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Review of Podcast - History of Diet Trends & Medical Advice in the US, Fat & Cholesterol, Seed Oils, Processed Food, Ketogenic Diet, Can We Trust Public Health Institutions? with Orrin Devinsky at M&M

https://mindandmatter.substack.com/p/history-of-diet-trends-and-medical?utm_source=publication-search 

This podcast episode features a conversation between host Nick Jaccomus and Dr. Orrin Devinsky, a neurologist with an interest in nutrition and the history of science. Their discussion centers on a 2022 paper by Dr. Devinsky analyzing dietary trends in the United States since the 1800s. They examine changes in calorie and macronutrient consumption, the rise of processed foods and seed oils, and the evolution of dietary advice. The conversation critically evaluates the "diet-heart hypothesis" and the energy balance model of obesity, exploring the historical context and scientific basis of these ideas. Dr. Devinsky shares his perspective on the trustworthiness of public health institutions and the influence of industry on dietary recommendations. Ultimately, the episode provides a historical overview of American eating habits and questions the prevailing nutritional wisdom.

Briefing Document: Dietary Trends in the US Since 1800 and Their Health Implications

Source: Excerpts from "Mind & Matter - History of Diet Trends & Medical Advice in the US, Fat & Cholesterol, Seed Oils, Processed Food, Ketogenic Diet, Can We Trust Public Health Institutions_ _ Orrin Devinsky _ #135.mp3" featuring an interview with Dr. Orrin Devinsky, Professor of Neurology, Neurosurgery, and Psychiatry at NYU School of Medicine.

Date: October 26, 2023

Prepared for: [Intended Audience - e.g., Personal Knowledge, Research Team, etc.]

Overview:

This briefing document summarizes the key themes and important ideas discussed in the Mind & Matter podcast episode featuring Dr. Orrin Devinsky. The discussion primarily revolves around a 2022 paper Dr. Devinsky published on US dietary trends since the 1800s and their potential links to non-communicable diseases. The conversation delves into historical shifts in macronutrient consumption, the rise of processed foods and seed oils, the controversial "diet-heart hypothesis," the energy balance theory of obesity, the role of public health institutions, and the potential benefits and drawbacks of ketogenic diets. Dr. Devinsky brings both scientific and historical perspectives to these complex issues, offering critical insights into how our understanding of diet and health has evolved (and sometimes gone astray).

Main Themes and Important Ideas:

1. Historical Dietary Shifts in the US (Since 1800s):

• Early Diets: In the 1800s, meat consumption was high and readily available, even with socioeconomic variations. Tracking dietary intake before the mid-20th century is challenging due to limited data collection, especially for food consumed on farms.

• Rise of Processed Foods and Seed Oils: The introduction of Crisco in 1909 marked the beginning of widespread consumption of industrially processed seed oils (often mislabeled as "vegetable oils"). These oils, not naturally occurring, have significantly increased in the American diet, replacing traditional cooking fats like butter and lard. Dr. Devinsky suggests a rule of thumb: "if your great grandparent consumed it then it probably was fairly healthy. But if it had to go through a factory in the Midwest to get to your plate, you should be suspicious of it."

• Macronutrient Changes: Protein consumption has remained relatively stable over time. A significant rise in total calorie intake began around 1970, driven by increases in both carbohydrates and fats. Interestingly, after around the year 2000, total calorie, carbohydrate, and fat consumption started to decrease somewhat, while obesity rates continued to rise, challenging the simple "calories in, calories out" model.

• Fatty Acid Profile Shifts: Saturated fat consumption has remained relatively stable. The major changes in fat intake involve a dramatic increase in polyunsaturated fats (primarily from seed oils) and monounsaturated fats (like olive oil). This shift occurred concurrently with a rise in heart disease, despite the theory that saturated fats were the primary culprit.

• Increased Consumption of Caloric Sweeteners: The availability and consumption of caloric sweeteners, particularly corn-based sweeteners like high fructose corn syrup, have dramatically increased due to industrial processing and sugar subsidies.

2. The Diet-Heart Hypothesis: Origins and Critiques:

• Ancel Keys' Role: Dr. Devinsky characterizes Ancel Keys as a "very brilliant, hard-working, remarkable individual who made some enormous mistakes." Keys formulated the diet-heart hypothesis, initially proposing that total fat intake correlated with heart disease rates based on selective cross-country data in 1953.

• Evolution of the Hypothesis: When feeding studies showed that dietary cholesterol had a minimal impact on blood cholesterol levels and that saturated fats were the primary dietary factor raising total cholesterol, Keys pivoted his hypothesis to focus on saturated fat as the main driver of high cholesterol and, consequently, heart disease.

• Weakness of the Evidence: Dr. Devinsky emphasizes that "the evidence has never been good" for the diet-heart hypothesis in its strong form. Keys selectively chose data to support his initial correlations.

• Ignoring Other Factors: The hypothesis largely ignored the role of processed carbohydrates and sugars, which also differentiated populations with varying heart disease rates.

• Institutional Entrenchment: Keys' influence, including his role on the American Heart Association's Nutrition Committee, helped solidify the diet-heart hypothesis as national policy despite limited evidence.

• Suppressed Research: Dr. Devinsky highlights a four-year nutritional study conducted within the Framingham Heart Study in the late 1950s that found no correlation between saturated fat intake and cholesterol levels or heart health. This study was allegedly suppressed and never officially published due to its conflict with prevailing dogma.

3. The Energy Balance Hypothesis of Obesity: Limitations:

• Simplicity: The energy balance hypothesis (calories in vs. calories out) is deemed "mainly wrong" by Dr. Devinsky as a sole explanation for obesity and metabolic syndrome. While acknowledging the laws of thermodynamics, he argues that the human body is not a simple engine.

• Ignoring Biological Complexity: The hypothesis fails to account for the influence of hormones (like insulin), individual metabolic rates, microbiome differences, and the body's differential processing of various calorie sources. "The idea that it's just calories is just way too simplistic."

• Ineffectiveness of Calorie Restriction Alone: The fact that many obese individuals have tried and failed to lose weight through calorie restriction alone suggests that other factors are at play.

4. The Role of Public Health Institutions and Trust:

• Potential for Misguided Recommendations: Dr. Devinsky raises concerns about how health institutions can make long-standing recommendations based on "very thin evidence" that later turn out to be incorrect or even harmful.

• Influence of Industry: The significant influence of industries like sugar on public health messaging and even scientific publications is highlighted as a major problem. FDR is quoted saying the sugar industry was the "most powerful lobby to descend upon Washington."

• Balancing Public Health Messaging and Scientific Doubt: While acknowledging the need for unified public health messages in certain situations (like vaccine campaigns during a pandemic), Dr. Devinsky cautions that suppressing scientific doubt can lead to harmful long-term consequences, as potentially seen with dietary recommendations. "Science is the religion of doubt."

• Erosion of Trust: The history of dietary recommendations based on weak evidence and the potential influence of vested interests can erode public trust in health institutions.

5. Ketogenic Diets and Metabolic Health:

• Ketosis Explained: Ketosis is a metabolic state where the body shifts from primarily burning carbohydrates to burning fats, producing ketone bodies.

• Weight Loss Effectiveness: Ketogenic diets can be effective for weight loss due to their impact on insulin levels. Chronically high insulin levels in overweight/obese individuals prevent fat cells from releasing stored fat. Lowering carbohydrate intake and inducing ketosis can help overcome this.

• Other Potential Benefits: Ketogenic diets can lead to lower triglyceride levels, improved blood sugar control, and reduced insulin resistance.

• Potential Drawbacks: Possible negative consequences include higher rates of kidney stones, constipation, and potential nutritional deficiencies if the diet is not well-balanced.

6. Plant-Based Diets vs. Diets Including Animal Products:

• Environmental Considerations: Plant-based diets may have ecological advantages in terms of sustainability.

• Health Perspectives: Dr. Devinsky believes both plant-based and diets including animal products can be healthy. He is skeptical of the notion that vegetarian diets are inherently superior based on current scientific evidence.

• Critique of the "China Study": Dr. Devinsky strongly criticizes the "China Study" and its conclusions advocating for purely plant-based diets, calling it "probably some of the worst science I've ever encountered." He cites the lack of mainstream publication and contradictory findings within the original data.

• Focus on Minimally Processed Foods: Regardless of whether one chooses to eat plants or animals, the emphasis should be on consuming minimally processed, whole foods.

7. Brain Health and Nutrition:

• Limited Specific Data: While specific "brain-healthy" foods are not definitively identified, Dr. Devinsky suggests that minimally processed diets, similar to those consumed historically before the rise of modern chronic diseases, are likely beneficial for brain health.

• Harm of Processed Foods: There is evidence to support the idea that highly processed foods are detrimental to all parts of the body, including the brain.

Key Quotes:

• "if your great grandparent consumed it then it probably was fairly healthy. But if it had to go through a factory in the Midwest to get to your plate, you should be suspicious of it."

• "the evidence has never been good" [for the strong form of the diet-heart hypothesis].

• "The idea that it's just calories is just way too simplistic."

• "Science is the religion of doubt."

• "I think the ultra refined diet that Americans eat that's killing them and causing obesity and diabetes."

• Regarding the "China Study": "I think it's a fraud. I think people should look under the covers, and if they do, and take a deep dive live. It's It's just the worst science ever."

• "it's not plants or animals, populations have been, you know, eating what they can get that's high quality, nutritious foods whenever they can get it. Uh, but as much as it can be minimally processed..."

Conclusion:

Dr. Devinsky's insights provide a critical historical and scientific perspective on the evolution of dietary trends and medical advice in the US. He argues that the prevailing focus on saturated fat as the primary driver of heart disease was based on flawed evidence and overshadowed the potential harms of processed foods and refined carbohydrates, particularly fructose. He also challenges the simplistic energy balance model of obesity and raises concerns about the potential for bias and the suppression of dissenting research within public health institutions. His emphasis on consuming minimally processed, whole foods, regardless of their plant or animal origin, offers a more nuanced and potentially healthier approach to diet. He encourages a degree of skepticism towards established dietary guidelines and a deeper understanding of the complex interplay between food, metabolism, and health.

• Dr. Devinsky suggests that the rise in obesity and diabetes was a slow but exponential epidemic likely beginning in the wealthy class centuries ago. An early indicator was Dr. Elliot Joslin's observation of a diabetes epidemic in his hometown in the late 1800s/early 1900s.

• The initial Diet Heart Hypothesis, formulated around 1952-53 by Ancel Keys, proposed that heart disease was caused by high levels of cholesterol in the blood, which congealed in arteries. He initially believed that all dietary fats were responsible for raising cholesterol.

• Keys later shifted his focus to saturated fats as the primary dietary factor raising cholesterol after feeding studies in the mid-1950s showed that saturated fats had the most significant impact on total cholesterol levels.

• The energy balance hypothesis states that weight gain or loss is determined solely by the balance of calories consumed versus calories expended. A key criticism is that it oversimplifies the complex metabolic processes in the body, ignoring the roles of hormones and the different metabolic effects of various macronutrients.

• There was a significant decline in the consumption of animal fats like butter and lard, particularly after the mid-20th century, while the consumption of vegetable oils dramatically increased over the same period, accelerating even further around the year 2000.

• The recommendation stemmed from studies in the mid-1950s showing that polyunsaturated fats could sometimes lower total cholesterol levels, fitting the simplistic view that high cholesterol directly causes heart disease. This ignores the complexities of different types of unsaturated fats and other metabolic factors.

• Many colonial physicians in various parts of the world observed that cancer appeared to be a rare disease in indigenous populations prior to the introduction of industrialized and processed foods into their diets.

• Glucose can be metabolized by virtually all cells in the body and stimulates insulin release, while fructose is primarily metabolized by the liver and does not directly stimulate insulin. In the liver, fructose is readily converted to fat, contributing to metabolic dysfunction.

• During ketosis, the body shifts from primarily using carbohydrates for energy to using fats, producing ketone bodies as a byproduct. This can lead to weight loss because chronically elevated insulin levels, which prevent fat burning, are reduced on a very low-carbohydrate, high-fat ketogenic diet.

• Dr. Mann's study found no correlation between saturated fat intake and cholesterol levels or heart health in the Framingham cohort. The study was allegedly suppressed by those who adhered to the prevailing Diet Heart Hypothesis and was not widely published.

Glossary of Key Terms

• Diet Heart Hypothesis: A theory that posits a direct link between dietary saturated fat and cholesterol intake, elevated blood cholesterol levels, and an increased risk of heart disease.

• Energy Balance Hypothesis: The concept that changes in body weight are solely determined by the difference between the number of calories consumed and the number of calories expended.

• Saturated Fats: A type of fat in which the fatty acid chains have no double bonds and are fully saturated with hydrogen atoms; typically solid at room temperature.

• Unsaturated Fats: A type of fat in which the fatty acid chains contain one or more double bonds; typically liquid at room temperature. This category includes monounsaturated and polyunsaturated fats.

• Polyunsaturated Fats: A type of unsaturated fat containing multiple double bonds in the fatty acid chains, often found in vegetable oils and some fish.

• Monounsaturated Fats: A type of unsaturated fat containing one double bond in the fatty acid chains, found in foods like olive oil and avocados.

• Cholesterol: A waxy, fat-like substance found in all cells of the body. It is necessary for building healthy cells but high levels can contribute to heart disease.

• Triglycerides: A type of fat (lipid) found in the blood. High levels, often linked to high carbohydrate intake, can increase the risk of heart disease.

• Insulin Resistance: A condition in which the body's cells become resistant to the effects of insulin, leading to elevated blood sugar levels.

• Metabolic Syndrome: A cluster of conditions that occur together, increasing the risk of heart disease, stroke, type 2 diabetes, and other health problems. These conditions include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels.

• Ketosis: A metabolic state characterized by elevated levels of ketone bodies in the blood, produced when the body breaks down fats for energy due to a lack of carbohydrates.

• Ketogenic Diet: A very low-carbohydrate, high-fat diet that forces the body into ketosis.

• Processed Foods: Foods that have been altered from their natural state through methods such as cooking, canning, freezing, drying, or the addition of preservatives, flavors, or other additives.

• Ultra-Refined Foods: A subset of processed foods that have undergone multiple industrial processes and typically contain high levels of added sugar, salt, unhealthy fats, and artificial additives, while being low in nutrients and fiber.

• Lipogenic: Tending to promote the formation of fat in the body. Fructose is considered a highly lipogenic sugar.

Frequently Asked Questions: Dietary Trends, Heart Health, and Public Health

1. How have total calorie consumption and macronutrient intake (carbs, proteins, fats) changed in the United States since the 1800s?

Total calorie consumption in the US remained relatively stable until around 1970, after which it began to rise significantly. This increase was driven by a rise in both carbohydrate and fat intake. However, around the year 2000, total calorie, carbohydrate, and fat consumption started to decrease somewhat, while obesity rates continued to rise, suggesting that calorie quantity alone does not fully explain weight gain. Protein consumption, on the other hand, has remained relatively flat throughout the 20th and early 21st centuries. The sources of these macronutrients have also shifted, with a significant increase in processed foods and seed oils replacing more traditional fats.

2. What is the "Diet Heart Hypothesis," and what was the initial evidence and its evolution?

The Diet Heart Hypothesis, largely popularized by Ancel Keys in the mid-20th century, initially proposed that high dietary fat intake led to high blood cholesterol levels, which in turn caused heart disease. Keys' early work showed correlations between fat consumption and heart disease rates in select countries. However, this selection of data was later criticized for ignoring contradictory evidence from other countries. Subsequent research indicated that dietary cholesterol had a minimal impact on blood cholesterol, but saturated fats were found to raise total cholesterol levels. Consequently, the hypothesis evolved to focus on saturated fat as the primary dietary culprit driving high cholesterol and heart disease.

3. How have consumption patterns of different types of fats (saturated, monounsaturated, polyunsaturated) changed over time in the US?

While precise data from the early 20th century is limited, saturated fat consumption appears to have been relatively stable overall. The most significant change has been the dramatic increase in polyunsaturated fats, primarily from the introduction and widespread use of industrial seed oils (often mislabeled as vegetable oils) starting around the early 1900s and accelerating throughout the century. Monounsaturated fat consumption has also increased, likely due to greater availability and consumption of olive oil and other sources. Simultaneously, the consumption of traditional animal fats like butter and lard has decreased substantially, being replaced by these vegetable oils.

4. What is the "Energy Balance Hypothesis" of obesity, and what are its limitations according to Dr. Dinsky?

The Energy Balance Hypothesis posits that weight change is solely determined by the difference between calories consumed (energy in) and calories expended (energy out). If you consume more calories than you burn, you gain weight, and vice versa. Dr. Dinsky argues that this hypothesis is overly simplistic for biological systems, especially humans. He points out that our bodies are not simple engines; factors like hormones (e.g., insulin), the gut microbiome, and the type of calories consumed (not just the quantity) significantly influence metabolism and fat storage. He notes that many obese individuals have tried calorie restriction without success, suggesting that the hormonal regulation of fat storage, particularly by insulin, plays a more critical role than just calorie balance.

5. How did the consumption of specific foods like red meat, poultry, and added fats and oils change in the US during the 20th and 21st centuries?

Red meat consumption has fluctuated but remained relatively stable overall. Fish and shellfish consumption has also been fairly consistent. The most dramatic shift has been the exponential increase in poultry (chicken) consumption, which was once a luxury item but became widely available and promoted as a healthier alternative to red meat following the popularization of the Diet Heart Hypothesis. Regarding added fats and oils, there has been a significant decline in the use of animal fats like butter and lard, particularly after the mid-20th century. Concurrently, the availability and consumption of vegetable oils have risen dramatically and continue to accelerate, becoming the dominant form of added fat in the American diet.

6. What are the key concerns regarding the increased consumption of processed foods and caloric sweeteners, particularly high-fructose corn syrup?

Dr. Dinsky emphasizes that a significant negative dietary trend has been the increased consumption of ultra-processed foods and refined caloric sweeteners, including sugar, white flour, and high-fructose corn syrup. He suggests a rule of thumb: if your great-grandparent wouldn't recognize it as a whole food, be suspicious. Processed foods often have altered macronutrient profiles, lack fiber and micronutrients, and contain industrial ingredients not found in natural diets. High-fructose corn syrup is of particular concern because fructose is primarily metabolized by the liver, where it is readily converted to fat. Unlike glucose, fructose does not stimulate insulin release in the short term, but its metabolic processing in the liver can contribute to fat accumulation and metabolic dysfunction, especially when consumed in large quantities alongside glucose.

7. What is ketosis, how is it induced by a ketogenic diet or fasting, and what are some potential health implications?

Ketosis is a metabolic state in which the body shifts from primarily burning carbohydrates for energy to burning fats. This occurs when carbohydrate intake is very low, such as during prolonged fasting or when following a ketogenic diet (very low carb, high fat). In ketosis, the liver produces ketone bodies from fat breakdown, which can then be used as an alternative fuel source by the brain and other tissues. A ketogenic diet can be effective for weight loss, improving blood sugar control in diabetics, and is a recognized treatment for certain types of epilepsy. Potential negative side effects can include an increased risk of kidney stones, constipation, and potential nutritional deficiencies if the diet is not well-balanced.

8. Given the history of dietary recommendations and the current state of public health institutions, how much trust should the average person place in them today?

Dr. Dinsky expresses mixed feelings about trusting public health institutions. While acknowledging the good intentions and expertise of many in medicine and science, he highlights historical instances where recommendations were based on weak evidence or influenced by industry (e.g., the sugar industry's role in shaping early dietary advice). He also discusses the inherent tendency in public health to present a unified message, which can sometimes lead to the suppression or ignoring of contradictory evidence, as potentially happened with studies questioning the Diet Heart Hypothesis. Therefore, while not advocating for complete distrust, he suggests that the average person should adopt a degree of skepticism and seek information from diverse sources. He emphasizes focusing on consuming minimally processed, whole foods, regardless of whether they are plant or animal-based, as a generally sound approach to health.

Discuss United States diet.

The discussion with Dr. Orrin Devinsky on the Mind & Matter podcast delves into the history of dietary trends in the United States since the 1800s, drawing on his 2022 paper on the subject1 . The conversation covers significant shifts in calorie consumption, macronutrient profiles, the types of fats and carbohydrates consumed, and the influence of historical events and scientific theories on American eating habits1 .

Changes in Calorie and Macronutrient Consumption:

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Overall, there was a rise in total calorie consumption in the US, particularly starting around 1970, driven by increases in both carbohydrate and fat intake2 .

•

However, around the turn of the millennium (around 2000), total calorie, carbohydrate, and fat consumption started to decrease somewhat, even as obesity rates continued to rise2 . This suggests that factors beyond just the amount of calories consumed are crucial in understanding obesity and metabolic health1 ....

•

Protein consumption, in contrast, has remained relatively stable over time2 .

Shifts in Fat Consumption:

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A major shift has occurred in the types of fats consumed1 .... There has been a significant increase in the consumption of vegetable oils (seed oils), which are industrial processed fats, since their introduction around 1909 with Crisco3 . These now constitute about 8% of the American diet3 .

•

Concurrently, the consumption of traditional cooking fats like butter, lard, and tallow has decreased significantly (by 70-80%) and has been largely replaced by vegetable oils3 .

•

Looking at specific fatty acids, saturated fat consumption has remained relatively stable, although precise data from the early 20th century is limited4 . The most substantial increase has been in polyunsaturated fats, primarily from vegetable oils, and also in monounsaturated fats like oleic acid found in olive oil4 .

•

This shift from animal-based fats to vegetable-based fats became pronounced around the mid-1900s and has continued dramatically5 .

The Diet-Heart Hypothesis and Fat Recommendations:

•

The diet-heart hypothesis, largely attributed to scientist Ancel Keys, proposed that high blood cholesterol causes heart disease, and dietary fat, especially saturated fat, drives up cholesterol levels1 ....

•

Initially, in 1953, Keys believed all fats contributed to high cholesterol7 . However, by the late 1950s, research suggested that saturated fats were the primary dietary factor raising total cholesterol7 ....

•

Despite saturated fats also raising HDL ("good" cholesterol), this was largely ignored by Keys and the American Heart Association (AHA)7 ....

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Keys' work and his influence on committees like the AHA nutrition committee led to national policies recommending reduced saturated fat intake to prevent heart disease10 ....

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Dr. Devinsky points out that the evidence supporting the diet-heart hypothesis has "never been good"6 . He also mentions a buried study from the Framingham Heart Study in the late 1950s that found no correlation between saturated fat intake and cholesterol levels or heart health12 ....

The Rise of Processed Foods and Sugars:

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Dr. Devinsky emphasizes that the rise in processed foods is a critical factor in understanding dietary changes and their health impacts1 .... He suggests a rule of thumb: if your great-grandparent wouldn't recognize it or if it went through a factory in the Midwest, be suspicious3 .

•

The consumption of caloric sweeteners, particularly corn sweeteners like high fructose corn syrup, has increased dramatically over time17 . This rise is linked to industrial processing and government policies like sugar subsidies17 .

•

Fructose, a component of table sugar (sucrose) and high fructose corn syrup, is metabolized differently than glucose18 . Unlike glucose, which can be used by most cells, fructose is primarily processed by the liver, where it is readily converted into fat (lipogenic)18 .... This makes high fructose consumption particularly problematic for metabolic health18 .

Changes in Meat Consumption:

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While red meat consumption has fluctuated but remained relatively stable overall, there has been a remarkable increase in poultry (chicken) consumption since the mid-20th century20 . This is partly attributed to industrial farming and the AHA's promotion of chicken as a healthier alternative to red meat20 .

•

The macronutrient profile of meat has also likely changed due to modern farming practices. For example, grass-fed cows have a healthier omega-3 to omega-6 fatty acid ratio compared to grain-fed animals21 .

The Energy Balance Hypothesis vs. Food Quality:

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The traditional energy balance hypothesis (calories in vs. calories out) as the primary driver of weight gain is considered too simplistic by Dr. Devinsky1 .... He argues that the type and quality of calories, influenced by hormones and individual metabolism, are more critical22 .... He notes that many obese individuals have tried reducing calorie intake without success25 ....

Public Health Institutions and Trust:

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Dr. Devinsky expresses mixed feelings about public health institutions1 .... While acknowledging the good intentions and expertise of many colleagues, he highlights instances of bias, the influence of industry (like the sugar industry), and the tendency to present a unified message that may not always be based on strong evidence27 ....

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He uses the example of the buried Framingham study to illustrate how data that contradicts established dogma can be suppressed13 ....

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Given the history, Dr. Devinsky suggests a degree of skepticism is warranted when considering dietary recommendations from these institutions and individual physicians, encouraging people to seek more information27 ....

In conclusion, the United States diet has undergone significant transformations since the 1800s, marked by a rise in processed foods, a shift from animal to vegetable fats (particularly industrial seed oils), increased sugar consumption (especially fructose), and changes in meat preferences. These shifts have occurred alongside evolving scientific understanding and the influence of public health recommendations, which Dr. Devinsky suggests have not always been based on the most robust evidence and have sometimes been influenced by industry or the desire for a unified public health message1 .... He emphasizes the importance of focusing on minimally processed, whole foods for overall health14 ....

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Discuss Dietary trends history.

The Mind and Matter podcast episode features a discussion between Nick Jaccomus and Dr. Orrin Devinsky, a neurologist with interests in nutrition and the history of science, focusing on his 2022 paper about dietary trends in the United States since the 1800s1 .... Their conversation covers a wide range of topics related to how American diets have changed and the implications for health1 .

Early Observations of Rising Metabolic Issues:

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Dr. Devinsky notes that observations of rising rates of diabetes date back to the early 20th century with Elliot Joselyn3 .

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Historically, obesity was a marker of status, as only the wealthy could afford the processed foods that led to weight gain3 .

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A striking example from the mid-20th century in East Africa illustrated a rapid shift from difficulty in getting people to gain weight to an epidemic of obesity and diabetes within a few decades, highlighting a significant change in the food environment4 .

The Diet Heart Hypothesis:

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The discussion delves into the diet heart hypothesis, which gained prominence in the mid-1900s and suggested that high blood cholesterol, driven by high dietary intake of saturated fat, causes heart disease1 ....

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This idea seemed like "cold hard facts" to many by the late 20th century5 .

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Dr. Devinsky credits Ancel Keys as the central figure in formulating this hypothesis6 . While acknowledging Keys' brilliance, he also points out his mistakes and strong advocacy that confused opinion with science6 .

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Keys' initial work in the 1950s showed correlations between high fat consumption and high rates of heart disease in select countries, but this was criticized for selective data use7 .

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Early on, Keys believed all fats were problematic8 . However, later feeding studies indicated that saturated fats were the primary dietary factor raising total cholesterol levels9 . This led to a pivot in the hypothesis, focusing specifically on saturated fat8 ....

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Despite saturated fats also raising HDL ("good cholesterol"), this was largely ignored by Keys and the American Heart Association (AHA)8 ....

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Dr. Devinsky points out that Keys became influential, holding positions in committees and shaping national policy10 ....

The Energy Balance Hypothesis of Obesity:

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The conversation also touches upon the energy balance hypothesis, which posits that weight gain or loss is primarily determined by the balance between calories consumed and calories expended1 ....

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Dr. Devinsky argues that this hypothesis is too simplistic for biological systems, as the body is not a simple engine13 ....

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Factors like hormones, the microbiome, and individual differences in metabolism play significant roles14 .

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He emphasizes that many people who struggle with obesity have tried reducing caloric intake without success, suggesting that it's not the primary driver15 .

Historical Changes in Food Consumption:

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Dr. Devinsky and Jaccomus discuss the challenges of obtaining accurate dietary data, especially from the early 20th century16 ....

•

One major trend is the introduction and widespread consumption of industrially processed seed oils (vegetable oils), which didn't exist in the American diet before 1909 with Crisco18 . These oils now constitute a significant portion of fat intake18 ....

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Concurrently, the consumption of natural fats like butter, lard, and tallow has significantly decreased18 ....

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Despite the shift from saturated animal fats to unsaturated vegetable oils, rates of heart disease rose18 .

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Protein consumption has remained relatively stable over time21 .

•

Total calorie consumption rose significantly around 1970 but started to decline somewhat around the year 2000, while obesity rates continued to climb19 ....

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Saturated fat intake has been relatively stable, while polyunsaturated fats (from vegetable oils) have seen a large increase, and monounsaturated fats have also increased19 .

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The idea that unsaturated fats are "heart healthy" stems from studies in the mid-1950s showing they could lower total cholesterol and LDL levels, and some population studies on Mediterranean-style diets22 . However, the complexity of different types of unsaturated fats (e.g., omega-6 vs. omega-3) is important23 .

Changes in Meat Consumption:

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Historically, meat consumption was high in the US17 ....

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Red meat consumption has been relatively stable, with some fluctuations25 .

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The most significant change in meat consumption is the dramatic rise in poultry after the mid-20th century, coinciding with the promotion of chicken as a healthier alternative to red meat25 .

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Industrial farming practices have altered the macronutrient profile of meats, such as grain-fed cows having a less healthy omega-3 to omega-6 ratio compared to grass-fed cows20 .

The Rise of Caloric Sweeteners:

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There has been a significant increase in the consumption of caloric sweeteners, particularly corn sweeteners like high fructose corn syrup26 .

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This rise is linked to industrialization and sugar subsidies26 .

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Fructose, a component of table sugar and high fructose corn syrup, is metabolized differently than glucose. It is primarily processed by the liver and readily converted to fat27 .... The combination of glucose and fructose in processed foods is unlike anything seen before industrialization28 .

Processed vs. Non-Processed Foods:

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Dr. Devinsky emphasizes the importance of distinguishing between processed and non-processed foods, suggesting that if your great-grandparent wouldn't recognize it as a whole food, you should be suspicious18 .

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He identifies sugar, white flour, and white rice, along with packaged, ready-to-eat meals, as major culprits in unhealthy diets29 .

Ketosis and the Ketogenic Diet:

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Ketosis is a metabolic state where the body shifts from primarily burning carbohydrates to burning fats for energy, producing ketone bodies30 .

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The ketogenic diet, very low in carbohydrates and high in fat, induces ketosis and can be an effective weight loss strategy30 ....

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Metabolically, in a state of chronically high insulin (common in overweight/obese individuals due to high carbohydrate intake), the body is less able to burn stored fat. Reducing carbohydrate intake and lowering insulin levels allows fat cells to release fat for energy31 ....

Influence of Public Health Institutions and the Diet Heart Hypothesis Legacy:

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Dr. Devinsky expresses concern about the influence of financial interests and biases in nutrition science and public health recommendations, citing the sugar industry's historical manipulation of research33 .

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He discusses the Framingham Heart Study, a landmark study, but also mentions a suppressed study within Framingham that found no correlation between saturated fat intake and heart disease33 ....

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He believes that public health institutions sometimes prioritize a unified message over scientific uncertainty, which can lead to the propagation of flawed advice, as potentially happened with the diet heart hypothesis36 ....

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Given the history, Dr. Devinsky advises a degree of skepticism towards current dietary recommendations, even from medical professionals and established organizations38 ....

Plant-Based Diets:

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While acknowledging potential environmental arguments for plant-based diets, Dr. Devinsky does not believe that vegetarian diets are inherently superior for health compared to diets that include meat40 .

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He is highly critical of the "China Study" and its conclusions promoting exclusively plant-based diets40 ....

Brain Health and Overall Dietary Advice:

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Dr. Devinsky notes the lack of specific data on brain-healthy foods but suggests that minimally processed diets, similar to those of populations with low rates of diseases like Alzheimer's in the past, are likely beneficial41 .

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His key takeaway is to prioritize minimally processed, high-quality, nutritious foods over highly processed items, regardless of whether they are plant or animal-based41 . He uses the analogy of heroin to describe the short-term pleasure but long-term harm of highly palatable processed foods41 .

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Discuss Diet heart hypothesis.

The Diet Heart Hypothesis is a widely influential belief that high blood cholesterol drives heart disease, and a high dietary intake of saturated fat raises blood cholesterol levels1 . This idea gained prominence in the mid-1900s1 .

Here's a breakdown of the Diet Heart Hypothesis as discussed by Dr. Orrin Dinsky:

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Origins and Ancel Keys: The hypothesis is largely attributed to scientist Ancel Keys2 . Keys was a "brilliant, hard-working, remarkable individual who made some enormous mistakes"2 .

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His initial interest in nutrition stemmed from designing the K-rations for World War II2 ....

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An observation during a trip to Naples, where wealthy people eating roast beef and desserts had high cholesterol compared to poor laborers eating simple bread and vegetables, led Keys to hypothesize that fat intake was the culprit3 . He initially didn't consider the role of processed carbohydrates and sugar3 .

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In 1953, Keys proposed the Diet Heart Hypothesis in a paper in the Mount Sinai hospital journal3 . He showed correlations between high rates of fat consumption and high rates of heart disease by selectively choosing data from six countries out of the available 223 .

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Keys initially believed all fats caused cholesterol buildup and heart disease4 .

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Shift to Saturated Fat: Later feeding studies in the mid-1950s revealed that giving people cholesterol didn't significantly raise their cholesterol levels, and neither did polyunsaturated fats. However, saturated fats were found to be the primary dietary factor that raised total cholesterol5 .

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Based on this, Keys pivoted his hypothesis in the late 1950s to focus on saturated fat as the main dietary driver of high cholesterol and heart disease4 ....

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Despite saturated fats also raising HDL ("good cholesterol"), this aspect was largely ignored by Keys and the American Heart Association (AHA)4 ....

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Influence and Adoption: Keys became highly influential, eventually chairing the American Heart Association Nutrition Committee and pushing for this hypothesis to become national policy6 .... His prominence was further solidified by mentions in the media, such as a front-page New York Times article by President Eisenhower's cardiologist9 .

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Lack of Strong Evidence and Contradictions: Dr. Dinsky emphasizes that the evidence for the Diet Heart Hypothesis has "never been good"2 .

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Keys' initial correlation study was flawed due to selective data reporting3 .

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A significant piece of data that Keys himself cited from the USDA showed that the biggest contributor to increased fat consumption in the US diet between 1910 and 1950 was fats and oils (excluding butter), not saturated fats from meat and butter10 . This coincided with a rise in heart disease10 .

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A well-conducted nutritional study within the Framingham Heart Study by Dr. George Mann (who studied populations with high saturated fat intake and low heart disease) found no correlation between saturated fat intake and cholesterol levels or heart health11 .... However, this study was "forbidden from publishing" and was essentially buried by what Dr. Dinsky calls the "heart mafia" (AHA, NIH, etc.) because it contradicted the prevailing dogma12 ....

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Public Health Implications: Dr. Dinsky suggests that public health institutions, while often operating with good intentions, have a tendency to promote a unified message and suppress dissenting evidence to ensure public compliance14 . In the case of the Diet Heart Hypothesis, this led to the suppression of contradictory findings because they feared it would undermine the message that saturated fats were harmful14 .

In summary, the Diet Heart Hypothesis, which posits that saturated fat intake leads to high cholesterol and subsequently heart disease, became a dominant paradigm despite what Dr. Dinsky describes as weak initial evidence and the subsequent suppression of contradictory research2 .... This hypothesis has significantly shaped dietary recommendations in the United States for decades1 .

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Discuss Energy balance obesity.

The energy balance hypothesis of obesity, as Dr. Devinsky explains, is the idea that body weight is determined by the balance between the energy (calories) consumed and the energy expended1 . According to this hypothesis, if calorie intake equals calorie expenditure, a person will maintain a stable weight. If calorie intake consistently exceeds expenditure, the excess energy will be stored as fat, leading to weight gain over time1 .

Dr. Devinsky states that this was the prevailing view he was taught in medical school and is often presented as being consistent with the laws of thermodynamics1 . However, he argues that while thermodynamics applies to physics, biology, and particularly human metabolism, are far more complex1 . He believes the energy balance hypothesis, as a primary explanation for obesity, is "mainly wrong," although it does contain some truth1 .

His critique rests on several key points:

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The Body is Not a Simple Engine: Dr. Devinsky emphasizes that the human body is not like an engine that simply burns fuel based on its caloric content2 . He uses the example of 4.5 ounces of ribeye steak and the same amount of gasoline or diesel fuel, which might have similar caloric values but drastically different effects on the human body1 .... Humans cannot derive usable energy from gasoline or diesel, illustrating that the source of calories matters, not just the quantity2 .

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Influence of Biological Factors: He highlights the role of other factors such as the microbiome and hormones in influencing metabolic rate and how the body processes and stores calories2 . He points out that men and women distribute calories differently after puberty due to hormonal influences, and children grow because of hormonal signals, not simply because they eat too much2 ....

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"A Calorie is Not Just a Calorie": Dr. Devinsky agrees with the sentiment that "a calorie is not a calorie," meaning that calories from different sources can have different metabolic effects in the body3 . He contrasts the metabolic fates of glucose and fructose, noting that fructose is primarily processed by the liver and readily converted to fat, unlike glucose which can be used by various tissues and triggers insulin release4 ....

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Limited Explanatory Power for Obesity: While Dr. Devinsky acknowledges that consuming an excessive amount of calories, even from healthy foods, can lead to weight gain, he argues that the energy balance hypothesis is too simplistic to explain the obesity epidemic6 . He points out the common experience of obese individuals who have tried to lose weight by reducing calorie intake without significant success7 . He uses the historical example from East Africa in the 1940s, where colonial physicians couldn't figure out how to fatten underweight individuals, suggesting that simply increasing caloric intake is not always effective in promoting weight gain8 .

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Insulin's Role: Dr. Devinsky explains that insulin plays a crucial role in fat storage and utilization. In individuals with normal insulin sensitivity, insulin levels drop during fasting (like sleep), allowing fat cells to release stored fat for energy9 . However, in overweight or obese individuals, chronically elevated insulin levels (due to insulin resistance) can prevent fat cells from releasing fat, even when calorie intake is restricted9 ....

In summary, while acknowledging the basic principle of thermodynamics that energy cannot be created or destroyed, Dr. Devinsky contends that the energy balance hypothesis is an oversimplified and inadequate explanation for the complexities of human weight regulation and the development of obesity1 .... He emphasizes the critical roles of food quality, hormonal influences, individual metabolism, and factors like insulin sensitivity in determining body weight and overall metabolic health2 ....

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Discuss Public health institutions.

Dr. Orrin Dinsky in the Mind & Matter podcast expresses mixed feelings and significant skepticism towards public health institutions, drawing on the history of dietary recommendations in the United States1 .... He questions the trustworthiness of these institutions, noting instances where recommendations were based on "very thin evidence" and turned out to be "wrong and even backwards"1 .

Here are some key points regarding Dr. Dinsky's views on public health institutions:

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Diet Heart Hypothesis and the American Heart Association (AHA): Dr. Dinsky criticizes the AHA as being the "most diehard advocate" of the Diet Heart Hypothesis3 . He suggests they should undertake a "deep dive over the history" of this hypothesis3 . He highlights how the AHA adopted Ancel Keys's evolving views, eventually focusing on saturated fat as the primary dietary culprit for heart disease, despite limited and selectively presented evidence4 ....

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Suppression of Contradictory Evidence: Dr. Dinsky points to the Framingham Heart Study as a prime example of how public health institutions can suppress scientific findings that contradict prevailing dogma6 .... A nutritional study conducted within Framingham found no correlation between saturated fat intake and cholesterol or heart health, but its publication was allegedly "forbidden" and the findings were "buried" by the "heart mafia" (AHA, NIH, etc.)6 .... Dr. Dinsky suggests this suppression was motivated by a desire to maintain a unified message and prevent the public from reverting to diets higher in animal fats7 .

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Unified Message vs. Scientific Doubt: Dr. Dinsky discusses the inherent tension between public health's need to present a "unified public opinion" for effective public action (using the COVID vaccine as an example) and the "religion of doubt" that should characterize science7 . He argues that while a unified message can be important in certain public health crises, it becomes dangerous when it leads to the suppression of uncertainty and contradictory evidence, as he believes happened with the Diet Heart Hypothesis7 .

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Influence of Industry and Politics: Dr. Dinsky also touches upon the significant influence of industries like the sugar industry, which he describes as an "immensely powerful" lobby capable of shaping research and public opinion9 .... He suggests that financial and political motivations can contribute to the dissemination of biased information, even within medical and public health establishments10 .

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Distrust and Skepticism: Given the history of dietary recommendations and the potential for bias and suppression of evidence, Dr. Dinsky suggests that the average person should be "skeptical" of current public health recommendations11 . While he acknowledges the brilliance of many scientists and doctors within these institutions, he also recognizes that mistakes are made2 . He personally disregards his internist's recommendation for a statin despite a cholesterol level of 210-215, citing his good HDL and triglyceride ratios2 .

Connecting this to our previous discussions:

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The Diet Heart Hypothesis, which Dr. Dinsky critiques, was a cornerstone of public health dietary advice for decades [Me, You]. His insights highlight how these institutions promoted a hypothesis with questionable evidence, impacting public eating habits.

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Dr. Dinsky's view that the energy balance hypothesis is "mainly wrong" also contrasts with the simplicity of this model often promoted by public health messages on weight management [Me, You]. His emphasis on hormonal factors like insulin and the metabolic differences between nutrients suggests that public health advice on obesity might also be oversimplified.

In conclusion, Dr. Dinsky presents a critical perspective on public health institutions, emphasizing the historical missteps, the potential for bias, and the dangers of suppressing scientific uncertainty in the pursuit of a unified public message, particularly in the realm of dietary health. He advocates for a more skeptical and nuanced understanding of the information these institutions provide11 ....

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