Eat More Tomorrow: Nutrition Through the Lens of Mental Models

“The truth may be simple, but we are up against a marketing budget that relies on misinformation and runs into the tens of billions of dollars each year; the primary goal of that money is to make us think eating is complicated, that we need to worry about protein, about tryptophan, about the health benefits of coffee.

We do not; we need to worry about eating real food.  Yet the marketing budget for this simple truth is usually about one quarter of one percent of that for lies.”

– Mark Bittman

The purpose of understanding mental models is to make better decisions than we would otherwise.  And, in turn, the purpose of making better decisions is to have better lives than we would otherwise.

While all of us make many decisions every day, most decisions are inconsequential.  We may agonize over whether to wear the blue shirt or the gray one to a client meeting, but the real impact is de minimis.  Following the 80/20 principle, only a small fraction of the decisions we make will drive a surprisingly large proportion of our outcomes.

From the standpoint of health – both physical and mental – one of the most important decisions we can make is getting 8-9 hours of sleep per night.  For those of us who are already doing that – or for those of us who won’t or can’t – another very important decision is what we choose to put in our mouths on any given day.

Along with maximizing sleep, minimizing stress, exercising regularly, maintaining social connection, and avoiding addiction, one of the biggest pillars of long-term human health is proper nutrition.

Thus, the purpose of this 50,000 word mental model is to combine the science of nutrition with insights on human behavior from Richard Thaler and insights on flavor from Samin Nosrat to provide you with the tools to make the best dietary decisions possible, given your personal tastes, constraints, and goals.  No matter what your starting point – or where you end up – I hope that this discussion helps you find ways to eat food that is both healthier and tastier on a daily basis.

Research consistently finds that a healthy diet can delay, prevent, or reduce the severity of a substantial portion of most death and disability from chronic diseases – whether heart disease, diabetes, cancer, Alzheimer’s, depression, or otherwise.

The World Health Organization notes:

The major causes of chronic diseases are known, and if these risk factors were eliminated, at least 80% of all heart disease, stroke and type 2 diabetes would be prevented; over 40% of cancer would be prevented.

These risk factors are obviously broad; they include other items like regular exercise and avoiding smoking, neither of which we are discussing here.  All told, though, even for those who are already nonsmokers, a healthy diet combined with other healthy habits could extend life expectancy by over ten years – and perhaps more importantly, reduce both the probability and severity of chronic disease.

Focusing purely on nutrition, one review titled “Food Groups and Risk of All-Cause Mortality” notes that there is more than a fourfold difference in risk of all-cause mortality between eating an optimal diet and an anti-optimal diet:

Optimal consumption of risk-decreasing foods results in a 56% reduction of all-cause mortality, whereas consumption of risk-increasing foods is associated with a 2-fold increased risk of all-cause mortality.

We will all die eventually, but we have a lot of control over how quickly that happens, and how healthy we are in the meanwhile.

Unfortunately, most of us don’t exercise our agency to exert that control.  In the modern world, particularly in America – though increasingly so in other countries as well – the base rate of dietary choices is sadly closer to anti-optimal than optimal.  Statistically speaking, even modest improvements could lead to a meaningful decrease in health risk for many readers of Poor Ash’s Almanack.

The reader I care most about is, of course, myself.  I’m a foodie, and I want to eat profoundly tasty food during every meal of every day.  However, I also want to live a long and healthy life.

So I’ve spent the past half a year or so reading the scientific literature about the impact of diet on human health, trying to do so with as open a mind as possible.  Knowing what I know now, I wish I’d learned all this five or ten years ago, but science suggests it’s never too late to start making better dietary choices.

Thankfully, I had few pre-existing biases.  I’ve been an omnivore throughout my life.  Other than alcohol – which I cook with, but don’t drink – there has never been any category of food I have categorically excluded from my diet.  My friends include vegetarians and vegetable-haters; expert bakers and pathological sugar avoiders; cheese connoisseurs and dairy refugees.

Me, on the other hand, I only had one rule: it tasted good, it went into my mouth!  I have never been vegan, or “paleo,” or avoiding gluten, or anything like that.  I have eaten at both vegan and paleo restaurants; I have cooked meals in both categories (though not intentionally, in either case.)

From that perspective, I simply wanted to learn which foods I should eat more frequently, and which I should minimize my consumption of to the extent possible, based only on science and not on ideology.

Homemade 83% whole-wheat seed bread with poached eggs, extra-virgin olive oil, chives, and Aleppo pepper.
Homemade 83% whole-wheat seed bread with poached eggs, extra-virgin olive oil, chives, rosemary, Aleppo pepper, and a spot of Kerrygold butter.

While I was already familiar with some of the scientific literature – i.e. “fruits, veggies, whole grains, legumes/nuts/seeds, extra-virgin olive oil, and fish are all great for you” – duh – much of it was a surprise to me.

I believe much of it will likely surprise you, as well.  There is a wide gap between popular understanding of health and nutrition, and scientific consensus.  Consequently, most of us – myself certainly included – have, over time, picked up wrong ideas from the world around us.

As one example of this gap: notwithstanding belief to the contrary among most people I know, science demonstrates that we should not worry about macronutrients; rather, we should worry about eating the right foods.

Healthy diets that scientists have studied have ranged from low-fat to high-fat, lower-carb to higher-carb, and lower-protein to higher-protein, but are all comprised of fundamentally healthy foods.  Unhealthy diets that scientists have studied have also spanned that same range, but, in contrast, are all comprised of fundamentally unhealthy foods.  Unfortunately, many popular diets, singing the siren song of macronutrients, lead people to eat less healthy foods and instead consume more unhealthy foods.

Here’s the best news I found: contrary to popular belief as well, eating healthier doesn’t mean sacrifice.  If you want to be healthy, there’s nothing you have to categorically give up: you can still eat anything you want (though some foods, of course, sparingly / in moderation – like bacon.)

In fact, few of the world’s healthiest populations live lives of culinary abstinence; at least one actively celebrates food.  The data suggests – unsurprisingly – that deprivation-focused “eat less tomorrow” diets fueled by willpower tend not to last long enough to drive meaningful long-term health impacts.

Duration matters more than intensity; perfect is often the enemy of good, and the edges of our diet tend to matter less than the majority of our diet.  As such, a smarter approach is to Eat More Tomorrow – focusing on eating more of certain things that are good for us, by making those things into flavor dynamite – and letting the less of other things naturally take care of itself.

Fixing problems of underconsumption (of minimally-refined plant foods) by learning how to make these foods tasty is far easier than fixing problems of overconsumption (intentionally depriving ourselves of unhealthy but tasty foods.)  Given our internal feedback mechanisms, “Eat More Tomorrow” is a twofer – we’ll naturally eat more of the good stuff, and less of the bad stuff.

Learning the fundamentals of flavor (major h/t Samin Nosrat) can empower us to make healthier dietary choices without compromising on taste or flavor.  Understanding merely a few key principles (the “mental models” of flavor, if you will), can make our diets not only tastier, but also far more healthful.

Although some of this information is undoubtedly easier to leverage if you prepare at least some of your own food, I know that cooking is bottom of the priority list for many readers of this site – so I’ve tried to make the information as accessible and applicable as possible, no matter whether you cook the overwhelming majority of your own food from scratch (like me), or live off Kind bars and Seamless (like many people I know).  Both paths can be consistent with optimizing for health, as long as you understand the fundamentals of flavor and nutrition.

While some healthy foods take a little technique and thought to make tasty, many other intrinsically tasty foods are both extremely tasty and good for us with no prep work required.

Here is a non-exhaustive list of things that most people find tasty without any special preparation, that also happen to be great for your health.  You can eat them out of hand, out of a jar, or out of the oven with literally five minutes or less of active prep work:

– fruits like blueberries and oranges

– vegetables like sweet potatoes, sugar snap peas, and shiitake mushrooms

– whole grains like popcorn and oats

– nuts, seeds, and legumes – like walnuts, peanut butter,  dark chocolate, tahini, hummus, and edamame

– healthy sources of fat, like salmon, avocados, yogurt, and extra-virgin olive oil

– herbs and spices like rosemary, garlic, and chile peppers

These are merely a sampling of the bounty of foods that can benefit our health.  The good news is that there are, in fact, so many foods that are good for us, that conversely to what many diet-book authors would have us believe, there is no one “optimal” diet that we must follow.

As I referenced a few paragraphs ago, research suggests that there are many varying dietary patterns that can lead to equivalently health-promoting outcomes.  This leaves room for individual tastes, cultures, priorities, and constraints (such as religious considerations and food allergies).

I can follow the diet that’s right for me, and you can follow the diet that’s right for you, and we can still end up in the same place: better health.  If you’re allergic to, or simply intolerant of, some “superfood,” that’s perfectly OK – you don’t have to eat it.  You can find something else to eat in its place.

However, when considering all of these healthy diets, there is a single common theme that is universal.  Decades of nutrition research on maximizing human health, conducted across the world on every population imaginable, can essentially be summed up by merely seven words.  What should we be eating?

“Real food, mostly plants, not too much.”

That’s a slightly paraphrased definition from Michael Pollan.  I think I’ve improved upon his original quote, while keeping the meaning intact.  Here is a more detailed explanation, on the same theme, from David Katz:

We do not know everything; but we know enough. The truth about food is simple; truly it is. It derives from both casual observation, and sedulous study. It represents the weight of scientific evidence, and has stood the test of time. We would all be better off eating mostly vegetables and fruits, nuts and seeds, beans and lentils, whole grains, and plain water to address our thirst- with or without additions of anything else.

Adding fish and seafood might make the overall diet better for some, but it might not. The same goes for modest additions of dairy, poultry, eggs, and unprocessed meat.

We should, we really should, all eat diets made of whole, wholesome foods, mostly plants. Michael Pollan asserted just that, appending “not too much.” But there is no extra work involved in eating “not too much” when the diet is made up mostly of whole, wholesome foods, mostly plants.

Among the many virtues of such wholesome foods in such a sensible assembly is that they fill us up on fewer calories. We don’t eat to fill a calorie quota; we tend to keep eating until we feel genuinely satisfied. If we can do that on fewer calories rather than more- and we certainly can by making the right choices- then weight control and satisfaction need not be mutually exclusive.

The science is clear and obvious: our poor diets are a behavioral problem, not a scientific one.  There is no longer any scientific dispute about what we should be eating most of the time: real food, mostly plants, not too much.  There are nuances around the edges, but none that have much impact on this broad theme.  Notwithstanding this reality, we are free to make whatever dietary decisions we like, but we are – importantly – not free to avoid the consequences of those decisions.

If we were all econs, then this is exactly what we would eat most of the time, with room for occasional unhealthy components to our liking and individual taste, whether that means steak or Coca-Cola or biscuits and gravy – or all three on the same plate.

But since we’re not econs – instead, we’re humans – various biases, both evolutionary and cultural, conspire to distort our understanding of clear and evident facts about which there is little to no scientific dispute.

By fully understanding mental models such as structural problem solving, opportunity costs, local vs. global optimization, and feedback – with a little detour into flavor – it becomes far easier to make healthy choices without triggering deprival superreaction syndrome (i.e., you’re taking away my tasty food!)  Utilizing and actively leveraging our natural incentives, we can make healthier choices without exerting any effort.

In fact, some of the advice in this post encourages you to make your food tastier than it already is – for example, by learning how to properly salt food.  Despite the likely negative first-order impacts of higher sodium consumption, learning how to properly use salt to make healthy foods into flavor dynamite will likely ultimately have vastly positive second-order impacts on the quality of your diet and health, displacing unhealthy foods that likely have more sodium anyway.

When we understand flavor, we can choose to Eat More Tomorrow – more healthy foods, that is – however and whatever that means in our own contexts.

What I aim to do here is twofold: first, convey my best understanding of all of the various mental models that contribute to people making poor dietary choices. in a comprehensive “Wait But Why” style exploration of how and why people make poor dietary choices.  (Shoutout to Tim Urban for demonstrating that there’s actually an audience for massively long-form web content.)

Second, with that foundation established, we’ll utilize those same mental models to do for diet what Thaler did for retirement savings with his “Save More Tomorrow” plan – i.e. work with, rather than against, human nature, to achieve our desired outcome (better health, without sacrifice.)

Katz is a doctor, but there are far too many inappropriate “appeals to authority” in nutrition. Many popular diet book authors – like the late Dr. Atkins – were both a) doctors and b) completely unscientific (and dangerously wrong) in their approach to nutrition. Therefore, I’m intentionally not using the “Dr.” honorific in relation to Katz throughout this post; you shouldn’t take him seriously because “he’s a doctor” – rather, you should take him seriously because his interpretations of the relevant literature are consistently thoughtful and unbiased.

One quick note: although I’ve read an overwhelming number of studies myself, and cited dozens of them here, I’ve also found that a man named David Katz (pictured at right) tends to have the most consistently unbiased and thoughtful interpretations of the data as a whole.  I actually encountered Katz very late in my process; his thoughts less shaped my views than corroborated and added nuance to what I’d already learned.

Therefore, while I cite an overwhelming number of actual studies in this post, ranging from associational studies to population-level interventions or randomized control trials, I’ve often utilized quotes from Katz to drive a point home – particularly quotes from his book  The Truth About Food.

You should not misinterpret this to believe that I am over-relying upon a single source; nothing in the post – and none of my beliefs – would change if you threw out every single one of Katz’s quotes.

Katz simply provided nuance to my existing research.  However, given that Katz has spent his career reading this literature (and writing some of it himself) vs. my few months of spare-time reading, his observations about certain topics are simply usually more pithy and impactful than my own words would be – similar to how Richard Thaler’s observations on behavioral economics are likely funnier and more insightful than my own.

I do, however, provide source material for most of the factual points discussed here, and encourage you to read the research yourself to come to your own conclusions.  I have directly cited many studies, although given the risk of cherry-picking and sample size (or bias) issues with any one study, I would encourage you, if you are deeply interested in the topic, to not take my word for anything I have written here – but rather, to review the available data with an open mind, through the lens of the mental models presented here.

Meanwhile, there are some valid criticisms of associational epidemiology.  However, conveniently, people who criticize nutritional epidemiology end with the criticism; they conveniently have no data supporting their chosen diet because there is no such data. It’s indicative that the preponderance of the data, whether associative or interventional, points in the same direction – i.e. eat more minimally-refined plants.

I would also like to point out that I am definitively not a nutrition expert.  I’m not even a scientist, really – I have a bachelor’s degree in biochemistry, but I never used it professionally, and don’t remember much of what I learned.

As such, this is not advice – it is simply me communicating the lessons I have learned through my research.  There may be items here where my understanding of the literature is not 100% correct.

If anyone who is more literate than me on a given topic finds an egregious error, please do let me know, and provide the data that you think I may have overlooked.  In the vein of scientific thinking, I will be happy to update the post and make a note of where I erred.

Directionally, however, I believe that all the points I make here are fundamentally valid, and they are the basis upon which I have constructed my own diet.  In some senses, this is the biggest bet I’m making in my life – certainly a bigger and more impactful bet than any in my portfolio currently – so I treated this research process with all the diligence and care that I apply to investment research projects.

Finally, I would like to point out that while I am primarily focusing on the two issues of taste and nutrition/health, some readers may have other considerations when constructing their own diet.  These include religious restrictions, individual medical situations, ethical/environmental considerations, or other factors.  I respect these concerns; touching on just one, the book Cod, for example, explores how our eating habits can dramatically impact ecosystems.

Nonetheless, these issues are beyond the scope of what I can adequately research, address, and discuss in this post, although I will note that, with occasional exceptions (like wild fish), what’s healthier for us also tends to be healthier for the planet.  Beyond that high-level observation, I leave it up to readers to integrate the general framework provided here with their own specific set of constraints to arrive at the outcome that’s right for them.

Author’s note: I have formally included this as the newest mental model in the latticework, although its format differs materially from the other models.  Also, a big thanks to my friend Dave R., whose feedback on my initial draft vastly improved the clarity and quality of this discussion!

Part 1: All I Want To Know Is Where I’m Going To Die… So I’ll Never Go There

We... are Iron Man.


Thanos: I am… inevitable.

Tony Stark: And I… am… Iron Man.


The section heading above is often used as a quip about sidestepping bad decisions: know the paths that will get us in trouble, and avoid them.  Nutrition is one of those rare instances where it’s literally true.

We’ll all die eventually.  Death is inevitable.  But some diets are the equivalent of Thanos – they lead directly to an early death, or extended ill health.  Most of us fall into this bucket, whether or not we’re trying to be health conscious.

Some diets, on the other hand – all variations on the theme of“real food, mostly plants, not too much” – protect our bodies the way the Avengers protect Earth.  These diets lead to longevity, and a higher probability of remaining free from physical or mental afflictions.

Which diets are which is, objectively, clear and obvious.  However, it is also clear and obvious that most people should be saving more for retirement – yet they do not.  Just as retirement savings is primarily a problem of behavior rather than knowledge, so too is following a healthy diet.

Making better decisions often starts with a thorough explanation of the behavioral biases and other mental models that lead us to make bad decisions in the first place.  Diet is no exception; I believe that behavioral biases – and other mental models – are the primary reason that most people eat a suboptimal diet (even if they are trying to be health-conscious.)

As such, in this analysis, I spend as much or more time on the mental models that get between us and practical application of the science, as I do on the science itself.

In Part 1 of this model, I aim to explore most of the important factors that I believe lead us to make incorrect dietary choices.

Some of these biases are applicable to all of us, while some of these affect some of us more than others.  If you feel that a certain section is not interesting or applicable to your own life, you are certainly welcome to skim or skip it, and you will hopefully not lose too much value in the process.  Still, I think understanding all the possible missteps sets us up for making the right decisions, so I would encourage you to at least get the gist of each section I’ve laid out below.

Entropy Gets Us All In The End

The most obvious place to start is with Geoffrey West’s “Scale” (SCALE review + notes), a fascinating book that discusses how scaling laws impact the world around us.  The relevant part: West’s simple observation that the accumulation of the energetic stress of being alive unavoidably causes our demise over time.  (See pages 194 – 199 of Scale in particular.)

In West’s view, we don’t die from old age, per se; we die because as we age, parts of our systems break.  Most of the time, our bodies can work around these nicks and bruises.  However, eventually something breaks that we can’t live without – and that’s the end.

West makes the analogy that our internal systems are like pipes in an engine.  Through this lens, our bodies are not so different from engines – neither can run forever, and the more they’ve been used, the more wear and tear they’ve accumulated, and thus the likely they are to give out.

The analogy is more apt than you might think; while we’re not going to go into the biochemistry of the Krebs cycle, which I once memorized and promptly forgot, for our purposes, the process by which we turn food into energy is really not all that dissimilar from an internal combustion engine, including the generation of “waste heat” that helps us maintain our body temperature, as this anatomy textbook notes:

The core temperature of the body remains steady at around 36.5–37.5 °C (or 97.7–99.5 °F). In the process of ATP production by cells throughout the body, approximately 60 percent of the energy produced is in the form of heat used to maintain body temperature.

The temperatures and pressures of oxidation in our bodies are not as high as they are in an engine, of course – but the net effect of wear and tear on our systems, over time, is directionally similar.

West notes, interestingly, that most animals cluster around the same number of heartbeats in a lifetime (1.5 billion); smaller animals with faster heart rates tend to live shorter lives.  Humans are an exception to this rule – 2.5 billion heartbeats – thanks to our consistent shelter and food supply, combined with miracles of modern medicine such as vaccines, which eliminate our susceptibility to many terrible diseases that many of us would otherwise contract.

Here is a chart from Rob Dunn’s website that visualizes this nicely – we will quote Dunn again later:

The idea is that systems can only sustain so much wear and tear; some systems just accumulate it faster or slower than others because of the pace of their usage.

Small animals with fast heartbeats are like a rental car or work truck used intensively every day in the heat – they wear out fast.  Large animals with slow heartbeats are like a collector’s classic car spending most of its time resting in an air-conditioned garage – they’ll last much longer.

Both may have roughly the same lifespan in terms of miles, but one has a longer lifespan in terms of years because less miles are accumulated per year.

It is thus reasonable to posit that everything we eat is slowly killing us.  Of course, not eating is not exactly an option; we will die much more quickly from not eating (on the order of weeks or months) than we will from eating a proper amount (on the order of decades).

The lifespan of engines, similarly, can be linked to cycles or “heartbeats” of the engine (since each cycle leads to wear and tear.)  But few engines last forever; entropy gets us all in the end.

The finite limit on lifespan across systems both biological and mechanical, measurable by heartbeats, lends credence to the idea that aging can be thought of as the gradual accumulation of wear and tear caused by oxidative stress.  There is a lot of emerging and ongoing research on the role that “inflammation” plays in age-related disease; one of the key mechanisms here is oxidative stress.  The linked review explains:

Moreover, many studies suggest that chronic inflammation could have serious role in wide variety of age-related diseases including diabetes, cardiovascular, and autoimmune diseases. [The] inflammatory process induces oxidative stress[,] and reduces cellular antioxidant capacity. Overproduced free radicals react with cell membrane fatty acids and proteins[,] impairing their function permanently. In addition, free radicals can lead to mutation and DNA damage that can be a predisposing factor for cancer and age-related disorders.

To be clear, not all preventable diseases are a product of oxidative stress, nor is oxidative stress the only underlying causal factor.  However, oxidative stress is certainly a factor that contributes to feared diseases ranging from Alzheimer’s to atherosclerosis, cancer to diabetes.

As such, while from an underlying biological/mechanical perspective, there is far more complexity and multicausality than I can address in the scope of this article – i.e. the mechanisms for the beneficial (or detrimental) effects of diet are multifold – I simply offer oxidative stress as one illustrative example that is helpful and easy for readers to visualize and concretize.  There are other mechanisms, such as immune function (well-documented), and I do not mean, with my analogy in this section, to imply that oxidative stress is the only important item here.  It is not.

However, what we sacrifice in terms of scientific precision, we gain in terms of usability in our everyday lives.  The specific mechanisms by which fruits, vegetables, whole grains, legumes/nuts/seeds, fish, and extra-virgin olive oil are good for us are somewhat less relevant for our purposes than the obvious fact that they are, indeed, preventative of a wide variety of diseases.

I am, here, focusing more on outcomes than mechanisms: while mechanisms are not always precisely known (though we are learning more about them), it is well known that healthy foods help prevent most diseases, whereas unhealthy foods accelerate their onset, progression, or severity.

So, continuing with the oxidative stress model, leading researchers from other fields come to largely the same conclusion as West.  For example, our house favorite Dr. Matthew Walker, sleep researcher extraordinaire and author of the phenomenal Why We Sleep (sleep review + notes), stated on a recent podcast that:

“Wakefulness is low-level brain damage.  Sleep is the price we pay for wakefulness.”

Dr. Matthew Walker, explaining the importance of sleep during his Talk at Google.

Cognition is energetically expensive – our brain accounts for roughly 20% of caloric expenditure despite being merely 2% of body weight – so, as Sam Kean observes in The Violinist’s Thumb (TVT review + notes), some evolutionary environments actually selected against intelligence.

Given our brain’s massive energy consumption, it’s unsurprising that research by Walker and others finds that being awake creates oxidative stress in our brain, which we have limited ability to mitigate while we are awake.  Nightly sleep is our brain’s way of repairing much of that damage.

While we cannot avoid oxidative stress entirely – it is an inevitable consequence of being alive –  a nightly 8-9 hours of sleep, like a healthy diet, can in fact reverse much of the damage.  These measures thus prolong our life, and our health, by vastly slowing down the accumulation of oxidative stress, and thus reducing the amount of wear and tear on our physiological systems over the course of our lives.

Conversely, shorting ourselves on sleep – or eating an unhealthy diet – actively accelerates the accumulation of oxidative stress.

There are meaningful interactions between sleep and diet, discussed in Walker’s book as well as in a recent podcast; Walker notes that when sleep-deprived, people who are dieting will burn muscle instead of fat, and also that sleep directly impacts metabolism of glycogen (while also making people more likely to eat junk food).

So there are feedback-driven lollapalooza effects here: there is bidirectional causality in which good sleep can lead to good diet and our body handling that diet better, which helps our sleep; bad sleep can lead to a bad diet and poorer handling of that diet, which hurts our sleep.

Sticking with our engine analogy: in the podcast, Walker actually uses an eerily similar analogy to West to discuss how a lack of sleep can lead to cardiovascular damage:

It’s almost as though you’ve got a beautiful car engine, you’ve put it in neutral, and you’ve put your foot on the gas pedal, and you’re revving the living daylights out of that engine…

If you do that chronically, which is what most people do with insufficient sleep, day after day, week after week, year after year, decade after decade… it’s not surprising that just revving the daylights out of that engine, at some point, gaskets are going to start blowing.  The engine’s not designed to operate [constantly] in that high-revving state.  High-revving occasionally – that’s just fine.

Walker’s points here are as applicable to diet as they are to sleep.  Our systems are resilient to occasional insults; the occasional steak sandwich or piece of cake isn’t going to ruin our health.  Even after all I’ve learned about nutrition, I’m happy to eat steak, or cake, once in a while.  But if we redline our bodies by eating nothing but steak and cake every day, our systems will naturally wear down much more quickly due to constant stress.

To this end, it is important to note that aging is a gradient: West demonstrates that organ function steadily declines from roughly age 20 onward; research I’ve encountered elsewhere suggests that various physical reflexes and cognitive functions peak at some point in our twenties and thereafter enter terminal decline.  (It is worth noting that from a practical perspective, experience and efficiency – i.e. wisdom – can offset many of these effects as we age, which is why quality of decision-making often improves vastly from our twenties to our fifties, despite slightly lower intellectual horsepower.)

Nonetheless, from a purely physiological perspective, the corollary to this is that many diseases typically associated with old age (such as heart failure, diabetes, and so on) represent the reaching of critical thresholds where this slow degradation reaches a point of no return.

This mental model helps put a finer point on the idea of age-related disease.  This model does not apply to all diseases – for example, it does not apply to cystic fibrosis, or other unpreventable diseases caused by genetic errors that prevent synthesis of key proteins.

Nonetheless, many of the major preventable diseases in our world today should be viewed as gradients rather than absolute black and whites.  All of us have some arterial plaque and some nascent tumors, and many of us have some level of insulin resistance.  However, some of us have much more of it than others – and with enough of it, our bodies can no longer fight off the damage, and we end up with a heart attack, stroke, cancer, diabetes, or other life-threatening outcome.

It seems obvious when you think about it, but to use heart disease as an example, it’s not like anyone wakes up one day and their arteries go immediately from 100% clear to 100% clogged, just as a bridge doesn’t immediately go from 100% structurally intact to 100% collapsed into a river.

Rather, plaque builds up slowly, over time, like rust.  And then one day there’s enough of it in some critical artery that severe damage is done.

The same idea applies to many other health conditions.  Take diabetes.  Whether we’re talking about insulin-creating beta cells in the pancreas, or our body’s reaction to the insulin they secrete – we don’t just wake up one day and suddenly lose all of our beta cells (or responsiveness thereto).

Rather, an unhealthy diet causes a slow burn of these cells (or a slow loss of responsiveness to insulin) over the course of our lives.  Unfortunately, one day, it’s too late: the damage is irreversible.

The reason that this gradual build-up process is important: while genetic factors and luck undoubtedly play a role in the development of many diseases, we actually still have a meaningful amount of control over whether or not we end up with them, by taking steps to slow down the process.  We all know our cars won’t last forever, but if we routinely change the oil and perform preventative maintenance, they’ll last a lot longer than they would otherwise.

Just as with investing, we can never guarantee a good outcome, but a good process maximizes our likelihood of achieving an acceptable outcome.  It is within our agency to take steps to meaningfully slow down the progression of the aging/disease gradient.

We will all eventually have some plaque in our arteries – this is unavoidable – but we have a lot of control over how much plaque builds up, and how quickly.  We will all still die eventually, but we can make choices that delay that death, and preserve our health in the meanwhile.

In this vein, not all calories we consume are equal.  Continuing with the engine analogy, some of our food (healthy food) is fuel with extra additives that clean muck (plaque, cancer, etc) out of the engine and help it run its best.

Some of our food (neutral food) is just normal fuel that neither actively heals nor harms the engine (beyond the base rate of the accumulation of oxidative stress).

But some of our food (unhealthy food) is fuel with dirty contaminants that will further muck up the engine (i.e. accelerate the deposition of plaque, the progression toward Alzheimer’s, or the growth of cancer).  We only have one engine for the rest of our lives, so if we care about it, we should obviously try to maximize our consumption of top-grade fuel.

Another approach to the same problem might be simply trying to become more fuel-efficient (i.e., operating on less fuel), thereby potentially accumulating less oxidative stress.  To this end, as West mentions, there is some interesting emerging work on potential benefits of fasting and calorie restriction.  The underlying premise seems logical.  I would caution, however, that this research is far too early-stage to come to strong conclusions on its long-term effects on human health.

We also need to be careful of complexity. As Dr. James Lock sagely observes on pages 147 – 149 of Groopman’s How Doctors Think (HDT review + notes), while logic can be powerful, we often don’t know all the variables we’re dealing with when it comes to a complex system like the human body.  There may be unintended consequences of following an approach that is seemingly logically sound.

Moreover, for those of us already at a healthy weight, intentional caloric restriction (below a typical 2,000 calorie per day diet) would not in any way be necessary to achieve the health outcomes that most of us want, which is why I have excluded discussion thereof here.

A related issue is that we accelerate many of these diseases by overeating, which is easy to do because our bodies are incredibly energy efficient.  To give you an idea of just how energy-efficient our bodies are, and how easy it is for us to overeat, West’s book points out – fascinatingly – that our biological metabolic rate (~2,000 kcal/day) is equivalent to that of a 90-watt lightbulb.

Think about that for a second.  My desktop computer has a power supply that I believe is on the order of 750 – 1000 watts.  If it draws maximum power when I’m playing a video game, it is using on the order of 10x as much energy as I am.  This doesn’t even count the energy used by my monitor, speakers, mouse and keyboard, etc.

Unlike the lightbulb or the computer, of course, if someone feeds more current into us than we need at the moment, we have the ability to build an on-demand “battery” (fat) to store that current for future use.

Our extraordinary energy efficiency and propensity for fat storage served us well as a species in an environment that was long energy-scarce – but in today’s energy-rich environment, it does not serve us well anymore.  (We will return to this mental model of trait adaptivity momentarily.)  The act of overeating itself subjects us to additional oxidative stress, and the n-order impact – fat deposition – causes additional problems.  As such, many of our diseases today can be classified as diseases of abundance rather than diseases of deprival.

Opportunity Costs: Compared To What?

Before we go any further, we need to set up a core idea here.  One of the most profoundly important mental models applying to nutrition is the idea of opportunity cost.  As with the previous discussion, it becomes obvious once you think about it, but is worth discussing because most people’s eating habits – and most discussions of what foods are “good” or “bad” for us – don’t take this reality into account.

Let us start by making the simplifying (though somewhat inaccurate) assumption that if someone chooses to eat X rather than Y for lunch, the consequences are isocaloric – i.e. whether we eat the salad or the burger, we consume the same number of calories.  (This is an inadequate and incorrect assumption, which we will return to later in more depth, but please work with it for now, as a starting point to build upon.)

The consequence is that just as it’s difficult to classify a stock as “worth buying” or “not worth buying” without having some idea of what other investment opportunities are available, it is difficult to categorize consumed foods as “healthy” or “unhealthy” without also asking the question: if the individual in question did not eat X, what Y would they be eating instead?

It is a subtle but important distinction.  While the absolute effects of a given food on health are largely knowable, at the level of an individual’s diet, it is not relevant, in a practical context, to think about a given dietary choice without thinking about the other dietary choices that it necessarily crowds out.

Katz, as an example, discusses why dairy is often found to be positive for childrens’ health.  Generally speaking, the balance of evidence seems to suggest that the absolute health impact of most forms of dairy are “neutral or worse.”  There is good evidence that some forms (yogurt) are positive, and also emerging evidence that some kinds of cheeses may not be so bad for us.

However, no dairy product other than yogurt is really a “health food,” and the rest of them range from perhaps slightly positive at best, to probably meaningfully negative  at worst (ex. heavy cream).

Nonetheless, we can’t think about dietary dairy properly without thinking about the Y that people are not consuming because of dairy.  And dairy, in the context of kids’ diets, often means milk, which crowds out soda, Capri-Sun, or other drinks with lots of added sugar, which we all know are bad for us.  As such, while milk is likely not good for kids per se in the absolute sense, and kids don’t need to drink milk for any reason, it is certainly better for them than soda on a relative basis, resulting, on net, on a positive health impact.

Illustratively: on some hypothetical minus-ten to plus-ten healthfulness scale, let’s imagine that sugary drinks are a minus-5 and milk is a zero (0).  We still gain five points by moving from minus five to zero – hence, milk can have positive effects on kids’ overall health by replacing unhealthy sugary drinks even if milk is not, per se, healthy in the absolute.  Katz explains:

To the best of my knowledge, we have no evidence—zero—that adding dairy to balanced, prudent vegan diets improves health outcomes in any way. On the other hand, we also have no evidence to my knowledge that such optimized vegan diets produce better health outcomes than comparably balanced, optimized Mediterranean diets that do include dairy…

[Despite this]… many studies of dietary intake in the U.S. do suggest benefits of dairy, for children in particular.  This may be because dairy is directly beneficial, but it may also be because of the generally ignored pebble-in-a-pond aspect of dietary intake: more of X as a percent of total calories means less of Y.

So, perhaps in the context of the typical American diet, the inclusion of dairy is consistently beneficial because it tends to mean less soda, among other things…

You can have an optimal diet that includes or excludes dairy.  For that matter, you can have a crummy diet that includes or excludes dairy, too.

The takeaway here is that many times, asking “is it okay for me to eat X” is the wrong question – the right one is “am I better off eating X instead of Y.”  Because if we’re eating X, it necessarily means we are not eating – or, at least, eating less of – some other Y, and we can’t properly evaluate the net health impact of eating X without also considering the opportunity cost of the foregone Y.

This opportunity cost phenomenon is where, for example, poultry gets its health “halo” from.  It is quite reasonable to call chicken “healthy” relative to steak, pork, or bacon, as it has fewer negative consequences on health than those foods.   Poultry, like milk, appears to be in the neighborhood of “neutral” or “zero” – neither super harmful nor super helpful.  However, red meat is definitively “very bad” – i.e., fuel with contaminants that mucks up our systems.

As such, given the high proportion of red meat in the typical American diet (meatloaf, hamburgers, steaks, pork chops, ham, bacon, etc), someone who chooses to substitute chicken for any of the aforementioned is certainly making a healthier choice, and the research very consistently bears this data out.

Returning to our hypothetical scale, if poultry is a zero-ish and red meat is a minus-7, we’re gaining 7 health points by replacing red meat with poultry – just as we’re gaining significant health points by replacing soda (obviously bad) with milk (like poultry, another zero).

But this health halo can extend too far: many people think chicken is a “health food,” which it is categorically not.  Remember, poultry is still a zero.  It is good in some aspects, and bad in others (as we will explore.)  Ultimately, poultry does not promote human health in the absolute; there are far better foods we could be eating instead.

So eating chicken is not good for our health relative to instead eating almost any minimally-processed plant-derived food like blueberries, sweet potatoes,  kale, lentils, hummus, extra-virgin olive oil, walnuts, or whole-wheat bread – plus-ten type foods which clearly protect and promote human health.

If we choose to eat more poultry and thereby forego the opportunity to eat more of these plus-ten foods, we are giving up ten health points that we easily could’ve had.  Even if we want to stick to something fleshy, fish is easily a plus-five or plus-seven type food, and poultry crowds that out as well.

To be perfectly clear, this isn’t to say that we have to eliminate poultry from our diets – it’s just to say that poultry should not be an overwhelming component of our diets to the extent that it crowds out far superior options.  In fact, the research demonstrates that reasonable consumption of poultry, and even occasional consumption of red meat, can still be part of a healthy diet.  Several dietary patterns considered nutritional gold-standards – like the traditional Okinawan and Mediterranean diets – have in fact included modest portions of both white and red meat.

Given how dose-dependency and marginal utility work, the healthfulness of the majority of our diet is far more important than the healthfulness of the edges of our diet; most of the healthiest populations that scientists have studied still have some flaws in their diet.  We don’t have to be perfect to be healthy.

To ensure you’re not worrying about any biases on the table here – I’m not a vegetarian, let alone a vegan, and I’m not advocating that anyone become either (I don’t believe it’s tenable for the majority of people).  While I now predominantly eat vegetarian food, I still eat both poultry and red meat, albeit only about 1 serving of each per week.  (I would exclude fish from my definition of meat, here, although it’s somewhat moot because I don’t eat much fish anyway, primarily for price/value reasons.  This is likely the largest flaw in my diet, and the one I’d most like to remedy in future.)

My meat consumption represents a far lower amount than the average person will probably want to consume, and a far lower amount than research suggests is necessary to optimize for health.  Please understand that I am not advocating that anyone else follow this path; while the science is overwhelmingly clear that a predominantly plant-based diet is the best path to health, it’s also clear that modest meat consumption (particularly of poultry) is not overtly harmful – so if meat makes you happy, please do eat it.

2x/week is merely a target I set for idiosyncratic preference reasons that likely don’t apply to most readers.  In the context of my overwhelmingly minimally-refined plant-based diet comprised predominantly of fruits, vegetables, legumes/nuts/seeds, whole grains, and extra virgin olive oil, I prefer to spend my modest budget of discretionary “non-health-optimizing” calories on things like cheese and added sugar (i.e. sweetened coffee and Coca-Cola) rather than meat.  Others could and should make different choices that are more appropriate for their own utility functions.

For now, the point is that we should always try to trade up, not down, within the context of whatever is tenable for us.  Knowledge of where any given food ranks on the totem pole can help us ascertain how much of it is appropriate to include in our diet, in context of other factors (such as taste, physique, or performance) that are important to us.

We will return to this issue in a few sections through the lens of salience and local vs. global optimization.

Trait Adaptivity: What’s Good For The Paleolithic May Be Bad For The Anthropocene

As with many phenomena in life, evolutionary biology can help shed light on many of our eating-related behaviors.

I don’t think I need to dwell on the fact that for the vast majority of human existence, we were far likely to die from having too few calories (i.e., starvation) than too many calories (i.e., obesity).

There was no sense in us naturally preferring a diet that would optimize our health in 80 years if it wasn’t certain that we would be around in 80 days.  Making it through this winter, when food might not be available, was far more important than getting through some hypothetical maybe-we’ll-get-there winter in ten, twenty, or fifty years.  The long-term health effects of red meat or refined starches are irrelevant if you’ll die next week if you don’t eat them today.

A good analogy to diet quality is water quality: when we live in the city with an abundance of safe water, we have the luxury of preferring filtered or bottled water over tap water, and worrying about minute amounts of contaminants in the water supply.  If we’re stranded in the wilderness, contaminants be damned – any potable water is good potable water, because it increases our chance of surviving until tomorrow.

It’s similar to the argument Peter Godfrey-Smith makes about the brief lifespan of the octopus in Other Minds (OthM review + notes): the octopus is engineered to get to reproductive age, and whether it lives any longer than that is not evolution’s concern.  So evolution never selected for genes promoting octopus longevity.

Human eating behaviors make sense through this lens.  Evolution wasn’t optimizing our hunger pangs, or tastes in food, to drive eating behaviors that would maximize our health many years down the road.  There was no selection pressure for this.

To the contrary, in an environment where the availability of future food was uncertain, it was in our best interests to seek out high-calorie-density foods, and consume heavily when we found them, storing any excess energy in the form of fat.  There is, in fact, modern evidence of this: studies on the Dutch Hunger and Overkalix (in Sweden) suggest the possibility of not only epigenetic impacts on fetuses conceived during periods of high or low food supply, but in some instances, transgenerational impacts occurred as well.

In today’s environment, where the availability of future food is guaranteed for most of us in developed countries, these same traits that were adaptive in prehistoric times have become maladaptive.

"Possum Fren" frequently visits our back porch to much on our compost.
“Possum Fren” frequently visits our back porch to munch on our compost.

In fact, our tastes are almost perfectly maladapted to the modern environment.  We tend to over-eat refined starches, refined sugars, and the fat or flesh of land animals, all of which naturally taste good to us without much effort, but are usually bad for us, at least in their most commonly-consumed forms.

We are, intriguingly, not the only species to fall prey to this trap.  Domesticated or pet possums, if allowed to select their own food, will so severely deprive themselves of calcium that within merely weeks or months, their bones become malformed to the degree that they literally can’t walk.  As such, anyone raising a pet possum has to very strictly monitor and control its diet.  (I plan to do this someday; possums are really adorable.)

The opossum had no natural pressure to consume calcium-rich foods, because its natural diet takes care of that – so it doesn’t have a drive to eat calcium-containing foods; it just ends up doing so by happenstance because everything naturally available to it is teeming with calcium.  When you put that same possum in an artificial environment (a house), where not all foods are teeming with calcium, it ends up eating the wrong things.

Modern humans, similarly, when placed in our artificial new environment, undereat the “right things” that maximize our health and longevity – we forego fibrous, phytochemical-rich foods like whole grains, nuts, legumes, fruits, and vegetables, some (though not all) of which take a little effort to make tasty, particularly in contrast to hyper-processed Doritos.  (We’ll get to food engineering later.)  This is a shame, because there’s clear and compelling evidence on the health benefits of fibrous foods.

Millennia ago, it would have been simply impossible to underconsume fiber, because the vast majority of everything we ate did not undergo any processing to remove the fiber.

For example, the anthropological record suggests that our ancient predecessors did make proto-tortillas or flatbreads from the ground seeds or roots of wild grasses like the cattail and bur reed – wild, prehistoric versions of whole grains and starchy root vegetables, if you will.  The cattail was abundant in many environments, so you would naturally expect hungry humans to make use of its bounty.

But our predecessors didn’t have any efficient modern technology by which to separate out the fibrous bran and germ from the endosperm, or the starch of the root from the fiber – so by default, they were eating whole-grain (or whole-root) “tortillas” and flatbreads rather than refined white flour tortillas and breads, as many of us might eat today.

So, as evolutionary biologist Marlene Zuk explains in her intriguing book Paleofantasy.” our “paleo” diet in the hunter-gatherer era included many multiples of the fiber we now consume:

“Fiber is also good for us, yet we seem to lack that same enthusiasm for filling our diets with bran.  

Why wouldn’t natural selection have instilled a drive to seek out high-fiber foods similar to the drive it instilled for sweet foods?

The answer is simple: fiber was abundant in our ancestral environments, and no one had to do anything special to acquire it.  

People eating a diet similar to that eaten by hunter-gatherers can consume up to 100 grams of fiber per day, in contrast to the standard American intake of less than 20 grams, just because their food is all unprocessed.”

Similar trait-adaptivity arguments can be made for why we’re so quick to mindlessly, without research, accept what other people tell us about what we should eat.  In a Paleolithic world without Wikipedia and with a lot of things that could potentially poison or kill us, relying on culture (what our ancestors have safely eaten) and social proof (what other people around us have safely eaten) are good ways to simultaneously a) not starve, and b) not die.

This is often suggested as one of the reasons toddlers are such picky eaters – it doesn’t make sense to be picky in the middle of the Sprouts produce section, where literally everything is health-promoting.

What should you eat? Everything in the Sprouts produce department is a good start.
What should we eat? Everything in the Sprouts produce department is a good start.

But caution and relying on others’ experiences and opinions does, of course, make sense in the middle of a forest, where many things that are growing might be likely to poison us.  To this end, one of my best friends and I – in our terrible twenties, rather than terrible twos – thought we found some wild blueberries on a hike in Maine.  It was the middle of blueberry season, and they looked exactly like store-bought blueberries.

However, both of us were – naturally – scared to eat them because of the off-chance that they were something else that might kill us.  It was a bad risk-reward: we could cheaply buy as many known-safe blueberries as we wanted from roadside farm stands, whereas we could potentially get sick (or even die) from eating these wild maybe-blueberries.

Culture and social proof would have given us confidence: if an expert local who had eaten the berries and lived to tell the tale had informed us that they were, in fact, true blueberries that were safe to eat, we would have trusted their judgment and happily stripped the bush bare of its plentiful fruit.

Given that the vast majority of most modern humans in developed countries spend very little time foraging in forests, this trait becomes maladaptive: what we eat is often very much a function of what other people like us eat.

Sometimes this can mean we predominantly eat the foods that are native to our culture (whether geographic or ethnic).  Sometimes, it can me we predominantly eat the foods that are eaten by people we want to be like (i.e. that trim woman who’s avoiding gluten, or the ripped guy at the gym who’s chugging protein shakes.)

In some cases, this monkey-see monkey-do behavior can be beneficial: traditional Indian, Japanese, or Italian diets can be very healthy, and those brought up in such culinary traditions can look forward to superior health outcomes with no special attention or effort.  For most modern humans, however, it’s not beneficial: the traditional American diet, and more broadly the typical modern diet anywhere, is anything but healthy.

When we’re not simply eating what our parents or friends eat, we’re often too quick to listen to diet “gurus” pitching a new fad.  As noted earlier by Bittman and Katz, the truth about diet is simple: real food, mostly plants, not too much.

This simple truth doesn’t necessitate hundreds of new diet books per year, but there’s lots of money to be made selling books, and parlaying those books into pricey supplements, courses, coaching, speaking engagements, and so on – a clear incentive to spread an opinion, whether it’s correct or not.

Unfortunately, altogether too many of these opinions are factually incorrect; my mom once came home from Costco with a demonstrator’s pamphlet that suggested people substitute lard for extra-virgin olive oil in their daily cooking (a nutritionally-deranged suggestion if I’ve ever heard one.)  Of course, that was just the tip of the advice-berg; the real secrets would only be divulged a few hundred or thousand dollars later.

My mom, thankfully, wasn’t swayed by the pamphlet – but I’ve seen many of my friends misled by nonsense masquerading as “nutrition expertise.”  A book that a good friend of mine sent me, telling me it would change my life, had other similarly un-factual advice.  Perhaps most egregious among this advice was encouraging the consumption of bacon and sausage, and the use of bacon grease as a cooking oil.  This was not one lone author; there is a whole cottage industry that incorrectly proclaims – on the basis of literally no data – that “bacon is good for you” and we should all be eating more bacon.

I mean, look: bacon is undeniably tasty, and I eat it once in a rare while.  But it’s nonetheless quite literally one of the worst foods on the planet from a human health perspective.  (This applies even to the supposedly-but-not-actually healthier “uncured bacon.”)

We should not frequently eat bacon unless we want, as Cyanide and Happiness or South Park might so eloquently put it, “ass cancer.”  (To be clear, getting cancer in your butt is not the only potential negative health effect of eating too much bacon.)

No, really, if you think this is a joke, it’s not.  I’m being serious here: one study published in April 2019 notes that for each thin slice of bacon we eat per day, our risk of colorectal cancer increases by roughly 20%:

In this large contemporary prospective study of half a million men and women from the UK that included 2609 cases of incident colorectal cancer, we found that a 25-g/day increment in processed-meat intake (equivalent to about one rasher of bacon or one slice of ham) was associated with an 19% greater risk of incident colorectal cancer.

Pretty much every study ever done finds similar conclusions about the risks – in terms of butt cancer, and otherwise – of consuming processed meat.  The World Health Organization (WHO), in fact, lists processed meat as “Group 1” – or carcinogenic to humans – alongside asbestos and tobacco.  This doesn’t mean bacon is as bad for us as tobacco, to be clear – but it does mean that the evidence linking processed meat to cancer is as strong, in the WHO’s evaluation, as the evidence linking tobacco and asbestos to cancer.

As such, it took me only about five minutes to determine that this “life-changing” book’s best and highest use was being recycled: not only did I have no interest in reading it, but I didn’t want anyone else reading it, either.  You cannot simultaneously claim to take science seriously and claim that bacon is good for us, yet that’s exactly what this author did – undoubtedly making lots of money in the process, while influencing who knows how many people to consume much more of many foods that are categorically bad for our health.

The author, of course, is not responsible for paying readers’ medical bills, nor for supporting their families if they meet an untimely end.  The sad part is that this sort of anti-scientific paradigm seems to be more the norm than the exception in the world of popular diet advice.

There is appreciable irony in the fact that Dr. Atkins himself, one of the first to popularize the anti-health high-red-meat, low-plant diet, was not exactly the picture of health.  In addition to being overweight by the NIH definition of BMI, Atkins had a history of cardiac problems, hypertension, and congestive heart failure, which are of course among some of the more meaningful risks of the sort of red-meat-heavy diet he promoted.

So, unfortunately, in most cases, social proof from friends and popular diet “experts” are negative dietary influences, particularly as the base rate of healthy eating is low in most Western countries.  In fact, as we will observe in the ensuing two sections, even many people who are “health-conscious” don’t necessarily end up in a better place, thanks to misunderstanding various mental models.

The Macronutrient Myth: The Curious Case of Protein

Perhaps the most interesting cultural aspect of our diets, perpetuated via social proof, is the pervasive myth of macronutrients: the idea that we can glean anything useful about food by seeing how much of it is composed by carbs, fat, and protein.  How many people do you know who are trying to “eat more protein” or “eat less carbs?”  So many.  So, so many.

Like many elements of culture, like our society’s anti-sleep fetishism, the macronutrient myth persists because it exists – not because it has any basis in reality.  We know scientifically that sleep is imperative for human health, and we also know scientifically that macronutrients are not particularly relevant to health and nutrition.

Yet the myth, stubbornly, persists.  As Sunstein/Thaler explore throughout Nudge (ndge review + notes) – although particularly elegantly on pages 58 – 59 – completely pointless, made-up traditions can persist through generations simply because they exist.  That’s called status quo bias.

Macronutrient analysis is one such made-up tradition that serves no purpose.  As David Katz puts it:

“Perhaps one rung up on the ladder of folly from ‘just one wrong nutrient’ claims are ‘just one wrong dietary pattern’ claims.  Salient among these are: it’s all about dietary fat, or, it’s all about carbohydrate.

Such arguments are remarkably popular despite being stunningly silly…. Macronutrients are to diet what building materials are to homes.  There is a short list of available materials in both cases, and most of the time, all entries are needed and used. How they are used makes all the difference.”

Indeed, one of Katz’s papers – Can We Say What Diet Is Best For Health? –  makes the compelling argument that diets with various macronutrient profiles – higher or lower in fat vs. carbohydrates vs. protein – can all be consistent with nutritious eating.

There is no single “optimal diet” – rather, there are many optimal diets centered around the core tenets of “real food, mostly plants, not too much.” You can eat meat or not eat meat; you can eat fish or not eat fish; you can eat some dairy or not eat any dairy.

Similarly, nuts and legumes are clearly health-promoting, but if you’re allergic to many nuts and legumes (like some of my good friends), have no fear – you can still construct a very healthy diet without eating anything that’ll give ya anaphylaxis.

This is consistent with long-term population studies, as well as the dietary patterns of unusually long-lived clusters of people – the traditional Okinawan diet is extremely high in carbs and low in fat, for example, while the Mediterranean diet, with its liberal use of extra virgin olive oil, is somewhat lower in carbs and much higher in fat.

Yet they are equally health-promoting.  Such diets are also, generally speaking, equally health-promoting to fully vegan diets – so as long as you’re eating “real food, mostly plants, not too much,” it’s somewhat less relevant if you want to include eggs, dairy, and meat as modest parts of your diet, or whether you want to eat a lot of fat or very little, or whether you want to focus on high-protein plant-based foods like lentils, or just eat a balanced diet of all of them.  You have options – many of them.

Despite this inherent flexibility in nutrition, the vast majority of popular dietary approaches are premised around the idea that there is One Correct Diet.  Typically implicit in such approaches is the idea that some macronutrients are Inherently Good, while others are Inherently Bad.

Indeed, almost all popular diets have one thing in common: an emphasis on consuming large amounts of animal-based protein, which is nearly universally accepted as healthy by the general public.  This is… wrong, very wrong.

In fact, I would posit that animal-derived protein is probably the single most problematic component of the American diet today.  Why?  It’s simple: everyone generally knows and accepts that added sugar and white bread are anywhere from neutral at best, to actively bad for you.

Nobody sensible really disagrees on this to any meaningful degree; I have not once heard anyone argue that we should be eating more sugar and white bread for the sake of our health.

Not so wonderful – and everybody knows it!

Given the image problem of sugar and refined starch in the public consciousness, anyone who is still eating those is doing so knowing the negative health consequences (and not caring about them), which is fine.  Everyone is free to eat what they want.

Many people, however, celebrate meat, particularly lean poultry, as a “healthy” choice – despite the fact that it has tremendously negative health consequences relative to essentially any plant-derived food you could choose to eat instead.

Katz goes on to explain a fact that is well-understood scientifically but misunderstood by the general public.  Raise your hand if you knew this – I didn’t, for sure; it was one of the most surprising takeaways from my months of research.

Consumption of meat provokes a far greater insulin response than consumption of starch or sugar, and is thus more likely to lead to diabetes:

“The same fallacy applies to many other arguments.  Another whopper? The claim that since insulin resistance and type 2 diabestes abound, carbohydrate must be the one true source of our dietary ills.  

There are many problems with this, beginning with the fact that ‘carbohydrate’ refers sweepingly to everything from lentils to lollipops… the other rather grave problem with the claim is that dietary protein produces a more pronounced release of insulin than does most carbohydrate.  Yes, really!”


Protein ingestion is “insulinemic,” meaning that protein induces an insulin release independent of blood sugar levels….

Spikes in insulin levels may contribute to weight gain, which in turn can lead to insulin resistance, and higher spikes in insulin levels, until the pancreas can no longer keep up- and diabetes ensues. Glycemic measures by no means fully account for the key contributions of excess protein and calories to this process.

See here for a more extensive discussion in a 2017 study by McMacken/Shah titled “A plant-based diet for the prevention and treatment of type 2 diabetes.”

Indeed, as the Physicians’ Committee for Responsible Medicine notes on their website in an article titled “Does Sugar Cause Diabetes,” the causality goes the opposite way from what most people expect.  Counterintuitively, lower-carb / higher animal protein diets are more likely to cause diabetes than higher-carb / lower animal protein diets:

The recent film What the Health raised the question as to whether sugar or other carbohydrates cause diabetes.

The notion is understandable. Blood sugar levels are high in diabetes, so a common idea has held that eating sugar somehow triggers the disease process. However, the major diabetes organizations take a different view. The American Diabetes Association1 and Diabetes UK2 have labelled this notion a “myth,” as has the Joslin Diabetes Center,3 which wrote, “Diabetes is not caused by eating too much sugar.”


In Japan, China, and other Asian countries, the transition from traditional carbohydrate-rich (e.g., rice-based) diets to lower-carbohydrate Westernized eating habits emphasizing meats, dairy products, and fried foods has been accompanied by a major increase in diabetes prevalence. Similarly, in the United States, a meat-based (omnivorous) diet is associated with a high prevalence of diabetes, compared with dietary patterns emphasizing plant-derived foods. In the Adventist Health Study-2, after adjusting for differences in body weight, physical activity, and other factors, an omnivorous diet was associated with roughly double the risk of diabetes, compared with a diet omitting animal products.


It has become fashionable in recent years to blame sugar for many health problems. However, per capita sugar consumption has actually been falling in the United States since 1999, when bottled water and sugar-free beverages began to edge sodas off the shelf. At the same time, consumption of cheese and oily foods has steadily increased, as has diabetes prevalence. This suggests that something other than sugar is driving the diabetes epidemic.

A number of studies have looked for relationships between sugar and diabetes risk. A 2017 meta-analysis, based on nine reports of 15 cohort studies including 251,261 participants, found no significant effect of total sugars on the risk of developing type 2 diabetes.7 Those consuming the most sugar actually had a 9 percent lower risk of developing diabetes, compared with those consuming the least sugar, although the difference was not statistically significant (meaning that it could have been a chance result). Similarly, fructose was not significantly associated with diabetes risk. Sucrose appeared to have a significant protective association. Those consuming the most sucrose had 11 percent less risk of developing type 2 diabetes, compared with those consuming the least.

Other studies have focused, not on sugar overall but specifically on sodas and other sugar-sweetened beverages. Many have found no significant relationship, apart from sugar’s extra calories that lead to weight gain.

The article goes on to note that “still, sugar is not a health food” – which is obvious.  Too much sugar is unequivocally bad for us; even though it may not cause diabetes, it does contribute to other health problems.

The problem, however, is that an over-focus on sugar (or simple starches) as the “one problem” in the public consciousness leads many to give other food groups, like meat, a free pass – when, in fact, they are equally problematic, if not perhaps more problematic, from a health standpoint.

Katz goes on to observe that many popular rationales for high protein consumption are simply inaccurate, whether that rationale is that protein is metabolized differently than carbs/fat, or some form of the “appeal to Paleo” fallacy.  (“Paleo” ideology is addressed more thoroughly in an ensuing section from an anthropological perspective; here we focus more on modern nutrition science.)

Converse to what many fitness nuts will tell you, too much (animal-derived) protein is likely a far greater risk to our health than too little – protein deficiency is simply not observed in developed countries (even among vegans).

The myth that vegetarians don’t get “complete protein,” let alone enough protein, has also been put to rest (here’s a study).  As Katz notes in the block quote we’re about to get to, clinical protein deficiency is simply not observed in the U.S., even among vegans (though vegans can, it should be pointed out, face deficiency of B12 and iron, but these are likely not concerns for the overwhelming majority of us who aren’t planning to become vegans).

There are certainly some vegetarian diets where protein sufficiency might be a risk (for example, if you tried to survive purely off fruits, nuts, and olive oil), but for someone consuming a balanced diet, this is profoundly unlikely.  I actually built a spreadsheet calculating the grams of protein per calorie of foods that I commonly eat, and realized that even if I became a full vegetarian (which I’m not planning to), I would comfortably exceed daily protein requirements.

There are also some rather vapid arguments floating around the internet and the diet-book world, perpetuated by people who clearly don’t understand science, that if you eat more vegetables and less meat, you’re losing out on nutrients.  This is also scientifically inaccurate.

Indeed, from a pure nutritional sufficiency standpoint, a thorough 2019 review of the available evidence for (and against) the low-meat, moderate-fish, mostly plant-centric Mediterranean Diet noted that any diet designed to optimize for intake of identifiably valuable micronutrients will inevitably tend towards the profile of the Mediterranean Diet.  Neither land-based animal meat, nor dairy, was on the list of foods that contributed the most to nutrient sufficiency:

Nutrition profiling and nutritional quality are topics of considerable current interest.156 In this context, an additional element that adds biological plausibility to the findings of cohort studies and RCTs is a body of evidence supporting the high nutritional quality of the MedDiet (ie, it is a nutrient-dense option) over alternative actual dietary patterns which tend to be energy-rich but nutrient-poor.

Maillot et al157 modeled nutritionally adequate diets to simultaneously met the requirements for a whole set of nutrient goals (proteins, fiber, essential fatty acids, 10 vitamins, 9 minerals, sodium, saturated fatty acids, and free sugars) while deviating the least from the observed diet in terms of food content. They found a strong consistency in the dietary changes needed to fulfill the constraints, and the greatest increases were seen for unsalted nuts, whole grains, legumes, fruit, fish/shellfish, and vegetables. They concluded that regardless of the different scenarios that they assumed, those foods which are typical of the MedDiet are needed to reach overall nutrient adequacy.

In the Mediterranean SUN cohort, a closer adherence to the MedDiet was reported to be strongly associated with a lower risk of failing to meet the goals for nutrient adequacy.158,159 As adherence to the MedDiet increased, the probability of not fulfilling the micronutrient goals sharply decreased.159 This finding was replicated in other studies.160 In another study, the SUN cohort investigators evaluated the intakes of Zn, I, Se, Fe, Ca, K, P, Mg, Cr and vitamins B1, B2, B3, B6, B12, C, A, D, E, and folic acid. …

The results were similar… These results were replicated also in the PREDIMED cohort.161 Therefore, it seems very likely that the overall better nutritional quality of the MedDietary pattern may be able to bring about a substantial reduction in the risk of atherosclerotic-ischemic events, which are known to be related to biochemical disorders caused by suboptimal intakes of several micronutrients.

To be clear, since some beta readers exhibited some confusion on this topic: the Mediterranean Diet, as it is parametrized in the research, refers not to Mediterranean cuisine specifically, but rather to a dietary pattern with food from any part of the world, that is primarily based upon whole grains, nuts, legumes, fruits, and vegetables, with some seafood and also modest portions of meat and dairy.  There is meaningful flexibility among components; the only nonnegotiable element is extra-virgin olive oil (EVOO), used liberally in and on most/all food.

The Mediterranean diet has been successfully adapted in many vastly different geographies and populations.  This could be interpreted as broadly as a traditional Indian diet based around vegetable shaks, lentil dals, and whole-wheat rotis, so long as EVOO is substituted for ghee and brown rice for white.

The Mediterranean diet could also be interpreted in the vein of Chinese or Thai food (vegetable/tofu stir-fries and curries) or Southwestern cuisine (dishes like vegetarian chili / fish tacos on corn or whole-wheat tortillas, again with plentiful EVOO, and perhaps with a plant-based sauce like mole).

It could even extend to something like sushi or a poke bowl, so long as brown rice was substituted for white.  Or it could extend to something completely acultural, like roasted sweet potatoes.  So no matter whether your preferred cuisine hails from South America or Siberia, you could find a way to follow a Mediterranean dietary pattern.

So, it’s better to focus on foods rather than worrying too much about nutrients (or even cuisines).  The only food “component” we should be explicitly optimizing to maximize is fiber – not protein – because beyond the direct health benefits of fiber, which are well-documented, optimizing for naturally high-fiber rather than high-protein foods almost ensures we’re eating healthy.

Where fiber is found – i.e. in fruits, vegetables, legumes/nuts/seeds, and whole grains – so too reside phytochemicals that prevent atherosclerosis and fight cancer, that enhance and extend our cognitive function.  As Katz observes, you can add or not add other foods if you wish, but that’s a plenty-good foundation to start.

Anyway, with the exception of those who wish to optimize for their athletic performance or their physique, there is no reasonable scenario in which the average person needs to worry about not getting enough protein.  (We will return to this issue in the next section.)

Conversely, there are overwhelming reasons to worry about getting too much animal-derived protein.  Although land-based meat can be part of a healthy diet (and, as mentioned, is part of mine – don’t mistake me for a vegan activist!), meat should not be an overwhelming component of any of our diets.

Why?  There are clear adverse health consequences from excessive consumption of animal-derived protein, whether that is in the form of milk or flesh-derived proteins.  Katz, again:

Dr. Gardner goes on to point out that the RDA for protein for adults is 0.8 g/kg/day, and the average American eats 1.2-1.6 g/kg/day. Contrary to the idea that vegans must be careful to get enough protein, they readily exceed the estimated average requirement of about 40 grams daily, and would have to be very careful about food choice NOT to do so! Too much protein is far more plausible for most of us than too little.

Dr. Gardner closes his case against the vegan protein myth by noting that protein deficiency is only ever found where overt malnutrition is found. He routinely asks audiences of clinicians in the United States if any of them has seen “protein deficiency” and to date, none has. I have not, either, in my 25-year clinical career.


The mythology of protein tends to propagate the notion that more is better. When this thinking pertains to absolute protein quantity, it is clearly wrong. There are many concerns about adverse health effects of high protein intake over a lifetime, many of which are still subjects of investigation. These include potential harms to the kidneys, liver, and skeleton, to name just a few. Importantly, and despite folklore to the contrary, excess calories from protein contribute to fat gain and obesity like excess calories from any other source.

The case for protein intake at the high end of the range sanctioned by the Food and Nutrition Board of the National Academy of Medicine (the source of the Dietary Reference Intakes) – roughly 35% of total calories is made partly on the basis of adaptation. Experts suggest that our Stone Age intake of protein was at or near this level.

However, average life expectancy in the Stone Age was decades shorter than in the modern world, and average daily physical exertion was thought to be considerably greater. The implications of comparable protein intake in the context of modern living are uncertain.


Human beings do not need to eat meat. We can, certainly- but it is not required. We do not need meat in our diets for any reason. Meat is not necessary to build muscle, despite mythology to the contrary. Passions about meat and the mythology of its role in building strong muscle should be tempered by common observation.

Animals routinely build much more powerful muscle than any ever owned by any human out of meat, or plants. Carnivores like the great cats build muscle from meat. Herbivores, like horses and elephants, build comparable and greater muscle bulk and strength exclusively from plants.

What this tells us is that the construction of muscle depends not on meat, per se, but on the foods to which a given kind of creature is adapted. Herbivores are adapted to build their muscle from plants, and the mightiest of all land animals are herbivores. Carnivores are adapted to build their muscle from meat.

Omnivores- bears, raccoons, chimps, and humans- are adapted to have choices…

Despite an apparent eagerness among some to match our “Paleo” levels of protein, I have encountered no one keen to do the same with fiber- perhaps because modern schedules simply don’t allow for that much time in the bathroom! Our Stone Age ancestors were estimated to have consumed 100 grams of fiber daily. That may be contrasted with the roughly 30 grams now recommended, and the prevailing intake in the U.S. among adults, which is less than half of that.

For that matter, few I know seem eager to try the insects that were thought to contribute significantly to a true “Paleo” diet, either. We seem inclined to practice emulation of Stone Age eating very selectively…

A compelling argument against high protein intake in general, and again animal protein ingestion specifically, is made in T. Colin Campbell’s famous book, The China Study. While the title might imply the book is all about one study, it actually addresses many, most conducted by Dr. Campbell and his colleagues, ranging from experimentation in the lab to epidemiology at the population level. This work suggests that animal protein, and the milk protein casein especially, are important contributors to the risk of cancer and ill health in general. The concluding guidance emphasizes both limiting total protein intake to the low end of the DRI range, or even below it.

The contention that protein sourced from animal foods is disadvantageous to health relative to protein from plant sources has garnered additional support from research published since The China Study. In 2010, researchers at the Harvard School of Public Health published a paper examining protein substitutions in the diets of women, finding significant reductions in cardiovascular events when plant sources, such as beans, displaced animal sources such as beef.

The scientific research on nutrition in general, such as the study cited above on protein substitution, is actually surprisingly easy to read yourself, and I encourage you to do so, although you of course have to be careful about sample size and selection bias issues – i.e., looking at consensus as a whole across multiple studies conducted by many researchers, rather than the results of any particular individual study.

Also, of course, take into account the issue discussed above – just because a study finds no association between X food and all-cause mortality does not mean you should go hog-wild eating that food.  There are foods that show clear inverse associations with disease, and your diet should emphasize consuming as many of those foods as is possible/palatable.  (We will, later, address the issue of how to construct a diet you can actually follow, rather than one you’ll drop in a couple weeks.)

The point here, however, is that the idea of using macronutrients as a dietary decision point is silly.  Katz, on carbs:

While addressing any of the macronutrient classes as a single entity belies the tremendous variety and variable contributions to diet and health housed within, this is perhaps even more true of carbohydrate than the others. Ever since the meteoric rise of Dr. Robert Atkins in the late 1990s, it has been in vogue to refer to “carbs” as a unitary concept about which summary judgment could be passed, that judgment more often than not negative.

One hears reference routinely to “carbs” in popular culture now, from social media to movies, such reference often lamenting their tempting charms, and assailing their latent harms. All of this is terribly silly and misguided. Quite simply, plants are comprised mostly from carbohydrate, and so- most plant foods are as well.

Most of the food supply is plants; and nearly all plants are overwhelmingly carbohydrate. Technically, then, a “low carb” diet should mean a diet low in virtually all plant foods. Leaving aside the many arguments, made throughout this book, for diets rich in a variety of whole plant foods, I can simply note here that despite devoting my life to this area, I am aware of no real-world instance of a “low plant food” diet being associated with the good health of any population.

Most people studying “low carb” diets are presumably as aware of this as I, so the common ploy is to cook the books, and contrive the nomenclature. Diets are at times called “low carb” except that . . . vegetables don’t count as carbohydrate. Sometimes, fruit doesn’t count, either.1 …. Studies routinely refer to “carbs,” but actually mean: bad foods, made of refined starches and added sugars, among other things.

But then the word “carb” is interpreted-by the press, and the public- to mean just what it says, all carbohydrate sources, which, let’s be clear, run the gamut from pinto beans to jelly beans. The next thing you know, without the vaguest hint of  published data to justify it, people are carefully avoiding beans, or fruit, or whole grains.

None of the diets in real-world populations associated with the best health outcomes are low in total carbohydrate. Extraordinarily good health has been observed in populations with exceptionally high total carbohydrate intake, but to my knowledge, not in any with exceptionally low total carbohydrate intake. Quite simply, diets cannot exclude vegetables and fruits and other plant foods, and be conducive to optimal human health outcomes.

More detailed arguments point in the same general direction. Beans figure prominently and consistently in diets associated with longevity.  Intake of whole fruit is associated with defense against diabetes.  High intake of fiber- a carbohydrate- can help lower lipids as effectively as [medication]. …

Let’s stop talking about macronutrients. The simple truth is, if you get the foods right, macronutrients will take care of themselves- and you will be eating well. If you fixate on any given macronutrient, as our culture has now done for decades, there is a considerable risk that you will figure among those who keep exploring new ways to eat badly.

Macronutrients are irrelevant.  Foods, on the other hand, matter.

Mirror, Mirror, On The Wall… Who’s The Healthiest Of Them All?

Of all the parts of this model, my guess is that the previous section will be met with the most skepticism.

At least five guys I know reading this are the eager kids with their hands raised in the air, butts bouncing a couple inches off the chair.  They can’t wait to ask a question: but, wait, doesn’t protein improve athletic performance and help build lean muscle mass / physique?  Don’t high-protein / low-carb diets help lower body fat?  So how can you say macronutrients are irrelevant – shouldn’t we be optimizing for more protein?

Here, we arrive at another two mental models that lead people to make poor health decisions: salience and local vs. global optimization.

Although I vastly prefer Thaler’s Misbehaving (M review + notes) to Kahneman’s tedious “Thinking Fast and Slow,” I do find  Kahneman’s”WYSIATI” to be a useful acronym.

“What You See Is All There Is” is a great, memorable summary of the salience mental model, also known as “vividness” or “recency bias”: humans tend to react to the data points that are in our face, rather than the ones that are actually important.

We’re scared of Ebola and airplane crashes, which have cumulatively killed far fewer people in developed countries, over the past two decades, than a good flu virus can kill in a single season. Even if we’re young and healthy and not at huge risk from the flu ourselves, we could still contract a mild case of it and pass it along to some nice old lady on the street, who could very well subsequently die.  Despite the reams of evidence  and the fact that most of us can get our flu shots for free, many of us still fail to get our annual flu shots.

The same phenomenon applies in nutrition.  To return to our earlier analogy of our body’s physiology being like pipes, as Jonathan Waldman so beautifully explores in Rust: The Longest War (rust review + notes), rust moves so slowly that most of us can’t be bothered to care about it on any given day:

“[R]ust sneaks below the radar.  Because it’s more sluggish than hurricanes, tornadoes, wildfires, blizzards, and floods, rust ranks dead last in drama.  There’s no rust channel.  

But rust is costlier than all other natural disasters combined, amounting to 3 percent of GDP, or $437 billion annually, more than the GDP of Sweden.  

[…] rust is glossed over more than it’s taught, because […] it’s just not sexy.”

Waldman goes on to observe that without human intervention, rust would wipe out a substantial portion of human structures within a few decades.

Just like our complacency towards real rust, we’re complacent about the slow accumulation of bio-rust in our bio-pipes.  Arterial plaque and incipient tumors are not salient whatsoever.  We literally never see, hear, or even think about them.

On the other hand, what we can and do see every time we get out of the shower is our naked body in the mirror: that, and everything about it that we wish were different, is extremely noticeable.

The most salient result of our diet. in the short term, is our physical appearance – are we trending in the direction of abs or flab?

Our waistline is very prominent; the health of our arteries and the existence or lack thereof of nascent tumors is completely invisible.  People have out-of-the-blue heart attacks or late-stage cancer diagnoses every day; we can look and feel 100% fine until suddenly, we aren’t.  (Remember the critical thresholds discussion earlier?)

As such, most people tend to indiscriminately focus on not the true drivers of long-term health, but rather the visible, “salient” KPIs they can observe in the mirror.  These are accelerated by societal pressure: women are made to feel they need to be thin as a rail; guys are made to feel that they need to be manly and muscular.

If you think about it, our focus is even reflected in our language.  When was the last time you heard someone make a New Year’s Resolution to “eat healthier to reduce my long-term risk of cardiovascular disease or cancer?”

You never frickin’ hear that.  Instead, you hear “I want to get in shape” or “I want to lose ten pounds” or “I want to bench 300.” These are all fine goals – admirable, even – but they can also lead us down some dangerous roads if we’re not careful.

“Eat a salad.” – Thor’s Mom.  (Solid advice for us all, regardless of weight.  She is indeed the wisest woman in the Nine Realms.)

It is easy to understand how and why we can make this mistake.  We all know that not only is exercise directly beneficial to our health, but moreover, that many of its n-order impacts – like lower body fat and higher lean muscle mass – are also generally correlated with better health outcomes on most dimensions that matter.

So, we make the mistaken assumption that anything that helps us “get in shape” – i.e. lose weight or build muscle – must be good for our health.

And that’s where we go wrong.  This is a correlation vs. causation and multicausality issue.  There are many ways to get to the same place, not all of which are good.

For example, in high school, I knew (and unsuccessfully tried to help) a girl who struggled with anorexia, at least in part due to stressors at home.  She clearly needed love, therapy, and more food.  Nobody in their right mind would have called her eating habits “healthy”- even though they gave her a figure that many women seem to wish they had (perhaps, it should be pointed out, because of social pressure from men.)

Similarly, smaller balls are the least important health worry for a man who chooses to take steroids – even though they build muscle mass like crazy, and can also help you shed fat.

Steroids are an example of a clear local vs. global optimization issue, in which we must navigate between short-term and long-term concerns: if you wanna get swoll, fast, steroids are great.  But like anorexia, steroids happen to be truly awful for your long-term health.  I’ve never heard anyone tout the long-term health benefits of shooting steroids, or struggling with anorexia.

“This mirror will give us neither knowledge or truth. Men have wasted away before it, entranced by what they have seen, or been driven mad, not knowing if what it shows is real or even possible.” – Albus Dumbledore

Unfortunately, we often fail to apply the same obvious logic to our diets, and mistakenly equate “looking better in the mirror” to “being healthier.”

Often this correlation is true and correct, but if we’re not careful, we can run into situations where it is not.

Because it turns out that, for example, pretty much any diet leads to weight loss in the short term, mostly because the act of dieting increases our intentionality with regards to what we eat.

This intentionality increase, alone, combined with restricted choices, consistently leads to weight loss (vs. no intentionality with unrestricted choices.)

Katz notes that all diets work in the short term, but that doesn’t tell us anything about their long-term health effects:

Generally, when diets are compared fairly, the results are predictable, if a bit disappointing: any diet restricting choice and calories produces weight loss in the short term; weight loss in the short term is associated with improvement in the cardiometabolic profile; and adherence to any diet assignment is relatively poor over time.

Short-term diet studies are particularly prone to mislead about health effects because as noted, almost any diet can produce weight loss, and weight loss makes most metabolic risk markers look better in the short term. Weight loss is associated with reductions in blood glucose, blood insulin, LDL, triglycerides, and blood pressure to name a few.

But still, wouldn’t it be true that if Diet X produced short-term weight loss that in turn lowered blood glucose, blood insulin, LDL, triglycerides, and blood pressure- then it must be genuinely “good” for you?

No, it would not be true at all. Some very bad things can cause weight loss: cancer, cholera, and a cocaine binge among them. These, too, can produce “favorable” changes in standard measures of cardiometabolic risk, partly by virtue of weight loss and the early stages of starvation.

Acute illness is so well known to cause blood lipid levels to fall, that those measures obtained at the time of hospitalization have long been considered unreliable- a problem colleagues and I wrestled with in a paper we published in 2006.

There is, I trust, no need to make the case that acute illness, cancer, cholera or otherwise; or a cocaine binge- is the very opposite of “good” for health. This leads to a very important reality check about research studies in general, and the statistics used to report their outcomes specifically: science is only ever truly meaningful in context.

If we interpret short-term study outcomes out of context, we are apt to conclude that if Diet X “improves” those measures, it’s a winner. If we consider context, we immediately recall that short-term effects and long-term outcomes that truly matter may align perfectly, or not at all.

In a study of effective treatments for fever, immersion in liquid nitrogen would work impressively.  It would also kill every participant.

To this end, many people celebrate various diets such as “keto” or “high-protein” as being beneficial to their metabolism; I can’t even count the number of people I know who avoid “carbs” because they make them “gain weight,” or eat lots of meat because it helps them “build muscle.”

Here’s the problem: opportunity costs, which we covered a few sections ago.  Even if it were true that all “carbs” make us gain weight (a tenuous-at-best proposition, as we’ll address in a moment), from a health standpoint, we have to consider what we are replacing those carbs with.

And – unfortunately – most people tend to replace them with too-large and too-frequent servings of land-based animal products, which we definitively know are anywhere from neutral at best (eggs, poultry, some dairy) to very bad for us (red meat, bacon.)  Intentionally eating more of these foods necessarily leaves less room on our plate for definitively health-promoting carb-containing foods like legumes, whole grains, fruits, and vegetables.

If we eliminate foods from our diet that protect against cancer and heart disease, and replace them with foods that are either neutral, or that actively promote cancer and heart disease, then we’re gonna have a bad time.

In direction, though not magnitude, choosing to forego eating fruits, vegetables, and whole grains while actively aiming to eat more meat is like foregoing sleep and instead using cocaine to stay alert: we’re not only doing less of something that’s great for us, but also doing more of something that’s awful for us.

The long-term results of these sorts of diets are exactly what smart readers will expect.  Even given the health benefits of the weight loss associated with high animal protein diets, over the longer term, such diets lead to meaningfully higher rates of all-cause mortality, as well as higher incidence of cancer, diabetes, cardiovascular incidents, and so on.

To this end, a 2018 study published in The Lancet, examining the progress of over 15,000 adults over 25 years, found some truly sobering results:

Low carbohydrate dietary patterns favouring animal-derived protein and fat sources, from sources such as lamb, beef, pork, and chicken, were associated with higher mortality, whereas those that favoured plant-derived protein and fat intake, from sources such as vegetables, nuts, peanut butter, and whole-grain breads, were associated with lower mortality, suggesting that the source of food notably modifies the association between carbohydrate intake and mortality.


There are several possible explanations for our main findings. Low carbohydrate diets have tended to result in lower intake of vegetables, fruits, and grains and increased intakes of protein from animal sources,  as observed in the ARIC cohort, which has been associated with higher mortality. It is likely that different amounts of bioactive dietary components in low carbohydrate versus balanced diets, such as branched-chain amino acids, fatty acids, fibre, phytochemicals, haem iron, and vitamins and minerals are involved.

 Long-term effects of a low carbohydrate diet with typically low plant and increased animal protein and fat consumption have been hypothesised to stimulate inflammatory pathways, biological ageing, and oxidative stress.

Cardiologist Dr. Sara Seidelmann, the study author, noted to a media source (Blue Zones) that:

“We need to look really carefully at what are the healthy compounds in diets that provide protection. Low-carb diets that replace carbohydrates with protein or fat are gaining widespread popularity as a health and weight loss strategy.

However, our data suggests that animal-based low carbohydrate diets, which are prevalent in North America and Europe, might be associated with shorter overall life span and should be discouraged.”

A separate study, also published in 2018, found alarmingly similar results:

Compared to participants with the highest carbohydrate consumption, those with the lowest intake had a 32% higher risk of all-cause death over an average 6.4-year follow-up. In addition, risks of death from coronary heart disease, cerebrovascular disease, and cancer were increased by 51%, 50%, and 35%, respectively.


Professor Banach said: “Low carbohydrate diets might be useful in the short term to lose weight, lower blood pressure, and improve blood glucose control, but our study suggests that in the long-term they are linked with an increased risk of death from any cause, and deaths due to cardiovascular disease, cerebrovascular disease, and cancer.”

Regarding the mechanisms underlying the correlation between low carbohydrate diets and death, Professor Banach noted that animal protein, and specifically red and processed meat, has already been linked with an increased risk of cancer. He said: “The reduced intake of fibre and fruits and increased intake of animal protein, cholesterol, and saturated fat with these diets may play a role. Differences in minerals, vitamins and phytochemicals might also be involved.”

Our study highlights an unfavourable association between low carbohydrate diets and total and cause-specific death, based on individual data and pooled results of previous studies. The findings suggest that low carbohydrate diets are unsafe and should not be recommended.”

Of course, as all readers are likely familiar by now, there is equally compelling evidence for substitutions in the other direction.

For example, in the North Karelia intervention (and Finland more broadly), among other lifestyle changes, such as smoking cessation – the substitution of more plant-based foods (such as vegetables, fruits, whole grains, and canola oil) for animal-based foods (such as meat and dairy) contributed to an increase of life expectancy of over a decade, and a massive decrease in cardiovascular disease.  Diet was, of course, not the only contributing factor, but it played a major role.

This is merely one of many studies conducted at different times, in different populations, by different researchers, that demonstrates the clear health benefits of eating less meat and more minimally-refined plants.  While some people criticize associational epidemiology as a justification to ignore it and eat more meat and less plants, you’ll notice that they all – conveniently – ignore interventional data that comes to the same conclusion as associational data.

Meanwhile, such armchair nutritionists have no data of their own supporting their point of view.  All they can do is criticize other people’s data; criticizing the scientific process is a convenient way to shift focus away from the fact that there is no science backing up the claims of most of these fad diets.

Isn’t it more than a little odd that all the data – whether associational or interventional – points in the direction of “more minimally-refined plants?”  And a little odd that we have no evidence whatsoever that eating less minimally-refined plants and more meat results in better health outcomes?

If all the claims you see on Crossfit or Paleo websites about “eating more wonderful meat and less evil plants fixed all my problems” were true, then why does the exact opposite effect consistently show up in the data, whether associational or interventional?

We can all agree that refined starches and added sugars are bad for health, yet research consistently finds that controlling for other factors, (pesco)-vegetarians tend to be healthier than omnivores – making it difficult to claim that because refined starches and added sugars are bad (which they are), that meat, particularly red meat, must somehow be exonerated from all the scientific data surrounding its damaging effects on our health.

Surely if higher consumption of animal products was such a clear and strong path to health, associational data on health outcomes would trend in the opposite direction, and these bloggers/authors would be able to rely on rigorous science rather than the anecdotes and personal experience which they rely on instead?  Every point I’ve made here has reams of research backing it up; the same cannot be said for the vast majority of popular diet blogs or books.

Anyone familiar with inside / outside view thinking is smart enough to realize that best decision process is to start with base rates.  The base rate of nutrition is very clear: with a couple exceptions (fish and yogurt), we should eat more minimally-refined plants and less of most everything else (i.e. meat, highly-refined plants, added sugars.)

Amidst all of this, it is worth noting, of course, that if you still want to increase your protein intake to optimize for “look in the mirror” goals, you can do so safely – as long as you’re doing so in the context of a broadly plant-based diet.

The authors in the Seidelmann study, for example, noted that the negative effects found for animal-based proteins and fats completely disappeared when plant-based proteins and fats were substituted for carbohydrates.  The Lancet study, again:

In our analysis, when carbohydrate is substituted [by] higher animal fat or protein intake it is associated with both higher cardiovascular and non-cardiovascular death, whereas plant-based substitutions are associated with both lower cardiovascular and non-cardiovascular death, indicating that food source could be an important consideration for both causes of mortality.

So if you want to optimize for protein for the sake of look-in-the-mirror goals, that’s totally fine!  That is, it’s fine as long as you’re doing so primarily from plant foods like legumes, whole grains, nuts and seeds, and so on, all of which contain plenty of protein, but also plenty of phytochemicals / fiber / etc that are health-promoting rather than health-destroying (like many animal based foods).

Ken Maynard [CC BY 2.0 (]
Surprisingly, there are, in fact many vegan athletes, including famous ones like tennis champ Venus Williams.  While going vegan is too extreme for most of us (count me out for sure), the point remains that you don’t need to eat meat to build muscle, as Katz noted previously.  Nonetheless, research suggests that fish is healthful, and, to a lesser degree, a modest portion of land-based meat (primarily poultry, and even occasional red meat) is perfectly fine in the context of a largely plant-based diet.  Some is okay; just don’t go overboard.

If you’re focused on your waistline at all costs, there’s still good news.  The research also finds that diets heavily reliant on animal protein or animal fat are also far from the only way to reliably and sustainably reduce BMI.  Anything on the scale from pesco-vegetarianism (frequently eating fish and plants, but avoiding land-based meat) to full-on veganism, typically higher-carb and lower-fat than most meat-heavy diets, tend to be consistently linked to lower BMIs.

The same has been observed for the moderate-carb, high-plant-fat Mediterranean diet.  

There is, in fact, a large body of evidence that fruits and vegetables of all types – often sacrificed in a misguided effort to “cut carbs” – are consistently linked to lower levels of C-reactive protein (CRP – one biomarker for inflammation) as well as metabolic syndrome.  One study observes:

Higher intakes of fruit and vegetables are associated with a lower risk of the metabolic syndrome; the lower risk may be the result of lower CRP concentrations. These findings support current dietary recommendations to increase daily intakes of fruit and vegetables as a primary preventive measure against cardiovascular disease.

Here’s the point: this variety of plant-based ways to reduce BMI renders null any supposedly unique benefits of animal protein or ‘keto” diets on metabolic syndrome.  Animal protein-centric or “keto” diets can certainly represent potential path to a slimmer waistline, but they hardly represent the only path; plenty of moderate-to-high-carb plant-centric diets achieve similar short term outcomes with infinitely better long-term outcomes.

Meanwhile, however, what we eat at mealtimes isn’t the end of local vs. global optimization woes when it comes to our overall health.  Many people who get heavily into gym culture end up not only changing their diet, but also taking on a new supplement regime.  And, similarly to ramping up consumption of animal protein, these supplements may improve athletic performance or physique in the short term, but damage health in the long term.

Here are a couple examples.  Circulating levels of branched-chain amino acids (BCAAs) – which some people take as a performance supplement because they can help repair muscle after exercise – have been linked to diabetes, which isn’t surprising given the insulinemic effect of protein discussed previously.  The study authors note that adding BCAAs to a high-fat diet contributes to insulin resistance, particularly in the context of a high-fat diet, whether or not your body weight changes:

As aforementioned, high-protein diets are associated with impaired glucose tolerance, insulin resistance and an increased incidence of type 2 diabetes

[…] Circulating levels of BCAAs are elevated in individuals with obesity, impaired fasting glucose and type 2 diabetes Furthermore, circulating levels of BCAAs have the potential to predict development of type 2 diabetes.

Not only carbohydrate and fat metabolism, but also protein metabolism is related to insulin resistance. Interestingly, in insulin-resistant states of obesity, plasma concentrations of AAs are elevated, particularly BCAAs.

These findings are in agreement with studies showing that the infusion of AAs induces insulin resistance in experimental settings, similar to what is observed with lipid administration. The addition of BCAAs to a high-fat diet contributes to the development of insulin resistance, impaired glucose homeostasis that can occur independent of body weight.

So, any workout junkies who are combining a “keto” diet with BCAA supplements might be doubling down on the badness.

As another example, a surprisingly high percentage of male gym-goers who routinely consume supplements like whey protein, creatine and L-carnitine have run into severe health challenges (even hospitalizable ones) directly related to their use of those supplements:

Eight percent of participants were told by their physician to cut back on supplement use because of health side effects, and 3 percent were hospitalized for related kidney or liver problems, which can be caused by excessive use of protein powders and other supplements.

I’m not trying to be alarmist here.  To be clear, the average performance-supplement taker is not going to end up hospitalized with kidney or liver problems, nor is the average BCAA-chugger going to end up diabetic.

That said, there is emerging research around synthesis of TMAO (trimethylamine N-oxide) from L-carnitine being one of the potential mechanisms for red meat’s cardiovascular risk profile.  Taking extra L-carnitine as a workout supplement would undoubtedly contribute to many of the same risks:

Now, researchers are homing in on another possible culprit: a dietary metabolite linked to red meat called trimethylamine N-oxide, or TMAO. Three recent meta-analyses confirmed that high blood levels of TMAO are associated with increased risks of cardiovascular disease and all-cause mortality. One of the studies, published in the Journal of the American Heart Association in 2017, found a more than 60% heightened risk of both major adverse cardiovascular events and death from all causes in people with elevated TMAO. Other research has associated higher TMAO levels with heart failure and chronic kidney disease.

Research suggests that TMAO is part of an additional biological pathway through which red meat raises heart disease risk, said JoAnn Manson, MD, DrPH, a professor of medicine at Harvard Medical School in Boston, who coauthored the 2017 analysis. The body makes TMAO from foods with choline and l-carnitine, nutrients that are abundant in meat, poultry, fish, dairy, and egg yolks. Liver enzymes produce TMAO from its precursor, a gas called trimethylamine (TMA) that’s formed when gut bacteria break down these nutrients.

Red meat is particularly high in l-carnitine. […]

“A chronic red meat–ingestion diet—there are many, many studies that connect that to heightened mortality risk and cardiovascular risk, and we think that a partial reason for that is because of this carnitine-TMAO connection,” said Stanley Hazen, MD, PhD, section head of preventive cardiology at the Cleveland Clinic.

Incidentally, the saturated fat content of the meals made no difference to TMAO levels in the study, which Hazen published this year in the European Heart Journal. “The TMAO pathway seems to be independent of the saturated fat story,” he said.

This type of data – in the broader context of what we know about nutrition, as well as the accumulated-damage model- does suggest that the long-term health consequences of routinely consuming meaningful amounts of supplements like L-carnitine and BCAAs may in fact be meaningfully negative.

This is, importantly, despite the reality that they likely make us feel better in the short term by promoting muscle gain or reducing post-workout soreness.  Again, to Katz’s point earlier, lots of things that make us feel great in the short term (like cocaine) have deleterious long-term effects, so we can’t use short-term subjective experience as a guide to long-term health.

Exercise is good; exercise is both directly and indirectly health-promoting.  However, all of the health benefits of exercise can be accomplished without increasing consumption of protein, let alone animal protein, let alone workout supplements like L-carnitine or BCAAs.

These latter habits are still something we can choose to maintain, of course, so long as we understand – and accept – the potential long-term consequences.

Just as some of us choose to eat unhealthy foods because we’re willing to sacrifice some long-term health for short-term gustatory pleasure, so too it’s okay for some of us to choose to sacrifice some long-term health for the sake of short-term physique or athletic performance, if that’s important to us.

We are all free to make our own decisions; we are not free, however, to avoid the consequences of those decisions.

Personally, I have chosen not to optimize for physique or performance.  I optimize instead for health and taste, in the process almost optimizing against protein and related compounds like L-carnitine – but I totally understand if someone else finds a different set of decision parameters to be more appropriate for themselves.  My diet is not perfect, and there are certainly things I could do better.

The point is that we should all carefully think through which goals are important to us, and find ways to optimize for both our short-term and long-term goals without creating unnecessary tradeoffs between the two.

(For what it’s worth, although the plural of anecdote is not data, I have had no problems gaining lean muscle mass despite optimizing against protein in my diet – I am stronger now than I was six months ago, and two years and five years ago before that, despite the fact that my protein consumption has meaningfully declined over time.)

Dose-Dependency and The Limits of Disaggregation: Theoretical vs. Practical Harms

The point translates more broadly.  One of the mental models we’re getting at here: there are limits to the utility of disaggregation.  In other words, we can only learn so much about a problem by breaking it up into pieces.  We’ve just learned, for example, that trying to break up our diet into “pieces” of “carbs, fat, protein” not only doesn’t help us reach our goals, but can in fact lead us in the wrong direction.

This concept has many applications.  To illustrate: I am fond of stating that we can’t learn anything meaningful about traffic jams by thinking about quarks, even though traffic jams are, ultimately, comprised of quarks.  We can know every little thing about the quarks on the highway from a physical chemistry standpoint, but it won’t do a darned thing to solve the civil engineering problem.

This is due to a phenomenon known as emergence: properties emerge at one level of a system that are inscrutable by merely studying smaller individual components of the system.  Pulitzer Prize winning historian John Lewis Gaddis discusses this on numerous occasions in both The Landscape of History (LandH review + notes) and On Grand Strategy (OGS review + notes).

Not every granular detail is important, or even relevant.  For humorous effect, Gaddis frequently cites the example of Napoleon’s underwear – knowing what kind of undergarments the emperor wore doesn’t really help us understand his impact on world history.

Focusing on such minute details can, in fact, obscure the bigger and more important point because we lose our sense of scale: rather than focusing on what matters, we’re focused on what doesn’t.  This shows up a lot in nutrition, as we’ll explore in the next two sections.

Let’s turn this into a tangible example: one of my friends, smart enough to pull a summa cum laude GPA in college, recently told me he prefers eating meat to vegetables because “vegetables have pesticides on them” – the implication being that he thought meat was better for his health than veggies.

It’s such a strange, almost comical argument that I kind of thought he was joking.  Nobody seriously believes that, right?

But Google makes it sound like something that at least a few people believe; there are even a few people advocating all-meat “carnivore diets” using this pesticides argument as a prop (among other equally silly justifications).  Being as neutral as I can, I’ll just say that… there are… um… well, several interesting mental models takeaways from this irrational viewpoint.

Although, to be fair, very few people likely use pesticides as a reason to wholesale reject fruit/veggie consumption, I do think that at least some consumers probably try to avoid the so-called “Dirty Dozen” fruits/veggies with the most pesticides (if they can’t buy organic).  This is unfortunate, because the literature strongly suggests that people foregoing these “Dirty Dozen” items probably aren’t instead eating other healthy produce – rather, foregone consumption of these items probably represents completely lost opportunities for produce consumption.

(If you aren’t interested in this section, ctrl+F for “Bogeymen” to skip to the next one.)

First of all, it’s worth noting that there are many sources of environmental pesticide exposure – such as the water supply, insect foggers / “bombs” – and lawncare products.

Moreover, some pesticides are also known to bioaccumulate in animal products like meat and milk – presumably what you would be eating more of, if you were eating less produce.  (Pesticides even show up in honey.)

Finally, the American Association of Pediatricians issued a statement in August 2018 stating that they were concerned about:

“emerging child health concerns related to the use of colorings, flavorings, and chemicals deliberately added to food during processing… as well as substances in food contact materials.”

So it sounds like these pediatricians are concerned about kids’ chemical exposures.  What were their recommendations on how to address these problems and reduce chemical exposure for kids?  Well, here are the first two: more produce and less processed meat:

– Prioritize consumption of fresh or frozen fruits and vegetables when possible, and support that effort by developing a list of low-cost sources for fresh fruits and vegetables.

– Avoid processed meats, especially maternal consumption during pregnancy.

So if you want your kids getting less unnatural chemical stuff in their bodies than they otherwise would… pediatricians recommend more produce, not less, and less meat, rather than more.

Implicit in the “produce has pesticides!” argument is an implicit logical fallacy: “part to whole,” also known as the “fallacy of composition.”  Just because some set X (in this case, produce) contains element Y (in this case, pesticides) does not mean that set X’s properties can be inferred from those of element Y.  Just because one government official is corrupt does not mean that the entire government is corrupt; just because one drug dealer is an undercover cop does not mean that all drug dealers are really good guys in disguise.

Similarly, consuming straight-up pesticide would obviously be bad for our health.  Nobody disputes this.  However, importantly, that does not mean that fruits or vegetables with infinitesimal pesticide residues are also bad for our health.  Quite the opposite, of course – produce is definitively good for our health.

To return to where we started, we have to have a sense of “scale” here – we’re talking about totally different effect sizes.  It’s pretty much impossible to make a credible argument that kids should be eating more Easy Mac, bacon, and Coca-Cola and fewer apples, sweet potatoes, and sugar snap peas – even if it were found conclusively that items in the former category have zero pesticides on or in them.

Unless you’re planning to starve, you have to eat something. What will it be? 

The reason pesticides on produce aren’t something to worry about is well-explained by this thoughtful analysis by a nutritionist, Brierley Horton, who doesn’t fret over buying organic vs. conventional produce:

Another reason I don’t go all-organic: there’s decades of nutrition research that shows eating a diet brimming with produce can cut your cancer and heart disease risk, and potentially lead you to live a longer life. Much of that research has looked at—uh-huh, you guessed it—eating conventional produce.

When you consider the population as a whole—a big group of children and adults who typically fall short every day on their produce quota — we don’t need a single reason to discourage people from eating fruits and vegetables…

An analysis by the University of California showed that a child could eat thousands of servings of a fruit or vegetable in a day (think 7,446 helpings of kale) and still not have any health effects from residues… if you can afford organic items, and you want to buy them, go for it. For better health, though, eating plants—whether they’re conventional or organic—should be the priority.

There’s dose-dependency involved: the dose makes the poison.  We shouldn’t do a kegstand on a bottle of Roundup, or add a DDT vinaigrette to our culinary repertoire.  But the dose of pesticides from produce is de minimis.

One study at UC Davis (likely the one Horton references above) explored the supposed “Dirty Dozen” (the 12 produce items with the highest pesticide residues) and concluded, rather firmly:

Probabilistic techniques were used to characterize dietary exposure of consumers to pesticides found in twelve commodities implicated as having the greatest potential for pesticide residue contamination by a United States-based environmental advocacy group. Estimates of exposures were derived for the ten most frequently detected pesticide residues on each of the twelve commodities based upon residue findings from the United States Department of Agriculture’s Pesticide Data Program.

All pesticide exposure estimates were well below established chronic reference doses (RfDs). Only one of the 120 exposure estimates exceeded 1% of the RfD (methamidophos on bell peppers at 2% of the RfD), and only seven exposure estimates (5.8 percent) exceeded 0.1% of the RfD.

Three quarters of the pesticide/commodity combinations demonstrated exposure estimates below 0.01% of the RfD (corresponding to exposures one million times below chronic No Observable Adverse Effect Levels from animal toxicology studies), and 40.8% had exposure estimates below 0.001% of the RfD.

It is concluded that (1) exposures to the most commonly detected pesticides on the twelve [“Dirty Dozen”] commodities pose negligible risks to consumers, (2) substitution of organic forms of the twelve commodities for conventional forms does not result in any appreciable reduction of consumer risks, and (3) the methodology used by the environmental advocacy group to rank commodities with respect to pesticide risks lacks scientific credibility.

Commenting on the study, one of the authors – food toxicologist Carl Winter – observed:

Think of it this way. Pesticides may be present, but mere presence is not enough to cause harm. Winter explains that the first principle of toxicology is that “the dose makes the poison”; it’s the amount of a chemical, and not its presence or absence that determines the potential for harm.

Sometimes, inversion can provide a different perspective on the same data.  Another way of looking at this is the way Horton did, in terms of how many fruits and vegetables you’d actually have to eat to breach the “No Observable Adverse Effect” threshold (i.e., a level of exposure, which – even if maintained chronically – does not result in observable adverse effects to health.)

Here is a calculator that converts government data on pesticide exposure into servings.  Or you could just look at the tables in this analysis.

The results: unless you were planning to consume a thousand apples, thirty thousand celery stalks, or (slightly more doable) 21 cups of cucumber for your lunch  – every single day from now until the robots take over –  you likely aren’t even going to reach the No Adverse Effect level:

Even a toddler would need to eat 6 cups of cucumber, 500 servings of cherries, or seven thousand carrots each day, every day (not gonna happen!)

Seriously – if you attempt to feed your toddler seven thousand carrots a day, you’ll soon be worrying about their orange skin – and their sudden severe behavioral problems and habit of randomly screaming “I HATE CARROTS, AND I HATE YOU” – far more than you’re worrying about their pesticide exposure.

Effective, safe for use every day.  Every day, Every… day. Diligently, Patty.

There are analogies elsewhere.  Common mouthwashes contain ingredients that can be poisonous in high doses.  Listerine, for example, contains methyl salicylate, which can be fatal in high quantities.  It also contains alcohol – a substance which many of us intentionally ingest for fun, despite it too being poisonous or fatal in high-enough doses.

It turns out that there’s at least one case of a man dying from mouthwash ingestion.  So should we all throw out our mouthwash for fear of imminent death?  Should we start a petition to get mouthwash banned from the shelves?

Come on now, be reasonable.  In the case I referenced above, the man drank three liters of mouthwash – equivalent to six of the bottles pictured at right.

All of us ingest a tiny amount of mouthwash whenever we use it – and if you’re reading this, clearly you lived to tell the tale.  For the sake of everyone in your life, please keep using your Listerine!

Speaking of pesticides directly, after some research last year, I’ve started spraying a pesticide – permethrin – all over my backpacking/camping clothes and gear before I head out on any excursion.  I spray it on pretty much everything but my underwear.

Why?  There is compelling evidence that permethrin-treated clothing (and gear) can kill or disable the vast majority of ticks that might otherwise transmit Lyme disease or other serious infections before they have a chance to transmit the relevant infectious agent (such as Borrelia), thereby preventing an overwhelming majority of potential infections.

This is the reward.  Meanwhile, on the risk side, there is also strong evidence that permethrin, in the doses it would be absorbed during a few weeks of hiking and camping, has zero health impact on me.  The number is perhaps not exactly zero, but it’s like Matthew Walker says about the odds that any given person can function on six hours of sleep or less – rounded to a whole number and expressed as a percentage of the population, it’s zero.

So there is profound net health benefit to treating outdoors clothing and equipment permethrin overall: whatever tiny, negligible negative effects it may have on my health, those are far, far less concerning to me than the very real, very scary potential impacts of contracting Lyme disease, Rocky Mountain fever, or the like.

This is a perfect analogy to fruits and vegetables.  Whatever pesticides may or may not be on our fruits and vegetables, produce is still clearly vastly health-promoting, with or without those pesticides.  We shouldn’t stop eating fruits and veggies any more than we should quit using oral hygiene products.  We know that anything else we could eat instead has very real, very tangible health harms – higher rates of cancer, heart disease, diabetes, and so on.

This “dose makes the poison” argument is important to consider whenever assessing an argument that someone makes to you about nutrition.  For example, one study did show that switching from conventional to organic products lowered childrens’ exposure to pesticides, as measured by excreted pesticide residues.

And, at first, that seems compelling – who wouldn’t want their kids to be exposed to less pesticides?  If I were a parent, I’d take that seriously.

But there’s a difference between being able to detect pesticide residues in urine with extremely sensitive scientific instruments, and those pesticides actually resulting in negative health effects.

An analogy: I can definitely detect it with a highly sensitive system (my nervous system) when I cut myself while shaving.  That doesn’t mean that the occasional nick on my chin has any deleterious impact on my health.

The awesomeness of Swiss chard is not dose-dependent. Swiss chard needs no margin of safety. You can eat as much of it as you like.
The awesomeness of Swiss chard is not dose-dependent. Swiss chard needs no margin of safety. You can eat as much of it as you like.  Hand for scale.

Even though switching to organic produce might reduce pesticide exposures by a big percentage number – say, 50% – sometimes absolute numbers are more helpful: in hypothetical numbers (roughly based on the table above), instead of consuming 0.01% of the dose of pesticides with no observable effects, now you’re consuming 0.005% of that dose by going organic.

If the average person somehow managed to consume seven thousand servings of kale on a daily basis, then perhaps they should worry about pesticides – after they’ve bought a house-sized refrigerator in which to store all that kale, and also another spare house in which to store all the toilet paper they’re gonna need to deal with 20,000 grams of daily fiber intake (vs. an American Heart Association recommendation of 25 – 30 grams per day.)

For those of us sticking to more reasonable plate-sized portions of fruits and veggies, we should just rinse fruits and vegetables to the best of our ability and not worry about it beyond that.

Rinsing may or may not do much for pesticides, but it can definitely wash off bacteria such as E. coli that are on the surface – which aren’t an issue if you’re cooking them for any length of time, but are an issue if you’re eating them raw.

Bogeymen, Bogeymen, Every Which Where: Fructose and Lectins and Omega-6s, We Don’t Care

Combining this understanding of the limits of disaggregation and the phenomenon of dose-dependency with the previously-discussed maladaptivity of social proof and culture, we arrive at another fascinating topic: the “bogeyman” phenomenon, in which people try to point to one single component in or on a certain type of food – like we discussed earlier with “carbs,” but more specific – and use that as a reason to wholesale reject the food from our diets entirely.

Note how the logical fallacies in this section are the exact same as the ones in the previous section: just because some individual chemical in your food might have negative health consequences, that doesn’t mean that your food overall has negative health consequences, because:

A) That one potentially negative ingredient is likely only a tiny fraction of the overall health impact of that food, and perhaps not even large enough a fraction to make a tangible impact, and,

B) The rest of the food in question is probably really good for you, so whatever little negative portion that might or might not exist, the whole package is a great deal for health.

I address this in some depth because, besides the “protein” myth, it is possibly the most frequent and egregious behavioral bias I’ve observed with relation to diet; it likely affects many people you know and care about.

However, if you don’t feel like this is applicable to you, feel free to scroll down to the next section (or ctrl+F for Supplements are Just That.)

Many people – without any scientific training or actual, fundamental knowledge of nutrition – latch on to some new “bogeyman” like gluten in wheat, fructose in fruits, “lectins” or “phytates” in various plants, or soybeans or corn that are genetically-modified organisms (GMOs).  They subsequently state that these foods should categorically not be consumed, due to that one aspect of their chemistry, without regard to any other data regarding anything else about that food, including our best knowledge about its overall health effects.

Like a tantrum-y toddler, people shout from the rooftops about these issues, and convince many people they’re right, simply because they say it a lot.  And they’re loud.

Can you see the problem?  In ancient times, there was a direct correlation between whether people around you said something was good to eat and whether or not you should eat it.  People knew what they were talking about because they or their forebears had tangible experience of eating something and getting sick immediately thereafter.

As anyone who’s ever had food poisoning knows, when we eat something that’s actually immediately dangerous, we become aware of it so suddenly and severely that no p-value is required to determine correlation or causality.  We thereafter permanently avoid eating whatever new thing we just ate that made you sick: we never go back to that restaurant, etc.

Today, we don’t actually eat anything on a daily basis that will kill or poison us immediately.  However unhealthy soda, white bread, and red/processed meat may be – and I think at this point, everyone who is still reading will agree that none of those are good for us – the vast majority of us who aren’t a single burger away from a heart attack can confidently eat a bacon cheeseburger and Coke without risking death or dismemberment in the near term.

Happy Meals may be the antithesis of a Healthy Meal, but they’re not exactly angel-of-death mushrooms or castor beans that could easily kill us before tomorrow’s sunrise.  (This, I should point out, is a good rebuttal to the “appeal to nature” fallacy – lots of things that are perfectly natural, like pufferfish skin, can kill us rather quickly.)

As such, science has far outstripped our own personal ability to assess the “goodness” or “badness” of what we eat – easily demonstrable by the fact that we, as a country, vastly underconsume fruits, vegetables, whole grains, legumes, and nuts, while overconsuming sweets, refined starches, and meat, despite literally tens of thousands of pages of research over multiple decades demonstrating that we should do exactly the opposite.

The issue here is, again, one of opportunity costs.  Typically, the “bogeyman” ingredients tend to be in foods like whole grains, legumes, fruits, and vegetables that literal mountains of research has demonstrated are good for us.  There are clear actual harms to not consuming these foods; pretty much every public health authority in the world is begging their populace to eat more of these.

Yet the “bogeyman” argument leads people in the opposite direction: it typically encourages people to stop consuming what little of these healthy foods people are already consuming.

And, look, that would be okay if you swapped it for another perfectly-healthy food: ex. if you eat less whole wheat and more lentils, or less lentils and more sweet potatoes, or more strawberries and less extra-virgin olive oil, you’re not making yourself much worse off.

In fact, you could construct a healthy diet without including any grains at all, or any legumes, if that’s important to you: between vegetables, olive oil, fish, fruits, and nuts/seeds, there’s enough variety to comprise a diet that’s both healthy and varied enough to be sustainable.

This isn’t what tends to happen in the real world, though; rarely do people cut out grains and replace them with vegetables, or cut out legumes and replace them with fruits and nuts.

Whether due to explicit recommendation by the conspiracy-theory proprietor, or merely due to habit, people typically tend to replace these known-good foods in their diet with known-bad foods for which we know there are actual harms – primarily, it seems, meat.  Especially red meat.

Of course, in the previous section, we already comprehensively overviewed the perils of eating less plant-based foods and more animal-based foods: higher risk of cardiovascular disease, cancer, and death.

It is usually unhelpful to try and slice-and-dice individual chemical components of food, in an effort to pick or replace specific foods.  In other words, unless you have some specific medical condition that requires that you optimize for or against specific food components or nutrients, there’s no point in trying to focus specifically on increasing your consumption of Vitamin A, or eating the most antioxidant-rich fruits, or the most fibrous vegetables and whole grains.

I would be irresponsible if I didn’t point out exceptions: good friend of mine in high school was legitimately gluten-intolerant (she had celiac disease); she, and people with similar conditions, should by all means avoid gluten.  As I referenced, a friend of mine is deathly allergic to most nuts and some legumes; he obviously needs to avoid them.  Some people are legitimately harmed by subcomponents of certain foods, and they have extremely valid, life-or-death type reasons to be cautious.  But those idiosyncratic medical concerns of our individual friends don’t apply to the rest of us more broadly.

Public health reminder: get your flu vaccine annually, and depending on your age, please don’t forget your HPV vaccine, tetanus booster, or shingles vaccine!

Here’s the sad conclusion: when constructing our own diets, we still often rely on some rando’s personal judgment or experience on matters like these, rather than that of science, despite the fact that no mommy blogger (or daddy blogger) has any basis on which to have any independent knowledge about pesticides, fructose, GMOs, or lectins.  Many people I know are avoiding legumes, or whole grains, or fruits, or veggies, while eating lots of meat (and particularly red meat) instead.

The misinformation spread by such bloggers or authors is every bit as dangerous to public health as the misinformation spread by “anti-vaxxers.”

That’s why I’ve encouraged every reader of this analysis not to take my word for anything, but simply to read the actual scientific research out there with an open mind, and see the clear patterns that emerge across time and geography: real food, mostly plants, not too much.  Those whose minds are already made up are a lost cause, but for the vast majority of readers of this site who are willing to seek the truth, it’s quite easily found.

Katz, ever the insightful commentator, points out the profound irrationality of worrying about theoretical harms rather than practical ones:

“But wait a minute; don’t we know that vegetables are good for us?  Don’t the longest-lived, healthiest populations on the planet consume beans and whole grains routinely?  Does the sudden danger of lectins mean they should stop immediately, or face dire consequences?

Yes, yes, and no.  Lectins were no more introduced last Monday into vegetables than fructose was introduced last Wednesday into fruit  The exposures have been there all along, whatever new information we may receive about them. The net effect of eating vegetables, or beans, or whole grains is what it has been – no matter what we learn about lectins.

This doesn’t mean that lectins, or fructose, must be entirely non-toxic.  It simply means that the foods that contain them that confer net health benefit, still confer net health benefit despite new water cooler worries.”

Some lectins are actually overtly toxic – certain lectins, “phytohaemagglutins,” in red kidney beans, can cause severe food poisoning if consumed via raw or undercooked kidney beans.  (Merely simmering beans, such as in a slow cooker, can in fact potentiate rather than destroy the lectin – so you either boil the hell out of them, or just use canned beans which are pre-cooked.)  So, again, as with pesticides, it is understandable why people might worry about them.

The primary concern people express about “lectins” and “phytates” are that they are antinutrients – i.e. that if you consume food that contains them, they will prevent nutrients from being absorbed.  This among the primary justifications used by trendy diets like “Paleo” and “Whole30” wholesale ban legumes and grains.

But it’s an unscientific justification that conveniently ignores important factors.  Not all lectins are the same; some are implicated in positive functions, like immune health:

The immune system consists of various types of cells and molecules that specifically interact with each other to initiate the host defense mechanism. Recent studies have shown that carbohydrates and lectins (carbohydrate-binding proteins) play an essential role in mediating such interactions. Both lectins and carbohydrates are widely distributed in the mammalian tissues as well as in microorganisms. Carbohydrates, due to their chemical nature, can potentially form structures that are more variable than proteins and nucleic acids.

Lectins can exist in either soluble or cell-associated form, and although overall structures vary, invariably possess carbohydrate-recognition domains (CRD) with various specificities. The interaction between lectins and carbohydrates have been shown to be involved in such activities as opsonization of microorganisms, phagocytosis, cell adhesion and migration, cell activation and differentiation, and apoptosis. The number of lectins identified in the immune system is increasing at a rapid pace. The development in this area has opened a new aspect in studying the immune system, and at the same time, provided new therapeutic routes for the treatment and prevention of disease.

Moreover, we need to focus on real-world results rather than hypothetical concerns.  Let’s re-quote a study we quoted earlier, which reviewed evidence demonstrating that higher consumption of legumes, whole grains, and nuts – often singled out for their “lectin” or “phytate” contents – was correlated with superior nutritional outcomes for a plethora of micronutrients:

Maillot et al157 modeled nutritionally adequate diets to simultaneously met the requirements for a whole set of nutrient goals (proteins, fiber, essential fatty acids, 10 vitamins, 9 minerals, sodium, saturated fatty acids, and free sugars) while deviating the least from the observed diet in terms of food content. They found a strong consistency in the dietary changes needed to fulfill the constraints, and the greatest increases were seen for unsalted nuts, whole grains, legumes, fruit, fish/shellfish, and vegetables. They concluded that regardless of the different scenarios that they assumed, those foods which are typical of the MedDiet are needed to reach overall nutrient adequacy.

In the Mediterranean SUN cohort, a closer adherence to the MedDiet was reported to be strongly associated with a lower risk of failing to meet the goals for nutrient adequacy.158,159 As adherence to the MedDiet increased, the probability of not fulfilling the micronutrient goals sharply decreased.159 This finding was replicated in other studies.160 In another study, the SUN cohort investigators evaluated the intakes of Zn, I, Se, Fe, Ca, K, P, Mg, Cr and vitamins B1, B2, B3, B6, B12, C, A, D, E, and folic acid. …

The results were similar… These results were replicated also in the PREDIMED cohort.161

This is a clear and obvious example of the theoretical vs. actual harm fallacy: in theory, it is perfectly reasonable to allege that phytates or lectins might inhibit nutrient absorption.

In practice, data such as the thorough review above demonstrates that the more we consume foods such as legumes, nuts, and whole grains – with their phytates and lectins included – the more likely we are to achieve nutrient sufficiency for pretty much every micronutrient that matters, and the more likely we are to achieve long-term health outcomes that we care about.  By inversion, if we choose to arbitrarily exclude these foods from our diet, we’re increasing our actual (not theoretical) risks for nutrient deficiencies.

It is no coincidence, then, that lectin-free diets often require – you guessed it – expensive supplements from diet-book authors to make up for the nutrients you’re missing out on by no longer eating nutrient-dense lectin-containing plants.

Readers will note that beans, peanut butter, whole wheat bread, and lentils are some of the cheapest foods on the planet on a per-calorie and per-nutrient basis.  While some health foods (like fish, and to a certain extent extra-virgin olive oil) are admittedly pricey for those on a tight budget, legumes and whole grains are totally democratic.

They are literally commodities like whole-wheat flour and whole-wheat bread; as such, there is not much money to be made by advocating people go buy more 99-cent cans of beans or three-dollar loaves of generic whole wheat bread and jars of peanut butter at their local grocery store.  (Apparently, many cans of beans at Wal-Mart are even cheaper – 68 cents!)

There is, however, lots of money to be made advocating that people stop buying those beans, peanut butter, and whole wheat bread, and instead start buying 99-dollar boxes of supplements, or thousands of dollars worth of personal coaching.  Incentives.

This is, of course, not to say that it couldn’t be true that phytates and lectins have some negative effects.  I do not believe this is likely the case; however, it would also not be inconsistent to believe that phytates and lectins are bad for us, and that we should still eat phytate or lectin-containing foods anyway.

Why?  Like the amount of pesticides on plants, the amount of phytates and lectins in plants is so tiny in scope that whether or not they have negative effects is more or less irrelevant: the whole package (of produce) is still, on net, vastly beneficial.

At the very least, thinking about our opportunity cost framework, it’s absurd to eliminate whole grains and legumes from one’s diet and replace them with any kind of meat, but especially red meat – legumes / whole grains are known-good; red meat is known-bad, and poultry is in the middle.  Keep in mind that in the study quoted earlier on protein substitutions found that eating beans instead of beef had the single most positive health impact of all the substitutions studied.

It is amusing that many popular diet authors pitch a fit about the theoretical harms of lectins without any scientific basis or merit to their claims, yet conveniently ignore the extensive, well-documented literature on the plethora of real, actual harms of frequent red meat consumption.  One popular Paleo blogger and “health coach” goes so far as to call red meat “one of the healthiest foods you can eat” – which strains the bounds of credulity.

To Horton’s earlier discussion about pesticides on vegetables – modern people already eat few enough whole grains and legumes as it is; we don’t need more pseudoscience scaring people away from these cheap, healthful foods.

A similar discussion could be made about omega-6 fats (one type of “polyunsaturated fat,” or “PUFA” for short), a topic which has attracted a lot of scientific and public attention in recent years.  Katz, indeed, states that there is reasonable basis to think that America’s general consumption of omega-6 vs. omega-3 fats is disproportionate.

That said, I would note that per the scientific literature, the current disproportion of omega-6 is probably relatively mild in its negative effects (omega-6 is not really directly pro-inflammatory, although it can interfere with omega-3 pathways) and has positive effects too.  Omega-6s, broadly, are probably not the worst thing about the modern diet.

Nonetheless, if we eat a generally plant-based diet with oil primarily in the form of EVOO, and not a lot of processed food or fried fast food, these nuances, such as omega-6 to omega-3 ratios, are not really something we explicitly need to optimize for.  Katz notes that:

While there are arguments, in the context of prevailing modern diets, for less saturated fat, no industrial trans fat, more omega-3 fat, less omega-6 fat, and so on- all such considerations are handily encompassed by “wholesome foods in sensible combinations.: … by getting the foods right, the distribution of fats- like that of other nutrients- tends to take care of itself.

To this end, all the diets that have historically promoted human health (such as the Mediterranean and Okinawan diets) do not require people to freak out over food labels or the specific makeup of underlying foods.  They just require focusing on the right things overall.   The Mediterraneans did not know, or care about, the ratio of omega-6 to omega-3 fats in anything that they ate.

It is unwise to focus on part of the package rather than the whole: similar to the fructose/lectin and pesticides discussion above, there is no compelling evidence whatsoever that nuts and seeds are bad for health, despite their high omega-6 to omega-3 ratios.  Sesame seeds, despite their nearly 60:1 omega-6 to omega-3 ratio, are likely anti-inflammatory.

The same goes for pumpkin seeds, with a nearly 120:1 ratio.  And almonds take the cake with a staggering 2000:1 omega-6 to omega-3 ratio.  Yet they, again, are strongly linked to a variety of positive human health outcomes.  I have yet to see a compelling study that suggests that consuming almonds is bad for our health.


So you shouldn’t stop eating nuts and seeds, with their fiber and nutrients and all, because you’re worried about omega-6s.   A good analogy: fruits and vegetables, nuts and seeds are like the absolutely incredibly perfect love of your life; pesticides or fructose or lectins or omega-6s – or whatever the latest “bogeyman” is – might, at worst, be the one little annoying habit they have, like picking their teeth after they eat.

In this horrible worst-case scenario, that teeth-picking habit might irritate you a tiny little bit for thirty seconds of your twenty-four-hour day, but you’re still far better off with the whole package (the love of your life) sitting across the dinner table than not.

And the teeth-picking might even be in your head – there is no compelling evidence, as of yet, that pesticide residues, fructose, lectins, or omega-6s from minimally processed plant-based foods are causing any meaningful harms to human health.

Here is why I’ve spent so much time discussing this.  Undoubtedly, over the coming years and decades, many more “bogeymen” will come to light.  Some of these may be fictitious; some may in fact represent interesting nuances that add to the existing scientific literature.  But from a probabilistic thinking standpoint, it is extremely unlikely that they’ll necessitate a change to the heuristic that we’ve known for decades: real food, mostly plants, not too much.

The effect size of this is humongous.  The effect size of any new nuances we discover as we go forward – like exactly which types of cheese are better or worse for us, or exact differences between organic and conventional produce – are far less important.

As such, whenever you hear a new argument along the lines of “we shouldn’t eat plant type X because it contains component Y,” realize that all the arguments in this section will apply 100% to whatever new X and Y attention-seekers come up with.

Bayesian reasoning / priors is a helpful approach here.  For those who aren’t familiar with the concept, the short version is that we should interpret new evidence through the lens of the strength of our convictions about how the world works.

For example, if someone claims to be a rain god, and claps their hands, and then it starts raining – we know, factually speaking, that rain gods do not exist.  So our interpretation of the new information is that the timing of the two events is far more likely to be mere coincidence.  We can come to this conclusion because we have very strong “priors” – or prior beliefs – that are based on our scientific understanding of the world.

When it comes to nutrition, we can have equally strong priors.  There are decades of research conducted across millions of people demonstrating the healthfulness of fruits, vegetables, nuts, seeds, legumes, extra-virgin olive oil, and fish.

We have similar decades of research demonstrating that excess consumption of added sugar, refined starches, meat, and dairy, and in particular excess consumption of concentrated forms of dairy and red/processed meat, are unhealthful.

Therefore, our priors should be set very high.  This isn’t to say we should close ourselves off to new evidence, but rather, that we should have a very high bar for arguments that contradict the well-understood dichotomy above.

If we took every current fad diet seriously, we would be carefully avoiding all legumes, whole grains, fruits, and many vegetables from our diets – leaving us to subsist primarily off meat.  This is, of course, the exact opposite of what decades of science demonstrate that we should be doing.  But it’s a mistaken conclusion we could come to if we didn’t have strong priors, and allowed ourselves to be pulled in five different directions by five different anti-scientific fad diets.

Supplements Are Just That: Supplements

We’ve been talking a lot here about the limits of disaggregation, and there’s one final area to explore: supplements.

We already talked about workout supplements earlier, but those are kind of a niche; far more of us take multivitamins or omega-3s than Weight Gain 4000.  How should we think about this in the context of our nutrition – particularly given that many popular diet books advocate cutting certain foods out of our diets, then buying expensive precision-engineered supplements to replace the nutrients found within those foods?

As intriguing as this idea sounds, and as profitable as it may be for the authors (cough incentives cough), unfortunately, it is a terminally flawed approach.  The science is clear on the topic.  Supplements are just that – supplements – rather than replacements.  We need to primarily get our nutrients from real food.  Food is the 80; supplements are the 20 – and not the other way around.

One reason is that there is significant complexity as it relates to the human body’s absorption of nutrients and phytochemicals, and how they interact in the body.  Just because some isolated polyphenol has anti-cancer properties in vitro (i..e. in a test tube in a lab) does not mean that it will work in vivo (inside your living body.)

There are numerous reasons for this: sometimes nutrients in food are more “bioavailable” than isolated nutrients (i.e., they are absorbed better from food.)  In other cases, there is synergy between different compounds we ingest from food, and merely adding lots of one doesn’t replicate the benefit of having small amounts of all of them.

While it is often challenging to isolate the specific components and mechanisms of the health benefits associated with certain foods, it is nonetheless clear that eating real, plant-derived foods provides a clear pathway to health that the food’s isolated or synthetically created components do not.  Dietary turmeric clearly has benefits despite the fact that curcumin’s track record as a standalone supplement is mixed; dietary red wine likely has benefits too despite the fact that resveratrol’s track record, as a standalone supplement, is also mixed.

In some cases, supplements can be helpful – for example, although omega-3 supplements are clearly not as good as fish, many of us should probably be taking them anyway.  Perhaps Vitamin D supplements as well, particularly for those of us with darker skin, living in more northern latitudes, who primarily work inside at desk jobs.

More obviously, there are some cases where supplements are tremendously helpful.  Most modern humans would severely lack iodine if it was not added to our salt.  Iodized salt is one of the few free lunches in public policy, costing literally on the order of pennies per person:

In 2006, around 120 world countries have implemented salt iodization programs. Of these countries, 34 countries have eliminated iodine deficiency disorders through universal salt iodization (USI) [6]. USI is a remarkably cost-effective public-health strategy which is on average, and the one-time increase in cost is only 3–5 cents per person per year—a price so low that even consumers in the least developed countries would barely notice it, and it is a major global public health success

For this trivial cost, the payoff is absurd: iodizing salt probably boosts IQ by a standard deviation, among other health benefits.   It’s for this reason that, unlike most foodies, I almost exclusively consume iodized salt – and would encourage everyone to do the same, particularly if you are pregnant, may become pregnant, or are feeding your children.  I only make an occasional exception to use a finishing salt like Maldon – but otherwise, it’s plain Morton iodized for us.  I’ve tried plenty of fancy salts and for the most part, in the context of cooking, they all end up just tasting like salt.  (Pink salt is an entirely separate taste entirely, not really substitutable for normal salt.)

However, on the flip side of supplements, taking a multivitamin does not make up for a bad diet; the NIH makes this clear while noting that “evidence to support [multivitamin] use for overall health or disease prevention in the general population remains limited.”

Paradoxically, in certain instances, taking isolated components of a food can have an inverse effect to eating the food itself – while antioxidants in vegetables, fruits, extra-virgin olive oil, whole grains, etc are widely believed to fight cancer and reduce inflammation that in the long term causes many disease and systemic failures, one study found antioxidant supplements to have the opposite effect.

Anyway, I take several supplements myself (algae-derived omega-3s, B12, Vitamin D, CoQ10, a few Brazil nuts every once in a while for selenium) because I think there’s likely modest benefit and likely limited risks – but I do so selectively, and as an addition to rather than in place of healthy eating.

One study suggests that consuming merely a handful of Brazil nuts once in a while might lead to meaningful improvement in lipid profiles, due to potential antioxidant benefits of selenium. However, in a great example of dose-dependency, selenium can be toxic at high doses, so a Brazil-nut-butter sandwich is out of the question.  You shouldn’t eat more than a few Brazil nuts a day if you eat them regularly!

While I believe it’s reasonable to assume that some selected supplements are health-promoting around the edges, they’re very rarely a magic bullet (with occasional exceptions, like iodine).  Selectively focusing on individual micronutrients or chemical compounds is usually less helpful than simply eating an overall diet that is health-promoting.

Marginal Utility: Superfoods Aren’t So Super

Returning to real food, the corollary natural conclusion is that we should not worry too much about attempting to “rank” foods within a category (i.e., the best or worst fruit, or the healthiest or worst type of cheese) on the basis of their individual components.

The whole concept of “superfoods” implies that certain foods within a category are vastly superior to others – acai berries, quinoa, etc etc – but the research demonstrates that that isn’t really the case, other than in limited exceptional instances (ex. kale is, self-obviously, a whole lot more nutritious than iceberg lettuce.)

The other problem here is one of framing: the whole idea of a “best food” violates the principles of marginal utility and dose-dependency.  Different fruits, vegetables, nuts, sources of fat, etc have different positive effects that are independent of one another, due to different micronutrients and phytochemicals.

Grapefruits and mushrooms are both good for us; this much is obvious.  But fad diets suggesting you try to solely survive off one of those two foods are self-obviously a terrible idea: we need nutrients from many different foods to comprise a complete and healthy diet.

There are a couple of exceptions, but they sort of prove the rule.  First, a lot of the health benefits from fish appear to be attributable to omega-3s, which are only found in fatty fish, and are more prevalent in some types of fish.  Conversely, most of the health risks of fish appear to be attributable to mercury.  So, overlaying “high omega 3, low mercury” in a Venn diagram pretty much gives you a ranking of fish you should eat, with other considerations (taste, sustainability of the fishery, etc) guiding you from there.

Similarly, one source of cooking fat is vastly superior to all the others: that would be extra-virgin olive oil.  EVOO is, per the research, the most conclusively health-promoting cooking oil that exists, and it should be preferentially utilized over any other cooking oil whenever possible.  (We’ll return to the “why” a little later.)

But just because it should be your only cooking oil doesn’t mean it should be your only source of fat; you should still include other health-promoting foods with independent nutritional benefits – like avocados, nuts, salmon, or yogurt.  The Mediterranean diet, despite its extensive use of EVOO, used the last three of those four foods – and now that we have access to avocados, we should be using those as well!

In any case, consumption of multiple healthy foods can lead to better results than merely one by itself.  Some mechanisms for this are well-understood: for example, piperidine (in ground black pepper) massively increases the bioavailability of turmeric.

Meanwhile, consumption of healthy fats (like EVOO or avocado) can vastly improve absorption of fat-soluble nutrients and phytochemicals in fruits, vegetables, and whole grains.  Similar effects exist for Vitamin C and non-heme iron absorption.  Other mechanisms are lost to complexity, but the point remains that variety is good.

Healthy diets, for this reason, tend to have health-promoting power that goes beyond the explanatory power of their individual components.  For example, here is a discussion of the Mediterranean Diet – one of the most famous and well-studied health-promoting dietary patterns – in a 2015 paper in the American Journal of Medicine. Note the magnitude of the impact – adherence to the Mediterranean diet can have long-term health benefits comparable to quitting smoking.  Also note the discussion of diet-level synergies vs. individual components:

Consistently, the Mediterranean diet consisting of fish, [extra virgin olive oil], whole grains, fruits and vegetables, nuts and legumes has consistently been shown to reduce cardiovascular morbidity and mortality as well as surrogate markers in meta-analyses, cohort studies, and randomized control trials (RCTs). These improvements match reductions in cardiovascular disease burden demonstrated by highly proven and advertised interventions, and approach measures such as physical activity and smoking cessation.

The primary advantage of the Mediterranean diet appears to lie in its synergy among various cardioprotective nutrients and foods. Indeed, the diet and, to a lesser degree, its components, have been found to reduce cardiovascular disease risk by mechanisms including reduction of surrogates of cardiovascular disease such as blood pressure, lipids, endothelial dysfunction, glucose, BMI, and waist circumference, as well as by providing increased NO bioavailability, antioxidant properties, and anti-inflammatory effects.

So, it’s clear that our focus should be less on which healthy foods are the healthiest, and more on just eating lots of healthy foods.  Eat More Tomorrow.

On the converse side, let’s think about unhealthy (or neutral) foods.  There is reasonable basis for believing that some cheeses are probably better or worse than others.  Milk derived from certain animals is probably better than milk derived from other animals.

Similarly, grass-fed beef is probably better than grain-fed beef, and free-range eggs are probably somewhat healthier than caged eggs (even though studies on this topic appear to be somewhat inconclusive.)  Unpeeled fruits and veggies are clearly more nutritious than peeled fruits and veggies, as phytochemicals and fiber are often concentrated in the skins.  Similarly, there may be slightly differential health effects to eating foods raw vis-a-vis boiling them, vis-a-vis roasting them, vis-a-vis turning them into a puree in your Blendtec.

Samin Nosrat is just the best.  Pictured here with giant wheels of red-cow Parmesan.

Nonetheless, these nuances are, for the most part, irrelevant from a practical dietary standpoint: no amount of free-range grass-feeding will turn beef into broccoli, pork into peanuts, or eggs into eggplant.  You will not make a terribly meaningful impact on your long-term probability of heart disease by swapping Provolone for Cheddar or bison for beef in your nightly bacon-egg cheeseburger on a plain white bun.

And if you insist on peeling your fruits and vegetables for whatever reason, you’re not dooming yourself to death next Wednesday; the peeled apple or carrot that you do eat is unquestionably better for your health than whatever else you would’ve eaten in its place.  Similarly, whatever metabolic differences spiced squash puree may have from roasted spiced squash (or boiled squash), a squash is still a squash: a fantastically healthy, nutrient-and-fiber-rich thing to have for dinner.

Worrying about such nuances is to miss the point entirely; the impact of substituting healthier, minimally-processed plant-based foods for unhealthier, animal-based or heavily processed plant-based foods in the diet is far, far greater than any potential impact from substituting one slightly-better version of a neutral or unhealthy food for another.

The worst fruit is still way better for us than the best kind of cheese or meat; the worst legume or whole grain is still way better for us than the best refined grain.  The vegetable cooked (or not cooked) in the worst way for health is still infinitely better than the best way you can cook meat for health.  These are the substitutions we should be worried about.

Unfortunately, most people tend to spend the vast majority of their time on this less-relevant “20” rather than the far more relevant “80.”  Whether or not non-GMO wheat is better than GMO wheat, or whether or not organic produce is better than conventional produce, the magnitude of potential impact is far less meaningful – and thus far less worth thinking about – than the magnitude of impact from switching from worse to better categories of food.

That’s all we really need to worry about.

Willpower, “Grit,” and Deprival Superreaction Syndrome

At this point, you might think I’m gearing up to tell everyone to become a vegetarian.  Actually, I’m not going to do that, particularly since – as mentioned earlier – I’m not a vegetarian myself.  I think that people should eat less meat, but the path to doing so is probably not actually trying to eat less meat, let alone telling anyone they can’t have it.

Why?  People do not tend to react well when you tell them they can’t have yummy food they’re accustomed to eating.  The phrase “like taking candy from a baby” belies how kids actually react when Jimmy Kimmel tells their parents to (pretend to) steal their Halloween candy.

Adults have a relatively similar reaction when told they should eat less of some given food {sugar / meat / etc}.  Forbidding something paradoxically makes it more attractive (scarcity bias.) Meanwhile, forcing people to eat food that sucks donkey balls (to use a technical nutrition term) is really not a sustainable approach to health; if you force someone to choose between unsalted raw broccoli and a pack of Doritos – or a well-salted steak – it’s only going to take so long before they’re binge-eating the unhealthy stuff.

As such, the path to health rarely lies through intentional deprivation, especially since readers who understand mental models know that willpower is the worst solution to pretty much every problem.  “Grit” is worse than overrated when it comes to diet – the data says it simply doesn’t work for most people, most of the time.  We often suffer planner-doer empathy gaps when setting diet goals; we vastly underestimate how much we’ll want to eat unhealthy stuff in the future.

This is actually scientifically validated. Indeed, the whole concept of “going on a diet” has a abjectly miserable base rate of success.  Most diets die a sad death, as UCLA researchers noted in 2007:

“You can initially lose 5 to 10 percent of your weight on any number of diets, but then the weight comes back,” said Traci Mann, UCLA associate professor of psychology and lead author of the study.

“We found that the majority of people regained all the weight, plus more. Sustained weight loss was found only in a small minority of participants, while complete weight regain was found in the majority. Diets do not lead to sustained weight loss or health benefits for the majority of people.”

Changing your overall dietary approach, rather than “going on a diet,” is thus the only sensible, mental-models approved way to create sustainable change in your health.  Duration is more important than intensity; eating a +5/10 diet for the rest of your life is far better for you than eating a +10/10 diet for a week a year, and a -5/10 diet the rest of the time.

A 2015 paper in the American Journal of Medicine notes:

Preventive measures depend strongly upon length of time followed— it is a life-long commitment, not something that can be done episodically. Duration may be more important than intensity, especially because high intensities are difficult to sustain.

Simply changing one or following a few dietary constituents does not exclude detrimental effects of the rest of the diet or lifestyle. This is, of course, why the dietary pattern is much more important than the effects of individual constituents.

Clearly, the typical approach attempted by most of us fails miserably.  In the second section of this post, we’ll discuss how to use mental models to sustainably change our dietary pattern for the better – in terms of both taste and health.

I explore this through a personal example – my mom, who has struggled with the issues discussed in this specific section for multiple decades, and has recently managed to make meaningful, sustained progress for the first time.

Ideology and Confirmation Bias: The Final Nail in the Dietary Coffin

We’ve covered many of the factors that cause us to make incorrect dietary decisions.  Of all of them – certainly, in my own experience – I believe the hardest to overcome is the usual barrier to good decision-making: ideology and confirmation bias.

It is comfortable to stick to what we know and pound the table on what we already believe, but we are better served by remaining open to the truth rather than prematurely closing off our minds.  Katz himself, to his credit, took that unusual step, as he explains:

As for my position on nutrition: it has undergone evolution, but never revolution. There has been no need for revolution, because I had it mostly right at the start. I always knew that a diet of whole, wholesome foods, and plain water for thirst was a good idea. I have eaten this way since I was a teenager. I have not had a soda in over 35 years.

However, I was once sufficiently caught up in the case for low-fat eating that I carefully limited my intake of nuts, and avocado, and extra virgin olive oil. I no longer do. I once banished eggs from my diet on the basis of their cholesterol content, and that, too, is much less of a concern to me now- although I rarely eat eggs because of concern about how the hens are treated.

I have also focused ever more on foods and dietary pattern, and ever less on nutrients- as I have seen the nutrient tail wag the dietary dogma in all the wrong directions. An inevitable nod here to Michael Pollan for calling out the liabilities of “nutritionism,” and pointing out the simple merits of: food, not too much, mostly plants.

Katz stands out as the exception to the general rule.  Perhaps given our deeply emotional connection to food – it’s literally life-giving – it inspires tribalism that is oddly powerful and often misleading.

As such, throughout this post, I’ve tried very hard to abstain from over-pitching my own dietary pattern (the Mediterranean Diet, which, as noted, has nothing to do with Mediterranean cuisine except for non-negotiable inclusion of extra-virgin olive oil as the primary cooking oil).

While it’s a gold-standard health-promoting diet with both culinary and nutritional merits, and I do advocate that most people with no specific other preferences follow it – or some reasonable approximation thereof – I simply can’t state in good conscience that it’s the only path to good health.

Because that’s not what the data supports.  You can eat less extra-virgin olive oil and more lentils/legumes, or less olive oil and more fish, and still arrive at roughly similar health outcomes.  If for whatever reason you don’t like the taste of EVOO, and you choose to instead use another oil – like canola oil – you are certainly sacrificing some health benefits, and should use less oil vis-a-vis the Mediterranean diet – but it is still completely possible to construct a healthy diet that does not include a single drop of extra-virgin olive oil.

The Mediterranean Diet, practiced with cuisines ranging from Southwestern to Mediterranean to Asian, is one path to good health, and I believe that for the average person, it’s certainly among the most tasty and thus the most tenable/sustainable over the long term.  So I do advocate it from that perspective.  But I also recognize that it’s not the only way.

Unfortunately, few people are willing to take such a scientific thinking approach to nutrition, and many – whether diet-book authors or diet devotees – are more wedded to their existing beliefs than they are to the truth.  Given the large volume of nutrition research out there, and the perils of sample size and selection bias, you can cherry-pick individual studies (or individual data points from individual studies) to arrive at conclusions that are very far from the truth.

This shows up at polar opposite ends of the spectrum.  We’ll discuss both vegans and carnivores, starting with the former.

Throughout this post so far, my tone has been pretty anti-meat, because that’s generally what the data supports.  There is no nutritional reason whatsoever to frequently consume significant portions of meat, particularly red or processed meat, and overconsumption of meat is undoubtedly a major problem in the Western/American diet today, just as overconsumption of sugar and refined grains is a major problem today.

That said, there are some nutritional reasons to suggest that occasional meat consumption is OK and maybe even good.  In particular, vegans need to supplement with B12 (which is only found in animal products), and can often be iron-deficient as well (since heme iron is more readily absorbed than non-heme iron.)

Vegans and vegetarians often overlook or downplay this issue; I believe it’s very real, even though I have still opted, myself, to move to a far less meat-intensive, predominantly vegetarian diet.  There are, around the edges, other potential challenges with an exclusively plant-based diet, although from my understanding, they seem to be less important.

However, as I have stated previously, in the context of a diet overwhelmingly comprised of healthy plant-based foods like whole grains, legumes, nuts, seeds, vegetables, fruits, extra virgin olive oil, and the like, there is limited evidence suggesting that occasional, infrequent meat consumption is particularly harmful.  Meat, like sugar or refined starch, can be a component of a healthy diet, as long as it’s not an overwhelming component thereof.

For most of us, meat is likely a component that, in addition to increasing the variety of foods we can eat, makes life easier – when traveling, or eating out with friends, or eating at friends’ houses, being vegetarian can be inconvenient.

I enjoy that Katz, despite being an extreme eco-activist and mostly a vegetarian (very rare consumption of poultry), is completely unbiased in his presentation of meat consumption as a dietary choice.  He notes that occasional meat consumption is OK and totally consistent with a healthy diet.  In his book, he explains about vegans:

I have just one bone (as it were) to pick with veganism. The more ardent advocates for this dietary pattern routinely present it as if it is decisively established not as one of the optimal choices for health, but as the optimal choice for health. I have heard the arguments that within the context of a vegan diet, any food is fine; and every food that does not fit within the confines of a vegan (or, as it tends to be called these days, “whole food, plant-based”) diet is toxic and lethal.

Many in the health field simply assert that veganism is best for health, ignoring or refuting the evidence for other dietary patterns that include some animal foods, from traditional Asian to traditional Mediterranean diets. The problem with making false assertions other than the fact that they are false is that they pave a slippery slope. If advocates for veganism can assert a wish or hope as a fact, so can advocates for low-fat vegan diets, or macrobiotic diets, or fruitarian diets. We are now in a realm of competing dogma and ideology that looks a lot more like religion than science.

I much prefer a separation of church and plate.

I’ve certainly found this to be the case – for example, Michael Greger’s “How Not To Die,” while interesting and informative overall, goes way overboard and totally cherry-picks data in several places.  As one example, Greger, a whole-food vegan (basically means he is not only vegan, but eats no food that has been processed in any way), vastly misinterprets the literature on extra-virgin olive oil, the health benefits of which are as well-corroborated as the health benefits of vegetables.

Greger would have you believe extra-virgin olive oil is bad for us and something we should avoid; that’s simply not true by any stretch of the imagination – if olive oil were bad for us, it would be extraordinarily difficult to explain the profoundly well-replicated data corroborating the gold-standard healthfulness of the Mediterranean Diet.

The Mediterranean diet is a largely plant-centric dietary pattern in which it’s not unusual for 30%+ of calories to be derived from extra-virgin olive oil – the caloric equivalent of 4+ cans of Coke per day, if not closer to 5 or 6.  If EVOO was anything but profoundly health-promoting, it would be extraordinarily difficult for the Mediterranean Diet to achieve the gold-standard results that it repeatedly has, over studies spanning multiple decades and many geographies with millions of subjects.

Unfortunately, Greger even goes so far as to miscite PREDIMED, twisting and selectively citing language in the study to invert the authors’ actual conclusions on the health benefits of EVOO.

Greger, similarly, seems to ignore the majority of the literature on the positive health effects of fish consumption – because, again, this literature is not convenient for his vegan point of view.  Finally, Greger also ignores the literature Katz references suggesting that modest dairy consumption (such as that in the Mediterranean diet) does not appear to have detectably negative health consequences.

Why is this important?  It’s important because How Not To Die could have been a great book – one that I would recommend to many – except that it’s going to either alienate or be impractical for the vast majority of us.  Vegans get a lot of things right, and are closer to health than the average person, but whole-food veganism is not required for health – so evangelizing it as the only option is counterproductive.  (Greger also launches an ill-advised anti-salt campaign, which I will discuss in the second half of this analysis.)

Extra-virgin olive oil makes literally every vegetable and whole grain taste profoundly better than it would otherwise, making them not just palatable – but genuinely tasty – for even the most dedicated carnivore.  Similarly, fish, particularly fatty fish such as salmon, is genuinely good for human health – and most people, particularly those who value lean protein for non-health-related, “look in the mirror” reasons, are far likely to give up meat entirely than they are to try to switch from meat to fish on a reasonably frequent basis.

As Katz explores, there is no compelling evidence suggesting that optimal representations of pescatarian or Mediterranean diets are meaningfully inferior to vegan diets, so why let vegan ideology get in the way of public health when pescatarian / Mediterranean diets are likely far more palatable and suitable for the vast majority of the population?

It’s probably easy for most readers to laugh at vegans, and perhaps harder to laugh at dedicated carnivores (since most of us, statistically speaking, are likely closer to the latter than the former.)  But over the past decade, meat has made a bit of a comeback in terms of its reputation, to the extent that I have heard several extraordinarily intelligent, highly-educated friends of mine call steak, pork chops, and bacon “health foods.”

Now, look: bacon is tasty.  This is undeniable.  Steak is tasty, too, as is Coca-Cola.  I do not categorically exclude any of the above from my diet; in fact, there have been several occasions where I’ve had all three during the same meal. Askeladden used to be a shareholder of Brazilian steakhouse chain Fogo de Chao, and my family still celebrates special occasions there.

I would certainly love it if science said that bacon, steak, and Coke were good for you, because they are all things I enjoy eating, and I would consume them more often, in greater portions, if I didn’t believe they were all bad for my health.

Unfortunately, science provides no evidence that backs up what I would like to be true. I have to set aside my own liking bias for sugar-sweetened beverages and red meat, and understand that however much I may like them personally, my own preferences don’t dictate reality.  Katz, wittily:

Just because we wish something were true (e.g., bacon is good for you now!), doesn’t mean it is. Preference does not equal truth. - David Katz Click To Tweet

The argument most frequently used to promote frequent meat consumption is one I referenced earlier: the “appeal to Paleo” fallacy, which we’ve touched on several times.

What is interesting is that this approach is rational from first premises – i.e., it is reasonable to think about what we ate hundreds of thousands of years ago as a guide for what we should eat today – but the problem is that the airquotes-“Paleo” diet many people follow today (no legumes or whole grains, lots of red meat) bears basically no resemblance to the actual anthropological record of what we ate way back when.  The popular “Paleo” diet isn’t just bad nutrition – it’s also bad anthropology!

As I previously mentioned, the anthropological record suggests that we ate a lot of fiber – some of which came from legumes and whole grains.  (In fact, Paleo ancestors probably ate way more legumes and whole grains than the average modern human).

While some paleolithic diets undoubtedly included a high percentage of meat, evidence seems to suggest that most paleolithic diets were in fact predominantly vegetable matter.  “Paleo” advocates tend to cherry-pick points in time where we ate a lot of meat, whereas this was not actually the case for the vast majority of pre-agriculture evolution.

Biologist Rob Dunn integrates what we know about our digestive systems with what we know about the anthropological record, noting that over the vast majority of the evolution of the human gut, we ate mostly plants:

The majority of the food consumed by primates today–and… for the last thirty million years–is vegetable, not animal. Plants are what our apey and even earlier ancestors ate; they were our paleo diet for most of the last thirty million years during which our bodies, and our guts in particular, were evolving.

There is very little evidence that our guts are terribly special and the job of a generalist primate gut is primarily to eat pieces of plants. We have special immune systems, special brains, even special hands, but our guts are ordinary and for tens of millions of years those ordinary guts have tended to be filled with fruit, leaves, and the occasional delicacy of a raw hummingbird….

Which paleo diet should we eat? The one from twelve thousand years ago? A hundred thousand? Forty million? If you want to return to… the [diet] your ancestors ate… you might reasonably eat what our ancestors spent the most time eating during the largest periods of the evolution of our guts: fruits, nuts, and vegetables—especially fungus-covered tropical leaves.

Zuk, in Paleofantasy, also notes on page 119 that meat consumption was as driven by technology as grain consumption – prior to the invention of the bow and arrow, which occurred at different times in different places, we would have been far more limited in our ability to frequently consume large portions of meat:

“Another implication of the importance that Marlow attaches to bow hunting is that… ancient humans would have been able to increase the proportion of meat only after newer technology had come about, a mere 30,000 years ago…

…this means… contrary to the claims of many paleo-diet proponents… the earliest humans did not have an exclusively meat-based diet… second, our ancestors’ diets clearly changed dramatically and repeatedly over the last… hundreds of thousands of years, even before the advent of agriculture.”

Another important differentiation is that we can’t make apples-to-apples comparisons between then and now.  Other factors, ranging from our different lifestyles and caloric throughputs, to the different kind of meat available for us today, come into play.  Katz:

We know, in fact, that the meat that prevails today is far removed from the meat to which we are natively adapted. The peer-reviewed papers on Paleolithic nutrition suggest that the Stone Age meat our ancestors ate was roughly like the flesh of antelope in its composition.

The published estimates suggest that roughly 7% of the calories in antelope come from fat, rather little of that fat is saturated, and a substantial portion is omega-3. Contrast that with modern, grain-fed beef, where roughly 35% of the calories may come from fat, much of it saturated and none of it omega-3, and the fallacy of using the term “meat” indiscriminately is immediately revealed.

We know that life expectancy today is much greater than the Paleolithic mean. We know that humans can and do thrive on diets that are mostly or even exclusively plant-based, and that adaptations to the consumption of both plants and animals means we have choices. Evolutionary biology clearly allows for meat in the human diet, but does not require it.

Here is another anthropological challenge: there was no single “Paleo” diet.  Rather, the varieties of food available on a tropical island were completely different from the varieties of food available on the Great Plains of North America, which were completely different from the varieties of food available in Alaska or the Siberian tundra.  Just as the modern Indian diet differs dramatically from the modern Latin American diet, so too would the paleolithic diet have differed from one place to another.  You can’t expect residents of a high-altitude mountain range to eat anything like residents of the tropics if they’re both surviving off the local land.

So trying to point to a singular “Paleo diet” is nonsensical; the “Paleo diet” varied widely depending on geography as well as the time of year – our ancestors did not have refrigerators or international shipping.  Zuk, in Paleofantasy, makes a comparison to the differences between modern culture from place to place, although the differences in the Paleolithic era were of course even more extreme:

“There was no single Paleo Lifestyle, any more than there is a single Modern Lifestyle.  Early humans trapped or fished, relied on large game or small, or collected a large proportion of their food, depending on where in the world they lived and the time period in which they were living… neither one is more ‘authentic’ than the other.”

Christina Warinner analyzes this in her TED Talk as well, noting that modern plants and animals look nothing like their predecessors; it might surprise you to learn that “superfoods” like carrots, kale, and broccoli are all man-made inventions; they are every bit as “genetically modified” (by selective breeding over millennia) as GMO corn or soybeans.  Carrots, kale, and broccoli did not exist in their modern forms 100,000 years ago; they are in some senses just as man-made as Doritos and Coke – but they’re profoundly health-promoting.

Similarly, Cara Cara oranges arose through a spontaneous mutation in the navel orange in the early 1800s; there is no evidence that I am aware of that their relatively recent provenance makes them negative for human health in any way, or whatsoever inferior to “Paleo” citrus fruits from a nutritional standpoint.

As such, just because a food is “modern” does not automatically mean it is bad for us.  Any attempt to “eat like our ancient ancestors” is bound to fail, because the food our ancestors ate largely no longer exists, and they ate so many different things depending on time and location that mimicking their diet would be impossible.

Christina Warinner debunking the paleo diet.
Christina Warinner debunking the paleo diet.

Nor, as Warinner and Zuk both point out in their own way, should we try to imitate them.  Our ancestors were limited by not having access to an infinite variety of fresh, healthy foods from all over the worlds.

Tomatoes were not native to Italy, but they sure perfected the use of them; okra comes from Africa, but it’s become a celebrated vegetable in both the South and India.  And there’s no data, to the best of my understanding, that suggests that Indians or Southerners would be better off avoiding okra, or that Italians should give up their beloved tomato sauces.  We are not koalas; we are not constrained to narrow food types.  Our digestive systems are adapted to foods from any provenance.

Additionally, modern refrigeration and greenhouse technology allows us to consume fresh fruits and vegetables in the middle of a blizzard.  In my backyard, I have blackberry bushes and muscadine grapevines that ripen at very specific times, but the modern world allows me to buy fresh blackberries and grapes pretty much year round if I want them.

To the best of my knowledge, there is not a single study out there suggesting that we would be better off foregoing fruit and vegetable consumption in the winter months because our ancestors never had access to fresh fruits and veggies in January.  And to Dunn’s previous point, just because we used to eat fungus-covered leaves and fruits doesn’t mean that it’s health-promoting for us to wait for our strawberries and whole-wheat bread to get moldy before consuming them.

So just because one person’s particular ancestors might have had to survive mostly off the taro root for many months of the year does not mean that person is nutritionally best off eating an overwhelmingly taro-based diet when far better options might now be available.

Variety is important too, from the context of both taste and nutrition.  As discussed earlier, humans are adapted to eat a wide range of things, including all kinds of plants, meat, and now even dairy (Zuk, in her book, discusses the rapid evolution of lactase persistence over the past 10,000 years).  As such, overreliance on a genetic argument for eating or not eating any food group is suspect.  We can eat meat and dairy if we like, but that doesn’t mean we have to.

A final example of ideology mucking up our nutrition is some authors being a man with a hammer with tools like the glycemic index.  It is a tool with some merits; the American Diabetes Association notes that for diabetics, the glycemic index, along with carbohydrate counting, can be helpful for managing blood glucose – obviously critically important if you’re on insulin.

However, just as not all problems are nails, not all dietary challenges can be solved with the glycemic index.  Katz notes that for those of us who aren’t diabetics, although glycemic index/load can be helpful for choosing among processed foods, it is mostly irrelevant (for most people with no specific health problems) when choosing among “real food, mostly plants,” as Pollan would put it.

A high-GI fruit or vegetable is still a fruit or vegetable that is phenomenal for our long-term health, notwithstanding whatever its glycemic index may be.  In fact, over-focusing on a food’s glycemic index could lead people to make wildly inappropriate substitutions, like heavy cream for walnuts, or diet soda for blackberries.  Katz:

Neither the glycemic index, nor load, should ever be invoked as a reason to jettison any fruits or vegetables from your diet. In my 25 years of clinical practice, I never met a single patient who could blame obesity or diabetes on too many carrots.

Whatever their glycemic measures, the net effect of eating more fresh produce is consistently better health, not worse. Fad diet authors who have advised against eating fruits or certain vegetables to adhere to low-GI eating have done the public a disservice, however they may have profited. Fruits have been shown specifically to defend against diabetes, the very condition most directly related to untoward glycemic effects.

You should not mistake a glycemic measure for a measure of overall nutritional quality. Fresh fruits and vegetables are generally very good for us, whatever their glycemic scores. Crisco—pure trans fat—is in no way exonerated by its glycemic scores of zero. Don’t forget what these measures do and don’t measure.


Carrots, apples, chickpeas, walnuts, black beans, and strawberries all have a much higher glycemic index than either heavy cream, or diet soda. If that leads you to believe these last two are the better choices for your health, you can enjoy them for lunch while enjoying the view from the bridge I would like to sell you.

Indeed, research tends to consistently find that glycemic index is not particularly helpful within the context of a healthy diet.  For example, one study on low-GI controlled feeding in the context of the DASH diet found no improvements in any of the studied measures:

At high dietary carbohydrate content, the low– compared with high–glycemic index level decreased insulin sensitivity from 8.9 to 7.1 units (−20%, P = .002); increased LDL cholesterol from 139 to 147 mg/dL (6%, P ≤ .001); and did not affect levels of HDL cholesterol, triglycerides, or blood pressure. At low carbohydrate content, the low– compared with high–glycemic index level did not affect the outcomes except for decreasing triglycerides from 91 to 86 mg/dL (−5%, P = .02). In the primary diet contrast, the low–glycemic index, low-carbohydrate diet, compared with the high–glycemic index, high-carbohydrate diet, did not affect insulin sensitivity, systolic blood pressure, LDL cholesterol, or HDL cholesterol but did lower triglycerides from 111 to 86 mg/dL (−23%, P ≤ .001).

In this 5-week controlled feeding study, diets with low glycemic index of dietary carbohydrate, compared with high glycemic index of dietary carbohydrate, did not result in improvements in insulin sensitivity, lipid levels, or systolic blood pressure. In the context of an overall DASH-type diet, using glycemic index to select specific foods may not improve cardiovascular risk factors or insulin resistance.

Another study, examining the effects of fruit on diabetes prevention, was unable to find any correlation with glycemic index:

The differences in the associations between individual fruits were not accounted for by variation in the glycemic index/glycemic load values of individual fruits. Overall, these results support recommendations on increasing consumption of a variety of whole fruits, especially blueberries, grapes, and apples, as a measure for diabetes prevention.

Diets like those suggested by CrossFit, which emphasizes meat consumption at the expense of high-GI fruits and vegetables, clearly does us a disservice – we’ve already covered the damaging long-term health ramifications of substituting animal-based fat and protein for minimally-refined plant-based carbohydrates.  There is nothing wrong with modest portions of meat in a largely plant-centric diet, but treating meat as a centerpiece – or something to eat more of – is, empirically, the wrong approach.

Again, there is a local vs. global optimization issue at play here – I’m sure that there’s some rationale for such a diet being better for athletic performance or physique in the short term; I haven’t studied the science in depth because I don’t much care.  What I care about is long-term health.

And in the context of long-term health, no amount of sugar or starch, intrinsic to a plant and unaltered by human processing, is bad for human health; there is no evidence that we are better off eating more steak and less blueberries.  As we’ll touch on in a few sections, the high glycemic index sweet potato comprised half to two thirds of the caloric intake of the traditional Okinawan diet – one of the most health-promoting diets scientists have studied.

All things equal, if someone wanted to eat more lower-GI fruits or veggies rather than higher ones, that would be fine – but it’s not beneficial, in the long-term, to forego high-GI fruits or veggies for the sake of animal products (with the potential exception of fish or yogurt.)  Sweet potatoes and blueberries are better for our health than meat, regardless of their glycemic index.

There are plenty of other “ideologies” in nutrition – such anti-gluten / anti-wheat or more broadly anti-grain / anti-legume sentiment – that get it wrong in similar ways.

There is not scope here to address every single fallacious line of reasoning that exists out there; again, the core takeaway is that healthful diets are not made or broken by one ingredient or one category of foods.

There are many health-promoting dietary patterns but all of them focus on maximizing intake of healthful categories of food and minimizing intake of unhealthy categories of food.

If you’re allergic to (or don’t like) wheat, or legumes, or any other food category, that’s fine.  However, simply eating (or not eating) any given category of food is not sufficient to constitute a healthful diet.  A healthful diet requires integration of health-promoting foods from multiple categories.

Interlude: The Two-Line Heuristic

Before we get to practical applications, I think it’s helpful to provide a brief summary of what is, and isn’t, good for us.

Below is a roughly ranked list of where I believe various food categories fall on the totem pole.  This is just my own assessment from having read a lot of research; please note that I am not a nutrition expert – this is just what I use for my own personal reference.

Please also note that, as discussed, I am not particularly interested in minor nuances, i.e. whether specific kinds of dairy are exactly neutral or slightly bad or quite bad for our health: it is enough to know that they are not good for you, and should be used occasionally when their taste merits demand it, but should not be used overwhelmingly in place of better alternatives.

Each food, of course, has somewhat different impacts.  Extra-virgin olive oil is rich in polyphenols and has well-documented anti-inflammatory effects, but doesn’t contain fiber or many important micronutrients.  Most vegetables, legumes, and fruits do provideplenty of micronutrients and fiber, but don’t contain easily-used omega-3s found in fish.  And so on.

On the flip side, the choline in eggs, for example, might participate in the TMAO pathway, as discussed earlier in reference to L-carnitine.  As discussed earlier, poultry (like all animal protein) is insulinemic and can contribute to diabetes.  And sugar-sweetened beverages can contribute to weight gain and lead the accompanying health problems.

So, there is some nuance – but I trust that nobody sensible is trying to construct a diet entirely comprised of Coke, chicken, and eggs on the one hand, or surviving exclusively off olive oil and fish on the other hand.

In the context of a dietary pattern with varied components that we know conclusively are healthy, these items are less relevant.


Vegetables (incl. herbs), fruits, legumes (lentils/beans), nuts / seeds (incl. spices), extra-virgin olive oil (see also), whole grains (oats, corn, whole wheat, brown rice, etc), copious amounts of water


Fish, yogurt, dark chocolate, tea & modest (~ 1 cup per day) coffee (probably, although time-dependent as caffeine disrupts sleep), other plant-derived oils such as canola oil or avocado oil that are not extra-virgin olive oil but are still primarily monounsaturated, or primarily polyunsaturated (with a reasonably low omega-6 to omega-3 ratio (particular source is mostly irrelevant – canola works), red wine in moderation (probably)


Eggs (probably), poultry (probably), tea & coffee (maybe, especially if coffee disrupts sleep), some refined grains like pasta (maybe), some dairy products (maybe), white wine and some other forms of alcohol in moderation (maybe), cocoa butter (probably), coconut oil and some other sources of saturated fat (maybe),


eggs (maybe), poultry (maybe), most refined grains and added sugar in the context of an otherwise-healthy diet not marked by metabolic syndrome (probably), particularly highly-refined grains (ex. white rice / white flour), coconut oil and most sources of saturated fat (probably), most dairy products (probably), added salt (probably), most forms of alcohol other than wine (probably)


red meat, some dairy products such as heavy cream (maybe), some other sources of saturated fat (maybe), most refined grains and added sugar in the context of an unhealthy diet and metabolic syndrome


processed red meat (bacon, hot dogs, etc), trans fats / hydrogenated fats (which have mostly been eliminated from the food supply anyway)

While that general ranking is easy enough to conceptualize, here is a two-line heuristic for determining whether or not a food is good for us:

1. Did it come from a plant?

2. Has it avoided processing that removes critical health-promoting nutrients?

If the answer to both 1 and 2 is yes, then it is good for you.  If the answer to either 1 and 2 is no, then it is probably anywhere from neutral to bad for you.

What this heuristic lacks in precision, it makes up for in usability.  There are obvious exceptions which we can all remember: fish is good for you, as is yogurt, and neither come from a plant.

Meanwhile, some smart-alecks will likely point out that there are many exceptions to the “plants are good for you” heuristic: nightshade, castor beans, and many wild mushrooms will make you severely ill or severely dead.

This is a fact; it is undeniable.  There are many, many plants that will kill you.  I am setting a constraint on our discussion – nobody is foraging for random leaves, berries, or mushrooms; everything we are talking about is something that was grown by a farmer and sold in a grocery store.

(Other smart alecks will point out that mushrooms are not technically plants, but fungi; this is true botanically but for all practical purposes relevant to nutrition, a mushroom is a vegetable.)

Within that reasonable, modern-day set of constraints, it bears noting that with limited exceptions (like vitamin B12 from meat/dairy or omega-3s from fish, or the probiotics in yogurt), the majority of compounds known or believed to have meaningfully positive impacts on long-term human health – fiber, polyphenols, etc – are found exclusively in plant-derived rather than animal-derived foods.

We’ve discussed the plant thing to death so I won’t go there; let’s talk (very briefly) about processing.  With the caveats we touched on previously in the discussion about the limits of disaggregation, we do know conclusively that certain components of food – like micronutrients, fiber, and phytochemicals – are health-promoting.

We also know that processing that removes these components causes plant-based foods to lose their healthfulness.  For example, while non-extra-virgin olive oil is not bad for you, research consistently finds that it (and other plant-derived oils) lack the health benefits of extra-virgin olive oil (EVOO), because EVOO is extracted without removing polyphenols and other health-promoting constituents.

As observed in a 2019 paper in Circulation Research:

Red wine and EVOO contain several bioactive polyphenols (hydroxytyrosol and tyrosol, oleocanthal, and resveratrol) with postulated anti-inflammatory properties.7 Postulated antiatherogenic properties of olive oil were supposedly attributed to its high content of monounsaturated fat (MUFA; oleic acid),8 and some more recent investigations also suggest that bioactive polyphenols, only present in the EVOO, but not in the refined-common variety of olive oil, may contribute to these cardioprotective actions.9

EVOO is the product from the first pressing of the ripe olive fruit and contains many antioxidants (polyphenols, tocopherols, and phytosterols).10 Lower-quality oils (refined or common olive oils) are believed to be devoid of most of these antioxidant, anti-inflammatory, or pleiotropic capacities because they are obtained by physical and chemical procedures that keep the fat but lead to the loss of most bioactive elements.

It is worth noting, here, that much of what is labeled EVOO is not true extra-virgin olive oil, and thus does not confer EVOO’s health benefits.  See Tom Mueller’s Extra Virginity for more detail.

Similarly, while white bread and Coke are entirely vegetarian, they’re not good for you either.  White flour and refined sugar have been stripped of all their fiber, nutrients, and phytochemicals, leaving only pure energy.  As such, these sorts of highly processed plant-based foods are, like most animal-based foods, neutral to actively bad for us.  (Again, where exactly they are on the scale matters somewhat less.)

I should make it clear, here, that I haven’t seen any evidence suggesting that you should confuse this sort of nutrient-removing processing with nutrient-neutral food preparation.

While our household is big on homemade everything – I bake my own whole-wheat bread and blend my own tahini; my mom even makes her own yogurt – we aren’t purists, and don’t waste time preparing stuff at home that is more efficiently prepared on an industrial scale.  We eat hummus out of a Sabra tub from Costco and vegetarian refried beans out of a Rosarita can from Wal-Mart.

There are no points for snobbery.  While I’ve made my own mesquite-pecan butter, too, there is precisely zero chance I’m wasting my time on making peanut butter rather than just buying a jar of Jif Natural.  (Creamy, not crunchy, if you were wondering.)

More broadly, I eat a lot of dips/spreads/breads; there is some evidence that our bodies may process ground foods (like whole-wheat flours or nut butters) slightly differently than they’d process the unground version.  I do think it’s reasonable to assume that there would be some benefit to entirely consuming food made from scratch, that was never pounded or ground into a fine paste or flour.

However, to the earlier point about theoretical vs. actual harms, we also have to consider the reality that few of us have the time (let alone inclination) to slave away for many hours every day, and that breads and Blendtecs make for far more interesting eating than simply trying to eat whole food.

I have seen no evidence that nut butters or whole wheat breads, hummus, or peanut butter aren’t great for you, whether or not they’re homemade or prepared outside.  So there’s no point in being puritanical; the whole-wheat bread, hummus, and peanut butter we buy from Costco is far, far better than what we’d be eating otherwise, so long as nothing really terrible is on the ingredient label.

(Some “whole-wheat” products have little actual whole wheat, but I trust that everyone reading this is smart enough to read an ingredients label and do their own research.)

Part 2: Eat More Tomorrow

“What we decided to do is think about this starting with the psychology and ask, well what is it that’s preventing people from saving enough?

So[…]  these things are preventing people from saving.  Let’s flip the problem around and use those to create a plan that will take those weaknesses if you want to call it that, and use them to help.

So the plan we created, we called Save More Tomorrow… to invite people now to save more later, because self-control is easier for later.  [P]articularly… when they get their next raise, so they won’t see their income go down. That will eliminate the loss aversion.  

And then we’re gonna keep that up until they hit some goal, so we’ll get inertia working for us.

Richard Thaler’s Nobel prize presentation

In Part 1, I provided a thorough, Tim Urban “Wait But Why” style exploration of not only the science of nutrition established over multiple decades, across the world, but more importantly, why there is a large gap between public perception and empirical evidence.

Knowing the truth is not enough, however.  Even for people who know these truths about their diet, there are many barriers that make application difficult.

My aim in Part 2 is to do what Richard Thaler did for retirement savings with Save More Tomorrow, except for diet.  I’m calling it “Eat More Tomorrow.”

That may seem strange, given that we live in an age of diseases contributed to by overeating… but please bear with me.  The widely-attempted approach of “eat less tomorrow” (whether that means less absolute food, or less tasty food, or “less carbs”) has failed, miserably, to solve our public health crisis – and in the last case, has likely exacerbated it.

I suggest that we try something a little different, that works with intrinsic human nature rather than fighting against it.

In Save More Tomorrow, Thaler took the mental models – hyperbolic discounting / present bias, loss aversion, activation energy, status quo bias, etc – that were preventing people from adequately saving for retirement.  Thaler then flipped those models around, creating a solution which didn’t fight against those human tendencies, but rather utilized those human tendencies to solve the problem.

I believe we can do the same: flip around many of the same mental models that lead us to make poor dietary choices, and instead utilize them as a structural problem solving solution to help us make better dietary choices.  What if we could obviate loss aversion – and use incentives (tasty food) in our favor rather than against it?  Over time, we will build the benefits of habit and thereby leverage status quo bias.  

Don’t underestimate the power of this last one.  As Thaler once put it:

Passivity is one of humans’ greatest skills. People are good at doing nothing. - Richard Thaler Click To Tweet

In any domain, a large portion of human decisions are driven simply by what’s available or what’s easy / low activation energy.

As Shawn Achor explores in The Happiness Advantage (THA review + notes), simply taking the batteries out of your remote causes you to watch less TV.  Sleeping in your gym shorts makes it more likely you’ll hit the treadmill in the morning.  Etc.  So simply keeping healthy foods around and minimizing the number of unhealthy foods you purchase makes it far easier to eat the healthy foods later.

Longer-term, building consistent habits helps drive behavior.  Duhigg’s The Power of Habit (PoH review + notes) is a good read here.

Getting to this point is with our diets is easier than you might expect.  We spent a lot of time building up the foundation; the finishing piece is now much easier.

Deprival Superreaction Syndrome vs. Structural Problem Solving: Utilizing Feedback To Our Advantage

We are all designers in the sense that all of us deliberately design our lives... and the way we do things. - Don Norman Click To Tweet

(from “ The Design of Everyday Things” – DOET review + notes)

One of my most ardent beliefs is that we should all aim to solve most of our problems through thoughtful design rather than brute force.  If we design our lives correctly, making appropriate decisions becomes easy rather than hard.  With the same amount of effort, we can accomplish more.

As Don Norman puts it:

“How is it that so many people are so incompetent? Answer: they aren’t.  It’s a design problem […]

We should treat all failures in the same way: find the fundamental causes and redesign the system so that these can no longer lead to problems.

It is not possible to eliminate human error if it is thought of as a personal failure […]

If the system lets you make the error, it is badly designed.  And if the system induces you to make the error, it is really badly designed.”

Let’s start with a story.  Ever since having me, my mom has always been extremely overweight.  To be clear, this is an objective fact and not a character judgment; my mom is a wonderful person and I love her deeply.  I am simultaneously both anti-fat-shaming and pro-healthy-eating.  The two are not mutually exclusive.

My mom, for decades, attempted (and failed) to change her eating habits via willpower.  Her story will likely be familiar to many of you as something you’ve experienced yourself, or in the life of someone you know or care about.

Throughout my childhood, my mom would occasionally make resolutions to eat better – and my dad and I would shudder, because my mom’s normally-fantastic cooking would go a bit kooky.

We would spend a week, as a family, going through the latest diet craze… wheat germ in everything (even orange juice, which I permanently lost my taste for).  Spinach in everything (even in rotis – essentially Indian whole-wheat tortillas).  Low-carb pasta was the worst; cardboard might literally have been preferable.

My mom would religiously stick to the new diet fad for a week or a month, losing some weight… and then she’d spring back, binge-eating candy, or potato chips, or whatever else she’d been avoiding, and she’d end up at the same weight where she started – if not a bit higher.  She was actually always pretty good about what she ate at mealtimes; unhealthy snacks were the bigger problem.

This went on for about two decades, with really no delta in her long-term eating habits or her weight.  This is, of course, consistent with the scientific literature’s well-established base rate on the (abysmal lack of) success of most diets.  Most people, most of the time, fail to achieve sustained progress.

Recently, however, my mom has – for the first time in her life – seen a sustained, long-term improvement in both her eating habits, and her waistline.  She’s lost 15+ pounds, and now finds herself craving greens like broccolini and brussels sprouts as frequently than junk food or meat.

What changed?

In the vein of Shawn Achor’s Ted Talk, when you see an outlier, it’s usually worth investigating.  Don’t you want to know why that one red dot is way different than all the others?

In some ways, what’s happened with my mom over the past few years is what got me thinking about the mental models at play here

Well, in addition to newfound motivation on my mom’s part (she deserves credit for that), I started cooking.  She still eats whatever she feels like eating, and she still (frequently) makes suboptimal dietary choices.  She has not forbidden herself from eating junk food.  She still, sometimes, eats junk food.

However, because she now has a greater variety of tasty, healthy food readily available, she often chooses to eat that instead – and there’s only so much room in her stomach.

To be clear, my mom was (and is) a wonderful cook – but she didn’t often have the time or inclination to risk trying new things (because we needed dinner on the table, and there were other things to be done that prevented re-cooking a bad meal.)

When I started cooking – first on occasion for fun, then nearly full-time – I simply added a much greater variety of healthy foods she never would have tried otherwise, like roasted vegetables, farro, and various plant-based dips and spreads.

So without a single ounce of effort on her part, she ended up making vastly healthier choices.  All she had to do was eat more tasty food – a really easy thing to do! – rather than eat less tasty food – the really hard thing to do, that she had tried, and failed, to do for decades.

Here’s one of the mechanisms by which Eat More Tomorrow works.  We have natural feedback mechanisms that tell us when we’re full; conveniently, healthy foods also generally tend to trigger those feedback mechanisms more reliably than unhealthy foods.

Conversely, there is increasing evidence that highly processed foods either unintentionally or intentionally short-circuit those feedback mechanisms, causing us to eat more than we need (and thus contributing to obesity.)  For example, one recent study observed:

The researchers found that by the second week of each diet, people were eating, on average, about 500 more calories per day when the fare was ultraprocessed. That extra consumption led to a weight gain of about a kilogram during the 2 weeks on the ultraprocessed diet, versus a loss of about a kilogram on the unprocessed diet, they report today in Cell Metabolism.

“They showed that the effect [of processing] goes beyond nutrients,” says Carlos Monteiro, an epidemiologist at the University of São Paulo in São Paulo, Brazil, who helped develop the NOVA classification system and supports government interventions to limit processed food consumption. Simply reformulating packaged foods to contain less sugar, salt, or fat—as many large companies are now attempting—won’t eliminate their risks, he says.

Yet on surveys, the participants rated the processed meals as no more pleasant than the unprocessed ones. If they weren’t enjoying the food more, why were they eating more of it?


One possibility is that industrial processing produces softer foods that are easier to chew and swallow—and thus easier to scarf down. The participants ate faster on the ultraprocessed diet, and studies have found that people tend to eat more when they eat faster. Blood tests also revealed that, while on the unprocessed diet, people had higher levels of an appetite-suppressing hormone called PYY and lower levels of the appetite-stimulating hormone ghrelin, though it’s not clear how these changes relate to food processing.

This is one of the primary dangers of added sugars and refined starches, for example.  Neither starch nor sugar is harmful in the context of a fibrous plant food like a whole grain, a fruit, a vegetable, a legume, or a nut/seed.  However, when you strip away the satiating fiber, and leave only the airy, light, energy-dense but fiber-light starch or sugar, it becomes far easier to overeat.

This isn’t the end of it.  I found Mark Schatzker’s The Dorito Effect sort of fascinating in this regard – just as social-media apps like Twitter and Facebook are precision-engineered to get us addicted, so too is junk food.

“Betcha can’t eat just one” is thus less betting, and more insider trading: food companies make sure we can’t eat just one.

And herein lies the key to sustainable, healthy eating.  If we consistently attempt to avoid foods that we love, and instead force ourselves to consume foods that we don’t love, we will eventually deplete our willpower, and/or trigger deprival superreaction syndrome.  This is why the base rate for the success of New Years’ Resolutions is so awful: we make perfection the enemy of the good.

The perfect diet that we follow for three days, then permanently abandon, is worse for our health than the workable diet that we follow for the rest of your lives.

In a world where both restaurants and supermarkets are stocked with food precision-engineered to get us to overeat (and eat the wrong things), few of us have the willpower to constantly forego things we love, and instead force ourselves to scarf down things we hate.  Unless we’re planning to become hermits and never visit a grocery store (or a potluck) again, it’s stupid to even try this approach when better solutions are available via thoughtful design.

The only sensible, mental-models approved approach is to allow ourselves to eat any foods we really want if and when we want them – but only in the context of providing ourselves with a fuller, healthier array of possible choices, which will inevitably promote healthier eating and help you to re-wire our preferences via conditioning

What we eat is often a function of what we eat; for example, immigrant kids’ diets often trend towards the diet of their new homeland, rather than that of their parents.

The oldest piece of nutritional advice in the book comes from Grandma: “eat your vegetables before your dessert.” This is one of the keys to making healthier choices: if we throw out all our ice cream and force ourselves to survive off broccoli, we’ll end up hating broccoli for life and having a big Ben & Jerry’s binge later.  We’re worse off than when we started.  This is just human psychology 101.

If we instead simply try to eat as many healthy, tasty, nutritious foods as we can – and learn how to make healthy foods every bit as tasty as unhealthy foods – we’ll simply have less desire to eat unhealthy foods, because we’re full already.

Foods that are good for you – such as fruits and vegetables, extra-virgin olive oil, nuts and whole grains, etc – tend to promote “satiety” (a feeling of fullness), whereas highly refined / processed products do not (i.e. why you can easily overeat junk food.)  This makes sense intuitively as well – we’ve all eaten one too many Doritos, but how many of us have ever overeaten carrots, grapes, or beans?  Few of us can blame our love handles on stuffing our faces with oatmeal and lentils.

As such, to return to that issue of “isocaloric” meals we discussed earlier – being hungry is hard; for the sake of our survival as a species, our bodies give us powerful biochemical incentives to eat when we’re hungry.

Fighting these incentives tends not to work sustainably.  Conversely, even if we don’t count calories, eating healthy will help us lose weight without feeling any less full, because real food tends to fill us up faster than processed junk on a per-calorie basis.

We can, of course, still track calories if we wish – I have done so at various points in my life, and it can certainly be helpful in incentivizing our behavior – but when we’re eating healthy foods, calories tend to take care of themselves.

The best part about focusing on eating more healthy foods rather than the converse (eating less unhealthy foods) is that we avoid triggering loss aversion / deprival superreaction syndrome, because we’re never actively using willpower to deprive ourselves of something we enjoy.  We can still have it, if we want, but it’ll likely be a much smaller serving (if at all.)

I still have ice cream whenever I want it – I just now happen to want it only once or twice a quarter, versus several times per week when I was younger.  When I do have it, it’s a much smaller portion, because it’s topped with EVOO and sea salt (phenomenal, if you haven’t tried it.)  I have soda whenever I want it, too – but my consumption has dropped to about three-quarters of a can per day, vs. 2-3 per day at various points in my life.

“Eat more [healthy foods] tomorrow” is the opposite of a typical diet: it expands, rather than limits, choices; it doesn’t say no to anything; rather, it says yes to a lot of new things.

How do we get there?  It’s pretty easy.  Although there are plenty of places you can go for recipes – Katz’s wife, for example, runs a great recipe site called Cuisinicity that provides inspiration for everyone from vegans to meat-eaters – I personally find that recipes are more helpful when you know why they work and what taste buds they satisfy.

Moreover, for the large percentage of us who don’t have time or inclination to cook a significant portion of our own meals, it’s also important to be able to identify packaged snacks or prepared restaurant foods that will taste good, yet still be healthier than whatever we would’ve eaten instead.

So, the remainder of this model analyzes the fundamentals of flavor.

Disaggregating Flavors

We spent a lot of time in Part 1 talking about the limits of disaggregation: the idea that a food’s macronutrient content, glycemic index, or omega-6-to-omega-3 ratio doesn’t really tell us anything helpful about the food’s overall contribution to our health.  This doesn’t mean that disaggregation is useless in the context of diet.  To the contrary, I believe it’s one of the most powerful tools we have available to us.  Most of us just use it the wrong way.

You know one thing that’s weird?  Terrible food substitution suggestions.  Like, has anyone ever told you to substitute spaghetti squash for spaghetti?  Tofu instead of Thanksgiving turkey?  Cauliflower crust for… real pizza crust?  A portabella mushroom between two buns instead of a hamburger patty?  I mean, seriously – what the !@#$?  Who thinks that tofu bears any resemblance to turkey, or spaghetti squash to real spaghetti, in aroma, texture, or anything else?

Look – cauliflower, tofu, squash, and mushrooms all have culinary merit, as well as health benefits.  I eat and enjoy all four.  But they are terrible substitutes in each of the situations above.  They are the blow-up doll of food: their cartoon outline vaguely resembles the real form (if you squint), but they aren’t the same where it matters, in any way that matters.  With all apologies to the vast minority of people who find these substitutes remotely palatable, all these poor substitutions serve to do is trigger contrast bias and remind us of all the goodness we’re missing out on.

To make healthy substitutions, we need to actually understand how food works.  That is to say – what makes food X taste good, and what healthier food Y would hit all the same notes?  Foods that may look completely different may in face taste very similar, whereas

One of the fascinating aspects of human existence is that we often don’t truly know our own motivations.  Many of us (me!) can attest to eating out of boredom or habit; i.e., snacking or sipping is just something to do while watching a movie or working on a project, whether or not we’re actually hungry.  It’s like being at a cocktail party: even if we really don’t want to drink anything, we feel less awkward with a drink in hand.

In a similar vein, many of us don’t fully understand how our tongues work, and what makes certain foods taste good to us.  This is a shame, because if we learn to disaggregate the foods we eat into flavors that make them taste good, we can do two things.:

A, find healthier substitutes with minimal opportunity cost – and,

B, vastly improve the flavor.

Here’s a tangible example of the first scenario.  Perhaps the single-worst component of my own diet is, as referenced earlier, my taste for sweetened beverages.

I put a lot of sugar in my coffee.  I like Coca-Cola.  I like sweet tea, though I don’t make or drink it all that much.  I like lemonade, though I also don’t make or drink it all that much.  I like mochas and honey-vanilla-lavender lattes (I think I dropped my man-card somewhere, can you find it?  thx.)  I like Frappuccinos and Sonic slushies and ICEEs and sugarcane juice and… oh I could go on.

My Southern roots run deep.  I am so universally amenable to sweetened beverages that it would probably be easier to list the sweet beverages I do not like (Thai tea, flavored milks) than the ones I do like (pretty much the rest of them.)

I did a reasonably good job reducing my consumption of sugary beverages over several years simply by being mindful of it; i.e., only drinking one when I really wanted one, and not just because it was there.  I went from drinking many sodas per day in college to a few a day when I was an analyst.

But beyond a certain point, progress slowed.  I couldn’t find a way to further reduce my soda consumption without triggering deprival superreaction syndrome, or burning precious willpower that I needed for more important pursuits such as my day job.

For many, reducing meat consumption might be the most difficult health-promoting step to take; for others, it will be refined starches.  Those two were easy for me.  However, excessive consumption of sweetened beverages was the last bastion of ill health for me to overcome.

I found a surprising answer, completely unintentionally.  One of my two New Years’ Resolutions for 2019 was to eat more fruit – specifically, at least 2+ and preferably 3+ servings of fruit per day.  (1 small apple or 1 cup of berries or grapes counts as one serving.)  I did this because I learned that an apple a day really does keep the doctor away – fruits have independent positive health benefits vis-a-vis other categories of minimally-refined plant foods, and I’ve seen several studies finding that each incremental daily serving of fruits reduces all-cause mortality risk by 6-7%.

I like fruit perfectly well – quite a lot, actually.  Fruit consumption is actively enjoyable rather than neutral or negative.  Historically, however, I just… didn’t make a point of eating it.  It wasn’t a habit.  I vastly overindexed on vegetables, extra virgin olive oil, whole grains, etc – eating those was habitual.

I just somehow never really made a point of habitually eating fruit unless someone (usually my mom) offered it to me.

So I set out to intentionally add more fruit to my diet.  And – given that it’s not only painless, but instead actively enjoyable – I’ve met or exceeded my goal most days this year.

The unintended consequence (n-order impact) is that I have suddenly found myself desiring less soda or sweetened coffee than I once did – and not because I am intentionally depriving myself, but rather because I simply don’t crave it as much anymore.

Why?  Disaggregation makes the answer clear: for whatever reason, my enjoyment of many meals is vastly enhanced by having something acidic, sweet, and wet in my mouth between bites.  I also crave that same flavor profile at other times during the day as a pick-me-up.

Sugary beverages satisfy those three criteria.  Sweetened beverages, universally, tend to be acidic, wet, and sweet by nature.

But so do real fruits.  Grapes, blueberries, blackberries, and citrus have an extremely similar flavor profile to Coca Cola in many important aspects.  Several of the critical ingredients in the “secret formula” for Coke syrup are, in fact, actually various citrus oils/essences – lime, orange, lemon, neroli (an extract from the bitter orange, which is also used to make marmalade), etc.

Of course, all of the various “flavors” of sweetened beverages tend to be fruit-based as well – Cherry Coke, orange soda, lemon-lime Sprite, peach or raspberry iced tea, Lemonberry Sonic slushes, etc.  So instead of consuming fake fruit juice with lots of added sugar… why not just consume real fruit?

I quickly realized that a lot of the time, when I thought I wanted a Coke, what I really wanted wasn’t necessarily a Coke, but instead simply something acidic/sweet/wet.  I can literally observe this on a real-time basis; often, I’ll open a can of Coke with a meal, but also have some fruit alongside it – and whenever I have the fruit, I tend to have only a third or a half of the can of Coke, whereas without the fruit, I’ll usually drink the whole can (and kind of want to open another one).

Knowing this, I’m better able to figure out when nothing but a Coke will do, or when I’d be equally happy munching on a whole kiwi, skin and all (extra fiber and nutrients!)

Eating more fruit is an easy, trivial step that anyone can take to improve the quality of their diet.  Fruit is one of the best foods you can eat, from a health standpoint; it’s also likely to displace something bad (like a snack with refined starch and added sugar) that we might otherwise eat.

Better yet, I’ve never met anyone who doesn’t like fruit.  Sure, most of us have a few fruits we don’t like – I don’t like bananas, and I’ve never developed a taste for papaya – but with dozens of fruits to choose from, all of us can find a few that serve as a good side to a meal, or as a standalone snack.

Tradeoffs and Inversion: Using Salt, Fat, Acid, and Heat

The concept concretized in the above anecdote is easily extensible to diet more broadly.  Even if you don’t plan to cook – ever – Samin Nosrat’s Salt, Fat, Acid, Heat is still a wonderful read for anyone who eats food (i.e. all of us), because understanding flavors can help us make far healthier choices.  (There’s also a Netflix mini-series, which is fun to watch but less educational.)

In her book, Nosrat provides insight into some of the major components that make food tasty – craveable, even – and it turns out that with this knowledge, we can both reverse-engineer why we like a given food, and subsequently find other foods that satisfy the same cravings.

Nosrat concisely but thoroughly disaggregates good cooking into four key elements:

1. Salt.  The largest single reason why most people prefer restaurant food to home-cooked food is that almost every restaurant properly salts their food; there is an ideal level of salt that makes all food “sing” – elevating and enhancing flavors.  Too much salt makes food taste salty, but most people undersalt their food, leaving flavor potential on the table.

2. Fat.  Given that many flavor compounds (such as most spices) are more soluble in fat than they are in water, fat can help unlock and spread flavors throughout a dish.  Beyond serving as an independent source of flavor itself, fat also provides a rich, satisfying mouthfeel that enhances our enjoyment of many foods.  If you want to run an a/b test, try a really low-fat ice cream – beyond a certain point, eliminating fat eliminates all of the mouthfeel that makes ice cream appealing.

3. Acid.  Like salt, a few drops of acid (the kind found in lemons, not the 1970s) can act as a prism, enhancing flavors in a dish.  What would guacamole be without lime juice – or tabasco / barbecue sauce / ketchup without a source of tanginess, like vinegar?  Acid also seems to refresh and enliven our palates.  Nosrat observes that the reason many of us overload on cranberry relish at Thanksgiving is that it’s the only acidic food on the table.

4. Heat.  Why would we laugh someone out of the room if they tried to boil a steak?  Why do we all turn our heads at the sizzle and aroma of a platter of fajitas?  Because the application of high heat makes many foods taste better. Different types of heat are appropriate for different types of food, but in general, most food tastes better when it’s been exposed to high heat.  Something called the Maillard reaction begins to occur at 280 – 330 F (140 – 165 C), and this is responsible for the browning (and development of various flavor compounds) that makes everything from grilled meat to caramelized onions to s’mores taste good.  Given water’s boiling point of 212, foods simply cannot brown through steaming or boiling – dry heat (such as a pan, or an oven) is needed to bring foods to these temperatures, and thereby unlock their full flavor potential.

There are a few elements that Nosrat foregoes in her high level discussion, like sweetness, umami, starch, and spice, but we’ll cover those along the way.

Boiled broccoli violates three sections of the Geneva Convention.  Well, maybe not, but it violates all four sections of Salt, Fat, Acid, Heat.

Why does all of this matter?  It matters because most people pit healthy food against unhealthy food on an uneven playing field.

No person or restaurant I know would ever serve an unsalted, boiled or steamed steak.  They would serve a well-salted, well-seared steak, which checks at least three of the boxes above (salt, fat, and heat.)  Even if you sous-vide a steak or roast, as I’ve done, you always sear it afterwards in a ripping-hot cast iron skillet, to get that crust.

Yet the same people (or restaurants) who sear steak to generate Maillard flavor compounds will often serve unsalted boiled or steamed broccoli – which meets zero of the boxes above.  No fat, no salt, and no proper use of heat.

Is it, then, any wonder that most people relish steak, and treat broccoli as a chore?

If you boil your veggies, you’re gonna have a bad time.

Resolving the Asian Paradox

One of the most fascinating phenomena I’ve encountered in thinking about diet and nutrition is that – in my experience – Asian-American households do not seem to have the “kids hate vegetables” phenomenon that is so prevalent in white America.

There does not appear to be any genetic basis for this, nor does there appear to be any sort of parenting-specific reason.  Asian kids, in my experience, like Coke and mac and cheese just as much as white kids.  Yet they also quite happily tuck into their vegetables – which white kids, largely, do not.

While you could point to the strictness and discipline of Asian households as a potential difference, the majority of my white childhood friends grew up in conservative Christian households with equal or greater parental authority / discipline to Asian households.  Yet the majority of my white friends with strict parents still hated vegetables; none of my Asian friends did.

Nosrat’s book was like a lightning bolt of clarity on this issue; it immediately revealed the answer to my lifelong question: why did all my white friends hate vegetables, when I found them perfectly inoffensive?  The answer, as best I can tell, is that there’s no meaningful difference in innate preferences between Asian kids and white kids.  There is, however, a massive difference in what “vegetables” means in the two cultures.

Let’s disaggregate the differences through the lens of salt, fat, acid, heat (and spice).  My experience with “vegetables” in childhood was often through the lens of an Indian shak: the basic recipe starts with sauteing (heat) onions in a heart-healthy oil like olive or canola (fat), then adding tomatoes (acid), lots of spices, including salt, and of course vegetables in question.  Whether the vegetable in question is okra, green beans, giloda (a tiny Indian cucumber), cauliflower, pureed eggplant, or anything else, the general cooking process tends to be a riff on this theme.

This checks all of the Nosrat boxes: there’s plenty of salt, plenty of fat (the oil), plenty of heat to get Maillard flavors going (sauteed vs. boiled/steamed), and even acid (from the tomato).  Meanwhile, there’s also lots of flavorful spices – cumin, garlic, turmeric, mustard seeds, chili powder, etc.  We’re batting four for four here.

The same applies for other Asian cuisines: Chinese stir-fries (heat) with oil (fat), soy sauce (salt and umami and even some acid), and spices.  Thai curries hit all the same notes.  Again, we’re four for four here on the flavor boxes.

So Asian kids grow up eating flavorful vegetables that taste good – hence, Asian parents rarely have to bully their children into eating vegetables.  (That leaves Asian parents with more time to bully their kids into practicing piano/violin, or taking more AP courses.)

Whenever I ate vegetables, it was in this context.  So, while I liked brisket, bacon, Doritos, and Coca Cola as much as any white kid, my mom never had any problems getting me to eat my veggies.  I was just as happy eating veggies for dinner as I was eating a bacon cheeseburger for dinner.

There were, of course, certain veggies I categorically did not like – cabbage being one – but I ate the majority of others with no complaint.

By contrast, many of my white friends grew up eating vegetables that were boiled, unoiled, and unseasoned – no salt, fat, acid, OR heat!  Somewhere, Samin Nosrat is crying… while also laughing.  (Story of her life.)

Anyway, rather than being congenital vegetable-haters, my white friends were, instead, just natural haters of food that tastes bad, like most of us are.  I would’ve hated vegetables, too, if I’d grown up eating the sort of vegetables my friends were subjected to.  My own mother, in fact, hated broccoli before I started cooking because she’d only ever had it boiled or steamed; despite being a talented cook, she’d never stopped to think that broccoli could be prepared in a more interesting and tasteful way than that in which it is usually served.

So, two quick examples here – both involving broccoli, the vegetable almost synonymous with “eww” and turned-up noses (really, you can look it up in the dictionary).

The first is an email I received on subsequent days from my friend Dave R., after he’d read an early draft of this post and noticed my mention of roasted broccoli:

Roasted broccoli. 

Where were you all my life?

Roasted at 425 with extra-virgin olive oil, garlic, and salt for 20 mins in our toaster oven (our apartment does not have an oven, lol).

We loved it.

We eat broccoli all the time, but generally boiled, steamed, or sometimes raw in a salad. This was vastly better, and crazy easy

By merely changing three elements (salt, heat, and fat) of the broccoli-cooking process, Dave exponentially increased his enjoyment of broccoli.

With no offense intended to Dave’s culinary skills, it doesn’t take any fancy equipment or distinguished talent to do this.  Roasting vegetables merely takes a sheet pan, some aluminum foil, a generous glug of extra-virgin olive oil, an oven (or, as Dave observes, a countertop toaster oven), a shaker of garlic powder/salt, and less than five minutes of prep work.

So easy, a caveman could do it.

Similarly, it doesn’t take a mental models expert to do the math on this: if something tastes way better, we’re gonna eat a lot more of it.  We don’t need an empirical study proving this; we can merely observe the world around us.  What do most people eat, if given the opportunity?  Stuff that tastes good.  Indeed, Dave sent me a follow-up email the next evening:

I’m making it again tonight… it’s strange that I’m as excited for the broccoli as the [fish], lol.

Dave is hardly alone in his newfound appreciation for an understandably long-maligned vegetable – when you roast broccoli with extra-virgin olive oil, something magical happens to its flavor and texture.  My own mom, like me, was an ardent broccoli-hater who had probably consumed ten florets of broccoli, total, in the past twenty years.  The first time I tried roasting it, she consumed ten florets in twenty seconds, and then asked me why I hadn’t made more.

A second trick here is simply using spices – note that Dave used garlic.  Many foodies look down upon garlic powder because it’s not the real deal; I agree that fresh garlic has a taste that garlic powder can’t match, and I primarily use fresh garlic from whole bulbs that I peel and mince myself.

But, again, there are no points for snobbery.  Fresh garlic can be a pain to peel and dice; it also has a tendency to burn when cooking or being roasted if you’re not careful.  For more casual cooks, or someone who simply wants to improve the taste of food that’s already on their plate, garlic powder (or garlic salt) bypasses these issues.

My friend Aaron, for example, refused to eat his veggies as a kid because they were prepared traditional American style.  When he became an adult, however, like Dave above, he came to a miraculous discovery: roasting instead of boiling, and putting… garlic and salt… on vegetables… made everything taste good.  (Living in a household where having fewer than five bulbs of garlic in the fridge at any given time is grounds for calling the National Guard, my mom and I had a pretty good laugh about Aaron’s magical discovery of garlic as an adult.)

Far from avoiding his veggies, Aaron and his girlfriend recently served me a dinner comprised almost exclusively of roasted vegetables.  (With garlic salt, to be clear!)  Aaron also eagerly consumed a 100% vegetarian meal at my house – he took seconds!

Aaron the lifelong vegetable-hater, pictured here happily digging in to an ancho chile – garlic roasted acorn squash bowl filled with farro (a form of whole-grain wheat), kale, shiitake mushrooms, roasted red bell peppers, plenty of EVOO, and some smoked Gouda.

This is something I’ve heard from no fewer than half a dozen of my white friends – i.e. that they went from veggie-haters as kids to veggie-lovers as adults, once they learned how to make veggies taste good.  

To be clear, many of my white friends’ parents were equally talented cooks to my mom and my other Asian friends’ parents; I think all cuisines have their strengths and weaknesses.  However, for whatever reason, most people (of any culture or ethnicity) stick with status quo bias and prepare foods in the traditional manner that they learned from their parents, who learned from their parents, etc.

The traditional American manner of preparing roast beef or apple pie is great –  veggies, unfortunately, not so much.  The good news is that it doesn’t take any special effort or skill to learn to make veggies taste more on par with roast beef and apple pie; most everyone I know could do it!

So if you’re reading this and you’re skeptical that you could ever like veggies as much a cheeseburger and french fries, know that many people just like you have come to that exact realization.

Working With Human Nature Instead Of Against It: Learning to Leverage and Substitute Salt, Fat, Acid, and Heat (+ Spice, Sweetness, Starch, Umami) 

Let’s now return to two mental models discussed in Part 1: tradeoffs and marginal utility.  As Katz quite firmly establishes, evaluating the impact of a given dietary decision is unhelpful without thinking about the foregone dietary choices that the decision at hand necessarily crowds out.

As a brief, illustrative refresher: Coke and cookies are bad for us and nobody sensible really disputes this.  But we also know that smokers tend to have better success quitting when they give themselves something to do with their hands and mouths.  So if an afternoon Coke or cookie helped someone give up their smoking habit, I think we’d overwhelmingly agree that this would be a net positive.

Why?  The effect size of added sugar and refined starch is far less meaningful to our health than a pack of cigarettes or long-term alcoholism.  Recall that the effect size of the entire Mediterranean diet – a top-to-bottom change in what most people eat – approaches the effect size of quitting smoking.

Through this lens, I think that being puritanical about diet is counterproductive; perfect is very clearly the enemy of good.  This is for several reasons.

The first is that, as discussed extensively throughout this piece, most of what we eat is what drives most of the outcome – whether we choose to include some meat, dairy, eggs, or sugar around the edges is less important to the overall health outcome.  So if including modest portions of meat, dairy, eggs, or sugar in our diet helps us eat a healthier diet overall, then we should absolutely include those things in our diet.

The second is that, in the vein of Thaler’s Save More Tomorrow plan, it’s usually vastly more effective to work with human nature than to fight against it.  Everyone knows they should be saving more; few people actually do.  But Thaler’s plan was a clear a/b test of how effective the “try harder” approach is versus the “structural problem solving” design-centered approach.

Here’s a screengrab from the presentation: Save More Tomorrow quadrupled participants’ savings rates, which eventually rose to over 2x that of participants who declined to receive any help.

This is the best proof I can offer that structural problem solving / choice architecture – and more broadly, a thorough understanding of mental models – is the best way to solve hard problems.  Munger talks about how you get a “ lollapalooza” – a nonlinearexponential type response – when you stack mental modelsSave More Tomorrow is a great example.

As it relates to the problem at hand – why we eat badly, and how we can do better – we can apply many of Thaler’s thought patterns.  I think that one of the most obvious problems with most dietary advice – restricting ourselves, of course, to only sound, science-backed dietary advice, and avoiding hokum about lectins and carbs- is that most diets trigger loss aversion, uses up willpower, and work against our hard-wired cravings for fatty, sweet, savory, starchy, and salty foods.  Is it any wonder, then, that the research demonstrates that “just do it” is a fatally flawed diet strategy?

This is the basis on which I advocate the Mediterranean diet, with its inclusion of many flavorful components such as lots of EVOO and modest amounts of meat and cheese, over other options with similar health outcomes (such as a vegan diet) – for the average individual, MedDiet is the dietary pattern that tastes the best, as it is aligned with substantially all of our hard-wired cravings, and doesn’t require us to categorically forego any of them.

Nonetheless, no matter what we choose to eat, we can leverage our natural cravings to work for us rather than against us; this section will overview exactly how, with a big debt of gratitude to Samin Nosrat for her elegant disaggregation of food into the components that make it taste good.  I’ve added four components (spice, sweetness, starch, and umami) to her original four (salt, fat, acid, and heat.)

Some of these require tradeoffs; others are free lunches, or better – lunches that pay you to eat them.  On net, they will massively improve the quality of your diet from both a health and taste perspective, without necessitating any sacrifice.

All of these sections encourage you to “Eat More X” – which will not only make your food taste better, but will also help healthy foods compete on a more even playing field with unhealthy foods.

I am not prescriptive as to how you use these tools; I only ask that you use them to better your health, rather than worsen it.  Whether you’re trying to substitute fish or poultry for red meat, or whether you’re trying to substitute whole grains, legumes, and vegetables for animal-derived foods, most or all of these can be helpful.

We’ll start with four categories of flavor not covered in Salt, Fat, Acid, Heat – then return to the four that are covered by Nosrat.

Eat More Herbs and Spices: Bland Food Is Bad For Your Health

(Foodies: please note that I am, throughout this section, using “seasoning” to refer to the addition of herbs and spices, and “salting” to refer to the addition of salt, as such terms are more logical and familiar to a lay audience than the culinary world’s use of the term “season.”)

There is a school of culinary thought that discourages the use of lots of seasonings; the philosophy is to “let the ingredients speak for themselves.”

This school of culinary thought is bullshit.  Rubbish.  Hogwash.  Pick your favorite derogatory: the seasoning-free approach to food is just plain nonsense.

There are two separate and equally important reasons for this.  The first flaw is that bland food is an egregious crime committed against your tastebuds.  There are, of course, rare exceptions – my personal opinion is that the raw sugar snap pea cannot be improved upon, only made less perfect by human effort.  I have never managed to do anything to a sugar snap pea that made it taste better than it did straight off the vine.

But by and large, as my friend Aaron observed above, “garlic makes everything taste better.”  Herbs and spices make healthy foods taste better and thereby increase consumption of such healthy foods; there’s actually study data corroborating this:

The first goal of this study was to identify barriers for vegetable preparation and consumption among adolescents at a rural middle/high school. The second goal was to determine if students liked and preferred vegetables seasoned with herbs and spices more than plain vegetables prepared with comparable amounts of salt and oil.

Surveys conducted in the first phase of the study suggested this population is not exposed to an extensive variety of herbs and spices. Despite this, taste tests in a school setting clearly demonstrated that for most vegetables, seasoned versions were liked and preferred more than plain.

Moderate additions of dried herbs and spices significantly increased liking and preference for most vegetables over oil and salt alone. As such, this strategy may have important implications for use within the National School Lunch Program where budgets are limited and programs must adhere to strict Federal nutritional guidelines.


Despite limited spice use in this population, taste tests suggested that students liked and preferred seasoned versions more than plain for most of the vegetables.

This supports previous research in adults that found positive effects of herbs and spices on the acceptance of reduced-fat and low-sodium foods (Ghawi et al., 2014Peters et al., 2014Wang et al., 2014). It is particularly noteworthy that students liked and preferred seasoned over plain recipes, even when spices included were more novel.

For example, the dill-seasoned broccoli and the coriander-seasoned cauliflower both garnered higher ratings than plain, even though dill and coriander were rarely reported on parent, staff, or student surveys.

Admittedly, those two studies were funded by spice-peddler McCormick, so I take them with a grain of salt (pun intended).  Notwithstanding the potential for bias of many kinds, however, the results still pass the sniff test (pun also intended.)  Run your own a/b test, if you like: serve your friends any given food with herbs and spices, or without, and see which bowl or plate gets cleaned first.  No shit broccoli tastes better with garlic than without it.

A spice cabinet not only makes food taste better; it also makes food taste different – it can turn the same basic ingredient (say, sweet potatoes) into many totally unique dishes.  For example, think about the difference between savory EVOO-roasted sweet potatoes with garlic, rosemary, sage, thyme, black pepper, and chile flakes, versus a sweeter holiday-style preparation with cinnamon, nutmeg, vanilla, and a drizzle of honey or maple syrup.  (Both are excellent, by the way.)

Given our hardwired drive for novelty (see: social media apps), herbs and spices can vastly expand the palatable permutations of a limited set of ingredients.  There are only so many vegetables, but there are so many different ways to prepare them.

The second reason that bland food should be rejected is that it’s a foregone opportunity to increase consumption of plant-derived foods full of fiber and phytochemicals.  Think about it: mint and basil are leaves just like spinach or kale; peppercorns and chili peppers are fruits just like blueberries;.  Cumin and mustard seeds are seeds all the same, and what are garlic and onions, ginger and turmeric but root vegetables?

Just because we happen to call certain kinds of leaves, roots, and seeds a “spice” or “herb” rather than a “veggie” or “seed” doesn’t make them any less healthy.  As one example, turmeric consumption is very likely a contributing factor to the 10x lower incidence of colon cancer in India vs. the U.S.; I make a habit of adding a little bit of turmeric to most of my food, whether the dish is Mexican, Italian, or otherwise.

Meanwhile, rosemary and its extract are well-studied; one study notes the laundry list of rosemary’s beneficial properties:

Rosmarinus officinalis L. (family, Lamiaceae), commonly known as rosemary, is one of the most popular perennial culinary herbs cultivated all over the world. Both fresh and dried leaves of rosemary have been used for their characteristic aroma in food cooking or consumed in small amount as herbal tea, while rosemary extracts are routinely employed as natural antioxidant to improve the shelf life of perishable foods. …

Among the pharmacologically validated medicinal uses of rosemary are antibacterial [], anticancer [], antidiabetic [], anti-inflammatory and antinociceptive [], antioxidant [], antithrombotic [], antiulcerogenic [], improving cognitive deficits [], antidiuretic [], and hepatoprotective [] effects.

Seems Popeye should’ve been popping rosemary rather than spinach.

Jokes aside, an important note here is that there is reasonable evidence that rosemary can improve the health qualities of even patently unhealthy foods.  For example, if you’re a diehard burger fan, I’m not here to stand between you and your favorite food – but I am gonna ask that you consider sprinkling a little rosemary into the burger.

One study notes that due to its antioxidant properties, rosemary extract can reduce the formation of carcinogenic heterocyclic amines (HCAs) formed during the cooking of a hamburger patty by up to 90%.  If rosemary isn’t your thing, other studies have found the same effect (albeit at a much smaller magnitude) for garlic and onion added to fried beef patties.

To be clear, seasoning your steaks and hamburgers with rosemary, garlic powder, and onion flakes isn’t going to turn them into a health food, but any marginal decrease in the unhealthfulness of a hamburger is self-obviously a good thing.  And even if you primarily eat food prepared by restaurants, adding some spices on top will still have some positive impact.

To help demonstrate the potential magnitude of impact, here is a visual demonstration.  Ancho chile powder is a heatless / non-spicy chile powder, like paprika, that gives much of Southwestern and Mexican cuisine – everything from mole to Texas Red chili to a platter of sizzling chicken or beef fajitas – its characteristic red-brown color and complex, smoky flavor.

Ancho chile is often described as having a somewhat raisin-y taste, although in a savory way.  It adds subtle depth to food; you often can’t identify it directly, but – like garlic – a little bit makes most things taste better.

Ancho chile is the red, dried version of the poblano pepper, which looks like this when it’s green:

One of those chiles would equate to roughly a serving of fruits or vegetables (how you classify it is less relevant).  One of those same chiles, ripened and dried and ground up, equates to a tablespoon or so of chile powder.  A tablespoon of sugar, for comparison, looks like this against my hand:

Not a lot, right?  How does it manage to shrink so much?  Well, most people don’t realize that many fruits and vegetables are 80 -90 percent water by weight, so when you dehydrate a fruit or vegetable, you’re left with a really small remainder.  1 tablespoon of onion powder equates to one medium onion, etc.

It still astonishes me whenever I see it happen.  I once dehydrated a large salad bowl of fresh homegrown basil, and after it was dried and crumbled, I didn’t even have enough to fill a standard-sized spice jar.

Vis-a-vis the amount of food you eat in a day, a tablespoon of ground herbs and spices is an achievable amount to add to your diet; this is equivalent to another full serving of fruits or vegetables – the equivalent of a small side salad or a medium apple.  Each incremental serving of fruits or vegetables represents a roughly ~5% decrement in your cardiovascular risk.

If that sounds like something to scoff at, consider that the average American eats fewer than three servings of fruits and vegetables per day, so if the average American merely poured on the paprika and garlic powder to the cheeseburger and fries they were already eating, they’d be increasing their fruit/vegetable consumption by a non-trivial 30%.

1 tablespoon of ancho chile powder, meanwhile, contains about 4 grams of fiber, which would represent a 25% increase to the ~15 grams of fiber that the average American consumes in a day.

The potential array of herbs and spices are vast; while there are some (garlic, rosemary, paprika) that are familiar to most all of us and can be added to almost any savory food, others are more exotic (sumac, star anise) and more niche in their use profiles.

A variety, nonetheless, will not only directly benefit our health modestly, but also create far more massive indirect n-order impacts on the quality of our diet, by helping put healthy plant-based foods on a more even playing field with dairy, meat, and refined starches.

So, consider starting an herb garden, even if you live in a studio apartment with a tiny window.  Many herbs (like rosemary, sage, and thyme) will tolerate all sorts of abuse and still produce.  And at the very least, spend more time in the spice aisle of your favorite grocery store.

Eat More Sweetness: A Spoonful Of Sugar Makes The Medicine Go Down…

Sugar gets a bad rap.  It is not poison; it is not our enemy.  It is, undoubtedly, component of our diet that is bad for us, and most of us should be eating much less of it.  There is no nutritional justification for frequent consumption of cake, cookies, or Coca-Cola.

But sugar is hardly the only bad component of our diet, and context matters: in some of its forms, added sugar is clearly not the worst part of our diet (we review the evidence in some depth here).  So we need to be careful not to throw the baby out with the bathwater; trying to eliminate all added sugar is likely a counterproductive goal.

For some historical context, it is not coincidental that even prior to the modern era, pretty much every major cuisine has its own long legacy of sweets and desserts.  Sugar and sweetness are not  a love that was forced on us by evil, conniving food-company executives.

Sweets are things we’ve always wanted, and always will.  There is a reason we call our loved ones “sweetie pie” or “honey” rather than “bacon” or “beef jerky.”  There is a reason that crushes are called “sweethearts” and not “beef hearts.”  We may like meat, but sugar always has been, and always will be, what our heart yearns for.

I am somewhat less fond than many people of the “food-industrial complex” line of argumentation regarding our societal sweet tooth for several reasons.  One reason is that I don’t really put much stock in either conspiracy theories, or lines of argumentation that blame institutions rather than human nature (the latter of which is usually a far more likely villain in any story.)

"Earn It" Coca Cola Commercial
My favorite commercial of all time.

However, the primary reason I disagree is that I strongly believe that companies like Pepsi / Frito-Lay and McDonald’s are more just responding to basic human drives rather than actively shaping them.  I don’t think Coca-Cola is evil; I think that per consumer dollar spent, Coca-Cola probably creates, in aggregate, more human happiness than any other company on the planet.

Whatever the undoubtedly negative health consequences of Coke may be, that’s worth something in my book.  I would never invest in a tobacco company, but I’d have no problem investing in Coca-Cola.

Our love for fat and sugar long predates the Golden Arches; to argue that it’s been conditioned into us by Big Food is absurd.  If you’ve read classic American fiction – The YearlingThe Adventures of Huckleberry Finn, The Grapes of Wrath – you’ve undoubtedly encountered plenty of characters with food preferences (salt, fat, sweet) largely similar to modern humans.

Kids in the 1700s and 1800s dreamed about molasses and scarfed down anything their momma cooked with bacon grease.

These are historical records, of a sort, demonstrating that we needed no bamboozling to learn to love the foods that we love.  Our thirst for salt, fat, and sweet is self-obviously a non-conditioned biological drive every bit as innate and fundamental as our pursuit of status, sex, or social connection.

We have not been tricked into anything; we like what we like.  A baby raised in isolation on a desert island would prefer a sweeter pineapple to a mouth-puckeringly sour one.  Our sugar consumption, in fact, increased far more – in both absolute and percentage terms – from 1820 to 1920 than it did from 1920 through today (roughly 2020) – bear in mind that sugar consumption has fallen farther since 2005, so the current state of the blue line would be closer to the red line:

Given that sugar consumption has been largely flat since the early 1900s – when obesity was not as much of a thing today – it is difficult to ascribe to sugar sole blame for obesity.  It is a contributing factor, but not the only factor.

Nor can you blame Coca Cola for all of it.  Indeed, dozens of millennia before Coca-Cola existed, we would eat honey whenever we found it – and honey is an order of magnitude sweeter than Coca-Cola.  1 tablespoon of honey contains 17 grams of sugar; 1 tablespoon of Coke contains about a tenth of that – 1.6 grams.

To our taste buds, Coca Cola, in other words, is basically 1 part honey, 9 parts water; a can of Coke contains the same amount of sugar as merely two tablespoons of honey.  It is difficult to plausibly argue that Coke tricked us into liking sugar when honey arrived millions of years before – with ten times the sweetness.

Moreover, astounding levels of honey consumption in hunter-gatherer tribes doesn’t appear to lead to all the modern ills that are solely blamed on sugar.  As one observer, Stephan Guyenet, observes:

A well-studied Tanzanian hunter-gatherer tribe called the Hadza gets 15 percent of its average year-round calorie intake from honey, plus fruit sugar on top of it. This approximates US sugar intake, yet the Hadza do not exhibit obesity, cardiovascular disease, or any of the other disorders Taubes attributes to sugar (1011). In fact, many hunter-gatherer groups relied heavily on honey historically, including the Mbuti of the Congo whose diet was up to 80 percent honey during the rainy season (10). Yet they do not exhibit obesity or insulin resistance (12).

And then there’s the previously-discussed fact that per capita sugar consumption has been declining since 2000 (according to multiple data sources).  Finally, there’s the fact that vegetarian and vegan diets are almost always found to be health-promoting vis-a-vis ominvore diets, even though vegans and vegetarians tend to consume as much sugar – if not more, on a relative basis – than omnivores.  Based on the preponderance of evidence, it’s not remotely reasonable to blame sugar consumption for all of our dietary woes.

If sugar were the only problem with our diet, then health outcomes would be getting better as sugar consumption declines- instead, they continue to rise, suggesting that there are many things about our diet that are bad (of which sugar is merely one.)  It is good that we are eating less sugar, but that is not enough, and eliminating sugar alone does not automatically make a diet healthy.  The all-meat-and-dairy “carnivore” diet has no sugar – but also has nothing that’s good for us; from a health perspective, it’s likely as bad, if not much worse (given absolutely no fruit/veggie consumption) than the standard American diet today.

It is amusing that many people point to a Big Sugar conspiracy theory, blaming all of our health ills on Coca-Cola and the like, without stopping to consider that Big Dairy and Big Beef might, themselves, have incentives to put all the blame on Coca Cola.  In reality, we should be eating less dairy, less added sugar, AND less beef – just because one is a problem with our diet does not preclude the other two also being problems with our diet.

Again, I’m not saying we should all eat lots of sugar, and certainly not travel-sized sugar-sweetened beverages – please don’t get me wrong.  But it’s a bit concerning that some people take the view of “sugar is THE problem,” because this opens the door to nonsense like “cut out all sugar, but eat all the red meat and butter you want.”

It’s not at all clear that such an approach leads to better health; certainly neither “lots of red meat and butter” nor “lots of added sugar” are health-optimizing diets; it is strange that many people today vilify the latter while championing the former.

We should reject both, and instead not make either sugar or red meat out as the “only” enemy to be eliminated at all costs (even if that means eating way more of the other).  They should both be viewed as foods that we should minimize consumption of when possible, and eat only in the context of a broadly healthy diet.  We can eat a little of both, but not too much of either, and certainly not too much of both at the same time!

In the context of our diets, of course, we should view our enjoyment of sweetness as a trait – one that was adaptive through much of our existence, but is (broadly speaking) maladaptive today.

The beauty of the trait adaptivity model is that it reframes “strengths” and “weaknesses” in a more helpful context-dependent framework.  The winter coat of a moose that enables it to survive harsh Canadian winters will make it heat-stressed at anything above freezing.  That doesn’t make the coat good or bad; it means that the moose is well-suited to live in northern Minnesota, but not southern Mexico.

And so it is with our sweet tooth: we can either fight it, or we can use it.  Satisfying it with standalone fruit consumption, as discussed earlier, is a win-win: we’re happy, and our bodies are healthier.

But that doesn’t have to be the end.  Many foods taste better with some sweetness.  It is not coincidental or accidental that popular condiments like ketchup, barbecue sauce, sweet-and-sour sauce, and honey mustard all have sugar in them.

Through this lens, trying to avoid sugar always and everywhere seems to be a counterproductive effort to fight our true selves.  Damage control seems far wiser: if we know we’re gonna end up eating sugar anyway, isn’t it better to eat a little of it in a good way than to eat a lot of it in a bad way?

There is certainly no nutritional justification for consuming a 700-calorie Lemonberry Slush from Sonic.  But to paint all sugar with the same brush is as reductionistic as vegans like Greger painting salmon and bacon with the same brush: one is great for our health, the other is horrible.  Overgeneralization is counterproductive; just as it’s far more tenable for most people to eat a diet with fish than without, it’s similarly far more tenable for most people to eat a diet with some added sugar than without.

Here’s the evidence trail.  We know, first of all, that when sugar is consumed in the form of unaltered fruits or vegetables, it is a free lunch – sugar intrinsic to whole plant-based foods has no negative effects whatsoever in any dose.  There is no research – none – suggesting that the routine consumption of whole blueberries, oranges, sweet potatoes, sugar snap peas, or carrots is bad for human health, notwithstanding the high natural sugar content of these foods.  As we’ll explore in the next section, the sweet potato in fact comprised 50 – 75% of calories in one of the healthiest diets ever studied.

Using fruits and vegetables as natural sources of sweetness is, thus, not only non-harmful, but actively advisable: fruits make for a great standalone snack.  Carrots can provide subtle sweetness to many dishes along with plenty of vitamins and fibe.  Berries in a salad provide their own health benefits while also making the spring mix more enjoyable to eat.

What may come as a surprise to many people, however, is that added sugar is also hardly the bugaboo it’s often made out to be.  I am not suggesting that added sugar has any direct health benefits; I believe the opposite is true – i.e. that added sugar, depending on context, is somewhere between “neutral” and “very bad.”  But I think we should strategically leverage it anyway; sugar can act as a natural incentive and thereby, via n-order impacts, lead to better health overall.

Here’s why: many foods with added sugar actually confer substantial net health benefit, notwithstanding the likely negative health impact of their contained added sugar.  The most obvious example is dark chocolate, which is found to confer net health benefit despite not only having significant saturated fat content (neutral at best, though cocoa butter is likely less harmful than many other forms of saturated fat), as well as substantial added sugar.

In other words, the positive health benefits of the beneficial components in chocolate (minerals, flavonols, fiber) are so profound that they can withstand significant addition of neutral-to-bad components (cocoa butter, plain white sugar) and still confer net health benefit.  Very few of my suggestions below will result in nearly as much sugar added as a bar of dark chocolate, and none require the addition of such amounts of saturated fat.

Now, it is worth noting that these studies do generally tend to find that sugar-free cocoa has an equal to greater health impact to sugared cocoa; i.e. sugar is not the component of the dark chocolate which is good for us (duh, sugar is anot a health food).  This begs the obvious question: wouldn’t it be better for us to all eat sugar-free chocolate? 

This question would completely ignore the fundamental truth about why people eat dark chocolate in the first place: because it tastes good.  Even as a chocoholic, I can’t eat 90% dark chocolate (I typically eat 70%.)  

From a taste perspective, sweetness offsets bitterness; pure cocoa powder, without added sweetness, isn’t just damn near inedible – it is actually inedible.  (really, try some – even if you’re a chocolate lover, it’s revolting.) 

Nobody I know could, let alone would, eat unsweetened chocolate.  Conversely, lots of people I know love to eat dark chocolate – not because it’s a health food, but because it frickin’ tastes good.  So the sweetened dark chocolate we do eat is better for us, in reality, than the hypothetical unsweetened dark chocolate we’re never actually going to eat.

The concept extends more broadly: I strongly believe that in many instances, as Mary Poppins might say, “a spoonful of sugar makes the medicine go down.”  Whole wheat, for example, has a somewhat bitter taste that many people, including myself, find unpleasant. 

But 2-3 added tablespoons of honey in a whole-wheat loaf adds 100 – 150 calories worth of sugar to 1500 – 2000 calories worth of whole wheat, milled flaxseed, EVOO, and various seeds.  While the honey is likely independently a negative, calling back to the chocolate discussion above, there is no plausible scenario in which 10 – 20 calories worth of added sugar per slice mitigates the meaningful, well-documented health benefits of whole grain consumption.  A slice of honey-whole-wheat bread is infinitely superior to 95% of other foods we could/would choose to eat instead; the slightly sweetened whole wheat bread we actually eat is far better for our health than the puritanical, bitter, unsweetened whole wheat bread we never eat.

Amidst all this, it is worth noting that the harms of sugar are different than those of, say, red or processed meat.  Most of the harms of red and processed meat accrue regardless of our overall health and nutrition status; bacon is carcinogenic whether we are ripped or morbidly obese.  Sugar is a little bit different – it does not appear to be carcinogenic, nor is it strongly insulinemic (as all animal protein is.)

Rather, a substantial portion, and perhaps a majority, of its ill effects, tend to be from promoting weight gain due to a lack of satiety – consumed sugar doesn’t make us full, so we end up eating more calories with added sugar than without it.  Thus, even though the added sugar itself may not be directly harmful, it makes it easier for us to gain weight, and thereby exerts negative effects through the intermediary mechanism of weight gain.

This appears to be particularly true for sweetened beverages (i.e. the entire Sonic menu.)  One study, for example, found that added sugars in solid food – whether intrinsic or extrinsic – were not pro-inflammatory, whereas added sugars in beverages were:

Higher intakes of sugars from non-alcoholic beverages and sugar added to tea, coffee, cereal were associated with glycaemia and inflammatory markers. Sugars from solids were not associated, irrespective of whether they were intrinsic or extrinsic. Positive associations of free sugars were largely explained by contribution of beverages to intake.

Other studies have noted that there’s no clear answer to whether or not sugar has negative health effects independently, or whether these are merely an artifact of sugar’s lack of satiety, and, therefore, its contribution to weight gain as a source of excess calories that is not offset by calorie reduction elsewhere.

As further evidence of this, fruit juice – which, similarly, would not promote satiety – has been linked to negative outcomes, despite whole fruit being massively positive.  It is obviously somewhat strange that the apple juice inside of an apple we eat is non-harmful and likely actually positive, to the extent that there is literally no ceiling to healthy sugar consumption inside of an apple, but that same sugar is somehow harmful once extracted from the apple and the fiber it contains, even though many of the other nutrients come along for the ride.

Satiety is a compelling explanation, as many studies have found, for example, that once you control for energy intake, fruit juice shifts from negative to neutral – and perhaps even positive – in childrens’ diets.  One review notes:

Twenty-two studies on weight status provided evidence that did not support an association between 100% fruit juice consumption and weight/adiposity in children after controlling for energy intake.

Limited evidence from eight studies suggests that children consuming 100% fruit juice have higher intake and adequacy of dietary fiber, vitamin C, magnesium, and potassium. Differences in methodology and study designs preclude causal determination of 100% fruit juice as sole influencer of weight status or nutrient intake/adequacy of shortfall nutrients.

In context of a healthy dietary pattern, evidence suggests that consumption of 100% fruit juice may provide beneficial nutrients without contributing to pediatric obesity.

The takeaway here is that if added sugar consumption occurs in the context of a healthy diet that doesn’t contain excess calories, it’s not linked to weight gain.  Of course, added sugar makes it easier to gain weight, so I’m certainly not suggesting that we should go hog wild.  But as we’ve explored thoroughly, the “Eat Less Tomorrow” paradigm of deprivation has failed – so rather than trying to eat no sugar, we should instead try to limit our sugar consumption to a healthy context.

Another analysis looking at sugar from a broader perspective discusses this confounding effect, noting that some analyses have found no impact from sugar on inflammation if weight or calorie intake were fully controlled for:

Because obesity and sugar intake are closely linked (at least with respect to SSB) on the one hand, and obesity and inflammation are closely linked on the other, it is certainly possible that weight gain is a potential mediator in the association between sugar intake and inflammation. In this context, it is of interest to separately investigate the eucaloric and hypercaloric effects of dietary sugars on inflammatory markers, as the former can give relevant information on the metabolic pathways linking sugar and inflammation, whereas the latter informs on the public health relevance for inflammatory biomarkers in a hypercaloric setting, as is often the case in real-world intakes. The question of whether it is excess energy intake or excess sugar intake that leads to adverse health outcomes requires further research. Similar work was done in a review by Sievenpiper et al., who found that fructose intake only affected weight gain in hypercaloric versus isocaloric trials [].

Considering the relationship between obesity and low-grade inflammation, a discussion of the change in body weight in the included trials would be relevant. Two studies included in this review observed that weight loss resulting from energy-restricted diets was associated with greater improvements in inflammatory markers (regardless of fructose-intake amounts) [,]. The remainder of the studies did not take changes in weight into account. Future studies interested in the association between dietary sugar intake and low-grade inflammation should bear in mind that weight loss may mediate the results [].

The corollary to this, obviously, is that some or most (though certainly perhaps not all) of sugar’s health effects are mitigated if we eat it in a context that does not promote an unhealthy weight.  This is not to say that sugar cannot be pro-inflammatory on its own, or that it does not have any negative independent impacts (I do believe it does.)

Rather, however, if we control for sugar’s effect on weight, then its effects in the context of a healthy diet that allows us to maintain a healthy weight are far more muted than its effects outside of the context of a healthy diet.

Said differently, the negative effects of red meat consumption don’t change much from the base rate regardless of our BMI; the TMAO / L-carnitine, heme iron, and other pathways / mechanisms are not, to the best of my understanding, changed by other factors in our diet.  However, in the context of a healthy weight and a generally healthy, plant-centric diet that does not promote overeating, the negative effects of sugar and other refined starch consumption are seemingly quite meaningfully mitigated.

In any event, the effect size of direct added sugar harms seems to be far smaller than the effect size of direct red meat harms; as such, it is  hypocritical that many shout about the (somewhat-bad and context-dependent) dangers of added sugar while extolling (known dangerous and non-context-dependent) red meat consumption.

It is sensible to reduce our consumption of both, but in the context of a generally healthy diet that maintains a healthy weight, it seems likely that modest added sugar / refined starch consumption is less overtly harmful than isocaloric consumption of red meat, and particularly processed red meat (like bacon.)  Consider, for example, the negative health results of the low-carb / high animal protein diets discussed earlier; this is at least suggestive that replacing sugar (and metabolically-similar refined starches) with lots of meat – including both red meat and poultry – doesn’t actually drive better health outcomes.

Based on my reading, I’m far less concerned with eating a little sugar than I am with eating a little steak or bacon, given that the latter categories appear to be likely carcinogens independent of the rest of our diet, whereas sugar is not a carcinogen and its impact on our health seems largely tied to its role in perpetuating metabolic syndrome – so all things considered, since I’m very far away from metabolic syndrome, a little sugar concerns me far less than a little bacon.

Even for someone with metabolic syndrome (a large percentage of the population), the added sugar in a Kind Bar, like a little bit of honey drizzled on broccoli, is not public enemy #1 – and it doesn’t do anyone any good to suggest that we’d be better off eating less fruit, Kind bars, dark chocolate, sweet potatoes, and slightly-sweetened broccoli or salads, and instead gorge ourselves on red meat, butter, and bacon.

The easier way for those of us with metabolic syndrome to fix overconsumption of sugar is not to avoid it at all costs – as we’ve seen, these sorts of deprivation approaches have a horrible base rate and mostly fail.

A smarter approach is to satisfy our sweet tooth in helpful, healthful ways – through sweet potatoes and blueberries instead of Coke and Cake; through a little sweetness added to our salads, vegetables, and whole-wheat breads instead of a lot added to the BBQ sauce on our brisket.  The likely n-order impact, as I discussed above with regards to my fruit consumption, is that our desire for added-sugar goodies like Coke, cake, and cookies will naturally decrease thanks to our natural feedback mechanisms.  Adding a little sugar to fiber-rich real foods satisfies our sweet tooth while triggering satiety mechanisms.

To be clear!  This does not make apple pie a health food.  Nor does it mean that we should chug Coca-Cola; I still drink Coke because I like it, but I am in no way deluding myself into believing that it is a neutral, let alone positive, component of my diet – and, as discussed, I have materially reduced my consumption of sweetened beverages over time.  Sweetened beverages are bad; the only question is “how bad.”

However, in the course of our daily eating and cooking, as long as we’re operating in the right context, we shouldn’t be overly worried about adding a little sugar ourselves, or eating foods with added sugars.

As one example, for those of us (i.e. many) with busy schedules who don’t have time to cook, Kind bars – full of whole grains and/or nuts and/or dark chocolate, with a modest amount of added sugar – are a perfectly healthy snack.  Even if you believed they’re a plus-seven rather than plus-ten, few of us are going to eat raw kale for a snack – so Kind bars are superior to the vast majority of other realistic options we do have.  Between potato chips, mozzarella sticks, or a Kind bar, it’s no contest as to which is best for our health.

Meanwhile, my mom made a (fantastic) vegetarian chili that turned out to be missing a little salt, lime juice, and – last but not least – sweetness.  I figured this out using my palate, but later discovered – with a grin – that Dean Fearing’s classic recipe for Texas Red includes orange juice (providing both sweetness and acid.)

Similarly, the bitterness of kale vanishes in a salad dressing with a little sweetness and some acid.  For the same reason, I always add a pinch of sugar or a drizzle of honey to tahini or pesto, as the tiny hit of sugar neutralizes some of the inherent bitterness of sesame seeds and basil leaves.

To return to our roasted broccoli recipe, Aaron (the aforementioned veggie hater-turned-aficionado) likes to add a little honey and a sprinkle of sesame seeds to his roasted broccoli – and it tastes great.  I do something similar with broccolini, drizzling maple syrup across it after it’s roasted.  If a tablespoon of honey or maple syrup gets us to eat a pound of broccoli, it’s a tradeoff that’s well-worth it in my book.   

I’m not an oatmeal person myself, but it again would be extremely difficult, on the basis of the literature, to suggest that oatmeal with apples and some cinnamon sugar is anything but an extremely nutritious, health-promoting breakfast.

Consuming slightly sweetened vegetables or grains is not only directly health-promoting, but has the likely n-order impact of making us hanker after that cookie or soda less than we would otherwise.

As a reminder, I have not encountered any compelling evidence – none – suggesting that the edges of our diet matter very much.  As I’ve mentioned repeatedly, vegan, Mediterranean, and pescatarian diets can all be paths to good health, despite the fact that all of these diets tend to contain at least a few hundred calories per day of neutral-to-worse foods.  MedDiet includes cheese as well as occasional red meat, for example; many vegan diets tend to include a meaningful chunk of refined grains.

So, live a little.  Find ways to make the healthy food you want to eat a little sweeter, and reap the health rewards – as well as the smiles.

Eat More … Potatoes and Pasta?  Collaring Runaway Public Opinion On Starch

Closely linked to sugar, of course, is starch; right behind the advice to slash sugar is the advice to cut down on starchy foods.  I literally know not a single person who would agree with the statement “starchy foods are good for your health.”  Everyone thinks they’re bad; we feel guilty about eating starchy foods even if we eat them.

As with sugar, this is an area where the baby has been thrown out with the bathwater.

To be clear: highly refined starches are, unquestionably, anywhere on the scale from neutral to bad.  White bread / white rice are nutritionally vacuous and should only be eaten sparingly for the sake of taste.  There is not much to debate on these topics.

I have, on the basis of the evidence, eliminated the vast majority of refined grains from my diet.  I categorically do not eat white bread, white rice, or so on unless there is an extremely compelling reason to do so; I’ll make the occasional exception for biscuits (hey I’m Southern, ok?), and I do sometimes include a small portion of white flour in my 80%+ whole-wheat bread for the sake of texture.  (I like it just fine 100% whole-wheat but my mom prefers it 80%-ish).  I also have whole wheat Goldfish every once in a while, although they still contain some white flour.  That notwithstanding, I even make my brownies and crumble toppings with whole-wheat now.

However, not all starches are white rice or white flour, and this is an important distinction.  Plenty of other starchy foods are fine – great, even – but are thrown out via guilt-by-association. 

Let’s start with the most compelling evidence that exists.  The high-carb, low-fat, low-protein Okinawan diet – one of the nutritional “gold standards” for health and longevity – was half-or-more comprised by the purple sweet potato:

For example, the staple of the Okinawan diet was the ubiquitous sweet potato—not rice or other grains. Over half of daily caloric intake was from these colorful sweet tasting tuberous roots from the morning glory family.

Some analyses peg this number at up to 70% of daily caloric consumption.

Now, look.  For those of you who’ve never seen let alone eaten a purple sweet potato – that thing is frickin’ starchy.

It is, in fact, way less sweet, and way more starchy, than the kind of “sweet potatoes” that most of us are accustomed to eating (my own preference being jewel / garnet yams, which are not actually yams, but are actually phenomenal.)  Purple sweet potatoes are absurdly starchy; it’s like if Mr. and Mrs. Starch had a baby, and raised it on a diet of pure starch, and then dyed it purple.

You can, in fact, make mashed beni imo that looks exactly like American mashed potatoes with purple food dye.  Here is a picture of mashed purple sweet potatoes with no additives:

How baked Stokes sweet potatoes look straight out of the oven. Photo doesn’t do it justice; it’s more purple/violet than pink.

It is worth noting that my picture above used “Stokes” purple sweet potatoes (which are purple-skinned) rather than the Okinawan purple sweet potatoes, which are white-skinned (though purple-fleshed).  However, given both are purple-fleshed Ipomoea batatas cultivars with high anthocyanin content and reasonably consistent texture/taste (most recipes I found noted that Stokes and Okinawan purple sweet potatoes are interchangeable), there is likely no particularly meaningful nutritional difference between the two cultivars.  One may be slightly better than the other, but this falls in the bucket of “largely irrelevant nuance.”

Earlier, I noted that absent all the other evidence, the simple fact that EVOO comprises 30 – 40%+ of the gold-standard Mediterranean Diet makes it clear that extra-virgin olive oil cannot be anything but profoundly health-promoting,  The math just doesn’t work otherwise: considering we know that MedDiet has some neutral-to-negative components (modest portions of meat, sweets, and dairy), you can’t get to gold-standard health outcomes without pretty much all other components being vastly health-promoting.

Well, the evidence is, if anything, even more extremely in favor of the starchy-as-!@#$ Okinawan sweet potato: given everything we know about human health, it would be extraordinarily difficult for the Okinawan diet to be anywhere close to health-promoting – let alone global gold standard – if the Okinawan sweet potato were anything other than 100% grade-A genuine health food.  (It’s also implausible to attribute all the health benefits solely to anthocyanins; as such, any Ipomoea batatas – the normal orange kind, or otherwise – seems likely to be as health-promoting as any other vegetable, and a sensible food to make a large portion of your diet.)

So, clearly, starchiness itself is not a bad thing – one of the world’s healthiest-known diets was based overwhelmingly on a single, very-starchy staple food.  This is good, because starch, like sugar, is one of our fundamental, hardwired loves.

We have already, thoroughly, debunked the myth that “carbs” are generically bad; the quality of the food contributing the carb, protein, or fat is all we need to care about – not the specific mix of carb, protein, or fat itself (which is irrelevant, from a health/nutrition standpoint.)

Starch is, of course, a slightly more specific subset of “carbs.”  Most everyone who isn’t insane or in the throes of confirmation bias can agree that broccoli, lentils, and nuts are good for you.  However, there’s more reasonable debate on other “warm, carb-y things” (as a friend of a friend likes to call them.)

Potatoes are a surprising example: I had the general impression that they were somewhere between neutral and bad, and… that’s actually probably not true; they’re probably somewhere between good and very good, although how good exactly is hard to tell.  We can make a probabilistic assessment, but likely can’t arrive at the same strength of conclusions we can for, say, broccoli or blueberries.

If this seems confusing, consider the problems of guilt by association.  Katz, in his book, notes – under a section titled “guilt by association” – the difficulties of removing confounding from analysis of the healthfulness (or lack thereof) of eggs:

If I were to say “_______ and eggs” to you, what’s the first thing that comes to your mind to fill in the blank?… I bet you will be in the overwhelming majority if you go with “bacon.” …

In a study of eggs and atherosclerosis, such items as bacon and ham are “confounders” if (a) people who eat more eggs eat more bacon; and (b) people who eat more bacon have more atherosclerosis.

When these conditions are met, eggs may appear to be directly linked to vascular disease without contributing to it at all, or nominally. Eggs could be implicated by mere association. The remedy, and only a partial one in all observational studies, is controlling for obvious confounders in the analysis.

Potatoes, too, seem guilty by association.  Some studies indeed do find negative associational outcomes from potato consumption, but this may not be the fault of the potato – but rather, what’s on it, or what’s besides it (probably some red meat and soda.)

Setting aside the red meat and soda that potatoes are often served with, think about the forms in which most of us most commonly eat potatoes.  It is reasonably clear that potato chips, McDonald’s french fries, loaded baked potatoes with more sour cream, Cheddar, and bacon than actual potato, or Joel Robuchon’s pommes puree are not health foods.  (As an aside, a Michelin star for figuring out that potatoes taste good when you mix them with butter in a 2:1 ratio?  Really, it tastes good when you mix 1 pound of butter and two pounds of potatoes?  No shit it tastes good, but a Michelin star, I don’t know about that.)

Pommes puree aside, none of us consider broccoli-cheese soup (or casserole) a health food, for the obvious reason that if you drown a stalk or two of broccoli in a Texas-sized vat of cheese, whatever positive health effects the broccoli has are washed out by the cheese, which is somewhere between neutral and bad (doesn’t really matter much exactly where).  But this does not, importantly, make broccoli bad for you just because one of the most common forms of broccoli consumption in the U.S. happens to be broccoli drowning in a sea of Velveeta.

And this is, I think, what has happened with some foods like the humble potato.  The potato is, after all, an unrefined plant food.  The base rate is overwhelmingly in favor of unrefined plant foods, so the potato – rather than being guilty until proven innocent – should be, I think, treated as innocent until proven guilty.

Some researchers make just that point:

In the United States, however, the potato is often maligned for contributing to obesity and diabetes. As American writer Jean Kerr once said, “If you have formed the habit of checking on every new diet that comes along, you will find that, mercifully, they all blur together, leaving you with only one definite piece of information: French-fried potatoes are out.” In fact, potatoes are shunned on weight-loss diets with little scientific evidence that they contribute to weight gain… However, because not all potatoes are fried, their relegation to the Western dietary pattern seems arbitrary and judgmental.


Although the white potato is a vegetable common to all ethnic groups and food cultures, only the white potato was arbitrarily eliminated from the white vegetable and fruit group in a study of fruit and vegetable consumption by color and incidence of stroke ()….

In addition, a recent meta-analysis showed that potassium intake is associated with reduced risk of stroke. For every 1000-mg increase in dietary potassium, the risk of stroke declined by 11% (). White potatoes are one of the highest sources of potassium in the American diet, with 1 small baked potato providing ∼740 mg of potassium (). Including white potatoes in the white fruit and vegetable group may have further reduced the risk of stroke associated with this group in the Oude Griep et al. () study.


White potatoes are a good source of several critical nutrients: potassium, magnesium, dietary fiber, and vitamin B-6 ()….

Potatoes are also a good source of phytochemicals, many of which function as antioxidants. The total phenolic antioxidant index for potatoes was estimated to be 124.5 mg vitamin C equivalents/150 g of fresh weight, 13% of which was derived from the ascorbic acid content with the balance derived from carotenoid and phenolic compounds…

White potatoes have historically been a staple food for many cultures and continue to be an inexpensive nutrient source around the world. Unfortunately, the white potato has been labeled as a “food to avoid” because of inconsistent epidemiologic research showing that a “Western” dietary pattern, which included all white potatoes regardless of preparation method, was linked to weight gain and increased risk of type 2 diabetes.

Consequently, the role of white potatoes in providing a low-cost source of critical nutrients, high-quality protein, and a satiating carbohydrate is ignored. White potatoes are typically grouped with “other” or “starchy” vegetables in food guides, but these subgroups do not adequately describe the energy, vitamin, mineral, and phytochemical contributions that white potatoes make to the diet.

Raise your hand if you knew that potatoes were a rich source of potassium and a good source of vitamin C?  Anyone?  I so would not have called this, but one medium potato provides almost as much vitamin C as a small orange, and over twice the potassium of a medium banana.  Maybe potatoes aren’t the enemy we think they are; they just spent the past five decades running a long-term undercover op in the lair of Bacon, Sour Cream, and Cheese, while also hanging out with the wrong crowd (Soda and Red Meat).

Other researchers note that – for both white potatoes, and other white vegetables in general, such as parsnips and kohlrabi – color is only a marker for some (not all) polyphenols and nutrients, such that white vegetables are unfairly penalized by both public perception and dietary guidelines promulgated by various organizations that promote “eating the rainbow” (something I, admittedly, try to do myself – get in my greens and oranges and reds and blues and etc.)

It turns out that potatoes actually contain enough antioxidant phenolics that they, alone, represent fully a quarter of phenolics in the American diet:

Barnes et al. () suggest that color is not necessarily a guide to what or how much beneficial or toxic phytochemicals are present in what we eat. Plant-based foods contain, in addition to micro- and macronutrients, several classes of phytochemicals. In many cases, phytochemicals account for the (various) colors of foods. Although aesthetically pleasing, the colors of food may mislead the consumer as to the effective content of nutrients and phytochemicals.

Human vision is limited to a small window (390–765 nm) of the electromagnetic spectrum. For other creatures, being able to see in the ultraviolet range allows bees to locate the pollen-rich region of a flower, whereas others (e.g., a pit viper) can visualize their prey being “seen” in the infrared area of the electromagnetic spectrum.

Many important nutrients, such as vitamin C, have no absorbance in the electromagnetic spectrum range visible to humans. Therefore, the human eye cannot judge directly the vitamin C content of a food. Other nutrients for which color is not an accurate measure include potassium, dietary fiber, calcium, and vitamin D were identified as nutrients of concern in the 2010 Dietary Guidelines for Americans due to low levels of intake ().

Color can be an indicator of certain phytochemicals, but not others. This is particularly true of the polyphenols, a broad class of compounds with antioxidant and other health benefits. Three major classes of phytochemicals in foods are colored: carotenoids (colors from yellow to red), chlorophylls (green), and anthocyanins (blue, purple, and red). The latter are a particular type of flavonoid in the general family of polyphenols, the majority of which are not colored. Thus, the authors point out that color-based dietary guidance is an inaccurate approach for overall flavonoid content, which will overemphasize the importance of anthocyanin-containing foods versus those containing colorless flavonoids.


Liu () reviews the health-promoting compounds in fruits and vegetables, in particular, the phytochemical categories of phenolics (including flavonoids) and carotenoids. He notes that phenolic compounds are not limited to fruits and vegetables with bright colors. For example, potatoes contain substantial amounts of phenolics, including flavonoids (quercetin and kaempferol), phenolic acids (gallic acid, chlorogenic acid, and caffeic acid), and contribute 25% of vegetable phenolics in the American diet, making potatoes the largest contributors among 27 vegetables commonly consumed in the United States

For what it’s worth, white potatoes actually have a higher ORAC value per 100g of food than green beans or carrots, and nearly 2x the ORAC value of green peas.  Nobody reasonable disputes that green beans, carrots, or green peas are health foods.  ORAC score is a measure of a food’s antioxidant capacity; while it, like any other measure, is only of limited use as a single measure without further context, I think it does provide some helpful context here, i.e. that the potato is not completely devoid of antioxidant capacity, and in fact outscores some “green” and “orange” vegetables.

If there’s one thing to dislike about potatoes, it’s low fiber content vis-a-vis other vegetables (and the fact that unlike the sweet potato, they have no beta carotene / vitamin A).  However, it’s worth noting that the carbs-to-fiber ratio in a generic Russet potato (13.5:1) is not all that far off from the Okinawan sweet potato (somewhere in the neighborhood of 10:1) or other orange sweet potatoes (8:1).

We know these latter two categories are linked to positive health despite not being the world’s most fibrous vegetables.  We also know that fruits are healthful despite many being reasonably low-fiber – grapes have a 20-to-1 carbs-to-fiber ratio, yet red grapes are clearly health-promoting.  So, low fiber alone cannot be a reason to jettison the potato.

And what does low-fiber mean anyway?  To put this another way, by inversion: if you ate 1,000 kcal of Okinawan sweet potatoes (as the Okinawans routinely did), you would end up with 24 grams or so of dietary fiber from that portion of your diet.  If you ate 1,000 kcal of ordinary Russet potatoes, you’d end up with 17 grams or so of dietary fiber from that portion of your diet.

There is a difference, to be sure, and Russet potatoes are not a particularly high-fiber food vis-a-vis, like, broccoli – but not everything has to be a source of fiber to be a health food.  EVOO has zero fiber, and yet is still very good for you; the same goes for salmon.

Considering that the average American adult consumes merely ~15g/day of fiber, potatoes are certainly not low-fiber relative to the American diet.  If you ate 2,000 kcal of Russets per day, you’d end up with more than double the fiber intake that the average American has, and slightly above the 25-30 gram recommendation from most public health organizations.

The potato may not be the best vegetable, certainly, and I’m not suggesting that anyone eat more of it in place of eating more broccoli and lentils – I don’t think potatoes are quite on par with kale or broccoli.  I don’t have data for this; it’s just an intuition.  And traditional potatoes are not a huge part of my own diet; I have no homer bias here – I overindex to cruciferous vegetables, sweet potatoes, salads, etc.

But – as an unrefined/unprocessed whole vegetable with some fiber, polyphenols, etc – the potato is likely still far better than most non-vegetable foods (except perhaps fish or yogurt).  At the very least, it seems silly to throw out potatoes and eat more chicken breast in its place; wherever potatoes may rank on the totem pole, they are clearly more health-promoting than meat, which I imagine is what health-conscious people are usually replacing potatoes with, following the usual pro-protein tripe.

Meat and potatoes might not be the basis of a healthy diet – but potatoes are likely the healthiest part of that diet, contrary to popular opinions.  And to the extent that they aren’t exactly displacing broccoli in most people’s diets, we shouldn’t be societally discouraging or condemning consumption of potatoes, except when they’re turned into french fries or covered with so much cream, cheese, and bacon that there’s little potato left to the visible eye.

The fact that potatoes contribute 25% of the antioxidant capacity of the American diet may speak more to the woeful state of the American diet than to the nutritional merits of the potato, but given the “if we’re not eating X, we’re eating Y” challenge, I think it’s really dangerous to condemn potatoes when people are more likely to replace them with more meatloaf rather than more broccoli.

I would be willing to accept more compelling, specific evidence disputing my hypothesis, but I also can’t see a way that potatoes are anywhere below neutral at worst – i.e. potatoes, at worst, are still very likely on par with, or superior to, the vast majority of animal-derived foods.

I’m not suggesting anyone try to eat as many potatoes as the Irish; nonetheless, this is useful from an Eat More Tomorrow behavioral standpoint, because like sugar, potatoes can be the spoonful of reasonably healthy starch that makes the medicine go down.

A few culinary examples: my mom’s Indian shaks often feature some potato: just eating cauliflower or green beans by themselves would be a little bit boring, but cauliflower-potato or green bean-potato makes for an interesting (and healthy) combination that gets a green or cruciferous vegetable in while also comforting the starch taste buds.  (I have also heard the idea of mashed cauliflower-potato suggested, though I’d never try this personally.  Somebody tell me how it is.)

Elsewhere, the Dutch dish Stamppot is basically mashed potato with some braised kale; it tastes like a comfort food (I’ve made it).  It could potentially be a great way for picky eaters to get some greens in.  Although many recipes call for butter or sausage, a healthy EVOO version could very easily be made instead.

So as long as you don’t do anything horrible to your potato – like drown it in sour cream, Cheddar cheese, or bacon, or deep-fry it three times in suboptimal oil that hasn’t been changed for days – it’s not, by a long shot, the worst thing on your plate.  May I suggest herb-EVOO roasted potatoes with Nik Sharma’s super-easy five minute, no-chop, no-cook, just-blend-it pepitas chutney?  (Use EVOO instead of butter, obviously.)  Even plain ol’ mashed potatoes are just fine, so long as you don’t load up on the dairy.

A similar baby often thrown out with the bathwater is refined pasta.  It is, again, worth thinking about the risks of confounding with pasta consumption.  Anecdotally, at most potlucks, the pasta dishes I’ve seen present tend to be covered with large doses of one or more of heavy cream sauces, cheese, and meat; there are no vegetables in sight.

The Cheesecake Factory, meanwhile, serves a 2,000-calorie abomination with a heavy cream gravy and fried chicken on top of that.  None of these pasta dishes are whatsoever healthy, to be sure – but it’s not immediately evident that it’s the pasta itself that’s the worst offender on the plate, just as it’s not immediately evident that mashed potatoes are the worst part of a meal starting with white rolls and ending with meatloaf.

Indeed, one curious artifact of the gold-standard Mediterranean Diet that a lot of people gloss over is that at least some portion of the literature tends not to differentiate between whole and refined grains, and yet still finds relatively consistent health-promoting results.

This is, to be clear, not to say that refined grains are equally healthy to whole grains: that would be a categorically untrue statement.  Rather, however, it suggests that at the margins, in the context of a diet rich in extra-virgin olive oil, fruits, vegetables, nuts, and legumes, occasional modest consumption of refined grains – just like occasional modest consumption of meat and dairy – does not appear to be particularly overtly harmful.

Focusing on such context, there is obviously a very different whole-meal health implication for 200 calories worth of pasta topped with 600 calories worth of olive oil, vegetables, and/or nuts/legumes/seeds, with perhaps some modest cheese to finish, vis-a-vis 800 calories worth of pasta topped with another 800 calories of cream, cheese, and meat.  To this end, when pasta is substituted for other typical sources of carbohydrates in the diet, there is actually a modest improvement in various measures:

The people involved in the clinical trials on average ate 3.3 servings of pasta a week instead of other carbohydrates. One serving equals about one-half cup of cooked pasta. They lost about one-half kilogram over a median follow-up of 12 weeks.

[…]”In weighing the evidence, we can now say with some confidence that pasta does not have an adverse effect on body weight outcomes when it is consumed as part of a healthy dietary pattern,” said Dr. Sievenpiper.

For what it’s worth, as best I can tell from my own research, whole-wheat pasta is largely an American invention, and much of the pasta consumed in Italy is the same kind of off-the-shelf Barilla pasta you’d get here.  Whole-wheat pasta is basically inedible (I’ve tried and failed to like it), which is why it’s unsurprising that it’s not flying off the shelves in Italy.  On the topic of Barilla, they (unsurprisingly) seem to have funded some of the pro-pasta research out there, so I again note potential bias here.

However, thinking about pasta in the broader context of what we know about both the Mediterranean diet, and diets in general, it doesn’t seem that refined pasta is public enemy #1, either – beef stroganoff is completely out of the question, but if refined pasta serves as the base of a dish where all the other components are health-promoting, that’s not a bad thing.

A pile of kale and bell peppers and sage and walnuts with olive oil is not exactly a meal; put a modest pile of pasta underneath all that, however, and you have a healthy meal in hand that most people would be happy to eat.

Eat More Umami: Understand Why We Like Meat

Quite fairly, I think the biggest resistance most readers will have to much of what I’m saying here is the belief that there’s no substitute for meat.  This is true in some respects; no vegetable will ever taste like a steak.  Notwithstanding that I’m predominantly vegetarian at this point, I still eat steak every once in a while for pure taste reasons – there is no substitute.

However, most consumption of meat is not consumption of steak; while people consume meat for many reasons, one of the major ones is flavor.  For any given dish (salad, pasta, etc), many people tend to feel that a fully vegetarian version is “missing” the meaty flavor dimension.

With the caveat that boiling any food down to a single flavor is just as reductionistic as trying to reduce any food down to a single nutritional component, the element that’s often missing in vegetables is something called “umami” – the culinary word for our taste for foods that are “savory.”  Scientifically speaking, we have taste buds that respond to “glutamates” – various naturally occurring compounds.

Many of these are found in meat, and are the reason why meats (and meat broths) tend to have such a savory dimension.  Conversely, most plant-derived foods don’t have a lot of free glutamates, and hence don’t satisfy the same taste buds.

However, there are plenty of ways to add umami without resorting to sprinkling bacon on top of everything.  I will note that I had a meal at a vegan restaurant in Salt Lake City – Zest Kitchen and Bar – that completely surpassed my expectations and transformed my preconceptions of what vegan food could taste like.  The meal I had there was every bit as satisfying and umami-rich as the steak fajitas I had the next day for lunch, and I say this as a card-carrying Texan who knows his way around a good piece of beef.

Non-meat based umami sources include:

– fermented Asian sauces/pastes such as soy sauce, miso, black bean paste, doubanjiang, gochujang, fish sauce, oyster sauce, etc

– shiitake or porcini mushrooms (common white/brown mushrooms aren’t very umami)

– Parmesan cheese

Although there are many other foods that contain umami (tomatoes, apparently, though I’ve never tasted it), I’ve listed the ones above because they tend to be concentrated sources of umami.  I don’t personally like Chinese takeout, but most people would agree that even a vegetarian lo mein has a savory dimension that many vegetable foods lack.

A little bit of Parmesan can add a powerful punch to most any vegetarian dish; Eggplant Parmesan is typically vegetarian, but is nonetheless a perennial favorite at Italian restaurants, even among meat-eaters.  Similarly, if you’ve ever reconstituted dried shiitakes or porcinis, both the mushrooms themselves (and the broth they create) are intensely savory.

It is worth noting that these sorts of additions can add depth without overwhelming the flavor.  Soy sauce is obviously a pretty strong flavor and I don’t want most of my non-Asian-inspired food tasting like soy sauce, but I was recently surprised to find that a little soy sauce added savory dimension to a tahni-based salad dressing without overwhelming the flavor.  (Heavily modified version of this recipe – 1 cup of sesame seeds in place of the 2 tbsp of store-bought tahini, plus EVOO.)  Green beans sauteed with a dot of doubanjiang take on a rich, savory flavor without tasting overly Oriental.

Similarly, Parmesan is such a strong flavor that a little bit goes a long way, amping up a dish without making it taste cheesy (or adding many calories.)  And for those who aren’t big fans of mushrooms or don’t have the inclination to mess around with dried ones, some vegetable broth – like our house favorite, Knorr – contains plenty of savory glutamates.  Farro cooked in reconstituted mushroom broth with Knorr veggie cubes  is as intensely savory as any steak I’ve ever eaten.

Although the most commonly-used glutamate salt (monosodium glutamate, or MSG) has gotten a bad rap, added glutamates are chemically identical to glutamates in food, and we consume far more of the latter than the former.  As the FDA explains:

The glutamate in MSG is chemically indistinguishable from glutamate present in food proteins. Our bodies ultimately metabolize both sources of glutamate in the same way. An average adult consumes approximately 13 grams of glutamate each day from the protein in food, while intake of added MSG is estimates at around 0.55 grams per day.

Again, while we probably shouldn’t try eating an entire bottle of MSG all at once, added glutamates – whether via food containing them, or through a broth or salt with glutamate in it – are unlikely to be harmful at the scale in which we consume them.

Eat More Salt: Second-Order Effect Sizes Vastly Outweigh First-Order Effect Sizes

Ironically, the familiar part of MSG – sodium – might be the part that’s more realistically dangerous to our health than glutamate.

Although there is some controversy, the balance of evidence strongly suggests that higher salt consumption increases blood pressure, which contributes to a variety of health ails; as such, most dietary guidance from public health organizations tends to suggest the minimization of salt intake.

This is perhaps the only area where I strongly disagree with scientific consensus and public health policy.  I think we should all salt our (healthy) food more, not less, and that suggestions to “use less salt” are dangerous.  I am thus advocating that we should try to Eat More Salt Tomorrow – in the right context, of course.

I make this assertion based on relative effect sizes and n-order impacts.  While reducing sodium intake (absent second-order impacts) would be a good thing, discouraging people from salting their food is likely to lead to unintended consequences (i.e. lower consumption of healthy minimally-processed foods, and higher consumption of unhealthy processed foods.)

It’s a bit like the classic story about how if you pay college students for dead rats, you don’t have a smaller rat problem – you have college students breeding and killing rats.

Guidelines of <2,300 mg sodium per day are unrealistic for the vast majority of us; it would be difficult to sustain anything near 2,000 mg sodium per day on a 2,000 calorie diet without all of our food tasting like cardboard.  I’ve done the calculations; anything below 3,000 mg sodium per day is likely very hard to accomplish without ruining the taste of food.

Salt is very 80/20; the last 20% of salt drives 80% of the flavor, so cutting out some is basically akin (from a flavor perspective) to cutting out all.  If something doesn’t taste perfect, we usually sprinkle a few grains of salt on a spoonful, and taste it again – if it’s right (which it usually is), we add more salt to the whole dish.  Salt makes food sing.  There are some people (including some I know) whose taste buds work a bit differently and can achieve targeted salt guidelines; for them, salt reduction is a “free lunch” that they should take advantage of.  However, for most of us, unsalted food is unpalatable.

I haven’t yet met anyone eager to eat 2,000 calories per day of cardboard when they could instead eat 2,500 calories per day of very salty junk – which not only has more salt than you’ll ever put on your broccoli or farro, but also has a whole host of other stuff that’s bad for you.

For those of us without severe hypertension or a medical directive to reduce our salt intake, salting our food less – a common public health recommendation – is, as such, a likely a case of winning the battle but losing the war.

Here’s why.

First, most of our sodium consumption does not arise from the saltshaker, but rather from processed food.  Katz observes:

Roughly 80% of the sodium in most modern diets comes from processed food, not salt shaken onto food once served. Therefore, the best strategies for reducing sodium intake are the avoidance/reduction of highly processed foods, and reformulation by food manufacturers.

​Sodium intake will tend to fall within healthful, advisable ranges whenever the diet is mostly made up of wholesome, whole, minimally processed foods in sensible combinations. Such a dietary patterns allows for optimizing sodium intake, without preferential attention to sodium.

Actively trying to reduce salt intake by adding less salt to our food, in the context of a very salty modern world, is like asking your teenage son to keep his eyes from wandering in a room full of scantily-clad supermodels.  It’s just not gonna happen.  As mentioned earlier, the unsalted piece of broccoli will lose out to the salt-packed Dorito or bacon cheeseburger every single time.

Even with the quite high rate of vegetable and whole grain consumption in my own household throughout my life, our recent vegetable and whole grain consumption has skyrocketed – while our recent processed-food consumption has plummeted – because I learned how to properly salt food.  We are undoubtedly better off eating fewer Doritos and potato chips, and more vegetables/legumes/whole grains, even if we’re consuming the same amount of salt in the process.

There is actually data backing this claim up.  First, achieving meaningful blood pressure reductions through sodium reduction alone is a difficult endeavor; for normotensive (<130 mmHg systolic) individuals, cutting salt intake by 2,000 mg per day (equivalent to more than half of our 3,400 mg sodium average) would result in merely a 5-6 mmHg reduction, whereas for hypertensive individuals, it would result in a 10 mmHg reduction:

Reducing sodium intake by 1,000 mg per day generally reduces systolic blood pressure by 5 to 6 mm Hg among people with hypertension, and by 2 to 3 mm Hg among normotensive individuals.1 The modest blood pressure reduction in people whose blood pressure is in the normal range is cited to support recommendations to lower sodium intake to help prevent hypertension.

Other studies have found much lower real-world reductions in blood pressure – for example, merely 2-3 mmHg per 1000 mg reduction in sodium for hypertensive individuals and 1-2 mmHg per 1000 mg reduction in normotensive individuals, or half of what was quoted in the previous analysis:

Overall, a median reduction in urinary sodium of 1840 mg/day sodium (4.6 g salt/day) was associated with a mean reduction in blood pressure of 5.06/2.7 mmHg in hypertensive subjects and 2.03/0.99 mmHg in normotensive individuals ().

The present study also examined the effects of a 1200 mg/day and a 2400 mg/day reduction in dietary sodium from a meta-analysis () that examined the dose-dependent relationship of different levels of reduction in dietary sodium.

Reduction in sodium intake of 1200 mg/day (3 g salt) was associated with a reduction in blood pressure of 3.6/1.9 mmHg in hypertensive subjects and 1.8/0.8 mmHg in normotensive subjects. A reduction in sodium intake of 2400 mg (6 g salt) was associated with a reduction in blood pressure of 7.1/3.9 mmHg in hypertensive and 3.6/1.7 mmHg in normotensive subjects.

For the sake of argument, let’s take the higher end of this range and assume a 10 mmHg reduction in systolic bp.  What does this get us?  ~20% reduction in CVD risk:

 In a large meta-analysis of 123 studies involving 631,815 individuals, systolic BP reduction of 10 mm Hg was associated with significant reduction of major cardiovascular disease events (20%), coronary heart disease (17%), stroke (17%), heart failure (18%), and all-cause mortality (13%).

As the previously-cited analysis noted, the <2,300 mg target is achieved by fewer than 5% of American adults, which is half to a third of the level of adults who meet public health recommendations for fruit and vegetable intake.  This suggests that something about our biological drives makes extreme salt reduction likely untenable for most of us – no matter whether we eat lots of vegetables or few, lots of meat or none, we all tend to eat a lot of salt, that is largely not modified by our general health-consciousness or other dietary behaviors.

So, in the process of striving towards an essentially impossible goal we can’t reach, we’re looking at a 20% reduction (or less) in CVD risk as our reward if we get there (if we’re hypertensive; it’s half that reduction if we’re normotensive).  Far more likely to be achievable is a 5-10% reduction in CVD risk.  Okay, that’s one data point.

Here’s another: adherence to more plant-centric diets, absent any specific efforts at sodium reduction – which is very achievable for most of us – very consistently results in meaningful decreases in CVD risk.  Here’s one study finding a 28% risk reduction from better adherence to the MedDiet;  here’s another finding a 40% risk reduction for a vegetarian diet.

Not believing me yet?  Here’s another finding 4-7% reductions in cardiovascular risk for every incremental serving of fruits and vegetables, suggesting 20%+ decreases in CVD risk for optimal fruit/vegetable consumption, along with 20% and 30 – 40% decreases in cardiovascular risk for frequent consumption of whole grains and nuts, respectively.  And here’s yet another study finding, depending on the subgroup and the condition in question, anywhere from 20 to 70% reductions in cardiovascular disease via better adherence to the Mediterranean diet.

The exact numbers from any one study are less relevant; what is consistent from the literature is that eating a better diet with more whole grains, vegetables, legumes, etc can consistently and meaningfully lower cardiovascular risk by amounts substantially greater than the extent to which CVD risk can reasonably be lowered via lower salt consumption.  It doesn’t seem realistic for us to reduce salt consumption enough (as an individual goal) to result in more than a ~ 3- 5 mmHg type reduction in systolic blood pressure, which would likely result in no more than a 10% reduction (or thereabouts) in most CVD risks we care about, and (at 500 mg sodium reduction) more likely a 5% reduction.

Which sounds better to you?  Shooting for 5 – 10%, or shooting for 20 – 40% (if not in excess of 50% once you consider the synergistic effects of the diet as a whole)?  It is reasonably clear that the positive effect size of vegetables, legumes, extra-virgin olive oil, and whole grains vastly outweighs the negative effect size of whatever amount of salt we wish to put on such foods; we are better off, on net, eating salted minimally-refined plant-based foods than we are eating few minimally-refined plant-based foods, and lots of salt anyway – which is what the vast majority of us are doing today.

I have not seen any compelling evidence suggesting that the effect size of reasonably-achievable sodium reductions is at all comparable to the effect size of reasonably-achievable plant consumption.  Moreover, sodium reductions are far more easily achieved by preparing food at home from scratch, which tends to result in less salt consumption that restaurant or processed food, even if we add a lot of salt.  If I have overlooked part of the literature and you have encountered evidence to the contrary, please do send it my way – I’d love to have a look.

Also, self-obviously, if you have extreme hypertension and your doctor has told you to cut back salt, then please do.  I am not a doctor and nothing in this post is medical advice.  But for the majority of us who are normotensive or mildly hypertensive, using salt as a lever seems more likely to achieve desired outcomes than trying to accomplish the diametrically opposed goals of eating healthier food and adding less salt to our food.

Finally, it is worth that Samin Nosrat herself learned how to salt in Italy (one of the birthplaces of the Mediterranean diet).  Previously in this very long post, we have – extensively – discussed that one ingredient does not make or break a diet; the overall pattern is of far more importance.

Indeed, one review of the Mediterranean Diet in relation to sodium intake noted that among its gold-standard health benefits are lower blood pressure; this despite it being a relatively high-sodium diet:

 These foods which are recommended to be consumed on a daily basis, according to the Mediterranean diet scheme, are the everyday hidden sources of sodium, due to sodium addition during manufacturing, and seem to add substantially to the total dietary sodium.

However, the inverse relation of Mediterranean diet adherence and arterial BP levels has been shown in recent epidemiological studies, despite the aforementioned high sodium intake. This protective influence is not caused by single nutrients, such as dietary fatty acids, potassium, antioxidants, or dietary fibre, but can be attributed to the Mediterranean diet as a whole.

Thus, it is emphasized that healthy dietary patterns can represent a stronger predictive factor of BP levels among adults and children than the intake of individual foods or nutrients.

Other studies have demonstrated meaningful direct benefits on blood pressure as well; PREDIMED cohorts supplemented with extra-virgin olive oil or nuts both achieved 4.0 mmHg reductions in systolic blood pressure – comparable to or substantially greater than the effect size (on a population-weighted basis) of reducing sodium intake by 1000mg/day.  MedDiet adherence and eating more nuts/olive oil is a far easier, more achievable, and more enjoyable task than slashing salt intake by 30% to achieve the same blood pressure outcome.

Meanwhile, of course, MedDiet has profound health benefits far beyond just blood pressure, whereas cutting sodium consumption does not (other than potential modest benefit, albeit disputed, against stomach cancer.)

So, through the lens of tradeoffs, it makes total sense to intentionally increase the amount by which we salt healthy food that we want to eat more of, because it provides us with a natural incentive to eat more of those foods. We would already be consuming that much sodium anyway – if not far more – so we’re creating no new net negative health impact that didn’t already exist in our diet.  We’re probably, if anything, reducing our net sodium intake – which is good.

We’re doing this by two mechanisms – first, by reducing calories consumed via higher satiety of real food, leading to lower sodium intake overall.  Second, by probably consuming less sodium via non-processed food.

Meanwhile, by making vegetables, whole grains, nuts/seeds, fish, and legumes far tastier, however, we are eating more of those foods instead of the unhealthy processed food, fast food, meat, or other such foods that we would eat in their place.  This leads to profound health benefits.

In a perfect world, we’d all consume less salt.  However, we don’t live in a perfect world – we live in the real world – and in the real world, the effect size of the harms of modestly excess sodium consumption are far lower than the effect size of the harms of vastly excess consumption of animal-based foods and refined plant-based foods, and appalling underconsumption of minimally-refined plant-based foods.  Salt added to vegetables, whole grains, and lentils does not rank in the top 20 (let alone 3) of problems in our diet today.  If we get to the point where salt is the biggest lever in our diet that we can pull to improve our health, we’re already in the top 5% of diets in the world, from a health perspective.

So go ahead and pour on the salt (on the healthy foods you want to incentivize yourself to eat more of) – you’re doing your health a favor.  Even if you don’t have any good options (i.e. steamed broccoli and carrots is the only “healthy” side at some given restaurant), the saltshaker can help it compete on more even ground with the mac and cheese.

One thing I would note – in contrast to Samin Nosrat, I strongly advocate using only iodized salt for the vast majority of cooking, unless you’re okay with you (or your kids) having an IQ that’s one standard deviation lower than it would be with iodized salt.

The average person will not notice any meaningful taste difference between iodized salt and table salt (despite being a big foodie, I barely notice a difference – and I only notice it when I’m looking for it, not when I’m just eating food.)

Iodine is far too important a nutrient to risk shorting yourself on.  If you don’t use iodized salt already, start using it quasi-exclusively.  If you do use it already, but you’re planning to cut salt out of your diet, be aware that you need to find a replacement iodine source; iodine deficiency is a meaningful risk if you are decreasing salt consumption:

Even though salt restriction did not show a statistically significant decrease in dietary sodium intake in men, it was limiting enough in women to influence iodine nutritional status. It is likely that those restricting salt may have more control on salt used at home, most of which is iodized,11,39 than the mostly uniodized “hidden” salt used in processed foods and restaurants.40 Between 50 and 70% of the US population choose iodized salt for domestic use.11,39 On the average, iodized salt contributes about 50µg iodine/day11 which is substantial considering the fact that good dietary sources of iodine are few.

Finally, there are other ways to lower sodium consumption without hiding the salt-shaker.  Lower sodium consumption is one nice side benefit of increasing consumption of fruit, and a compelling reason to not intentionally or unintentionally exclude fruit from your diet.

Fruit has essentially zero natural sodium, and other than grapefruit, there is really no fruit to which I or most people I know would routinely add salt to.  As such, if you ate merely 200 calories worth of fruit per day – the equivalent of two medium apples, one large mango, or two cups of blueberries – you’d be eliminating 10% of the sodium in your diet, assuming a 2,000 calorie diet.  Moreover, given that real food contributes to satiety, there’s a further n-order impact of reducing total calories consumed, which not only has direct health benefits, but also means less sodium consumed as well.

So, eating more fruit either reduces absolute sodium intake meaningfully, or, at the very least, frees up salt to reallocate to other healthy foods to make them taste better – either way, you’re far better off from a health perspective!

Dark chocolate is another food in this category; even if you add a sprinkle of Maldon sea salt to your dark chocolate (as I often do), the total amount of sodium consumed basically rounds to zero vis-a-vis Doritos or French Fries.  There are other foods which need far less sodium than their calorie count implies; I’ve never felt the need, for example, to add salt to peanut butter, even as a total salt hound who adds salt to almost all food anyone else makes for me.

Other no-salt foods include vegetables eaten out of hand; sugar snap peas are a perfect creation and need no modification.  I literally have never managed to do anything to sugar snap peas that makes them taste better than they are.

If you have a combined total of 400 calories per day from foods like dark chocolate, fruit, peanut butter, and sugar snap peas – all health-promoting foods that are naturally tasty – you’re essentially cutting out 20% of your daily sodium intake without having to even try.  This is a far easier approach to sodium intake reduction than the torturous, counterproductive approach of making your food taste like cardboard by withholding 20% of added salt at the stove and at the table.

So in the end, the right way to reduce sodium intake is not to reduce the amount of salt we use to make healthy food tasty, but rather to use sodium as a lever to encourage healthy dietary choices.  Salt on broccoli is not the public health enemy we should be worried about when we’re fighting (and losing) the war against bacon cheeseburgers.

Eat More (Good) Fat: Guilt-Free Flavor

A high-fat diet is not explicitly necessary for any nutritional reason; low-fat diets such as the traditional Okinawan diet, or modern vegan whole-food or pescatarian type diets, are very health-promoting.

However, some particular kinds of fat – such as whole or pureed nuts/seeds, extra-virgin olive oil, avocados, and the omega-3 rich fat found in fish – are independently health-promoting.  In other words, research suggests that you’re not doing yourself any disservices by foregoing vegetable/legume/whole grain consumption by proportionately increasing your consumption of these healthy fats.  (The fat in dark chocolate is likely not per-se healthy, but dark chocolate as a whole is, so dark chocolate could also be considered in this category, though I wouldn’t choose to eat more of it and eat less vegetables, at least from a nutrition standpoint.)

As discussed earlier, fat does several things: it directly improves the flavor of food, but it also promotes a rich, satisfying mouthfeel.  If you get some low-fat and normal cheese or yogurt, and compare them side by side, you’ll thereafter instantly be able to recognize what fat does in your mouth: low-fat dairy products simply aren’t satisfying.

For most of what I make, from a pure taste perspective, the answer to “how much fat should I add” has always been – “more.”  Whether we’re talking about roasted vegetables or dips/spreads/sauces, if something is missing and it isn’t salt or acid, it’s usually a final hit of olive oil.

A common concern is that eating more fat will make us more fat; this is a fallacy similar to “eating sugar will give us diabetes” that follows the same incorrect associational logic.

As long as the fat is healthy, this isn’t really the case.  EVOO has been linked to satiety, for example, and the Mediterranean Diet is consistently found to result in lower weight (and/or maintenance of a healthy body weight), despite 30-40% of calories (and in some cases more) deriving from EVOO, making it difficult to plausibly assert that EVOO promotes weight gain (at least compared to baseline diets.)  Similar effects are observed for nuts such as almonds/walnuts.

A clinical trial showed an increase in satiation and a sense of fullness within three to four days after beginning an isocaloric diet containing 48 g/day [314 calories] of walnuts; however, no effects were observed on resting metabolic expenditure, insulin resistance, or hormones known to mediate satiety in subjects with metabolic syndrome.


As with almonds, although the walnut dose represented a large amount of calories, weight gain was not observed in the walnut treatment, which, curiously, was associated with a decline in waist circumference (WC) [].

Even easier for most people to eat than nuts is nut butter; any parent can tell you that peanut butter is A+ kid-approved, and it conveniently can be eaten straight out of a jar (no prep needed).  We do, of course, have to be mindful of the “peanut butter and ______” phenomenon – while peanut butter is health-promoting, the white bread and sugar-added jelly it is often served with are certainly not health-promoting.  Nonetheless, peanut butter makes a great dip for apple slices and can even be incorporated into cooking (such as Thai curries.)

Turning to cooking, extra-virgin olive oil should be the only cooking oil most people use for most applications, as its multi-decade record of health promotion is unparalleled by other cooking oils.  Several myths abound about EVOO that are simply untrue.  First, EVOO stands up to heat just as well – if not better than – other commonly-used cooking oils.

Second, EVOO does not really impart a strong flavor to food in the context of cooking or baking; if you pour EVOO on top of finished food, you can taste it, but I’ve used quite bitter/spicy EVOOs in everything from roasted vegetables to brownies, and the end product has never tasted overtly olive-y – at most, it has a pleasant depth/complexity of flavor that’s lacking if you use a more generic oil.

Even in vinaigrettes, once all the other ingredients are in there, EVOO’s taste blends into the background.  My mom was initially resistant to using EVOO (rather than refined olive oil, or canola oil) in her Indian cooking, but over time she’s slowly come to realize that EVOO doesn’t negatively change the flavor of dal or shak.

There’s plenty of variety within olive oil, too; many Arbequina varieties, for example, are noticeably buttery in both taste and mouthfeel, to the extent that you can use it on popcorn or bread with limited loss of utility vis-a-vis butter. At the very least, using a lot of Arbequina EVOO and a little butter captures the best of both worlds: rich buttery taste, and the health benefits of EVOO.

For niche applications (such as deep frying), other oils are probably better for cost reasons, but the vast majority of us don’t deep-fry food on a regular basis anyway, so it’s more or less a moot point.  I personally use avocado oil for super high heat searing, and we use canola oil for very rare deep frying, but most any mostly-unsaturated oil without too many n-6 polyunsaturated fatty acids is fine, really – just as long as you aren’t cooking extensively in animal-derived fats or highly saturated plant-derived fats (like palm oil or coconut oil), it likely won’t make a big difference in your diet unless used frequently and extensively.

Oil is not the end of healthy fat additions, however; nuts, seeds, fatty fish, yogurt, and avocadoes make tasty additions to many meals.  Moreover, some of those make great standalone dips/sauces/spreads – who doesn’t like guacamole?

But if you have a blender, you have plenty more options: walnuts, combined with red peppers and pomegranate molasses, makes wonderful muhammara.  I earlier referenced a wonderful pepitas-based chutney.

And we’ve had great results with homemade tahini,  which requires no effort (just toss sesame seeds in a blender with some EVOO and puree until liquid; then add water, lemon juice, salt, and whatever spices you like, and puree further until desired consistency.)  Tahini makes a great dip for roasted vegetables; I’ve also started using it as a salad dressing.

Roasted broccoli with homemade tahini.
Roasted broccoli with homemade lemon-garlic-cumin tahini sauce.

If we realize that our craving for any given fatty/salty food is often more a craving for fat and salt generically than a craving for french fries specifically, we then, by inversion, have an array of options to satisfy that craving.

That could include hummus from a Costco tub with a healthy glug of EVOO, guacamole, a lemon-yogurt sauce with a little Parmesan and a lotta EVOO, or so on.  It can even become a twofer: around my house, what we’re dipping is often something like roasted broccoli or brussels sprouts, which are both healthy and fatty (considering all the olive oil we roast them in.)

Of course, as Nosrat points out, animal-derived fats like butter and bacon grease, or highly saturated plant fats like coconut/palm oil, have culinary merits too – although not nutritional ones.

While some recent evidence does suggest that some forms of saturated fat may not be as harmful as once thought, this is a nuance that falls into the bucket of irrelevant – far too much is made of it.  Why?  We know that there are definitively health-promoting fats like nuts, seeds, avocadoes, fatty fish, and extra-virgin olive oil – no highly-saturated fat is remotely in the same conversation; whether it’s “not bad” or “a lotta bad,” there’s still a wide gap between “not bad” and “good.”

We also know that overconsumption of meat and dairy is linked to negative health outcomes, and that replacing these components of our diet with minimally refined plant-derived foods leads to better health outcomes (North Karelia being a prime example.)  Even the low-carb / high animal protein diet data discussed earlier applies here.  So whether it’s saturated fat or animal protein that’s the problem, both tend to come in the same package – and there’s no reason to go hog wild (pun intended) when we have healthier options that are equally flavorful.

So, it’s fine to incorporate certain animal fats on occasion.  We use cheese moderately – particularly for vegetarian Tex-Mex – and butter infrequently (Kerrygold is unquestionably amazing.)  We use even cream even more rarely, and something like pancetta only once in a blue moon (I have a single inch-thick slice of pancetta in the freezer that I’ve been working on for about two or three years.)  We do not use these ad libitum (unrestricted) like we use EVOO, nuts, and seeds, however.

For these neutral-to-very-unhealthy fats, we use merely enough to drive flavor and no more, in recognition of their neutral-to-very-bad health outcomes.  Often, a little goes a long way; I’ve found that a 1:3 ratio of butter to olive oil in baked goods maintains the flavor of butter, while contributing the positive health effects of EVOO.  Similarly, when using cheese, we use only enough cheese to drive flavor, and use copious amounts of EVOO to get the dish to the targeted total fattiness that’s pleasing to the taste buds.

As long as it’s the right kind of fat, eating more fat can be a powerful incentive to drive consumption of healthy foods, that’s also independently positive from a health perspective vis-a-vis what you would’ve eaten otherwise.

Eat More Acid (Not The Psychedelic Kind)

I can’t cover this much better than Samin Nosrat does, so I’ll be brief: there’s a reason why lemons and limes are popular the world over, part of why pickles, ketchup, BBQ sauce, and mustard are all popular condiments, and why sugar-sweetened beverages are such popular accompaniments to meals.

A little addition of acid – whether lemon juice, vinegar, white wine, or otherwise – often brightens food and enhances flavors without making it taste sour.  Similar to what we do with salt, we’ll often take a spoonful of a given food and add a drop of lemon juice to it – if it tastes better, which it often does, we add some to the whole dish.

Eat More Properly-Heated Food

This one’s easy:

Also, despite our salt love-affair around here, follow Nosrat’s instructions on when to salt so that your sauteed veggies actually brown.

Class dismissed.

Coda: Tradeoffs One More Time: How Much Is Too Much?

You don’t save by not going to a movie. There is a lot to be said about saving money by denying yourself enjoyment. Delayed gratification is not necessarily an all-qualified reason.” – Warren Buffett

As with frugality, it is possible to go too far in optimizing for nutrition.  I strongly and fundamentally do not believe that people should eat things that don’t taste good.  Nor do I believe that people should, in the name of health, forego their favorite foods – whatever their health consequences – on celebratory occasions.  What’s the Fourth of July without apple pie?

To return to where we started – Geoffrey West’s Scale (SCALE review + notes) – we are all going to die (sorry, Peter Thiel.)  There is an upper limit to the human lifespan (usually estimated at around 125).  Moreover, living so long that you see all of your friends – and maybe even some of your children – pass away is perhaps not the best lived experience either.

So my focus is more on quality than quantity; I’d like to preserve my health to the best degree possible into my eighties, and what happens after that, I leave to chance.  In that vein, while my diet is nearly optimal on a daily basis, I’m not worried about special occasions or once-in-a-while treats.  I firmly believe that this Pearls Before Swine strip has something valuable to add:

Even Katz notes the same:

Variations on a common theme nicely accommodate personal preference, allowing us all to find a dietary pattern to love that loves our health back. I do believe the whole truth about food needs to leave some room for: pleasure!

Most of us eat almost every day of our lives; it makes a very big difference if all that time is spent enjoyably, or otherwise. I vote for enjoyably.

After all, health isn’t really the prize; health works in the service of the prize: having a good life. Good food contributes to a good life, too- so it matters.

We can’t always choose “global” in local vs. global optimization problems.  I’m a little concerned about the long-term health effects of my near-daily usage of antihistamines during allergy season (Claritin and Zyrtec, often both), but I don’t have another option – without them, my seasonal allergies are intolerable to the point of vastly diminishing my quality of life.  Whatever the long-term consequences may be, it’s important that I’m not miserable every day in the interim.

Similarly, what’s a life without the occasional steak on special occasions, or without the joys of cheese, or the daily pleasure of Coca-Cola or sugar in my coffee?  A hot summer day without ice cream?  Not a life I really want to live.

I am totally OK trading off a year or two of my life for being able to enjoy some unhealthy foods as part of an overall healthy diet.  Given how dose-dependency works, I’m not shooting for perfect.

For many people, myself included, food has tremendous utility and is one of the great joys of life.  I’m very happy with the quality of my diet overall from a nutritional standpoint, and I’m not concerned about making it perfect – based on the data, I know I already have a near-maximal chance of achieving the health outcomes I want.

And if the difference between me and perfect is a couple years, so be it – I’d rather live 60 more years eating almost everything I want than 62 years without many of the things that make me happy.

Further Reading

I’ve cited many studies and papers throughout this post.  While some go into specific detail on narrow topics (like the health benefits of seeds), if you only wanted to read the abstracts / conclusions of three papers, I’d look at these:

Mediterranean diet –

Katz on the themes of good nutrition, and compatibility with multiple dietary styles:

Systematic review of food groups and risk of all-cause mortality:

In terms of books, David Katz’s The Truth About Food is by far the best I’ve found from an informational perspective, and the source of most of Katz’s quotes in this model.  However,  it is long, as well as repetitive at times, and it has a heavy environmental slant that is less immediately relevant to nutrition. Nonetheless, these are manageable flaws, and this is where I would start.

Greger’s How Not To Die is also okay – much of it is good, but I have severe reservations about his bias – as discussed, he advocates a vegan whole-food diet, and ignores or misrepresents all literature that doesn’t support his narrow point of view.

Finally, while it’s not exclusively nutrition-related, I did really enjoy Zuk’s Paleofantasy.”  It covers a lot of evolutionary-biology topics, including our real paleolithic diet.

Unfortunately, most books out on diet there just suck.  There are various litmus tests you can use: if the author makes a big deal about lectins or the glycemic index or whatever, ignore them.  If the author thinks red meat is a health food and encourages frequent consumption thereof, they don’t take science seriously.  If the author is trying to sell you something, especially supplements, consider their incentives.  Etc.

Generally speaking, besides Katz’s book, which summarizes the literature thoughtfully and concisely, there’s no real reason to read books on nutrition vis-a-vis just reading the studies yourself, without subjecting yourself to the bias of an intermediary.  (That includes me, by the way – I strongly encourage everyone reading this to fact-check my work.)