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A false dichotomy – dietary guidelines and the other diet

Dichotomy (2)
A Dichotomy – Black or White.

A dichotomy is a division into two entirely different and often contrasting domains, interests or activities (1). Examples of true dichotomies are black or white. Tall or short.

A false dichotomy is an argument giving a false illusion of there being only two choices whereas in reality there can be at least one other or even many possibilities (2). The argument is set up in such a way as the first choice is eliminated due to it being seen as a terrible choice, and the only other alternative is the second choice.

Over the last decade dietary guidelines have come under attack. Arguments against them are often presented in the manner of a false dichotomy. These are the steps used in that line of fallacy:

Step 1. Present Diet A as the government dietary guidelines.
Step 2. Present Diet A as flawed, weak or scary … making people sick in some way.
Step3. Present Diet B < insert name of alternative diet > as the only other choice.

Step 1. Present the government guidelines as Diet A

Government dietary guidelines were first issued in the early 1980s recommending we eat mainly bread and cereals (preferably wholegrain), vegetables, fruit and legumes; moderately lean meat, low-fat dairy, eggs, fish, and nuts; and only small amounts of added fats, sugar and salt (3, 4). With its emphasis on plant foods, moderate animal foods, and lower fat than previous intakes, the guidelines were labelled as a low-fat diet.

Step 2. Present Diet A as flawed, weak or scary.

Arguments attacking guidelines suggest they were based on flawed science, there are toxic foods we were not warned about and, due to consumption of those toxic foods, there are scary biochemical mechanisms disrupting our metabolism making us sick. Statistics are presented showing a rise in obesity and non-communicable diseases since the first issue of the guidelines, implying they are to blame or are contributory. (5)

Step 3. Present Diet B as the alternative diet.

Having presented the dietary guidelines as scary, the alternative Diet B < insert name of diet advocated by presenter or author of book > as the only other choice.

The false dichotomy

Apart from weaknesses in presented arguments of supposed flaws in the guidelines, such as whether foods suggested as toxic actually are, or whether people actually followed the guidelines; the false dichotomy narrative completely falls over in the presentation of there being no other alternative. No other reason for the rise in obesity and disease risk other than foods we eat. No changes in the fabric of society other than changes in our food environment. No change in our food environments other than the dietary guidelines. No other choice for a healthy diet other than Diet B.

In reality …

There are dozens of contributing factors to obesity and disease. There have been scores of changes in the fabric of our society. There have been a multitude of changes to our food environments (6). There are varying reasons people choose the diet they do (7). There are numerous dietary patterns shown to be healthful (8).

What slips through …

Apart from those weaknesses in the false dichotomy argument, what slips through of concern to me is there has been an emphasis on supposed flaws in the guidelines without strong evidence supporting long-term safety and effectiveness of the alternative diets presented.

Is there any evidence?

It is suggested advice for a safe effective long-term diet requires key supporting evidence across several domains including (a) plausible biochemical/ physiological mechanisms; (b) reliable epidemiological (within populations) studies; (c) clinical studies; (d) evidence for long-term safety and effectiveness; and (e) application of the nutrient or diet in question to complex bodily processes, the total diet and eating patterns. (9, 10)

As most dietary guidelines advocate a diet higher in carbohydrate and lower in fat, the commonly presented exact opposite diet (low in carbohydrate, high in fat) is often depicted as the only alternative. This has become a popular trend. Sometimes the carbohydrate content advised is so low whole foods are excluded including starchy vegetables, all cereals and most fruit. A diet that low in carbohydrate is by default either high in protein and / or high in fat.

I have wondered about this suggested alternative, in particular advocated low levels of certain whole-foods such as starchy vegetables, fruit and cereals; and consuming diets higher in protein or added fat. Where is the evidence for its safety and effectiveness? Does the evidence extend to long-term application?

Five years ago I began hunting for such evidence …

 

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Disclaimer: Nothing in this article or on this website should be taken as medical or dietary advice. Anyone reading any information provided within should seek advice from their own medical practitioner for any issue, disease, illness or health-related problem they may have. Always seek your own advice from a medical practitioner or dietitian before changing your own diet.

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Notes and References:

(1) Miriam-Webster dictionary: dichotomy

(2) False dilemma or dichotomy. Logically Fallacious. Retrieved 07/11/2018

(3) The Australian Dietary Guidelines were first issued in 1982, then 1992, 2003 and 2013.

(4) Dietary Guidelines for Americans 1980. Health.gov. Retrieved 07/11/2018; and history 1980 to 2000. Retrieved 07/11/2018.

(5) Arguments presented include: recommendation to eat a low-fat diet (being bland and boring) drove people to sugar for flavour; due to toxicity of fructose in sugar, addiction, or simply over-consumption of empty calories this leads people to overeat, become over-weight and develop disease; carbohydrate foods trigger insulin, driving fat into storage, holding fat in storage, and raising blood glucose levels; recommendations for a low-fat diet drive us to eat more processed foods. I will address these claims in future posts.

(6) There are many factors that can effect diet and disease. Social changes over the past 50 years include: a change in liquor licensing laws; higher ownership of cars; people drive cars more often, do less housework, eat less at home, eat out more; there are more women working. People can be affected by stress, life events and personal catastrophes.

There has been a massive change in our food environments to include more fast food, pre-prepared food, confectionery, sugar-sweetened beverages; a rise in supermarkets and convenience stores; larger refrigerators, home freezers; chilled beverages, aseptic packaging; high availability of fatty and sweet foods; social trends for gourmet foods, cafe dining, a coffee culture and taste festivals.

(7) Nutritional Guidelines: are we getting them so wrong, or are we getting lost in translation: Duane Mellor, Nutrition and Health August 1, 2018 Editorial.
Dr Mellor suggests diet choices are not simply based on health but also include affordability, accessibility, culture and hedonism (pleasure).

(8) The Dietary Guidelines for Americans 2015; the modelling system behind the 2013 revision of the Australian Dietary Guidelines; and the Dietary Guidelines for the Brazilian Population, all offer varying choices of eating patterns for a healthy diet.

(9) Dietary Reference Intakes. Institute of Medicine. 2011. (Calcium)
The report outlines the hierarchy of evidence to support nutrient intake with clinical trials being highest form of evidence followed by observational studies. There is also reference to requiring plausible mechanisms of biochemistry or physiology being required behind recommendations.

(10) The Longevity Diet. Dr Valter Longo. (New York: Avery/Penguin Books, 2018). Dr Longo describes five pillars of evidence required to support recommended diets for longevity including Juventology, epidemiology, clinical studies, epidemiology, and complex systems.

 

 

 

A return to the heart of the matter

Catalyst: a person or thing that precipitates an event.

Heart

In October 2013, the ABC TV in Australia aired a two-part documentary ‘Heart of the Matter‘ on their behind-the-science program Catalyst. The first segment investigated the diet-heart hypothesis and the history behind diet recommendations to eat less saturated fat. The second segment was on use of statin drugs for reducing the risk of heart disease.

This was a topic of great interest to me. My own father had had a heart attack in 1969 at the age of 45 years. He died from a stroke 5 years later at the age of 49. His death had a devastating and lasting impact on my family. For my whole adult life I had striven to avoid heart disease by following what is considered a heart-healthy diet. The Catalyst segment on diet went against some of my firm beliefs as to what is considered a healthy diet for prevention of heart disease.

The show was critical of dietary guidelines to lower foods with saturated fats such as meat, butter and dairy; and base the diet on bread, grains, and cereals. It implied those guidelines put us “in the nutritional mess we are now in” focussing on supposed flawed science that led to the guidelines. It implied saturated fat was not a contributor to heart disease, cholesterol in the blood is nothing to worry about, people have a pre-set cholesterol level you cannot change by diet; and sugar is the real cause of heart disease. It was the first time I had heard such claims from a reputable source (the ABC).

I had some concerns after watching the program. The program did not present any evidence (only opinion) that saturated fat was innocent in regard to heart disease, and no evidence of sugar instead being the supposed cause. It implied promotion of our cereal-based diet was at least part due to marketing from food companies, yet it presented no evidence of any supposed detrimental effects of diets based on cereals or other higher carbohydrate foods. It did not offer any alternative heart-healthy diet. It did not detail the “mess” we were now supposedly in.

The “mess” that was the 1970s

In the 1940s to early 1960s, heart disease was considered a normal part of aging. People grew old in their 60s. In their 70s, they had heart attacks and died. By the mid-1960s, two things had changed. Firstly, it became known younger people could also develop heart disease and could die. Secondly, research showed prevalence rates of heart disease were lower in other countries. With these two pieces of emerging evidence, it was postulated heart disease was not a normal part of aging but some factor to do with the western diet or lifestyle. Health authorities began to recognise that changing diet and lifestyle could have a bearing on the disease. This was a radical change to the way medical authorities had thought and advised up until that time. Did the program (and others since) making the claim that dietary guidelines supposedly drove us into a “mess”, fail to grasp the grave underlying reason dietary recommendations were made in the first place?

Dietary guidelines were issued from the 1970s because we were already in a “mess”

Young people were dying prematurely of heart attacks and strokes. The dietary guidelines did not create the supposed “mess”. Whilst they did not get every aspect 100% correct in the first guidelines, and there have been some revisions since, the guidelines may have contributed to improved trends in heart disease rates. In Australia, there has been a decline in cardiovascular disease death rates >70% since the 1970s (1).

Figure 1. Age-standardised death rates, 1913-2012. Source (2).

Heart-Disease-deaths (2)

Having lived through that era of dietary change and those improved statistics, having lost my own father in 1974 through heart disease in his 40s, it baffled me that something considered pioneering – changing health outcomes by changing diet and lifestyle (which is actually quite sensible) – could be portrayed so negatively decades later.

Fried fatty foods

Another factor that deeply concerned me (in regard to what other people may assume who may have watched the program) were images scattered throughout of fried fatty foods, and the seeming fixation on establishing which type of fat to use for (deep) frying. There were eleven video clips in the half-hour program of sizzling fats frying eggs, bacon, sausages; deep-frying chips; or butter sizzling in a pan.  Was this the supposed alternative heart-healthy diet? Were we supposed to return to eating a lot of fatty and deep-fried foods (as long as the fat we used was saturated fat)? Was this the message? Was it implying frying foods and eating butter were not only not unhealthy, they were actually healthy? If so, where is the evidence? None was presented.

Frying foods was one of the things that had been swept out of my own diet after my father’s heart attack 45 years before … although the fat and the frying had crept back in.

My own catalyst

A few weeks before the program I had my own ‘catalyst’ (7) and at the time Catalyst aired I was midstream following diet advice as promoted on the website of the Australian Heart Foundation (3). Despite the Catalyst program implying such recommendations were based on weak science, flawed and probably would not work (and I note that adding fats and frying foods were two of the things I dramatically reduced), remarkably within ten weeks my total cholesterol had dropped 25%, my LDL cholesterol plummeted 31% and my triglycerides 18% (4). (These components a doctor may test for are described here.) Whilst I could not exactly be sure which foods had which effect (foods I added being beneficial, or foods I restricted being detrimental), changing my diet did make a difference and thus at least one claim on the Catalyst program for at least one person (me) did not hold true – “you cannot change your cholesterol level by changing your diet“. I changed mine. Moreover the changes were based on guidelines of a health advocacy group. Maybe the science and guidelines can be trusted after all.

In case you missed the point I am trying to make, I will repeat it.

Young people were dying in the 1960s and 1970s. Struck down in their prime.

My father was one of them. In remembrance of him and his untimely death, I can no longer let pass opinions given without evidence that imply dietary guidelines were or are responsible for any supposed health ‘mess’, that advocated dietary guidelines are not worth a try, or that include statements that are factually incorrect (5, 6). The guidelines seek to advise how people may improve their own health.

It is time for me to speak up …
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Disclaimer: Nothing in this article or on this website should be taken as medical or dietary advice. Anyone reading any information provided within should seek advice from their own medical practitioner for any issue, disease, illness or health-related problem they may have. Always seek your own advice from a medical practitioner or dietitian before changing your own diet.
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References and Notes:

(1) Australian Heart Disease Statistics 2014. Australian Heart Foundation.
In Australia, there has been a decline in cardiovascular disease death rates >70% since 1970s. This trend is reportedly due to equal measures of both improved survival and lower incidence rates. Lifestyle factors of reduced smoking, exercise and better diet are contributory lifestyle factors. Australian heart disease death rates are lower than in other high-income countries such as USA, UK and Germany, although higher than Japan.

(2) Australian Heart Disease Statistics 2015. Australian Heart Foundation.

(3) The (Australian) Heart Foundation (AHF) is a charity dedicated to fighting heart disease. On their website www.heartfoundation.org.au in September 2013 dietary advice I read was: To lower LDL: eat foods high in soluble fibre (oats, beans, legumes, apples, pears, barley); eat fish two serves a week and omega-3 fatty acids; eat nuts; reduce consumption of saturated fats and trans fats. To raise raise HDL: become more physically active, lose weight, choose healthier fats (mono-unsaturated and omega 3 fats), eat fish and nuts, drink alcohol in moderation.

(4) The actual changes to my diet that I made in that ten week period were to eat more oats, barley, beans and lentils; eat oat bread, less other bread; eat some nuts; swap from 1% milk to skim milk at home, skinny milk when out; drop full-milk coffee lattes; cut out red meat; reduce chicken or fish to twice a week; eat more vegetables; use canola or olive oils when cooking, although I actually cut out added oils and fats almost entirely in this period. As a disclaimer: I rarely consume sugar, and I infrequently consume and did not have any sweet fatty foods in this period (eg cakes, biscuits or ice-cream).

(5) There were some statements factually incorrect for the Australian context such as margarine being laden with trans fat. Trans fats have been largely removed from Australian margarine since the mid 1990s. The dietary pyramid depicted the US pyramid which puts bread and cereals at the base. The Australian Healthy Eating Pyramid pyramid had cereals, fruit and vegetables at the base.

(6) The Catalyst program described researcher Ancel Keys comparing heart disease rates in six countries, implying he cherry-picked countries to formulate a hypothesis that formed the basis of our dietary guidelines. The graph shown in the program was from 1953. After his preliminary hypothesis, Keys went on to conduct the seven countries study (including Greece that went against his initial hypothesis); and the dietary guidelines were not introduced for another 25 years.

(7) A few weeks before the program I had my own ‘catalyst’. At a doctors’ check my blood test results revealed my cholesterol was higher than previous levels that had, until a decade before, been remarkably low for 22 years. Over that decade I had experienced several chaotic life events distracting my attention from my health. I resolved to re-focus. By the time Catalyst aired I was midstream in following diet advice as promoted on the website of the Australian Heart Foundation (3). Remarkably within ten weeks my total cholesterol had dropped 25%, LDL cholesterol plummeted 31% and triglycerides 18%. Whilst I could not exactly be sure which foods had an effect, either foods I had more of (oats, barley, beans, lentils, nuts) exerting a cholesterol-lowering benefit, or foods I had restricted (red meat, dairy, and oils) no longer having cholesterol-raising effects, one thing was definite – changing my diet made the difference.

(8) Image by Leonie Elizabeth 22 July 2018.

Living through history. Our changing food environments. 1980s – 2010s.

Ultra-processed food (2)

Within two generations there has been a complete restructure of our food environments from mainly fresh foods prepared in the home, eaten with family or friends at the table with plates and utensils; to a high proportion of fast food, convenience food, snack-food, confectionery; from or at restaurants, cafes, take-away outlets and food-halls; out of bags, packets, bottles, cans, tubes, tubs … and eaten on the run. Continue reading “Living through history. Our changing food environments. 1980s – 2010s.”

My food history # 12: Critical events and life catastrophes …

 

ID-10059806.africa

In the 1980s and 1990s, life was skipping along …

Then came the dark events – life catastrophes

As well as significant milestones and some major disruptions, over fifteen years from 1998 to 2013,  I lived through several crises and some distressing catastrophes. A crisis, whilst painful, tends to be a temporary situation or turning point (1), whereas a catastrophe is a complete upheaval (2). Both are demanding and stressful. Continue reading “My food history # 12: Critical events and life catastrophes …”

My food history # 11 – 2000s – health claims, social trends and slow-ticking time bombs

 

Alcohol

Life gets busy

Two years after my youngest child started school I began working full-time.  I became involved in community groups and projects. Life became very busy.
Continue reading “My food history # 11 – 2000s – health claims, social trends and slow-ticking time bombs”

My food history # 10 – 1990s – combining ‘friendly’ food with ‘healthy’ food makes a bland basic (yet healthy) diet

Photo 2-3-18, 12 28 11 pm
Bread, rice, pasta, oats, potatoes, rolled/puffed wholegrain cereals become the base foods of meals in my longer-term diet. Photo by Leonie Elizabeth 01 March 2018.

Following my nutrition studies and some sideline research, I made changes to my diet: Continue reading “My food history # 10 – 1990s – combining ‘friendly’ food with ‘healthy’ food makes a bland basic (yet healthy) diet”

Food History # 9 – ‘Please can you help?’ – Nutrition Studies 1991

Fat_Oil

After dramatic improvements in my son, I was inundated with queries from people wanting to try the Royal Prince Alfred Hospital exclusion diet for a range of symptoms. While I was pleased to help, I was concerned I did not have the required expertise to assist. I therefore studied for a Graduate Diploma of Human Nutrition, completed in 1991 through Deakin University. Continue reading “Food History # 9 – ‘Please can you help?’ – Nutrition Studies 1991”