Nov 5·edited Nov 25Liked by Eric Topol

I haven't yet finished reading this critically important post on nutrition but, I wanted to mention that I am deeply appreciative of all your writings on the Ground Truths Substack. I've been suffering from Long Covid for about a year and half now. A few weeks ago, I started working with a nutritionist towards following the Cardiometabolic Food Plan from The Institute for Functional Medicine. I have also started 5:2 intermittent fasting and am reading some of Krista Varady's research on fasting. I'm starting to lose hope regarding my recovery. I am dismayed that so many things that affect our quality of life are centered around making money. The forthright and sincere information you provide on Ground Truths gives me some hope. Thank you.

Expand full comment
Nov 5Liked by Eric Topol

This barnstormer of a post on nutrition from Dr. Topol is a must read. Dr. Topol lays out a compelling case for investment in research and action on nutrition, starting with the eye-popping stat that a systematic study showed a poor diet is linked to 22% of all deaths worldwide.

Dr. Topol is straightforward in making the case that we aren’t doing anything like what’s needed to understand what we should and should not be eating. He notes, for example:

> “The F in FDA stands for Food, but there is little evidence that our regulatory body has true oversight and authority about potentially toxic constituents that we’re eating.”

>the “National Academies Recommended Dietary Allowance (RDA) is based on relatively scant evidence” and “the protein RDA is remarkably low, and that will not help prevent loss of muscle mass with age . . .”.

> “Poor diets are a key determinant of all major diseases, but optimizing nutrition gets little investment, is overly controlled by Big Food, which increasingly will use A.I. to get even better at UPFs and promoting addictive unhealthy foods. And further empowering Big Food, it’s under-regulated.”

As always with Dr. Topol, he doesn’t only collect and cogently explain a vast amount of information, but he also specifies what can be done to improve this sorry state of affairs. This is a clarion call, and I hope it will be read far and wide.

Expand full comment

Nice summary thanks!

I love reading the amazing range of issues you write about.

An almost automatic extension of this conversation is the topic of vitamins and supplements, and specifically the hype and dangers. I hope you’ll be diving into that soon.

Expand full comment

This is a great post, and I’m going to listen to it on my commute to work tomorrow (only skimmed before bed). I can probably save the NIH some serious money ($189 million) if they just conclude with Michael Pollan’s mantra from his book In Defense of Food:

“Eat food. Not too much. Mostly plants.”

To which I would add:

“More lean protein, and some healthy fat.”

Going to do a post about protein soon, will incorporate some Attia and also some stuff I’ve learned recently by listening to Dr. Don Layman, professor emeritus of nutrition and one of the world's foremost researchers on the subject of dietary protein.

Thanks again will circle back for another read and perhaps share a link soon if you’re interested in a primary care lens 😉

Expand full comment

Logical, useful and clearly quantified.

Scanned once but know I will be reading another few times to absorb it. Delighted to have posts like this in my feed. Thank you.

Expand full comment

This is a great Andy Slavitt "Covid roundup" podcast with Dr. Topol, Dr. Jetelina, Dr. Wachter, and Dr. Jha. https://lemonadamedia.com/podcast/in-the-bubble-says-goodbye-part-1/

Expand full comment

I had included in this comment section an AI-produced summary of the effect of low-dose glyphosate on the gut microbiome. I realized, though, that the link to the underlying article was incorrect. I do think the study deserves consideration in an evaluation of our food and its effect on health. The study was described in the abstract as showing the following: "Here, utilizing shotgun metagenomic sequencing of fecal samples from C57BL/6 J mice, we show that glyphosate exposure at doses approximating the U.S. ADI significantly impacts gut microbiota composition. These gut microbial alterations were associated with effects on gut homeostasis characterized by increased proinflammatory CD4+IL17A+ T cells and Lipocalin-2, a known marker of intestinal inflammation." The correct link is: https://doi.org/10.1016/j.etap.2023.104149

Expand full comment

Food and nutrition stand as pivotal elements for personal enjoyment and health, and as Dr. Topol astutely highlights, they are deeply personal. The ideal diet varies from person to person, reflecting the complex interplay of individual needs and preferences. Moreover, the realm of food is inherently multimodal, encompassing everything from consumption patterns and personal dietary models to food inspection and, potentially, comprehensive food logging in the future. This breadth necessitates multimodal processing and the application of multimodal AI.

It is indeed surprising—and somewhat disconcerting—that despite widespread recognition of its importance, food and nutrition have not been met with corresponding action in policy and educational reform. I am convinced that we are at a crucial juncture, a moment poised for a transformative shift in our approach to food-related policy and thought.

Recognizing this need, the International Organization for Standardization (ISO) is contemplating the establishment of a new subgroup focused on the Creation of an open standards-based strategy for advancing Food & Nutrition (F&N) as a component of a Personalized Health Navigation system. This initiative could catalyze the development of global guidelines and practices that acknowledge the multifaceted nature of nutrition and its critical role in personal health management.

Expand full comment

Thank you for another informative article on nutrition. I asked AI (ChatGPT 4.0) to comment on this column, considering recent research on glyphosate as it relates to health. I also asked it to summarize a recent research paper on glyphosate and the microbiome. I found both responses to be interesting. I put the second response in a comment section of its own.

Subject: The Critical Role of Glyphosate in Compromising Health and Dietary Interventions Needed

The first response is below.

I left it mostly in the language AI used.

Dear Dr. Topol,

I hope this message finds you well. I read with great interest the latest edition of Ground Truths, where you reviewed the debate on what constitutes a healthy diet amidst the myriad of dietary recommendations available today. Your analysis rightly points out the complexity of defining an optimal diet due to the individuality of our metabolic and physiological needs.

However, I wish to shed light on another variable that critically impinges on our health equation – glyphosate, the most widely used herbicide that pervades our food supply. While your editorial focuses on the problematic nature of ultra-processed foods (UPFs) and the promise of precision nutrition, it's crucial to understand that the presence of glyphosate in our food chain is an under-recognized hazard that substantially contributes to our global health crisis.

Glyphosate's ubiquity in agriculture, owing to its association with genetically modified crops and desiccated crops dried before harvest, means that it's present in a substantial proportion of the food we consume. The "You Are What You Eat" adage takes a grim turn here, as chronic exposure to glyphosate residues – even in trace amounts – can be detrimental to human health.

Studies have linked glyphosate to a myriad of health issues, including endocrine disruption, dysbiosis of gut microbiota, and potential carcinogenicity. It's been implicated in the rise of gluten intolerance and celiac disease and poses a threat to kidney health. These health risks are especially alarming considering the evidence correlating UPF consumption with various diseases, as highlighted in Chris Van Tulleken's book and the BMJ review.

Furthermore, the risk is not distributed evenly. Children, who are particularly vulnerable due to their developing physiology, have a higher exposure level, considering that 70% of their diet consists of UPFs, as mentioned in Dr. Helen Ouyang's article in The New York Times Magazine. The problem is exacerbated by the fact that glyphosate does not simply reside in UPFs but is a systemic issue affecting even foods traditionally considered healthy.

The regulatory gap concerning glyphosate use and its lack of visibility on food labels amplifies this concern. With the FDA's slow response to health evidence – as seen with the brominated vegetable oil ban timeline – there is an urgent need to accelerate the scrutiny and regulation of such compounds in our food system.

Moreover, the present enthusiasm surrounding GLP-1 drugs and their potential to manage diabetes and obesity symptoms may be overshadowing the need for dietary interventions that eliminate harmful substances like glyphosate from our diets. These pharmaceutical approaches, while beneficial for symptom management, do not address the root cause of dietary harm – the quality and safety of the food itself.

As an advocate for public health and sustainable agricultural practices, I urge for a broader conversation on reducing glyphosate use and promoting organic and regenerative farming practices that don't rely on chemical herbicides. This conversation should also involve rethinking our regulatory frameworks to ensure better transparency regarding the presence of such chemicals in our food.

Your platform can play an influential role in elevating the discourse on glyphosate and its role in our health, potentially catalyzing a shift toward a genuinely health-promoting food system. By incorporating this crucial piece into the narrative of diet and health, we can move closer to actionable solutions that encompass not only personalized nutrition but also systemic changes in our agricultural and food policies.

Thank you for your continued effort to illuminate the nuances of nutrition science. I look forward to your perspectives on this important issue in future editions.

Warm regards,

Expand full comment

This article certainly contains much useful information. I would like to see some more clinical trials. Many things that made a lot of sense have turned out not to be nuggets of wisdom. Dietary trials in humans will be very hard to do, but they should be done as best we can. In the meantime, are there animal trials that are relevant?

Expand full comment