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Jeanne Calment was a fraud?!!

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This Live Science article has been getting some attention since it was posted a few days ago (you may have caught the Aug. 16 topical segment on NPR Science Friday):

https://www.livescience.com/oldest-people-may-not-be-so-old.html

The World's Oldest People Might Not Be As Old As We Think--Poor record-keeping and fraud may be inflating the numbers.

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 Another investigation earlier this year presented evidence that Jeanne Calment, who at 122 years old was the oldest woman whose age was well-documented, was actually her 99-year-old daughter, claiming her identity for a pension. Fraud and misreported data might seem especially unlikely in the case of Calment given how well-documented her life was, and the investigation's allegations of fraud haven't been confirmed. But it happens all the time, even among the highest-profile supercentenarians, said Saul Newman, a data scientist at Australian National University and author of the new BioRXiv study. 

 

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It seems that quite a bit of the fundamental-level science is being re-examined. Some of it for the sake (and survival) of pop science. The British weekly excels at sensationalism ...

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That 13 July cover story about nutrition even calls in to question fruits and veggies. 

Despite all this marketing and scientific noise, I do think for those of us who can tolerate CR, and on an uninterrupted and life-long basis, we can safely ignore much of this distractia . 

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I'm usually pretty down on health clickbait articles, but as they say, even a stopped clock is right twice a day. In this particular case, I think we should all be troubled by the poor quality of "evidence" we have for various healthy behavior recommendations, most certainly wrt. diet. It is not wrong to say that most if not all of the so-called evidence behind various diet recommendations is subject to all sorts of caveats and that in some ways it is an insoluble problem insofar as population level recommendations are often in contrast to individual recommendations. Personal medicine is the next frontier. Why should anyone who is not a healthcare policy official care about population based studies and recommendations when it comes to their own practice? What might be true for various values of "majority" of the populace might be radically different for me or you as an individual - and that's true even for the most basic things like macronutrient recommendations. You might do well on low carb, I might do well on high carb and we both might seriously affect our health if we get this wrong, never mind what's true for the "majority". This of course is true in spades the further you get into more fine-grained recommendations, the role of your individual microbiome and your particular physiology. At this point, I must confess, I have increasingly less interest in population based studies in general, whether it pertains to diet, exercise, particular drugs or any other health practice. What might be true for you might be the opposite for me. So what's the point of taking some kind of "average" human and applying that to yourself? That "average" individual might not even exist and be purely a figment of statistical artifact.

Sensationalism or not, it might be a well-deserved corrective to the endless flood of breathless reporting that gets contradicted from one day to the next. At this point, I think the public is thoroughly confused about nutrition, and it is not their fault. What's worse, it's not even exclusively the fault of poor reporting by pop science journalists, but by bad science done by medical researchers in pursuit of acclaim, credit and academic careers. The field can definitely stand to be re-examined from the foundations on up. I'd say, we can pretty much chuck out most of what is the "scientific consensus" about diet, were it not for the fact, that increasingly it's hard to come by any consensus regarding this field in the first place. 

Question away, I say. 

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Tom,

I'm sympathetic to your perspective, but not entirely convinced. What do you consider the best evidence to support your contention that:

13 hours ago, TomBAvoider said:

What might be true for various values of "majority" of the populace might be radically different for me or you as an individual - and that's true even for the most basic things like macronutrient recommendations.

Is there good (or any?) evidence that a whole food, plant-based diet which is high in healthy carbs, moderate in healthy fat (20-25%) and sufficient in plant-derived protein (~15%), perhaps with meat once or twice a week if you think that is necessary (and justified ethically) would be deleterious for some individuals or subpopulations relative to another diet?

I'm not talking about sick people, like the morbidly obese who might be better served in the short term by other diets (e.g. low-carb for weight loss, or ketogenic for epilepsy). And I'm not talking about people who are already metabolically sick (like diabetics) who might do better, at least in the short term, avoiding even healthy carbs. And maybe we should exclude body builders or hardcore endurance athletes who might need more protein or calorie to support their pursuits. And I don't count people who have identified food allergies, like celiac disease.

I'm talking about relatively healthy, average people like you and me who want to know what they should eat to maintain and even improve their health status and prospects for longevity, but who aren't interested in weight loss or the diet that will be easiest for them to stick to (e.g. to minimize hunger or cravings, or satisfy their sweet tooth).  

You make it sound like all bets are off when it comes to our knowledge about nutrition. That seems exactly what the purveyors of each new fad diet would like us to believe. But I'm skeptical of the idea that radically different types of diets can be healthiest for different people. Do you really doubt that the diet outlined above would be harmful or dramatically suboptimal for some meaningful some subset of people, and if so, do you have positive evidence to support it, not just the general perspective that all nutrition science is bunk?

--Dean

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Dean, my thesis is that the diet should be calibrated precisely to each individual, and therefore is unique to each individual. As such, I don't think there is much danger that fad diet proponents would make an easy buck off my approach :) - a fad diet tries to get as many adherents as possible, whereas what I advocate is a diet for 1 individual. 

Would a diet as you described (whole food, plant based etc.) be deleterious? What it really comes down to is the word "deleterious". If our baseline is that anything that is suboptimal is ipso facto "deleterious", then it really all comes down to very detailed considerations. After all, if a diet causes you to live one day - or one hour - less in lifespan than the optimal diet, then it is by that definition "deleterious". Now, in common usage, most people would probably think that describing such a minute difference as "deleterious" is way too strong, but it's always a matter of degree - at what point do we apply that word - at one year, 2 years 3 years off your lifespan? Remember, by some reckoning (Aubrey de Grey), CR might only give an adult human a 2-3 year lifespan advantage anyway, so all that CR effort is an effort to avoid deletrious effects of ad-lib diets. 

So, if we accept in a mathematical sense that any suboptimal diet is "deleterious", then the answer to your question is a qualified yes - because your question is not precise enough. It's as if you asked "if your diet is composed of healthy food, how can that be deletrious" - "healthy food" is too broad a term (in addition to begging the question in this particular case). So too "whole food, plant-based" etc. is way too broad. Which whole food, which plants, which protein etc. - the points at which we can see a health impact are much more detailed than simply "whole foods". 

Now, for what I say to be wrong, you'd have to assume that each food and food combination has exactly the same impact on every human being (that's generally healthy, as you indicated) - and that's clearly wrong, just on the face of it. But, my point isn't merely technical tiny effects at the margin - the effects are much more dramatic. How do we know that? At least in part because each individual has a different gut microbiome, in addition to our individual genetic and epi-genetic profile and physiology. There was a paper that I linked some time ago by a team of Israeli researchers that showed astonishing and hugely different effects on people of exactly the same food - the effect was on blood glucose, showing dramatic differences in the handling of that food by a given individual. The lead researcher even had a TED talk about that, which I linked to as well. I am away from my main computer at the moment, but I'm sure one can find it pretty easily, sorry I don't remember the name of the researcher. In any case, they are trying to develop a system whereby you send in a sample of your gut microbiome, which they test and then attempt to tell you what an optimal diet would be for you. At this point, I'm sure it's super crude if it works at all, but this is the general direction I think future dietary recommendation must go of necessity - precisely because each of us is unique, therefore each of us will have a unique diet that is optimal just for us. 

That of course can be expanded to the whole panoply of health behaviors - supplements, exercise, pharmacological interventions, other health behaviors etc.

The future of medicine is in it being tailored to each individual. As such, the function of population wide studies will change from generalized recommendations, to their being merely pointers for future research - the same way we treat studies in animals today, as results that are not directly transferable from animal to human, but pointers to future research. Same here - a result in one individual will not be directly applicable to a different individual human.  

Btw. I think many of us practice some aspects of this approach on a small scale already - those of us who diligently test our blood sugar with different food combinaitons. It's a start. The point being - it's you, uniquely you.

Edited by TomBAvoider

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4 hours ago, TomBAvoider said:

... Now, for what I say to be wrong, you'd have to assume that each food and food combination has exactly the same impact on every human being (that's generally healthy, as you indicated) - and that's clearly wrong, just on the face of it. But, my point isn't merely technical tiny effects at the margin - the effects are much more dramatic. How do we know that? At least in part because each individual has a different gut microbiome, in addition to our individual genetic and epi-genetic profile and physiology....

Actually, all that's needed for you to be wrong is to show broad correlations which can be tested by their broad predictive power. And this is exactly how we know that certain habits are healthier than others and certain habits are worse than others.

Such reasoning is easy to be exploited and it often is. The anti-vaxers fall into this category. But probably the most glaring example is the case with tobacco smoking and its correlation with increased mortality, which had been noted as early as the 17th century in Europe. But tobacco companies were able to seed enough doubt to exploit the confirmation bias of smokers and would be smokers and make them ignore the broad evidence. Exceptions such as the odd old geezer who smoked (including Calment, who actually smoked one cigarette on most days) were touted to make the point of each one's "uniqueness." Even after the exact effect of tobacco smoking on the mutation process of the p53 gene was shown in the 1990s, there is enough random nonsense floating around the web touting uniqueness and the very real ability of some individuals to resist such mutations.

But the fact is, for the vast majority of humans, smoking is bad. Just like for the vast majority of humans, eating more fruits and vegetables is much better than eating a lot of sausages, steaks and buckets of KFC.

As to microbiomes, yes, they are different. But if you look at the data provided by uBiome, for instance, you'll find broad similarities between vegans and vegetarians, and obese meat-eaters. You can choose to ignore it, because you convince yourself that the probabilities do not apply to you, but the science behind it remains valid, nevertheless.

As to this Russian-driven Calment conspiracy theory, it has all the credibility of Pizza-gate. But there were lots of folks who believed in that, too.

Edited by Ron Put

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Actually, all that's needed for you to be wrong is to show broad correlations which can be tested by their broad predictive power. And this is exactly how we know that certain habits are healthier than others and certain habits are worse than others.

Sorry, but this is logic class 101 - unless you can show that all commonly consumed human diets lead to identical health outcomes in any two individuals, my claim is exactly correct. In fact, this applies even to genetically identical twins:

Nutrition: Even identical twins respond differently to food

"The largest ongoing study of its kind finds that people's responses to food vary depending on a wide variety of factors. The findings suggest that the future of nutrition lies in personalized dietary advice."

That pretty much says it all, really. 

Good luck trying to show identical responses to the same food from disparate individuals. If that is so, then my claim is necessarily logically correct - food impacts people differently as it's impossible for two individuals, even identical twins to reproduce the exact same physiological conditions.

Meanwhile, I never claimed that certain diets/behaviors compared to other distinct behaviors don't lead to better health for great numbers (NOT ALL!) of people. But the fact that those differences exist, is irrelevant. All that's relevant, is that for a given individual, you cannot predict the peak optimal diet from any given population based study. You need to tailor the dietary advice to the individual even if they do better on a given diet (say, whole food) that's true for the majority, or percentage X of the population. If everyone followed exactly the same whole foods, plant based or whatever the best diet study says, and even if everyone was an identical copy of everyone else, you would still have different outcomes for any given individual compared to another - this clearly follows from the study showing that even identical twins react differently to the identical food. Sorry, those are the facts.

Making - false - claims that my arguments are like tobacco industry misleading arguments are simply a tactic you keep using, thinking that ad hominem attacks or attacks on the supposed credibility of the source has any impact on the validity of the argument itself. Ooh, scary Russians and their conspiracy theories. This gets us nowhere - after all, I can make the same claims about your arguments (and frankly with more justification, given the paucity of actual arguments you make), that they are in the nature of Pizza-Gate, Anti-Vaxxers, 17th century this and that, and tobacco industry. Where does that get us? How about we stick to the evidence and the arguments and leave "credibility" attacks and ad-hominems and such out of it? Because I did note that you are not able to refute my arguments - not surprising, as it would be hard to do, as you'd have to show that large groups of people respond identically to diet, when the fact is that even identical twins don't and can't, as there are still too many differences (as the study noted, identical twins share 37% of the gut biome compared to non twins of 35% - hardly a big difference). And the gut biome is just one variable among scads of others.

Stick to the arguments please. Unless you have none.

I feel very justified in claiming that any truly optimal diet will need to be tailored to the particular individual - this is where medicine is going anyway, personalization. Broad population based studies have serious limitations when applied to any given individual. 

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Tom, 

Please do yourself and the rest of us a favor. Please read the white paper (hint - there is no peer-reviewed, published paper) on the twin study you're pointing to, summarize the study population, the study protocol and the results for us. Then use your normal skeptic hat to see if you really think it represents strong evidence to support the case for personalized nutrition. If you do, I'll be happy to provide the counterpoint argument, if Ron doesn't beat me to it. 

You can attack Ron (or me) all you want. But I feel you owe us more support your argument that personalized nutrition is necessary than a flashy quote and a link to an (IMO) very dubious and financially motivated article about an unpublished study of variation in glucose response to unhealthy test meals (muffins) that none of us would touch with a ten foot pole and in which the study population had unspecified and likely widely varying baseline health and lifestyle parameters who were eating (both before and during the study) uncontrolled, likely crappy diets, and therefore likely suffering from various degrees of acute and longstanding metabolic dysfunction. 

Dean 

 

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TomBAvoider:   my thesis is that the diet should be calibrated precisely to each individual...

---------------------------------------------------------

What is the evidence  that it is possible to calibrate diets precisely, correctly and reliably for each individual (at every stage in their life)?  

How  do you suggest that should be done?

And what is the evidence that "calibrating" diets precisely,  using whatever method you propose,  means  in all but extreme cases more than just tweaking the application of some general healthy -diet principles?

 "Any truly optimal diet will need to be tailored to the particular individual " seems to me  to be  a truism. On the other hand,  if you want to describe what you think is the best method to systematically individualize diets,  that might be interesting

If, however,  this precise individual diet calibration you propose can't be done in a reliable, systematic,  scientifically-proven way at this point in time,  what are the implications of that fact?

Quote

unless you can show that all commonly consumed human diets lead to identical health outcomes in any two individuals, my claim is exactly correct.

If your claim is basically a rebuttal of  that clear impossibility,  then it may be exactly correct,  but profoundly trivial.

 

 

Edited by Sibiriak

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Tom, I am not sure that I agree with your strongly worded conclusions, based on what I read from your link.
 

  • This large variation is only partly explained by genetic factors (less than 50% for glucose, less than 30% for insulin and less than 20% for triglycerides) and there is only a weak correlation between an individual's responses to fat and carbohydrates.
  • Identical twins who share all their genes and most of their environment often had different responses to identical foods. The study also finds that identical twins shared just 37% of their gut microbes - only slightly higher than the 35% shared between two unrelated individuals. ...
  • The results suggest that personal differences in metabolism due to factors such as the gut microbiome, meal timing and exercise are just as important as the nutritional composition of foods, supporting the idea that simple nutritional labeling is insufficient for assessing food.

This actually seems to support the notion that there are some general guidelines which apply to human populations regardless of specific genetic attributes. If you eat, for example, a (healthy) vegan diet, your microbiome will fit a certain pattern and if you eat lots of meat and dairy, your microbiome will fit a different broad pattern.

In other words, catering to your current microbiome may, or may not be "optimum" for you, whatever that means.

Moreover, your microbiome will dramatically and usually rather rapidly change, based on changes in your diet and lifestyle, too, as seen by testing through companies like uBiome.
 

2 hours ago, TomBAvoider said:

unless you can show that all commonly consumed human diets lead to identical health outcomes in any two individuals, my claim is exactly correct.

Why would one need to show "identical health outcomes in any two individuals?!!"

We are talking probabilities and patterns. To use the smoking argument, one may get lung cancer without ever having smoked and some life-long smokers do not get lung cancer. But it doesn't mean that smoking tobacco does not significantly increase the likelihood of developing a p53 mutation which leads to cancer.

 

2 hours ago, TomBAvoider said:

I feel very justified in claiming that any truly optimal diet will need to be tailored to the particular individual

What does this even mean? We already know what diets broadly improve the healthspan of populations -- we just can't make most people to follow them. What makes you think that if a "truly optimal diet tailored to the particular individual" (whatever this means to you) was possible to design, that individual would follow it, any more than they follow the general broad guidelines?

And, finally, speaking of BS meters, this is quite notable:

"About ZOE:

ZOE is a nutritional science company on a mission to help people eat with confidence. We are leading the world's largest ongoing scientific nutritional research project to understand our unique responses to food, developing a consumer at-home test and app that makes it easy for everyone to understand the right foods for their unique metabolism in order to improve long-term health and manage weight more easily."

It reminds me of one of popular "blood type diet" apps which had a tagline going something like: "Everybody is different! Ever body is different! Personalized nutrition for everybody!" 😄

Edited by Ron Put

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AFAIK the ZOE project is similar to the Israelian project of monitoring individual blood glucose by continuos glucometer in response to various food and meals.

The studies by Elinav and Segal, which we previously discussed in this forum, according to which the blood glucose response after the ingestion of the same foods varies wildly across individuals. Teh authors wrote a book on the project (The personalized diet) plus at least an article discussed in this same forum.

The results seem to support the value of individual nutrition to optimize blood glucose, admittedly in a pretty costly fashion (cost of glucometer about 1500 US$ plus 500 US$ per month for the dermic sensor) or in a pretty unconvenient way (multiple pricks and monitoring by common portable glucometers). 

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3 hours ago, mccoy said:

The results seem to support the value of individual nutrition to optimize blood glucose.

As you noted on the other thread about personalized nutrition, it isn't clear that preventing transient rises in blood glucose after meals is necessary for good health, and it is clear that it isn't ALL that's necessary for good health.

But focusing narrowly on blood glucose for the moment. There is no doubt that people's post-meal glucose response to different foods varies substantially. But Tom and these researchers/entrepreneurs pushing personalized nutrition seem to assume that these variations are due to intrinsic differences between individuals, although paradoxically pointing out that genetics has very little to do with it.

Instead they seem to attribute it largely to differences in microbiome from person to person. But there is a lot of research to suggest that microbiome differences are caused by the diets we eat. So it seems to me a very credibly hypothesis that the glucose response differences are merely an artifact of eating an unhealthy diet that leads to an unhealthy gut microbiome and insulin resistence. As a corollary, my hypothesis would suggest that if people ate a healthy, whole food plant-based diet, with time their gut microbiome and insulin resistance would improve, glucose responses would settle down, obviating the need for "personalized nutrition".

In other words, I haven't seen any evidence that a WFPB diet won't work for everyone if followed consistently for a a year or two to get your weight, gut microbiome and insulin sensitivity in order.

I'm happy to acknowledge that getting to this point of health from the poor state many people are in as a result of a lifetime of bad diet and lifestyle choices may require some personalized tweaks along the way (e.g. temporarily avoiding even certain healthy carbs for diabetics). But in the steady, healthy state, it seems to me that we haven't seen any evidence that personalized nutrition is required.

--Dean

 

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8 hours ago, Dean Pomerleau said:

As you noted on the other thread about personalized nutrition, it isn't clear that preventing transient rises in blood glucose after meals is necessary for good health, and it is clear that it isn't ALL that's necessary for good health.

Right, thanks for reminding. Also, one point that pretty much baffled me (discussed in the exercise and blood glucose thread) is that it appears that it isn't so easy to lower post prandial glucose peaks, even with exercise . So the advantage of wanting to lower BG with its peaks at all costs may be dubious (too much time and energies required and a choice of foods which is not undisputably healthier).

It remains pretty controversial as a topic though.

I'd like to underline that I'm eating plenty carbs right now, simple and complex but I'm ready to intervene should my fasting BG cross consistently the prediabetic borderline (100 mg/dl).

 

Edited by mccoy

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Dean, where have I attacked you or anyone else? I rather resent your stating "You can attack Ron (or me) all you want." - I have done no such thing, other than respond to Ron's attacks which were based on attempting to smear sources and not focus on the merits of arguments - in fact the opposite, I urged Ron to please stick to arguments and not range wildly questioning my credulity/scepticism, comparing to Russian misinformation, medieval times, antivaxxers etc. Please desist from making such inaccurate accusations. Thank you. 

In any case, Dean, certainly genetic differences aren't the only factor. In fact, we know that, because if indeed identical twins can have drastically different physiological reactions to food, that's kind of the point. And while I've cited the gut biome as one variable among many, it is hardly the only one. The point rather is that an individual constitutes a totality of influences that are both internal and external. In other words, there are literally millions of variables, and hence why it is impossible to get exactly the same effects on two different individuals. Even the argument about gut biome is not entirely correct - it is NOT true that as long as you consume an identical given diet to someone else, your gut biome will become substantially the same - that is clearly untrue because diet is not the only factor impacting your gut biome, it is your physiology as in your immune system, your anatomy (example, when I had my colonoscopy, the doctor who perfomed it told me I had an unusually long gut, which has all sorts of discreet health impacts, susceptability to diverticulosis etc. - all nothing to do with diet, or rather the same diet will have a different impact on someone with a different gut anatomy), your lifestyle choices, medications, supplements, exercise etc. - on and on and on. In fact, not too long ago, we had a study showing the dramatic impact of whole body vibration on the gut biome and drastic physiological impact to the point of powerfully influencing diabetes and blood sugar. And WBV has nothing to do with diet - so that's an example of how a completely non-dietary factor impacts the gut biome. Who would've thought that vibration would have such an impact? Again, that points to the fact that we are dynamic systems with millions of variables in extremely complex interactions. We can therefore never simply assume that "whelp, change your diet to vegetarian/vegan and your gut biome will be just like the other guy" - nope, it won't be just the same, because there are tons of non-dietary factors that impact that. 

Furthermore, while we talk about genetics and gut biome and blood surgar, these are just a few factors. Who has the odd idea that somehow those of us who recognize the importance of personalized medicine limit ourselves to just those factors? Just blood sugar, or just gut biome? Not in the least! As I said, there are tons and tons of variables. We know that even the exact same genetic profile will have a different health outcome based on slight external enviromental differences, which is why the whole giant field of epigenetics exists. Every individual is... an individual.  

As to plant based diets or any other kinds of diets - yes, there will be genetic differences. In fact, I remember a few years ago, we were exploring SNPs that impacted health and diet and Dean you were participating in it - wherein I discovered that I was one of those individuals (according to 23 and me data), for whom F&V did nothing, and in fact with more consumption tended to slightly negative outcomes. If you remember, you can probably dig up that thread. Yes, there are drastic differences between individuals - and I'll come back to the idea that just because WFPB diets may be better as a class for large numbers of people, it means a hill of beans wrt. an particular individual, as in you

Ron, you make very puzzling remarks, indicating to me that you did not understand my points at all:

This actually seems to support the notion that there are some general guidelines which apply to human populations regardless of specific genetic attributes.

Come again? Where did I say that genetic differences are the only factors that affect health outcomes, period, never mind gut biome? I cited that study to make the opposite claim - that even if, the genetic profiles were identical (as in identical twins), you would still have different gut biomes (similarity is greater only by 2% from 35% to 37%) and different reactions to food, and different health outcomes. In other words, I'm making the opposite point - even if you normalize genes and diet (as in identical diet down to the molecule), you would still have differential outcomes, and furthermore you could go down a long list of other factors you can normalize (exercise, medications, supplements etc., etc., etc.) and still come up with different health outcomes. Because we are unique individuals, there are widespread differences with all those factors in turn - which is why we all react differently to exercise, to how we gain/lose weight, how we react to medication and supplements and so on. Not merely do these factors work differently for different people, but their interactions in turn explode the complexity of dynamic systems for differential health outcomes. And so, one diet does not fit all.

Now, can one make crude observations which would hold true for health outcomes for large groups of people, or indeed everyone? Sure. For example, eating lobster and then undergoing cephalectomy (i.e. beheading) will have a negative health impact on all individuals. But what is the value of such crude observations?

My argument in a nutshell: all such nutritional studies are to be treated extremely sceptically and are of limited value for any individual application, because the recommendations are far too crude/blunt as an instrument. In the same spirit I have a salad recommendation - please avoid adding hemlock to your dressing if you care about health outcomes; thanks, I guess.

20 hours ago, Ron Put said:

Why would one need to show "identical health outcomes in any two individuals?!!"

We are talking probabilities and patterns. To use the smoking argument, one may get lung cancer without ever having smoked and some life-long smokers do not get lung cancer. But it doesn't mean that smoking tobacco does not significantly increase the likelihood of developing a p53 mutation which leads to cancer.

Let me try one more time - even though I've already made this point which you somehow are not absorbing. I have not claimed (in effect) that smoking tobacco "does not signifacantly increase[blah, blah]" - I have not claimed that studies showing WFPB diets don't show large numbers of people benefitting healthwise vs another diet. Here, I'll cite it for you again, since you somehow missed it - see my post you are responding to:

 Meanwhile, I never claimed that certain diets/behaviors compared to other distinct behaviors don't lead to better health for great numbers (NOT ALL!) of people.

I guess I'll just have to repeat what I said, because the answer to your point has already been made:

"You need to tailor the dietary advice to the individual even if they do better on a given diet (say, whole food) that's true for the majority, or percentage X of the population. If everyone followed exactly the same whole foods, plant based or whatever the best diet study says, and even if everyone was an identical [genetic] copy of everyone else, you would still have different outcomes for any given individual compared to another - this clearly follows from the study showing that even identical twins react differently to the identical food."

Let us not forget (Dean and Ron) where all this started from. It started with my claim that vast numbers of nutrition studies have limited value for any given individual to the point where they may in fact be irrelevant - because if we all have our unique responses to any given diet, then knowing that "oh, a large number of people react X" is of little value to you (other than perhaps probabilistic).

Perhaps an analogy would help. Every one of us has a unique set of fingerprints. I think we would want for any crime investigation to focus on us as unique individuals with our unique fingerprints and not be told, well, "we performed a survey study in our prisons, and the largest group of criminals has an X pattern of fingerprints, and since your fingerprints fall into this broad group too, we've decided you belong in prison" (fingerprints fall into different group patterns). It does me no good to know that X diet is good for large (or small) numbers of people according to this or that study. I am a unique individual with a unique health signature, and I'd like to tailor my health interventions and diet to myself, not some statistical group identified somewhere in some study. 

As to ZOE and attacks on the credibility of the sources - what I really care is about the strength of the arguments and casting aspersions on the author of those arguments is not useful in my opinion - we should be a priori sceptical of all. Because I can do exactly the same for any number of those studies you cite - in fact, we know nutritional studies and medical studies in general are notoriously unreliable and fail replication. Just because you don't know about the various conflicts of interest and machinations behind the scenes for academic credit, publish or perish pressures, bias and so on for a particular study, doesn't mean you should relax about it. Tons of scientists have had commercial ventures - including the favorite around these boards, David Sinclair. Guarante has Elixir, Longo has Prolon, Barzilai has his, and on and on it goes. I am equally sceptical of ALL of them. In fact I've said so repeatedly, including in a previous post:

"In any case, they are trying to develop a system whereby you send in a sample of your gut microbiome, which they test and then attempt to tell you what an optimal diet would be for you. At this point, I'm sure it's super crude if it works at all, but this is the general direction I think future dietary recommendation must go of necessity - precisely because each of us is unique, therefore each of us will have a unique diet that is optimal just for us." [emph. mine]

I don't get hung up on ZOE or any other commercial ventures - I suspect they may not even work at all! That is not the point. The point is that the direction is correct - toward personalized medicine, personalized recommendation, personalized practices, even if these early commercial applications are not worth much or anything at all. 

Sibirak:

If, however,  this precise individual diet calibration you propose can't be done in a reliable, systematic,  scientifically-proven way at this point in time,  what are the implications of that fact?

The implications are that something is true or not, even if we don't have the tools at present to affect outcomes. We need personalized medicine, even if at present we are barely starting out and don't have many tools at all. It means we should treat sceptially all studies, including WFPB studies, because ultimately we're all individuals. The study may, or may not be applicable to you. Call it trivial, but it's not trivial given potential outcomes down the road. We should still acknowledge the limitations of population based studies when attempting to address a particular individual.

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AHA! I found the thread I spoke of, Dean! Very interesting:

Absolutely stunning. Here we have in BLACK AND WHITE a scenario where the vaunted F&V don't do jack sh|t. You wrote:

"In summary, this study suggests that if you have one or (especially) two G alleles for rs4977574, you are at higher risk for cardiovascular disease, and that consuming wine, but not vegetables, can help lower your risk."

Take that WFPB! Again, and again, it's all about the individual. I might benefit not at all from F&V - despite all of Ron's probabilities. I was supremely correct to be deeply sceptical about the applicability of any population based study for any individual application. Now, to throw another wrench into this, upping the complexity even more - who is to say that if I combine F&V with a very particular health regimen and some intervention or another, those F&V might not be beneficial to me after all! See, as I said, I'm sceptical a priori of all such studies, including this one. My point is - until we have much better tools, we should take all such studies, including WFPB and this genetic F&V and wine one with a metric ton of salt. Personalized medicine for the win. I rest my case.

Edited by TomBAvoider

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13 hours ago, TomBAvoider said:

I found the thread I spoke of, Dean! Very interesting:

Nice find Tom. I'd completely forgotten about that one. That is the kind of evidence (and astute analysis 🙂) I was looking for from you. 

First, it should be noted that the study [1] that I analyzed in that thread didn't find vegetables to be bad health-wise for anyone - simply that they didn't appear beneficial for people who carry a particular allele the way they were for others without the allele with respect to one particular health outcome (cardiovascular disease).

But that still leaves the strong (even likely) possibility that the people with the allele who benefit little from veggies would fair even worse when it comes to CVD if they substituted veggies for other foods that nutrition science has found to be unhealthy (e.g. processed meats, refined carbs). Not to mention the fact that they would very like fair worse when it comes to other health outcomes like cancer or diabetes if they eliminated veggies in favor of those other, generally recognized as unhealthy foods.

13 hours ago, TomBAvoider said:

Now, to throw another wrench into this, upping the complexity even more - who is to say that if I combine F&V with a very particular health regimen and some intervention or another, those F&V might not be beneficial to me after all!

Yes, exactly. Or maybe some other genetic or environmental factor makes the results of [1] irrelevant for you or me specifically.

13 hours ago, TomBAvoider said:

My point is - until we have much better tools, we should take all such studies, including WFPB and this genetic F&V and wine one with a metric ton of salt. Personalized medicine for the win. I rest my case.

I agree that "N of 1" medicine would likely be very helpful. If I were a woman I'd like to know if I had the BRCA gene which dramatically elevates risk of breast and ovarian cancer so I could consider taking proactive measures or at least monitor for cancer very carefully.

Epistemic humility is a good thing, and certainly warranted in the case of nutrition, particularly when it comes to interpreting and applying studies done in animals, or people very different along various axes from ourselves. But until we each have medical nanobots swimming through our bloodstreams assessing the impact of every specific food and environmental factor on our personal risk of CVD, cancer, dementia, eczema, fatty liver, etc, it seems like controlled studies of the correlations between foods and health outcomes is all we've got.

We've got to eat something, and unless you're advocating that we abandon the scientific method entirely, we have to base our food choices on the data we've got. Saying there just isn't enough evidence from nutrition science to believe that eating vegetables will be better for you personally than eating say hot dogs (obviously an extreme example), seems like a degree of skepticism that won't serve anyone very well. 

I see Ron's analogy as an apt one here. There are some people with genes that make them much more resistant to cancer than others, allowing them to smoke with abandon and still live to 100 (e.g. George Burns). We know this to be the case, but we don't yet have the knowledge or the tools to tell if a particular person is so lucky.  In light of this uncertainty, would you suggest we should take all the studies showing that smoking causes cancer in the general population "with a metric ton of salt" and light up a cigar, gambling you might be one of the lucky ones? Or would you instead use some sort of baysian reasoning to predict your likelihood of cancer will go up if you smoke, or if you eat hot dogs instead of vegetables?

I personal would (and do) opt for the latter, baysian approach, knowing full well I might be an outlier, or the study may have had fatal flaws that I'm not aware of, or that I might get hit by a bus tomorrow, meaning all my efforts to maximize my probability of a long and healthy life based on the available science will be for nothing.

Personalized medicine sounds terrific, but in the meantime we've got to make choices based on the available data. I suspect your feel (and behave) in the same way, and that we aren't as different as it might seems. But I'm curious about how you see things.

--Dean

------------

[1] BMC Med Genet. 2014 Dec 31;15(1):1220. [Epub ahead of print]

The chromosome 9p21 variant interacts with vegetable and wine intake to influence the risk of cardiovascular disease: a population based cohort study.

Hindy G, Ericson U, Hamrefors V, Drake I, Wirfält E, Melander O, Orho-Melander M.
 
Full Text: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4331503/pdf/12881_2014_Article_138.pdf
Abstract
BackgroundChromosome 9p21 variants are associated with cardiovascular disease (CVD) but not with any of its known risk markers. However, recent studies have suggested that the risk associated with 9p21 variation is modified by a prudent dietary pattern and smoking. We tested if the increased risk of CVD by the 9p21 single nucleotide polymorphism rs4977574 is modified by intakes of vegetables, fruits, alcohol, or wine, and if rs4977574 interacts with environmental factors on known CVD risk markers.MethodsMultivariable Cox regression analyses were performed in 23,949 individuals from the population-based prospective Malmö Diet and Cancer Study (MDCS), of whom 3,164 developed CVD during 15 years of follow-up. The rs4977574 variant (major allele: A; minor allele: G) was genotyped using TaqMan® Assay Design probes. Dietary data were collected at baseline using a modified diet history method. Cross-sectional analyses were performed in 4,828 MDCS participants with fasting blood levels of circulating risk factors measured at baseline.ResultsEach rs4977574 G allele was associated with a 16% increased incidence of CVD (95% confidence interval (CI), 1.10¿1.22). Higher vegetable intake (hazard ratio (HR), 0.95 [CI: 0.91¿0.996]), wine intake (HR, 0.91 [CI: 0.86¿0.96]), and total alcohol consumption (HR, 0.92 [CI: 0.86¿0.98]) were associated with lower CVD incidence. The increased CVD incidence by the G allele was restricted to individuals with medium or high vegetable intake (Pinteraction¿=¿0.043), and to non- and low consumers of wine (Pinteraction¿=¿0.029). Although rs4977574 did not associate with any known risk markers, stratification by vegetable intake and smoking suggested an interaction with rs4977574 on glycated hemoglobin and high-density lipoprotein cholesterol (Pinteraction¿=¿0.015 and 0.049, respectively).ConclusionsOur results indicate that rs4977574 interacts with vegetable and wine intake to affect the incidence of CVD, and suggest that an interaction may exist between environmental risk factors and rs4977574 on known risk markers of CVD.

PMID:  25551366

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Dean, thank you for your very reasonable response. I agree that obviously we operate in a world of imperfect information and imperfect tools. How do we formulate a strategy in such an environment? My approach is really a very traditional one, the same as utilized in most longevity studies in humans: biomarkers. I have regular blood tests (quarterly in the last 18 months, although that will be tapering off to once yearly) and I use a glucometer daily. I have attempted to modify my diet and see what impact they may have on biomarkers. Of course, this is extremely hazy as there are so many moving parts that it's extremely difficult to pin down any particular variable as responsible - f.ex. I lowered my protein intake in an effort to lower BUN, and that worked, but I have no idea if that wasn't confounded by a thousand other things that were going on at the same time, like exercise changes etc. I did that in response to my taking a statin as it can be hard on the kidneys and liver so I thought I'd do all I can to get good liver and kidney numbers through diet and exercise. Given how crude those tools are and how many variables there are, it's really groping in the dark. But it's the best I have. In this context, I pay much less attention to nutritional studies, but rather follow a few very simple principles. My thinking is based on this:

https://jamanetwork.com/journals/jama/fullarticle/2673150

The study put people on different macronutrient diets, but took pains to use only the highest quality ingredients (to avoid quality of food disputes) and the conclusion was that in aggregate it's impossible to point to any one as superior - however the flip side of it is that some people did very well on one and very poorly on another, and there was no way to predict who would do what. There was no one "best" diet. Consequently, the lead researcher reached the conclusion that rather than attempt to follow any particular diet, it's better to follow a very few crude principles, as he outlines in this 4-minute video:

Although there is no "best diet" - ultimately, he boils down the principles to just three: cut out added sugar, refined grains and take in tons of F&V. This emphasis of the third principle on F&V is of course highly ironic given the previous study we just discussed, where evidence shows that people respond differently even to F&V. Which only says, we may know even less than the 3 principles Gardner outlines. Still, I take that as a good baseline for a generalized approach, always keeping in mind that it may prove wrong at some point - hence, I use my glucometer, and if I find a given food is suboptimal, I cut if off, no matter its reputation (in my case bananas - supposedly a good fruit!).

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4 hours ago, Dean Pomerleau said:

... Full Text: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4331503/pdf/12881_2014_Article_138.pdf

Abstract
... ConclusionsOur results indicate that rs4977574 interacts with vegetable and wine intake to affect the incidence of CVD, and suggest that an interaction may exist between environmental risk factors and rs4977574 on known risk markers of CVD. ..."

Looking at the Promethease description for rs4977574, it states: "Some studies - but not others - report a slightly increased risk for myocardial infarction."

While this points to an interesting aberration, replacing vegetables with bacon and drinking a bottle of wine a day is probably not a wise  decision for anyone, based on preponderance of all available evidence. Humans are made up of more than rs4977574 and my guess is that other factors may be at play as well.

Here is something else to ponder:

"RESULTS: There were 925 cases with CAD and 634 without CAD enrolled in the present study. The G allele conferred a significant increase in risk of CAD (odds ratio = 1.47, P = 0.003 in the dominant model; odds ratio = 1.36, P = 0.018 in the recessive model). During a median of 11 years (inter-quartile range between 5.2 and 12.5 years) of follow-up, neither the total nor the cardiovascular mortality was different among CAD subjects with different genotypes. Using Cox regression analysis, genotypes of rs4977574 still failed to predict cardiovascular mortality (hazard ratio = 1.25, P = 0.138 in the dominant model; hazard ratio = 1.05, P = 0.729 in the recessive model).

CONCLUSIONS: The rs4977574 at chromosome 9p21 is associated with presence of CAD in Han Chinese. However, rs4977574 could not predict cardiovascular mortality in these CAD subjects during the eleven-year period of the study."

https://www.ncbi.nlm.nih.gov/pubmed/24804228?dopt=Abstract

Edited by Ron Put

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20 minutes ago, TomBAvoider said:

Although there is no "best diet" - ultimately, he boils down the principles to just three: cut out added sugar, refined grains and take in tons of F&V. This emphasis of the third principle on F&V is of course highly ironic given the previous study we just discussed, where evidence shows that people respond differently even to F&V. Which only says, we may know even less than the 3 principles Gardner outlines. Still, I take that as a good baseline for a generalized approach, always keeping in mind that it may prove wrong at some point - hence, I use my glucometer, and if I find a given food is suboptimal, I cut if off, no matter its reputation (in my case bananas - supposedly a good fruit!).

That seems like a very sensible approach to determining what to eat. It is pretty similar to my own dietary practices and I suspect most other people around here.

As far as I can tell about the only significant thing about the "common wisdom" that has changed in the nearly 20 years we've been chatting about diet and CR is the switch to a much reduced amount of protein - from the early days when it thought that the macronutrient ratio of the Zone Diet (with 30% of calories from protein protein) was the right way to eat for CR folks trying to maximize health and longevity.

I think a pithy summary is Michael Pollan's maxim - Eat whole foods, mostly plants and not too much.

--Dean 

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replacing vegetables with bacon and drinking a bottle of wine a day is probably not a wise  decision for anyone

That "probably" does a lot of work there, Ron. If you wanted something more definite - and about equally useful as your observation - you could have said "replacing vegetables with arsenic and a gunshot to the head is probably not a wise decision for anyone". But if instead we move to a real-life scenario, it may in fact be that someone will do much better by replacing those F&V with fat in a more high fat and very low carb diet. Those are the kind of diets that are studied, and we know that for some that is more effective - again, no one size fits all, even with F&V. 

Dean, I agree with Pollan's maxim, but I think my point rather is that compared to, say, ten years ago, I am far less excited by nutritional studies - at this point I just think that those results are not terribly relevant to me as an individual, as I figure it's purely a matter of chance whether they apply to me or not. In other words, my general level of doubt has escalated the older I get - it doesn't mean that I therefore jump to some kind of opposite conclusion, rather, that I hold my opinions much more tentatively and with much less conviction compared to a decade or two ago. 

And a corollary to that - I am equally doubtful of the certitude of others in these matters, which might result in arguments on these boards :)

Edited by TomBAvoider

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Tom, your skepticism seems to me a bit too much like a "god is in the gaps" argument.

There is enough data at this point to  establish some basic probabilities. "Probably" is a key word in life, as well as genetics, period.

To give another analogy, If you wear a seat belt and have airbags in your car, your chances of surviving a crash generally increase compared to someone who does not. But there are specific instances where these safety measures may not work, and even be detrimental. For instance, under very specific circumstances, people of slight stature, may even receive more damage by such safety devices than from a particular crash.

If I understand your absolutist argument, you should be waiting until we have "smart" materials and safety devices which adapt to an individual's physical characteristics AND the conditions. AND have absolutely no error rate....

And yet, you appear to throw your skepticism out of the window the moment you are presented with a PR blurb touting an "app that makes it easy for everyone to understand the right foods for their unique metabolism in order to improve long-term health and manage weight more easily." Or, the moment you see a BBC headline proclaiming that a quarter of a million CENTENARIANS have gone missing in Japan.... 😄

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Ron, I see you are still very confused about what warrants scepticism and how one should approach tainted data. You're back to the "BBC headline proclaiming that a quarter of a million CENTENARIANS have gone missing in Japan.... 😄". It really doesn't matter if there's a headline from the BBC or the Prairy Gazette put out by Joe Sh|t the Ragman. That's not the source of the number - those are reports of the number. As long as the reports are accurate, you should take up your quarrel with the source. The exact number was 234,354, from the investigation by the Justice Ministry into the widespread fraud of claimed pensions. In the course of this investigations, one of the avenues through which they investigated was the Family Register System (Kosek), and that was the source of this number - indicating a huge problem with ureliable records. Now, this is where you grow all confused. First, this number was not made up (by anybody, including the BBC or Prairy Gazette) - it was a number from Kosek. Take it up with them. Somehow you think that this indicates that I am all credulous because I take that number at face value. I do no such thing. I cite that number - correctly - as one that came up in the course of that investigation. I did not assume that the number was correct, or dispositive. This is where you don't appreciate my scepticism - I distrust all sources and claims, unless there's overwhelming evidence in favor. But I have no proof either way - I cannot prove that the number is incorrect. You seem to think that the number is absurd and therefore can be dismissed. Here is where you go wrong - let us assume that you are in fact entirely right, and the number is incorrect. Well, you just lost the case in the court of evidence. Because if the sources are so unreliable that they come up with wrong numbers, then why do you put any faith in ANY OTHER numbers from the same sources? It's like a witness who has been impeached in court - they lose credibility, and that witness becomes worthless. If the number is so wrong as to be absurd, then my scepticism leads me to doubt all the rest of the numbers from Japan in this matter, because if they can be so wrong, then who says they aren't wrong here too. You can't have it both ways. Either the sources are unimpeachable, or the sources are highly impeachable - either the data is reliable, or is so full of holes that the Ministry has to launch official investigations (which they did, precisely because of fraud!). Thus, either way the result is a loss of credibility - if the number is right, then obviously that's a terrible indictment, or if it's wrong, that's bad in another way because now we don't trust the source. Game, set, match in the scepticism olympics. Got it? And that's why I don't trust the centenarian data from Japan or any Blue Zone claims based on such highly impeachable sources. You really need to up your scepticism game :)

And so on, my friend. You are entirely too unsceptical about the various nutritional studies showing what you claim is "there's enough data at this point to establish[..]". No there isn't. The quality of nutritional studies is extremely low. To begin with, the whole field of biomedical studies suffers from terrible replication numbers (a theme we've explored on these boards repeatedly). But in nutrition it's much, much worse. We really have NOT ONE - and cannot have for practical reasons - properly randomised studies in humans, because while we can cage rats for life and feed them controlled food for their lifetime, we can't in humans. Human studies in nutrition by their very nature do not lend themselves to high confidence, especially the ones reliant on epidemiological data, recall, short-duration interventions and so on. In fact, this is how this thread started - the studies are of low quality, even for the whole field of biomedicine. So no, I don't accept your claims of "enough data". Furthermore, even of the studies that we have, the data is contradictory. The Stanford study I linked to above shows why there is no diet that fits all - by large percentages people fall into disparate groups with drastically different reactions to even such crude differences as macronutrient apportionment. 

I think you overestimate the degree of consensus in this field - there is none regarding even such basic things as to the effect of fats on health - sometimes things we thought were settled, like saturated fat, upon closer examination show not to be. And so on for pretty much everything. Things on which there is consensus are in turn low value, to exaggerate - in effect telling us that jumping into a fire has negative effects on your gut biome. We don't know - with sufficient degree of certitude - what is an optimal diet for any given individual. And the things that we do know with sufficient degree of certitude, are not very profound - or as Sibirak put it "trivial". 

We can go round and round on this, but you really need to up your scepticism, otherwise you'll continue to be confused :)

Edited by TomBAvoider

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