Reductionism and/or Wholism?

[JeffN]

Reductionism and/or Wholism? - While the whole is greater than the sum of its parts, sometimes the parts matter.
Jeff Novick, MS, RDN

In his recent article, Scientific Reductionism Detracts from Whole Food, Plant-Based Message, T. Colin Campbell, PhD said...

http://nutritionstudies.org/scientific-reductionism-detracts-whole-food-plant-based-message/

"It is my belief that solely relying on reductionism—all too often an inappropriate guide for understanding nutrition research—must be brought under control. If this is not done, there is no chance that the true health benefits of the WFPB dietary lifestyle will be advanced to the larger community. WFPB nutrition cannot be interpreted or adequately judged for its value through the lens of reductionism."

I agree with the overall concept of the article. The overall dietary pattern is much more important than any individual foods and/or individual nutrients. I wrote about this here...

Three Essential Keys To a Healthful Diet
https://www.drmcdougall.com/forums/viewtopic.php?f=22&t=44163

However, sometimes, individual foods do matter, both good and bad. Anyone with a food sensitivity, allergy, autoimmune disease etc., knows this.

This new article by Dr. Campbell states...

"Reductionism is not the way that nutrition works—by definition.

"In the case of the WFPB diet, its benefits are so dramatic—for example, in reversing (curing) heart disease(1)(2) —because it works wholistically, a concept that is awesomely illustrated during cellular metabolism, especially when the elements of time and space are also considered."

"We don’t need to avoid high-fat, plant-based foods like nuts, avocados, and coconuts as if their fat/oil is the same as added oil. Similarly, we should beware of generalizations like “the fat we eat is the fat we wear,” “high-carb diets are the cause of increased diabetes and obesity,” “cow’s milk makes strong bones and teeth,” and “consumption of saturated fat in whole plants should be minimized.”

Yet when we go to the two references used to document these comments and the dramatic reversal of heart disease, we find...

1. C. B. Esselstyn, S. G. Ellis, S. V. Medendorp, T. D. Crowe, A strategy to arrest and reverse coronary artery disease: a 5-year longitudinal study of a single physician’s practice. J. Family Practice 41, 560-568 (1995).

2. D. Ornish et al., Can lifestyle changes reverse coronary heart disease? Lancet 336, 129-133 (1990).

I think we are all familiar with these two studies and the work of both Dr. Esselstyn and Dr. Ornish. To this day, both recommend not just any WFPB diet but a WFPB diet that is very low in fat (</= 10% fat) and the elimination and/or dramatic reduction (minimization) of certain plant foods high in fat and high in saturated fat. While Dr. Esselstyn does allow for a tablespoon or two of ground flaxseeds per day and Dr. Ornish has recently allowed a very small amount of nuts/seeds, their diets are still </=10% fat.

Therefore, the references used to make the point of Wholism over Reductionism, actually contradict it. In both studies, the diets used were not just any WFBP diets but WFPB diets with very specific modifications.

While the whole is greater than the sum of its parts, sometimes the parts matter. Focusing on the bigger picture, a diet based predominately on minimally processed plants and low in added salt, sugar and oil, is most important. However sometimes, to experience the true health benefits of the WFPB dietary lifestyle, the details matter.

In Health,
Jeff

[JeffN]

From FB

This is a conundrum for me. While we all agree eating WFPB is healthy, Drs Ornish and Esselstyn recommend not eating high fat plant foods. And Mr Pritikin pointed this out too.

Let me clarify...

First, I am just trying to show that the references used in the article to support the main contention of the article, not only do not support it, but support the opposite view. I am going to post a follow up next week going into more detail on this.

Second, I am just trying to show the importance of *both* issues and that it is not one of the other. Yes, the general WFPB dietary pattern is what is most important from a public health standpoint for the general public. However, those of us who work with individual patients in a clinical setting know that the general WFBP overall dietary pattern must be adjusted to the individual, especially in those who are very ill and trying to reverse their diseases.

I am not sure people realize that about 1/3 or more of the people who come to our clinical programs are already on the general WFPB dietary pattern but are not doing well.

Third, in regard to your conundrum, remember the programs of Pritikin, Ornish and Esselstyn that are referenced in the article were not dealing with the general public but were designed for those with advanced heart disease, etc., and may not be necessary (and applicable) to someone not in that situation.


This was then posted in response by someone else on FB

This is so true Jeff, very glad you've written this. Even after being whole, food, low fat, plant based (no oils or high fat plant foods), for over three years, my BMI was still 30.8 and I was still hypertensive. So when we went to the USA for a 6 week holiday earlier this year (from Australia), I booked an outpatient appointment with Dr. Goldhamer. My BP was 170/90 in his office. He was great. Explained that I had to lower my calorie density (no more wholegrain flour/bread and more veggies in relation to starches), plus get rid of every scrap of added sodium. He told me my gender and genetic heritage meant I was great at conserving every calorie and mg of sodium, wonderful for allowing my ancestors to survive, but not so great in this environment. I took this advice. BMI is now 28.5 and declining slowly on a diet that would see a rapid weight loss in many other people - though I've lost 10 kilos overall since going WFPB (and I'm just 156.5 cm tall). BP at last reading was 104/75 (I've also cut out caffeine). If I was also eating high fat plant foods (which I wasn't), my weight loss would have been even slower or completely non-existent (or I could even have gained weight).

In Health
Jeff

[JeffN]

Another response

I don't know if you see these but in these articles, Dr. Colin Campbell also builds the case for the argument that we should focus on a whole plant food diet and stop looking at micro and macro nutrients

Nutrition and Cancer Journal, Jun 2017
The Past, Present, and Future of Nutrition and Cancer: Part 1—Was A Nutritional Association Acknowledged a Century Ago?
http://www.tandfonline.com/doi/full/10. ... 17.1317823

Nutrition and Cancer Journal, Jul 2017
Nutrition and Cancer: An Historical Perspective.—The Past, Present, and Future of Nutrition and Cancer. Part 2. Misunderstanding and Ignoring Nutrition
http://www.tandfonline.com/doi/full/10. ... 17.1339094

In this one, which came out around the same time, he explains that dietary protein correlates more closely than fat for heart disease, that this has been known for a long time and that it is essentially ignored because it is not convenient.

Journal of Geriatric Cardiology, May 2017
A plant-based diet and animal protein: questioning dietary fat and considering animal protein as the main cause of heart disease
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466939/

Your response?

Thanks. I read those when they came out and think they do add to the discussion, but by adding more support to my perspective.

First, let me address the third article you posted, which actually came out just before the other two.

Of course animal protein is similarly correlated as saturated fat, the two almost always come in the same package, animal food. However, when we try to separate them out to study the impact individually, the results really point more to saturated fat, which many think has one of the strongest correlations to LDL and to heart disease, than to animal protein.

From the third linked article

"In examining nutritional effects on the development of cardiovascular diseases, one must recognize the totality or ‘wholeness’ effect, as in a whole food plant-based dietary lifestyle. The comprehensiveness of evidence now available suggests that there is no other protocol—dietary or non-dietary—that offers the same health benefits. Perhaps the best testimonial for this whole food effect is its reversal of coronary heart disease during its advanced stages of development.[68–71] The most recent of these studies[71] included 196 patients, 177 who complied with the dietary advice. In 2–7 years, only one of the patients who complied suffered an event; in contrast, 62% of the non-compliant patients suffered an event. I am not aware of a single other cardio-therapy protocol that approximates such spectacular results."

There are 4 references cited...

68 Ornish D, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary heart disease? Lancet 1990; 336:129–133.

69 Gould KL, Ornish D, Scherwitz L, et al. Changes in myocardial perfusion abnormalities by positron emission tomography after long-term, intense risk factor modification. JAMA 1995; 274: 894–901.

70 Esselstyn CB, Ellis SG, Medendorp SV, et al. A strategy to arrest and reverse coronary artery disease: a 5-year longitudinal study of a single physician's practice. J Fam Pract 1995; 41: 560–568.

71 Esselstyn CBJ, Gendy G, Doyle J, et al. A way to reverse CAD? J Fam Pract 2014; 63: 356–364.

As you can see, two of the references are to the Esselstyn program and two are to the Ornish program so we have the exact same situation here as I pointed out above in regard to the 'wholeness' effect. These studies did not use any WFPB diet but one with specific modifications and restrictions including the restriction of fat, saturated fat, cholesterol and the avoidance of high fat plant foods.

In regard to supporting the contention that animal protein is the main cause of heart disease and not fat and saturated fat, 3 of the 4 studies allowed the use of animal protein but limited fat and saturated fat. Therefore, they actually did the experiment by keeping both fat and saturated fat to very low levels and allowed for animal protein that was free of, or very low in, fat and saturated fat. In addition, in the cited Ornish and Esselstyn studies, the allowed animal protein was mostly fat-free dairy, which contains casein as the main source of the protein.

In addition, while not referenced in the articles, the Pritikin Program, which has produced similar results in regard to heart disease, also limited fat and saturated fat to very low levels and not only allowed non-fat dairy, but also allowed for limited amounts of animal flesh low in fat and saturated fat.

In addition, in reference 69, we see the name Gould, KL, which is Lance Gould. He worked with Dr Ornish early on and then went on to establish his own reversal program in Texas, which also limited total fat to </=10% and limited saturated dat. However, he also allowed more servings of animal protein low in fat and saturated fat, which I wrote about here.

https://www.drmcdougall.com/forums/view ... 83#p567783

All of these results point more to fat and saturated fat rather then animal protein as the problem. I covered this issue before showing the many concerns there are with saturated fat in these 2 articles. These concerns and my position still stands. If you have not read this before, I encourage you to read them now. Saturated fat is not benign.

Saturated Fat: Still Unhealthy After All These Years, Pt 1
https://www.drmcdougall.com/forums/view ... 22&t=45911

Saturated Fat: Still Unhealthy After All These Years, Pt 2
http://www.jeffnovick.com/RD/Articles/E ... Years.html

So, I don't see how any of these point to animal protein as the main cause of heart disease, or that just any WFBP diet can reverse heart disease and produce other "dramatic" results.

Now, in regard to the other two articles and all three together.

- I think we all agree that whole foods are superior and sometimes you can't separate the whole from its parts, but sometimes you can and both aspects play a role.

- If one is going to make the case that focusing on fat and saturated fat as a cause of disease is considered reductionism, then switching the focus to animal protein as the cause of disease is also reductionism.

- I think Dr Fontana’s more recent work on cancer, protein, animal protein and specifically casein come to different conclusions then Dr Campbells older work and must be considered. I discuss his recent work in my first post in this thread here...

https://www.drmcdougall.com/forums/view ... 22&t=40765

- Clearly there has been far too much reductionist thinking over the last 50 years trying to take food apart to all its components.

- While the whole is greater than the sum of its parts, sometimes the parts matter. Focusing on the bigger picture, a diet based predominately on minimally processed plants and low in added salt, sugar and oil, is most important. However sometimes, to experience the true health benefits of the WFPB dietary lifestyle, the details matter.

- More importantly, lets not let the pendulum swing so far the other way that people think there's something "magical” about the WFPB dietary pattern rather than the actual known science-based reasons (i.e., reduced calorie absorption from whole plant foods, lower calorie density, lower fat, lower saturated fat, higher fiber, phytochemicals, etc ) of why whole plant foods are beneficial.

In Health
Jeff

[tcolin]

I challenge Jeff’s interpretation of my interpretation of wholism.

I don’t see how Jeff’s interpretation of the Ornish and Esselstyn findings contradict my conclusion. As I said here, “solely relying on reductionism …must be brought under control … and if this is not done, there is no chance that the true health benefits of the WFPB dietary lifestyle will be advanced to the larger community.” I have never said that reductionist research should not be done. Instead, I’ve long said that the parts (reductionism) help to explain the whole (wholism)—the parts contribute granulation. When we rely “solely” on the presence or absence of one part (as with a small amount of fat) either to explain the whole or to contribute an independent part, then I want to see the supporting data. To my knowledge, neither Esselstyn nor Ornish have tested the effect of the WFPB diet, with and without a small amount of high fat whole foods (e.g., flaxseeds, nuts, seeds, avocados) under conditions where total dietary fat remains “</= 10% fat”. Of course, they got fabulous results and I have often talked about their work when I give presentations but I have never seen direct evidence either to support or to deny the presence and activity of small amounts of fat in that protocol. Also, it is a separate conversation as to whether we are talking about whole food fat or added fat (usually as oil)—these are very different.

Also, I am somewhat more casual with statements concerning precise amounts of fat. Specificity of amounts is a form of reductionism that can easily be discounted, depending on circumstances. The evidence on precise amounts is really an approximation which varies, in turn, with the kind of fat, and its effect on the response being studied and the composition of the rest of the diet, among other mitigating factors.

On the point about saturated fat being specifically causal of disease, we really have to struggle to find convincing biochemical data to show how saturated fat works. I know that for a long time, saturated fat has been considered, back to the days of Ancel Keys, as the bad guy, even a major cause of cardiovascular disease and several cancers. I am convinced that this has been a serious mistake that has cost us an untold number (hundreds of millions) of premature deaths. In human population studies, the association of saturated fat with disease can be more sensibly explained by some combination of increasing consumption of animal-based foods and decreasing consumption of plant-based foods. Unfortunately, the relative proportions of disease accounted for by animal vs. whole plant-based foods has not been established and, in any case, what may be true for one disease outcome may be quite different for another.

Also, animal based protein, as opposed to plant based protein, has unique biochemical properties—creation of metabolic acidosis, production of reactive oxygen species, endogenous synthesis of steroids (hormones, cholesterol) and many other deleterious mechanisms. We should keep in mind that associations of the consumption of animal protein-based foods with disease outcome (e.g., breast and colon cancers, CHD) appear to be linear all the way to the X/Y origin, thus indicating that any theoretical increase in animal-based foods (from zero) begins to increase disease risk. And one final point: polyunsaturated fats, when fed in isolation of their food source and fed at levels in excess of total fat requirements, i.e., about 10% of calories, are likely to be much more problematic than saturated fat. PUFAs (mostly isolated from plants) are generally consumed as an excess of omega-6 over omega-3 fats and in diets where total dietary fat is in excess of its requirement.

I agree that parts can matter, especially when fed in excess of the amounts present in whole plant based foods, but this is a pharmaceutical effect not a nutritional effect. A pharmaceutical effect can, of course, be real under some circumstances, but like drugs, unexpected side effects are often seen. Also, when these parts are fed in isolation, their effects almost certainly will be quite different than when fed in whole food.

One last comment concerns the significance of the concept of wholism. It is not simply the combined effects of lots of nutrients acting independently—a point that is too often misunderstood. At the cellular level, wholism is an infinitely complex dynamic of countless food substances acting together, but changing every nanosecond via an infinitely complex collection of mechanisms, all highly integrated in a manner that requires a very different analysis than that used to assess the usual cause-effect relationships. This perspective explains why almost always there are side effects for drugs and single nutrients and, most importantly, why there is far more confusion and argument about nutrition than necessary, both within and without the plant based community.

I accept that these very few comments barely touches on the important concept of wholism and how it can be used to structure experimental research and interpret the results. After professionally being in the research field on food and health (60+ years), actually doing reductionist experimental research for much of that time(!), I now find the concept of wholism to be an extraordinary concept that really has a very ancient history, all the way back to its being a fact of nature. It needs a lot more discussion than I am presenting here—I can only hope that I’ve added a couple worthwhile thoughts. It was this kind of analysis that was fundamental to my interpretation of our experimental results that led to the "The China Study". Then, when I had the pleasure in those earlier days (early 1990s) to learn of the clinical results of McDougall, Pritikin, Esselstyn and Ornish (many others after that), and when we personally visited each of them prior to the writing of "The China Study", that I became even more convinced that the combination of our experimental research findings with these clinical observations was a winner.

More can be found in my book "Whole" (2013) and in two new peer-reviewed, open access manuscripts (2017) now listed on PubMed.

Campbell, T. C. Nutrition renaissance and public health policy. J. Nutr. Biology 3(1), 124- 138 (2017). J Nutr Biol. 2017;3(1):124-138. doi: doi:DOI: 10.1080/01635581.2017.1339094 (2017), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5701757/

Campbell, T. C. Cancer prevention and treatment by wholistic nutrition. J. Nat. Sci. Oct 3 (2017). http://www.jnsci.org/files/html/2017/e448.htm

Thanks, Jeff, for the discussion. Please, for all readers, I am always prepared to be wrong or corrected—I just need to see the evidence.

[JeffN]

Thanks, Jeff, for the discussion.

Thanks Dr Campbell for your thoughtful response and for taking the time to write it. I appreciate your comments.

I think we both have made our points fairly clearly.

Have a great day and Happy Holidays!

In Health
Jeff

[JeffN]

Last month, I sent this thread out as a newsletter. I received many responses including the one from Dr Campbell, which he asked to post here. This week, I sent out the updated thread as a newsletter along with Dr Campbell's response.

It seems from the majority of responses I have received, both from health care professionals and non-professionals, that most people have missed the crux of my discussion and main points I was making.

People think I disagree with the concept of Wholism. This is not true. In my original post above, I link to an article I wrote that makes this very point.

My comments were only addressing three very specific points that he made.

Here they are...

1) If focusing on fat and saturated fat is reductionistic thinking then switching your focus to protein and animal protein is also reductionistic thinking. This truth is self-evident. If we are trying to move the conversation from one of reductionism (focusing on fat and saturated fat) to one of wholism (focusing on the overall dietary pattern), then shifting the focus to protein is still reductionism. You just can't have it both ways.

2) Dr Campbell said that focusing on limiting specific foods and items like nuts, seeds, avocados, cooconut, fat and saturated fat is unnecessary to get the dramatic benefits (such as reversing heart disease) of this dietary approach.

3) Dr Campbell said that animal protein is more important than saturated fat in acheiving these dramatic results (i.e. reversing heart disease).

He then gave several references to prove points 2 & 3, which are the same references he has used in several articles and published papers.

The problem is that the references he gives to make his points do not support his points, and in fact, prove the opposite.

The references he listed for point 2, that you don’t have to limit specific foods or components of foods including nuts, seeds, avocados, cooconut, fat and saturated fat, are to the early works of Dr Ornish and Dr Esselstyn, both of whom actually did strictly limit specific foods and items including nuts, seeds, avocados, coconut, fat and saturated fat.

His references he listed for point 3, that animal protein is more important then saturated fat in causing heart disease, are to the early works of Dr Ornish and Dr Esselstyn in reversing heart disease, two programs that actually did strictly limited fat and saturated fat while allowing animal protein, including fat free dairy products, which are foods high in casein. I also referenced the work of Dr Gould, who also strictly limited fat and saturated fat and allowed for even more animal protein.

In addition, he also referenced his book Whole to support his points. However, in the book Whole, he says...

"The ideal human diet looks like this: Consume plant-based foods in forms as close to their natural state as possible (“whole” foods). Eat a variety of vegetables, fruits, raw nuts and seeds, beans and legumes, and whole grains. Avoid heavily processed foods and animal products. Stay away from added salt, oil, and sugar. Aim to get 80 percent of your calories from carbohydrates, 10 percent from fat, and 10 percent from protein."

You just can't follow a minimally processed 80/10/10 diet with 10% of calories coming from fat without limiting certain foods.

My concern with point one is self evident.

The references for point 2 & 3 do not support the referred claims and actually prove the opposite.

In addition, the following article, Plant-Based Grocery Shopping Guide, was posted on 1/4/2018 on his website about a week after the above discussion. In contrast to his claim that you don't have to limit specific foods (nuts, seeds, avocados), it actually says to limit these very foods.

http://nutritionstudies.org/plant-based-grocery-shopping-guide/

Specifically, it says

Fresh Produce (Fruits and Vegetables)
Enjoy a wide variety of fruits and vegetables! Choose plenty of dark leafy greens. Avoid avocados if you have heart disease and use sparingly if you are trying to lose weight.

Nuts, Seeds, and Dried Fruits
Avoid nuts if you have heart disease. Use very sparingly if you are trying to lose weight.

Omega-3 rich chia and flax seeds can used to top cereal and replace eggs in baked goods (1 tbsp chia or ground flaxseed plus 3 tbsp water = 1 “egg”). Whole flax seeds are not digested so it is best to buy ground flax seeds or even better, grind them right before use in a coffee grinder. Use other seeds (sesame, pumpkin, sunflower) sparingly.

Most dried fruits are acceptable when they are eaten sparingly and do not have added sugar. Keep in mind they are higher in calories than fresh fruits. If you are diabetic or trying to lose weight, eat fresh fruits rather than dried fruits. Avoid dried banana chips as most are actually fried.

Considering 75% of Americans are either overweight or obese, that heart disease is the #1 cause of death, and that about 10% of the population has diabetes, 25% are considered undiagnosed diabetics and 34% have pre-diabetes (~50% of those over 65), I think the modifications for certain foods in his Plant-Based Grocery Shopping Guide, and not just any WFPB Diet, are for everyone.

And with that, I agree!

In Health
Jeff