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Issue #13 (November 2015)

From the Editor

Volume 1

“Diet” can be a noun or a verb. It comes from the Greek root diaita, meaning “way of living” (is it clear now why diet is so controversial?). The noun just refers to what you eat—pretty straight forward. The verb indicates placing a restriction on what you eat, commonly to lose weight. This is where the controversy ensues.

In fact, the very concept of “dieting” has come under fire in recent years. There’s obvious merit to avoiding the obsessive practices common in restrictive dieting, but there’s more to this issue than meets the eye.

Part of the controversy stems from the practice of judging what other people eat. If you had success limiting your calories by counting them each and every day, you may become a cheerleader for this kind of dieting. People who use a seemingly less restrictive diet may be critical of counting calories, eliminating foods, and especially eliminating entire food groups.

In this issue of NERD, we cover time-restricted feeding, which is quite a hot research topic. This type of diet is restricted in a totally different dimension. It doesn’t restrict WHAT you eat, but WHEN you eat it. Or rather, when you don’t eat it. Most people can easily eat enough food to satisfy their hunger within a 12 hour eating window. In fact, some people do it naturally without thinking about it, either with three square meals a day (and no late night snacks), skipping breakfast, or something else.

This type of eating doesn’t often get labeled as “restrictive dieting,” because it doesn’t imply a change in foods. But it turns out that you can restrict your diet in many ways other than going low-carb, low-fat, gluten-free, vegetarian, and so forth.

I once worked at a research center that was doing a study on mindful eating. What would happen if you were having dinner with a friend, told them you’re on a diet, and proceeded to slowly and mindfully eat a large dinner followed by two scoops of ice cream? There’s nothing inherently unhealthy about eating a large meal, or eating ice cream. But diet critics will invariably choose some aspect of the meal they want to focus on. The size of the meal, the sugar or gluten or FODMAPs, whatever.

Here’s the thing: when you diet, it’s YOUR diet. If someone else can’t handle dairy, that doesn’t mean your dairy-rich diet is harmful. If someone else had success with a vegan diet, it doesn’t mean your meat-rich diet is harmful. And even though mindful eating worked wonderfully for many of our study participants, it doesn’t mean that wolfing down food is inherently bad.

The more you slog through PubMed articles on nutrients, foods, and diets, the more you start to notice when people make unfounded generalizations, or judge other people’s diets or views on dieting. It’s a very subtle distinction: analyzing and criticizing studies (and arguments) is healthy, but when you go several steps beyond that into hypercritical and judgmental territory, especially of someone’s personal diet, it’s not called being an expert. It’s called being a jerk.

Kamal Patel,
Editor-in-chief, Nutrition Examination Research Digest

Volume 2

There’s one crucial thing that almost NEVER comes up in nutrition evidence debates: journal articles use some of the dryest writing possible in getting their points across. And partly due to this, 90% of those who argue about the articles don’t actually read them.

On the one hand, this kind of dry language is to be expected. Journal articles are not opinion pieces that employ flowery or persuasive language, and using standardized language actually makes them a lot more understandable across cultures. On the other hand, there is very little incentive for the average Jane or Joe to read health-related literature (or start learning to understand it), even if it could benefit their own health conditions.

All is not lost. Certain journals (such as the British Medical Journal, see example here) provide plain-language summaries that tell you what’s known about a topic and what the study adds to it, in just a few sentences. That’s kind of neat, although with complex studies, it’s easy to miss the most important details by reading only the tiny summary.

Did you think I was going to list NERD as another potential way to address this issue? Nah … too easy.

The general public doesn’t technically need to be familiar with reading scientific research in order to benefit from it. In fact, the complexity and breadth of information on life sciences is astounding, and would take quite a chunk of time away from busy people who don’t have that time to spare. Rather, it’s most important for health practitioners of all types to know some basics about “Evidence Based fill-in-the-blank”.

This includes fields ranging from dietetics to physical therapy. Some fields are more difficult to study in a typical evidence-based fashion. Like you can’t really randomize people to sham surgery, most of the time. But perhaps more difficult than surgery studies are diet and chronic disease trials. It’s relatively easy to measure intermediate biomarkers, but much more difficult to assess the impact of diet on long-developing conditions like cancer or Alzheimer’s Disease.

An obstacle to widespread use of “Evidence Based fill-in-the-blank” in healthcare professions is a simple lack of fluency in biostatistics and epidemiology. Public health graduate programs make you take a course series in each of these fields, at minimum. Medical school makes you take some, and some other programs do the same. But it’s rarely a priority. In fact, a friend of mine had wanted to do her MD-PhD with epidemiology as the PhD portion, and it took a massive amount of work to get that funded. Why should that be? Is there actually a reason why microbiology is sooooo much more important to improving public health than epidemiology? Or maybe it’s just the inertia of the status quo and NIH funding.

So all in all, I don’t really mind the dry writing in articles that much. The need for verbosity and clever descriptions can be had by reading Game of Thrones. The most important thing is to make sure articles are accurate (another issue entirely) rather than fun to read. But perhaps more attention should be placed on getting health professionals equipped to actually read these articles, through more biostats and epi prep.

Kamal Patel,
Editor-in-chief, Nutrition Examination Research Digest

See other articles in Issue #13 (November 2015) of Study Deep Dives.