Searching for Causes for Chronic Conditions

Across the US, UK, and EU, Health and Health Care is Declining

A video from Dr. John Campbell highlights a recent study on Vitamin D deficiency Common deficiency and dementia. The study discussed is Vitamin D deficiency and insufficiency among US adults: prevalence, predictors and clinical implications in the British Journal of Nutrition (12 April, 2018). Other published research on benefits of Vitamin D are discussed as well.

However this Harvard Gazette article reports Vitamin D benefits linked to body weight (January 17, 2023):

This study sheds light on why we’re seeing 30 to 40 percent reductions in cancer deaths, autoimmune diseases, and other outcomes with vitamin D supplementation among those with lower BMIs but minimal benefit in those with higher BMIs, suggesting it may be possible to achieve benefits across the population with more personalized dosing of vitamin D,” said Manson. “These nuances make it clear that there’s more to the vitamin D story.”

Americans overweight or obese is a problem: “Percent of adults aged 20 and over with overweight, including obesity: 73.6% (2017-2018)" (CDC source). And more of a problem: percent of these overweight people deficient in Vitamin D? “as high as 90%.”:

Vitamin D deficiency is common in people with obesity, with reported prevalence rates as high as 90%. The higher risk of deficiency is thought to be related to several factors. One contributor could be less sun exposure. In addition, since vitamin D is fat-soluble, people with higher amounts of body fat will ‘sequester’ vitamin D in fat cells, leading to lower amounts circulating in the blood. Due to this, people with obesity typically need higher amounts of vitamin D to maintain adequate levels and/or to correct a deficiency. (Vitamin D, Obesity and COVID-19, UC Health Insights, Jan. 31, 2021)

Yet still today the National Institutes of Health “Vitamin D” page, under “How much vitamin D do I need?” advises just 600 IU for most ages. The page further claims:

In the United States, most people have adequate blood levels of vitamin D. However, almost one out of four people have vitamin D blood levels that are too low or inadequate for bone and overall health.

Students and others should do your own research. Some recommend receiving from sun or supplements at 4000 IU Vitamin D (with K2) daily. But still many public health authorities recommend just 600 IU in US and 400 in UK.

Apart from Vitamin D deficiencies are a wide range of chronic conditions link to poor nutrition and lifestyles.

Critics note federal nutrition programs and policies called for low-fat (i.e. high-carbohydrate) meals across federally-funded food assistance programs, schools, hospitals, nursing homes, military bases, and prisons serving meals based on the Dietary Guidelines. For an overview of this history see Did the Government Make Us Fat? (Goodman Institute Brief Analysis No 142, February 24, 2022).

America’s obesity epidemic has also been blamed on other causes, from the booming fast-food industry (from 100 McDonald’s in 1960 to 250,000 total fast food outlets today), to highly-processed junk foods and candies for sale today at 40% of all retail outlets, to oversized portions served at restaurants, and to less active work and lifestyles.

Some blame increased consumption of sugar and high-fructose corn syrup. Dr. Robert Lustig and other medical researchers argue fructose consumption causes increasing obesity. Others blame “industrial seed oils,” marketed as vegetable oils for cooking and as an ingredients in packaged high-carb foods. These polyunsaturated oils (PUFAs) are considered healthy by public health authorities, but easily oxidize and are believed a source of inflammation by nutrition researchers. So, ongoing and relevant debates over PUFAs as good or bad for our health, along with a similar debates over saturated fats as healthy or dangerous. For overview see: Vegetable oils: Are they healthy? (DietDoctor)

Federal Dietary Guidelines advocate reducing saturated fats and recommend polyunsaturated fats (PUFAs). And, no surprise, nutrition researchers disagree, with some supporting PUFAs, others opposing.

However, evidence from observational studies and randomized clinical trials demonstrates that replacing saturated fat with carbohydrates, specifically refined, has no benefit on CVD risk, while substituting polyunsaturated fats for either saturated fat or carbohydrate reduces risk. A significant body of research supports the unique health benefits of dietary patterns and foods that contain plant and marine sources of unsaturated fats.” source: A healthy approach to dietary fats: understanding the science and taking action to reduce consumer confusion (Nutrition Journal, Aug. 30, 2017)

Other research points to changes in our gut microbiome from overuse of antibiotics as a major contributor to obesity, along with overconsumption of processed foods.  Research continues at The Center for Human Microbiome Studies at Stanford University. See also Tim Spector’s The Diet Myth.

Still others point to dieting itself as unnatural and disrupting our natural instinct to eat until full. Constant fears of being overweight, promoted by thin culture and diet industry have unfortunate metabolic and mental health consequences. Books like Don’t Diet and Intuitive Eating offer “eat until full” dietary advice. (However, most doctors, nutritionists, and public health officials advise “eat less and exercise more”: a misleading energy balance theory of obesity that suggests people are overweight due to gluttony and sloth. Instead, obesity is now believed to be a problem of impaired blood glucose metabolism, that is, carbohydrate intolerance and insulin resistance. Discussed further below.)

The problem of engineered addictive sugar and carbohydrate-rich foods

Ultra-processed snacks are designed by the food industry to be addictive (say critics), and a culture of snacking and sipping through the day has emerged (and is predicted to continue into the future in the movie WALL-E). Consuming many small meals each day is recommended by nutritionists and the federal dietary guidelines. But critics say snacking is problematic and fewer larger meals is a healthier tradition and lifestyle (intermittent fasting also called time-restricted eating). Most religions and cultural traditions include fasting as well as feasting, rather than all-day snacking and small meals. 

Public health policies face challenges when new research appears to undermine existing policies and programs. Nutritional science is rarely settled and disagreements continue on ethical, religious, and environmental grounds, as well as on conflicting nutritional theories and research. The current Dietary Guidelines for Americans are based on weak epidemiological studies rather than more recent and reliable Randomized Control Trials (RCT). See: “Scientific Panel on New Dietary Guidelines Draws Criticism From Health Advocates” (New York Times, June 17, 2020)

Time magazine provides a history of federal dietary policies in The U.S. Food Guidelines Have Always Been Controversial (Time, Jan. 7, 2016). The 2016 date is important since the article is reviewing the then new 2015-2020 Dietary Guidelines (health.gov). 

Scientific and policy controversy over the 2015-2020 and the current 2020-2025 Dietary Guidelines can support a dynamic and educational national high school debate season. Student’s health is at stake, along with their parents and grandparents.

Childhood obesity worldwide has increased ten-fold since the 1970s. And “In the United States, the percentage of children and adolescents affected by obesity has more than tripled since the 1970s.”

Critics claim the federal Dietary Guidelines are biased and not based on current nutritional research. The Departments of Health and Human Services (HHS) and Agriculture (USDA) appoint members of each Dietary Guidelines Advisory Committee to review the Guidelines. Critics claim most have strong biases and financial ties to industry. (“95% of Expert Committee for the 2020 Dietary Guidelines Had Tie with a Food or Pharmaceutical Company”). Of course it is in the nature of things that experts in any field are likely to have employment or funding ties to the industry where their expertise is valued.

Majorities of Americans, young and old, suffer from chronic diseases, though many are as yet undiagnosed (“Approximately 96 million American adults—more than 1 in 3—have prediabetes. Of those with prediabetes, more than 80% don't know they have it.”).  A University of North Carolina study found: “Only 1 in 8 Americans are achieving optimal metabolic health, which carries serious implications for public health.

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The March 2023 White House Conference on Hunger, Nutrition, and Health reports on the September 2022 conference: Ending Hunger and Reducing Diet-Related Diseases and Disparities, from White House Conference on Hunger, Nutrition, and Health: 

Millions of Americans are affected by food insecurity and diet-related diseases — including heart disease, obesity, and type 2 diabetes — which are some of the leading causes of death and disability in the U.S. The toll of hunger and these diseases is not distributed equally, disproportionately impacting underserved communities…

Students researching federal nutritional policies and the Federal Dietary Guidelines will face an avalanche of conflicting resources and advocacy, ranging from medical conference presentations, to documentaries, podcasts, medical societies, to hundreds of major nutrition and diet companies selling their services, books, and podcasts. Discussed and linked to in: Did the Government Make Us Fat?

Students can further research the nutritional debates and politics with their school lunches, long a topic of state and federal political wrangling, see “How School Lunch Became the Latest Political Battleground,” New York Times, Oct. 7, 2014 and still are today, “How the Politics of School Food Shape What Kids Eat,” (CivilEats, September 26, 2022)

[Added May 1: April 27, 2023 Washington Post on American Heart Association Dietary Guidance (April 27, 2023) “Popular keto and paleo diets aren’t helping your heart, report says: An analysis of various diets gave low marks to some of the most popular ones for straying from heart-healthy eating guidelines.”]

Further Notes and Links on Nutrition Policies and Controversies

Healthier food as alternative to diets, pills, or surgery

• “Medical Care Alone Won’t Halt the Spread of Diabetes: Now experts are calling for walkable communities, improved housing, and access to health care and better food, particularly in minority communities., Scientists Say” (New York Times, October 5, 2022)
At: www.nytimes.com/2022/10/05/health/diabetes-prevention-diet.html

• Why Experts Are Urging Swifter Treatment for Children With Obesity (New York Times, January 27, 2023) At: www.nytimes.com/2023/01/27/health/obesity-children-guidelines.html

The American Academy of Pediatrics recently issued new guidelines for treating the more than 14 million children and adolescents with obesity in the United States. The recommendations came as a surprise to many parents, and to some experts, as they encourage vigorous behavioral interventions even for very young children, as well as drug treatment or surgery for adolescents.

• More Kids Get Weight-Loss Surgery to Treat Obesity (Wall Street Journal, April 19, 2023)
  At: https://www.wsj.com/articles/weight-loss-surgery-obesity-children-ed0d4261

Critics of surgery and pharmacological approaches recommend instead dietary changes: less cereal, sugar, other carbohydrates, fewer sodas and fruit drinks, more fish, meat, whole-fat dairy (for those not lactose intolerant). More sleep and less stress (“bullying” in article above) would help as well.

Reform of the Dietary Guidelines for Americans will impact health care procedures and costs. Reformers advocate lifestyle changes (not diets) and “food as medicine” instead of or in addition to medications for most chronic conditions. Fast-growing companies and expanding networks of direct primary care doctors who focus on metabolic health as they de-prescribe medications to address and resolve chronic health care conditions. See, for example, the doctors, nutritionists, medical researchers presenting at low-carb conferences: Low Carb Denver 2023, Metabolic Health Summit, and Low Carb  USA/Society of Metabolic Health Practitioners.

Central to nutritional disagreements are two competing theories: the energy balance theory of obesity and the carbohydrate/insulin theory:

For nearly a century, obesity research has been predicated on the belief that the cause of the disorder “is an energy imbalance between calories consumed and calories expended,” to quote the World Health Organization. By this ubiquitous thinking, obesity is an energy balance disorder: People get fat because they take in more calories than they expend. They stay lean when they don’t.

• How a ‘fatally, tragically flawed’ paradigm has derailed the science of obesity (STAT News, September 13, 2021
At: www.statnews.com/2021/09/13/how-a-fatally-tragically-flawed-paradigm-has-derailed-the-science-of-obesity/

The paper, published in the American Journal of Clinical Nutrition offers an alternative model to the eat-less-move-more message and argues that success in weight loss, as well as weight-loss maintenance, is more about what you eat and less about how much you eat.

•  The carbohydrate-insulin model: a physiological perspective on the obesity pandemic. (The American Journal of Clinical Nutrition  (December 2021) At: www.sciencedirect.com/science/article/pii/S0002916522005172

Weight loss, the study found, is all about our hormonal response to certain macronutrients. Study authors include several of the most prominent nutrition scientists in the country.

The calories in, calories out concept is 'tragically flawed,' new research suggests (Today, September 20, 2021) At: www.today.com/health/new-paper-shows-overeating-does-not-drive-obesity-t231615