For this edition of Dr. Ruscio Radio, the Doc sits down with The Gluten Lie author Alan Levinovitz PhD, for a thought-provoking talk about all-things gluten.
If you are trying to determine what your relationship with gluten should be, click here.
Dr. R’s Fast Facts
- This episode was a very deep, thought provoking and philosophical conversation with Dr. Alan Levinovitz regarding his book The Gluten Lie.
- We cover some references that counter the position that all people need to avoid gluten and even some references that show grain consumption promotes health.
- This being said – Dr. Ruscio feels the most powerful dietary intervention for his patients is avoiding gluten.
- However, some people take this too far and create unneeded stress in their lives. For example not everyone needs to adhere to a celiac level of avoidance.
- This episode provided a reasonable approach to thinking about gluten and food in general.
Fast facts….. 4:25
Religion and dietary dogma….. 7:37
Dr. Ruscio’s position on gluten….. 15:11
Research studies on Celiac Disease, gluten and grains…..17:05
Alan’s approach to eating…..21:02
Is diet or lifestyle more important to overall health?….. 24:55
People want dogmatic rules – Confucianism vs. Daoism….. 31:03
Nutrition science vs. other sciences….. 36:55
Episode wrap-up….. 47:38
- (17:07) Those with Celiac do not have increased risk of dementia: http://www.ncbi.nlm.nih.gov/pubmed/26444775
- (17:14) Those with celiac DO NOT have increased cardiovascular disease risk: http://www.ncbi.nlm.nih.gov/pubmed/26444646
- (17:21) “Overall, people with CD have no major excess risk of cancer, digestive disease or respiratory disease related or cardiovascular mortality compared with the general population. These findings should be reassuring to patients with CD”
- (18:35) This meta-analysis indicates that higher whole-grain intake has a protective effect against CHD: http://www.ncbi.nlm.nih.gov/pubmed/25727082
- (18:43) http://www.ncbi.nlm.nih.gov/pubmed/25225349
- (19:09) Whole-grain consumption does not decrease body weight compared with control consumption, but a small beneficial effect on body fat may be present: http://www.ncbi.nlm.nih.gov/pubmed/23945718
- (19:09) Higher intakes of cereal fiber, particularly from whole-grain sources, are associated with lower total percent body fat and percent trunk fat mass in older adults: http://www.ncbi.nlm.nih.gov/pubmed/19726588
- (19:21) A significant trend was observed in both age groups for increased consumption of whole grains with lower BMI, WC, and percentage overweight/obese (Model 1); however, a significant trend was not observed when cereal fiber was added as a covariate (Model 2): http://www.ncbi.nlm.nih.gov/pubmed/21147364
- (50:52) http://theglutenlie.com/
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The Gluten Lie Author, Alan Levinovitz PhD
Welcome to Dr. Ruscio Radio, discussing the cutting edge in health, nutrition, and functional medicine. To make sure you’re up to date on this and other important topics, visit DrRuscio.com and sign up to receive weekly updates. That’s D-R-R-U-S-C-I-O.com.
The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor.
Now, let’s head to the show!
Dr. Michael Ruscio: Hey, guys, this is Dr. Ruscio, and before we go into our fast facts, I just wanted to let everyone know that I will be teaching a seminar in London that I’m really, really excited about. It’s a two-day event, January 16 and 17, in London with Melissa Hartwig and myself.
Day one will be a split between Melissa talking about the Whole30 Program and all the great stuff that entails implementing the Whole30 and how to navigate that and just the great program that she’s put together there.
The second half of day one I will come in with what are some first steps someone should go through if they’ve been on a healthy diet like Whole30 and they’re not able to respond fully. This is pretty much what I do in the clinic all day, so I’ll just be expanding upon that.
What I’m really excited about is the second day, which will be an even deeper expansion on all these issues in gut and with a little bit of expansion on thyroid. The second day is geared toward a more educated layperson or a patient who’s suffering with nonresponsive problems or, of course, a healthcare professional. We will be offering continuing education credits for that day, and some of the gut stuff should be really, really helpful. Of course, you’ve heard me talk about all sorts of gut “stuff,” to put it loosely, from testing to microbiota to treatments, so I’ll help outline what some of the most common causes of digestive problems are, what testing you can use to figure that out, and that is oftentimes much easier said than done, so knowing how to perform the right tests to get the right diagnosis and also doing it in a cost-effective manner is really what we’re going to be going after.
Another thing that I’m really excited about is a review of all gut and microbiotal interventions. If we’re talking about probiotics or prebiotics or fiber or FMT or fasting or an elemental diet, what kind of effect do those interventions have for things like IBS, IBD, weight loss, thyroid problems, celiac? I will break all of this down so that you will know for what condition you have—or for what conditions your patients have—what treatments are the most viable and the most validated. Then, of course, we’ll wrap that all together with an algorithm, if you will, or putting-it-all-together kind of action steps as to how to sequence this stuff. That will be about 60 percent of day two.
Then the tail section of day two will be on thyroid, something I haven’t talked a lot about lately on the podcast because we’ve been so inundated with gut stuff, but there’s certainly some very important thyroid stuff, as I’m sure many of you have heard me talk about awhile back regarding thyroid diagnosis, types of thyroid problems, and a simplified model of thyroid disorders. We’ll cover subclinical hypothyroidism, which is a pretty important issue. We’ll talk about iodine and give you some simple, straightforward treatments to navigate through thyroid.
I’m really, really excited about this. If you’re in the UK, I hope you can make it over to London to check it out. If you see the transcript, you will see the link for this, and if you’re just listening, if you google “Re-FIND Health” and then “Michael Ruscio,” you’ll see my name come up. Hopefully this will be something that some of you can attend, and I think it’ll be very well worth it.
OK, now we’ll jump into the fast facts. Thanks.
DrMR: Hey, everyone. Just wanted to give you the fast facts for today’s episode, which was The Gluten Lie with Dr. Alan Levinovitz.
This episode was very deep and thought provoking and philosophical, and we really get to a level much deeper than what to eat and what not to eat, but really just looking at how we think about nutrition, how scientists research nutrition, dogma regarding nutrition, and just problems and challenges and deeper constructs regarding food that we all need to be aware of that will help us better navigate the food issue in our own lives.
Now, we do cover some references that counter the position that all people need to avoid gluten and even some references that show grain consumption promotes health.
Now, before you lose it, I do also stipulate that in my clinical observation the most powerful dietary intervention that I make with patients is the avoidance of gluten. However, as you’ve probably heard me say before, some people take this too far and create unneeded stress in their lives. For example, not everyone needs to adhere to a celiac level of avoidance.
This episode provides a reasonable approach to thinking about gluten and about food in general. There’s a bit of science, but, again, this is much more philosophical, and it’s much more about thinking through these issues. I think and I hope that this will reach people and enable people to open up their minds and how they think about food in general, and I’ll be dying to hear your feedback on this in the comments section of the transcript that is associated with this podcast.
All right, guys, thanks a lot. Here we go.
DrMR: Hey, folks. Welcome to Dr. Ruscio Radio. This is Dr. Ruscio. I am with here with a guest I’ve really been looking forward to having on the podcast. He’s the author of The Gluten Lie, and he is a PhD. I came across him from an interview recently on Sean Croxton’s show, and I felt a real kinship with his perspective of not being an alarmist. I think many of you who have heard my position on different things know that I really have a strong look at the literature and I’m open minded, I’m progressive—or at least I like to think that I am!—but I’m not an alarmist, and I don’t believe in making sensationalist claims. With that, I think Dr. Levinovitz has done a really nice job, at least from what I heard from the interview, about drawing that sort of attention to the gluten piece.
So, Alan, thanks so much for being on the show today. I’m really excited to kind of dive into this talk.
Dr. Alan Levinovitz: Thanks so much for having me, Michael. I really appreciate it.
DrMR: Well, I’m happy we have this chance to connect. I didn’t read your book, so I apologize for not having read the entire book, but I did love what I heard on your podcast with Sean Croxton.
Religion and Dietary Dogma
DrMR: Can you tell people a little bit about kind of who you are, what you’re doing, and a little bit about your book?
DrAL: Sure, absolutely. I have a PhD, but it’s in religion and literature, which is an unusual discipline for someone who is writing about nutrition. One of the things I tell people about is how I got into writing about nutrition. Most people are probably familiar with religious dietary taboos on food. Everyone knows about kosher food in Judaism or halal in Islam, and in my own area of specialty, which is classical Chinese religion and philosophy, there were various Daoist monks 2000 years ago who had a no-grain diet, and these weren’t gluten-containing grains, but they advocated not eating any of the so-called “five grains” and you’d be immortal, your skin would clear up, and of course, they had proprietary supplement recipes as well.
DrAL: No, I’m serious! You wouldn’t believe it.
DrMR: Oh, really?!
DrAL: Yeah, I’m absolutely serious. You’d have to do the no-grain diet, but also you’d eat these pills that are a combination of milkweed and mercury, and that’s the real key to living forever and flying.
So I saw this and I said, wow, maybe there’s a kinship between the kinds of religious bases for dietary taboos and our own dietary taboos, which we see sort of with a veneer of science, right? Everything we hear about is proved by science even if it contradicts something else that was proved by science. So I said, well, maybe looking at the religious side of this will yield some insights into why we fear certain foods, why we have taboos on certain foods.
DrMR: Sure. I think you make a really interesting insight, which is kind of this maybe dogmatic, pseudo-religious view on food that masquerades as science. This is something that I’ve openly criticized on the show before, where when people have a certain position, they will go and find references that support their position, but really—in my opinion, anyway—that’s not how we should use science. We should study the available science on an issue and use that science to help us formulate or update our opinion, not use science to make a fancy footnote for the pre-existing belief that we already have.
DrAL: Oh, yeah. Absolutely. And also try, at least, as much as we can, not to be so zealous about our own opinions, right? The whole point of science is that it’s self-correcting, it’s humble, it’s invested in the truth, not in whatever position that’s currently adopted. One of the things I notice when I go on podcasts like yours, Michael, is that the first thing I see in the comments is people saying, “Oh, why does this guy think we should eat whatever we want?!” or “This guy doesn’t realize that we have dietary problems,” and of course, that’s what happens when you’re hearing what you want to hear. You want to turn everything into a battle of good versus evil.
DrAL: And in the book I recognize, you know, we consume way too many sugar-sweetened beverages, we have a problem with unhealthy lifestyle habits, whether it’s too much convenience food, whether it’s not enough exercise. All of these things are things that I recognize even though people, because they want to turn it into a kind of religious battle of good versus evil, they’re like, well, he has to be evil because he’s not dogmatic about not eating grains or he’s not dogmatic about some kind of diet, whether it’s vegetarian or paleo—take your pick, right? Whatever religious evangelist from the diet is listening to me, they’re going to try to figure out why I’m totally crazy. And of course, my book is much more moderate and really doesn’t assert a whole lot because part of the premise is that we don’t know that much and we ought to be humble about what we do and don’t know.
DrMR: I agree with you completely. One of the quotes that I really love—I’m not sure if this is a quote from me or if I stole this from someone. I probably stole it from someone, but essentially the quote reads that dogmatism can only exist in the presence of ignorance. If you truly are aware of all the data on a certain issue, it’s very hard to be dogmatic. With gluten, for example, there are studies showing that populations with high-grain diets are pretty healthy, and I want to maybe come back to some of the studies and pick those apart in a minute because the studies are maybe not conclusive and airtight, but that’s kind of the whole point, that we see data and we see certain populations that do well on grains. So it’s not to say that everyone should eat grains or everyone should not eat grains, but rather let’s have a reasonable approach regarding grains and regarding, I think, all philosophical issues because when you approach things from this more dogmatic or zealot-like or fear-based approach, it can really destructive to people. That’s one of the things I see a lot of my patients in the clinic struggling with. They read all this stuff on the internet or listen to these podcasts or attend these online summits, and they get the bejeezus scared out of them about gluten.
DrMR: For some, that’s really helpful, but then for some that don’t need to adhere to a celiac level of avoidance, it has really strong negative social implications to it, and it creates a lot of stress for that person, so it can be damaging. The knife kind of cuts both ways in that regard, and that’s why I really like your approach here because it seems reasonable and it doesn’t seem dogmatic.
DrAL: Yeah, I really appreciate that. One of the things, like you said—and I really like that you highlight this—is that these things can be traumatic, hearing fearmongers talk about how grains cause Alzheimer’s and cancer. People want to be good to themselves, they want to be good to their loved ones, and if you’re a parent—I have a three-year-old daughter, and there is nothing like headlines about meat killing people or sugar killing people to terrify you as a parent.
DrAL: I eat very healthfully. My wife and I love to cook for ourselves. We cook from every culinary tradition. We cook Japanese food. We cook Mediterranean food. We cook Southern fried food. We cook all different kinds of foods, but we eat in reasonable amounts and they’re well-balanced diets, I love exercise, but I’m not consumed by this fear that whatever I’m eating might destroy me—or, alternatively, I’m not thinking to myself, oh, this is an optimized dinner that’s going to help me live forever, because it’s kind of sad, I think. You talked about food and social phenomena, and it’s true, right? For me, it’s kind of sad if all of your food, your eating habits are kind of reduced to, how can I optimize my health? There’s so much more to food. There’s making memories with family. There’s going out with friends. There’s having popcorn and a soda at the ballgame or something, right? To me, it’s sad if in the pursuit of health those kinds of cultural moments or social opportunities are wasted or shut out because you’re too scared to engage in them.
DrMR: I absolutely agree. I often say don’t make yourself miserable in attempts to be healthy.
DrAL: That’s a great way to put it.
DrMR: That kind of defeats the whole purpose. Alan, I have a few studies here that I would just like to quickly make people aware of.
Dr. Ruscio’s Position on Gluten
DrMR: I guess, before I even do that, let me give people my position just so people don’t misconstrue where I’m coming from with this.
In my clinic, I see, of course, a population of people that have health complaints, and most of those complaints are either gastrointestinal or thyroid in nature, and in that population, the most effective dietary intervention that I see is people coming off gluten, so I’m certainly on board and open to the concept. But in with that whole piece is that some people—a lot of people—come in thinking that they have to practice a celiac-disease-like level of avoidance, and it’s really an interesting experience to watch them see all this pressure and fear relieved when we kind of run through a reasonable reintroduction and to help them identify what their relationship with gluten should be. Some people discover they have to be very, very careful with gluten, and other people discover that they can have occasional gluten and not have a problem with it.
So I do think it’s a valuable clinical tool, but again, it’s not this extreme everyone has to avoid it or no one has to avoid it. I think there’s a spectrum, and we should all try to identify where we fall on that spectrum, which seems pretty reasonable to me, but here are a couple of studies I just want to offer people to highlight the other side of the story and to kind of balance out the fear-mongering piece of celiac. Here are some things that suggest that celiac disease may not be a death sentence, so to speak, and that gluten is not a problem for everyone. I’ll quickly just run off these, Alan, and then I’d love to hear if you have any comments on these or any studies that you’d like to elaborate that kind of further highlight this.
Research Studies on Celiac Disease, Gluten and Grains
DrMR: There has been one review paper published that showed that people with celiac do not have an increased risk of dementia (1a). Another paper published showed that those with celiac do not have an increased risk of cardiovascular disease (2a). And another paper published showed that people with celiac do not have a major risk for “cancer, digestive disease or respiratory disease related or cardiovascular mortality compared with the general population,” and the researchers even concluded that “these findings should be reassuring to patients with celiac disease” (3a). I think it’s important for people to hear this because all we hear is the “you’re going to die from this or that” or “you’re going to have this or that increased disease,” and I really think that does an emotional and psychological disservice to people with celiac, because while it’s definitely a serious condition that needs to be properly managed, it doesn’t mean that if you manage it appropriately, you’re going to have a really kind of morbid life.
A couple of other quick pieces here: There is a systemic review with meta-analysis published on observational studies—and again, observational studies we have to be careful with because we can’t totally prove causality from an observational study, but a systemic review with meta-analysis is really high-level scientific data, and we’ll put all the links to these in the transcript notes. One systemic review with meta-analysis did indicate that whole-grain consumption has a protective effect against coronary heart disease (4a), and another systemic review concluded that whole-grain consumption, again, may be a marker of an overall healthy lifestyle (5a). This is something that we have to factor in. We can’t attribute everything to the grains, but this systemic review did also find that grain consumption can help lower cholesterol, may improve bowel function, may lower body mass index, and may be associated with a lower risk of diabetes. Another systemic review with meta-analysis—again, very high-level scientific data—showed that there may be a small benefit from whole-grain consumption on body fat (6a) (7a). Another one showed that there may be a favorable effect on waist circumference (8a).
These are just a few studies that, no matter how dogmatic you are on gluten, you can’t totally write these studies off. It’s very hard to conclude that grains are a universal poison with this kind of scientific data on the table. It’s not to say that no one has a problem with gluten, but there’s definitely some strong evidence here suggesting that not everyone is going to have a problem with gluten.
Alan, with that, anything you’d like to challenge or expand on or go with from there?
DrAL: It’s great to hear these studies. I hadn’t read these studies about how celiac might not be quite as bad for people with it as we thought, although they still, of course, have to avoid gluten 100 percent of the time.
DrAL: I guess what I would want to say is, for whatever it’s worth, Michael, I’ve been talking about this book for a long time now, and the people that are listening to this podcast, the ones that really do believe that grains are evil, those studies that you cited aren’t going to do anything for them. It’s not going to change them one bit.
DrAL: The way in which persuasion works in a nonscientific area, in a religious area, it doesn’t work… you can’t provide evidence and then deconvert people or convert people, right? And the same goes, of course, for the reverse. If there are people who think that gluten is totally fine, no one is sensitive to it, or whatever, you can cite as many studies as you want, and those people aren’t going to listen to you either.
Alan’s Approach to Eating
DrAL: So what I would say is that my book and my perspective at the end of the day is for people that are just kind of tired of it, and that may not be people that are listening to your podcast, but people who are exhausted by the endless back-and-forth of a study that shows this and another study that shows the opposite. They read T. Colin Campbell on how vegetarianism is going to cure everything, veganism, and then they read another book by another doctor that says that actually whole grains are causing Alzheimer’s and meat is necessary for a healthy brain. Then you read another book that says it’s really about organic vegetables. Then you see an article that says it’s not. I mean, this kind of endless back-and-forth with no authoritative ground, it forces people into a position where they have to start to believe in some kind of conspiracy theory, right?
DrAL: Big Government or Big Pharma or Big Organic—whatever—they have to invoke some kind of conspiracy that justifies all of this uncertainty. And of course, for me, there’s another option. There’s another option. For most people, people who aren’t suffering from terrible chronic diseases, you can just opt out. You can do what I do, which is cook for myself, really savor food, savor culinary culture, enjoy good ingredients when I can, and not perform some kind of mental calculus about the food on my plate.
When I sit down to dinner tonight, I have some local sausage, I’m going to have some roasted broccoli with olive oil, salt, and pepper, and some wild rice. That’s what I’m having for dinner. It’s not for this interview, it’s just what I’m having, but I haven’t thought for a moment, well, is the wild rice going to hurt me or is it going to help me? Is the broccoli going to hurt me or going to help me? Is the sausage—I’ve actually thought about this meal as a meal. For me, holistically, when you think about health in terms of mind, body, spirit, thinking about food the way I think about it for me is liberating, and I don’t have to participate in this kind of neurotic assessment of the state of the science. That’s liberating. And for some people, that’s not going to be the answer, but for me, looking at the history of our food fears and trying to get all this stuff in perspective actually means having to expend less mental energy on this kind of worry. Of course, worry—as you know, I’m sure, as a clinician—worry can cause precisely the same symptoms that are sending people into your clinic—gastrointestinal problems, psoriasis. Stress can trigger all of these conditions just the same way that gluten does.
So my preferred intervention, I guess, is chilling out a little bit about what we’re eating. There’s all the listeners that are like, “Is he saying we should eat whatever we want?!” Of course not. I’m not saying you should drink a liter of soda and go to McDonald’s every day. What I’m saying, though, is that taking a step back and thinking about food as food rather than food as medicine, participating in the beauty of culinary culture and of all the different dishes that my wife and I cook for ourselves, that might be a great medical intervention as well.
DrMR: I love that, and as you were saying that, there are a few different directions my mind wants to go. One thing that definitely runs through my mind—and I maybe will take this as a moment to commend my audience—is that I’ve been really impressed with the ability of my audience to think outside the box and be a little bit more progressive. I do think in this space people are kind of getting tired of the dogmatic, extremist view, and they’re looking for a little bit more of a reasonable approach. I think and I hope that this message will be well received by my audience, but knowing them, I think that it will.
It also reminds me of another quote. Sorry to be using so many quotes, but these things stick in my head. It’s a quote by Brian Tracy who is a human resource development expert, and he says, “A man convinced against his will is of the same opinion still.”
DrAL: Yes, absolutely!
Is diet or lifestyle more important to overall health?
DrMR: Then one or two other things. I’ve referenced this book a few times. It’s a book called Thrive: Finding Happiness the Blue Zones Way by Dan Buettner. Buettner went all over the world and studied the happiest cultures all across the world. There are some great lessons that we can pull out of that book, but it’s interesting to see that cultures eating what we may not consider a super healthy diet here in the States are actually much healthier both physically and mentally than we are. Sometimes I can’t help but think the biggest problem we have here in the States may not be our diet. I mean, within reason, right? Of course, if you’re eating McDonald’s every day, then you’re just way off the mark, but if you’re eating—
DrAL: Can I say something about that, Michael?
DrAL: It’s really interesting to me that in the time after writing my book, I used to say exactly what you’re saying, but I wouldn’t add that caveat because I was just in my own little world. I didn’t really think about the fact that if I go into Walmart there’s, like, 25 flavors of Oreo.
DrAL: That’s being marketed to people. I didn’t quite understand the severity of the dietary problems facing many people. That said, the people that listen to podcasts like yours or Sean’s, the people that are constantly monitoring the studies, they’re not the people that are eating a sleeve of Oreos for lunch, not knowing that that’s maybe undesirable. So on the one hand, yes, there are enormous problems. On the other hand, it’s the people that are super stressed about things that are precisely the ones who probably aren’t having those problems to begin with.
DrMR: Exactly. Right now I’m writing a book on the microbiota, and I was really happy with how this chapter came together because I think it speaks to exactly the type of people that we’re referring to, which is anyone probably listening to this. We don’t have to worry about them having a hellacious diet. They’re probably doing pretty darn good, probably better than most, and where I think people are most deficient, all things considered, is probably not their diet, but it’s probably their lifestyle. If you look at the amount of social interaction, free time, time with friends, time for hobbies that we have in the United States compared to, say, Denmark, it is disgustingly different. I think if people, once they get some of the dietary basics in place, could spend additional time investing that time in friends, family, hobbies—
DrMR: —that would be so much more well spent than trying to find, are there too many saponins in the sweet potatoes that I’m eating? Is that why every once in a while I have a little bit of bloating? Because you get to this point where it kind of follows the law of diminishing returns, where a little bit of investment will have a huge payout, but then if you keep investing more and more time, you come to a point where you get a negative return. I think that happens a lot. People get sucked into the computer and the internet and they just fall into this black hole of health research. And while they’re doing that, there goes time with friends, there go hobbies, there go social engagements, and that’s been shown to have a really deleterious health effect.
DrAL: Absolutely. I also understand now, having talked to a lot of people about these things, that for some people, just in order to make good on a lifestyle change that most physicians and most nutritionists would agree on—like, if you’re eating too many calories, eating less and not drinking five drinks a day, not going out to eat and eating fast food all the time—if what you need to make good on that is some kind of fear that sugar eats your brain and causes cancer and that Coca-Cola has paid off everyone around you to destroy you, if that’s the kind of narrative that people need to make good on their diets, then these narratives help people, right? They help individuals, and I recognize that there are some people who need to think that GMOs will turn their bones to Silly Putty and if they don’t only eat paleo then their brains will rot by age 60. There are people that need that—
DrAL: —in order to just start eating healthfully and living healthfully. Those people, they hear me talk and they think to themselves, “Well, I really did undergo a miraculous transformation by obeying these laws that he’s pooh-poohing.” I hear them, and I feel like I’m not going to reach them, but my message is for other people who want to see changes in their life and think that that’s the only way to do it, and the message is it’s not the only way to do it. You can stress out less, you can exercise more, you can eat fewer processed foods and cut down on the amount you drink or whatever—very common sense dietary recommendations. You can do that all without being scared that if you go to a holiday dinner there won’t be paleo food.
DrAL: You can do that all without being terrified that your veganism, which has sustained you because there’s no fat in it, is going to break at your kid’s birthday party. You don’t have to be the person who feels compelled to bring food in a plastic baggie if you don’t have celiac disease. This is the kind of thing that my great-grandmother who was an Orthodox Jew, she would show up at dinners with her own food in Tupperware. And to me, there are people who have to do that. There are people listening to this podcast who really do have those kinds of food sensitivities, but what we don’t want to do is infect the rest of the population that doesn’t have those with fear.
DrAL: I think that’s really important.
DrMR: I agree. I agree completely, and I think people have heard me make that kind of philosophical remark before. I think it’s becoming a really serious problem, where it’s almost like a pseudo eating disorder, where the infatuation with diet becomes so intense that it really starts to cause really negative health impacts.
People Want Dogmatic Rules – Confucianism vs. Daoism
DrMR: I’m probably stepping in way over my head with you on this, but to bring in maybe some Eastern philosophy here, is this like of looking at a more Confucianism approach on diet to a more Daoist?—Confucianism, as I understand it, having many rules and being very rigid, Daoism being more free flowing and kind of following your own content and there is really no way—the way is no way, sort of thing? Would you say there’s any kind of comparison or contrast there, or am I just a super Eastern philosophy hack and way off the mark?
DrAL: No, no! It’s funny. In the sort of classical philosophy of it, Daoist philosophy tends to be much more, like you said, free flowing, and Confucianism seems a little bit more didactic. That said, the monks that I was talking about, the monks that advocated the grain-free diet and had the proprietary supplements, those were Daoist monks. So one of the things that’s really interesting is that, say, you have this, as you called it, sort of this free-flowing, ambiguous Daoist philosophy. What happens is people can’t deal with that. They can’t deal with ambiguity. They can’t deal with the idea that maybe there are lots of different ways to live your life, and none of them protect you completely, but they are all not totally crazy. They don’t say do whatever you want, but there’s also a lot of variety within them. That’s not something that people can grab onto, so they demand commandments. They demand rules.
DrAL: And later Daoism started to ignore these early free-flowing, easy-going texts in favor of dogmatic rules because at the end of the day—this is what’s so interesting—that’s what people want. I feel like sometimes I’m fighting a losing battle because people don’t want to hear this. They want to hear, “Here’s the villain. It’s insert-X-food-here.” It’s meat, it’s grain, whatever. “Here’s the hero. Insert best-selling diet guru, author of whatever book, whether it’s The 4-Hour Body or David Perlmutter or T. Colin Campbell. People want their demons, they want their saviors, they want their clear narratives, that’s what Daoism eventually started to give people. It gave up on its free-flowing stuff because people wanted rules.
I see that as a little bit tragic, but also maybe that’s just how it has to be, and some people want that. The question is then, how do we keep those rules from making us pathologically worried about our food?
DrAL: How can we have those rules and eat according to them for ourselves without turning it into some kind of evangelical zeal?
DrMR: Right. You make a really interesting point, which I think pulls at a really foundationally important string, which is human nature. Can we as people really handle freedom, or like you said, do most people really maybe want the illusion of freedom but really want to be told more so what to do?
DrAL: Yeah. I’m very sympathetic, again. We live in a food environment that is just relentlessly difficult to deal with. Here’s an all-you-can-eat buffet. Here’s the food that’s on special. Eat this! Eat that! Half of the commercials that come on are about food. Everywhere you go there’s some kind of billboard about food. So I think that for many people, this is just an oppressively difficult and tempting environment to live in, and what they need is an equally powerful narrative and equally powerful set of symbols to push them in the opposite direction. I think for a lot of people the only way to compete with this onslaught of incentives to eat is a similarly powerful negative portrayal of all that. “All this stuff is garbage, and if you eat a single Dorito, it’s the end of the world.”
DrAL: I get that. I see that that’s necessary. I wish it weren’t, and so for me, if I were to control how we could change people’s relationship to food, I’d do two things, Michael. The first thing I would do is I would get people to understand that culinary culture is a beautiful thing, that cooking for yourself is not a chore. It has turned into a chore in order to sell people on processed convenience food. Cooking is a beautiful thing. Cleaning up the dishes is a chore, but cooking is a beautiful thing. I’d want people to learn how to cook and to value it and to savor and appreciate this art that everyone can learn. It’s an art that everyone can learn. That’s the first thing I would do.
The second thing I would do is I’d teach basic philosophy of science in middle school and high school. I’d have students do a study themselves and then ask themselves, “Wait. Did I really prove something? Could this have been random chance?” It’s something you can teach people really young so that then when they’re older and they see these headlines, they can say, “Oh. I don’t have to believe this is the gospel” when they see a book come out about whatever diet that is. “Oh. I understand what this is. This is a small piece in the much larger puzzle that’s science.”
Those are the two things I would do—emphasize the beauty of culinary culture and teach philosophy of science at an early age so people don’t fall prey to the sensationalist nutrition headlines and pronouncements that we’re bombarded with every day.
DrMR: I love it. One of the things that I’ve tried very diligently to do in the book that I’m writing is teach people how to evaluate science, not making it a very daunting, laborious task, but there are just some simple principles one can apply when confronted with a new piece of information to be able to fairly easily ascertain, is this something that I should pay attention to, or is it more sensationalism, fanfare, what have you? I think one of two things will happen—it’ll help people, and they’ll get it, or it’ll just fall on deaf ears, and then I’ll probably just give up going forward!
Nutrition Science vs. Other Sciences
DrAL: It’s so important. I’m glad you talk about that, how to read science. Also one thing I’ve noticed with nutrition science—imagine with astronomy, say, astronomers come out with a study. They go, “Oh, my gosh! We were totally wrong about Pluto. That was a flaw in the lens of the telescope we were using,” or something. People would say, “Wow! I can’t believe it! Pluto doesn’t exist! How interesting!” But when you get the science of nutrition changing, you already see the difference. People get angry.
DrAL: They don’t want to have to change their minds. They’re very invested in their beliefs. You can see the difference between nutrition science and other sciences, which is that people really don’t want to let go of what they’ve come to believe, because diet isn’t just about science for people. It’s about lifestyle. It’s about identity. It’s a spiritual exercise in a sense, but it’s really good, I think, for people—myself included—to think, “OK, why do I feel angry when the US government says, ‘Oh, nope! We were wrong about eggs’? Why do I feel angry when someone tells me that the food that I eat is bad for me? Shouldn’t I just listen to that knowledge and absorb it? Why is this kind of knowledge, why do I relate to it differently than I relate to, say, knowledge about cellphone engineering? Why don’t I feel the same way?” I think that’s a really important and interesting thing to think about.
DrMR: I think it’s incredibly important, and it touches on another issue that I think is also very important, which is in this space, to a greater or lesser extent, a lot of information is fueled by consumer demand. If everybody wanted a book on why gluten is so bad and someone wrote that book, that person would be rewarded with a million-dollar book contract and a huge readership, and that would fuel more and more.
I guess the point I’m making here is the healthcare consumer has an influence on the type of healthcare information that we’ll be presented with, just like they say when you shop, you vote with your wallet. If you buy lots of processed foods, that is going to fuel the processed food machine, and it may starve local farming if it doesn’t become supported.
The same thing, I think, applies to what sort of educational materials people pursue and follow and how people as healthcare consumers react to new ideas. If people are shunned for thinking outside of the box or proposing a new idea, you’re going to unfortunately kind of starve the very minds that may help steward in change. I’m not sure if I’m articulating that very well, but I think it’s just important for us to keep in mind that as consumers we help fund and drive these different sorts of researchers and authors. Sometimes it may be good for us to have an open mind to allow an open exchange of ideas.
DrAL: Yeah, I totally agree. I think it’s really important to think about how the consumer drives the kind of knowledge that’s produced. A great example is with my own book. Of course, in this religious battle, people say things like, “Oh, I bet he just published this to make a quick buck, right? This sensationalist book.” Of course, it couldn’t be further from the truth. The best way, as you pointed out, to make a million dollars is to promise people miracles, to identify a simple narrative—here’s evil, here’s good. Usually you rail against the mainstream. “Mainstream medicine just wants to kill you! They’ve been purchased by Big Grain! But let me tell you the secret truth that nobody wants you to know.” That’s the kind of book that makes you millions of dollars.
In fact, my editor, he said to me—I finished the book, and he said, “Well, this is a great book. I really love it, Alan.” And he’s a smart editor. He knows what consumers want. He said, “But you have to tell people what to eat.” I said, “Well, the whole point of the book is that we ought to be humble and not do that,” and he said, “Well, no one’s going to buy a book like that unless you tell them the solution.” You have to tell them the one true solution to rule them all, right?
DrAL: So we had this back-and-forth where I really didn’t want to offer any kinds of rules because the whole point of the book was, hey, let’s relax. He, on the other hand, would say to me, “No, no! That’s exactly what people want! They want clear-cut rules. They want to know exactly, like, what are the five quick tricks to do whatever.”
For me, I saw that struggle when writing for a popular audience—how do I balance being honest, being true to myself, being true to the science with actually what people want to hear, which is that there’s a giant conspiracy and here’s the truth. The US government this, Big Pharma that. I wish I could write that. It would have made me a hell of a lot more money. Unfortunately, reality and science are complicated, and we all want to find the next tobacco, we all want to find the next Hitler of nutrition science.
DrAL: But the truth is Hitlers don’t come up that often, and when you hear people talk about some political leader as if they were Hitler, that person hasn’t discovered anything. They’re just engaging in a kind of religious hyperbole to demonize someone. It would be nice if all of the nutritional demons were easily identifiable, but that’s just unfortunately not the truth.
On gluten, for example, you have Alessio Fasano, who’s this guy you hear quoted by everyone. He’s this Harvard researcher and a clinician who really put celiac and non-celiac gluten sensitivity on the map. He writes a book about gluten, and it doesn’t sell nearly as well as Wheat Belly or Grain Brain because Fasano, the guy who everyone else is quoting—he’s the guy actually doing the studies—Fasano doesn’t want to exaggerate.
DrAL: He doesn’t want to promise miracles or blame gluten for ADHD or whatever, and so what ends up happening is that people are quoting him, and now Fasano is coming out—he was just in a Boston Globe article; I encourage people to look it up—where he says we were too good; we lost control. He’s actually devastated by the crazy hyperbole that his own research is being used to propagate.
It think it’s really important that people recognize the way in which legitimate, humble scientific researchers are getting exploited by people who want to turn complicated science into a quick buck and promises of miracles. I think it’s absolutely disastrous.
DrMR: I totally agree. That’s why I love that quote that dogmatism can only survive in the presence of ignorance. It just kind of encapsulates that whole philosophy. Again, I think a true scientist, a very well-educated scientist or researcher, very rarely makes such strong claims because if you really understand everything, you understand the points, you understand the counterpoints, and it’s hard to say, “Yes! This is always good, and this is why it is!”
DrMR: You understand there are four or five studies or points that totally contradict that, and so you’re much more humble in your approach. If anything, I hope one of the things people are taking away from this call may be a really simple way to just cut through the bullshit—excuse my French—is if someone comes off overly hard driving, overly confident, overly dogmatic in a position, I would be incredibly wary because they’re probably biased, and that’s probably someone who’s not going to give you high-quality information but rather a sensationalist rendition of whatever they think.
DrAL: Yeah, I totally agree. In fact, I think of my book not so much as a nutrition science book, although it is about that, thanks to the scientists and clinicians, and I interviewed tons of them for this book because I’m not a nutrition scientist, so I wanted to talk to the experts—Peter Gibson, who’s studying gluten at Monash University. I talked to these guys, so I learned about the science that way, but what I see my own contribution as is to this, like you said, critical thinking. How do we think about this science? How do we process this information?
There are these tricks that people use. They’ll say things like, “Well, people are saying gluten isn’t bad for you now, but people used to say that cigarettes weren’t bad for you, right?” That sounds like a really compelling argument. It sounds like, “Well, yeah! If we were wrong in the past, we must be wrong about gluten now!” Of course, that doesn’t actually make sense philosophically. If you break down this “well, we were wrong in the past about tobacco, so we could be wrong about gluten,” well, we were also right in the past about a lot of things, and there were a lot of other candidates for the dietary demon. There was a really popular fad diet where people chewed their food 500 times. John D. Rockefeller was a part of it. Kafka did this diet as well. The Great Masticator was this guy’s name, Horace Fletcher. You could use the same logic with that. He probably used the same logic. “We were wrong in the past. Well, you could be wrong about mastication, so chew your food 500 times.” That’s not a good logic by which to begin believing something.
I want people to understand that there are these philosophical tricks that sound plausible that people use to convince you that their revolutionary truth is the right one. Don’t fall for it. Take a deep breath and think, “OK, I’ve seen this stuff before. I’ve seen in faith healing, right? I’ve seen it with holy water. I’ve seen it with demon exorcism.” Just because lots of people believed something in the past doesn’t mean that it’s true. My area of expertise is Chinese medicine and religion. People say, “Oh, this is ancient Chinese wisdom,” you know? And I say, “Well, OK. Ancient Chinese wisdom also said you should cover yourself in dog feces in order to treat (inaudible)!
DrAL: A lot of people also believed that for a very long time. So maybe we should, again, pause and not fall for these kinds of rhetorical and logical tricks that have been used again and again and again to convince us of things that aren’t necessarily accurate.
DrMR: I completely agree, and I hope that right now the pendulum is swinging and people are looking to be able to think for themselves, think through these things, and have a more reasonable look on these things and not just fall behind some sensationalist party line. I knew this would be a good call because I think we have that same line of thinking, and hopefully the people listening are appreciating this. I really hope that we’re reaching people with this because I think that the better the consumer can be with adopting this sort of mentality, I think the better the movement will be because it will foster better science and better dialogues and a more open exchange of ideas. I’m hopeful, but I guess time will ultimately tell.
DrAL: You’re making me hopeful, too, Michael. I really appreciate it. This really has been a great conversation.
DrMR: Good, yeah. Thank you, definitely likewise.
DrMR: Alan, I know you have to jet here in a minute. To bring us to a close, are there any closing thoughts or comments or ideas that you want to leave people with?
DrAL: Yeah. There are two things. The first is I think people should realize—this is something I like to tell people—every kind of restrictive diet is a medical intervention, by which I mean if you cut something out of your diet, people say, “Well, why not just try it? Why not try this and see how well it works?” Well, even just eating lower calorie, just trying that out to see if it helps you lose weight, that’s a medical intervention. It can have consequences. People get stuck in yo-yo diets. People become paranoid about whether they’re eating too many calories. People become anorexic or bulimic. And the same is true for any kind of dietary intervention. When you eliminate something, when you change your diet in order to see medical results, that’s a dietary intervention, it can have side effects, and so it’s very important to be cautious with dietary interventions the same way that you would be with any other kind of medical intervention. That’s the first thing I would say.
The second thing is that I’m so sympathetic to people who are suffering, the people that come to you, Michael, the people that come to your clinic looking for answers, and I wish those people luck, and I hope they find clinicians like you, Michael, or other professionals who, on the one hand, don’t just get brainwashed into thinking there’s one kind of pill to solve all problems and understand that individuals are individuals, but also don’t just to ram dogma down people’s throats, but are are cautious and humble. I know that everyone is on their own health journey, and I wish them good luck finding responsible practitioners who are willing to treat them as individuals but also don’t promise miracles because they know that that’s irresponsible. That’s what I would want to tell people.
DrMR: Yeah, well, I agree with both of those and very strongly with the second point because it’s very saddening to me to see that sometimes the sickest people, the ones who are the most motivated to get better, are the ones who can be the most taken advantage of. That’s a sad reality, and that’s why, again, I’m happy that we’re having this conversation and other conversations like this because hopefully that will help make the sick patient a little bit more wary before they sign up for some crazy $4000 bells-and-whistles healthcare plan that’s meant to revolutionize their life in two months or whatever it is—
DrMR: —and find a good clinician who’s going to be thoughtful with these things.
DrAL: Yeah. Or even something less drastic. A teenage girl who’s concerned about her weight goes to a clinician who takes a responsible plan instead of prescribing a 20-day fast that starts her on a lifetime of disordered eating. It’s nice when people are cautious and don’t just jump into some kind of crazy intervention because they’ve read about it in the latest fad diet book.
DrMR: I agree. Well, Alan, this has been a great talk, as I really had a feeling it was going to be. People can track you down at TheGlutenLie.com, right (9a)?
DrAL: That’s right, or they can follow me on Twitter. I tweet a lot. And obviously if they search me on Google they’ll find stuff I’ve written for Wired or The Atlantic or Slate, where I talk about a lot of these ideas in smaller bite-size pieces.
DrMR: And what’s your Twitter handle?
DrAL: It’s just my name, @AlanLevinovitz.
DrMR: Gotcha. Cool. Well, Alan, thank you again so much. This was a great call, and I’m sure that people are going to get a lot out of this.
DrAL: Thank you for having me. It’s been a pleasure talking.
DrMR: All right, Alan, take care. Thanks again.
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