Nutritional Orthodoxy: When Science Becomes a Belief System

colinchamp October 29, 2020 3 Comments

On April 26, 1478 Lorenzo de’ Medici and his brother Giuliano strode into the Church of Santa Maria del Fiore, underneath the massive and beautiful Duomo of Florence. Navigating to their typical pew, the brothers sat down to participate in Easter mass. However, at the midway point of the service, when the priest elevated the Host on the alter – or perhaps at the end of the mass when the priest said “the mass has ended” as sources are mixed here – Giuliano felt a shock-like, burning sensation as Bernardo Baroncelli buried a knife into his chest, calling him a traitor. Francesco de’ Pazzi followed, delivering multiple adjacent stab wounds into his chest, plunging his dagger repeatedly. Giuliano’s white shirt took on a dark purplish hue as his blood poured out through the multiple gashes.

Simultaneously, two priests lunged at Lorenzo, one swinging his knife at his body, missing full contact and merely slicing his neck. Lorenzo grabbed a nearby sword and began striking back at the attackers, before his friend Poliziano pulled him to safety. With fear of potential poison on the blades, Lorenzo’s allies began sucking at the gash on his neck, spitting out the potentially poisonous blood. Lorenzo retreated into the back room of the church, barricading the door shut to ward of the several other would-be attackers within the church.

At the same time, Jacopo de’ Pazzi, accompanied by 150 hired mercenaries, marched into town square calling for an uprising. Only for Jacopo, his sudden realization that Lorenzo was still alive left his plea falling on deaf ears. Additionally, Jacopo had made a deal with Pope Sixtus IV, who promised additional reinforcements, but none had arrived.

The coup had failed. Worse, yet, the head of the Holy Roman Catholic Church was implicated. While we do not know how much Sixtus IV was involved in the Pazzi conspiracy, when the conspirators met with Pope Sixtus IV, they asked “Holy Father, are you content that we steer this ship? And that we steer it well?” Finally, he nodded, “I am content.” They had the Pope’s blessing, as he was “fully aware of the deed to which he was giving his assent.” The Medici may have financially run the Florentine Republic, but the Pope and Pazzi wanted total control, utilizing the Pope’s greatest asset – Catholicism. Francesco Salviati Riario and Francesco de’ Pazzi were given the greenlight to rid Florence of the Medici family. Only, they failed.

Belief or Science?

“Belief has a tenacity that defies both intellectual and moral correction.”

-James Carse

While this famous episode took place four and a half centuries ago, the struggle for religious and spiritual power and the bloodshed that ensued has been repeated many times since. In fact, within the past year a modern-day Pazzi conspiracy took place, not within the walls of a Catholic Church, but in a newfound spiritual edifice with vague boundaries. A recent series of studies challenged the Nutritional Orthodoxy, not with an outward revolt, but rather by merely thoroughly analyzing one of the central tenets and most commonly preached verse of the Nutritional Orthodoxy: the harms of red meat. The group that performed the analysis was part of NutriRECS, which describes itself as “an independent group with clinical, nutritional and public health content expertise, skilled in the methodology of systematic reviews and practice guidelines who are unencumbered by institutional constraints and conflicts of interest, aiming to produce trustworthy nutritional guideline recommendations based on the values, attitudes and preferences of patients and community members.”

In total, they produced four studies analyzing the current evidence surrounding red meat recommendations and health, and then published a fifth with their recommendations.¹ Unsurprisingly, the group found that the bulk of the evidence for most recommendations regarding red meat was small and inconsistent. For instance, when they assessed 118 articles including 56 cohorts with more than 6 million participants for an association between meat and cancer, they found that:

“the possible absolute effects of red and processed meat consumption on cancer mortality and incidence are very small, and the certainty of evidence is low to very low.”

For anyone well-versed in the nutritional sciences, these findings hardly come as a surprise, as most dietary and food studies – especially when it comes to cancer – have produced consistently inconsistent results, and even when they do show a risk or benefit, it is incredibly small and difficult to take seriously.² As a result, dietary recommendations for cancer patients have been an inconsistent and confusing message that depends highly on the source, not necessarily the available data (further illustrating just how poor the data are).^3,4

The article describing the group’s red meat recommendations based on the analyzed studies recommended no change in dietary habits, i.e. lessening of meat consumption, but described this recommendation as weak and with low-certainty evidence.¹ In other words, the group reported that the available data are too weak to promote any significant changes in meat consumption recommendations, so on an individual basis, we do not necessarily have to decrease meat consumption levels like some other recommendations suggest. (It should be noted that dietary recommendations, and especially those dealing with cancer, have always been accompanied by controversy and inconsistency,³ so we should have fully expected the same here. Additionally, one may ask whether there is even enough data to make any recommendations, but that is another discussion in itself.)

Finally, it is important to note that the authors “considered issues of animal welfare and potential environmental impact to be outside the scope of our recommendations.” In other words, they were assessing the science in relation to health and nutrition only, and other unrelated topics intersecting with food but not health were not considered (though I would argue that animal welfare directly impacts human health by leaving these animals with healthier meat and fatty acid composition⁵).

These results, published in the impactful journal Annals of Internal Medicine, were hardly surprising to anyone who follows the contradictory back and forth of dietary studies – and especially epidemiology studies – and the recent work calling out these inconsistencies.⁶ These results were similarly unexpected to change much within the average person’s eating patterns, and for many of us in the field, would not change our thoughts concerning a well-rounded diet composed of an array of healthy nutrient- and vitamin-dense sources of animal products and vegetables. Yet, like most nutrition studies these days, the results were still expected to stoke some controversy.

The response, however, raised more than some eyebrows.

The Unscientific “Scientific” Response

“This is sure to be controversial, but it is based on the most comprehensive review of the evidence to date. Because that review is inclusive, those who seek to dispute it will be hard pressed to find appropriate evidence with which to build an argument.”

This comment, voiced in the recomendation article mentioned above, may be the understatement of the year. Many arguments accompanied the article, listed in the comments section underneath where individuals are given a chance to voice concerns and authors are given the chance to respond. One response absent from this section, however, revealed more about the field of nutrition than many of us were able to swallow. The Pazzi, several centuries after their major defeat in Florence, arose for their next conspiracy. In fact, the venomous response was so unprecedented that the Journal of the American Medical Association wrote a follow up article describing the entire conspiracy. This response, also further confirmed that “those who seek to dispute it will be hard pressed to find appropriate evidence with which to build an argument.” Oftentimes, when one lacks evidence for a rebuttal, they may be forced to turn to extremes or downright inappropriate behavior. This unscientific, Pazzi-like episode, was no different.

In the science world, when one disagrees with a published study, there are mechanisms set in place for dispute. For instance, the most common is a letter to the editor pointing out issues or oversights with a publication. This often undergoes review and the primary study authors are given time to respond to these criticisms with a written rebuttal. Oftentimes, there are multiple letters to the editor and multiple responses. Much like Martin Luther’s grievances nailed to the door at Wittenberg (which, coincidentally, criticized the Catholic Church’s practice of indulgences and the then Pope, Leo X, son of Lorenzo de’ Medici), these are then published for the world to see (for some further insight into this contentious topic, read the Comments Section below the article.

However, this grievance appeared to be outside of the realm of science. Working in concernt there were eleven members of the latest Pazzi, including the Sixtus IV of the Nutritional Orthodoxy and another, the founder of an organization that promotes “responsible medicine,” yet is clearly an animal rights group (and does little to hide this fact), as demonstrated on their website and through multiple actions in the past. The present-day Pazzi have a similar intriguing group of members and associations, claiming to promote health by preaching from pulpits in the past, revealing their belief system. A simple Twitter search reveals an array of interests, or perhaps agendas, that traverse nutritional science into those other topics that were purposely, and interestingly, left out of the red meat review as they were felt to be “outside the scope of our recommendations.” Defining this scope is perhaps a question of where science ends and belief begins.

The Pazzi and Conspirators Unite

Five days before the articles were published, the journal sent out a press release to a group of reporters with a standard embargo policy ensuring that they did not release information before publishing. A member of the Pazzi and newfound Nutritional Orthodoxy was on this list, breaching the embargo contract and distributing the information to his accomplices. The Pazzi responded by sending the journal a letter prompting them to retract the publication before it was even published. In an outlandish move, one member, who is also the head of a sect within the Nutritional Orthodoxy that focuses on animal rights (but is surreptitiously called a Physicians’ Committee though less than 10% of its members are physicians) even petitioned to the Federal Trade Commission to block the publication.

When available theories, research, and hypotheses are questioned (i.e. an integral part of the scientific process), steps are in place to respond to these questions. On the other hand, when a belief is questioned, the believers often turn to other methods of retaliation. In the above incident, when these less than savory methods failed, members of the congregation stooped lower by personally attracting several of the authors in an attempt to discredit them due to financial conflicts (ironically by one of the members with the largest amount of conflicts – when belief is at play consistency is unnecessary). Of note, this “conflicted” author did publish another article showing the poor data supporting recommendations to limit sugar. The findings did not recommend increasing sugar or even suggest it was safe, but merely posited issues with the research methodologies.⁷ While this article made many of us cringe, strangely, there was no outcry with the publication of these results though it was pertaining to sugar, a topic that most of us within the dietary research world would agree to limit. Something particular about red meat seems to incense this supposedly scientific group, a topic that uncoincidentally directly pertains to many of the members’ extracurricular activities as part of animal rights activism.

In fact, when one of the Orthodoxy members who describes himself as an “entrepreneur” was, in response, questioned by JAMA about his array of conflicts, those of other members, and whether the pot was calling the kettle black, his response failed to address his laundry list of conflicts and the seven figures in funding and pay he has received from an array of food companies.

The response to the meat papers was so outrageous and such a direct blow to the scientific process that JAMA decided to describe it in detail in a recent Medical News and Perspectives piece, interviewing several scientists throughout the nutrition field and authors of the publication. The response was described as “completely predictable” and “hysterical” by one author. A professor who studies linkages between science and technology, ethics and values, and public policy said that it “sounds like a political campaign,” and that “I’ve seen Monsanto do the same thing on the other side.” Steven Novella, MD, founder and executive editor of the Science-Based Medicine website described it as a “total hit job,” and that the group has “a certain number of go-to strategies…in order to dismiss any scientific findings they don’t like.”

The intense absurdity of the situation reached a peak when Annals Editor-in-Chief Christine Laine, MD, MPH, had her email shut down after receiving 2,000 caustic emails generated by a bot. Laine said that the response from the National Rifle Association was less vitriolic when they published on firearm prevention. In the end, she hit the nail on the head:

“The sad thing is that the important messages have been lost,” she said. “Trustworthy guidelines used to depend on who were the organizations or the people they came from…The public should know we don’t have great information on diet,” Laine said. “We shouldn’t make people scared they’re going to have a heart attack or colon cancer if they eat red meat.”

When Belief Masquerading as Science Overtakes Science

While reading about this entire ugly episode, an array of emotions surface. Firstly, as a health and nutrition researcher, fear of one day being castigated and personally attacked for simply producing a study that did not align with the belief system of this group and others is concerning. Secondly, it begs asking how far we have veered from science and into the territory of unwavering belief systems ready to attack if threatened.

To answer the latter question, I turned to the amazing James Carse, author of the masterpiece Finite and Infinite Games. The world unfortunately lost Carse, as he recently passed away just shy of 88 years old. Lucky for us, his mark has been left upon the world. As a Professor Emeritus of History and Literature of Religion at New York University who thoughtfully asked us whether we were focusing on the important aspects of our life, his recent work The Religious Case Against Belief seemed like an appropriate text on belief systems and the issues that surface when we cross into them to explain the unknown.

Returning to the meat studies, they were, in reality, unlikely to change much, especially as they merely stated the unknowns within the dietary world. They merely described a lack of answers and were by no means Luther’s Ninety-five Theses, questioning the entire belief system of Catholicism (or at least the Papacy’s handling of it). Back and forth epidemiological nutrition studies are produced by the dozens and the public had lost faith in their inconsistent message a while ago.^2,6,8 This study and the accompanying recommendations were viewed by many as more firewood to be piled onto the ever-growing mound of nutritional studies that the media parades to the public, further fatiguing them with incessant back and forth push and pulling, ultimately burning them as kindling. Others saw this as more of an explanation of the reasons for the ever-present back and forth. All-in-all, it is likely that few individuals, if any, have changed their dietary habits from a study stating there was not, and is not, great data on the health issues of meat consumption (getting people to change dietary habits often takes forces greater than those that can move mountains).

While the study itself provides us little in terms of tangible dietary recommendations, the venomous response of the Pazzi elite, on the other hand, was much more telling of the python of belief wrapped around the dietary science world and how it will forcefully tighten when one questions its authority. For instance, when Martin Luther supposedly nailed his grievances to the door of the All Saints’ Church in Wittenberg, he was merely pointing out his issues with the Catholic belief system surrounding Christianity and not Christianity itself. His Ninety-five Theses were purely a statement against the practices of the Catholic Church, including mainly its promotion of indulgences, or the ability of sinners to buy forgiveness from the Church. Luther’s complaints struck at the core voice of the current belief system of Christianity, the Papacy, not the religion of Christianity. As Carse reminds us, Luther and Pope Leo X (recall, he was coincidentally Lorenzo de’Medici’s son) had similar views when it came to the religion of Christianity, but the belief system surrounding this view was where things deviated. (Of note, when Luther refused to renounce these views to the pope and his clergymen, they excommunicated him and attempted to burn him with the charge of heresy, which was not very Christian-like for the Pope, but belief systems will lead to these types of things…).

This article, regardless of its findings, has questioned the core voice of the Nutritional Sciencedom belief system, and like Luther, the elite set out to destroy it.

Striving to be Knowers Versus Believers

“If I am a knower, I am open to correction; if I am a believer, I will resist it. The one says, this is what I am thinking; I will wait for your response to see if it is the truth. The other says, this is what I think; I will wait for you to see it as the truth.”

Carse’s quote above depicts true religion versus belief, but would work well were it describing science versus belief. Where the confusion enters is the difficult task of deciphering which factions of the scientific nutrition world are truly attempting to pose questions to further advance our quest to understand the optimal diet and eating habits for individuals, and which “scientists” are mere clergymen secretly (and, as per above, non-secretly) promoting other agendas as they endorse camouflaged beliefs in the name of science. It is quite clear that many of the “scientists” are acting more like believers trying to silence such questions, as opposed to those asking questions to get closer to a correct answer (i.e. researchers and scientists).

As Carse tell us, “To be human is to live in an ill-lit zone of imponderables.” There is no shortage of imponderables within our relationship with food and the science that researches it. These imponderables, unfortunately, allow the infiltration of those individuals that may be hijacking these sciences to impose their beliefs. For instance, one member of the Nutritional Orthodoxy has a clear history as an animal rights activist, a close relationship with PETA, and a tendency to go to extreme measures against those who do not share his views. He uncoincidentally strongly advocates for diets that exclude animal foods. His tactics included trying to block publication through the FTC. Oftentimes, the extensive tactics of staunch believers provide fear and trepidation in those who are simply attempting to research dietary strategies, and not further belief systems. Carse had recognized this from his decades of religious studies:

“Knowers have no investment in the truth of their claims, while believers are ready to defend the truth of theirs, sometimes at a high cost.”

Much like Cardinal Rialto’s role in the Pazzi conspiracy and his relationship with the Pope, we should pose the question whether legitimate researchers attempting to improve heath should conspire with similar unsavory modern figures? What are the rest of us to think of this unholy union? Are we driven by further knowledge or by furthering belief?

Nutrition science may have more questions than answers, and no current researcher or group knows the right answer to most of them. Yet, while dietary views will always remain strong, the science, and our acknowledgement of what we do not know, can still push us closer to that right answer. For instance, not far from Florence, Galileo, as Carse reminds us, was driven not by his knowledge, but rather by his ignorance. “He knew that he did not know. He also knew he never would know it all.” Science is the quest to get closer to knowing, while belief often stands as the purposeful obstruction of this quest. “No matter how many truths we accumulate, our knowledge falls infinitely short of the truth.”

“Ignorance thus described can be understood as a process of awakening, or of being awakened. The more we are aware of the limitations of our knowledge, the more awake we are to the world’s enormous varieties.”

• Why are groups trying to silence this awakening by petitioning journals or even the Federal Trade Commission to silence them?
• Why are they not openly voicing concerns in scientific discourse?

Such a lack of scientific dialogue is concerning, assuming we are talking about scientific endeavors here. Such a response would be less surprising were we not confronting science, but rather belief, as “Belief has a tenacity that defies both intellectual and moral correction.” Furthermore, “Belief marks the line at which our thinking stops.” And when it comes to belief and dialogue, “’Dialogue,’ therefore is obviously not the correct term to describe the way belief systems address the world. Other terms quickly suggest themselves: broadcasting, for example, or airing, or loudspeaking…essentially foreclosing any possibility of exchange between speaker and audience…blanking out anything else that might be said, to the point of silencing the listener’s own thoughts and replacing them with the language and sentiment of the speaker.”

The Failed Pazzi Conspiracy

Unfortunately for the Nutritional Orthodoxy, the assailants were unsuccessful. However, much like with the Pazzi in the 15^th century, the rest of the world learned some lessons from the failed coup. An ugly realization has set in that many researchers joined with assassins willing to stoop to new lows to silence their opposition, ignoring the rules of academia. They tried to block publication with the Federal Trade Commission, tried to turn to unimpressive conflicts while avoiding millions of dollars of their own conflicts, and perhaps most egregious, worked in the shadows and avoided scholarly interaction and dialogue to continue to push the nutritional conversation forward.

Thus, were the tactics of the original Pazzis fueled by Pope Sixtus IV. The failed coup and brutal murder of Lorenzo’s handsome and likeable brother, Giuliano, which merely fueled public outrage to the degree that the famous Florentine Journal, the Journal of the American Medical Association, reported on the attempted assassination, directly going against the mighty Pope of the Nutritional Orthodoxy – something they would have never dared to do in times past. The coup d’état failed, and worse yet, their plot was exposed to the public.

It must have pained Sixtus IV to no end to join with these unscrupulous individuals, but through the lens of history, one could see his conundrum. For a belief system to survive and propagate, victims are commonplace and the rules must not always be followed.

“When believers broadcast their truths to the world, it is obvious that they are simply quoting from an existing statement of them. They have a final authority, usually a text, or if not a text as such, teachers or institutions that have the same role as a definitive text.”

What this Pazzi conspiracy may indicate is to expect major pushback in the future when researching any topic that goes against the Nutritional Orthodoxy. With behind the scenes lawsuits and techniques to quiet the opposition, nutritional science will be limited in its ability to flourish and answer those difficult questions. Many scientists have dedicated their careers to helping individuals lose weight, fight illness, and achieve optimal health. Blocking these efforts is an insult to both science and our patients.

Yet, even nonbelievers within the research and medical world remain fearful: The believers have broadcast their belief system to the world, long with their tactics or retaliation, and many nonbelievers are fearful of repercussions if they are exposed, as “belief systems are not only impervious to opposition; they thrive on it.”

A recent study illustrated this fact rather well: of those physicians that outwardly preach the verse of Nutritional Orthodoxy from their clinical pulpit by promoting the scripture via recommending a DASH or American Diabetic Association diet to their patients, less than 1% actually follow the diet personally.⁹ Sometimes outwardly disobeying a belief system could make one lose their clinical or academic position, thus true beliefs must be kept behind closed doors. Just like the most recent Pazzi conspiracy, when the poor nonbelievers witness what happens to those in power who disobey, they are quickly frightened back into submission.

[stextbox id=’custom’ color=’fcfcfc’ ccolor=’000000′ bgcolor=’000000′ cbgcolor=’000000′ bgcolorto=’000000′ cbgcolorto=’000000′ image=’http://colinchamp.com/wp-content/uploads/2016/03/CC-Icon.jpg’] Sure, success with low-carb and ketogenic diets has now created its own set of believers in both patients and physicians, and any insult to their belief system strokes a fiery rebuttal. (For instance, when I questioned the current science on the ketogenic diet for cancer and concluded that we needed more studies, I received a nice bit of hate mail. One responder told me to do some research before I spoke, and then quoted studies that cited my very own research).
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Unfortunately, the bully pulpit of the leaders of the Church of Nutritional Orthodoxy have successfully evoked fear in the people they are supposed to be leading. This recent outburst has shown the world that their beliefs supersede those of their followers and those of the scientific process. But then again, we must remember, when truths are lacking, we simply must believe; anything that casts doubt on these beliefs will be silenced.

The most unfortunate consequence of this entire event is that there are multiple groups out there truly attempting to improve health on a personal level; these groups should work together to further the science and research instead of attempting to discredit each other or Pazzi them. There are no easy answers in nutrition, and trying to silence opposing groups will surely do little to help us advance as a field.

At the end of the day if we are all moving towards our common goal – increasing the health of our society as a whole – we should be moving in the same direction. The recent actions of the Pazzi conspiracy put this perspective into doubt, leaving us to wonder if we all have the same goal, or if some have simply hijacked the nutritional research world to push a belief system onto others.

Moving Forward to Promote Health                                                

While these actions may seem objectionable and unbelievable, when belief systems come into play, such extremes are more common. According to Carse, “The kind of belief that concerns us here stands at the far end of the scale of passion and action.” He goes on, “At this point believers have crossed the line from uncertainty to conviction. There is no possibility of a reasonable objection. Those who disagree are placed in the category of unbelief and can therefore be bracketed out of serious conversations.” And this latter point is one of danger within the scientific field. At this juncture, we no longer listen to opposition from the other side as we are thoroughly convinced ours is the way, thus defining belief and defiling science. Objections from the other side must be silenced.

Controversy and opposing views are not new within the science world, and Carse, a former Professor of Religion at NYU comments that “the sciences are populated with a huge crowd of brawling, non-monolithic thinkers. It is disagreement, not agreement, that keeps scientific passion at its keenest. One person’s conclusion is an invitation to another’s challenge.” Disagreement, however, must be accepted for the field to move forward, otherwise, we would still be following the Food Pyramid and stuffing ourselves with 6-11 servings of bread and pasta each day. With the Nutritional Orthodoxy, however, “Learning is reduced to mere repetition and can only confirm what has already been known.”

In the end, Carse reminds us that Pope Urban VIII condemned Galileo before the inquisition, not merely for his quest for science, but rather for exposing their willful ignorance:

“The old man who sat before the inquisitors was a living reminder of the mysteries that gave the Christian tradition its religious power. To acknowledge this, they would have to admit that their precisely stated beliefs had no durable substance, but were arbitrary inventions that falsely claimed the quest for truth had been completed. By declaring Galileo a heretic, they painted themselves with that very brush.”

The latest Pazzi conspiracy has exposed this brush of the Nutrition Orthodoxy, confirming it as a belief system, as opposed to a scientific quest, inching closer to answering the question as to which is the optimal eating pattern for mankind (newsflash – there are many and to define us all by a one size fits all approach is more a top-down ludicrous strategy than improvement). The Nutritional Orthodoxy has already claimed for us all that “the quest for truth had been completed” and any opposition must be silenced.

As Carse reminds us, “Science at its very best…calls for enlightened ignorance.” As scientists we must know that we don’t know. But when we start to force our knowledge onto others at all costs and quiet the scientific opposition, this is no longer science. Sorting out the nutrition world would be like uniting the varying religions of the world – or even reconciling the different factions within the same religion. Thousands of years have proved the difficulty in this task, and thousands more will confirm this. The only certainty is uncertainty.

Carse leaves us with a final message in regards to religion: “Centuries of scholarly quarreling over the definition of religion, with no resolution in sight or even imaginable, take us to the conclusion that religion is not only undefinable, but that we cannot say what religion is.” Food and eating patterns are no different (ahem, the Mediterranean Diet), but perhaps even more variable and difficult to pin down, as belief systems will continue to surface for centuries to come and future scholars will continue to quarrel over their definitions. But rest assured, the belief systems will follow to silence them.

The good news is that the belief system will fail, as have countless in the past. “The world abounds in pseudo-religions: belief systems that declare for themselves an eternal validity but can show only modest longevity. The irony is that their demise is certain. They have few resources for responding to challenges from without or to changing conditions within. They have an absolute commitment to their own orthodoxy.”

 “It is ignorance and not belief that is the source of the faith’s vitality.” In other words, the great religions have persisted for centuries due to the search for the truth and recognition of our ignorance of it. Belief systems shrouded in willful ignorance that claim to know the truth and preach it to their followers are short-lived. “Their boundaries are finally no protection against the inevitability that at least some of their believers will see beyond them and report what they have seen.”

They can try to silence the opposition, but these attempts will be futile.

From the Pazzi conspiracy to Luther’s ordered assassination for airing his grievances, one thing is certain: the response of the Nutritional Orthodoxy to the questioning of their belief system revealed more about itself than the red meat studies.

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References:

1. Johnston, B. C. et al. Unprocessed Red Meat and Processed Meat Consumption: Dietary Guideline Recommendations From the Nutritional Recommendations (NutriRECS) Consortium. Ann. Intern. Med. 171, 756 (2019).
2. Schoenfeld, J. D. & Ioannidis, J. P. A. Is everything we eat associated with cancer? A systematic cookbook review. Am. J. Clin. Nutr. 97, 127–34 (2013).
3. Champ, C. E. et al. Dietary Recommendations During and After Cancer Treatment: Consistently Inconsistent? Nutr. Cancer 65, 430–439 (2013).
4. Champ, C. E., Volek, J. S., Siglin, J., Jin, L. & Simone, N. L. Weight Gain, Metabolic Syndrome, and Breast Cancer Recurrence: Are Dietary Recommendations Supported by the Data? Int. J. Breast Cancer 2012, 9 (2012).
5. Haskins, C. P., Henderson, G. & Champ, C. E. Meat, eggs, full-fat dairy, and nutritional boogeymen: Does the way in which animals are raised affect health differently in humans? Crit. Rev. Food Sci. Nutr. 1–11 (2018). doi:10.1080/10408398.2018.1465888
6. Ioannidis, J. P. A. The Challenge of Reforming Nutritional Epidemiologic Research. JAMA 320, 969 (2018).
7. Erickson, J., Sadeghirad, B., Lytvyn, L., Slavin, J. & Johnston, B. C. The Scientific Basis of Guideline Recommendations on Sugar Intake: A Systematic Review. Ann. Intern. Med. 166, 257–267 (2017).
8. Ioannidis, J. P. A. Biases in obesity research: Identify, correct, endorse, or abandon effort? Obesity 24, 767–768 (2016).
9. Hendrix, J. K., Aikens, J. E. & Saslow, L. R. Dietary weight loss strategies for self and patients: A cross-sectional survey of female physicians. Obes. Med. 17, 100158 (2020).

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