The Anointed, The Experts, And Knowledge … Part Four

For real people, if something works in theory, but not in practice, it doesn’t work. For academics, if something works in practice, but not in theory, it doesn’t exist. – Nassim Nicholas Taleb

I thought I was finished with this mini-series of follow-up posts on my recent speech, but I want to address one more comment I’ve heard here and there … the one that goes something like Why would you criticize observational studies, then turn around and praise people for making decisions on a bunch of anecdotes?

Okay, I understand the objection. But anecdotes and observational studies are not exactly the same thing. In an observational study, researchers try to figure out what people have been eating for the previous several years (usually with notoriously inaccurate food-recall surveys), then look for statistical correlations to health outcomes.

Aha! People who eat bacon have a marginally greater risk of developing colon cancer! Bacon must cause cancer!

That sort of thing. Those studies certainly keep academics busy, but as Dr. John Ioannidis and others have pointed out, researchers often find what they expect to find. As Ioannidis pointed out in one tongue-in-cheek article, most ingredients in a common cookbook have been linked to a higher rate of cancer … and also to a lower rate of cancer.

People in observational studies aren’t intentionally changing their diets in hopes of achieving a result. They’re just fodder for number-crunching researchers.

In a clinical study, there’s an intentional intervention: researchers have one group of people take a drug, or switch from animal fats to corn oil, or take fish oil, or whatever. Then they compare those people to a control group of people who didn’t change anything and look for differences in health outcomes. Clinical studies are the gold standard in research — and they should be.

But suppose you suffer from migraines and several doctors have failed to find the magic pill that provides relief. Now suppose someone at a dinner party says he’s heard from several people that their migraines went away when they stopped eating grains. (This happened with the wife of a co-worker of mine, as you may recall.)

Are you SERIOUSLY supposed to wait until someone designs a clinical study on grain-removal and migraines, receives funding, gets approval, conducts the study and reports the results before trying it out for yourself? Are you going to say to yourself, Well, those are just anecdotes, so I’ll continue going from doctor to doctor and suffering from the migraines until I find that magic pill. Not a chance. You’ll give up the grains and see what happens. If the migraines go away, you’ll no doubt tell some people.

Ka-boom … we have knowledge based on experience. (But gosh darn it, it’s only anecdotal evidence!)

I understand the problem with anecdotes, of course. What appears to be cause and effect could simply be coincidence. I have a nagging digestive problem, I happen to start drinking green tea, and the digestive problem – which was going to subside anyway for other reasons – goes away. But I’m all excited about the result and run off to share my belief that green tea fixed my digestive problems on the internet.

Sure, that happens. But that’s where the Marketplace of Ideas concept comes into it. People promote all kinds of ideas. Some are good, some are bad, some are just useless. But the good ideas are the ones that stick around. They’re the ideas that gain traction … because they’re the ideas that actually work.

When people try a new diet, they’re engaging in an experiment. There’s an intentional intervention – the new diet. There are results to compare – themselves on the old diet vs. themselves on the new diet. Yes, it’s just an n=1 experiment. We can’t necessarily extrapolate the results to everyone else. But it’s still an experiment.

In the Fat Head Kids book and movie, we recounted the n=1 experiment Sam Feltham conducted. For 21 days, he consumed more than 5,000 calories per day of low-carb/high-fat real foods. He gained less than three pounds and actually lost an inch around his waist. After a washout period, he again consumed more than 5,000 calories per day for 21 days – this time getting most of the calories from sugars and refined grains. He gained almost 16 pounds and got fatter around the waist. Same number of calories, very different results in terms of both weight and body composition.

When Feltham reported his results, the response from the “it’s all about the calories” crowd was predictable: This is just anecdotal evidence! Not a randomized controlled trial, so we can just ignore it! And my favorite: this is a jokexperiment!

Oh really? And why was it a joke? I only see three possibilities here:

  1. Feltham is a liar and didn’t actually eat what he recorded or get the results he reported.
  2. Feltham isn’t intelligent enough to accurately record what he consumed or measure his results.
  3. Feltham ate what says he ate and got the results he reported.

Feltham is clearly an intelligent guy, so we can dismiss #2. If people would rather assume he’s a liar than risk changing their minds … well, okay.

But I think the only likely possibility is that he ate what he says he ate and got the results he reported. So even though it’s just an n=1 experiment, it still tells us something important. If Sam Feltham can experience wildly different results from changing what he ate (as opposed to how much he ate), then so can other people. I’m pretty sure he’s not unique among humans. I’m also pretty sure we can’t write off the changes in weight as a coincidence.

Same goes for what I mentioned in my previous post about stuffing myself with meats, eggs and greens on the low-carb cruises but not gaining any weight. I’ve done it several years in a row now. I’ve heard from many other people who had the same experience. I corresponded with a doctor who saw that among his patients – not all of them, but many of them. Add up all those n=1 experiments, and you can’t help but notice a pattern emerge.

There will never be enough clinical trials conducted to tell us everything we’d like to know about diet and health – especially since so many trials are funded and conducted by people who want to sell us something. That’s why we have to largely rely on the Wisdom of Crowds. That wisdom is based on experience, and that’s what anecdotes are: people’s experiences. What’s changed in the internet era is that we can share experiences with countless people all over the world.

I wouldn’t look at anecdotes about the effects of a diet and declare This Is The Way It Is, Period. But I’ll certainly look at them as evidence that a particular change in diet might work. And if it works, it works. I don’t especially care if The Anointed in academia agree.

Besides, wait another 20 years or so, and they’ll be saying they knew it all along.




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20 thoughts on “The Anointed, The Experts, And Knowledge … Part Four

  1. Selma

    … and since I live my life as n=1 – why should I care if it works (or not) for all people as long as it work for me?

    Those of us just looking for a way to live the best life we can for as long as we’re able to – for us – don’t care if it works for only 10% or even less than 1% as long as it does for me.

      1. Walter

        And if a diet doesn’t work for me it doesn’t prove it won’t work for you. For example, some people are very salt sensitive and some leak salt like crazy and I suppose everything in between. Some people need to drink pickle juice to keep electrolytes in balance which would kill some people. When treated the pickle juice people can go back to regular levels of salt consumption.

        “Jack Sprat could eat no fat; His wife could eat no lean as so between the two of them they licked the platter clean.”

        So adjusting dietary advice on the basis of general population studies is already incorrect.

        Dr. Chris Gradener A-Z studies showed the weight loss was equal in low calorie and low carb diets. But later found that low carb was superior for insulin resistant people.

  2. Anand Srivastava

    There is a 4th possibility. Felltham may not be able to store fat easily, when not accompanied with starch. That might also work for other people also. It would be interesting to compare the results when the other diet contains less than 5% of total fat calories. Just as in low carb calories were kept at less than what it was 5% of net carb calories. The Test should be equivalent on both sides. Having 20% fat in a high carb diet is not equivalent to 5% carb on a high fat diet.

    BTW, I have a very real suspicion that is was #2. Eating a lot of fat is not easy. At least for people who do not store it, very effectively. Excreting excess ketones in unnatural ways cannot be such a great thing for the body. I will call it unnatural, because we could not have evolved on excreting excess fat. Fat is the least easily available macronutrient in the wild. If the high fat diet really worked, lots of keto gurus would not have gained health like Jimmy Moore.

    1. Tom Naughton Post author

      Sam is naturally lean, as we mentioned in both the book and the film. But the notion that he’s not intelligent enough to measure and track what he ate strikes me as ridiculous.

    2. Derek

      Eating a lot of fat is not easy? Rubbish!

      My meals today:

      Breakfast :
      227g Sirloin Steak (Shallow fried in Dripping)
      ~200 g boiled red cabbage, with ~25g butter + pepper
      ~80g Field mushroom (shallow fried in Ghee + butter)

      Afternoon Snack:
      ~75g Ox Tounge

      ~50g Cheddar Cheese
      20g dark chocolate

      Then throughout the day, 300ml of double cream (50.5% fat) used in cups of tea and/or coffee.

      Which ignoring the cooking fats, works out at around
      F: 228g – 2053 Cal – 84% Cal
      P: 80g – 320 Cal – 13% Cal
      C: 18g – 72 Cal – 3% Cal

      That is not a untypical day for me; I’d guess my protein intake stays close to that level, and depending upon what I’m eating the Fat:Carb ratio may drift to 75%:13%.

      Since that cream intake stays constant most days, it tends to comprise the greater part of my calorie intake, and without any effort.

      Doing this, I almost never notice myself going in to ketosis (not that I bother measuring for it), and it is quite effortless, I guess I’m generally just burning off the fat.

      My mass tends to stay constant at around 90kg (14lb), and being a 6’6″ Male, I’m generally viewed as lean.

  3. Tom Welsh

    Of course, if reliable knowledge can be gained only from randomized controlled trials, that would mean we can learn only from large organizations that can afford to perform such trials.

    And why would they spend so much money? Presumably to gain something that they want.

    1. Tom Naughton Post author

      I can’t imagine Big Pharma or Big Food having any interest whatsoever in funding a study to test the health benefits of real foods.

      1. JillOz

        They just want to be the official go-tos for any advice. I mean, if you’re deciding for yourself what is suitable to ingest, how do they make money?

        It is hard not to want to interfere when one hears of babies getting fed on Coke, though. 🙁

  4. Bob Niland

    On enlightened ancestral diets, the unambiguous, unconfounded, conflict-of-interest-free RCTs we’d like to see will never, ever, be run. By the time it’s clear that the results would be valuable, it will also be clear that putting an arm on the present DGA would be unethical.

    Those who demand science before deciding need to grasp that there never was any science supporting the USDA’s MyPlateOfMetabolicSyndrome diet. It is now, and always has been, all lobbying, politics, money and ego. See The Big Fat Surprise (Teicholz) or Death By Food Pyramid (Minger) for the whole sorry tale.

    So where does that leave us?

    Contemplate the dissident diet arguments. Learn how to read papers. Learn what health markers really matter. Try some things. Yes, a personal clinical trial is “mere” anecdote, but when it’s your anecdote, and can be validated by re-challenge, odds are you’re onto something. Who’s more credible: your HMO’s chubby dietitian, or your own lyin’ HbA1c and bathroom scale?

  5. Lori Miller

    Those observational studies are used by people in positions of trust to determine rations and meals for the military, public school students, wards of the state, and anyone else the government has to feed. They’re used to give advice–again, from people in positions of trust–to patients struggling with serious illnesses. That’s why they need to be scrutinized. But suggestions from Suzie in Peoria? People are free to take it or leave it. Sure, there’s some bad advice out there–which is why you need to go by results.

  6. chris c

    Dave Feldman

    has been carrying out a series of experiments that are literally rewriting the book on LDL. One of The Anointed, a particularly obnoxious doctor on Twitter, yes you know the one, started screeching about “ethics committees” and how he should not be permitted to do such experiments. On himself. People who claim to be scientists should be interested in his results rather than just finding ways to dismiss his work.

    This is a huge problem, ethics committees would routinely block a LOT of relevant research, then journal editors would refuse to publish the results of the few studies that actually got done. If the ADA had studied their successful diabetics two decades ago they would by now have two decades of evidence. But they didn’t so they don’t. Now there has been an attack on the BJSM as one of the few journals that actually present low carb research. Here’s a clue, if they don’t want to read it they should stick with The Lancet. Pricks. (Pun intended). Currently Malcolm Kendrick and Uffe Ravnskov have been deleted from Wikipedia, the comments from their Editor/censor and its chums both on Malcolm’s blog

    and on Wikipedia itself are enlightening. They’re still here though

    interesting site I didn’t know before that appears so far to be less censored.

    The same types of people who claim to be scientists routinely dismiss thousands, nay millions, of similar/identical anecdotes in favour of a study on 30 genetically modified mice because RCT. The difference between a study and an anecdote is that someone has paid for the former so obviously they will expect the results they paid for. The anecdotes just happen.

    1. Tom Naughton Post author

      Yup. Anyone who thinks researchers and editors are simply on a quest for the truth hasn’t been paying attention.

      Feldman shouldn’t be allowed to experiment on himself? That’s laughable. Next they’ll be saying we shouldn’t be allowed to drink raw milk if we choose. No, wait …

    2. Elenor

      “Malcolm Kendrick and Uffe Ravnskov have been deleted from Wikipedia”

      So, STOP using Wikipedia and their pages that reflect only what its idiot and/or evil editors WANT you to know — the ones who force WP to reflect ONLY the narrative on every topic! (Well, except for the topics and people they delete entirely, eh?) Switch to “Infogalactic, the Planetary Knowledge Core” at Unlike WP, Infogalactic allows the person whose page is ABOUT that person (and only that person) to be certified and edit his or her OWN (certified) page — WP FORBIDS the person whom a page is about to edit, clarify, dispute, or lie about themselves…. Imagine if Malcolm and Uffe had ACTUAL control of their own page and could include links to their studies and info?!? (And yes, if someone want to lie about themselves — or hide something — on their own about page, they can; but the OTHER perspective pages about that person will show the truth as other editors and resources show it.)

      “Infogalactic is an online encyclopedia that aimed to be an improved version of Wikipedia. To this end, Infogalactic is a fork of Wikipedia, …”

      And oh PULEASE, don’t anyone freak out and pretend to be all hysterical because Vox Day — a figure insanely hated by those espousing the Narrative — set it into motion. If you have NOT done your own research, but merely accepted “the Narrative” about him — how does that differ from thinking its perfectly fine for WP to delete Malcolm and Uffe?!?

      Vox Day wrote about the “planned user-preferred perspective based information architecture”:
      “Infogalactic plans to solve the structural problems of a community-edited online encyclopedia through objectivity, proven game design principles, and a sophisticated series of algorithms. Currently in an operational Phase One, the Planetary Knowledge Core has a five-phase Roadmap that its founders claim will eliminate edit warring, significantly improve accuracy, neutralize vandalism and other forms of griefing, and render all forms of political bias on the part of administrators and editors irrelevant….
      “Infogalactic’s anti-bias architecture will permit users to select their preferred perspective and automatically see the version of the subject page that is closest to it based on a series of algorithms utilizing three variables, Relativity, Reliability, and Notability. This means a supporter of Hillary Clinton will see a different version of the current Donald Trump page than a Donald Trump supporter will, as both users will see the version of the page that was most recently edited by editors with perspective ratings similar to his own.”

      1. Archie Robertson

        “This means a supporter of Hillary Clinton will see a different version of the current Donald Trump page than a Donald Trump supporter will, as both users will see the version of the page that was most recently edited by editors with perspective ratings similar to his own.”

        “Anti-bias”? That sounds like a road map for confirmation bias.

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