January 23rd,2023

"I imagine -and in select cases know- that many of my colleagues were encouraged and gratified to hear that the NIH is allocating a sizable sum to the pursuit of precision nutrition. Some number of my colleagues will be directly involved in those research efforts, and others are simply pleased to see nutrition getting some small measure of the attention we agree it warrants. I can appreciate these reactions, but in my case, the response felt more like a wave of nausea accompanied by echoes of “here we go again, again.”

To be clear, I, too, see some value in the NIH’s predictably reductionistic approach to human sustenance. As an example, just in the past weeks a study has shown that variations in the microbiome can alter motivation and capacity for exercise- in mice. If such findings extend to humans- the proverbial “big if,” it might mean that dietary adjustments to alter the microbiome could, in turn, help enhance the motivations and fitness of formerly devoted denizens of the couch. ‘Tis a consummation devoutly to be wished, if somewhat far-fetched.
So, why the nausea? Because when the big picture (a blind spot academics may share with theologians, if parable is to be trusted*) is considered, allocating large sums to precision nutrition is like doing the same to learn the hidden secrets of a leaf on a tree in a forest that is burning to the ground, while doing nothing about the fire.

For starters, we are a species, a kind of animal. Across the full expanse of biodiversity, that speaks volumes about what kind of “precision nutrition” is warranted. The idea that we, and only we, among all the expressions of life, are so special that we can’t feed ourselves well without a personal poly-omic profile is testament to Homo sapien hubris and delusions of grandeur. It is, in effect, a denunciation of the universal relevance of adaptation, and basic biology- as if we are above all that.

Of course, within the expansive realm of what we know about how to feed the kind of animal we are, there is still ample room for personalization. We need only observe the diversity of cultural cuisines to be certain of that. That opportunity, however, resides largely in the burning branches of the forest, not at the distal tips of unreachable leaves.

We have large quantities of published evidence linking various dietary patterns to specific desired effects, and of course know even more about variations in human preference, largely predicated on upbringing, culture, and the familiarity of long exposure. We even know that taste preferences begin to take shape in utero, and are further propagated via the medium of breast milk. Nutrition can be tailored both to please taste, and to shape it; and to service personal aspirations of health and performance.

In other words, we know more than enough- right now- to (a) feed Homo sapiens very well in general, in accord with our shared biology; and (b) to personalize nutrition to a very considerable degree. Might the NIH effort put a fine polish on all this? Sure- but to dig back into the operative metaphor, how much sense does it make to stockpile shellac while leaving your source of all wood to incinerate?

I contend very little, and further contend this particular visual field defect is itself “genetic.” To my eye, it shares epistemological DNA with the recent call by the AAP to manage ever-more-prevalent obesity in children with ever more drugs and surgery at ever younger age. To be clear, I certainly endorse suitably intensive intervention to address dire consequences of pediatric obesity- just not while neglecting the rampant and remediable causes that populate every child’s daily routine.

These, in turn, share heritage with the recent, and already notorious 60 Minutes piece contending that obesity is principally “genetic” (because human genes have changed sufficiently in the last 100 years to account for the staggering changes in the epidemiology of obesity, right?)- and the attendant remedy is pharmacotherapy for all.

I hesitate to go so far- but these, to me, it seems share heritage - albeit at a further remove - with our approach to gun control, namely: ignore the obvious. The one allegedly “civilized” nation with the highest rate of gun circulation also enjoys the highest rates of gun-related death, injury, and mass mayhem- yet manages to avoid communal projectile vomiting when invited to counter this by…putting more guns in circulation. That the craven hypocrisies of the N.R.A. and the scholarly aspirations of the N.I.H. might own a common deficiency of vision is a disconcerting notion.

I am tempted to connect one dot more into the bigger picture I see. The cutting edge of climate calamity mitigation- think the management of droughts and deluges- involves crucial “back to the future” insights that subordinate modern technologies to the evolved prowess of natural systems. In such context, the role of scientific advance is supporting, with the primary aim of restoring natural equilibria that worked wonderfully- until we opted to obliterate them.

Might not the same be true for the natural equilibria within? One wonders at the likely luminous benefits of lesser NIH fortunes allocated to the requisite supports for feeding and moving our bodies in accord with our native adaptations. Given a choice between new blueprints of rarefied proteomic pathways, and putting the known blessings of the Blue Zones within reach of us all, you can guess which way I would vote.

So, in summary, what we have is a food supply known to be willfully engineered to promote overeating; that is known to work exactly as intended; that is in turn known to induce weight gain, and thus foment rampant obesity- which we will in turn address by dispensing the remediation of drugs and surgery to adults and their children, while our best and brightest seek answers to the questions we have not yet thought to ask. If this is not the definitive case of mopping the floor while ignoring the running faucet, I can’t think what would be.

Despite what we already know reliably about the fundamentals of feeding Homo sapiens well, and despite the massive good we know it could do for plagues both chronic and acute, we are being invited to twiddle and dither while the NIH seeks answers more suitably recondite if less practical, and Big Pharma applies Band-Aids at ruinous cost.

Hence, my nausea. There are pills for that, too- but I think a walk in the woods with my dogs will do the trick.

David Katz, MD

He so eloquently writes what we know to be true. History has shown us the path. We just need to hop on and walk the way of health and vitality. Instead, many Americans follow the convenience taste path to poor health.

Dr. M