More on Diet and Carbohydrates

Hi Caffeine,You say some things that are absolutely correct, but let's start with something that's maybe not so correct: Americans' consumption of carbohydrates and rates of obesity both increased dramatically in concert. The currently ongoing change of emphasis from low-fat to low-carbohydrate diets is a direct reaction to this fact. There's no doubt here. Absolutely the picture is much more complex than just carbohydrates. The point I'm making isn't that only carbohydrates are to blame for obesity, because that's not even true, but that past government and mainstream dietary advice about fat and carbohydrates are to blame for the obesity/diabetes/heart-disease epidemic of the last half century and more. We're only just beginning to admit to ourselves how different the gathering of health data can be across different countries. Cross country comparisons should be viewed skeptically. For example, the French paradox concerning wine's health benefits? Likely fictional, a result of data gathering differences.--Percy

Certainly not on your part. Near the end of your message you mention a number of factors, but they're the kind of things that studies attempt to control for. You want to put in no effort and just declare that it's all so complicated that there's no way we could possibly know how it happened, but the reality is that there has been a great deal of detailed research, and I've described some of it at an undetailed level. You don't have to respond to it, but there's not really much to discuss if you don't. Keep in mind I didn't blame only the government. I think we just believe differently about whether the responsibility for bad advice lies with those who give it or those who follow it. The government and certain organizations represented their dietary advice as deriving from the best scientific research available, and that wasn't true. Such hubris shouldn't be given a free pass.--Percy

Given what you say next, I think what you really meant to say here is not that there's any doubt about the concurrent increases in carbohydrate consumption and obesity, but that things are more detailed and nuanced than that. And of course you're right, and of course I'd love to delve beneath the surface details. Moving on to what you say next: Your can't say that increasing sugar consumption was a different change from increasing carbohydrate consumption because sugar is a carbohydrate. Increasing sugar consumption led directly to an increase in the proportion of consumed carbohydrates that were refined. The proportions in the mix of carbohydrate types changed, not the types. Yes, absolutely. It's worth noting that carbohydrates include not just sugar but also many grain products like pasta and breads. You might think that sugar is the most refined of all carbohydrates, and it certainly is in a technical sense, but it doesn't have the highest glycemic index (a measure of the bodies reaction to carbohydrates). The glycemic index of sugar is 68, but that of white bread is higher at 70. Yes, also true. They've eaten more fat, not "a lot more fat". Fat consumption was rising modestly, but carbohydrate consumption in general was increasing dramatically by around 40%, as your chart shows: From 1970 fat consumption rose very modestly by maybe 10-15%, not taking off until the 1990's when doubts about dietary fat advice began taking hold: So though total caloric consumption, including both fat and carbohydrates, increased during the latter half of the 20th century, carbohydrate consumption increased much more dramatically. The proportion of fat in the diet declined even though fat consumption in absolute terms increased. Most importantly, the proportion comprised of refined carbohydrates increased most dramatically. No, of course not. Government and many health organizations advised minimizing sugar consumption, sugar being the most refined of carbohydrates. That's something they got right. What their advice was missing was that the negative impact of sugar and other refined carbohydrates goes way beyond just the extra calories. In terms of their advice, people drinking too much soda, especially after the advent of HFCS, should be expected to know they're consuming too many calories, but not that they're negatively impacting their health by increasing their risk of metabolic syndrome and diabetes. Consuming the same number of grams of complex carbohydrates as there are refined carbohydrates in a soda carries with it none of the same health risks.Since fiber plays a significant role in mitigating the negative impacts of carbohydrates (most measurably in terms of reducing glucose spikes), your surmise that the decline in fiber consumption played a significant role in the obesity and diabetes epidemic is strongly supported by the evidence. All low-carb diets include the advice to try to maximize the presence of fiber in any carbohydrates consumed, often referred to as complex carbohydrates.--PercyEdited by Percy, : Minor clarification.

You could only reasonably say this about someone with a habit for blaming the government, and what part of "Keep in mind I didn't blame only the government" didn't you understand? For example, the American Heart Association is big into low fat advocacy (they're beginning to gradually back away from this).And it isn't "my problems" but an issue of public health. As I said, I think we disagree about whether the responsibility for bad advice lies with those who give it or those who follow it. In the case of the government's advice on diet they convened groups of experts and scientists, availed themselves of resources not available to the average person, and came up with dietary guidelines that supposedly represented the best that science had to offer. Guidelines developed in this way carry a great deal of weight, and in this case the guidelines were wrong in two critical ways: they didn't follow the science, and they were bad for health. You're not wasting your time if your hope is that the material you presented will be given fair and unbiased consideration. What more could you want? It's only necessary to ask the rhetorical question that if nobody was following the government dietary guidelines about reducing dietary fat, who was buying all the reduced fat options in grocery stores? The ones that are now seeing their shelf space taken over by reduced carbohydrate options now that our understanding has evolved (and in almost coerced reaction to escape the embarrassment, the guidelines are also evolving in that direction). As I explained to Caffeine, while both fat and carbohydrate consumption increased, carbohydrate consumption increased more, causing the typical American diet to be proportionately more carbohydrates. Here's a link to the 1980 Dietary Guidelines for Americans. You won't find any reference to whole grains. People were not ignoring the advice to eat whole grains because the advice wasn't there. Not until many, many years later. These are legitimate and significant factors, and my focus on one particular aspect, dietary advice, isn't meant to imply that they are not. But overeating that emphasizes fat carries far fewer health risks in terms of obesity, diabetes and heart disease than overeating that emphasizes carbohydrates, particularly refined carbohydrates. My focus on the dietary advice aspect is justified just in terms of the sheer irony of emphasizing carbohydrates to an increasingly obese audience. It's like telling someone to stop a car by stepping on the gas. Keep in mind again that I didn't only blame government. My use of the term "hubris" refers to those in the scientific community who defended inadequate science and those in the dietary advice community (Dean Ornish comes to mind) who demonized those advocating low carbohydrate diets.--PercyEdited by Percy, : Grammar.

The way scientists defended inadequate science (perhaps believing they'd eventually be shown right since it just made so much sense that eating fat makes you fat) and the way low fat diet advocates like Dean Ornish vilified those advocating low carbohydrate diets (for example, declaring that people following low carbohydrate diets were destroying their health) has all the hallmarks of hubris. If you reduce fat in the diet then you have to make up the calories somewhere, and that means increased intake of carbohydrates. Those at the lowest end of the economic spectrum were particularly severely affected by the bad advice, since carbohydrates are the cheapest source of calories. Increasing carbohydrate intake, particularly refined carbohydrates, is bad for health. There can be no doubt about the connection now.One other comment. It's easy to write "government advice" instead of the awkward "advice from government, health organizations and the diet advice community," and I'm guilty of this too, but let's not forget that it wasn't just the government giving out bad diet advice.--Percy

Think about it. Why would grocery stores be filling their shelves with increasing numbers of low-fat options if no one was buying them? I never said they did. Only dieters in the first blush of a new diet maniacally manage portion sizes. What happened is that Americans responded to the guidelines by increasing the proportion of carbohydrates in their diet. This was reflected in supermarkets by the increasing numbers of low fat food options. I just noticed I've been posting the wrong link. Though I labeled it as the 1980 guidelines, it's actually the 1990 guidelines. I was wondering why you kept referring to the 1990 guidelines, I guess that's why. My fault, I apologize. Here's a link to the actual 1980 Dietary Guidelines for Americans.The 1980 guidelines do advise eating whole-grain breads and cereals, but what comes before on page 13 is at the core of the misadvice about fats and carbohydrates: That advice to compensate for decreased fat intake with more carbohydrates is exactly what happened. Relative to one another, Americans decreased their consumption of fats and increased their consumption of carbohydrates. This change in dietary habits was reflected in the food choices available in supermarkets that I keep talking about. The foods available for sale in supermarkets are an excellent indicator of what people are eating.You're correct that Americans didn't follow the advice about numbers of servings of various food types, but they never have and never will, and that certainly wasn't what I meant when I said Americans followed the guidelines. I'm sure very few people eat meals that way. But Americans did follow the advice to consume less fat and more carbohydrates. And now they appear to be following the advice to reduce carbohydrate consumption.--PercyEdited by Percy, : Clarification.

You're ignoring the implications of the evidence, so I'm telling you to think about it. You seem to be denying the incredibly obvious, that what's on store shelves is excellent evidence of what people are eating. Anyone who has done the grocery shopping on a regular basis over the years has witnessed the changes. The increasing prevalence of low-fat options was a reflection of people's then increasing awareness of the dietary advice against fat, and today the increasing prevalence of low-carb options is a reflection of people's now increasing awareness of the dangers of carbohydrates.The advice against fat can still be seen in the nutrition news, where saturated fats and unsaturated fats and omega-3's and so forth are frequently the topic. Low-fat diet books don't seem to be around much anymore if Amazon is any guide, but I did find this low-fat advice book from the 1990's: Such diet advice books used to dominate the bookshelves in the nutrition section of bookstores. There'd be the tiny corner with the Atkins-style low-carb diet books, there'd be a variety of eclectic plans, and the rest would be low-fat diet books. It seems to be your contention that all the advice from the government, from health organizations, from the diet advice industry, from grocery store shelves, from the media, America just ignored it all and it had no effect. You seem to believe that the increasing proportion of carbohydrates in the diet just happened, and that all this advice against fat at the same time was just a coincidence.You can't deny that there was (and still is to some extent) a public consciousness about avoiding fat. Where do you think that came from? Was it mass psychosis? Was it just another expression of the unpredictable ebb and flow of public opinion? Or could it possibly originate from the decades of advice against fat from the government, from health organizations, and from the diet advice industry? You're being binary in your judgment. You're demanding a yes/no answer to an issue that has a large range. On a 0 to 100 scale I would give America a 70 for following the government guidelines and nutritional advice. America did clearly hear the "fats bad, carbohydrates good" part of the message that originated with the guidelines, and in reaction America greatly increased the proportion of carbohydrates in the national diet.--Percy

I didn't say they weren't, but the availability of low-fat and no-fat versions of food increased enormously. As dietary advice against fat began taking hold in the public perception the food industry responded by offering more and more low-fat and no-fat options. Milk that had been available only in whole and skim versions became available in 2% and 1% versions. Cream cheese and yogurt became available in low-fat and no-fat versions. Lay's introduced a fat free potato chip in the late 1990's. It goes on and on.I'm having trouble understanding the objection to what is nothing more than a simple observation. I know this is pre-history to the youngsters among us, but many of us lived this.--Percy

Except that I don't. Everyone doesn't have bad health, the government wasn't the only party handing out bad advice, and the bad advice isn't responsible for all obesity, diabetes and heart disease. It really isn't. I agree, but that's not what I've been saying, is it. I agree that your misstatements of what I'm saying are ridiculous. I didn't say the government's advice was responsible for everyone who's obese. I said the advice from a variety of sources influenced Americans to overemphasize carbohydrates in the diet and played a significant role in the ensuing obesity/diabetes/heart-disease epidemic. Those are also significant factors, but not all are completely independent ones. The fast food and junk food industries were able to leverage the bad dietary advice to successfully market foods with higher contents of carbohydrates and refined carbohydrates.--PercyEdited by Percy, : Clarify first paragraph.

I provided no specific date, so I don't know when you're talking about. If by "10 years earlier" you mean 10 years before 1980, I provided a link to a government diet brochure from 1980 because that's the oldest I could find, but dietary advice against fat began long before that.The point is that the dietary advice against fat caused the food industry to make available increasing quantities of low-fat options as time went by. This evolution of food choices toward more low fat options was reflected on grocery store shelves.--Percy

You're reading is getting increasingly careless. First, you originally said the fast food and junk food industries, not just the fast food industry. Second, I didn't say anything about their intent to follow dietary guidelines. What I said was that they took the public's focus on fat as an opportunity to increase carbohydrate and refined carbohydrate content.Concerning your comments about salt, making food appealing is more than just a matter of adding salt. It's a combination of fat, sugar and salt (I'm echoing the title of Michael Moss's book, sugar actually refers to carbohydrates). Taste and mouth feel are the most important components. I didn't say they did, but the more conscious the public becomes of any dietary concerns the more the food industry (all facets, not just fast food) will attempt to respond in ways that maximize profits. I'm having trouble figuring out why you can't see the rather large disconnect between what you claim I'm saying and what I'm actually saying.--PercyEdited by Percy, : Add clarification to 2nd para.

Except that I don't keep blaming the government. Frequently we refer to "government advice" as a sort of shorthand in these messages we're writing, but it's actually a complex of factors involving the scientific community, government advisory boards, health organizations, the food manufacturers, and the diet advice industry.That being said, I do assign a significant proportion of the blame to the government because they provided the anchor for the advice about fat provided by organizations like the American Heart Association and by the diet advice industry. But it wasn't a fad, and it wasn't just government advice. It was also organizations llke the American Heart Association, it was news reports about studies showing the negative health impact of fats (e.g., saturated fat, partially hydrogenated trans fats), it was diet experts writing books and appearing on radio and TV programs, etc., etc.--Percy

This is from Michael Moss's book Salt, Sugar, Fat, page 329:

quote:

---

Potato chips are also loaded with sugar...The sugar in regular chips is the kind of sugar that the body gets from the starch in the potatoes. Starch is considered a carbohydrate, but more precisely, it is made of glucose, the same kind of glucose you have in your blood..."The starch is readily absorbed," [Eric Rimm, assoicated professor of epidemiology and nutrition at the Harvard School of Public Health] told me. "More quickly even than a similar amount of sugar. The starch, in turn, causes, the glucose levels in the blood to spike, and this is a concern, in relation to obesity."

​

These surges in blood glucose are highly problematic for anyone watching their weight. Recent research suggests glucose spikes will cause people to crave more food, as long as four hours after they've eaten whatever caused the blood glucose to spike. Eat chips one hour, crave more the next.

---

Not mentioned here is the effect of glucose spikes on pancreas and on fat and muscle cells. They lead to metabolic and syndrome and diabetes.Fat doesn't cause glucose spikes.--Percy

It might not seem germane to those who have lost the context, but what Jon said that Coyote responded to was, "The fast food industry didn't change their menu to better conform to USDA guidelines." Coyote responded that menus will change based on customer wants. Inescapably, as the public became increasingly aware of the proscriptions against fat, it because increasingly important for purveyors of food to pay attention and construct a response. Coyote's example of a response was McDonald's adding salads to the menu. I don't know who Mickey D is, but the point being made isn't that they added low-fat/high-carb items to their menu in response to customer requests. What they did and do is stay aware of public perceptions and stay responsive to them. A public completely oblivious to government guidelines and the advice of health organizations and the diet advice community would not cause Mickey D or the food industry in general to respond with increasing numbers of low fat offerings. Since the food industry (again, I don't know anything about Mickey D) did respond with increasing numbers of low fat offerings, obviously they were responding to public perceptions about the dangers of fat. Sure, generally speaking McDonald's is high-fat/high-carbs, but their food offerings and marketing only reinforce Coyote's point that they are responsive to public perceptions of health as evidenced by their offering of salads. It's marginal, of course, because of who they are, but McDonald's doesn't exist in a vacuum. They have to compete with Burger King and Wendy's and maybe even Mickey D whoever they are, and a perception that their food is less healthy than their competitor's could hurt sales. Hence they're responsive to customer perceptions.--Percy

I don't know what date you mean. I believe 1% and 2% fat versions of milk started to become widely available in the 1950's. Over the ensuing decades the shelves of the milk section of grocery stores were taken over by the reduced fat offerings and whole milk was given less and less shelf space. Consumption rates of whole and low-fat milk from 1970 on are shown in this graph: Hopefully the trend away from whole milk has begun to reverse. Pretty much.--PercyEdited by Percy, : Correct misstatement in first paragraph.