6 ms·

When medicine ignores nutrition entirely, and nutrient supplements are still complete unknowns, you have to wonder who the FDA is working for.

by cwmoore 6mo ago

Simulacra 6mo ago
But there's a core problem with this, in many states doctors are legally forbidden to give nutrition advice. The academy of nutrition and dietetics has worked very hard to make it so that only dietitians can provide nutrition advice. Take Ohio for example, a medical doctor in Ohio is legally forbidden and actually in jeopardy of losing their license and going to jail if they were to provide nutrition advice without a dietetics license. Dietitians are not doctors, but the academy of nutrition and dietetics wants you to think they are.
- secabeen 6mo ago
  Mmmm, regulatory capture and rent seeking. Will it ever end?
- rootusrootus 6mo ago
  Aren't doctors actually exempted specifically from such regulations in almost all states? AFAIK they can actually give nutritional advice legally in nearly every jurisdiction in the US.
- tzs 6mo ago
  > Dietitians are not doctors And doctors are not dietitians. Doctors in the US receive an average of under 20 hours of training in nutrition over four years of medical school. What little they do receive is often focused on nutrient deficiencies rather than on meal planning for health and chronic disease prevention. Less than 15% of residency programs include anything on nutrition. To become a registered dietician requires at least a Master's degree in dietetics or nutrition or a related field, and at least 1000 hours of supervised internships. PS: before any Europeans hold this up as an example of the poor US health care system, doctors in Europe average 24 hours of nutrition training.
hammock 6mo ago
You don’t have to wonder. It’s public record that 45% of the FDA’s budget incomes from user fees that companies pay when they apply for approval of a medical device or drug. In the drug division specifically, the number is about 75%.
- throwaway2037 6mo ago
  Naive question: What is wrong with this? Lots of gov't agencies in highly developed countries operate similarly. User fees account for a non-trivial portion of department budgets. A more simple example: Should the Dept of Motor Vehicles (DMV) charge zero, low, medium, high, or infinity money to get a driver's license?
  - beezlebroxxxxxx 6mo ago
    In principle there is nothing wrong with it, as long as the FDA or other testing body retains an appropriate impartiality or lack of bias (perceived or real). The issue, however, would be a lax system that allows revolving door access between the approval body and the industry that is seeking approval. Ironically, the common refrain becomes that their industry specific knowledge means they "must" be the only possible candidates for the role, which just so conveniently starts the revolving door swinging between leadership in industry and upper roles in regulatory bodies.
XorNot 6mo ago
Medicine doesn't ignore nutrition, you just don't like the answers. And it shows on the research: e.g. does creatine help muscle building? No.[1] But cue some anecdote from someone where they also changed a dozen other things at the same time but are sure it was that. [1] https://www.unsw.edu.au/newsroom/news/2025/03/sports-supplement-creatine-makes-no-difference-to-muscle-gains-trial-finds https://www.unsw.edu.au/newsroom/news/2025/03/sports-supplem...
- endominus 6mo ago
  Creatine is probably the most well-studied nutritional supplement we have, and one of the most efficacious. You are presenting a single study to counter that. Not even a meta-analysis, but a single study of just 54 participants who did not exercise at all previously (from the study; "Apparently healthy individuals, with a body mass index of ≤30 kg/m2 and not meeting current physical activity guidelines of at least 150 min of moderate-intensity exercise were included. Individuals who undertook [resistance training] within the previous 12 months were excluded"). The general consensus is that it is absolutely helpful in muscle-building. See, for example [0] and [1]. Beware the man of one study. https://slatestarcodex.com/2014/12/12/beware-the-man-of-one-study/ https://slatestarcodex.com/2014/12/12/beware-the-man-of-one-... [0]: https://pmc.ncbi.nlm.nih.gov/articles/PMC12665265/ https://pmc.ncbi.nlm.nih.gov/articles/PMC12665265/ - Meta analysis results; "after intervention, the Cr group exhibited significant strength gains" [1]: https://www.mdpi.com/2072-6643/17/17/2748 https://www.mdpi.com/2072-6643/17/17/2748 - "A total of 69 studies with 1937 participants were included for analysis. Creatine plus resistance training produced small but statistically significant improvements... when compared to the placebo."
array_key_first 6mo ago
Medicine doesn't really ignore nutrition, but the problem is: 1. Most people don't believe it anyway. People want to hear they can eat hamburgers and milkshakes and be healthy. Telling them "we know that gives you heart disease and cancer" does nothing. 2. Nutrition is complicated and different for every person, because everyone has different things they can tolerate. The "perfect" diet is actually worthless because it has a 0% success rate. Really, we have to optimize for how miserable people are willing to be. 3. Most people are unhealthy enough that nutrition is the least of their concerns. That sounds crazy, I know, but if you're obese (which most people are!), then priority is being not obese. Not your nutrition. I know those sound related but they're way less related than you think.
- hammock 6mo ago
  > Most people don't believe it anyway Maybe because so much of it is wrong, or (very charitably, as much is industry-biased) outdated? Lifestyle modification is a definite challenge and I’m not dismissing it. Still, hamburgers and milkshakes don’t give you heart disease and cancer. Overeating, oxidative stress from low-quality ingredients, etc might.
  - jmye 6mo ago
    > Still, hamburgers and milkshakes don’t give you heart disease and cancer. Overeating, oxidative stress from low-quality ingredients, etc might. What? “Oxidative stress”? Oh come on, at least go full “seed oil” if we’re going to talk nonsense.
    - TeMPOraL 6mo ago
      We already left the land of reason far behind by the time OP implied hamburgers and milkshakes give people cancer.
      - vixen99 6mo ago
        Depends on the nutrients that comprise them to the extent they contain a lot of omega-6 or not. Not heart disease so much but the other killer - might as well mention in this context. 'A high omega-3, low omega-6 diet with FO for 1 year resulted in a significant reduction in Ki-67 index, a biomarker for prostate cancer'. https://doi.org/10.1200/JCO.24.00608 https://doi.org/10.1200/JCO.24.00608. Also Prostate Cancer and Prostatic Diseases (2024) 27:700 – 708 'Our preclinical findings provide rationale for clinical trials evaluating ω-3 fatty acids as a potential therapy for prostate cancer'. Seed oils are not as bad as painted but some caution is needed given for instance the industrial processes used to bring them to market sometimes. Plus the way the oils are cooked when they create free radicals. This is not nonsense.
TeMPOraL 6mo ago
Nutrition is run on fads - see whole fitness and healthy food bullshit. Nutrition supplements ended up being a loophole that allows pharmacies and pharma companies to sell all kinds of random stuff that they can't or don't want to, show is safe, or doing anything at all.
- throwaway2037 6mo ago
  > Nutrition is run on fads - see whole fitness and healthy food bullshit. You raise an interesting point. I watched a YouTube video recently of someone walking around a large US supermarket pointing out all of the processed foods that now claimed to be high protein. It is nuts! I wonder what will come after the protein boom? My guess: Fiber is back because you need to "fibermaxx" when taking GLP-1 antagonists. I can remember some of the funny adverts in the 1980s of old people taking fiber supplements to "stay regular". (See SNL comedy skit "Colon Blow" for a good laugh.)
UncleMeat 6mo ago
Every primary care physician I have ever had has discussed nutrition with me.
- cwmoore 6mo ago
  All but one I have had did not, and his suggestion to eat something other than cheeseburgers every day was less than revolutionary. When I brought it up with other physicians the answer was always that I probably get all the nutrients I need from regular food. Whatever that may be. Dietary changes have helped me feel better and healthier and perform better, and a few vitamin and other supplements as well. I’m not selling a lifestyle. I’m criticizing the foolishness of a food and drug industry based in the idea that preventing death or lifelong disability is sufficient.

When medicine ignores nutrition entirely, and nutrient supplements are still complete unknowns, you have to wonder who the FDA is working for.

by cwmoore 6mo ago

When medicine ignores nutrition entirely, and nutrient supplements are still complete unknowns, you have to wonder who the FDA is working for.

Simulacra 6mo ago

But there's a core problem with this, in many states doctors are legally forbidden to give nutrition advice. The academy of nutrition and dietetics has worked very hard to make it so that only dietitians can provide nutrition advice. Take Ohio for example, a medical doctor in Ohio is legally forbidden and actually in jeopardy of losing their license and going to jail if they were to provide nutrition advice without a dietetics license. Dietitians are not doctors, but the academy of nutrition and dietetics wants you to think they are.

secabeen 6mo ago
Mmmm, regulatory capture and rent seeking. Will it ever end?
rootusrootus 6mo ago
Aren't doctors actually exempted specifically from such regulations in almost all states? AFAIK they can actually give nutritional advice legally in nearly every jurisdiction in the US.
tzs 6mo ago
> Dietitians are not doctors And doctors are not dietitians. Doctors in the US receive an average of under 20 hours of training in nutrition over four years of medical school. What little they do receive is often focused on nutrient deficiencies rather than on meal planning for health and chronic disease prevention. Less than 15% of residency programs include anything on nutrition. To become a registered dietician requires at least a Master's degree in dietetics or nutrition or a related field, and at least 1000 hours of supervised internships. PS: before any Europeans hold this up as an example of the poor US health care system, doctors in Europe average 24 hours of nutrition training.

hammock 6mo ago

You don’t have to wonder. It’s public record that 45% of the FDA’s budget incomes from user fees that companies pay when they apply for approval of a medical device or drug. In the drug division specifically, the number is about 75%.

throwaway2037 6mo ago
Naive question: What is wrong with this? Lots of gov't agencies in highly developed countries operate similarly. User fees account for a non-trivial portion of department budgets. A more simple example: Should the Dept of Motor Vehicles (DMV) charge zero, low, medium, high, or infinity money to get a driver's license?
- beezlebroxxxxxx 6mo ago
  In principle there is nothing wrong with it, as long as the FDA or other testing body retains an appropriate impartiality or lack of bias (perceived or real). The issue, however, would be a lax system that allows revolving door access between the approval body and the industry that is seeking approval. Ironically, the common refrain becomes that their industry specific knowledge means they "must" be the only possible candidates for the role, which just so conveniently starts the revolving door swinging between leadership in industry and upper roles in regulatory bodies.

XorNot 6mo ago

Medicine doesn't ignore nutrition, you just don't like the answers. And it shows on the research: e.g. does creatine help muscle building? No.[1] But cue some anecdote from someone where they also changed a dozen other things at the same time but are sure it was that. [1] https://www.unsw.edu.au/newsroom/news/2025/03/sports-supplement-creatine-makes-no-difference-to-muscle-gains-trial-finds https://www.unsw.edu.au/newsroom/news/2025/03/sports-supplem...

endominus 6mo ago
Creatine is probably the most well-studied nutritional supplement we have, and one of the most efficacious. You are presenting a single study to counter that. Not even a meta-analysis, but a single study of just 54 participants who did not exercise at all previously (from the study; "Apparently healthy individuals, with a body mass index of ≤30 kg/m2 and not meeting current physical activity guidelines of at least 150 min of moderate-intensity exercise were included. Individuals who undertook [resistance training] within the previous 12 months were excluded"). The general consensus is that it is absolutely helpful in muscle-building. See, for example [0] and [1]. Beware the man of one study. https://slatestarcodex.com/2014/12/12/beware-the-man-of-one-study/ https://slatestarcodex.com/2014/12/12/beware-the-man-of-one-... [0]: https://pmc.ncbi.nlm.nih.gov/articles/PMC12665265/ https://pmc.ncbi.nlm.nih.gov/articles/PMC12665265/ - Meta analysis results; "after intervention, the Cr group exhibited significant strength gains" [1]: https://www.mdpi.com/2072-6643/17/17/2748 https://www.mdpi.com/2072-6643/17/17/2748 - "A total of 69 studies with 1937 participants were included for analysis. Creatine plus resistance training produced small but statistically significant improvements... when compared to the placebo."

array_key_first 6mo ago

Medicine doesn't really ignore nutrition, but the problem is: 1. Most people don't believe it anyway. People want to hear they can eat hamburgers and milkshakes and be healthy. Telling them "we know that gives you heart disease and cancer" does nothing. 2. Nutrition is complicated and different for every person, because everyone has different things they can tolerate. The "perfect" diet is actually worthless because it has a 0% success rate. Really, we have to optimize for how miserable people are willing to be. 3. Most people are unhealthy enough that nutrition is the least of their concerns. That sounds crazy, I know, but if you're obese (which most people are!), then priority is being not obese. Not your nutrition. I know those sound related but they're way less related than you think.

hammock 6mo ago
> Most people don't believe it anyway Maybe because so much of it is wrong, or (very charitably, as much is industry-biased) outdated? Lifestyle modification is a definite challenge and I’m not dismissing it. Still, hamburgers and milkshakes don’t give you heart disease and cancer. Overeating, oxidative stress from low-quality ingredients, etc might.
- jmye 6mo ago
  > Still, hamburgers and milkshakes don’t give you heart disease and cancer. Overeating, oxidative stress from low-quality ingredients, etc might. What? “Oxidative stress”? Oh come on, at least go full “seed oil” if we’re going to talk nonsense.
  - TeMPOraL 6mo ago
    We already left the land of reason far behind by the time OP implied hamburgers and milkshakes give people cancer.
    - vixen99 6mo ago
      Depends on the nutrients that comprise them to the extent they contain a lot of omega-6 or not. Not heart disease so much but the other killer - might as well mention in this context. 'A high omega-3, low omega-6 diet with FO for 1 year resulted in a significant reduction in Ki-67 index, a biomarker for prostate cancer'. https://doi.org/10.1200/JCO.24.00608 https://doi.org/10.1200/JCO.24.00608. Also Prostate Cancer and Prostatic Diseases (2024) 27:700 – 708 'Our preclinical findings provide rationale for clinical trials evaluating ω-3 fatty acids as a potential therapy for prostate cancer'. Seed oils are not as bad as painted but some caution is needed given for instance the industrial processes used to bring them to market sometimes. Plus the way the oils are cooked when they create free radicals. This is not nonsense.

TeMPOraL 6mo ago

Nutrition is run on fads - see whole fitness and healthy food bullshit. Nutrition supplements ended up being a loophole that allows pharmacies and pharma companies to sell all kinds of random stuff that they can't or don't want to, show is safe, or doing anything at all.

throwaway2037 6mo ago
> Nutrition is run on fads - see whole fitness and healthy food bullshit. You raise an interesting point. I watched a YouTube video recently of someone walking around a large US supermarket pointing out all of the processed foods that now claimed to be high protein. It is nuts! I wonder what will come after the protein boom? My guess: Fiber is back because you need to "fibermaxx" when taking GLP-1 antagonists. I can remember some of the funny adverts in the 1980s of old people taking fiber supplements to "stay regular". (See SNL comedy skit "Colon Blow" for a good laugh.)

UncleMeat 6mo ago

Every primary care physician I have ever had has discussed nutrition with me.

cwmoore 6mo ago
All but one I have had did not, and his suggestion to eat something other than cheeseburgers every day was less than revolutionary. When I brought it up with other physicians the answer was always that I probably get all the nutrients I need from regular food. Whatever that may be. Dietary changes have helped me feel better and healthier and perform better, and a few vitamin and other supplements as well. I’m not selling a lifestyle. I’m criticizing the foolishness of a food and drug industry based in the idea that preventing death or lifelong disability is sufficient.