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Book Review: The Bad Food Bible

The Bad Food Bible, authored by pediatrician and food commentator Aaron Carroll, is a comprehensive and thoughtful enumeration of the fact and fiction of America’s modern food culture. Carroll diligently walks the reader through nutrition science basics; for instance, how do human research studies stack against each other and how do scientists reach a conclusion that x causes y? Carroll then applies these nutrition science fundamentals to 11 food topics; fat, carbohydrates, cholesterol, sodium, grains, genetically modified organisms, alcohol, caffeine, artificial sweeteners, monosodium glutamate, and conventional fruits and vegetables. I highly recommend The Bad Food Bible to readers who wish to learn more about design of nutrition research or one of the aforementioned topics. While the book makes modest recommendations to the reader in its closing chapter ‘Simple Rules for Healthy Eating’, the book falls short of suggesting effective habit changes or bringing awareness to the social and cultural constructs that heavily influence people’s diets.

Time and time again, it has been shown that teaching people how to be healthier doesn’t always result in behavior change. As stated in the Womens Health Watch blog of Harvard, change is a process, not an event.  While it may seem heavy-handed to criticize The Bad Food Bible for failing to acknowledge the role of behavior change in eating habits, Carroll states, “my goal in this book is to make you a more responsible consumer — both of foods and of the latest research about how foods affect your health.” I would recommend this book to anyone desiring to learn about nutrition research; however, while the book prescribes simple rules for eating, I wouldn’t necessarily recommend Carroll’s prescriptions to a person seeking to change their habits for the better, not because the recommendations are not valid or true, but because they do not include advice for making habit changes. The simple eating rules offered echo Michael Pollan’s sentiment: Eat Food. Mostly Plants. Not Too Much. Carroll similarly prescribes minimally processed foods, limited liquid calories, and cooking at home. However, readers are left with scant advice on how to act on these recommendations.

In a similar vein, The Bad Food Bible does not address the social and cultural constructs that inform eating choices. In the chapter on meat, Carroll makes the claim that moderate portions of healthier cuts of meat are completely acceptable in a healthful diet. However, Carroll doesn’t take into account that high-quality cuts of meat come with a price premium, and consumers respond to food prices by adjusting their demand and choices. If Carroll turned a little bit more of his focus on what kinds of factors go into an individual’s diet, he would be able to comprehensively address what it is to be a responsible consumer.

  • Critique of science — I’m a little behind, but I want to include a paragraph on my assessment of his scientific rigor. I’m a little daunted by it because of the amount of studies cited in the book. I’d love feedback on how to address his scientific rigor in an abbreviated way, more appropriate for a book review.

I definitely recommend Aaron Carroll’s “The Bad Food Bible” if you are interested in learning more about the nutrition science research process or would like to learn more about the topics discussed. My hope is that Carroll continues to bring criticism to the confusing realm of nutrition science; however, in my opinion, his ultimate goal of spreading knowledge should also include information on why it’s so hard to change eating habits and how social and cultural normatives affect food choices. I believe that including these topics are imperative to consuming responsibly, and the scientific community must provide not only nutrition knowledge to its consumers, but also behavior change strategies that effectuate change.


Is Collagen a Beneficial Supplement?

If you want to heal joint pain, improve skin texture and appearance, lose weight, and prevent leaky gut, they say collagen is the fix for you.

Collagen is definitely having an “it” moment. In a recent trip to beauty store Sephora, I saw a collagen-water advertisement stretching wall to wall with an encouragement to those in the check-out line to quench their inner thirst with collagen-boosted water. Collagen is touted as the main benefit to bone broth, a recent food trend sprouting at Farmers Markets and Whole Foods. Celebrities in the food zeitgeist, such as Dave Asprey (Bulletproof Coffee) and Melissa Hartwig (Whole30), praise collagen and offer personal stories of its benefits to their followers. How beneficial is collagen and how much scientific consensus exists for this supplement? The first task is to understand collagen as a protein. Next, the scientific studies of collagen’s benefits and underlying governmental regulations are discussed.

It is important to understand the biochemical structure of collagen to make sense of its potential utility as a supplement. Collagen is a type of protein that is classified as a connective tissue. It is abundant in the animal life in many different forms. Collagen has even been extracted from a 195 million-year old dinosaur! The structure of collagen determines its function. That is, the particular composition of a collagen protein elegantly determines what kind of role the protein performs in animal tissue.

Like all proteins, collagen is made of ordered amino acids. Similar to colored beads on a string, amino acids are the essential units of a protein. Collagen contains a high-proportion of three amino acids, glycine, proline, and hydroxyproline, which will form bonds when paired with a similar pattern of amino acids. As result, collagen is a triple-helix protein, similar to three-twisted strands of colored beads.collagen

The triple helix of collagen is structurally stable and strong, forming fibers that provide internal support and literally bind our body together. Collagen is found in the skin, ligaments, tendons, and cartilages. Collagen is also found in ground skin, hooves, and bones of other animals. Collagen supplement manufacturers derive collagen pills and powders (or beauty water!) from these sources. In fact, some collagen supplements are simply gelatin, the same ingredient used in Jell-O.

Dietary supplements, like collagen, are often intended to bolster a process that the human body is capable of under normal circumstances. Our bodies build collagen proteins from scratch; that is, the human body is capable of building collage proteins with a good diet full of protein, vitamins, and minerals.

Timing, frequency and dose are important factors to consider when one is serious about using dietary supplements to treat or optimize a process in the body. As a dietitian friend put it, ingesting why protein with a disregard to the timing of physical activity will not achieve the muscle-building qualities associated with whey protein.

A curious and thorough consumer may hope to find posted research about the benefits of collagen; however, many collagen supplement manufacturers do not post research studies or reference research on their websites. Unlike food products that must meet stringent research guidelines to advertise health claims on their labels, supplement manufacturers are not required to meet any kind of research standard before advertising a health claim on their label. This is a result of the 1994 Dietary Supplement and Health Education Act (DSHEA), which mandated the Food and Drug Administration (FDA) to oversee responsible manufacturing of supplements, but does not give the FDA power to regulate health claims on the labels of dietary supplements.

The DSHEA act is highly controversial. Supporters of DSHEA argue that the law ensures consumers access to dietary supplements. Research to substantiate health claims on dietary supplement labels would be costly and result in less variety and supply. In my opinion, the critique falls short. Strong research trials show that vitamin C is not an effective treatment for the common cold. However, Vitamin C dietary supplements frequently tout the vitamin as a natural cure for the cold.  If Vitamin C manufacturers were barred from including a cold prevention message on the supplement label, would that stop consumers from buying the product? I don’t think so, and it would at the very least prevent unnecessary spread of biased and untrue information.

Because supplement companies are not invested in proving the scientific validity of their claims, there is generally less research on dietary supplements in comparison to food products. What type of research does exist for collagen supplements?

For joint pain, I found a few references to a research study on athletes with activity-related joint pain. The study utilized an intervention, or placebo group, which is the gold-standard for these types of studies. The article reports statistically significant differences in various types of joint pain between the placebo and collagen groups, and the reader assumes a beneficial effect occurred from collagen; however, the research statistics point to a much different conclusion. The standard deviations of the differences are overlapping, and in statistical speak, this means the results are inconclusive.

I also found reference to a systematic review article about the treatment of osteoporosis and osteoarthritis with collagen supplementation.  A systematic review article gathers all available evidence of a scientific question and suggests a conclusion based on the evidence. This review article concludes that hydrolyzed collagen has a positive therapeutic effect on osteoporosis and osteoarthritis. The ‘gathered’ evidence of this article includes a total of 5 human trials, 3 of which were conducted on less than 10 people.

In my overall review of collagen supplementation, I did not find compelling research results. Keep in mind that the number of clinical trials on collagen supplementation are limited, much less trials on diets high in amino acids glycine, proline, and hydroxyproline, the three most abundant amino acids of collagen. Should you try collagen as treatment for an ail or just optimal health? It’s unclear which leaves people to trust…anecdotes.