, and one never knew). This means a fresh start, renewed sense of psychological worth, and external enemy against whom one’s dieting efforts are a form of war (Big Food, Meat, Ag, etc.) Never underestimate the demotivating effects of self-blame and the value of having an external enemy to motivate purchasers of your prospective best-selling pseudoscience diet book.

The second thing they are doing is:

b.) Eliminating not just calories (somewhat innocuous) but toxins (dreadful). This means a new and stronger negative motivational frame toward toxic (read: calorie-dense) foods.

This is empowering because it frame-shifts people’s diet experiences: On the side of the person, all past failures meant nothing, the future is wide open, and everything was someone else’s fault. On the side of the foods, these are more terrifying and forbidden than ever.

Remember: toxins, not calories.

As mentioned, you must enhance the above effect by tying the above facts into an emotional narrative commenting upon contemporary political, social, moral, or cultural concerns. Examples include resentment toward impersonal corporations, anxiety/hatred of modernity and biotechnology, romanticization of the remote past or distant pre-modern places, animal rights, progress of science and modernity, masculinity anxiety, etc.

The incorporation of the above themes makes the dietary paradigm resonate with people’s personal identities and makes the rules fit within a broader worldview. This increases personal commitment to the diet recommended in your pseudoscientific best-selling diet book.

In this context, conspiracy theories are the very nearly indispensable components of the above worldview-reinforcement strategy. Conspiracy theories should be tactically deployed whenever a commonly recognized “fact” denies the possibility of important claims that your diet book requires to be made about the world but which is at odds with common knowledge or scientific consensus. In fact, you should be certain to make at least a few such claims. This serves to increase the sense by the reader that they are being initiated into a new world of previously “forbidden” knowledge, i.e. your readers should believe that they are “in the know” (versus the “normies” who are not). This increases the sense of exclusivity, prestige, and status in the adherents to your pseudoscientific diet and makes the reader more inclined to share the book with others. This also enhances adherence by making the reader more resilient to alienation from his or her peers for practicing the dietary habits prescribed in your book. Conspiracy theories when properly deployed moreover should not only “stitch up” the otherwise irreconcilable fabric of the ideas presented in the book; they should also be resonant with the worldview itself. A classic and often-used strategy is to claim in a book with a patently “anti-corporate” worldview that the sick have been lied to–and made more sick!–in order for nefarious forces to reap a profit.

If you implement the above steps and they are fully and successfully internalized by readers, those who achieve diet success will have a newly discovered inner power, an enemy, a worldview, and a dietary religion–and they will meme-ify your book and spread the word far and wide. This process is so psychologically powerful when it succeeds in provoking change that it will even convert many lifelong critical thinkers and otherwise highly intelligent and thoughtful people.

Welcome to your nutritional pseudoscience best-seller.

(Note: my speculations on this process are entirely those of an amateur. While I appreciate the field of psychology, I have no training in it apart from a few courses in college and some reading during adolescence and early adulthood. When I have commented on the psychological motivations of pseudoscientific thinking, it has been entirely an exercise of jotting down my own reflections as I have tried to make sense of a part of the world that often confuses and fascinates me.)

If you liked this article, please consider donating below.

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As an MD/PhD student, my passion is for communicating the cutting edge of medical science and fighting misinformation. If this post is of use to you, please consider donating to my Patreon account. Your contribution will make a significant positive impact, and I will be greatly personally appreciative.

You can sign up as a patron at my page, here.
===

You can find me on Twitter at @kevinnbass.

I do not pretend that I am the final judge of scientific fact. Sometimes—or even often—I am wrong. My emphasis is on intellectual humility, an openness to evidence, and a respect for the weight of that evidence.

It is important to keep our discussion of health science within the realm of the factual, and it seems to me that recently Jason Fung and many of his friends’ claims have begun to diverge ever more from this norm of decent behavior. Their claims grow ever more extreme, their self-reinforcing circle of gurus ever more cloistered. When their errors are pointed out, they neither defend or engage with the fact-checkers but instead continue promoting statements that are scientifically indefensible. They have formed a cloistered echo chamber that is accountable only to itself. And they imply with their behavior and denunciations of the establishment that they more scientific than most scientists. Theirs is the height of intellectual dishonesty, and they represent a danger to society.

Low-carbohydrate diets have interesting and potentially important health applications. I try to maintain good relationships with experts on the low-carb diet. Among low-carb people on social media, I like Ethan Weiss a lot and have had great scientific conversations with him. Likewise, while I have been critical of David Ludwig, we have often had interesting and quality scientific discussions. I love Peter Attia’s podcast and enjoy interacting with him. I will probably be interviewed by Gary Taubes; I hope to discuss with him his upcoming debate with Stephan Guyenet on the Joe Rogan Experience podcast. And although I don’t know him personally, one exemplar of science-based discussion in the keto space is Dom D’Agostino. While important criticisms have been leveled at some of Dom’s ideas in the area of cancer, it is clear that he is knowledgable and takes facts seriously.

The serious effort to try to take criticisms seriously is the mark of a scientific person, and most if not all of the above individuals try to fit that bill.

Jason Fung and many of his friends (Tim Noakes, Nina Teicholz, Zoe Harcombe, etc.) represent the opposite. Their demonstrated unwillingness to engage rationally with others shows that they regard themselves as immune to criticism. Their constant lying shows that they have little regard for the facts.

Western societies are facing multiple crises that require a clear understanding of the facts to handle appropriately. Because we live in a democracy, a widespread misunderstanding of the facts can be detrimental to a well-functioning political process. Some of these facts are related to issues with a substantial nutritional or food component—e.g. the obesity epidemic, the present crisis of chronic federal (read: healthcare) overspending, greenhouse gas emissions, and environmental degradation.

If the popular discussion is to be characterized by the circulation of claims that are factually false, the consequences to the political process—and decisions made as a result of this process—could be catastrophic. This happened at the highest levels of government in the 20th century in Europe. Arguably it is presently happening the highest levels of government today in America. Those of us with a voice and ability to influence discussion have a moral obligation to point these facts out in terms that might be uncomfortable to us.

Therefore we should say: the above-named individuals promote lies, and do so constantly and flagrantly.

Almost any paradigm, ideology, or dietary regimen that results in a calorie deficit while maintaining nutrient adequacy will improve health. Do we need lies that are tailored to inflame emotions and gain followers to achieve this? We do not. If Jason Fung’s ideas worked, and that was the end of it, there would be much less controversy. But then there would be no Jason Fung. Jason Fung has used deceptive and inflammatory rhetoric not because it is necessary to communicate his ideas, but because controversy about his lies is exceptionally good marketing for his advice. Jason Fung’s lies indeed have little directly to do with the actual recommendations he makes.

Therefore, if Jason Fung’s ideas help people, they should use them. But people should ask themselves whether the lies are necessary to embrace the truths, and whether it is appropriate to defend people’s bad behavior because one agrees with their advice. We can entertain alternative and interesting ideas without embracing pseudoscience. We can acknowledge advice without endorsing lies.

A final possibility can be suggested: that we tolerate and even secretly enjoy the lies because we are angry. Honesty is a norm of civilized society. But if one hates civilized society, then dishonesty is justified, even pleasant, even funny. It needs to be considered whether anger is the real driver of the lies coming from this camp in the health world—and whether a discussion motivated by anger is the one we really want.

The distinction between ideology and fraud is commonly asserted, but strikes me as false.

Both ideology and fraud are premised on the privileging of personal interest or feelings over a serious-minded respect for facts. Both sacrifice a respect for carefully considered facts to the desires of the ideologist or fraudster. Both represent moral failings with potentially grave consequences for others. Ideologists and fraudsters both become charlatans. That we cannot readily distinguish between ideology and fraud in nearly any case of charlatanism—ever—testifies to the fact that they are essentially the same. A charlatan is a charlatan. Whether ideology or fraud motivates him or her is a semantic distinction.

Ultimately, all fraudsters are necessarily ideologues: if only during the moment of deceit, the deceit must be believed by the deceiver to be absolutely convincing to others. And all ideologues are fraudsters: to believe something against all facts and reason requires the choice, if only implicit, to place the yearning for certainty over that for truth, i.e. to privilege something fake and whole over something real and fragmentary, to value deceit over truth.

To then communicate that self-deceit to others completes the loop: one deceives oneself with the full knowledge of the intention, then, to deceive others. In fact, this is strikingly similar to the above-described move that the fraudster makes: to force his or herself to believe, with the hope and expectation of being convincing to others.

No doubt self-deceit and knowledge of that self-deceit exist simultaneously, in a kind of oscillating dialectical relationship which is obscure to the deceiver. But, in one way, it is this very knowledge of self-deceit that drives yet more self-deceit: if one knows, even slightly, that one’s knowledge is incomplete or fragmentary, one doubles-down on the self-lie through denial, emotion, an act of will.

This is the act of the fundamentalist, the ideologue, the zealot.

However, this is too transparent to a thoughtful person to work so smoothly. Who wants to transparently believe that they reject all serious criticism, all reason, all apparent facts? For this act of rejection to be justifiable, for this strong emotional rejection of a reasonable argument or a contradiction to take place, the rejection of reason or criticism must be grounded in a moral duty: one must find ways in which lack of conviction is a moral weakness, and denial of reasonable arguments a moral virtue.

(This is what drives the moral frenzy of a suicide bomber: the suicide bombing is an act of will that overcomes all doubt and serves as proof of one’s faith. The doubling-down on the lie is sanctified by its morality.)

This is achieved by the belief that the facts themselves are immoral or corrupt. Reason itself (or the fake semblance thereof) comes to be regarded as a ruse (or act of incompetence) that only serves to conceal the truth. The mere words of the sophists, the false and idiotic statements of intellectuals, the lying of vapid wordsmiths. Appeals to reason and facts become appeals to lies and corruption. What was once appalling and irrational denialism, which is psychologically painful to many people, becomes a moral duty. What was once painful becomes thereby transmuted into the pleasant. This is the moral and psychological economy of denialism.

The “Real Truth” therefore becomes impenetrable to facts, since the reaction must always be the same: a moral, righteous act of denial that forecloses discussion.

Persons holding such an attitude are charlatans, frauds, and ideologues, all at once:

  1. Their views are based on a rejection of reality. Thus, they are ideological.
  2. This rejection of reality is based on self-deceit, which is intended to be communicated with others. Thus, they are fraudulent.
  3. This self-deceit is based on moral purpose, transmuting the immoral into the moral and fiction into fact.
  4. This self-deceit is communicated to others. Thus, they are charlatans.

This is why charlatans rarely recant, even when their reputations have fallen under the weight of their own lies. Why should they? They are, after all, right. Morally right. And since they are morally right, they are therefore also right about reality.

What could be more simple–and dishonest? The reason there is no difference between the fraudster and the ideologue is simple: lies are the lifeblood of any ideology, and the failure to refrain from telling such lies is the same as the failure to refrain from telling lies in general.

Often, we are hesitant to call someone with an opposing point of view a fraud. It stifles discussion. It is an ad hominem. It doesn’t address the real issue.

Another view, which I think is more correct, is that this norm itself is often used as an excuse for moral weakness in the face of evil. It is an unwillingness to commit to saying what we know is true. It is a commitment, at least implicitly, to appease the liar and avoid conflict.

It is easy to identify a charlatan: their unstinting, uncompromising refusal to engage in a serious and charitable way with views other than their own. Their lack of respect for other intelligent people. Their conspiracy mongering and consistent emotionality. Their lack of regard for evidence. Their intellectual inconsistency. Their relentless insistence over the course of years on ad hoc explanations when faced with countervailing evidence. Their contempt and even sometimes, their unseriousness.

Those who are intelligent but erratic or “creative” are not in the same category as such people. We all can distinguish between these types. We should talk about that distinction and apologize when we fail. And we must be charitable when we are at all unsure. But we also have the moral responsibility to make the distinction and make it openly where it is appropriate.

Just as we all have a strong thread of irrationality running through us, similarly we all have the capacity and often desire for deceit. Thus, even the deceiver, the fraud, the charlatan is not without possibility of redemption, because he or she is fundamentally like us. That is why, as an act of public education, it is important to call a spade a spade. To say who is lying and who is not is to clarify the situation to intelligent people–and even, possibly, to the liar who is in a position to reflect. It is important to be soft when mistakes are made–we all make them–but to be tough when these are repeated and the pattern of charlatanism seems to be fully in play. Engaging with charlatans as if they are serious people worthy of discussion is to ourselves participate in the lie that they seek to propagate. Being relentless in pointing out the lie undermines the lie through constant repetition, as surely as lies undermine the truth through the same such constant repetition.

It has been suggested that we live in some of the most polarized times in American history. This claim might be partly true, but it is also somewhat ignorant. Chernow tells many stories about how in the earliest days of this country, many of the most pre-eminent men had a seething hatred for one another, how there were cudgelings of political opponents on the House floor, and how a vice president once shot and killed the most distinguished advisor to America’s first president and advocate for the U.S. Constitution.

Those passions matched the stakes in a brand new country embarking on an unprecedented political experiment and in frequent crisis. Similarly, we too are in the midst of a grand, new social experiment called social media. On social media, lies have had the opportunity to flourish in the midst of a worsening economic, political, and environmental crisis. Dispassionate analysis, when appropriate, is critical. Likewise, invective and denunciation for the acts and words of those who would contribute to the chaos and do evil are likewise necessary.

Francis Fukuyama in interviews has pointed out that as European civilization grew and large-scale cities became an important part of life in the West, a new arrangement of social norms for the smooth functioning of civil society became necessary as impersonal interactions between strangers within these large cities became an integral (and new) part of the fabric of life. He claims that this process required centuries of negotiation and cultural innovation. (Norbert Elias’s classic text undertakes a similar analysis and was probably where Fukuyama derived his own views.) Fukuyama points out that we are probably in the midst of a similar such process with the advent of social media and the Internet.

Thus, this post proposes a way to think about this transformation of social life. Above all, I think that it is not enough to merely use social media, but also to think of ways that we could contribute to making it better.