Thank you for the empathy, this has been extremely challenging.
I think something similar to “why the post gave you the impression it did” could be helpful, and I’m even more interested in what you think could be done to convey the important, true points with as little animosity-due-to-misreading as possible
Thoughts on why the post gave (me) the impression it did, in no particular order:
‘Trade-offs’ is broad and vague, and the post didn’t make a lot of detailed claims about vegan nutrition. This makes sense in the context of you trying to communicate the detailed facts previously, but coming to the post without that context made it hard to tell if you were just making an unobjectionable claim or trying to imply something broader.
Some statements struck me as technically true but hyperbolic. Examples:
You can get a bit of all known nutrients from plants and fortified products, and you can find a vegan food that’s at least pretty good for every nutrient, but getting enough of all of them is a serious logic puzzle unless you have good genes.
[...]
Some people are already struggling to feed themselves on an omnivore diet, and have nothing to replace meat if you take it away.
[...]
If vegans are equally healthy but are spending twice as much time and money on food, that’s important to know.
[...]
If there are three vegan sources and you’re allergic to all of them, you need animal products.
I was very confused by what you were hoping to learn from an RCT or ‘good study’, and my impression of your in-office nutritional testing was that you were trying to gather new primary data about vegan nutrition. Because the basic facts about the risk of nutrient deficiencies in veganism seemed uncontroversial, my interpretation of that was that you thought there were other and potentially more significant ‘trade-offs’ that might exist at the level-of-evidence gap between an RCT or in-office testing and e.g. the introduction to the Wikipedia article on veganism.
The implied model for the relationship between diet and health felt...off, or at least different from my own. I tend to think of diet as an input to a set of homeostatic processes, which are generally robust but can be slowly pushed off-balance by sustained problems and usually fixed with gentle correction. This post seemed to model diet as an all-or-nothing ‘logic puzzle’ to be either solved or, more likely, failed.
...what you think could be done to convey the important, true points with as little animosity-due-to-misreading as possible
Beyond the points above, I genuinely don’t know. I’m probably not the intended audience anyway, since that seems to be vegans or potential vegans who don’t already know about the risks of nutrient deficiencies. The only thing I can think to contribute here is: if you’ve tried presenting the basic facts of the matter, and experienced pushback for it, does that necessarily mean that just presenting the facts is the wrong strategy? It’s a charged topic with a polluted local memespace, so some level of malicious or confused pushback is guaranteed; it’s what you would expect to see even when you are communicating well.
if you’ve tried presenting the basic facts of the matter, and experienced pushback for it, does that necessarily mean that just presenting the facts is the wrong strategy?
If people are very convinced I’m wrong then asking them why seems like a great strategy to me. They might be right and that might have implications for my plans. The point of this post wasn’t to convince anyone, it was to ask for evidence on a specific question.
I’m really glad we got to a more cooperative space and I hate to puncture that, but two weeks later I’m still kind of aghast you said “If you take out the references to veganism, this is just the current state of the world. People advertise their fast food restaurants and feed their children sugary breakfast cereals without caveats about the risk of heart disease or diabetes.” Surely you don’t think that’s the right moral category for ethical veganism?
Surely you don’t think that’s the right moral category for ethical veganism?
I don’t really understand what you’re asking here. How would you describe the moral category you’re referring to, and why do you think it doesn’t or shouldn’t apply to veganism?
McDonalds and sugary cereal advertisers are widely viewed as harmful if not evil for the way they confuse the epistemic environment in order to make money and others’ expense. Calling something “no worse than fast food and sugary cereal advertisers” is an enormous moral and epistemic insult to it.
I absolutely agree. McDonalds and the other demons of the Western Diet cause much more harm, both in absolute terms and per capita. That was really my point; within the class of ‘health misinformation and disinformation that causes harm’, furphies about vegan nutrition are a comparatively minor problem.
This sounds like you’re saying “I won’t prescribe B12 until my patient gives up oreos” or even “I won’t prescribe B12 until everyone gives up oreos”, which would be an awful way to treat people. Even if you’re right that oreos represent a larger problem, taking B12 pills is useful in its own right, and easier than giving up oreos[1].
I assume you don’t mean that. You probably mean “I don’t think Elizabeth/anyone should spend time on veganism’s problems, when metabolic issues are doing so much more aggregate harm.” But tractability applies even more on a population level. People aren’t eating oreos out of ignorance: they know they’re bad. They eat them because taste is winning out over health.
It’s impossible for a blog post to fix “oreos taste good” or “people care more about taste than health”. But it’s pretty easy theoretically possible for a blog post to fix ignorance of the benefits of some tests and supplements. When I see similarly tractable opportunities to help omnivores, I take them.
Hell, I found a (vegan) cure for oreos tasting good (n=1). Finding it took years of self-experimentation (where the iron post took a few days, for more certainly). AFAIK no one else has tried it, because it takes consistent effort over several months to see an effect on weight[2].
So no, I am not going to let McDonalds shitty advertising hold up alerting people to problems with simple diagnoses with simple solutions
It also costs $5-$10/day, but I know people jumping through a lot of hoops to get semaglutide, so I’m pretty sure the issue here is the delay and uncertainty.
This sounds like you’re saying “I won’t prescribe B12 until my patient gives up oreos” or even “I won’t prescribe B12 until everyone gives up oreos”, which would be an awful way to treat people.[1]
[...]
You probably mean “I don’t think Elizabeth/anyone should spend time on veganism’s problems, when metabolic issues are doing so much more aggregate harm.”
I wouldn’t say either of these things. A quick and easy treatment like B12 replacement is not mutually exclusive with a long-term and difficult treatment like diet modification. (This is not an abstract question for me; prescribing a statin and counselling on lifestyle changes are both things I do several times a week, and of the two, the script is orders of magnitude easier for both me and the patient, but we’ll usually do both in parallel when treating dyslipidaemia.)
As I said earlier in the thread, I’m all in favour of you or anybody else spending time on making people aware of the risk of nutrient deficiencies associated with veganism and what to do about them. (Again, this is not an abstract issue to me; I routinely discuss, screen for, and treat nutrient deficiencies with vegan and vegetarian patients.) I do recognise that you’ve had some bad experiences doing this, which is unfair.
Thank you for the empathy, this has been extremely challenging.
I think something similar to “why the post gave you the impression it did” could be helpful, and I’m even more interested in what you think could be done to convey the important, true points with as little animosity-due-to-misreading as possible
Thoughts on why the post gave (me) the impression it did, in no particular order:
‘Trade-offs’ is broad and vague, and the post didn’t make a lot of detailed claims about vegan nutrition. This makes sense in the context of you trying to communicate the detailed facts previously, but coming to the post without that context made it hard to tell if you were just making an unobjectionable claim or trying to imply something broader.
Some statements struck me as technically true but hyperbolic. Examples:
I was very confused by what you were hoping to learn from an RCT or ‘good study’, and my impression of your in-office nutritional testing was that you were trying to gather new primary data about vegan nutrition. Because the basic facts about the risk of nutrient deficiencies in veganism seemed uncontroversial, my interpretation of that was that you thought there were other and potentially more significant ‘trade-offs’ that might exist at the level-of-evidence gap between an RCT or in-office testing and e.g. the introduction to the Wikipedia article on veganism.
The implied model for the relationship between diet and health felt...off, or at least different from my own. I tend to think of diet as an input to a set of homeostatic processes, which are generally robust but can be slowly pushed off-balance by sustained problems and usually fixed with gentle correction. This post seemed to model diet as an all-or-nothing ‘logic puzzle’ to be either solved or, more likely, failed.
Beyond the points above, I genuinely don’t know. I’m probably not the intended audience anyway, since that seems to be vegans or potential vegans who don’t already know about the risks of nutrient deficiencies. The only thing I can think to contribute here is: if you’ve tried presenting the basic facts of the matter, and experienced pushback for it, does that necessarily mean that just presenting the facts is the wrong strategy? It’s a charged topic with a polluted local memespace, so some level of malicious or confused pushback is guaranteed; it’s what you would expect to see even when you are communicating well.
If people are very convinced I’m wrong then asking them why seems like a great strategy to me. They might be right and that might have implications for my plans. The point of this post wasn’t to convince anyone, it was to ask for evidence on a specific question.
I’m really glad we got to a more cooperative space and I hate to puncture that, but two weeks later I’m still kind of aghast you said “If you take out the references to veganism, this is just the current state of the world. People advertise their fast food restaurants and feed their children sugary breakfast cereals without caveats about the risk of heart disease or diabetes.” Surely you don’t think that’s the right moral category for ethical veganism?
I don’t really understand what you’re asking here. How would you describe the moral category you’re referring to, and why do you think it doesn’t or shouldn’t apply to veganism?
McDonalds and sugary cereal advertisers are widely viewed as harmful if not evil for the way they confuse the epistemic environment in order to make money and others’ expense. Calling something “no worse than fast food and sugary cereal advertisers” is an enormous moral and epistemic insult to it.
I absolutely agree. McDonalds and the other demons of the Western Diet cause much more harm, both in absolute terms and per capita. That was really my point; within the class of ‘health misinformation and disinformation that causes harm’, furphies about vegan nutrition are a comparatively minor problem.
This sounds like you’re saying “I won’t prescribe B12 until my patient gives up oreos” or even “I won’t prescribe B12 until everyone gives up oreos”, which would be an awful way to treat people. Even if you’re right that oreos represent a larger problem, taking B12 pills is useful in its own right, and easier than giving up oreos[1].
I assume you don’t mean that. You probably mean “I don’t think Elizabeth/anyone should spend time on veganism’s problems, when metabolic issues are doing so much more aggregate harm.” But tractability applies even more on a population level. People aren’t eating oreos out of ignorance: they know they’re bad. They eat them because taste is winning out over health.
It’s impossible for a blog post to fix “oreos taste good” or “people care more about taste than health”. But it’s
pretty easytheoretically possible for a blog post to fix ignorance of the benefits of some tests and supplements. When I see similarly tractable opportunities to help omnivores, I take them.Hell, I found a (vegan) cure for oreos tasting good (n=1). Finding it took years of self-experimentation (where the iron post took a few days, for more certainly). AFAIK no one else has tried it, because it takes consistent effort over several months to see an effect on weight[2].
So no, I am not going to let McDonalds shitty advertising hold up alerting people to problems with simple diagnoses with simple solutions
Especially by the time someone is in the doctor’s office for oreo-related problems. The people who find oreos easy to give up have already done so.
It also costs $5-$10/day, but I know people jumping through a lot of hoops to get semaglutide, so I’m pretty sure the issue here is the delay and uncertainty.
I wouldn’t say either of these things. A quick and easy treatment like B12 replacement is not mutually exclusive with a long-term and difficult treatment like diet modification. (This is not an abstract question for me; prescribing a statin and counselling on lifestyle changes are both things I do several times a week, and of the two, the script is orders of magnitude easier for both me and the patient, but we’ll usually do both in parallel when treating dyslipidaemia.)
As I said earlier in the thread, I’m all in favour of you or anybody else spending time on making people aware of the risk of nutrient deficiencies associated with veganism and what to do about them. (Again, this is not an abstract issue to me; I routinely discuss, screen for, and treat nutrient deficiencies with vegan and vegetarian patients.) I do recognise that you’ve had some bad experiences doing this, which is unfair.
I’m not sure if you chose this example intentionally, but for what it’s worth: Oreos are vegan.