The events culminating in our election outcome were characterized as the advent of a “post truth era.” We have since devolved from post-truth, to “alternative facts:” essentially, a choice between bald-faced lies about verified reality- or delusion, calling out for medical care. Either way, we are being fed a daily diet of unpalatable (to most of us), insalubrious (for all of us) deceit.
Tempting as it is to address that matter, I have a related case to make that keeps me ensconced more decisively in my native professional purview. We are now all dealing with a diet of alternative facts. While that’s a new twist, alternative facts about diet have been our cultural standard for decades. The perils overlap, and it may even be that alternative facts about diet were the appetizer, and a culture-wide diet of alternative facts the inevitable main course to follow.
Nutrition has been mired in a post-truth era in the U.S. since long before anyone in our country had thought to coin the term. Let’s go back a little over half a century.
Leaving aside the contentious particulars, rival perspectives, and forays into revisionist history, we may simply note that Ancel Keys did indeed note an association between variations in dietary patterns, and variation in the rates of heart disease. In this country, where corporate interests got involved early, that ultimately came to mean: eat low fat junk food, and all will be well. I have challenged my peer group to find me a single instance of Keys advocating for Snackwell cookies, and promised to give up my day job and become a hula dancer if ever they do. My wardrobe is still thankfully free of grass skirts.
Low fat junk food did not exist when advice about the benefits of more plant foods, less meat and cream, was simplified, excessively in hindsight, into “cut fat.” The only way to cut fat when the advice originated was to eat more foods natively low in it, notably vegetables, fruits, beans, lentils, whole grains, and such. In North Karelia Finland, Keys’ insights were applied in exactly that manner, and the result has been an 82% reduction in the rate of heart disease, and a ten-year addition to average life expectancy.
In this country, we not only contorted sensible advice about dietary pattern into a new variety of highly profitable junk food, we never in fact applied the advice at all. Had we actually reduced our fat intake, and replaced it with sugar and refined starch, it’s unlikely our health would have improved. But despite entire careers predicated on this notion, it is false. Dietary intake data from multiple sources confirm that Americans never reduced our intake of fat. Instead, we simply added the low fat junk foods- and reduced the percent of calories we derived from fat by increasing our total calories. We even know why this occurred. Is anyone really still confused about why this didn’t make us all lean and healthy?
That was the reality, and its expression would have forced us to acknowledge our folly, confront the forces fostering it, and perhaps avoid replicating it. Instead, we were served a provocative set of alternative facts about diet, blaming our problems on bad advice rather than our absurdly bad use of reasonable advice, and providing us- inevitably- a scapegoat, in the form of an alternative macronutrient class. And so, we moved on to cutting “carbs,” in all the silly ways we cut fat- and despite the fact that everything from lentils to lollipops is a source of “carbs,” making summary judgment about the entire class not a wit better than idiotic.
Any hope that this second deep dive into nutritional nonsense where sense might have prevailed would have cured us of our penchant for replicating the follies of history capitulated long ago to experience. We moved on to cutting gluten as a cure-all, or blaming our woes on genetic modification. There is a booming cottage industry in discovering the harms of excess sugar, again, and again. But the truth about excess sugar is also corrupted into falsehoods to provide cover for the pecuniary interests of the meat industry.
Diet helped establish the pattern that bad execution of reasonable advice could be blamed on the advice; that the remedy for picking the wrong scapegoat was not to renounce the practice, but to pick another; that all opinion was the same as expert opinion; that a dissenting voice anywhere, whatever its motivations, meant lack of consensus; and that the forces of profit perverting the messages of public health could be overlooked as we wondered what went wrong.
I hope this sounds as ominous as it should. For one thing, it has meant we have squandered decades of opportunity related to diet and health, and instead find ourselves fatter and sicker than ever. For another, it means the lessons of alternative facts learned in the marketing of dietary nonsense, and tobacco too, have now been applied to the climate, with calamitous consequences, and are currently very much de rigueur in the running of our country.
There are fundamental truths about diet and health, to say nothing about dietary impacts on the planet, born of massive aggregations of diverse scientific evidence, backed by a global consensus of multidisciplinary experts. All that stands between us and the extraordinary good use of those truths could do -the addition of years to lives, the addition of life to years, and the protection of our natural resources- is alternatives to the truth.
Whatever the domain, it is toxic to conflate conviction for knowledge; isolated dissent for general controversy; principle for practice; the part for the whole; to say nothing of outright lies for the truth. It is toxic in its immediate effects, but perhaps even more so over time. For the conflation of alternative facts with actual facts propagates distrust at best, and disgust at worst. It propagates a background din of discord and doubt inhospitable to truth, however unassailable and urgently needed that truth may be.
Presidents of both parties have long affirmed that America is a global leader less for the many examples of our power, and more by the power of our example. That sentiment was echoed this week by Pakistan’s former Ambassador to Washington, who noted the power of American credibility. That very source of authority is surrendered when alternatives to fact are peddled as alternatives for them.
Bad practice does not belie good principles, not in nutrition and not in the national interest. Bad principles are a remedy to no ill in either case. Isolated dissent does not a controversy make. Dissenters about climate change are a rounding error, and they are wrong. So, too, dissenters about the net benefits of vaccination. As for dissenters about the general merits of science who tweet about it-they are not merely wrong, but hypocrites, too.
Ultimately a diet of alternative facts and alternative facts about diet can be harmful in all the same ways, undermining credibility, sowing dissension, misleading the public, curtailing human rights, and damaging the planet.
Alternative facts about diet have long been poisoning public health, and our bodies. Instead of heeding the lessons in that precautionary tale, we now look on as a diet of alternative facts about everything else poisons the body politic, too. Now, as ever, it is ours to decide when to swallow- and when to spit.
David L. Katz, MD, MPH, FACPM, FACP, FACLM, is the Founding Director (1998) of Yale University’s Yale-Griffin Prevention Research Center, and former President of the American College of Lifestyle Medicine. He has published roughly 200 scientific articles and textbook chapters, and 15 books to date, including multiple editions of leading textbooks in both preventive medicine, and nutrition. He has made important contributions in the areas of lifestyle interventions for health promotion; nutrient profiling; behavior modification; holistic care; and evidence-based medicine. David earned his BA degree from Dartmouth College (1984); his MD from the Albert Einstein College of Medicine (1988); and his MPH from the Yale University School of Public Health (1993). He completed sequential residency training in Internal Medicine, and Preventive Medicine/Public Health. He is a two-time diplomate of the American Board of Internal Medicine, and a board-certified specialist in Preventive Medicine/Public Health. He has received two Honorary Doctorates.