What’s causing obesity? I can’t believe it’s not butter.

This is a blog post I wrote in response to a three day trip to Washington D.C. with my Nutrition Policy class at UNC Chapel Hill. We got a chance to meet with a wide variety of policy makers, public health nutritionists, food industry executives, and lobbyists, all who have careers that have a significant influence on the food available in our country. It was a very eye opening experience, and I’m happy to be part of an educational program that provides such great opportunities for real-life learning!

One of the major themes I heard come up over and over during our three days in Washington D.C. was the emphasis on “science-based” nutrition policy. From the Dietary Guidelines themselves, to the policies created to enact the guidelines, to the food manufacturers’ efforts to create product based on those guidelines, it would seem that taking an evidence-based approach is the gold standard for nutrition in our country. After all, why would we want to enact national nutrition policies that cost billions of dollars but don’t actually work?

The major issue I saw over the three days was that most of the speakers were under the impression that their understanding of nutrition science was infallible and completely up-to-date. I heard statements like “the tenets of nutrition are stable,” that “the science of what we should eat is almost irrelevant,” and that “we know what people should be eating, but we don’t know how to get them to eat that way.” It seems that most nutrition professionals, at least in the public health and policy world, assume that our understanding of what makes a nutritious human diet is 100% accurate and complete, and that the only issue is that Americans are ignoring our perfectly sound advice. But is this the total reality of the situation? Personally, I think not.

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I would argue that one of the biggest problems facing nutrition in this country is the fact that not only do we not understand what dietary factors truly cause obesity, but that we are enacting nutrition policy based on dietary beliefs that are outdated and, frankly, often inaccurate. An example that was used consistently this week was the issue of dairy fat, and how policy makers and public health nutritionists are doing their best to ensure that Americans, particularly children, are only consuming low fat or fat-free milk. These professionals believe that full fat dairy products, and saturated animal fats in general, are completely unhealthy and are significantly contributing to the obesity and chronic disease epidemic in this country. This could not be farther from the truth.

Dairy Fat: Public Health Enemy #1?

A recent article in Today’s Dietitian, the magazine published by the Academy of Nutrition and Dietetics, explained that the saturated fat found in dairy may actually be health promoting, and that the message to drink low-fat milk products is inaccurate. There are hundreds of compounds in milk fat, such as distinct fatty acids and fat-soluble vitamins, that may play a role in supporting our health. For example, trans-palmitoleic acid, a fatty acid found in full fat milk, cheese, yogurt, and butter, may substantially reduce the risk of type 2 diabetes and other metabolic disorders. Other research has found that that people with the highest levels of milk fat biomarkers in their blood, suggesting they consumed the most dairy fat, were actually at a much lower risk of heart attack.

Furthermore, dairy is a food recommended by the dietary guidelines due to its high calcium content. But research shows that calcium requires both vitamin D and vitamin A, as well as a newly emphasized form of vitamin K (called vitamin K2), to properly assimilate the calcium for the promotion of bone growth. Did you know that dairy fat, particularly from grass-fed cows, is one of the highest sources of vitamin K2 in our diet? Vitamin K2 is an essential fat-soluble vitamin that works synergistically with vitamins A and D to create calcium binding proteins, which ensure the proper placement of calcium in our bones rather than our soft tissues (eg. our arteries), preventing both atherosclerosis and osteoporosis. Without adequate vitamin K2, we cannot properly use the calcium found in dairy for healthy bone growth, and that unused calcium may end up hardening our arteries instead.

It is important to note that vitamin K2 specifically, and not the vitamin K1 found in leafy greens and other plant foods, that is protective against atherosclerosis and osteoporosis. So I would like to question policy makers where they expect our nation’s children to get vitamin K2 from if dairy fat is stripped from our diets. Will we be serving goose liver in school lunches? How about natto? Maybe copious amounts of egg yolks? Could it be that the deficiency of vitamin K2 in children’s diets is causing toddlers to display signs of cardiovascular disease at such young ages? Perhaps not, but we don’t know for sure.

As you can see, the evidence strongly supports the health protective effects of dairy fat. And yet our nutrition policies are pushing hard to get dairy fat out of our diets, and particularly out of children’s diets. The belief that dairy fat is directly contributing to childhood obesity, or that switching to skim milk after age 2 will improve our children’s health in any way, requires blatant denial of the scientific evidence supporting the consumption of whole-fat dairy products. Or perhaps just ignorance of human nutrition and biochemistry.

While there’s no way to know what the health impact of eliminating dairy fat, and other animal fats, from the American diet will be, I think it brings up another important theme that came up several times over the three days: the law of unintended consequences. For as much as public health nutritionists honestly believe they’re helping their constituents lead healthier lives, many of the nutrition policies developed in the past 20-30 years have not only not made us any healthier, but may have even left us worse off than we started before the Dietary Guidelines existed. It doesn’t seem like anyone in the government is actually evaluating the long term health effects of the shift in our diet composition as a result of the recommendations they’ve made. Why have obesity rates increased in velocity ever since the Dietary Guidelines were enacted? Sure, correlation doesn’t prove causation, but it’s definitely something to consider. Why do we continue promoting the same policies if they’ve never actually worked, and may actually be causing harm?

Thanks to fellow UNC student Adele Hite, MPH-RD for this image.

Since saturated fat and dietary cholesterol have never been shown to cause heart disease, diabetes, or obesity, why are we still working so hard to reduce Americans’ intake of these nutrients? Since the evidence shows that dairy fat is health-protective, why aren’t we providing whole milk – not high sugar flavored skim milk – in our children’s school lunches? Some research even shows that calorie restriction and long term dieting actually leads to weight gain over time, thanks to the chronic psychological stress it causes, so why are we pushing our clients to count calories so meticulously? Why are nutrition professionals resting on their laurels and not questioning their understanding of human nutrition as the available science continues to improve?

The most important thing I learned this week is that there is a serious knowledge deficit in the world of public health when it comes to understanding what constitutes a truly health-promoting diet. I realized this week that if our country’s overall health is ever going to seriously change, we need to challenge conventional ‘wisdom’ about what a nutrient-dense diet is. Believe it or not, animal foods – and animal fats – can be highly nutrient-dense as well, not just fruits and vegetables. The truth is, the world of obesity research is ever changing and expanding, and scientists are constantly learning more about the factors that truly contribute to obesity and its related diseases – and I can tell you pretty confidently, it’s not saturated fat, dietary cholesterol, or full-fat dairy products.

If public health nutritionists continue their misguided attack on certain innocuous dietary components, I believe the health of our country will continue to suffer, and will likely even get unintentionally worse. Therefore, I see it as my responsibility, as some of the speakers pointed out, to continue to be persistent and advocate for better nutrition guidelines based on evidence rather than conjecture or conventional (but incorrect) belief. I hope that my role as a public health nutritionist will be to eradicate misconceptions and misunderstandings about what constitutes a healthy diet, and find a way to better educate my colleagues about the ever-changing world of nutrition science. It worries me that a marketing executive knows about our country’s dietary choline deficiency but that as an MPH-RD student, I’ve never even heard choline discussed as an essential nutrient in class.

I hope one day, when I’ve entered the world of public health nutrition, I can help to address that gap in knowledge, and ensure that Registered Dietitians are truly the nutrition experts we purport to be.

  • http://mypathtopaleo.blogspot.com/ snicci

    Thank goodness for people like you.

  • Anthony

    “and ensure that Registered Dietitians are truly the nutrition experts we purport to be.”

    Kick ass!!!

  • Jay Miller

    A great, great read. The K2 connection is a marvelous one- banning red meat, dairy, butter, and basically anything with any actual K2 most likely leads to an A/D/Mg/K2 imbalance.

    Brilliant, Laura.

  • Lesley McHugh

    Curious as to your opinion about raw milk versus whole, pasteurized milk. Are the health benefits the same? Does K2 get stripped out of “factory” milk?

    • Lauren

      I would also like to know that.

    • Laura

      Well, I believe raw milk is healthier for a variety of reasons. But I do think there is K2 left in “factory” milk, though not as much as there would be if the milk was grass fed and unprocessed. Chris Masterjohn has a list of menaquinone (K2) amounts in various foods, and I’m pretty sure they would only test pasteurized dairy products, not raw milk.

      http://www.westonaprice.org/fat-soluble-activators/x-factor-is-vitamin-k2#fig4

      • Ian

        Hi, what an insightful article, great job. I’m a Paleo guy and I really don’t drink milk, but if I did, I would NOT go the raw milk route and in no way would I ever give it to a baby. Sorry to disappoint, but with raw milk you run a huge risk of catching E.coli. Give raw milk to a baby that happens to have e.coli in it, well … I don’t really want to say, but it won’t be good. Getting E.coli is not something you want to play around with.

        Thanks and keep up the good work.

        • http://twitter.com/wmlamont Miles L (@wmlamont)

          Sorry to disappoint, but with raw milk you run a minor risk of catching E.coli, which is mitigated even more by sourcing that milk from a reputable, grass-fed source. ( http://www.newtrendspublishing.com/PDFS/15MilkFinal.pdf )

          Also, thanks for scare-mongering with the whole “raw-milk to a baby” thing – who the hell would give ANY sort of cow-milk product to an infant in the first place? Or is it propositional fallacy day and no-one told me…

          • http://ancestralizeme steve

            Miles L don’t be a jerk! Propositional fallacy? Wow you must be really intelligent, lol. Nobody is giving raw milk to infants, that said, whole milk is what I fed my children and thank GOD they are healthy!

    • Kevin

      I know an organic farmer who told me that the paturization process stips milk of the “good fats” and the fats that are added back in”especially for whole milk” are nothing the human body can use for nutrition or proper digestion. Raw milk has everything nature (God) intended.

  • Lauren

    So so so true! I don’t understand how public health experts, RDs, MDs, etc. can honestly believe that fortified, omega 3 oil based margarines are healthier than a real food – butter. As a dietetic intern, I hate telling patients they are allowed to order sugar-laden milkshakes made from Ensure (more sugar…) but can only eat low-cholesterol eggs. More RDs really need to step up and challenge beliefs like you are.

  • http://www.primalpal.net Chris

    Great write up! Sounds like it was a good experience to witness first-hand how out of date the policy makers are with the information about what makes up a healthy diet. I really appreciated your discussion on K2. I did not know that the fat from grass fed cows was one of the highest sources of K2. I will be investigating this further. Overall, I’m kinda sad and upset about the way policy makers don’t have a clue. It’s really not cool. So many people do follow their guidelines, yet continue to struggle with obesity and disease. I’ve watched the talk by Adele Hite on youtube and I think it’s a message more people should listen to. Anyway… enough rambling by me. Thanks for a great article.

  • http://www.facebook.com/ReachAndyWilliams Andy Williams

    Great blog post! I’d be really interested to know who you heard from and met on your trip. I see this problem as part of a much larger issue about the nature of evidence-based policy making and the limits of what government can or should recommend. I’m just starting on the dissertation for my Ph.D. in public policy, and my subject will be the utilization of knowledge in nutrition policy decisions and how coalitions form around shared belief systems (as you have described).
    These “advocacy coalitions” permit stable policy (e.g. nutritional guidelines) as long as everyone shares the same paradigm. I’m going to attempt to study what happens when enough new knowledge accumulates to call into question the current policy paradigm, and how various policy actors and policy systems deal with conflicting information. So I will be closely following the ancestral health / paleo movement for a while! If my paper gets accepted at this years Ancestral Health symposium, you might here more about that! ;)

    • Laura

      I wish I could tell you who we heard from, but let’s just say there were some very influential people who came to speak to us. I was actually impressed that our program was able to get some of the folks they did. They mentioned that the tipping point is 15% – so we need to get that many people in our country to challenge the current paradigm before we see any major shift. I think we can accomplish it, more and more people are hearing about ancestral nutrition all the time!

      And I think trying to create recommendations for the entire US population is an impossible task. It completely overlooks individual nutrition needs, and the guidelines we have are not appropriate for anyone in my opinion. That’s why our government is failing at it. I don’t blame them for being unable to do something that is impossible!

      • ASusan

        (Just curious as to how your advisors deal with your alternative views; are they holders of the establishment?)

        • Laura

          My teachers are generally wonderful and supportive. I have a few in particular who have been quite encouraging of me which has been really key in helping me maintain my sanity throughout some of the educational experiences I’ve been through. Honestly I can’t imagine going to a better RD program than here at UNC, they’ve got to be the most progressive program in the country, and certainly one of the top ranked.

          That said, they do have curriculum that they have to teach based on AND (formerly ADA) guidelines. So while they support my dissension, they still teach the standard government-approved information in most circumstances. I’m just glad that they respect my opinion and don’t give me a hard time!

  • http://packofpacks.weebly.com Lory

    Thanks for this very informative post and spreading the word. As a personal trainer I am often met with adamant resistance when promoting healthy fats. It has become stubborn “common knowledge” that fat free is good for you.

  • Carin

    Excellent post Laura, a shame many dieticians are still anti dairy fats. Well done for doing your part!

  • http://www.facebook.com/skip.swanson Skip Swanson

    Thank you for this powerful and clear article, it needs to be read by millions. Wake up, America!

  • Elanor

    Thanks for providing an inside look at our food policy and its issues. Follow the truth!

  • Larry Schwartz

    THANK YOU for your blog post, Laura!! You certainly have a passion for changing the way we (the U.S., at least) need to look at, understand, and be educated about whole food nutrition. Looking forward to reading more from you! Cheers

  • val

    Laura, I applaud you efforts and those in the community that are trying to re-educate folks about what constitues health promoting dietary factors. I feel so beat down at times by the lack of knowledge and understanding people exhibit. Good luck in your worthy endeavor!

  • Marty

    Nicely done! Purely focusing on eliminating fat ignores the whole nutrient side of the picture (perhaps assuming they come from a “complete” multivitamin?).

  • http://truthbutter.com Alyssa

    Great post, but so frustrating! Every time I read something about the massive ignorance in nutrition policy, I get angry, although every day I’m discovering more allies who are seeking true science-based nutrition. I’m sure it was fascinating to hear from these people directly! Sometimes it seems impossible that such ignorance could really exist in our government, but they continue to surprise me (:

  • http://coloradogreenchannel.com Robbie

    While I am so grateful for the science in the post and would love to comment in an thoughtful way…BUT… I’ve been so hungry for so long to hear the TRUTH stated in a compelling and accessible form that I simply can’t be unemotional about it. I JUST. ADORE. YOU. (Please think of that in a totally non-creepy, Grandma holds you in very high esteem way)…

  • Ninfa

    Too much fats and preservatives in processed foods and lesser outdoor activities made people fat. Let’s go back to the basic wherein children were just eating all foods made from scratch and no tv nor computer to make them inactive. too much calorie intake and lesser calories burned equals obesity.

  • http://www.facebook.com/barbara.a.loska Barbara Ann Loska

    having struggled with obesity all my adult life, and being “good” and drinking non fat milk and using “light” margarine, I find my self heavier each time I try to lose weight, now in my
    mid 60′s with damaged joints…I am grateful for the shining light you offer with your blog, and sites like Just Eat Real Food and the Paleo movement…it gives me hope that my children and grandchildren and avoid the fate that awaits me.

  • http://www.reinventyourdiet.com Pam Schoenfeld RD

    Love the title – how true! Obesity in children is so much more complicated than excess calories from saturated fats. And to think that dairy fat used to be considered an important part of a child’s diet per the USDA guidance (pre-1960), when it was rare to see an obese, even an overweight child. I guess it feels good to these RDs, etc. to be able to control what can be controlled, since so many health behaviors almost impossible to truly control. So if we take the fat out of the milk and add in sugar, and the kids will drink it, we feel we have accomplished something. Maybe not something good, but something. It is not only the misguided RDs, the pediatricians are enforcing the same low-fat dogma. More than one has told parents of my pediatric patients that they disagree agree with the advice I am giving their patients. Parents are really between a rock and a hard place if they don’t look outside the healthcare box. But I think we will see that 15% tipping point within the next few years, as people are “fed up” with the USDA, the conventional RDs/MDs, and the advice that is basically destroying America’s children’s health.

  • http://www.tuitnutrition.com TuitNutritionAmy B.

    Amen, Laura. Your writing is so eloquent. Keep fighting the good fight. It’s clear that your knowledge of biochemistry and physiology, and your dedication to spreading the truth will lead you to a career of helping people get the messages they so desperately need about what good food and good nutrition *really* are.

  • meghan

    I’m also curious how you feel about raw milk. Could you respond to Lesley McHugh’s comment?

  • http://www.facebook.com/faithrichfidler Faith Rich Fidler

    So how do you weigh the “Forks Over Knives” documentary against the info you’re giving? I know you’re talking more from a nutrition stand-point, but what do you think about disease promoting foods regardless of nutrition? Just curious, as I’m trying to wade through the muck of information that is so contrary to each other. I’m not an expert on anything except my own field (psychology), so any opinion will be weighed. Thanks, ~Faith

  • http://www.purifyyourbody.com rebecca

    Thank you for this article. It frustrates me to no end when my friends and family drink non-fat milk or butter substitute products. They look at me crazy when I drink my whole, raw milk and slather on the butter. I don’t know what to do to prove these things to them, and I think it is rude of me to point out that my BMI is 22 while theirs is over 30! (how do you do something like that, tactfully?) However, I also don’t eat processed flour (try to limit my flour to sprouted wheat) nor do I eat sugar except when it is hidden in certain condiments. And I take Vitamin D3 and Vitamin K2 supplements every day!

  • Carter

    Laura- As a former academic and policy wonk I have to commend you for staying so positive when the system seems so stacked against your beliefs. I have been following a Primal/Paleo/Ancestral diet and am healthier, happier and more energetic than I have been in years. I credit my diet and discovering a gluten intolerance for this change. Of course I would not have known about any of this without Marks Daily Apple :) (Seriously, I wonder how many lives Sisson has saved!). I am glad there are more voices in the arena and yours is very compelling. Please keep it up and good luck!

  • Kim

    I have just embraced the Paleo/Real food way of eating. I am introducing some things back into my diet and wondered, if one can’t get raw milk, is organic much better than non-organic when it comes to dairy products?

    • Laura

      I’d say the most important thing to look for is whether the animal was grass-fed or not. That will make a huge difference in the nutritional quality of the milk. Organic may just mean the animal was fed organic grains. Look for the words “pastured” or “grass fed” when buying dairy products. Products like cheese or butter from Europe (eg. Kerrygold Butter) or New Zealand/Australia may be your best bet.

      • Elanor

        I agree. Grass fed dairy is the best! The real problem is finding a real grass fed option. The USDA National Organic Program requires farmers who are certified organic to have a meaningful amount of grass, or pasture, in their diets. But the USDA’s NOP manages a lot, and sometimes things aren’t what we would like them to be. Here is a link to a Cornucopia review (Cornucopia is an organic advocate and industry watchdog) and report card on brands in the organic dairy world:

        http://www.cornucopia.org/dairysurvey/index.html

        The page that leads to the report can help with interpretation:

        http://www.cornucopia.org/2008/01/dairy-report-and-scorecard/

        There are farms and products that are only organic, meaning grass fed, in name. But there are also those who base the cows’ entire feed plan on grass, and care passionately about the health of their cows, and the health of the people who drink their milk!

  • http://awlr.org Larry
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