There is a narrative online that Americans have become obese because they have too closely followed the Dietary Guidelines. I looked at this suggestion in depth in my post here and found it to be lacking. This post will have a narrower focus and look specifically at refined grains and sugar.

So did the Dietary Guidelines cause Americans to eat more refined grains and sugar? Let’s look at the facts.

Americans currently eat about a quarter of the whole grains recommended by the current Dietary Guidelines for Americans, and about double the recommended refined grains.

Reference: https://health.gov/dietaryguidelines/2015/guidelines/chapter-2/a-closer-look-at-current-intakes-and-recommended-shifts/

If Americans eat too many refined grains, can it be the Guidelines’ fault?

Indeed, a 2010 study showed that only 1% of Americans eat the quantity of grains recommended by the dietary guidelines. One percent! Meanwhile, as we can see above, the average American far exceeds recommended intake of refined grains.

Here is a screenshot of the 2015-2020 Dietary Guidelines for Americans showing that it recommends at least half of grains consumed to be unrefined:

Reference: https://health.gov/dietaryguidelines/2015/resources/2015-2020_Dietary_Guidelines.pdf

Some claim that only current Guidelines included the recommendation to consume unrefined grains, and that the early Guidelines didn’t. This is false. The Dietary Guidelines for Americans from 1980 repeatedly emphasized eating unrefined carbohydrates:

Reference: https://health.gov/dietaryguidelines/1980thin.pdf
Reference: https://health.gov/dietaryguidelines/1980thin.pdf

Indeed, the entire 4th guideline was dedicated to recommending unrefined carbohydrate foods. Since there were only 7 guidelines, that means 14% of the 1980 DGA were dedicated to telling consumers to eat unrefined carbohydrates.

Here is the second and final page of the 4th guideline again:

Reference: https://health.gov/dietaryguidelines/1980thin.pdf

Its summary statement says: “Select foods which are good sources of fiber and starch, such as whole grain breads and cereals, fruits and vegetables, beans, peas, and nuts.”

Does it say to eat refined grains and sugar? Does it say to eat donuts and pizza? Does it say to eat ice cream and cupcakes? No. It says to eat foods that Americans still don’t eat very much of. Many people do not eat any.

On the topic of sugars, do the Dietary Guidelines tell people to eat a bunch of sugar to “replace fat”–as is often claimed? No. The Guidelines tell people to limit sugar. In fact, #5 of the 7 guidelines is dedicated to this! Here is its summary statement:

Reference:https://health.gov/dietaryguidelines/1980thin.pdf

According to USDA food availability data, Americans today eat more refined grains AND sugar than they did in 1970. Americans have not followed the dietary guidelines. Americans have largely ignored them.

Reference: https://www.ers.usda.gov/amber-waves/2017/july/us-diets-still-out-of-balance-with-dietary-recommendations/
Reference: https://www.ers.usda.gov/amber-waves/2017/july/us-diets-still-out-of-balance-with-dietary-recommendations/

There is a large and thriving low-carbohydrate diet industry worth hundreds of millions of dollars. One of its major figureheads is @DietDoctor1, who spreads this kind of misinformation on his website, in a way strikingly similar to many anti-vax websites:

This is not a small website! It claims to have over half a million subscribers and runs a lucrative membership-only part of the website.

On this website, many of the above myths are propagated widely. For example, here is @bigfatsurprise‘s presentation on the topic:

https://www.dietdoctor.com/introduction-dietary-guidelines-start-obesity-epidemic

In this video, @bigfatsurprise propagates many of the myths that I have debunked in this thread, in large part by slickly presenting data that superficially supports her point of view and excluding data that does not. Because there is so much data, it is very easy to do this.

Spreading these myths is highly lucrative to these authors and doctors. The video I posted is only a preview. The full version is only available to those who have purchased memberships.

I am not sure what to do about this, but I am working on it with others. It is important to be vocal and assertive. These people are exploiting and generating confusion about nutrition to make millions. People deserve better than this.

(For more information about the carbohydrate and fat trends and their relationship to the dietary guidelines, please refer to the first half of my post The data overwhelmingly indicate that Americans do not follow the Dietary Guidelines.)

=====

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.

Stephen Phinney and Jeff Volek are among the most important minds of the low-carb movement. With three advanced degrees between them (Volek is a PhD and Phinney has both an MD and PhD) and hundreds of scientific publications on low-carbohydrate diets going back decades, after almost 10 years of low-carbohydrate dieting under my own belt, last year I was excited to sit down and read their book The Art and Science of Low-Carbohydrate Living, their popular primer on low-carbohydrate diets and, after having read almost everything published on low-carbohydrate diets in other popular books, really deepen my understanding.

Looking for a scientific treatment of the strengths, weaknesses, and gaps in the research record on low-carbohydrate diets, as I read I was first a little disappointed by the book. Then I was appalled. The first two chapters called into question everything that followed. This was a turning point for me in understanding low-carbohydrate diets and the people who advocate for them.

Phinney and Volek engage in rampant conspiracy mongering. I wanted to like the book. But I couldn’t. The content of this book and its worldview, in my opinion, so poisons the well of scientific discussion that it makes any serious adherent to the book immune to rational argument.

It is said that a great piece of literature raises more questions than answers. I believe the same could also be said of a great piece of science. It is also said that a work is not literature if it only provides answers–it is propaganda. By this definition, Phinney and Volek’s book is propaganda. It needn’t be, because I know that there remain many questions about low-carbohydrate diets.

Here is my thesis:

I believe this is a poisonous book. By believing that the other side is responsible for a conspiracy, one is justified in one’s own selective and misleading use of scientific research. I will now try to demonstrate what I mean by this.

These first two chapters are about indigenous groups that consume low-carbohydrate diets. Here is the key introductory paragraph to these paragraphs:

Before commenting, I should introduce my background. I have two bachelor’s degrees. One was my bachelor’s of sciences degree in biology, but I also have a bachelor’s of arts degree in anthropology. I decided to major in anthropology in part because after high school, I read Loren Cordain’s book The Paleo Diet, and this changed my life. I was Paleo. I was also an angry kid, and I thought that I wanted to learn about hunter-gatherers, because modern society was a bum deal.

So, as an anthropology major, imagine my perpetual surprise when I hear that hunter-gatherers were adapted to consuming low-carbohydrate diets. Just as with Phinney and Volek’s (hereafter, PV) claim that this was the case, this is never referenced. The reason it is never referenced is because it isn’t true. Every dataset that looks at hunter-gatherer diets–and there are several mainstays of anthropologists over the past century, employing varying methodologies–shows a range of carbohydrate intakes.

PV indicate that these three groups are “examples” of low-carbohydrate hunter-gatherer groups, while in fact they exceptions. Of the hundreds of hunter-gatherer groups observed, these are the only groups that might provide evidence for PV’s thesis.

Also the notion that Homo sapiens lived in barren or temperate regions until very recently–including during the Ice Ages–also is not supported by any evidence that I am aware of. When the Ice Ages occurred in Europe, Homo sapiens retreated to the Mediterranean:

They only recolonized Central and Northern Europe relatively recently. Indeed, Scandinavia was only colonized by humans at around 12,000 BCE–an eyeblink in human evolutionary history. Indeed, the lifeways of Scandinavia are only as old as agriculture itself.

The famous Inuit? Same deal. According to the book “A Paleohistory of the North: Human Settlement of the Higher Latitudes”, Alaska too was only colonized around 12,000 BCE, with the Inuit themselves arising on the scene only 2,000 years ago:

The Inuit arrived in Alaska after the fall of Attica at the hands of the Peloponnesians, after the deaths of Socrates, Plato, Aristotle, Alexander the Great, and Julius Caesar and during the reign, approximately, of Augustus in Rome. There was a reason indeed that the great civilizations began in Southern Europe: everyone else was just getting started. The existence of humans in the Northern climates is, to be clear, neolithic and in some cases almost modern in its novelty.

In point of fact, modern genetic studies show that modern Inuit (a population from northern Alaska) spread through the Arctic less than 700 years ago, genetically and culturally replacing the Paleo-Eskimos, residents of the Arctic for about 4000 years. What this means in turn is that the Inuit were just getting settled in when the Renaissance was underway in Europe. Yet PV want to propose that the Inuit are an ancestral population!!!

When PV were imagining our ancestors chasing around woolly mammoths, they were probably actually eating pasta with Francesco somewhere in the South. OK, minus the pasta. But you get the point. What PV have done in this passage is to pretend that low-carbohydrate living in these harsh climates was the normal human lifeway. The Ice Age was a recent event, and humans had a very ambivalent relationship to it, with permanent settlements largely only existing in the South.

What this means is that the Inuit, Masai, and Bison People were not necessarily representative of our human ancestors. In fact, they were chosen by PV precisely because they stand out as exceptions, even as PV propose they represent the rule. And they aren’t even exactly what they seem either. We have only seen this in the case of the Inuit, but we shall soon see it with the Masai as well.

Yet, through a bit of hand-waving, they try to make this work:

Again, no reference is provided to support that most of the world’s cultures survived on low-carbohydrate diets–in fact, this is at odds with the available evidence, which shows copious dependence of our ancestors on a wide variety of foods, including fruit, tubers, legumes, and grains.

PV’s discussion of Ireland is unreferenced and just wrong: archaeologists believe that cereals, including wheat and barley, arrived in Ireland almost 7,000 years ago and were extensively cultivated.

The discussion on Scandinavia and Russia is equally unreferenced. It is difficult to know what to take seriously. Even if true, the amount of gene flow because of repeated migrations, especially in Scandinavia from mainland Europe during the course of the neolithic (except perhaps for Finland) would substantially undermine the argument.

Yet behind these attempts at justification lingers a rather curious value judgment: “low carbohydrate cultures were suppressed by the agricultural imperative.” A whiff of Jared Diamond and Marshall Sahlins and an insinuation of romanticization of hunter-gatherers so often latent among Paleo diet writers makes itself felt here. There is much more of this in the book, but we shall have to pass it by for our purposes at this time.

PV, perhaps sensing that their evidence is paper thin, now appeal to a supposed gap in evidence:

In other words, because writing didn’t exist, we don’t know that just because the evidence is so thin, these supposed low-carbohydrate cultures didn’t exist. Here PV make an incredible claim: >99% of ethnographic observers misreported their findings. The ones who told the truth are the ones that PV is reporting on. What a convenient and ridiculous remark.

PV give no evidence that this happened, content instead to accuse most observers of faking data. Still, if only an empirically unfounded claim, we might chalk it up to (serious) disagreements about interpretation. But it isn’t. It also simply doesn’t make any sense.

Here’s why. Ethnocentricity is a commonplace pitfall that most ethnographic observers are aware of. This is why it is so controversial when they report on infanticide, or on cannibalism: the observers might be biased, and trying to paint HGs are “primitives” or “savages.” Indeed, there is a (dominant) school of thought within anthropology that asserts that there is no such thing as an objective cross-cultural observer, precisely because such observers will always distort their analysis with their own biases. Even perception is biased.

But report they do. Outside the West, we know from cross-cultural observers that infanticide is a cultural universal. And we know that in diverse cultures, Bob is frequently offered as a blood sacrifice, or even taken as the main course on festive occasions. (Sorry Bob.) And this kind of reporting goes back to Herodotus, perhaps the most ethnocentric and biased cross-cultural observer in the Western canon. Indeed, most scholars now believe that Herodotus way over-reported differences.

Why? In part because they’re interesting. That’s why cross-cultural observers are interested in other cultures. They want to find differences. Through these differences, in turn, it is frequently argued that cross-cultural observers want to understand themselves.

That is why I studied anthropology: because I wanted to know the range of possibilities of human existence. Because I wanted to learn about something different. That is one of if not the major motivation of cross-cultural observation.

“Primitives” through Western history always been a foreign Other, an Other that contrasts with modern civilization; “primitives” tell us by their negative example who we are. Thus, the tendency in anthropology has been to exaggerate differences too much.

We need to ask, therefore, why it has been consistently OK to talk about eating Bob but not about restricting carbohydrates? About bizarre sexual rituals but not about eating only meat? About pagan idol worship, but not about foregoing grain?

Before proceeding, let us take a brief look at the paragraph that comes after PV accuse 99% of cross-cultural observers of fabricating data, because finding other human societies who don’t eat wheat would be too much existentially to bear.

Here PV, thinking they are supporting what they are saying, provide a perfect counterargument to their own argument. According to PV, when observers encounter HGs that do not live in houses, they report this accurately, and call them derogatory things like “uncivilized” or “unsettled”. Yet when they encounter HGs that do not eat carbs, they fabricate data.

This simply doesn’t make sense. It is like PV are trying to refute themselves.

At this point I started to become incredulous. Is it really possible that PV are truly the excellent minds that many claim them to be? Or is this a case of “hugely overrated”?

PV’s attempt to make the argument that cross-cultural observers couldn’t stomach low carbohydrate HGs demonstrates a lack of familiarity with the ethnographic literature, and the anthropological tradition. And just plain bad reasoning skills. What is most striking however is the lack of self-consciousness about this terrible way of arguing, yet the confidence of PV’s prose.

It’s questionable moreover whether PV’s examples serve their own argument. Inuit are widely understood to have rare genetic mutations that prevent them from entering ketosis, the very state that PV claim is ideal and evolutionarily normal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4225582/

Also, as Evelyn Carbsane has pointed out, Masai women demonstrably do not eat low carbohydrate diets. Image below.

Original ref: https://books.google.com/books?id=T7aaAAAAIAAJ&pg=PA11#v=onepage&q&f=false
Evelyn’s post: http://carbsanity.blogspot.com/2015/03/masai-women-ate-low-fat-diet.html

What are the implications? Hyuge. This means that if we want to make the argument that Masai are low carb adapted, it’s only the men, but not the women. Yet… that’s not how genetics work.

Probably knowing that just discarding the evidence wouldn’t be sufficient, they accuse observers of not living with the people that they report on. Excerpt:

This is false. There are sections of libraries filled with books on HG populations by people who lived with them. Yet again we see PV accusing their opponents not just of dishonesty but now of laziness. Worst of all, in order to do this, they have to make things up.

In order to dismiss archaeological evidence as well, PV conclude that plant foods were probably not eaten or fed to dogs:

10/10 intellectual gymnastics. And no, there is not “some” data that dispute “these proportions”. Rather, virtually all available data do.

Let’s unpack this. First, they say “not all that is written of hunters and nomadic shepherds is incorrect.” No, they only mean to impugn everything that is in conflict with their theory. Which brings us to the next point.

What do PV mean when they say “when assessed against a modern understanding of metabolism”? Just what it sounds like. They cherry-pick the evidence that is consistent with their theory (although not really).

As for a “sparse but useful truth”—whether simple or complex, I prefer my truth unqualified, and not requiring in order to function, a vast intellectual conspiracy over hundreds of years to hide data by thousands of investigators.

If this post seems to drip venom, that’s because reading these chapters really did piss me off. And it makes me wonder, if the evidence from archaeology is so readily dismissed when it conflicts with their ideas, what would keep PV from doing the same when evidence from the own fields conflicts with their assumptions?

This is why I do not trust or value the work of PV. That is not to say that it cannot be valuable. It can be. But I question whether they are objective interpreters of their own science, and I now pay particular scrutiny when evaluating work on which either of them are an author.

===

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 also find me on Twitter at @kevinnbass.


The following is a reposting of a thread (here)–with minor, introductory and concluding modifications to make it more appropriate for a blog–that I wrote on Twitter as part of an exchange with Joe Rogan on August 18-19, 2018. Before I wrote these things to Joe, I want to make clear that I had been a close follower of his for some time, and was very fond of his show, the aggressiveness of the exchange notwisthanding.

I also want to make clear that in response to that exchange, Joe had Dominic D’Agostino debate/discuss with Layne Norton and Chris Kresser debate/discuss with Joel Kahn. The final and most anticipated of these debates is that between Stephan Guyenet and Gary Taubes, which will take place on March 19th, 2019. The background information for this last debate can be found here.

Without further ado, it all started with a tweet…

To which Joe responded…

To which I responded…

Your show has positively impacted my life and scientific trajectory, @joerogan. However, contrary to tweets attached–JRE *does* present a unbalanced perspective on nutrition that overwhelmingly promotes a low-carb narrative. I will show this with data.

Here is a screenshot of my spreadsheet that I used to analyze these data. The two colored left-hand columns are an indication of the positions taken on the podcast re: carbohydrates. Green is positive, red is negative. Right column is Joe’s view; left is guest.

I will make the spreadsheet publicly available upon request (note: screenshot is not final), and in this thread, I will be communicating the methods after I have presented the data.

Graphical breakdown of overall findings, below. Of 1136 episodes analyzed, 99 (9%) discussed carbohydrates in a way that framed consuming them as “good” or “bad”. (Interestingly, of the last 157 episodes, 33 (21%) had discussions about carbs.)

There were 6 episodes where carbohydrates were discussed by scientists. 3 negatively (@gadsaad, @jordanbpeterson, @DominicDAgosti2 ), 1 neutral (@sleepdiplomat), and 2 positively (@DrAndyGalpin, @tattoosandbones). If we limit ourselves to nutrition scientists, there was one positive about carbohydrates (Dom) and one negative (Andy).

In contrast, there were 27 episodes with non-scientist gurus (popular communicators who are not scientists, such as healthcare workers, authors, etc.), of which 21 were negative, 4 were positive, and 2 were neutral. The positives were @richroll , @DBolelli, @CameronHanes. The two neutrals were @bengreenfield.

Of athletes, there were 24 episodes. 10 positive, 11 negative, and 3 neutral about carbs.

Of the 99 episodes, you (Joe Rogan) took a position 60 times. 53/60 were negative, and 7 were neutral. Some of these 7 might be considered positive depending on coding criteria. It should be noted that many of these 53 were overwhelmingly negative. “Bullshit” was not a rare word.

Next up. Here is a screenshot of the software that I used. As you can see, the audio “scrollbar” lights up with each mention of “carb”, according to the computer-generated transcript.

The most frequent occurrences of “carb” were Gary Taubes (@garytaubes), Nina Teicholz (@bigfatsurprise), and Robb Wolf (@robbwolf). These interviewees discussed carbohydrates the most (naturally). Here is a screenshot.

Note that all of the non-scientist gurus use scientific language and make scientific claims. Here is a shot of a real scientist, Dom D’Agostino (@DominicDAgosti2). He is also on the first page.

Now take a look at @AndyGalpin. 7 of 15 pages. Andy talks about carbs less than almost half of everyone else who talks about carbs. And Andy was as far as I am aware the only scientist to do something even close to a sustained critique on keto (9 minutes).

This means of approximately 100 episodes where scientific claims about carbohydrates are made (which are usually negative and lengthy), only 1 includes a scientist who can actually give an opposing expert opinion, and he barely talks about it.

You can do whatever you want @joerogan. Obviously.

But what else would you call not taking the many high-carb ppl who have wanted to be interviewed over the years–than refusal? Not sure if conscious or not. Does it matter?

Again, @joerogan you don’t have to have a balanced show. It’s obviously your choice. I commend you on your tweets yesterday where you promised more balance.

However, you did tell Chris Cage exactly this in Episode #939: “I am going to bring in people who are anti-ketogenic diet, as well, so that I can get a balanced perspective on it.” Episode #939 was two years ago.

Now you’re telling everyone you’re going to bring more balance to the show with an anti-keto guy AGAIN. When is it going to be @joerogan? A debate is NOT enough. We need someone who is capable of making an extended argument against @garytaubes and team.

You’ve one-on-oned dozens of people making an extended case against carbs. Interview one capable of making a scientific case a case for them. That’s balance.

Let’s talk methods.

(Then we’ll move onto the comment about kooks.)

I used the software FluidDATA (http://www.fluiddata.com ) to search through the computer-generated transcripts of 1136 JRE episodes available. This suggests 20 missing episodes, but this almost certainly will not affect the analysis.

Using the search terms “carb” (149 hits) and “carbohydrate” (128 hits), I found all instances in these episodes where these terms were discussed–at least according to the transcripts. I then characterized the discussions as positive, negative, or neutral.

Positive discussions were defenses of carbohydrates. Negative discussions were carbohydrate bashing. Neutral discussions were when views about carbohydrates were qualified, or when carbohydrates were spoken about in an ironic (i.e. ambiguous) manner.

In addition, I categorized the speakers involved in each discussion. I then categorized each speaker as of a) comic/author/media, b) guru, c) athlete, d) scientist, or e) @joerogan.

Looks like Twitter is ending my thread. Before I continue, I want to remind you why I responded this way. Attached.

My point is you always choose alt-health guests. Then you interview quacks like Shawn Baker (and others). But you won’t interview at any length a serious scientist that will criticize your beliefs. It’s either out of the mainstream or off the deep end.

Why not get a serious, establishment scientist? You know, to respond to the things you say about them. As for the Lancet paper, who is “legitimate” to you, @joerogan? This is all I have to say.

The rest is history…

===

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 also 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…

===
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.
===

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.

===
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.

Not tolerating carbohydrate is a pathology. If diabetes has been reversed, glucose tolerance should be restored.

Want to read more beyond the above preview? The full post will be available for free on January 30th. Alternatively, head over to my Patreon page and become a subscriber to get immediate access to this and other exclusive content now available only to subscribers: https://www.patreon.com/posts/24034393.

Receiving a paycheck dependent on performance in promoting partisan claims about science–e.g. paid roles as author, speaker, and paid director of lobbying group promoting such claims–is a serious conflict of interest when writing articles that purport to be scientific. Nina Teicholz, whose financial situation is described above, recently co-wrote a Medscape article, which self-portrays as being science-based. Problematically in this article, she presents the very same views for which she receives a.) royalties as author of the The Big Fat Surprise, b.) honoraria as speaker on the claims contained therein, and c.) a salary as Executive Director of the Nutrition Coalition, which promotes these same claims and lobbies the United States government about nutrition policy.

Indeed while Nina appears to have no financial disclosure page on her website–and so we do not know the extent of her conflict from royalties and honoraria–the publicly available Nutrition Coalition’s 2015 501c tax filing shows a compensation of $24,046 for 10 hours of work per week as secretary:

Since being promoted to Executive Director of the organization, it is not clear what Nina’s current compensation is.

Yet, she does not disclose these financial conflict of interests in her article. Why is this important? To be clear, Nina Teicholz is disincentivized from evaluating new information on her hypotheses objectively because changing her opinion in light of new information would come into conflict with prior paid commitments. Thus, her financial conflicts of interest qualify her claims to objectivity or science-based writing, in a way not dissimilar to pharma consulting, investments in healthcare technology companies, etc.

Such financial conflicts of interest should be disclosed to give context to readers. These conflicts are highly relevant to the article’s claims.Medscape is widely read and highly regarded. Therefore, this oversight should be corrected so that readers are aware of the serious problems with her claims to be free of bias. Troublingly, Nina did disclose some of these conflicts in another article published for Medscape just one year ago:

Nina’s present disclosure oversight is probably intentional. As obesity doctor, University of Ottowa professor, and anti-obesity campaigner Yoni Freedhoff has pointed out, Nina has a history of not disclosing conflicts of interest:

Here is a closer view of the email in question:

The problem goes deeper:

Despite dozens of similar exchanges with other critics–as well as being forced to disclose conflicts of interest after failing to disclose them in the above BMJ article–Nina continues to claim ignorance about what constitutes a conflict of interest.

Yet in dozens of places, she shows a persistent (and selective) focus on the conflicts of interest of university-affiliated researchers:

An advanced search on her Twitter account demonstrates a clear if systematically selectively applied understanding of how conflicts of interest work. Here is a sample of about half of pertinent tweets.

Notably, the above represents only about 10% of her total tweets on conflicts of interest in academic health science. In other words, conflicts of interest is a theme in her work.

One of Nina’s associates, Jason Fung, recently denounced the failure to disclose conflicts of interest by a prominent cancer researcher:

Ironically, Nina would retweet a similar tweet denouncing the financial ties between academic medicine and industry, and the failure to disclose these.

But most telling is a recent tweet that Nina sent to me:

This seems to be a tacit admission that Nina knows that she is not disclosing conflicts of interest. Instead of fully owning up to her shortcoming, she deflects by pointing out that, apparently, David Katz also does not disclose his.

More tellingly, however, is the implication that disclosing financial conflicts of interest is something to be avoided–and that giving the misleading impression of financial independence is acceptable so long as other people do the same thing (allegedly).

In this statement, Nina reveals that her objective is not to give readers the most accurate representation of reality–but to use whatever means available to persuade them of a particular point of view, even if this involves misrepresenting herself. Thus, this tweet amounts to a tacit admission to a willingness to use facts tactically.

If this is her orientation toward the truth, I think it is fair to ask the question: What else is Nina Teicholz hiding?

UPDATE 09/28/2018
The following replies distill the point succinctly:

Lastly, if there any question about the cause of Nina’s professed confusion about what constitutes a conflict of interest, this suggests an answer–and verifies what was written above:

If you liked this article, please consider donating below.

===

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.