Shireen: Adele Hite discusses current gaps in nutritional health policy and raises important questions about the ethics of nutritional interventions. She talks about how the Dietary Guidelines for Americans created a correlation between diet and chronic disease that has shaped chronic disease management. Tune in to find out how you can challenge the rhetoric of personal responsibility and individualism as the cause of chronic illness and diabetes. 

Podcasting from Dallas, Texas. I am Shireen and this is the Yumlish podcast. Yumlish is working to empower you, to take charge of your health through diet and exercise and reduce the risk of chronic conditions like type two diabetes and heart disease. We hope to share a unique perspective and a culturally relevant approach to managing these chronic conditions with you each week.

Adele Hite, PhD MPH RDN is a registered dietitian with graduate training in nutritional epidemiology and public health and a doctorate in rhetoric, communication, and digital media. Her work combines biomedicine and cultural studies to explore food politics, nutrition science, and public health nutrition policy. Welcome Dr.Hite!

Dr.Hite: Thank you. Thank you for having me. 

Shireen: An absolute pleasure having you on. Diving right in, why did you decide to pursue a career focused on public health nutrition policy? 

Dr.Hite: Well, after I had some  nutritional concerns in my personal life, I started working with Dr. Eric Westman at the Duke University Medical Center Lifestyle Clinic. And there I met many women and a few men who had tried to lose weight and get healthy using our standard, eat less and burn more calorie, counting approach. And they were not only unsuccessful, but also hungry and tired and unhappy and just not living their best lives. And, when I asked them about what approach they were using to think about what to eat, they talked about, well, I just try to eat a healthy diet and it occurred to me. Do we really know what that means and how do we know what that means? 

I've always been one of these people who like questions, everything. So it's like a healthy diet, the idea of a healthy diet, where did it come from? And that's how I ended up in public health, nutrition and nutritional epidemiology, because I want to know where we got this idea of a healthy diet from, 

Shireen: And in talking about a healthy diet, we always associate an unhealthy diet with chronic diseases. So. What does nutritional prevention for chronic disease currently look like in the United States today? 

Dr.Hite: Well, we do that now, but that's not always the association that we used to have. So one of the things that I like to point out to people as you have heard, like Michael Pollan and Marion Nessel who are, you know, considered nutrition and nutrition, policy experts say things like only eat food that your great-grandmother would. But when your great-grandmother was choosing foods to feed herself and her family, she was not thinking about prevention of chronic disease. She was thinking about making sure that everyone was adequately nourished, that they wouldn't get rickets or scurvy, or at least in the south at the time pellagra was a big issue.

So it was all about preventing diseases of deficiency, not about preventing chronic disease. Chronic disease was considered genetic. It was considered environmental. It was considered bad luck. It wasn't your personal fault. So what we've gotten to now with nutritional prevention of chronic disease is that there are good foods to eat, and there are bad foods to avoid.

And unfortunately, lots of food fall into both categories. For instance, salt, too much salt is bad. But we have to have salt in our diet. If we didn't, we would die. What about protein foods? Protein is our most important macronutrients or one of the big nutrients that we need as opposed to micronutrients, vitamins and minerals, but a lot of protein foods come with that. Even saturated fat, which we're supposed to avoid. So we don't know what to do. Do we eat protein because it’s good for us? Do we avoid saturated fat because it's bad for us? And it leads to a lot of confusion, difficulty making decisions about what we should be eating and what we shouldn't be eating because there are so many components to a particular food, some of which might be good and some of which might be bad. And, and so we don't know what to eat. 

SHireen: Can you walk us through and help us understand the dietary guidelines for Americans? How were they created and what are they?

Dr.Hite: So right now they are a gigantic policy document that steers all of the decision-making and communication around food and health in the U S and across the globe, it's had a tremendous amount of impact, influence and impact on how other countries define what healthy food is for them, which is interesting because what it ends up creating is this sort of colonial approach to diet and health.

As if we assume that the diet that's healthy for white Americans, white middle-class Americans, all points is the right diet for everyone on the planet. And it's absurd on its surface, if you think about it. And when I go to conferences where I'm talking to scientists and people in critical theory, and I say something like we've come up with one diet that prevents all chronic diseases known to mankind for every human being on the planet. No matter what their circumstances, no matter what their genetics, no matter what their health history is, they laugh out loud. If I say that, In a nutritional setting, everyone goes, oh yeah, we've done so good. You can hear the applause as they pat themselves on the back, but it is absurd.

It's absurd to think that way about food and health that people are so lacking in diversity of life, circumstances and genetics and epigenetics and all of the rest that they're diseases are so unified in their etiology and their progression. This would jever make sense. So it's, it's a really bizarre thing, but in 1977, and in 1980, we decided that this was the case that we could prevent chronic disease by telling people how to eat.

And they were created at first by a. Committee of interested parties, not an official committee put together. There was no scientific review that preceded them. In 1980. It was a bunch of government officials who decided that we needed a unified voice on nutrition and health in the U S and it was very political and that it was an attempt to preserve a committee that looked like it was getting ready to be defended.

It was a 19 page pamphlet that looked like it had been run off on a mimeograph. And it has turned into this giant 200 plus page thing. That's not even directed at the American public anymore because it's gotten too quote, unquote complicated for us, regular folks, even though that's how it started out as a 19 page consumer pamphlet that you are supposed to read and then know what to buy, to eat, to stay healthy.

And now it's directed at public health officials, dieticians, and doctors at food companies. So they know what to make and what to tell people and how to interpret this. And it is preceded by a quote unquote thorough review of all available evidence, which is a little bit of a joke because all available evidence that we have that relates nutrition to chronic disease is observational. And not only is it observational, but it's observational based on a particular slice of, =American humanity, which is white well-educated, health professionals, the nurses health study, the health professionals follow-up study. All of these are a specific slice of the American public. They are not representative of the U S, much less the world.

And you get into this conundrum where most of these studies took place after 1980. In fact, the nurses' health study started off as a contraceptive study. And so it only involved married white nurses who were selected because they were compliant because they were rule following. Yes. These are the actual words that they use to describe their population compliant rule following well-educated people.

They knew that these women had better access to healthcare and that they were generally healthier than the American populace in LA. And thousands of studies have been based on this population and then extrapolated to all the rest of us. Now tell me what a white nurse, what do these women have in common with a young African-American male who's growing up in a ghetto whose educational system is falling apart and who is the major concern for the day, maybe getting home safely and not preventing chronic disease. 

That's not going to emerge for another 30 or 40 years. In addition to the fact as we've seen with COVID, there are lots of reasons for certain populations not to trust the advice given out by our public health system. We've had a bad history in the past. Ignoring the special circumstances of, of certain groups. The pellagra story is a very interesting one in that it was associated with poverty and because it was associated with poverty, we thought it was about poor sanitation. So there were all of these public health campaigns, directing poor communities and poor individuals to wash their hands more, to get indoor plumbing, um, to practice.

You know, good manners at the table and do adopt basically a bunch of middle-class values and lifestyles. And of course the disease wasn't related to sanitation at all, and it was related to diet. And so it didn't matter how many times you washed your hands or whether or not you got indoor plumbing. It wasn't going to end because pellagra wasn’t very focused on adopting behaviors that mimicked the lifestyle of the group, making the public health rules. 

And that is still true today. You know, when we talk about sedentary time and how it's bad to avoid sedentary time, that's directly related to the idea of TV watching or video. But are you going to tell someone, you know, somebody in grad school, somebody in law school, you need to avoid sedentary time. So stop studying and stop reading and go out and jog. No it's about a certain set of values that are attached. Certina behaviors.

Shireen: So I see what you're saying, Dr.Hite.  So if I understand correctly, these dietary guidelines were essentially created for one sub group in the United States, but applied population-wide. And then to that end, there's this correlation between diet and then chronic disease. Can you help us understand how this relationship really works and impacts our understanding of disease management?

Dr.Hite: Well, there are three major assumptions that underlie our understanding of the relationship between diet and disease. One is that we actually know what it is and we don't. And that's because of the populations that we've studied and what their behaviors are and they're rule followers. And once the reports came out that says, here's what to eat, to stay healthy. Whether or not, these people actually ate that way when they filled out those questionnaires that ask people what they ate, what do you think the answers were going to be? Right. They were going to answer with what they knew was the right answer.

So we don't really know what people eat in the first place. We also knew that these people are already healthier than the rest of the population. And why were they healthier? Was it because of what they were eating or because they were wealthier, better educated, had more access to healthcare? We don't know. And they tended to, there's also this thing called the healthy user effect, where you have people who quote, unquote, eat a healthy diet or think that they do also participate in a lot of other health-related behaviors, like taking vitamins and exercising and not smoking, not drinking too much. In fact, Michael Paulen had this, you know, handy-dandy tip where he said, do we need to take  vitamins and supplements? And he says, no, but we need to act like the people who do take vitamins and supplements. In other words, people who are concerned about their health tend to be healthier than people who are not concerned about their health. I mean, duh. So we, we believe that we know, we assume that we know the relationships between food and chronic disease.

The other assumption is that because we think that we know, we also assume that we need to act upon this knowledge and because we know how to act, there's another assumption that we have a moral imperative to act. And what that means is it means that eating good food equals having good behavior and having this good eating behavior. It means  being a concerned, ethical, imprudent individual. And because nowadays good eating and the size of your body have been so closely intertwined. We think that we can judge a person by looking at their body. We look at a person with a big body and we go, you are a bad person. You have eaten badly and you are not being an ethical, prudent citizen of the world by, and I can tell by looking at you  that you have overeaten or you've eaten the wrong foods or too much of the right foods, whatever that means. But I can just tell you're a bad person. And as a result, I mean, it goes beyond fat shaming. This is actually written into the dietary guidelines where it says people say that they eat a reasonable amount of calories.

But since most of the US is now obese and we know that obese people lie about what they eat. We can't trust those statistics. That's actually written into our policy statements, not to trust, lying fat people about what they eat. And to me, that's a really, really dangerous place to go. But when you build on that, those assumptions, that's where you went. So one of the things that you have to understand about moral and ethical developments of policy is that when you come up with a scientific conclusion, smoking causes lung cancer, you still don't know what to do with that conclusion. Policy is what you do about that conclusion. 

And so there's this famous old gap. Philosopher David Hume said that in between the is of science and the art of policy is a gap. And it's filled by the values that we have already. So with smoking, we have values that people should be able to make their own choices and that, we shouldn't legislate ethics. And if people want to smoke, they should be able to. So instead of outlying cigarettes, which would have been one possible policy approach. We didn't, we taxed them. So we basically said, if you have enough money, you can go ahead and kill yourself and be a burden on our medical system by, by making yourself ill. And that was considered, you know, okay. 

And we know it's a regressive tax and we know that we could have done things another way, but, in the situation of pellagra we did something very, very sick. So once we found out that polego was related to a vitamin deficiency, instead of making sure that poor people had access to the foods that would prevent this, we simply added the missing nutrients to foods that poor people already could afford, like flour and rice and things like that, corn meal. And we didn't change anything about poverty or about the circumstances that created these poor diets.

We just added a nutrient to the food supply and that's a policy choice again, based on a set of values, which is if you're poor, why are you poor? You're poor because you used money badly, just like you're fat and sick because you ate badly. It's a moral decision. It's your own fault. And we're not going to rescue you from that by giving you food that you need.

These are the kinds of things that we're dealing with. When we talk about morals and ethics in nutrition, guidance is who's good. Who's bad? Who deserves it? When are we impinging upon other people's freedoms? Are we using the right standards of evidence? And the dietary guidelines have never, ever been examined from an ethical perspective, they were just given to us and nobody looked at them.

Adverse consequences or intentional or otherwise, nobody examined that at the time. And these things have just grown and grown and grown. One of the jokes I like to make is that if you're looking at correlation and making correlation and causation arguments, as the dietary guidelines have gotten bigger and bigger and longer and longer, our obesity rates have gone up as well. 

So there's a strong correlation between. The number of pages in our dietary guidelines and the obesity rates in the US so is it cause and effect, or is it just a correlation? 

Shireen: It's an amusing correlation. If there is one. You've actually written a book focusing on vintage meals. Can you tell us a little bit about the book? The name of the book is Dinner Plans, Easy Vintage Meals. What is that about? And how does meal planning play into, when we're thinking about food and nutrition? 

Dr.Hite: Well, we call it, easy vintage meals because it hearkens back to the day before we were concerned about links between diet and chronic disease. Back when we were concerned about making sure that we ate good foods rather than avoiding bad foods. So the most important it has, it follows this sort of ABC. The most important food that you can eat for your body is protein, food and protein. Food is important because protein is our most important macronutrient. It's, it's different from carbohydrates and fats, which are the other two macronutrients. And that those are mostly for energy, but protein is for structure and for function, it builds our bones. It builds our muscles. Not only that, it builds our hormones and our enzymes, everything that our body needs to work. It usually has some protein or piece of protein and amino acid in it that it needs to build. And without those, and without a steady supply of those, our bodies don't work very well. 

Whereas carbohydrates and fat are primarily for energy. We have two essential fatty acids that we need to make sure that we get in small amounts, but there are, there's no such thing as an essential carbohydrate. We are recommended by the dietary guidelines to eat up to 65% of our calories from a non-essential macronutrient. It makes no sense. So I want to ask the person who wrote the Institute of medicine, dietary reference groups that has a statement in it that dietary carbohydrates are not essential. And I said, so why do we recommend that people eat so much of them?

And she said, well, so they don't end up eating fatty foods. So the reason for that recommendation is not because carbs are good for us, but because they're not bad for us. So the focus of our book is figuring out what is good for you? 

Well, the first thing that's good for you is adequate protein. The second thing is just B is brightly colored vegetables. The third thing is C, which is careful carbohydrates, and they're called careful carbohydrates because carbohydrates aren't evil. They won't, you know, Kill you. They're not toxic, although they might be for some people in some circumstances. But the careful part is you should be careful to eat the ones that have actual nutrition in them.

There are a lot of carbohydrates in the world that are just devoid of useful nutrition, but there are other carbohydrates in the world in North Carolina in the summertime, sweet corn, you know, cattle got a lot of fiber. It's delicious. It's part of our local food culture. You know, there's value in that even though maybe it's not nutritional value, but there's a lot of value in that.

So, the book focuses on those three aspects and there's a few more letters. Um, we don't treat fat as if it's toxic or evil either. It's just another food component that happens to be attached to. And so if you try to avoid protein in your, I mean, fat in your diet, you often end up avoiding protein, which is, that's a bad thing to do. It's not smart.

Shireen: Industry-wide when you're, when you're talking about exactly what that meal needs to, it needs to look like., I assume then you have not based it on the dietary guidelines or is there, or how have you, I guess a better question is how have you gone about creating what that nutrition plan needs to look like based on the idea of adequate essential nutrition?

Dr.Hite: So we've lost with the dietary guidelines and the focus on preventing chronic disease. We've lost sight of what food is for. So why do we eat food? Well, there's lots of reasons why we eat food. We're hungry. We're with our friends. We like the way something tastes, but the real reason that we must eat food is because there are substances that our bodies cannot make that must be acquired from the outside environment. And when we change the paradigm from getting adequate essential nutrition to preventing chronic disease, we forget that now we didn't forget it completely. There's still some of that in our dietary guidelines, but it's been minimized to the point where we actually recommend dietary patterns that don't provide us with enough nutrition.

Like right now it's a real issue. Young women in America, women of childbearing age don't get enough iron. In fact, they don't get enough protein in general, but these nutrients are really, really important for women of childbearing years. And they don't get them because they're trying to avoid fat. And so therefore they avoid protein or they're trying to avoid eating animal products because they don't want to kill any cute little chickies. Calves or anything like that. And they end up becoming malnourished and then there's a downstream effect of that, which is if you're malnourished as a pregnant woman, then there's a good chance that that baby is going to grow up with a body that is epigenetically programmed to eat food in a way that would have been different had that child's fetal environment been nourished. 

And we know this from the developmental origins of adult disease. And we've seen these and again, these are observational studies, so it's not super strong evidence, but we know the effects of epigenetics. And we talk a lot these days about the adverse effects of childhood trauma and not being nourished in utero childhood trauma. When your body is competing with the mother's body to get the nutrients it needs, it's going to interpret food and the food environment differently. What we forget is that food is information. So we think of our five senses, you know, hearing sight, taste, touch. The other one is smell, but food is also information. Food goes in our body and it tells our body what's out there. And if you are only eating plants and you're never eating animals, it tells your body, you are living through a drought or you're living through a famine where the animals that you would normally eat are unavailable, or you, your partner, is a really bad hunter.

So it's telling your body a lot of things, and basically it's telling your body, this is not a good environment into which to bring another human, because there's no food out there for you. So why would you bring another human in there? And so there's a good chance that that human that you're developing has a body. That's going to be well designed to absorb nutrients from the world and hang onto that. And never let them go. And so when we see obesity and we see how closely it's associated with poverty and adverse child events, we're probably not looking at genetic effects. We're probably looking at epigenetic effects and these things are, you know, they're, they're progressive.

So if you grow up. If you are developed in a non nourished environment in utero and you grow up with and end up with an adult chronic disease, your body is already malfunctioning. So you get pregnant, have a baby you're going to pass those sort of pre-programmed malfunctions on. And I think of that as you know, going all the way back in our history, two or three or four generations to blame.

You know, our, we, we, we keep blaming the individual for the way that they look and illnesses that they have when we know that it's far more complicated than that we are not just ourselves. And so this focus on personal behavior that we have blaming people for their illnesses, blaming people for their body shapes and sizes. We know it's inaccurate. And yet this is what our dietary guidelines insist that we do because they have the recipe for being healthy. Why wouldn't you follow. And if you follow it, then you're bound to be healthy, right? Because we know what the recipe is, we're giving it to you. And so we end up with this really strong focus on personal responsibility instead of improving the environment, you know, exposure to environmental pollutants, exposure to racism.

We know that stress has huge impacts on us. Imagine being a young African-American or dark skinned woman who goes into the grocery store to buy healthy food or herself and her baby. And you're followed around by store security. Right? That's not going to be good for you or for your baby. And it's, we're kidding ourselves. If we think that it isn't impactful. You know, our heart rate goes up. Our blood pressure goes up so that we can feel that physical impact on our own bodies. Why would we act as if it's not going to have an impact on the baby growing inside? It's currently. It is. 

Shireen: And so what I'm hearing you say is there's a lot in the environment that needs to be focused on the guidelines and how they are  based. That's just one piece of the puzzle, but there's so much in the environment that still needs to be done. And, and the guidelines itself need to be updated to just really be very, very inclusive with the way America looks today. With that Dr. Heidi, this has been very, very eye opening.  I'd love to learn more about how our listeners can connect with you and learn more about your work after this podcast.

Dr.Hite: I'm easy to find on Twitter. It's just @ahite. And I'm pretty responsive on Twitter unless I'm immersed in it. I have an ancient blog called ether apology. It's like anthropology, except it starts with eating. And, but I'm very proud of it. There's lots of good stuff on it. So it's fun to just get in there and even I do it every now and then, and just binge read.

So there's, I have a number of stuff, a bunch of stuff published in the academic world and it spans everything from rhetoric. To digital media, to, feminism and actual nutrition. I wrote a paper in 2010 called in the face of country, contradictory evidence that examines the 2010 dietary guidelines advisory committee report. And it points out the contradictions in that report. I think it was my paper and rhetoric, even before I was studying rhetoric, but it says, you say this here, and then you say this over here. And these two things are self-contradictory and there's so much of that in our nutrition guidance and our nutrition thinking like when you ask why people are fat, what, what answer you can. 'cause they overate. And it's like, what does that even mean? So how do you know if you overate, you can only tell if you've overeaten, when you step on a scale and you've gained weight. So now, you know, oh, I've overeaten. So what's the answer to that? Well, I should now under eat, but how do you know what that even means until you get on this scale and you see that your weight gone down.

So we have these bizarre ways of, of, of framing. The problem in the first place. No wonder we can't solve it, we can't figure out what we're even talking about. What's the answer to, you know, overeating and eating less, right? What's the answer to being sedentary, move more as if those two things are disconnected and we know they're not disconnected because all of us have heard our mothers, our aunts or grandmothers say, go outside and play and work up an appetite.

Right? So we know that moving more makes you happy. And what else makes you hungry, eating less. So you have a nutrition paradigm designed to actually make people eat, eat less, makes you hungry, move more, makes you hungry. So what are you going to do naturally? Your body, your body is not a machine. It's a critter, right? It's an animal and animals know when you're hungry, you should eat. And so when we do things that make us hungry, We eat. That's not a big surprise. I shouldn't surprise anyone. So anyway, that's me. 

Shireen: And we can find that on your blog as well. 

Dr.Hite: Yep. I rant about many, many things, but mostly about nutrition and, and I respond to comments on my blog. So I'm happy to talk to anyone for any length of time. 

Shireen: Lovely. and so with that, to where we're toward the end of the episode, Dr.Hite, Thank you so much again for your time and for being here with us. For listeners who are listening to us here today, we have a special treat for you. The book we mentioned earlier, Dinner Plans, Easy Vintage Meals is available for you to win on our social media.

So head over after you've listened to this podcast, head over to our Facebook to find us there, find this announcement for this podcast episode, and go on there and answer a very, very simple question for your chance to win this book again, it's called Dinner Plans Easy Vintage Meals. And so we'll see you there after this episode. And again, Dr.Hite, thank you so much for your time. 

Dr.Hite: Thanks so much for having me. This was my pleasure.

Shireen: Thank you for listening to the Yumlish Podcast. Make sure to follow us on social media @Yumlish_ on Instagram and Twitter and @Yumlish on Facebook and LinkedIn. For tips about managing your diabetes and other chronic conditions and to chat and connect with us about your journey and perspectives. You can also visit our website Yumlish.com for more recipes advice and to get involved with all of the exciting opportunities Yumlish has to offer. If you like this week's show, make sure to subscribe so you can hear more from us every time we post. Thank you again, and we'll see you next time. Remember your health always comes first. Stay well.

Connect with Adele Hite!

Website

Instagram

Facebook

Twitter

LikedIn

Connect with Yumlish!

Website

Instagram

Twitter

Facebook

LinkedIn

YouTube