I am speaking today as a clinical research scientist—an endeavour with which I have some familiarity, having conducted many such studies, and being aware of their difficulty, as well as a clinician and sometime philosopher of science.
We will start with the general, in this discussion, and move toward the specific.
Generally: It is vital to understand that science is an ethical, even philosophical/religious enterprise. Why? Because the scientists who advance humanity inevitably operate within a a priori framework of faith. What are the elements of that faith?
- That the world is orderly in its foundation, nature and spirit.
- That such order is understandable to the mind of man and woman.
- That the pursuit of such understanding is possible and laudable.
- That good itself will come of the pursuit of understanding.
A meta-principle underlies these more explicit rules: the understanding that the scientific aim must be true, for the truth to be revealed. This means that science aimed at career, prestige, professorship and funding, to say nothing of darker motivations—pride, revenge or the wish for destruction—is not science at all. Much of what purports to be science now is instead the garnering of personal credit, career advancement and economic gain that all derivative and essentially parasitic activity can temporarily achieve. This does not produce truth. We also should not be confusing “medicine,” as currently taught and practiced, with “science.” The education of modern physicians may familiarize them with the basics of physiology and biology and the details of their specific practice. This is by no means the same teaches them how to conduct or evaluate scientific research, which is something that requires years of specialized training to manage.
Why am I making these points? So that we understand explicitly that aim and ethical orientation define the scientific pursuit; so that we pay enough to attention to establishing that aim and ensuring that orientation.
Given all that, we might then ask ourselves, “what would it require to make America truly healthy again, and to orient true scientists toward that aim?” A re-tooling of the research enterprise from the top down, as well as the bottom up, so that the goal was clear, the incentives aligned, and the most productive actors identified, properly rewarded, encouraged and capitalized. This could be facilitated politically by making the more specific goal clear. We could begin that by formulating the appropriate diagnoses: what are the major problems bedevilling the American people? Public health is clearly one such concern, and more so all the time—despite the extensive government spending in that domain; despite the negligible attention paid to the details of health research and practice by the political class.
American children are fat, diabetic and increasingly miserable. As they progress toward middle age, those not yet captured in childhood by obesity, insulin resistance, high blood sugar and inflammatory/immunological dysfunction are likely to suffer it then, with near certainty by the onset of a declining old age, and expensively so. What might we aim for instead? Slim, healthy, athletic, optimistic and courageous children; strong, psychologically integrated, generous adults; resilient, active, productive seniors, still contributing to their communities—combined with either or both of much less spending or much better results for the cost. How could this aim be accomplished, within the community of health-focused researchers and practitioners, and incentivized, politically?
America faces a multidimensional diagnostic conundrum. Its people suffer from a plethora of symptoms and syndromes: too-high and increasing body mass indices; rising blood sugar levels; associated risk for psychological disorder; immunological dysregulation that increases risk of neurological degeneration, cancer and heart disease—to name a few.
My daughter referred earlier to her terrible childhood experiences, inquiry and experimentation, communication of all that, and the social consequences, among a multitude of people with various chronic health conditions. What was her prime scientifically-relevant realization? The answer to this question: What do all fat, sick, unhappy people have in common? At least this: they all eat. How could that brute and singular fact be varied and studied?
Epidemiological studies associating any given dietary habit with some outcome of health inevitably fail, trying as they are to establish a correspondence between only two factors in a veritable sea of causal possibility. Science can only progress when such inquiry is simplified so that single variables of interest can be assessed for causal significance. This is difficult to manage, in the complex case of diet, but it no longer seems impossible. Why? Because of the possibility of radical simplification on the food consumption side.
Elimination diets offer a potential solution to this problem. Most make little sense, however, conceptually or scientifically. They eliminate foods in an oft-random and faddish manner, often because of the spoken or unspoken ideological concerns of their proponents. In addition, they are insufficiently simple. The range of foods involved must be reduced to the minimum for genuine analysis of causality to take place.
Ketogenic diets, which switch the body to fat metabolism, constitute a step in that direction. Restricting carbohydrate/sugar intake, they eliminate the contribution of the glucose-dependent metabolic pathway to obesity, insulin resistance/diabetes, and inflammation. The consequence of ketogenic intake can be analyzed simply by monitoring of weight, blood sugar, and assorted symptoms of inflammation, including those associated with psychological disorder.
Plant-free ketogenic diets push that simplification to its most radical extreme. Such exceptionally simple but still remarkably manageable diets can be healthily maintained for the weeks, months and even years that allow the diagnostic and treatment enterprise to proceed. They also have as a clear advantage their essentially satiating nature: no one on a carnivore diet has to go hungry. Almost everyone who “diets,” in the common sense, gains back all the weight they lost and more when they revert to their pre-“diet” habits. This is arguably less likely with a plant-free ketogenic diet, given the reduced hunger, although that remains to be demonstrated empirically.
What then is the most logical, upward-aiming scientific approach to the problem of American health? Identification of diet as the potential common mechanism; radical simplification of that diet; analysis of programmatic variation of that simplified diet, as food items are added in, by category, one by one. Those with chronic intractable illnesses could thus well be placed by default on a plant-free ketogenic diet for the several mere months that it would take to assess the consequences. This is a revolutionary but manageable proposision. Before it becomes a generalized standard of care, however, the relevant studies should and must be done. We have more than sufficient anecdotal data pertaining to the positive effect of such simplified diets—the testimony of thousands of people, which is sufficient not to constitute proof but certainly to justify the relevant hypotheses.
The goal is health. The approach is, generally, of upward aim and commitment to the truth. The specific strategy is restriction of all extraneous dietary variables, analysis of the consequences of that restriction, and then systematic variation with a return to a more varied diet. Simple. Elegant. Implementable. Necessary. The alternative, given the crisis that confronts us on multiple health fronts, is dreadful: the continued sickening of the American people, with all the unsustainable economic burden that sickening is and will continue to produce—the demoralization, decline in productivity and spiralling health care costs that are already mounting to the point of unsustainability. We could replace that miserable future with something much brighter and healthier if we had the moral and political will to do so.