SANE Science

 

My long-time physician was kind enough to provide some 3rd party context around me and SANE. I thought a personal and medical look at the backstory behind the research and experience that resulted in SANESolution would be useful (or entertaining 🙂 ). – Jonathan

By Dr. Scott Ripple, Family Practice physician

During my 20+ year medical career I have treated thousands of patients ranging from individuals carrying more than 200 lbs. of excess body fat to professional bodybuilders with 2% body fat. It was clear from my first appointment with Jonathan nearly a decade ago that he had a unique approach to health and fitness.

When we first met, Jonathan was an experienced personal trainer and had educated himself extensively on traditional approaches to health and fitness. Almost obsessive in his implementation of typical diet and exercise approaches and spending around 20 hours per week on this effort, Jonathan achieved good results. In fact, I mentioned to him that I thought he could do quite well in an amateur bodybuilding competition without any further preparation. This suggestion generated little interest as Jonathan was more interested in focusing on ways to make health and fitness more practical so that he could focus his attention on other goals in his life.

A few years into the scholarly research that would later become SANE, Jonathan became further dissatisfied with the impracticality of hours of weekly exercise and the discomfort and bloating accompanying the traditional starch-based diet he was consuming. He eventually reached a plateau and began to see diminishing returns from all his time and effort. Then came the setbacks: shoulder pains, a hamstring injury, and finally a torn pectoralis muscle in his chest.

Feeling burned out after 10+ years of following the traditional “eat less, exercise more” approach, he made a full-stop switch to the eating and exercise practices now filling the pages of SANE.  I was surprised to see the effects during his recent visit. His waist shrunk by three inches, he is significantly more toned and defined, his strength, energy, and endurance are better than ever, and he is free of injuries. Even more surprising was that this resulted from exercising once per week and following simple nutrition principles rooted in even intake of protein, carbohydrate, and fat from natural foods.  With fasting glucose (an indicator of propensity for diabetes) and cholesterol (an indicator of propensity for heart issues) at levels that are extremely healthy and a physique on par with some famous fitness professionals (and superior to that achieved by his 20-hours-per-week traditional routine years prior), it seems unarguable that Jonathan achieved his goal of discovering a more practical approach to sustainable fat loss and wellness.

As a doctor, I know that people frequently go out of their way to avoid the topic of health and fitness. It is likely that you have tried to change your eating and exercise habits before and not seen the results you hoped for. It is natural to feel guilt and anxiety after such an experience. I hope that the research, medical support, and experience Jonathan brings to SANE living will alleviate your doubts and allow you to be inspired.

T. Colin Campell (from Forks Over Knives and The China Study) and I recently had a conversation on a public Amazon discussion board. Our chat started a bit rocky, but then became quite useful.

Context

The research supporting SANE was brought up by a reader on the aforementioned discussion board. T. Colin Campell then wrote (http://amzn.to/JtSwt5): “But fortunately, science will prevail over ad hominem attacks.” When this was brought to my attention I was quite startled as thousands of pages of peer-reviewed academic research do not agree with Campell’s recommended “low-protein, low-fat” and therefore unnaturally high-carbohydrate diet. To ensure that a diverse set of research was represented within the discussion, I shared a set of studies showing that natural fats are not harmful (http://amzn.to/K3EHoj) along with the short editorial: “You were right. Science prevailed.”

The Discussion

Note: If you visit the discussion board, you will see that many others contributed to this conversation. I’ve included only my chat with Campell here as I’m frequently asked what I think about Forks Over Knives and The China Study and this provides a useful answer.

Campell’s reply (http://amzn.to/KsXFlW):

I previously said, “…science will prevail”. I said what I mean and mean what I said. But this can have meaning, I suspect, if only the would-be scientists and their minions in this discussion group would agree to really learn some science.

John Bailor’s post is a beautiful illustration of the problem. He certainly is clever in creating a list of studies, some quite well known, supporting the hypothesis that it is not total fat that has caused our high rates of heart disease, obesity and related ailments.

I agree that these studies, mostly all published in the peer-reviewed research literature, certainly support this hypothesis. Moreover, I not only support this hypothesis but said so, publicly, BEFORE any of these studies were conducted!!!!!!!

I suspect that this comment of mine may be surprising for those of you who post so many silly `storeys’ in this discussion group. I believe that this is because these individuals do not understand science, have not been trained in the field of nutrition and/or have inadequate access to the literature.

I personally know several of the investigators involved in these studies and spoke about their shortcomings on the dietary fat question even before they were organized. I lectured three times at Harvard when the Nurses’ Health Study was initially being organized and once at the Fred Hutchinson Cancer Center who organized the mammoth Women’s Health Initiative, each time offering that it would be a shortcoming to investigate the role of total fat in the etiology of these diseases with the cohorts and the protocols that they were using (all the other studies cited by Bailor also had the same shortcoming).

Namely, I have always been unwilling to assume that single nutrient adjustments in an exceedingly complex nutrient diet would show much of anything. It is unlikely to see a meaningful single nutrient effect within such complexity because of the interacting and compensatory effects of countless-and co-linear-nutrients (e.g., of fat) having similar disease producing effects. Even more importantly, in these studies cited by Bailor, these countless other factors will have already `maxed out’ their deleterious effects. Removing or decreasing one dietary item, e.g., total fat, has very little, if any, chance of working. This is similar to the use of nutrient supplements that we now know do not work, and in some studies actually do the opposite of what wa intended.

In short, in ALL these studies, trivial changes are being studied. This is NOT the way that nutrition works. For example, in NONE of these studies, were their subjects consuming a truly low fat, low protein, whole food, plant-based diet (never mind the superficial and really stupid characterization of `low fat’ as being something like 25-30% of total calories-read again my commentary on this book). This is where truly large and sustaining effects are observed.

As far as I am concerned, the evidence now available for a low fat, low protein whole food, plant-based diet is irrefutable. What these studies listed by Bailor prove-and this is the best of science!-is that adjustment of fat alone in Western type diets will have little or no effect. I have spent far too long (more than a half century) doing the experimental research, publishing the results in peer-reviewed literature, and helping to develop national food and health policy to believe otherwise. It simply works when people do it the right way. This is the future history!

 

My reply (http://amzn.to/IurkjH):

T. Colin Campbell says: “I have always been unwilling to assume that single nutrient adjustments in an exceedingly complex nutrient diet would show much of anything.”

Well stated. I appreciate all of your work in this field and your focus on whole foods. My research 100% agrees that eating dramatically more non-starchy vegetables, more nutrient dense fruits (ex. berries and citrus), and more nuts and seed is critical to health and fitness. You are 100% correct that eating a lot more of the *right* plants is critical to long-term health and fitness. Great work and thank you.

Given that you are “unwilling to assume that single nutrient adjustments in an exceedingly complex nutrient diet would show much of anything,” why the recommendation to adjust the single nutrients protein and fat down? Data unquestionably show there are healthy and unhealthy plants as well as healthy and unhealthy non-plants. Sugar is a plant. Wild caught salmon is not. The evidence now available irrefutably states that given the choice between sugar and salmon that the plant is preferable. Tombs of research, including your work in China, suggest that the consumption of seafood (a non-plant) dramatically improves health.

Why not find the best plants and best animals and focus on consuming those rather than making polarizing statements along the lines of plants are good and non-plants are bad? As you state so well, the answer in this exceedingly complex area is more nuanced than that.

The broader research community 100% agrees that consuming more non-starchy vegetables, more nutrient dense fruits (ex. berries and citrus), and more nuts and seed is critical to health and fitness, so why not focus on that rather than making scientifically-unsupported statements against the consumption of healthy non-plants such as seafood? The data is equally clear for those foodstuffs.

Thank you for dedicating your life to making the world a healthier and happier place. We share that goal.

– Jonathan Bailor

 

Campell’s reply (http://amzn.to/II0PXG):

Jonathan Bailor says:

Given that you are “unwilling to assume that single nutrient adjustments in an exceedingly complex nutrient diet would show much of anything,” why the recommendation to adjust the single nutrients protein and fat down?

When I did the experimental research on protein and fat (mostly protein), I was doing it in a way that was generally accepted (i.e., nutrient by nutrient)–keep also in mind that this is the way that we got funding from NIH to do research because this the way that we think. As I got into this research during a 27-year project doing hundreds of studies, I found the responses to be so provocative, almost unbelievable (both because of my personal and professional backgrounds). Gradually I was accumulating a series of what were regarded as heresies, at least for me.

It was then that I started asking about the properties of other nutrients, other disease endpoints and, most importantly, other explanatory mechanisms, as well as becoming concerned about the relevance of this information for humans instead of experimental animals. This is when I began 1) to realize and to demonstrate that nutrient compositions characteristic of WHOLE plants aggregated together, both in kind and in amount, had what clearly was the centuries old idea, “the whole is greater than the sum of its parts”. It then became more of a question how and whether the effects seen individually could be accommodated within a whole diet framework.

There’s far more to this story that will be published in a new book that I am just now completing, “Whole”, due in January 2013.

By the way, sugar is not a plant, it is a fragment of a plant and, as such, it behaves very differently (in size and kind of effect). Yes, salmon is a whole food but it does not accommodate information showing in a rabbit experiment that its protein increases serum cholesterol more than any plant protein source. Also, salmon has very small amounts of the large group of antioxidants and none of the complex carbohydrates, both of which are the core of the benefits of whole plants.

When I draw generalizations between plants and animals, I do so partly on the totality of the evidence on nutrient composition, partly on the biological plausibility of the evidence and partly on the results that are obtained in human trials–and more.

 

My reply (http://amzn.to/JFnbYN):

T. Colin Campbell – The explanation of your focus on protein makes sense. Hopefully it also makes sense that your statement “I have always been unwilling to assume that single nutrient adjustments in an exceedingly complex nutrient diet would show much of anything,” and similar sentiment provided in your popular text, are contradictory with your message to essentially avoid protein, as doing so is a single nutrient adjustment.

I am aware that sugar is not a plant 🙂 I hope my point was clear and reasonable. Tobacco is a plant, and I suspect that you would not recommend eating large quantities of it. If anything other than the importance of water consumption is close to unanimously agreed upon in the broader nutrition research community, it must be that there are healthy and unhealthy plants as well as healthy and unhealthy non-plants.

You are a very influential man and if I may be so bold, I would urge you to use that influence to encourage people to consume whole foods that help us avoid overeating (have high satiety), do not have a detrimental impact our blood sugar or hormones, provide an abundance of nutrients etc. per calorie, and do not promote the storage of excess fat, rather than trivializing what you rightly call an “exceedingly complex area” by suggesting that all plants are good and all non-plants are bad. I realize that some of the correlations found in your research may not agree, but I do hope you acknowledge that there are tombs of research from highly respected institutions demonstrating the health benefits of non-plants fitting the criteria I outlined above.

Best of luck with your upcoming work and I do hope that our paths cross in the future.

– Jonathan Bailor

 

Campbell concluded our discussion with (http://tinyurl.com/6pqecxj):

Jonathan,

I must emphasize the rationale for doing the research the way we did, not only because it was opportunistic and potentially rewarding but also, because of the funding, we focused on protein as researchers did and still do with focused hypotheses and study designs. As time passed, the very provocative findings with protein prompted me to go further to see the extent to which similar phenomena existed with other nutrients. This is where w discovered lots of interesting things that pointed to the benefits of a whole, plant-based foods diet. I then suggested that the “closer we get to a whole foods plant-based diet the greater the health benefits.” Ever since, I have pointed out that I do not know of scientific evidence showing that going 100% the whole way is better than, say 95% or so. Therefore, I have never said that 100% plant based is a proven scientific fact and that every last drop or crumble of the difficult foods need to be excluded. This is what others have said about my findings. However, I also have said many times that 100% nonetheless is, for me, advisable because it allows our taste preferences to adjust and within 1-3 months, sufficiently adjusted to a point where we do not want to return to our old ways. It is analogous to telling heavy smokers to stop smoking but letting them have a cigarette or two a day. It really doesn’t work because of the tenacity with which old preferences keep us hooked. On this point, I believe people have told more than a few times that I am some sort of inflexible activist.

 

I hope this was useful or at least interesting 🙂

I covered The China Study briefly a few months back and a quick web search will provide much more thorough China Study commentary if you’d like to read more.

 

Update: Let’s repurpose this post to speak to Tara Parker-Pope’s recent NYTimes post “The Fat Trap” regarding the futility of traditional fat loss methods.

Parker-Pope is exactly right that studies show eating less of the typical diet and doing more of traditional exercise does not work for the vast majority of people. However, that does not mean we need to be “trapped” by body fat. Myriad studies show that by changing the quality of one’s diet and the quality of one’s exercise (vs. quantity of eating and exercise) long-term fat loss is not only possible, but practical.

Think about trying to burn body fat after years of the traditional American diet like trying to drain water from a clogged sink. Eating less of the same quality of food is like turning down the faucet. Doing more of the same quality of exercise is like scooping out the overflowing water with a teaspoon. Both are temporary ways to deal with the symptoms of the problem (too much water in, not enough water out). Neither does anything about the root cause (a clog blocking the sink’s natural ability to automatically balance “water in” with “water out”). That is why studies show eating less and exercising more failing long term 95% of the time.

The problem is the clog. The solution is clearing the clog. And clearing the clog requires thinking in terms of food and exercise quality, not quantity.

Reducing the quantity of food which lead to the clog and increasing the quantity of exercise which ignores the clog doesn’t really help us. That simply reduces the symptoms associated with the underlying clog. We remove clogs–and “drain” body fat long term–by putting the right quality in, and keeping the wrong quality out.

It’s not about less in and more out. It’s about higher quality in and higher quality out.

The only “fat trap” is being unable or unwilling to escape quantity-based fat loss theories which have been proven wrong.

 

This post is a response to Young, Obese and in Surgery by Anemona Hartocollis of the NYTimes

In the majority of cases, trying to “cure” obesity with surgery to shrink the stomach is like trying to “cure” allergies with surgery to shrink the lungs.

Why?

Researchers have proven that overeating isn’t the cause of obesity. Overeating is a symptom of a deeper hormonal issue, which is caused by low food and exercise quality. Obesity is no more of a quantity problem than allergies are. The cause is quality of what’s going into the body…not the quantity.

Regardless of the size of a person’s stomach, if it’s filled with low-quality food, that person’s health will suffer and their body fat percentage will rise in the long term.

We don’t solve problems by treating symptoms (overeating). We solve problems by fixing causes (repairing hormones). Fortunately, researchers have proven that we solve the hormonal problem causing obesity by eating more—but higher-quality food—and doing less—but higher-quality—exercise.

 

“Overweight children aged from 9 to 17 years eat fewer calories than kids of normal weight in the same age group, researchers from the University of North Carolina School of Medicine reported in the journal Pediatrics.”

In other news, rather than digging deeper and seeking out the hormonal issue that explains this elegantly, researchers search for way to cling to their preexisting manual calorie balancing hypothesis concluding: “One explanation for this would be that increased energy intake in early childhood is related to the onset of obesity, but other mechanisms, such as differences in energy expenditure, may contribute more to maintaining obese/overweight status through adolescence.”

D’oh!

The study – http://pediatrics.aappublications.org/content/early/2012/09/04/peds.2012-0605.abstract