Dr. Adele Hite Profile picture
Nutrition made critical. PhD | MPH | MAT | RDN | LDN. Writer at https://t.co/rwiMIWycai. Views are my own. DMs open. Tell me how you can help us change the world.
Feb 15, 2021 10 tweets 2 min read
Here it is. The "Why Nutritional Epidemiology of Chronic Disease (henceforth, NECD) Sucks" thread.

Let me be very clear: my animadversion has to do specifically with epidemiological studies that purport to link foods, diets, or dietary patterns to chronic diseases. 1/10 NECD sucks because: Confounding factors that affect associations seen in NECD studies, such as income, education, and other health-related behaviors, cannot be entirely “stripped of their metabolic consequences by sophisticated statistical methods” (Willett, 1998). 2/10
Feb 15, 2021 9 tweets 3 min read
"Risk factors." LOL.

Poverty, poor sanitation & poor diets were all strongly linked to pellagra in the early 20th century. They were considered "risk factors" for this disease. Germ theory proponents thought pellagra was caused by a microbe transmitted easily through poor populations because of lack of indoor plumbing.

Nutrition theory proponents thought pellagra was caused by something *in* the diet - or maybe, *not* in the diet.
Dec 10, 2020 8 tweets 3 min read
In 2010, Americans had met all of the macronutrient goals specified by the DGA except for the sodium & sat fat ones (& sat fat was very close, 1% away from goal). Of course, this meant the next edition of the DGA shifted the goalposts. Why? Because we must make SURE that poor health in the US is the fault of the consumer ONLY & has nothing to do with how the DGA have warped our food system, our nutrition education, our health interventions, & our very concept of what a "healthy diet" is.
Dec 9, 2020 4 tweets 4 min read
I (cynically) don't get excited about much. But I'm so excited about the existence of this new organization that I feel compelled to !!! & ♥️♥️♥️.

OMG check it out & you'll see what I mean!

TOTAL ♥️ GAMECHANGER for #lowcarb & #MetabolicHealth!

dietdoctor.com/new-organizati… Why is #SMHP a TOTAL GAMECHANGER for the #lowcarb landscape? I go on a bit about it: lowcarbusa.org/smhp-launch-ep…
Dec 5, 2020 9 tweets 3 min read
Sure. I'll bite.

…f-47f8-835f-90887a893dea.filesusr.com/ugd/7927a7_6ff… Twitter summary - The DGA:
1) Are ineffective. They were developed to prevent an "epidemic" of obesity & chronic disease & they did not.

2) Lack evidence. Don't take my word for it; Walter Willett says so too:
Dec 5, 2020 5 tweets 1 min read
LOL. Right.

And how do you think the food environment gets shaped?

You don't have to "know" about the guidelines in order to be affected by them *across the socio-ecological model.*

They impact everything, including how we think about & define what is "healthy food." Okay. Let's look at the food environment.

When the DGA created demand - which it did - for foods that had less fat, sodium, and cholesterol, what foods available for purchase changed.

in 1980, it was hard to find "low fat" yogurt. After a while, that's ALL you could find.
Nov 9, 2020 16 tweets 3 min read
What? I'm not sure where you are getting your information from or what Americans you hang out with when you visit, but I don't know anyone who fits this description. Thread. I've been trying to avoid going here, but here I go.

The desire to tell other people how to eat, because you are convinced - for some reason - that people do not "care" about their health & therefore "WE" (whoever "we" is) must tell them how to eat 1/n
Sep 8, 2020 10 tweets 3 min read
It's presumptuous (& wrong) to say evidence is "clear" in fields as young as these. This is exactly why we *should* be speaking on this topic: to counter people like you making vastly premature pronouncements about what is clearly *not* "clear." Thread. 1/n @NanciGuestRDPhD Vegan dietitian declaring herself & her ideological companio Nutrition as it relates to chronic disease and agricultural management of the food supply as it relates to climate change are (relatively) young scientific fields.

ALL science is tentative & likely to be refuted. This is especially true in young fields of science. 2/n
Aug 14, 2020 14 tweets 3 min read
To me, this comment & some that follow indicate that there are some misconceptions about how we got where we are now (& thus, I think, some mistaken ideas about how to change the situation). Thread. 1st, lower fat, higher carb national dietary guidelines *began* as a clinical intervention for high risk patients. Then (as now) docs who were trying to the right thing for patients in their care, read research & advised their (high risk) patients accordingly. 2/
May 22, 2020 12 tweets 2 min read
The Surgeon General's Report on Smoking - which dramatically changed the smoking habits of Americans - would not have happened without epidemiology.

Biochemistry is very important. But ... 1/n Mechanisms acting at cellular levels do not necessarily give full explanations of physiological level effects & outcomes. Metabolism is too complicated for that.

Effects of smoking are seen at cellular, physiological & population levels. You can't say the same for pizza. 2/
Apr 3, 2020 13 tweets 3 min read
I would say "anger" motivates me as well. But not MY anger.

I have in my heart & in my head the voices of the dozens of (mostly) women patients who tried hard, for years, to bring their heath in line by following the guidance they were given. They were told to
--eat less and move more, as if these two things are independent of each other
--count calories in/out, as if health is a math problem
--drink more water, as if that can nourish an underfed body
--write down everything, as if this would "Make It So."
Mar 27, 2020 19 tweets 4 min read
Okay, there's a bit of confusion about this out there in Twitterland:

Just as @JesseLunsford points out in this thread, there is no mandate for RDs to "follow" official USDA/HHS dietary guidelines when they counsel patients.

However, that's not the whole picture. 1/ First, I don't think we can completely ignore this incident, from around 2008-2009: nmsociety.org/2018/02/18/ann…

There have been other situations that are compared to Ms. Presley's, but they have involved other factors (unproven supplements, etc.) not just dietary information. 2/
Feb 14, 2020 18 tweets 4 min read
Y'know, this comment just got stuck in my brain. Yes of course, if a product doesn't sell well it won't last long on the shelves. But the notion that "stores just sell what people buy" is so disingenuous. So, let's look at a little more of this story. 1/ Who even pays attention to the Dietary Guidelines anyway?

Answer: The food industry. This has been true from the beginning. Now it is even more intense: They watch the committee hearings. They show up to listen (as well as testify). They prepare. 2/
Jan 9, 2020 11 tweets 3 min read
Stumbled across this thread after a call with @joannerinker who is with @AADEdiabetes. She helped me understand why our presentation was not accepted😕but was so encouraging that my little team is going to take it to #AADE20 as a poster. Read the thread, meet me back here. 1/11 She and I agreed that the world of diabetes educators & the world of clinicians who use therapeutic carbohydrate restriction to treat diabetes are waaaay too far apart. We could learn a lot from each other. 2/11
Oct 19, 2019 16 tweets 3 min read
I understand the point, but it doesn't really make sense without taking government guidelines - that *define* healthy food - into account.

Let's go back to the beginning. Sit back, relax - or lean forward & be tense, I'm fine with that too - this is gonna take a little bit. 1/ Before the DGA, "healthy food" (or "healthy diet") meant "foods that fulfilled adequate essential nutrition needs."

With the DGA, the meaning of "healthy food" shifted to mean "foods that prevent chronic disease." 2/
Oct 13, 2019 14 tweets 3 min read
Hmm. While I think it is true that diet is the fundamental key to good health (w/o adequate essential nutrition, you're sunk), I actually do think that saying "diet doesn't fix everything" might be a good public health message if it were taken up seriously. 1/

Hear me out. The creation of the 1977 Dietary Goals & 1980 Dietary Guidelines emerged from & amplified a seismic shift in how we think about public health.

Prior to this, "public health" had (mostly) been about clean air & water, feeding the hungry, safe cars, buildings, streets, etc. 2/
Sep 24, 2019 15 tweets 3 min read
Of course the issue of ideology, commercialism & tribalism isn't limited to the "LCHF community." (And yes, there is such a thing, as I will explain.)

Yes, if textbooks and guidelines reflected available data, there might not be any need for a LCHF community.

But ... The textbook & guideline makers have been getting it wrong since around 1977, when the collective thinking in nutrition took a hard turn away from science, prompted (largely) by US nutrition policy. Because policy *can* & *does* warp science (see Hite & Carter, 2019 in RHM),
Aug 20, 2019 15 tweets 3 min read
Dear tweeples, have you ever considered where the idea that "most health outcomes are controllable" came from? Not pharma. Thread.

Real culprit? You guessed it (it's my thread, after all): The Dietary Guidelines for Americans. The Dietary Guidelines for Americans (DGA, 1980) were, in part, a response to the fact that the medical-pharma enterprise COULD NOT reverse/prevent chronic disease.

Other things that were a part of the rise of healthism that the DGA reinforces & perpetuates:
Jul 14, 2019 5 tweets 1 min read
Very interesting thread. It's good to recognize expertise in different areas & turn down the volume on over-generalized & unsupported claims in the LCHF/keto discourses. It's one thing to say, "Fruit seems to spike post-meal glucose in many of my patients with diabetes." 1/5 It's quite another thing to say, "Fruit is bred to be 100x sweeter than in the past." Patient food/BG records support the first statement. But what is the second statement based on? Seems like it probably should be true? Fruit tasted different when I was a kid? 2/5
Jun 4, 2019 5 tweets 4 min read
@MacroFour @traderjodie Poor people will always buy cheaper food than people with more money. Across the globe, our economic systems are making plenty of poor people such that the food industry will not want for customers for cheap food. 1/ @MacroFour @traderjodie I think middle-class consumers are more likely to be drivers of what "the food industry" does/doesn't do bc there's more discretionary spending there anyway.

With Hyman's tweet it isn't so much the principle that offends, but the rhetoric. 2/
Jun 3, 2019 4 tweets 4 min read
@mrc314 @JohnCaseIII @AmandaZZ100 @MatthewJDalby 1) Eliminate dietary guidelines that attempt to prevent chronic disease, as we have no evidence to support such guidance.
2) Advise the public to first, get adequate essential nutrition from sources that do not need enrichment or fortification to be nourishing. 1/ @mrc314 @JohnCaseIII @AmandaZZ100 @MatthewJDalby 3) Advise the public to maintain a weight that is healthy for the individual involved; this should be a discussion between the individual & a professional & should not be measured via BMI charts. 2/