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NUTRITION / What we know, what we don't

Field Notes / 13 slides NUTRITION What we know, what we don't. A honest survey of dietary science: macros, micros, the metabolic narrative, ultra-processed...

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Field Notes / 13 slides NUTRITION What we know, what we don't. A honest survey of dietary science: macros, micros, the metabolic narrative, ultra-processed foods, the Mediterranean diet, the gut microbiome — and where the evidence runs thin. Key sections include: Carbs, fats, protein — and the calorie controversy; Vitamins & minerals: deficiencies and limits; Calories in / calories out — with caveats; Blood sugar, insulin, and the metabolic narrative; Hyper-palatable, low-satiety — the dominant culprit?; The strongest evidence base in nutrition; Emerging evidence — less than once hyped; 1.2 – 2 g/kg for active adults; The new frontier — far from fully understood; Consensus on moderation — details contested.

Key sections

  • 01Carbs, fats, protein — and the calorie controversy
  • 02Vitamins & minerals: deficiencies and limits
  • 03Calories in / calories out — with caveats
  • 04Blood sugar, insulin, and the metabolic narrative
  • 05Hyper-palatable, low-satiety — the dominant culprit?
  • 06The strongest evidence base in nutrition
  • 07Emerging evidence — less than once hyped
  • 081.2 – 2 g/kg for active adults
  • 09The new frontier — far from fully understood
  • 10Consensus on moderation — details contested
  • 11Most general advice is boring — and largely correct.
  • 12Keep going.
Slide outline
  1. 01Carbs, fats, protein — and the calorie controversy
  2. 02Vitamins & minerals: deficiencies and limits
  3. 03Calories in / calories out — with caveats
  4. 04Blood sugar, insulin, and the metabolic narrative
  5. 05Hyper-palatable, low-satiety — the dominant culprit?
  6. 06The strongest evidence base in nutrition
  7. 07Emerging evidence — less than once hyped
  8. 081.2 – 2 g/kg for active adults
  9. 09The new frontier — far from fully understood
  10. 10Consensus on moderation — details contested
  11. 11Most general advice is boring — and largely correct.
  12. 12Keep going.
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Slide 01

Slide 1

  • Field Notes / 13 slides
  • NUTRITION
  • What we know,
  • what we don't.
  • A honest survey of dietary science: macros, micros, the metabolic narrative, ultra-processed foods, the Mediterranean diet, the gut microbiome — and where the evidence runs thin.
  • Press → to begin · Updated 2026
Slide 02

Carbs, fats, protein — and the calorie controversy

  • 02 · Macronutrients
  • The three molecules that supply energy. The body burns them, builds with them, stores them. We have argued for sixty years about the ideal mix; the data keeps refusing to settle the question.
  • 4 kcal/g
  • Carbohydrates
  • Glucose is the brain's preferred fuel. Quality matters more than quantity: whole grains, legumes, fruit. Refined sugar and flour behave differently.
  • 9 kcal/g
  • Fats
  • Densest energy source. Once vilified, now rehabilitated. Saturated vs. unsaturated still matters; trans fats are unambiguous harm.
  • 4 kcal/g
  • Protein
  • Building blocks: muscle, enzymes, hormones. Most active adults underconsume. Plant or animal — both work if amino acids are complete.
  • Open question: Are all calories equivalent? Thermodynamically yes. Metabolically — satiety, hormonal response, thermic effect — almost certainly no.
Slide 03

Vitamins & minerals: deficiencies and limits

  • 03 · Micronutrients
  • Tiny doses. Outsized consequences. The body cannot synthesize most of them — they must arrive on the plate. Deficiency causes named diseases (scurvy, rickets, beriberi). Excess can cause harm too.
  • Vitamin D: ~40% of US adults below sufficient. Sun, fish, fortification.
  • B12: critical for vegans & older adults; supplement or fortify.
  • Iron: common deficiency in menstruating women; complex absorption.
  • Iodine: the public-health victory of iodized salt.
  • Magnesium, potassium: chronically under-consumed in Western diets.
  • Essential vitamins
  • 15+
  • Essential minerals
  • 90%
  • Of US adults below veg target
  • Multivitamin RCTs showing mortality benefit
  • Food > pills, in nearly every well-conducted trial.
Slide 04

Calories in / calories out — with caveats

  • 04 · Energy balance
  • The first law of thermodynamics holds. But "CICO" hides what matters: how appetite, hormones, sleep, stress, gut flora, and food composition shape both sides of the equation.
  • ~10%
  • Calories burned digesting protein
  • ~3%
  • Burned digesting fat
  • 60-70%
  • TDEE from BMR (mostly involuntary)
  • ±15%
  • BMR variation between individuals
  • What's true: Sustained energy surplus → fat gain. Sustained deficit → loss.
  • What's misleading: "Just eat less" assumes appetite is a free variable. It is not.
  • What's missing: Food matrix, fiber, processing, timing — all alter how many calories the body actually extracts and stores.
Slide 05

Blood sugar, insulin, and the metabolic narrative

  • 05 · Glycemic response
  • Eat carbs → blood glucose rises → insulin secreted → glucose stored. Sharp spikes followed by crashes drive hunger, energy dips, and (chronically) metabolic dysfunction.
  • Glycemic Index ranks foods by spike magnitude.
  • Glycemic Load adjusts for portion — more useful in practice.
  • Fiber, fat, and protein flatten the curve.
  • Continuous glucose monitors revealed: response is highly individual.
  • Type 2 diabetes is now widely framed as a disease of metabolic flexibility.
  • Caveat: CGM-driven "personalized nutrition" remains under-evidenced for healthy adults.
Slide 06

Hyper-palatable, low-satiety — the dominant culprit?

  • 06 · Ultra-processed foods
  • Industrial formulations engineered for shelf life, cost, and crave. The NOVA classification calls them group 4: ingredients you don't have in your kitchen, processes you can't replicate at home.
  • ~58%
  • Of US calories from UPF
  • Up from ~24% in the 1970s. Children & lower-income brackets eat the most.
  • +508 kcal/day
  • Hall NIH trial (2019)
  • RCT: subjects fed UPF ate ~500 kcal/day more than matched whole-food diet, gained weight in 2 weeks.
  • ↑ risk
  • Observational signal
  • Higher UPF intake associates with cardiovascular disease, type 2 diabetes, depression, all-cause mortality.
  • Honest caveat: "Ultra-processed" is a fuzzy category. Whole-grain bread is technically processed. The mechanism — palatability? additives? texture? — is still being unpicked.
Slide 07

The strongest evidence base in nutrition

  • 07 · Mediterranean diet
  • Olive oil, vegetables, legumes, nuts, fish, whole grains, modest wine, little red meat. The PREDIMED trial — despite a republished re-analysis — remains the most credible large RCT for cardiovascular protection.
  • 30% lower major cardiovascular events vs. low-fat control (PREDIMED).
  • Consistent observational benefits: stroke, cognitive decline, mortality.
  • Not a "diet" so much as a pattern of eating, social and seasonal.
  • Works across populations — though adherence outside the Mediterranean is harder than it sounds.
  • Daily / weekly pattern
  • DAILY Olive oil
  • DAILY Vegetables
  • DAILY Whole grains
  • DAILY Fruit, nuts
  • 2×/wk Fish, seafood
  • 2×/wk Legumes
  • MODERATE Wine, dairy
  • RARE Red meat, sweets
Slide 08

Emerging evidence — less than once hyped

  • 08 · Time-restricted eating
  • Compress eating into an 8–10 hour window; let the rest of the day be water and coffee. Animal models showed striking metabolic benefits. In humans, the picture has cooled.
  • Common protocol (16:8)
  • Practical for many; aligns eating with daylight; may aid adherence to modest deficit.
  • Weight-loss benefit vs. matched-calorie
  • 2022 NEJM trial & meta-analyses: when calories are matched, the timing benefit largely disappears.
  • ↓ muscle?
  • Caveat for older adults
  • Some signals of greater lean-mass loss in long-window restrictions; protein distribution matters.
  • Verdict: Useful as an eating-discipline scaffold for some. Not a metabolic magic bullet. The evidence is honest about that.
Slide 09

1.2 – 2 g/kg for active adults

  • 09 · Protein
  • The RDA (0.8 g/kg) is a floor, not a target — designed to prevent deficiency, not optimize performance, satiety, or healthy aging.
  • Muscle: resistance training without adequate protein wastes the stimulus.
  • Satiety: highest of the macros; meals with 25-40g blunt later hunger.
  • Aging: sarcopenia begins in your 40s; older adults likely need more, not less.
  • Distribution: 3-4 doses of 25-40g works better than one big hit.
  • Source: animal protein has higher leucine; plant works at higher total intake.
  • 0.8
  • RDA g/kg (floor)
  • 1.2–1.6
  • Active adult g/kg
  • 1.6–2.2
  • Building muscle g/kg
  • ~3-8%
  • Muscle lost / decade past 30
  • For an 80kg person: ~96–176g protein/day depending on goal.
Slide 10

The new frontier — far from fully understood

  • 10 · Gut microbiome
  • ~38 trillion bacterial cells. Hundreds of species. They digest fiber we can't, manufacture vitamins, train the immune system, talk to the brain. We are barely past cataloguing them.
  • ~30g
  • Daily fiber target
  • Most adults consume half. Fermentable fiber feeds short-chain fatty acid producers — arguably the single most evidenced lever.
  • 30+
  • Plant species per week
  • American Gut Project signal: diversity of plants > diversity of microbes > metabolic markers.
  • Probiotic supplements
  • Some strains help specific conditions; most "general health" claims are not supported. Fermented foods (yogurt, kimchi, kefir) more reliable.
  • Reality check: "Personalized microbiome diets" sold by startups are running ahead of the science. We don't yet know what a "good" microbiome looks like.
Slide 11

Consensus on moderation — details contested

  • 11 · Salt, sugar, alcohol
  • SALT
  • < 5g/day (WHO)
  • Average intake ~9g. Strong link to hypertension at the population level. The "salt skeptics" debate is real but minority.
  • SUGAR
  • < 25g added/day (WHO)
  • Average ~70g. Liquid sugar (soda, juice) most clearly harmful. Sugar in fruit and dairy: not the same problem.
  • ALCOHOL
  • No safe level (Lancet 2018)
  • The "1-2 drinks is healthy" J-curve has largely been retracted by better-controlled studies. Less is better; zero is best for cancer risk.
  • What we know: reducing all three reduces population disease burden. What we argue about: the precise thresholds, and how much they vary individually.
Slide 12

Most general advice is boring &mdash; and largely correct.

  • 12 &middot; The honest assessment
  • After all the controversies, the durable advice is unglamorous:
  • Eat vegetables &mdash; many, varied, often.
  • Eat fish a couple of times a week.
  • Eat whole grains, legumes, nuts; not refined.
  • Eat less added sugar; drink less alcohol.
  • Eat enough protein, especially as you age.
  • Cook at home. Avoid most ultra-processed things.
  • Sleep, move, share meals. The plate is part of a life.
  • "Eat food. Not too much. Mostly plants." &mdash; Michael Pollan, still hard to improve on.
Slide 13

Keep going.

  • 13 &middot; Further reading
  • Two starting points on YouTube &mdash; a general overview and a deep dive on the ultra-processed-food story that has reshaped recent debate.
  • YouTube search
  • Nutrition science, explained &rarr;
  • YouTube search
  • Ultra-processed food &mdash; Chris van Tulleken &rarr;
  • Ultra-Processed People &mdash; Chris van Tulleken (2023)
  • In Defense of Food &mdash; Michael Pollan (2008)
  • The PREDIMED Study &mdash; Estruch et al., NEJM (2018, republished)
  • The Hall NIH UPF Trial &mdash; Cell Metabolism (2019)
  • NIH Office of Dietary Supplements &mdash; ods.od.nih.gov
  • Examine.com &mdash; independent supplement & nutrition meta-reviews
  • NUTRITION / Field notes 2026 &mdash; what we know, what we don't
  • End of deck
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