Institutions and the scientific method have never been perfect bedfellows, because they have competing pressures. What can an anecdote from the world of fasting tell us about the scientific literacy challenge at hand?
The Right to Mobility in a Rich/Poor World – Global Humanist Shoptalk
In the last two episodes of Global Humanist Shoptalk, I explored the question of human agency in relation to food. In “The Humanist Chicken Egg”, I reflected on how product choices are shaped by the cultures we inhabit. In “The Humanist Carbon Footprint”, I considered the onus placed on consumers to interpret manipulative labeling. But since I recorded those episodes last fall, I’ve been dealing with another facet of the problem: how we sift through authority claims that come to us from competing expert and personal testimonials.
As political and cultural responses to COVID-19 made clear, we have a serious problem with scientific literacy, and it’s not just due to everyday misinformation about “the science”. Formal institutions and mainstream media also contributed to this recent crisis, through poor transparency, a lack of scientific caution when drawing conclusions, and mismanagement of error reporting as new data emerged.
But were their missteps really that surprising? For decades, we’ve struggled with the “institution” problem for science. Big Pharma putting its fingers on the scale for drug studies. Tech companies skewing public research toward pet projects. Medical lawsuits asking the courts to adjudicate science. Think tanks spitting out public-use data that serves specific corporate and political interests.
The food industry is no different. In fact, it’s so filled with players that have a vested economic interest in our ongoing consumption of specific products, it’s also yielded a secondary industry of books, movies, and media personalities focused on illustrating all the ways it’s gone wrong.
We want to be able to tell people “trust the experts!” and “follow the science!” But our track record for public policy shaped by rigorous food science has been abysmal.
The problem, though, isn’t that public institutions get so many things wrong.
It’s that we don’t have a cultural vocabulary to accommodate for their errors. We are not a scientific society. We’re messy capitalists. And once institutions grow up around preliminary findings, it becomes increasingly difficult to promote key parts of the scientific method, like replicating initial results and building research practices around falsifiability, without risking institutional stability.
Is it any wonder, then, that scientific literacy is such a challenge to maintain, and division around trusted authorities comes so easily? In one camp, you’ve got people whose first instinct is to follow anyone who disagrees with the latest received wisdom from public mandates. After all, only a fool would trust what an institution with self-preservation priorities tells them is settled science, right? In another, you’ve got people who will doggedly defend the authority of public institutions, even when their recent track records aren’t great. Why? Partly out of civic duty, and partly because they’re still well-established entities, so how wrong can they really be?
There has to be a better way to advance scientific rigor in public policy.
So let’s stick with the food theme, and consider the possibilities.
The dangers of the personal success story
Years ago, I started a ketogenic diet because Colombia finally made it affordable for me (avocados and fresh cheese for the win!), and I wanted to ease some of my bipolar-II symptoms. Bipolar shares treatment pathways with epilepsy, and the ketogenic diet was developed for epileptics, so why not? But some folks were immediately against this choice, thinking keto was the worst thing I could possibly do for myself, so I thought looking into the research might assuage them. It couldn’t, though, because although what existed did suggest a positive benefit, there was precious little out there, and not always of the most robust variety.
And that was a bit strange, wasn’t it? Because again, we’re talking about two conditions with shared treatment pathways. In an ideal scientific world, the extension of research from epilepsy and keto to bipolar and keto would follow easily. In our world, though, there just didn’t seem to be much vested interest in exploring a therapeutic solution that wasn’t centrally pharmaceutical.
I still went ahead with my lifestyle change, and experienced immediate and substantial benefits during my down-cycles. In depressive and anxious spells, my chest no longer hurt so much that death felt like a reasonable response to chronic pain. A huge win. But how was I to talk responsibly about this benefit, this personal success story, with so little academic research to back it up?
The personal plot thickens
This is a question I’ve lived with ever since, and which was compounded this year when I took up another lifestyle change. In May 2021 I got COVID, and after a month of primary symptoms, I never fully recovered my energy or mental clarity. This was beyond frustrating. I’d exhaust myself on trips to the grocery store. I could do workouts, and sometimes even have a really good run, but the recovery time was excruciating. I felt drained for days, rather than invigorated. And I found it extremely difficult to write in long stints, or concentrate on certain forms of editing.
These symptoms belong to one kind of long COVID, but research on this condition is still slender. What little I found in 2022 involved small-group studies and often came to conflicting conclusions. One study suggested an overstimulated immune system, for instance, while other blamed a suppressed immune system. And yet, both still saw immune system health as part of the problem. So, I looked into research for immune system repair, and that’s when I learned about autophagy.
Autophagy: An ongoing process in the body, literally “self-eating”, wherein cells clear out old and damaged components. The process gets a boost through fasting, exercise, and ketosis, and has peer-reviewed positive impacts for inflammation and immune health, along with uses in cancer treatment. Be wary of anyone who tries to tell you exactly when the body enters heightened autophagy, though. It’s still a nascent field of study.
Intermittent fasting: Any number of fasting protocols that involve going without caloric intake for a period of time, followed by a set eating window. The easiest level is “Time Restricted Eating” (essentially, no snacking between meals 4-5 hours apart). Then there are 16:8 (i.e. fasting for 16 hours, eating over 8), 20:4, and One Meal A Day protocols. Alternate Day Fasting can run anywhere from 36- to 48-hour fasting windows, and some people do “rolling” fasts of eating once every 72 hours. Anything above that is definitely considered extended fasting.
Ketosis: A state in which your body is focused on burning fat for ketones, which then show up in blood or urine, instead of burning carbohydrates for glucose. You’ll find different promised entry points for ketosis (e.g., under 50 grams of carbohydrates for two to four days, or under 20 grams with exercise much sooner), but a blood-ketone test is the best indicator.
Refeed: A key stage in the recovery process after an extended fast. Folks generally don’t need to worry about the refeed for shorter fasts, but when you haven’t consumed significant calories for many days, your digestive system needs to be woken up slowly. High-nutrient fluids come first, with solid foods introduced with care.
Water fast: A form of food abstention that involves only consuming water and maybe calorie-negligible liquids like black coffee and tea. Daily electrolytes mitigate side effects: sodium and chloride (salt!), potassium, and magnesium. Hunger pangs tend to go away after the first two or three days, and many fasters experience heightened mental clarity and euphoria in extended fasts, which can make them addictive to the point of danger. Always exercise caution, touch base with a medical professional for longer fasting plans, and stop if you ever feel nauseated.
But to put the body into heightened autophagy one needs to fast, consuming nothing but water (more or less) for at least a day, if not much more. The body usually runs on sugars from carbs, but switching to a low-carb diet puts the body into ketosis, where it’s primed to run on fat instead. When no external fats show up, the body consumes its own stores, and autophagy kicks off, targeting damaged or old cells for recycling.
I was highly frustrated with my status quo when I decided to do a 10-day water fast in June, which I extended to 17 days because of how well I was feeling on it. Euphoric! With more mental clarity than I’d had in a year! I finished a range of writing projects in a fully fasted state. My spine and joints lost some of their aches and pains. I cut weight (which I then kept off after a very careful refeed), and I felt in control of my health again. I transitioned to intermittent fasting, and I’ve been happily rebuilding muscle mass and stamina that had flagged this past year.
But again, how does one talk about such an extreme choice responsibly?
The state of scientific accuracy in popular nutrition
When we give ourselves only two options with respect to scientific authority (“follow the formal experts completely!” or “bring down the whole kingdom of lies!”), we invite all kinds of quacks to profit from pseudoscientific counter-knowledge, and we leave ourselves no out when the institutions we’ve always trusted turn out to be wrong.
Right now, unfortunately, many of our tried-and-true cultural myths around nutrition are incorrect. For half a century, we’ve built food pyramids, approaches to scientific study selection, and attitudes toward eating schedules and safe food types around tenuous or debunked evidence that we haven’t been able to shake. In part, this is because of the food markets heavily invested in our current consumption patterns. But also? We’re just not very good at being wrong. When whole organizations and careers are built around a given principle, it’s not only a matter of pride that binds us to earlier recommendations. It’s also fear of a litigious society, and of becoming legally culpable if we have to flip received wisdom on its head.
I hesitate even to name some of the people who’ve been outlining the politics of food science, though, because they’re often mentioned in exalted tones by those who thrive on “resistance” narratives, which also doesn’t help the cause of scientific literacy.
For instance, Jason Fung is a nephrologist who built a clinical practice around fasting when he realized the role insulin resistance was playing in exacerbating his patients’ conditions. In many of his talks, he is explicit about what he does and does not know, and where the research has and has not caught up with his clinical findings, which have themselves called for course-correction over time. But does that stop many from treating him as a replacement Perfect Dietary Authority with which to rage against conventional nutritional mandates?
Of course not.
Then there’s Nina Teicholz, a public-policy journalist whose deep dives into the food industry illustrate how our most trusted health organizations and research wings came to follow politics more than scientific evidence for the last 70 years. She’s well versed within her wheelhouse, but wobbles when her criticism of high-carb diets runs into environmental issues (a clash of policies, in other words, between what’s best for our bodies and how to build good food industries for the planet).
Moreover, she and Fung have an approach to talking about fatness that many might find dismissive, at best. They’re both emphatic that it’s not the individual’s fault for having followed state-sanctioned nutritional guidelines so well over the past decades, and expressly target failings in the medical profession. But they do treat fatness as an unhealthy state of being, obesity a scourge on our society, which for many possible listeners puts them firmly in a toxic political camp.
Everything is about “sides” in the market-economy of spin, right?
Staying rigorous when navigating messy science
Fung’s talks on water fasting first caught my notice, though, not because of what he guaranteed, but because of what he outlined as the limits of his knowledge. While talking in depth about how far the research on autophagy, insulin resistance, and therapeutic fasting has come in the last few years, I never saw him shy away from stating where peer-review hasn’t caught up to clinical results, and where clinical studies haven’t yielded enough data to make and test hypotheses. (Mileage may vary for shorter videos, though, so I do recommend sticking to fuller talks.)
And that should always be a marker we look for, in institutional representatives and individual testimonials alike: Do the speakers foreground their unknowns? How well do they talk about their margins of error? Do they explain different kinds of studies and their respective limits when referencing “the research”, or do they leave listeners and readers to assume it’s all the gold standard? When, if ever, do they name and discuss past errors in their research and clinical practices?
On a personal level, though, this is all much harder to enact, as I can attest to firsthand. When I regained my energy levels, effectively beating my single case of undiagnosed long COVID, I wanted to sing out my results to anyone in my vicinity. “Look at me! Look at me! I water fasted for 17 days and I feel on top of the world!”
But personal testimonials, and the whole “inspiration porn” genre that stems from them, are often the height of irresponsible conduct for empirical thinkers. There’s a reason that plenty of reprehensibly platformed people make a killing off touting miracle solutions, and it’s not in service to improving overall human knowledge.
When we have a terrific personal experience, then, the onus is on us to choose when, why, and how we disclose our success story to others. For the “when”? Be especially cautious when dealing with people struggling. Did they ask for your opinion? No? Then maybe don’t leap to offering it. Stick to forums and outlets where you’re either among like-minded people or able to curate what you say with significant caveats.
For the “why”? Ask yourself if you’re sharing this information because you want to boast, or because you think it might be useful. If the latter (and I hope it’s the latter), ask yourself what will actually make your story useful. Is it the single positive outcome, your precarious case study of n equals one? Or is it the journey through research that led you to try something new, and the process you applied?
Which brings us to the “how”—because if there is evidence, a journey of causal connections and documented steps that you can walk people through instead, why aren’t you leading with that instead, complete with an explanation of its limitations?
Fasting and the fragility of human science
Amusingly, fasting is an extremely old and storied practice, with extensive uses in different religions going back thousands of years. That makes the disconnect between contemporary scientific research and broader cultural knowledge even more acute.
But it’s not just in nutrition that such gaps emerge: human physiology in general is nowhere near fully documented by formal science, let alone always adequately represented by public policy. Scientists identified new organs in my lifetime! The Human Genome Project, “finished” in 2003, actually completed its catalogue just this year. We’ve only recently come to appreciate the role of gut microbiota in our health. What else will formal scientific communities uncover before we die? And more critically, what else will researchers realize that we’ve gotten wrong?
Our challenge, as we seek to combat scientific illiteracy, is to reclaim human and institutional fallibility as a normal rather than ruinous part of claiming authority on any given subject. Average citizens need to understand the differences between forms of scientific research, and be clearly informed as to when public policies are shaped by less robust bodies of intel, and why.
Broader media cultures also need to quit treating preliminary scientific conclusions as definitive. Emphasis needs to be placed on celebrating replication studies both when they confirm initial findings, and when they refute one and the same. Falsifiability is what makes the scientific method our gold standard, so why don’t we sing it, and not individual exceptionalism, out loud and proud?
Rhetorical question, I know: because we still live in a litigious society, a commercial society, a capitalist society. We are a long way off from inhabiting a culture with the curiosity and comfort with uncertainty necessary to be truly scientific instead.
But maybe what we need, to reach that better end, is a full-on acknowledgment of the scale of the problem. So let’s be clear about it, shall we? Recent COVID-19 public policy missteps only exacerbated an issue of institutional authority-failure that’s been with us for some time, across many critical fields for human thriving.
What are we going to do about it next?