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Preventive Medicine Column
February 3, 2017
A Diet of Alternative Facts
Nutrition has been mired in a post-truth era in the U.S. since long before anyone in our country had
thought to coin the term. More than half a century ago, Ancel Keys did indeed note an association between
variations in dietary patterns, and variation in the rates of heart disease. In this country, where corporate
interests got involved early, that ultimately came to mean: eat low fat junk food, and all will be well. I have
challenged my peer group to find me a single instance of Keys advocating for Snackwell cookies, and
promised to give up my day job and become a hula dancer if ever they do. My wardrobe is still thankfully
free of grass skirts.
Low fat junk food did not exist when advice about the benefits of more plant foods, less meat and
cream, was simplified, excessively in hindsight, into “cut fat.” The only way to cut fat when the advice
originated was to eat more foods natively low in it, notably vegetables, fruits, beans, lentils, whole grains, and
such. In North Karelia Finland, Keys’ insights were applied in exactly that manner, and the result has been an
82% reduction in the rate of heart disease, and a ten-year addition to average life expectancy.
In this country, we not only contorted sensible advice about dietary pattern into a new variety of
highly profitable junk food, we never in fact applied the advice at all. Had we actually reduced our fat intake,
and replaced it with sugar and refined starch, it’s unlikely our health would have improved. But despite entire
careers predicated on this notion, it is false. Dietary intake data from multiple sources confirm that
Americans never reduced our intake of fat. Instead, we simply added the low fat junk foods- and reduced the
percent of calories we derived from fat by increasing our total calories. We even know why this occurred. Is
anyone really still confused about why this didn’t make us all lean and healthy?
That was the reality, and its expression would have forced us to acknowledge our folly, confront the
forces fostering it, and perhaps avoid replicating it. Instead, we were served a provocative set of alternative
facts about diet, blaming our problems on bad advice rather than our absurdly bad use of reasonable advice,
and providing us- inevitably- a scapegoat, in the form of an alternative macronutrient class. And so, we
moved on to cutting “carbs,” in all the silly ways we cut fat- and despite the fact that everything from lentils
to lollipops is a source of “carbs,” making summary judgment about the entire class not a wit better than
Any hope that this second deep dive into nutritional nonsense where sense might have prevailed
would have cured us of our penchant for replicating the follies of history capitulated long ago to experience.
We moved on to cutting gluten as a cure-all, or blaming our woes on genetic modification. There is a
booming cottage industry in discovering the harms of excess sugar, again, and again. But the truth about
excess sugar is also corrupted into falsehoods to provide cover for the pecuniary interests of the meat
Diet helped establish the pattern that bad execution of reasonable advice could be blamed on the
advice; that the remedy for picking the wrong scapegoat was not to renounce the practice, but to pick another;
that all opinion was the same as expert opinion; that a dissenting voice anywhere, whatever its motivations,
meant lack of consensus; and that the forces of profit perverting the messages of public health could be
overlooked as we wondered what went wrong.
I hope this sounds as ominous as it should. For one thing, it has meant we have squandered decades
of opportunity related to diet and health, and instead find ourselves fatter and sicker than ever. For another, it
means the lessons of alternative facts learned in the marketing of dietary nonsense, and tobacco too, have now
been applied to the climate, with calamitous consequences, and are currently very much de rigueur in the
running of our country.
There are fundamental truths about diet and health, to say nothing about dietary impacts on the planet,
born of massive aggregations of diverse scientific evidence, backed by a global consensus of multidisciplinary
experts. All that stands between us and the extraordinary good use of those truths could do -the addition of
years to lives, the addition of life to years, and the protection of our natural resources- is alternatives to the
Alternative facts about diet have long been poisoning public health, and our bodies. Instead of
heeding the lessons in that precautionary tale, we now look on as a diet of alternative facts about everything
else poisons the body politic, too. Now, as ever, it is ours to decide when to swallow- and when to spit.
-fin Dr. David L. Katz;; founder, True Health Initiative