Why Less is Often More - a response

From all the many blog posts that I have proofread before they are loaded onto our site, the thought-provoking piece by Paul Ehren, ‘Why Less is Often More’, that recently came across my desk, made me feel compelled to respond.

Much like in a scientific journal, when researchers debate certain points, but unlike their often-antagonistic points of view, I wish now to complement and add to the points made by Paul.

In his article, Paul made the observation that research writers seem to feel obliged to add multiple references to back up each and every point that they make – almost like they are unwilling to rely on their many years of scientific observation and feel the need for camaraderie support to ‘prove’ their point. In academic circles, it is a badge of honour to be able to cite a large number of research studies they have authored – likewise, there is a similar attitude to the citation of references when articles are written. But that is the ‘way’ in which researchers currently work: they make detailed scientific observations in their daily work, and share these through respected publications.

The problem comes, not so much with the scientists, but with the modern-day over-reliance on science, which has affected the way the layperson thinks, including athletes and coaches, and, within the world of sports nutrition, how they think about food. Science is vitally important for progression in our understanding of a specific topic, but we need to accept and understand its limitations, which is something the layperson is generally unaware of. Having been a young scientist many years ago, undertaking and writing up my research theses with due diligence and huge attention to detail (as is required to be a scientist), I understand firsthand what it takes to produce a scientific observation that has statistical significance. You need to select a small number of variables during the design phase of the research study, with the end goal of ‘proving’ or ‘disproving’ your hypothesis front of mind. If you choose too many variables, the research picture becomes hazy and confusing, and you are unlikely to statistically prove that X affects Y, or not.

However, within the context of sports nutrition, we are dealing with human beings, who possess highly complex physiological systems, with multiple variables to consider. In the words of Kate Neil, founder of the Centre for Nutrition Education and Lifestyle Management in the UK, a lady I greatly admire: “Individuals are multivariable, non-linear, high order, differential and adaptive systems that interact in a multivariable, non-linear, high order, differential and adaptive environment.” No models of physiological research are currently being practiced that can take this complexity into the context of health and sport. Hence, we are limited by one-dimensional observations, such as the ratio of macronutrients in an athlete’s diet, and how that affects athletic performance. Thankfully, sports nutrition research has become more dynamic over the past decade by studying the likes of nitrates in vegetables, and how they affect vasodilation and athletic performance. Even so, the research remains one-dimensional and we cannot consider all components of an athlete’s diet, training programme, sleep patterns, lifestyle stressors, social interactions, supplement regimes, and their unique genetic tendencies in one go. This would be a scientific impossibility given the current models of statistics. That said, taking an athlete’s entire life into consideration is precisely what us practitioners and coaches must do…

We must consider all aspects of our client’s lives, including their historical timeline of health, and the functional integration of their physiology. That’s precisely what we do in functional medicine practices. As Paul said, many practitioners become very excited about the latest trends, tests, tech devices and apps, perhaps trying to add scientific observation into their practice. And the pressure to be practising scientifically is everywhere – in my discipline of nutritional therapy, there is huge rivalry with other nutrition professions, meaning a professional requirement to work with what we are now calling ‘evidence-based practice’. In fact, in order to obtain nutritional therapy and sports science accreditation for our integrative sports course, we have been required to build it around evidence-based practice. So, scientific integrity and observation is vital, and all of these ways of accruing information about our clients are valid and important, but it is the way we use these pieces of information and interface with these unique human beings that’s actually most important.

With this in mind, writing about an athlete’s ‘ecosystem’, as Paul has, can only come from a highly experienced practitioner. A practitioner who has got to know himself as a person, including subduing his ego state (also vitally important for a practitioner), and who has got to the point in his practice where he will deal with each of his clients in a completely different way, taking his time to get to know all the unique circumstances and challenges of that individual. That is what it takes to be a good practitioner… not overly relying on the latest scientific study or nutrigenomics test.

Paul also talks about a ‘stripped-back’ approach, i.e., working on some basic principles of health before pursuing apparently sexy protocols. To give an example of this, I have many athletes coming into my clinic wishing to improve their body composition, and seeking some magical approach that I may be able to assist them with. But after taking a thorough case history and evaluating all aspects of their highly stressed life, often including waking at 4 a.m. to train before work, I am increasingly focusing on self-compassion, where I recommend that they sleep more, train less, and eat more highly nourishing foods than they have been doing. In many cases, I find this the only way to support a battered metabolism, and to ease the athlete back into some degree of self-control over their previously wayward body composition. It is the complete opposite approach to what many of my sports nutrition peers would do: ‘evidence-based’ and scientifically sexy strategies such as intermittent fasting, ketogenic diets, and caloric restriction are unfortunately much more common than simple old-fashioned self care. I doubt that the research study to examine whether eating more can in some cases help you to loose body fat has ever been conceived in any scientists’ minds, but this is what I am observing and assisting with in my highly experiential and observational practice; in some, but certainly not all, cases.