Tuesday, April 17, 2012

The Skinny on the Fat Lie: Why My Inner Wonk is Angry

What if calories don't matter? What if the purported health benefits from the famed Mediterranean Diet were drawn from a tiny study done in an economically depressed island off Greece? What if fat doesn't make you fat and is instead a really important nutrient your body needs? What if exercise does virtually nothing to help you control your weight and instead just makes you hungrier? What if everything you think you know about diet and nutrition isn't just a little wrong, but a whole lot wrong?

It's been almost 20 years since a car accident started the constant pain and unending  migraines that ended my career and continue to rule my life every day. I still miss work. I still miss being a policy analyst. I still like to say I'm a policy wonk both by nature and by training. I find it impossible to turn that part of my brain off. I also like to remind my children that I didn't choose to be a stay at home mom. Not that being a stay at home mom is a bad thing or a choice I don't respect - it's just not the job I think I'm best at. If someone could get my pain to disappear tomorrow, I'd be back at work the day after.

The accident and my injuries also marked the beginning of my disillusionment with the medical establishment and the way medicine is practiced in the U.S.. While I'm loath to attribute anything arising from my injury as a good thing, my struggles to obtain adequate care for myself certainly prepared Stuart and I to be  assertive, questioning advocates for Jake when he fell from the high dive at Wilson High School in June of 1999 and sustained his severe traumatic brain injury.  The ignorance (as in the real definition of ignorance: The condition of being uneducated, unaware, or uninformed) of various doctors at some of this country's "best" hospitals almost killed Jake on several occasions in the 5 months he spent hospitalized. If we'd blindly followed all the "experts'" advice given in the years since, he'd be far more disabled than he is today.

Along the way I've been astounded to discover that despite med school pre-requirements  in organic chemistry and the like, the vast majority of doctors don't actually think like scientists at all. Many have no inclination to think outside the box, to problem-solve, to question . Even if what they see before them is glaringly different from what they've  been taught, they stick with - almost cling to - what was in their text books. Far from being scientists, they are much more akin to cooks - following recipes word for word. And as my friend Wendy (who also suffers from chronic pain) likes to put it - not only that - they're cooking from a pretty limited Betty Crocker cookbook rather than Mark Bittman's How to Cook Everything.

As my family and friends know, my constant pain imposes significant limits on what I can do, yet I continue to read voraciously and I am especially driven to follow the evolving science in all matters health. What my reading and personal experience has revealed is that increasingly, what doctors give out as daily advice to live by and the actual science has diverged so much as to be terribly dangerous for all of us. Sometimes when I think about these disparities and the real negative impact it has on friends and family it's overwhelming - it makes me feel like I'm carrying around really important information that would help the people I love, which makes me feel guilty - and deep down it makes my inner wonk really, really mad. 

A recent segment on NPR's Science Friday about the negative impacts of sugar and especially high fructose corn sugar in our diets, lead me to a series of articles and books by esteemed science writer Gary Taubes. Like many of us, he wondered why our 30 year battle with the obesity epidemic has only led to more obesity. Over the last 10 years he's dug through the entire history of our knowledge about food, diet and exercise and found we've got it all wrong.

His work is fascinating and impeccably researched. I worked my way through his 600 page book Good Calories Bad Calories and all the footnotes. His work is so provocative I think I have written a note in the margin on every page! Then I went online and read all his articles for the New York Times Magazine on the subject and then his book Why We Get Fat. My inner wonk is screaming! (I also read rebuttals from many of his critics, all of whom I found completely unconvincing - people blindly defending the status quo - or their agribusiness funded research grants!)

A calorie in does not require a calorie out. Fat (at least non-adulterated, natural fat - even lard!) does not make you fat and may indeed be an essential ingredient for a healthy diet. For the majority of us, exercise just makes us hungrier and drives our bodies to look for more food.  That Mediterranean Diet? Well, it sure can be tasty, but the science behind the concept comes from a sketchy study in 1960 of men living on the islands of Crete and Corfu - in that same study, none of the diets in other Mediterranean cities studied showed any heart-healthy benefits. 

In short - we are not fat because we can't control ourselves and eat too much and don't exercise enough. All that negative self-talk you've given yourself your whole life - all of it wrong, unnecessary and so, so mean. Over time I hope to share with you the things I've learned. I'm not a doctor, nor a scientist, but I am an analyst and my inner angry wonk thinks there are things you should know.