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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.

Press to begin  ·  Updated 2026
02 · Macronutrients

Carbs, fats, protein — and the calorie controversy

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.

03 · Micronutrients

Vitamins & minerals: deficiencies and limits

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.
13
Essential vitamins
15+
Essential minerals
90%
Of US adults below veg target
0
Multivitamin RCTs showing mortality benefit

Food > pills, in nearly every well-conducted trial.

04 · Energy balance

Calories in / calories out — with caveats

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.
05 · Glycemic response

Blood sugar, insulin, and the metabolic narrative

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.

baseline white bread + sugar whole grain + fiber crash → hunger time after eating → blood glucose Glycemic response
06 · Ultra-processed foods

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

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.

07 · Mediterranean diet

The strongest evidence base in nutrition

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
08 · Time-restricted eating

Emerging evidence — less than once hyped

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.

8h

Common protocol (16:8)

Practical for many; aligns eating with daylight; may aid adherence to modest deficit.

~0

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.

09 · Protein

1.2 – 2 g/kg for active adults

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.

10 · Gut microbiome

The new frontier — far from fully understood

~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.

11 · Salt, sugar, alcohol

Consensus on moderation — details contested

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.

12 · The honest assessment

Most general advice is boring — and largely correct.

VEGETABLES & FRUIT VEGETABLES ½ the plate WHOLE GRAINS ¼ PROTEIN fish, beans, poultry — ¼ OLIVE OIL Drink: water. Move daily.

After all the controversies, the durable advice is unglamorous:

  • Eat vegetables — 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." — Michael Pollan, still hard to improve on.

13 · Further reading

Keep going.

Two starting points on YouTube — a general overview and a deep dive on the ultra-processed-food story that has reshaped recent debate.

  • Ultra-Processed People — Chris van Tulleken (2023)
  • In Defense of Food — Michael Pollan (2008)
  • The PREDIMED Study — Estruch et al., NEJM (2018, republished)
  • The Hall NIH UPF Trial — Cell Metabolism (2019)
  • NIH Office of Dietary Supplements — ods.od.nih.gov
  • Examine.com — independent supplement & nutrition meta-reviews
NUTRITION / Field notes 2026 — what we know, what we don't End of deck