Weekend Bonus: This Is What We’re Up Against … Italian version

A reader named from Paolo wrote to me from Italy to recount an online debate he had with a doctor.  It’s very much like my recent go-round with the nutritionist.  Paolo translated the debate into English so I could enjoy the doctor’s ignorance.  Here’s a transcript so you can do likewise:

Doctor (to a reader):  Maureen, do not pay any attention to the articles found on websites which have not the slightest scientific foundation. Take your information from those who have no partisan interest and should not sell anything except health: public and then, not individuals who, for various reasons, are interested in selling something, sometimes just to have a reason to exist. INRAN, ISS, Ministry of Health … to name examples of Italian, or FDA or USDA for Anglophones are the references to follow. Everything else is … let’s say out of the scientific consensus.

Paolo: I see that you mention USDA and FDA as reliable sources of information on nutrition. Can you explain then why the obesity epidemic that devastated the U.S. started right after these organizations started to give official guidance on what to eat? Fault of the citizens who have not listened? Or deeply wrong directions (for example, the restriction of fat and the subsequent increased consumption of carbohydrates)?

My answer is implicit in the question, I would like to have an interpretation of the curious phenomenon.

Doctor: The obesity epidemic in the US is now experiencing is a tragic situation but it has certainly not exploded after the guidelines. Indeed, the guidelines were made just to put a stop to this. Even when Ancel Keys began the Seven Country Study Americans were concerned about the large number of cardiovascular diseases that afflicted the country, while this disease was unknown in Italy, as we were dying of hunger. Since then, the relationship between diet and a large number of diseases was clear and the recommendations are enacted. Not the opposite. It ‘s a bit like saying, since there are dentists man has more cavities. The recommendations are not deeply wrong, but if you believe that they are, please try to convince the scientific community.

Paolo: The first official guidance on what to eat came in 1977 (McGovern Commission). The famous cover of Time with the sad eggs is of ’84. Obesity has rocketed up since the ’80s, as shown here. You can’t deny that official statements have not brought the expected results (yes, you can to say that without the signs they would have gone worse, but it would be profoundly dishonest)

The famous Seven Country Studies was really about 20 countries, but Mr. Keys has chosen to ignore data that did not contribute to the demonstration of his conjecture (for example, has failed to consider the data of France and Switzerland where, despite a fat intake saturated well above the average, had an incidence of cardiovascular disease by far the lowest).

All this has led to an incredibly reckless campaign against animal fats, so that many have been consuming artificial trans fatty acids (oh my god…). It also has allowed pharmaceutical companies to make billions of dollars on anti-cholesterol drugs, which nobody has ever been able to demonstrate the effectiveness in preventing heart attacks (I know that doctors advise them to healthy people of 40 years because “who knows what can happen”).

This fat phobia led consequently people to consume more carbohydrates. A direct consequence: obesity.

In fact, carbohydrates are, unlike fat, addictive. Typically, three hours after a lunch of pasta or pizza, that unbearable stomach hole leads us to put in a sweet snack. With the fat this does not happen, and in fact I eat them at will.

Doctor: The first guidelines appeared in the 40s and 50s in “a daily food guide”. Obesity is increasing throughout the Western world and so guidelines were given to populations. Of course, if your nutritional culture is based on wikipedia, you can make big mistakes. Governments made for years anti-smoking campaigns and smoking is still increasing (he really said this!) . If there were no smoke problem recommendations would not exist.

Paolo: From wikipedia I took only a chart that seemed significant enough. As for smoking, no one questions the danger of smoking and in fact much less than before (where did you read that today smoking is increasing?)

In the case of nutrition the question is much more controversial and there are many scientists who are starting to question the “religion of cholesterol.” The problem is that questioning the sacred word of the USDA for a scientist means jeopardizing his career. He risks being excluded from the scientific community, and in fact many are convinced of the error, but avoid saying so for fear.

What can you say about the recommendations are given to American children to drink only skim milk? Do you know that this has been correlated with the epidemic of ADHD that has been fought with Ritalin and Strattera? (Strange, drug companies that make money). What a shame …

Doctor: I suggest you stop taking news from “Mickey Mouse Magazine” and pay attention not to say things that are completely false. If you are not a scientist, please just ask questions of me, or you are out. If you are a scientist, introduce yourself so we can discuss at the same level.

Paolo: It’s not important who I am, science is done with the facts and not with academic qualifications. The provocation (scientifically speaking) was clear from my first message, which I did not think it would have been published.   [NOTE: I know I’m missing something in translation in that last one– Tom]

Personally I am quite convinced of my opinions and I didn’t write to you because I wanted a confirmation, but because they I’m always ready to change my mind when I find some opposite evidence.

Unfortunately, I have to say that your contribution was not satisfying, as you carefully avoid commenting on the facts that I suggested and preferred to ridicule my sources (wikipedia from which, I remember, I extracted only a graph).

One last question: The American Diabetes Association recommends people with diabetes to maintain carbohydrate intake at 50%. What do you think about it?

Doctor: It’s very important who you are. It’s not easy to make science, nor to discuss about it. So you need to study. If you can produce any document that proves that USDA and FDA are wrong, I will be happy to read it. But I think it’s difficult, as USDA and FDA positions come from deep analysis of documentation provided by the scientific literature. What you say are personal opinions not approved by the scientific community. It’s good to give carbohydrates to diabetics, cause it’s the best way to prevent CHD, cancer, and metabolic syndrome and diabetes.

At this point, Paolo had an “Oh my god!” moment and chose not to continue.  How do you say “banging my head against my desk” in Italian?


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74 thoughts on “Weekend Bonus: This Is What We’re Up Against … Italian version

  1. Pasturedbeef

    “It’s good to give carbohydrates to diabetics, cause it’s the best way to prevent CHD, cancer, and metabolic syndrome and diabetes.”

    More like it’s good for the economy!

    It certainly keeps the health-care industry supplied with customers.

  2. PhilM

    That doctor is just unbelievable! Is there hope for his patients?

    Unfortunately, his patients would receive the same advice from most other doctors.

  3. Zooko Wilcox-O'Hearn

    Dear Paolo/Maureen:

    If your goal is to educate, then heed the doctor’s request: “produce any document that proves that USDA and FDA are wrong, I will be happy to read it.”. Perhaps start with http://www.nutritionjrnl.com/article/S0899-9007%2810%2900289-3/abstract . Doctors (who are not, by the way, trained as scientists) prefer to spend their precious time reading peer-reviewed journal articles instead of blog posts for a good reason.

    Regards,

    Zooko Wilcox-O’Hearn

    Even if Paolo flooded the doctor with articles from journals, it probably wouldn’t change his mind.

  4. Richard Tamesis, M.D.

    Which demonstrates once again that Mark Twain was right when he said, “Never argue with a fool, onlookers may not be able to tell the difference.” Paolo obviously had to learn the hard way.

  5. Ella

    The curriculum for doctors should shift significantly from keeping up with the latest synthetically produced drugs to the detailed study of nutrition. And by that I mean the current data about what nutrition crops of today contain by region, method of farming, soil, etc. Then case studies of large groups of people and what effect their particular diets have on their health (or lack thereof). I believe average doctor still only has 40 hours of nutrition in their curriculum. If you want to help people stay healthy, study nutrition and stress prevention. If you want more sick people to provide a constant revenue steam, then focus on man-made patented medications and deny the impact of diet/stress response on health.

    Well said.

  6. Pasturedbeef

    “It’s good to give carbohydrates to diabetics, cause it’s the best way to prevent CHD, cancer, and metabolic syndrome and diabetes.”

    More like it’s good for the economy!

    It certainly keeps the health-care industry supplied with customers.

  7. PhilM

    That doctor is just unbelievable! Is there hope for his patients?

    Unfortunately, his patients would receive the same advice from most other doctors.

  8. Zooko Wilcox-O'Hearn

    Dear Paolo/Maureen:

    If your goal is to educate, then heed the doctor’s request: “produce any document that proves that USDA and FDA are wrong, I will be happy to read it.”. Perhaps start with http://www.nutritionjrnl.com/article/S0899-9007%2810%2900289-3/abstract . Doctors (who are not, by the way, trained as scientists) prefer to spend their precious time reading peer-reviewed journal articles instead of blog posts for a good reason.

    Regards,

    Zooko Wilcox-O’Hearn

    Even if Paolo flooded the doctor with articles from journals, it probably wouldn’t change his mind.

  9. Richard Tamesis, M.D.

    Which demonstrates once again that Mark Twain was right when he said, “Never argue with a fool, onlookers may not be able to tell the difference.” Paolo obviously had to learn the hard way.

  10. Andre chimene

    Tom, everytime I read this stuff I get a hole in the pit of my stomach that can only be filled with Kerrygold Butter…I prefer unsalted.

    I like it with salt, but I’m with you.

  11. Ella

    The curriculum for doctors should shift significantly from keeping up with the latest synthetically produced drugs to the detailed study of nutrition. And by that I mean the current data about what nutrition crops of today contain by region, method of farming, soil, etc. Then case studies of large groups of people and what effect their particular diets have on their health (or lack thereof). I believe average doctor still only has 40 hours of nutrition in their curriculum. If you want to help people stay healthy, study nutrition and stress prevention. If you want more sick people to provide a constant revenue steam, then focus on man-made patented medications and deny the impact of diet/stress response on health.

    Well said.

  12. Paolo

    Thanks Tom for this post! Anyway, this doctor is an official nutritionist from the Italian equivalent of USDA / FDA.

    The conversation went along, I asked him why the Masai are so healthy without following his guidelines and he answered (I’m not joking, it’s online) “They are certainly not healthy as they eat a 100% animal product diet and we now too much meat is unhealthy.”

    sure… MAMMA MIA!

    That’s hilarious! Never mind their actual health — they MUST be unhealthy because of all that meat! Talk about a circular argument.

  13. Paolo

    Forgot to add.. after that incredible answer I suggested him to organize an expedition to Africa in order to tell the Masai the are unhealthy and that it’s time to change ther diet. He didn’t publish it…

  14. Kate

    Oh look, an MDiety. You have to be a scientist, or he can’t communicate with you like a grown up. It’s good to know that not all MDs are like that!

    He and T. Colin Campbell must have attended the same debating classes.

  15. Andre chimene

    Tom, everytime I read this stuff I get a hole in the pit of my stomach that can only be filled with Kerrygold Butter…I prefer unsalted.

    I like it with salt, but I’m with you.

  16. Paolo

    Thanks Tom for this post! Anyway, this doctor is an official nutritionist from the Italian equivalent of USDA / FDA.

    The conversation went along, I asked him why the Masai are so healthy without following his guidelines and he answered (I’m not joking, it’s online) “They are certainly not healthy as they eat a 100% animal product diet and we now too much meat is unhealthy.”

    sure… MAMMA MIA!

    That’s hilarious! Never mind their actual health — they MUST be unhealthy because of all that meat! Talk about a circular argument.

  17. Paolo

    Forgot to add.. after that incredible answer I suggested him to organize an expedition to Africa in order to tell the Masai the are unhealthy and that it’s time to change ther diet. He didn’t publish it…

  18. Paul

    http://www.bbc.co.uk/news/health-11501323
    Salt and fat content ‘too high’ in child hospital meals

    “Salt and saturated fat levels in food should be kept low to guard against the risk of diseases, campaigners say
    There is too much salt and fat in the food served to children in hospital, a survey suggests.”

    THIS is what we’re up against. This is criminal! No doubt about it. Simply criminal! Makes one’s blood boil.

    Keep fighting the good fight, Tom!

    Regards,
    Paul

    Oh lordy, that means they’ll up the carb content.

  19. Kate

    Oh look, an MDiety. You have to be a scientist, or he can’t communicate with you like a grown up. It’s good to know that not all MDs are like that!

    He and T. Colin Campbell must have attended the same debating classes.

  20. Paolo

    Zooko Wilcox-O’Hearn, I did send that document do the doctor (Tom did some good cuts as the complete conversation was too long), but he just said “And so? It just says that we need a little change to guidelines as people is getting obese”. I said to him “come on, it says terrible things about the giudelines” but he didn’t publish this message.

  21. Lori

    The Mediterranean Diet has its own food pyramid, which is shown in Cucina Amore by Nick Stellino. (Go to http://www.amazon.com/Cucina-Amore-Nick-Stellino/dp/0385478321/ref=sr_1_4?s=books&ie=UTF8&qid=1286720435&sr=1-4 and click on the picture of the book, click on Front Matter, and go to page 3.) Grains and potatoes are at the bottom, meat, sweets and pizza are at the tip, and olive oil, fruit, veg and dairy are in the middle.

    “Chef Stellino,” the book says, “urges that his readers try to use his recipes within the pyramid’s recommended daily balances.” I don’t mean any disrespect to Nick Stellino: he comes across as a delightful person, and I’ve never made a recipe of his that didn’t sing. But assuming that Chef Stellino is following his own advice, I think we can take one look at him and decide that the nutrition plan he recommends is not one for being slim.

    As the doctor quoted in your post says, at one time Italians were dying of starvation. The Mediterranean Food Pyramid may require a great deal of portion control and physical labor to work.

    Ancel Keys became convinced of the superiority of low-fat Mediterranean diets partly because he was in Italy after WWII and noticed a low rate of heart disease among the peasants. Didn’t occur to him that people on a semi-starvation diet can’t eat enough of anything to produce heart disease.

  22. Pissed Off Patient

    Wow. So scary. Not only the ignorance but the conceit as well.

    But then I argue with the doctor blogs about obesity and they are about as intelligent on the topic.

    So I am not surprised.

    M

    I’m not surprised either.

  23. Paul

    http://www.bbc.co.uk/news/health-11501323
    Salt and fat content ‘too high’ in child hospital meals

    “Salt and saturated fat levels in food should be kept low to guard against the risk of diseases, campaigners say
    There is too much salt and fat in the food served to children in hospital, a survey suggests.”

    THIS is what we’re up against. This is criminal! No doubt about it. Simply criminal! Makes one’s blood boil.

    Keep fighting the good fight, Tom!

    Regards,
    Paul

    Oh lordy, that means they’ll up the carb content.

  24. Paolo

    Zooko Wilcox-O’Hearn, I did send that document do the doctor (Tom did some good cuts as the complete conversation was too long), but he just said “And so? It just says that we need a little change to guidelines as people is getting obese”. I said to him “come on, it says terrible things about the giudelines” but he didn’t publish this message.

  25. McAnon

    Reminds me of some of the other people I talk to with doctoral degrees; they get smarter in a specialized field (unless that field is standard ADA nutrition) and start to think they know everything about anything barely related to it, like their opinions have inherently more value. Some don’t act this way intentionally and some seem to do, perhaps keep from admitting they might be wrong somehow.

    Doctoral degrees: A little more knowledge, a lot more arrogance.

  26. Lori

    The Mediterranean Diet has its own food pyramid, which is shown in Cucina Amore by Nick Stellino. (Go to http://www.amazon.com/Cucina-Amore-Nick-Stellino/dp/0385478321/ref=sr_1_4?s=books&ie=UTF8&qid=1286720435&sr=1-4 and click on the picture of the book, click on Front Matter, and go to page 3.) Grains and potatoes are at the bottom, meat, sweets and pizza are at the tip, and olive oil, fruit, veg and dairy are in the middle.

    “Chef Stellino,” the book says, “urges that his readers try to use his recipes within the pyramid’s recommended daily balances.” I don’t mean any disrespect to Nick Stellino: he comes across as a delightful person, and I’ve never made a recipe of his that didn’t sing. But assuming that Chef Stellino is following his own advice, I think we can take one look at him and decide that the nutrition plan he recommends is not one for being slim.

    As the doctor quoted in your post says, at one time Italians were dying of starvation. The Mediterranean Food Pyramid may require a great deal of portion control and physical labor to work.

    Ancel Keys became convinced of the superiority of low-fat Mediterranean diets partly because he was in Italy after WWII and noticed a low rate of heart disease among the peasants. Didn’t occur to him that people on a semi-starvation diet can’t eat enough of anything to produce heart disease.

  27. Pissed Off Patient

    Wow. So scary. Not only the ignorance but the conceit as well.

    But then I argue with the doctor blogs about obesity and they are about as intelligent on the topic.

    So I am not surprised.

    M

    I’m not surprised either.

  28. Drew @ How To Cook Like Your G

    What you say are personal opinions not approved by the scientific community.
    “Approved”? You can agree or disagree with an opinion. You can concur or refute. But approve? I don’t think that’s how opinions — nor science — work.

    Amazing, isn’t it? These goofs think facts are determined by majority opinion.

  29. TonyNZ

    “If you are not a scientist, please just ask questions of me, or you are out. If you are a scientist, introduce yourself so we can discuss at the same level.”

    This actually made me feel a little nauseous.

    It made me laugh. The guy is clearly a pompous ass.

  30. Laurie D.

    Now, we have to look at this is a positive way. It’s nice that other countries look up to us for something. Too bad they picked the wrong thing.

    America gained a reputation for top-level science because of fields like physics and chemistry. Too bad nutrition “science” rode in on that wave.

  31. Richard Tamesis, M.D.

    “Amazing, isn’t it? These goofs think facts are determined by majority opinion.”

    It’s obviously clear now why Galileo, Copernicus, Newton, Darwin and Einstein were all wrong.

  32. Rip @ MIPWID

    When Denise Minger’s work on the China Study was criticised, one of the first questions was, “And what degree does she hold, may I ask?”.

    Having a degree does not exclude one from having one’s own opinion. The fact that you have Doctors on the paleo side, like Dr Kurt Harris, and doctors on the vegetarian low fat side, like Doctor Campbell, basically makes such a question worthless. You can pass the same exam and still have differing opinions as to how the world works.

    Of course … people who can’t debate using facts usually make appeals to authority and/or attack the person citing the facts. Denise Minger’s father is a member of MENSA, is working on a doctorate, but says he comes to her for help with high-level statistics.

  33. McAnon

    Reminds me of some of the other people I talk to with doctoral degrees; they get smarter in a specialized field (unless that field is standard ADA nutrition) and start to think they know everything about anything barely related to it, like their opinions have inherently more value. Some don’t act this way intentionally and some seem to do, perhaps keep from admitting they might be wrong somehow.

    Doctoral degrees: A little more knowledge, a lot more arrogance.

  34. Drew @ How To Cook Like Your Grandmother

    What you say are personal opinions not approved by the scientific community.
    “Approved”? You can agree or disagree with an opinion. You can concur or refute. But approve? I don’t think that’s how opinions — nor science — work.

    Amazing, isn’t it? These goofs think facts are determined by majority opinion.

  35. TonyNZ

    “If you are not a scientist, please just ask questions of me, or you are out. If you are a scientist, introduce yourself so we can discuss at the same level.”

    This actually made me feel a little nauseous.

    It made me laugh. The guy is clearly a pompous ass.

  36. Laurie D.

    Now, we have to look at this is a positive way. It’s nice that other countries look up to us for something. Too bad they picked the wrong thing.

    America gained a reputation for top-level science because of fields like physics and chemistry. Too bad nutrition “science” rode in on that wave.

  37. Richard Tamesis, M.D.

    “Amazing, isn’t it? These goofs think facts are determined by majority opinion.”

    It’s obviously clear now why Galileo, Copernicus, Newton, Darwin and Einstein were all wrong.

  38. Rip @ MIPWID

    When Denise Minger’s work on the China Study was criticised, one of the first questions was, “And what degree does she hold, may I ask?”.

    Having a degree does not exclude one from having one’s own opinion. The fact that you have Doctors on the paleo side, like Dr Kurt Harris, and doctors on the vegetarian low fat side, like Doctor Campbell, basically makes such a question worthless. You can pass the same exam and still have differing opinions as to how the world works.

    Of course … people who can’t debate using facts usually make appeals to authority and/or attack the person citing the facts. Denise Minger’s father is a member of MENSA, is working on a doctorate, but says he comes to her for help with high-level statistics.

  39. gallier2

    Hey Tom, it’s Denise not Debra, funny that this error comes up so often, one of the banana-tards called her also Debra.

    I seem to have a mental block on that one for some reason. I’ve caught myself writing her name as Debra several times.

  40. Sue

    I’m doing an assignment on choices and options available to the elderly. Looking at nutrition, exercise and active ageing – how to prevent chronic diseases etc. Shit, if only the nutritional advice they were giving had any merit prevention would be easy. With their wrong advice there is reason for panic with the projected increase of the aged in the population. People are living longer but they are seen as a burden, disabled with chronic diseases. Eat the right foods and they’d be spritely into their old age.

    When I compare my health now at (almost) 52 years old versus 20 years ago when I was a grain-eater, it’s clear to me that a lot of the ailments we attribute to aging are mostly about eating the wrong foods.

  41. gallier2

    Hey Tom, it’s Denise not Debra, funny that this error comes up so often, one of the banana-tards called her also Debra.

    I seem to have a mental block on that one for some reason. I’ve caught myself writing her name as Debra several times.

  42. darMA

    I was lucky to have a doctor for most of my adult life who actually listened to his patients. He was late to climb on the statin prescribing bandwagon until he studied the subject thoroughly himself. After trying quite a few on me, all with some adverse reaction that made my life miserable, he wanted to try just one more – the newest one. But I’d had it by then and told him, doc, you can quote all the “experts” you want but in this case, my body is the expert and it’s clearly saying it doesn’t want any more statins. He thought a minute and said, all right, and never mentioned any cholesterol medicines to me again. He later told me if several patients had severe adverse reactions to a particular drug, he would take ALL his patients off that drug. Sadly, he is now deceased due to a cascade of adverse reactions due to a fluoroquinolone prescribed by his own doctor. Before he finally had to retire due to these health problems, he warned all his patients to NEVER take one of the quinolones. I miss him like hell and doubt I’ll ever find another doctor like him..

    That’s a good message for doctors everywhere: my body is the expert.

  43. Sue

    I’m doing an assignment on choices and options available to the elderly. Looking at nutrition, exercise and active ageing – how to prevent chronic diseases etc. Shit, if only the nutritional advice they were giving had any merit prevention would be easy. With their wrong advice there is reason for panic with the projected increase of the aged in the population. People are living longer but they are seen as a burden, disabled with chronic diseases. Eat the right foods and they’d be spritely into their old age.

    When I compare my health now at (almost) 52 years old versus 20 years ago when I was a grain-eater, it’s clear to me that a lot of the ailments we attribute to aging are mostly about eating the wrong foods.

  44. Pippi

    Funnily enough I too had a groan-inducing “this is what we’re up against moment” today. A doctor wrote a letter to my local paper advocating that a cholesterol-free vegan diet be adopted by all on the basis of humanity’s obvious “natural veganism”. The main basis for this bold assertion? Apparently the fact that humans are the only predators to cook their meat is (to him) sufficient evidence of our innate inability to cope with unprocessed meat.

    I can only hope that as he reads his own letter, printed on a piece of processed tree, or maybe even a smart phone, that he realises the idiocy of this little piece of naturalistic fallacy.

    Talk about tortured logic! I guess during the hundreds of thousands of years that humans lived as hunter-gatherers, they were ignoring their natural veganism. If the doctor knew anything about history, he’d know that humans often ate raw meat and fish.

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