Forbidden Food: How Science Says You can Eat what you Like and Like what you Eat

References

PREFACE

Once upon a time couple of unscrupulous characters with a sense of humour sold an imaginary set of clothes to an Emperor. Only people with wisdom, they convinced him, could see the magnificent raiment. Fools would see nothing. The Emperor took to the streets on his horse, everyone exclaiming at the wonder of the garments in hopes of hiding their own stupidity. A fascinating cautionary tale.

I can't fathom why diet professionals tell us things about food that are not supported by their own science. The scientific evidence so astonishingly contradicts most diet professionals' opinions, it's hard not to wonder whether some of them got overinvolved in their work. As a family physician with training in philosophy of science, scientific method and critical review of evidence, and also with enough sense of proportion to stand back and look at someone else's scientific work and conclusions objectively, I just may be the little boy on the sidelines of the Emperor's parade, declaring simply and correctly that he really has no clothes on at all. The only axes I have to grind are the conflicts of interest I declare below.

Of course academic focus is necessary in experts’ practices. But too close a focus may engender narrowness, experts settling into unassailable self-respect born of a more or less unique knowledge. I can't avoid concluding that this kind of myopia must have affected some diet experts' work. However well-intentioned they may be, in the end their conclusions start to look dishonest, self-serving and dangerous.

Experts are not the only people my views may offend. Once I began to see that science didn't support any connection between diet and health, it took me a couple of years to learn to be careful in conversations with very nice potential personal friends I didn't know until I found out how they felt about the subject. Several otherwise polite dinner times have ended early with bare civility and lack of eye contact before I figured out how to be discreet about my radical views. Diet and health is, after all, almost as hot-button an issue as abortion or euthanasia.

People have told me they find my opinions on the vacancy of healthy eating depressing. You mean there's nothing we can do to prevent (heart disease, cancer, fractures, car accidents...)? I'm not saying anything like that. Being cautious, being reasonable, following sound advice and trying to enjoy life are all, I am sure, wonderful and useful things to do. But if, as I believe, advice that you will live longer and prevent disease by eating certain foods has no basis in science, for me this would be cause for celebration, not a reason to feel blue and morose. I think the fundamental message of this book is liberating. Imagine the delicious treats you will enjoy without guilt.

I've decided to run the risk of taking on healthy eating common wisdom not only because there is virtually no scientific evidence to support it, but also because I have trouble abandoning some of my own attitudes about enjoying a long and healthy life. I'm declaring my conflict of interest in stating these main biases:

There has to be a good reason for me to change how I decide to live my life.

I am often skeptical about experts' advice, and usually, the better I know the field the expert is working in, the more skeptical I become.

I am a person, not a population.

I adore terrific food.

I'm attracted by how food makes me feel, not at all by its alleged health benefits. The taste, the smell, the look on the plate, the kindness and ceremony of service, the celebration that occurs with every meal (even enjoyed alone) and the culture and history of the dish all mean much more to me than the gastroenterology, biochemistry and epidemiology as they may be misapplied to the experience of eating.

When you read opinions on diet that come from an expert in nutrition, expect the party line. Here, I have intentionally stepped out of the academic box, and using my scientific education and a bit of common sense, I’ve brought together what I saw inside the box, looking in from the outside. I was as surprised as I think you will be at what I found.

A Word of Caution

This book is trying to get rid of the idea that eating habits will influence health outcomes for the healthy majority of people. But caution may be required. It may not apply to a minority who have certain health conditions, and this note intends to suggest who some of those people might be. You may be one of them, so please read it carefully.

If a health professional you trust has told you that you need to be on a special diet because of a health condition you have, I think you ought to understand why. Dietary recommendations are made in many circumstances, and it may matter a lot to you which circumstances you're in.

First, there is a group of illnesses, most of them rare, for which certain things normally present in food will harm you and must be avoided. In gluten-induced enteropathy, for example, wheat causes problems with the bowel and a wheat-free diet cures the disease. In children born with phenylketonuria, an enzyme to process one of the amino acids is absent, and a low-phenylalanine diet is its only effective treatment. If you are truly allergic to any food, you must be careful to avoid that food. These examples are not at all a complete list of this category of illnesses. And anybody who has such an illness had better be careful not to misunderstand me when I say that healthy people can eat anything they want.

Second, the treatment of some risk factors for getting sick may include diet recommendations along with other treatment. With these ones, you may or may not benefit from being careful about what you eat. Included here are Type 2 diabetes, high blood pressure, early heart failure, osteoporosis and high cholesterol. All these are routinely treated with drugs. Whether you should follow dietary advice along with taking the pills (if you have a mild form of any of them) should be thought over carefully. If your cholesterol is in the low-risk range because of taking a drug for high cholesterol after a heart attack, for example, you might be interested to find out whether cutting down on cholesterol in your diet really makes any difference to your cholesterol levels, considering the fact that a low-cholesterol diet has never been shown to make any difference to your survival. The same is true for high blood pressure and salt. Much as I dislike the idea of taking a pill, the scientific evidence for preventive drugs is much better than that for diet. Caveat emptor.

Third, certain foods may make you feel bad. Fat could give you gallbladder pain, diarrhoea if you don't absorb fat well, or heartburn at night. You might find out that when you eat too much salt your ankles swell. There are all sorts of people in the world with whom certain foods don't agree in all sorts of ways. Possibly some of those foods are disagreeable because of nothing more than an attitude or belief, but it doesn't matter. The writing is on the wall and you can see it for yourself -- whether you make changes in your diet should depend on whether those changes help you or not.

If you are overweight and don't want to be, solving the problem may be difficult, but at least there is no doubt about what you have to do about it: eat less food. However difficult it may be, losing weight will depend on how much, not what kind of, food you eat. More about this in Chapter 8.

Finally, some people with illnesses that have nothing to do with diet get general dietary advice because they go to the doctor frequently and doctors always tell us the same thing about diet. For those people, the ideas in this book may be just what you need to hear.

If you find what I've written interesting and are considering changing your diet away from health-related rules, please be sure that ignoring those rules won't directly affect your health condition. I am, however, confident based on everything I say here that if you are healthy you can eat whatever kinds of food you like without any significant effect on your well-being.

INTRODUCTION

Walk into a nice little local restaurant, find a seat and read the menu. By the time you get to the end it will have occurred to you that some of what's offered might not be good for you. Including, if you're hungry, some things you really want: seared red meat fragrant and running with fat, prawns or scallops deep-fried in lard or beef tallow, bacon or pickles, butter-crusted pie loaded with custard. Warned off such dangers as if by instinct, you choose instead, order, eat and pay for a raw vegetable starter, unsalted fish, whole grain salad, and a plain fruit dessert. So you leave the restaurant unsatisfied. Dealing with your natural desire for the deep pleasure of eating is a mixed, fraught experience.

To compensate for this you understand that what you ate was healthy. If you stopped to reflect what that means you would be pleased that it implies you will live longer or avoid getting sick. Or both. But there is more to your benefit from eating healthy than just the bare expectation of living longer. You feel healthy. You fundamentally understand that somehow you are healthy, and you glow with happiness and pride that among all the people on earth, you are part of the group that will, as a result of healthy eating, experience health. Finally, the reason you believe in your experience of these benefits is that hundreds of legitimate scientific studies have proven beyond any reasonable doubt that diet affects health.

The astonishing thing about this series of events is that trading satisfaction and enjoyment of the food you want for a feeling of health is based on a lie. You've made a fool's bargain. People all over the world make the bargain millions of times every day for no good reason that has anything to do with living longer or avoiding disease.

This book intends to wake you up to how thin the scientific structure supporting healthy eating is – and why this matters. It will attempt to convince you of something which could restore to you a long-withheld human pleasure:

You can eat any kind of food you want.

You may think you have misunderstood this; you haven't. It does not mean that you can eat anything except simple carbohydrates, or except certain kinds of fat, or as long as you drink a litre of water afterwards, or as long as you stick to plants or to traditional diets. It means, for well people, anything you want. Period. No modifiers.

But let's be clear that you may want or want not to eat certain foods for all sorts of weird reasons, be they religious, aesthetic, cultural, from your mum or the Food Channel, because you're in a hurry or just because you like the taste. Those reasons are all perfectly okay.

I’m saying you can follow any desire to eat or not to eat any food, as long as that desire doesn't come from ideas that say they are scientific. But beware, many folksy-sounding apparently zany food preference ideas and myths have their roots in concepts originally claimed to be scientific. Would-be best-seller self-help journalist authors troll the scientific literature for obscure diet-related issues, some of which explode via social media into cult beliefs about what to eat. Eating gluten-free started this way. Don't believe in them. The hard part, paradoxically, is to separate science from the wacko stuff-we-love-because-it-feels-good, and then accept only the wacko stuff as legitimate, and reject the science. The reason not to bother with any scientifically-based diet ideas about food is the second piece of surprising information this book contains:

There is no reasonable basis in good-quality science for believing that any food type or eating habit is healthier than any other.

I believe there are some fascinating reasons why we have somehow got ourselves into the opposite strange delusion, and why we cling to it so desperately, and I'll tell you about those.

That's why this book is important, and why you should read it.

Wait a minute. Before continuing, please remember that when I say "…for well people, any food you want" I am talking about the majority in the world who don't have an illness that is affected by what you eat. You should ask yourself whether you qualify as well. If you don't, or think you don't, you may want to go back and read A Word of Caution again. And I'm sorry, anything you want does not mean the same thing as as much as you want, and wouldn't include dirt, paperclips or material from the bottom of a dumpster. Just straightforward food.

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Today nearly everybody believes the benefits of healthy eating are as sure a thing as tomorrow morning. This idea has had a devastating impact in the world since it first appeared almost 100 years ago. But in the past 30, and particularly the past 10 years, it's as if a shock wave of health-related food preference and consumption has hit the $3.2 trillion worldwide food industry. The dollar and human cost of the changes in choice and value of primary products, processing and production, product development and marketing and retail presentation are almost incalculable.

Already in the 1970s, food manufacturers were responding to consumer demand by producing coarsely healthy foods: whole-grain cookies, low-fat ice cream, sugar-free candies and gum and high-fibre cereals. But lately, the demand that food also taste good while still being healthy has led to its being filled with gum instead of fat, bacteria (live cultures), soluble corn fibre, polydextrose, stabilizers to replace the mouth feel of wheat protein, açai fruit, and even water and air (the miracle calorie-reducing ingredients in chocolate). This is all alleged and generally taken to be in line with scientific proof of real health benefit.

The money food suppliers make from selling their products now depends heavily on what you and I believe about its impact on health. Gazing enviously at the drug industry's profits, the food industry has shifted from telling us about ingredients to making wellness claims: keeping skin young, avoiding heart disease and improving infant development. The world's leading food producer, Nestlé, has re-imaged itself from a mere maker of chocolate and cereals to providing functional foods. These look more and more like medicines. And there is a strong business case for Nestlé to