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Optimal Human Nutrition? There, There...

The Council of Directors of the True Health Coalition is already, only weeks after its formation, home to nearly 150 leading experts from nearly 20 countries, rallying around the same basic principles of healthy eating.
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The expression "there, there" is generally used to confer comfort; although exactly why, I have no idea -- and apparently no one else really knows, either. So, for instance, if you are frustrated by the constant discord and fractious bickering, and even religious zeal, about opposing views on nutrition in our culture, you might get a pat on the head and a consoling, "there, there" to assuage that frustration.

But we can do much better than that. While we may be rather clueless about the origins of "there, there," we are a very long way from clueless about the basic care and feeding of Homo sapiens. We know more than enough about the fundamentals of optimal human nutrition to do a world of good. In other words, there truly is a "there," there -- and we know where that is.

My preference is to develop my case first and describe those fundamentals after, but I know some of you like the take-aways up front. For that crowd, then, I will note right away that Michael Pollan pretty much nailed it with: "Eat food, not too much, mostly plants." Frank Hu and I landed on the slightly broader, and even slightly more succinct "wholesome foods, in sensible combinations." To put some flesh on those bones, permit me to refer you here, and for that matter, here. OK, moving on.

Experts in nutrition do, of course, disagree. But that's supposed to happen in any field. It's the job of experts to focus on what we don't know for sure, to try and work it out, to push back the frontiers of understanding. When the focus is preferentially on what we have yet to learn, what is most uncertain, what is most contentious -- be it in physics, fly fishing, or stir frying -- disagreement is inevitable, and healthy. It is, or should be, the source of good questions, that invite the pursuit of answers.

But where the inherent character of expert debate meets pop culture preoccupation, there is the potential for a uniquely toxic brew: pseudo-confusion. In the case of nutrition, that's exactly what we have.

In physics, for instance, which is subject to expert debate but lacks pop culture preoccupation if only because it makes most people's eyes glaze over, we leave the dissent to the experts, while the rest of us happily take advantage of what we reliably know. We function in the dimensions we know, even as astrophysicists debate the ones we know not of. We fly in planes that are informed and designed by what we know about physics, unconcerned that experts have yet to account fully for the behavior of a boomerang. They are working on it, and in the meantime, we are accumulating frequent flyer miles.

In the case of nutrition, it seems to trail only the weather as a source of constant pop culture fascination. In order to feed those flames, the media particularly love change. In the case of the weather, change is intrinsic -- although I bet you've noticed, as I have, the tendency to "hype" and "tease" every potential shift in the weather, especially storms. As changeable as the weather is natively, our forecasters do all they can to push that envelope, and make it all more exciting. Details at 11!

In the case of nutrition, the opposite is true. What we know most reliably, we have known for decades -- if not longer. Change to the prevailing consensus has been incremental and evolutionary, not revolutionary.

What we know from a truly stunning aggregation of scientific evidence, derived from every conceivable kind of study, including the much (and perhaps overly) venerated randomized clinical trial, is totally concordant with what we know from paleoanthropology, and population-level experience in the real world. The basic theme of optimal human nutrition is clearly, emphatically, and consistently supported.

How boring! Imagine a weather report in a place where the weather is exactly the same every day. How do you hype that? How do you tease that?

The answers are: You don't. And if you are in the business of titillation for profit, that's bad news.

The result is that our culture, with all versions of media in the vanguard, have turned our diets into the weather -- or a never-ending beauty pageant. They "feed" us every exaggerated vicissitude they can find, and do all they can to obscure the far greater, underlying constancy.

I know this from the inside out, having worked as an on-air contributor at one of our major morning shows, and done appearances at all the others. There is genuine motivation to showcase conflicting dietary advice at every opportunity, because repeating the same thing- however true- would be less diverting. Media actually want an unending parade of mutually denigrating fad diet claims, whatever the impact on public health -- or your health, for that matter. The publishing houses concur wholeheartedly.

The way this all plays out, though, is nothing short of calamitous.

The apparent, constant discord results in the prevailing perception, as my patients have told me many times, that no two nutrition experts agree about anything- and every so-called nutrition "expert" changes his or her mind every 20 minutes.

Both are false. They are pop-culture impressions manufactured by the motivated special interests for profit, at your expense; and at the expense of your family.

Nutrition experts do not change their minds every 20 minutes, or even every 20 years. Evidence regarding the underlying causes of premature death in the United States, for instance, from 22 years ago is entirely consistent with current thinking about the best dietary practices to add years to life, and life to years. While there is an ostentatious effort among some these days to act as if the harms of excess sugar intake were newly discovered, we got exactly the same admonitions from Jack LaLanne nearly 70 years ago.

Just as important, the notion that no two nutrition experts agree about the fundamentals of optimal human nutrition is not merely incorrect -- it is as colossal and willful a corruption of the truth about food as the adulterations of the food itself to which are subject, a tale so well told by Michael Moss.

How do I know, and why does it matter?

I know for several reasons. First, my job has included very specific efforts, larger and smaller, to review the world's literature on healthy eating. Second, I have worked in this very space for some 25 years now, and in that time have, quite literally, broken bread (or the equivalent thereof) with many of the world's leading nutrition experts. Across a full expanse of different predilections, from vegan to Paleo, we eat more like one another than any of us eats like the "typical American." (With the possible exception of my friend Brian Wansink, whose important contributions, and unique quirks, I have addressed before.)

That has long been my impression: Nutrition experts are all using what we know to benefit ourselves, and those we love most -- and are as a result eating in ways more alike than different. Meanwhile, the general public is only served the discord, and left in a constant state of befuddlement, or disgust.

Now, I have begun to prove it. As part of a new, global initiative to advance the use of lifestyle as medicine, I have been working with colleagues to convene global leaders in nutrition, health promotion, and disease prevention in a True Health Coalition. The response to the invitations thus far fully validates my conviction that there is a massive, global consensus among experts about the fundamentals of optimal nutrition, even as there are details yet to be worked out.

The Council of Directors of the True Health Coalition is already, only weeks after its formation, home to nearly 150 leading experts from nearly 20 countries, rallying around the same basic principles of healthy eating. The Council to date includes two former U.S. Surgeons General; a former Commissioner of the U.S. FDA; chairs of academic departments, and deans; celebrities and scholars; chefs, environmentalists, dietitians, and physicians. Even more impressively, the same council is home to some of the world's best known advocates of vegan and vegetarian diets, and some of the best known advocates of the Paleo diet -- acknowledging in public that even they agree about the fundamentals, that even they eat more like one another than either resembles the typical American.

So it's time to change what the "typical" American eats -- because the "typical" American is a real person, with real skin in the game. It's time to use what we know -- just as we keep flying, despite the persistent mysteries of boomerangs, just as we keep on computing, even as engineers debate the best way to build the next generation of computers.

Along with publishers and morning shows, Big Food loves the prevailing pseudo-confusion. They have been exploiting it for decades. They've had their fun, and made their fortunes at our expense, and the expense of our children. Enough is enough.

At the level of nutrients -- sucrose and fructose; gluten and GLAs; stearic acid and lauric acid; omega-6s and omega-3s; cholesterol and resistant starch -- there is, appropriately, differing opinion among experts as we work to learn what we don't yet know for sure. Meanwhile, most of the world's experts are using what we do know quite well to care for themselves and those they love.

My contention is simply that it's time for everyone to share in that opportunity. We can use what do know, even as experts work to sort out what we don't. The simple fact is that if you get the fundamentals right about foods, the raging debates about nutrients almost all prove moot. Get the foods right, and the nutrients take care of themselves.

In a landscape of golden arches; in a culture that runs on Dunkin; and in a society where we can somehow reconcile anguish over epidemic Type 2 diabetes in our children with the marketing of multicolored marshmallows as part of a complete breakfast, we must concede that we are a very long way from being a Blue Zone. There is a great deal of work to do.

But that work cannot even begin in earnest until or unless we acknowledge that we are not clueless about the basic care and feeding of Homo sapiens; that we, in fact, know where "there" is. A global coalition of experts is coming together to say exactly that. While I am dubious about the value of "there, there," I feel quite differently about the value of revealing that with regard to nutrition, we truly do know there is a there, there. That's the first key step in doing all that's necessary to get there from here.


David L. Katz, MD, MPH, FACPM, FACP has, as noted, broken bread with many of the world's leading nutrition experts. A few of them, on the other hand, have broken a baguette over his head. You can't please everybody.

Director, Yale University Prevention Research Center; Griffin Hospital

Editor-in-Chief, Childhood Obesity

Founder, The GLiMMER Initiative

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