Worry more about eating enough healthy foods than not eating unhealthy foods

So, my wife sent me this CNN article about a massive study of global diets that came to some interesting conclusions.  One– nothing, (not even smoking!) matters more for your longevity than diet.  And, secondly, the key is more, are you eating healthy foods, than are you eating unhealthy foods:

Which risk factor is responsible for more deaths around the world than any other? Not smoking. Not even high blood pressure. It’s a poor diet.

“In many countries, poor diet now causes more deaths than tobacco smoking and high blood pressure,” said Ashkan Afshin, an assistant professor at the Institute for Health Metrics and Evaluation at the University of Washington.
And it’s not just that people are choosing unhealthy options such as red meat and sugary sodas. Just as critical, said Afshin, the lead author of a 27-year global diet analysis published Wednesday in the journal the Lancet, is the lack of healthy foods in our diets, along with high levels of salt.

“While traditionally all the conversation about healthy diet has been focused on lowering the intake of unhealthy food, in this study, we have shown that, at the population level, a low intake of healthy foods is the more important factor, rather than the high intake of unhealthy foods,” he said. [emphasis mine]

That’s really interesting.  And certainly fits with what Aaron Carroll has been saying about “bad” foods.

The article also, interestingly, breaks down the various risk factors by country in a cool chart.

Maybe it’s motivated reasoning, but I’ve got to admit I’m somewhat skeptical on the hazards of salt.  I’ve certainly read enough over the years that suggests its dangers for the average person are overstated.  My guess is that salt is largely a proxy for processed food.  And it would seem there’s lots of evidence that you definitely want a diet higher in unprocessed food.

Also, not long after reading this piece, I came across another great piece arguing that, essentially, we know almost nothing about eating healthy:

When it comes to actual dietary recommendations, the disagreement is stark. “Ioannidis and others say we have no clue, the science is so bad that we don’t know anything,” Hu told me. “I think that’s completely bogus. We know a lot about the basic elements of a healthy diet.” He lists plant-based foods — fruit, veg, whole grains, legumes — but acknowledges that we don’t understand enough to prescribe specific combinations or numbers of servings. The ongoing controversy, he says, has generated “a lot of heat but not much light,” and he’s afraid Ioannidis’s dismissal of the entire field undermines nutritional advice.

But if nutritional advice is unsupported, a little undermining is in order. Ioannidis is in favor of fruits, vegetables and whole grains, but “the evidence behind them is pretty soft,” [emphases mine] he wrote in an email. Older observational studies showed big reductions in cancer risk but newer studies show small benefits, if any. “When the benefit in published studies in the literature shrinks 10-fold or 100-fold over time,” he continued, “you have every reason to worry about whether this type of research effort can give you any reliable answers.” Heart disease risk reduction has remained sizable, Ioannidis noted, but it’s still observational data, and confounding and data reporting issues mean we can’t definitively link diet to health, a point Hu makes in his own research.

In the two decades I’ve been writing about nutrition, my confidence in what we know about food and health has eroded, and I find myself in Ioannidis’s camp. What have we learned, unequivocally enough to build a consensus in the nutrition community, about how diet affects health? Well, trans-fats are bad. Anything else, and you get pushback from one camp or another…

The important question — what are we supposed to eat already?! — is still on the table, and I have a suggestion. Let’s give up on evidence-based eating. It’s given us nothing but trouble and strife. Our tools can’t find any but the most obvious links between food and health, and we’ve found those already. Instead, let’s acknowledge the uncertainty and eat to hedge against what we don’t know. We’ve got two excellent hedges: variety and foods with nutrients intact (which describes such diets as the Mediterranean, touted by researchers). If you severely limit your foods (vegan, keto), you might miss out on something. Ditto if you eat foods with little nutritional value (sugar, refined grains). Oh, and pay attention to the two things we can say with certainty: Keep your weight down, and exercise.

When I first started writing about nutrition, I used to say I could tell you everything important about diet in 60 seconds. Over the years, my spiel got shorter and shorter as truisms fell by the wayside, and my confidence waned in a field where we know less, rather than more, over time. I’m down to five seconds now: Eat a wide variety of foods with their nutrients intact, keep your weight down and get some exercise.

So, yeah, we do know something.  Fruits, vegetables, nuts, whole grains, minimally-processed foods.  That’s good to know.  But, beyond that, there’s a lot of uncertainty.  Okay, I’ll go eat an apple now.


Shocking news: America is a democracy and a republic

So, I’ve noticed for some time that there’s this odd tic, among some on the right, to argue, “America is not a democracy, it’s a republic.”  Ummm, surprise– it’s both!  I’ve mostly found this mildly amusing.  And useful.  It’s a nice tell that you are not actually dealing with someone who understands politics, but rather just thinks they do while getting inane talking points from Fox, etc.

Anyway, Dana Goldstein with an interesting story on how this is playing out in Michigan social studies standards.  Also, I had no idea that this inanity was driven, in part by, Republicans wanting to emphasize Republic and deemphasize Democracy.  Just ugh.  Anyway:

The changes were made after a group of prominent conservatives helped revise the standards. They drew attention to a long-simmering debate over whether “republic” is a better term than “democracy” to describe the American form of government.

That the two sides in that tussle tend to fall along party lines, each preferring the term that resembles their party name, plays no small part in the debate. But members of the conservative group also brought to the table the argument that K-12 social studies should be based on a close, originalist reading of the United States’ founding documents…

The Michigan conservatives — who prefer “constitutional republic” — say their arguments are historical, not partisan.

The kindergarten section of the new draft of the Michigan social studies standards. Previously, conservatives pushed for the nation to be called a “constitutional republic” founded on “core values,” not “democratic values.” The previous draft also used the term “roles of the citizen” instead of “civic participation.”

“When you read Article IV, Section IV, it says you’re guaranteed a republican form of government,” said Patrick Colbeck, a Republican former state senator, citing the United States Constitution.

While the founders were indeed skeptical of direct democracy, mainstream historians, political scientists and legal scholars say that the United States is both a representative democracy and a republic — and that there is no contradiction between those terms.

This is just so stupid.  I’m know comparative politics expert, but I’m pretty sure they study topics like democracy and democratization, not republics.

Anyway, next time somebody tells you we’re not a democracy, but a republic, ask them why it is that people whose job is to study politics study not republics, but democracies.

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