I follow the research in this realm of medicine, even if i am not an expert, but i am in the field.
What I can say is that the truth is usually in between. Maybe that is not very sexy.
There are some great pieces of research underway regarding health and diet. You can also pick studies to support, or reject, any medical point of view.
Studies of diet and physical activity are exceedingly hard to control. As such, data interpretation is often limited. Take it all wiith a grain of salt. It does not mean it is all wrong, but is also not all right. There is a lot we still do not know. I was chatting with a well known university professor/doctor who does such studies. He described the issues including confounding data, issues with correlation vs causation, patient compliance, study dropouts, and people lost to follow-up. Ignore the fact that 70% of people lie to their doctor (based on studies), often around compliance of such subjects.
The best studies ideally have fully controlled diets, but the people willing to institutanalize themselves long term for a truly controlled diet are limited, and Such studies unintentianally bias for specific socioeconomic status that often does not represent the whole. And when it happens, numbers are small, durations are too short, and dropout skews results. And then there is the correlation and causation issue. With diet it is very hard (impossible) to control only one variable. So take interpretation with a grain of salt.
We also need to distinguish between a population health approach to diet, vs individualized. The answer to one, is often not the answer to another... or at least it is more complex.
National “food guides” were more based on expert opinion (not always facts), and industry always had a hand in the pot. Goals were often widespread with many different interest groups advicating the pros and cons of so many foods. In reality, the biggest improver of life expectancy in the modern world was related to diet... and less people starving to death from malnutrition. And a reduction of birth related deaths... but that is off topic.
Keto diets work (high fat, high protein). I have seen many patients loose weight, get of hypergensive meds, get of lipid lowering meds, get off inulin 100%. I have seen many more get initial gains, but eventually fail because it was not sustainable for THEM.
I have seen many other diets “work” just as well also. A lot of data is there to support the idea that all (reasonable) diets work, and at a population level, humans commitment is what determines sucess, not the specific “diet”.
Day to day, the the focus often turns to small changes that are sustainable to the individual, and which the individual will buy into. This approach is one i promote when people are not willing to buy into wholescale change (and that is most people).
And genetics is part of it. I have been a healthy 130lbs my entire life since i was a teenager. Via bmi i am underweight. I often eat crap. Very often. My family is a similar build. There is no diabetes in my family. There is no overt cancer in my family. No heart disease. One grandfather lived to 94, the other is 102 and alive. My blood pressure is ideal. My heart rate is ideal. My cholesterol is ideal. Maybe i will die of a heart attack anyway. Who knows.
Some people get diabetes early. Some die of heart disease despite a perfect diet/lifestyle. Some people are born with diabetes. I treat diabetes regularily. I have a collegue who came from an area of europe where diabetes was so rare that only specialists deal with it. I would see 2-3 people a day with diabetes, maybe more. He was shocked.
Our current generation is the first generation that is expected to have a shorter life expectancy than their parents.
So the answer is in between. There is science to various diets, and calories in = calories out. And genetics is a part of it. And it is more complex than we like to pretend it is, and we will not all have the same outcomes. We are all different.
This is how I describe health to my patients: life is like poker. In the end we all run out of chips. I can’t give you a winning hand, but maybe we can do things like diet/medication/lifestyle to slip you a few face cards or aces now and then. We should always strive to stack the deck in our favour when it comes to health.
What I can say is that the truth is usually in between. Maybe that is not very sexy.
There are some great pieces of research underway regarding health and diet. You can also pick studies to support, or reject, any medical point of view.
Studies of diet and physical activity are exceedingly hard to control. As such, data interpretation is often limited. Take it all wiith a grain of salt. It does not mean it is all wrong, but is also not all right. There is a lot we still do not know. I was chatting with a well known university professor/doctor who does such studies. He described the issues including confounding data, issues with correlation vs causation, patient compliance, study dropouts, and people lost to follow-up. Ignore the fact that 70% of people lie to their doctor (based on studies), often around compliance of such subjects.
The best studies ideally have fully controlled diets, but the people willing to institutanalize themselves long term for a truly controlled diet are limited, and Such studies unintentianally bias for specific socioeconomic status that often does not represent the whole. And when it happens, numbers are small, durations are too short, and dropout skews results. And then there is the correlation and causation issue. With diet it is very hard (impossible) to control only one variable. So take interpretation with a grain of salt.
We also need to distinguish between a population health approach to diet, vs individualized. The answer to one, is often not the answer to another... or at least it is more complex.
National “food guides” were more based on expert opinion (not always facts), and industry always had a hand in the pot. Goals were often widespread with many different interest groups advicating the pros and cons of so many foods. In reality, the biggest improver of life expectancy in the modern world was related to diet... and less people starving to death from malnutrition. And a reduction of birth related deaths... but that is off topic.
Keto diets work (high fat, high protein). I have seen many patients loose weight, get of hypergensive meds, get of lipid lowering meds, get off inulin 100%. I have seen many more get initial gains, but eventually fail because it was not sustainable for THEM.
I have seen many other diets “work” just as well also. A lot of data is there to support the idea that all (reasonable) diets work, and at a population level, humans commitment is what determines sucess, not the specific “diet”.
Day to day, the the focus often turns to small changes that are sustainable to the individual, and which the individual will buy into. This approach is one i promote when people are not willing to buy into wholescale change (and that is most people).
And genetics is part of it. I have been a healthy 130lbs my entire life since i was a teenager. Via bmi i am underweight. I often eat crap. Very often. My family is a similar build. There is no diabetes in my family. There is no overt cancer in my family. No heart disease. One grandfather lived to 94, the other is 102 and alive. My blood pressure is ideal. My heart rate is ideal. My cholesterol is ideal. Maybe i will die of a heart attack anyway. Who knows.
Some people get diabetes early. Some die of heart disease despite a perfect diet/lifestyle. Some people are born with diabetes. I treat diabetes regularily. I have a collegue who came from an area of europe where diabetes was so rare that only specialists deal with it. I would see 2-3 people a day with diabetes, maybe more. He was shocked.
Our current generation is the first generation that is expected to have a shorter life expectancy than their parents.
So the answer is in between. There is science to various diets, and calories in = calories out. And genetics is a part of it. And it is more complex than we like to pretend it is, and we will not all have the same outcomes. We are all different.
This is how I describe health to my patients: life is like poker. In the end we all run out of chips. I can’t give you a winning hand, but maybe we can do things like diet/medication/lifestyle to slip you a few face cards or aces now and then. We should always strive to stack the deck in our favour when it comes to health.
