The social construction of competence: Conceptions of science and expertise among proponents of the low-carbohydrate high-fat diet in Finland

Abstract

The article looks at conceptions of science and expertise among lay proponents of the low-carbohydrate high-fat diet in Finland. The research data consist of comments on a webpage related to a debate on the health dangers of animal fats screened in Finnish national television in autumn 2010. The article shows that contrary to the prevailing image advocated by the national nutritional establishment, which is based on the deficit model of public understanding of science, the low-carbohydrate high-fat proponents are neither ignorant about scientific facts nor anti-science. Rather, they express nuanced viewpoints about the nature of science, the place of individual experience in nutritional recommendations and the reliability of experts. Inspired by discussions on the social construction of ignorance, the article argues that the low-carbohydrate high-fat proponents are engaged in what it calls the social construction of competence when they present their position as grounded in science and stylize themselves as lay experts.

Keywords

expert knowledge ignorance laypersons low-carbohydrate high-fat diet public understanding of science scientific controversies

1. Introduction

In September 2010, the Finnish national television broadcasted an investigative journalism programme, which contested the role of nutritional fats as a cause of cardiovascular diseases and criticized the science supporting this doctrine.¹ The programme suggested instead that so-called fast carbohydrates (white flour and sugar) were the dietary culprits. The criticism was a major departure from the national nutritional consensus. Finland has been the model country in cardiovascular disease prevention since the 1970s, and the doctrine of the health risks associated with excessive consumption of saturated fats has been the cornerstone of the endeavour (Puska et al., 2009), codified into the national nutrition recommendations (National Nutrition Council, 2005, 2014).

The programme started a lively debate in the media, which juxtaposed the health effects of fats and carbohydrates. The journalistic criticism of the cholesterol theory became an outlet for the proponents of the low-carbohydrate high-fat (LCHF) diet, who gained wide exposure in the media. This diet, popularized by the book Dr. Atkins’ Diet Revolution in 1972 has been common, besides in the United States, in the Nordic countries (Gunnarsson and Elam, 2012; Mann and Nye, 2009). Today there are on the market numerous versions, such as Montignac, South Beach and Zone, although in Finland the general term ‘LCHF-diet’ prevails. The diet emphasizes the harmfulness of fast carbohydrates, which it implicates in the general increase of obesity and chronic diseases. At the same time, it questions the idea of animal fats as the primary cause for cardiovascular diseases (Taubes, 2008).²

The debate was quickly reflected in food consumption patterns in Finland. Before Christmas 2011, the media reported about shops running out of butter because the suppliers had underestimated the growth of demand (e.g. Iltalehti, 2011). Industry complained about a steep decrease in the consumption of bread, which was said to have led to layoffs in bakeries and the development of new, low-carbohydrate bakery products (Ministry of Employment and the Economy, 2011). These observations were confirmed by a recent population-based health survey, which reported an increase in the consumption of butter and decrease in the consumption of bread (Helakorpi et al., 2012).

As will become clear below, characteristic to the debate has been an intense critique of the official nutritional doctrine and its representatives. The LCHF-proponents have a strong perception of proper diet and they are vocal in expressing their views. Especially on various Internet forums where anonymity prevails, the argumentation can become aggressive. Members of the nutritional establishment are accused of systematically ignoring diverging observations, upholding a false scientific consensus and co-operating with food and pharmaceutical industry.

The experts under fire have reacted with astonishment and indignation. They stick to their position, referring to what they call the overwhelming scientific evidence supporting the established doctrine and the consensus in the international research community. Moreover, some experts have claimed that the LCHF-diet represents a public health danger (Vartiainen et al., 2012). They have linked findings from a population survey that indicate an increase in blood cholesterol levels among the population to the reported dietary changes and explained them with the media debate. They warn that the shift in dietary choices, with corresponding effects on population cholesterol values, will lead to a future increase in cardiovascular diseases.

The experts have explained the popularity of the LCHF-diet and the corresponding criticism of established nutritional doctrines by pointing to the ability of media to shape public opinions (Vartiainen et al., 2012: 2367), the nature of the Internet as an open forum allowing for alliances of likeminded people and the quick spreading of trends and fads and the general decline in the status of expertise (Fogelholm, 2011, 2012). Adherence to low-carb diets is also seen as an example of refusal to accept recognized scientific facts, that is, denialism (Diethelm and McKee, 2009). Here, the critique of cholesterol theories is lumped together with distrust in vaccination programmes, climate scepticism and even denial of holocaust, as in a recent popular introduction to the cholesterol issue by two medical professors and a science journalist (Kovanen et al., 2011: 157–160).

Expert explanations of the criticism tend to construct the LCHF-proponents as misguided, poorly informed about science and hostile towards expertise, thus adopting the deficit model of public understanding of science (Wynne, 1995). According to it, laypersons dismiss official nutritional recommendations and favour the LCHF-diet because of lack of scientific literacy and false influences from, for example, the media. Better knowledge and information will lead to bigger support of science and greater adherence to expert advice, the model stipulates.

Previous research on the LCHF-phenomenon has focused on the cultural tropes and internal contradictions in the LCHF-doctrine (Knight, 2011, 2012a, 2012b) or the strategies of leading LCHF-proponents in gaining publicity and building a movement around the issue (Gunnarsson and Elam, 2012). Less is known about the outlook on science of people who are interested in or have followed the diet. In this article, I use media data drawn from a fats/carbs-themed net page to study how laypersons supporting the LCHF-diet and criticizing the prevailing nutritional recommendations relate to science and expertise. I show how the deficit model is not only misleading with regard to the positions of the critics but also counterproductive in terms of science communication with the LCHF-proponents.

The case is an example of scientific controversies (Engelhardt and Caplan, 1987; Nelkin, 1992), which include issues pertaining to food and health, such as the role of diet in cancer (Nelkin and Hilgartner, 1987), the health effects of fat and cholesterol (Garrety, 1997) or the safety of genetically modified (GM) foods (e.g. Lewidow, 2002). Scientific controversies often concern major environmental issues or technological innovations, such as climate change or biotechnology, which involve significant risks and uncertainties. Often, they are fought in the public arena between mobilized publics and interest groups and concern the scientific framing of the issues and involve political lobbying around them. Although taken up by the media and prompting a reaction from the national nutritional establishment, the LCHF-controversy in Finland is more mundane. It is not carried by recognized organized actors pushing for legislative reforms. At stake are not the anticipated future impacts or perceived risks of technological change, but recurring everyday decisions on what to put on the plate in an environment of increasing but conflicting dietary advice.

The case also illustrates the increasing mediatization of science (Fuller, 2010; Hepp et al., 2010). The publics typically encounter science in the form of representations produced by the media, which regards scientific findings as news items and experts as central sources of information (Väliverronen, 1993). The media has also the capacity to amplify scientific controversies. The Internet has brought a new dimension to science communication. Apart from established sources, health information is sought from discussion forums, online communities, blogs and websites of commercial companies. This has been variously read as having the potential to challenge traditional sources of expertise and empower patients/citizens/consumers, to alienate people or differentiate them according to their degree of scientific literacy, or to create space for alternative and independent interpretations of health information (Nettleton et al., 2005).

Finally, the controversy around the LCHF-diet illustrates how questions of expertise and scientific knowledge increasingly figure in the arena of personal wellbeing. A cultural climate permeated by ‘healthism’ (Crawford, 1980), ‘body projects’ (Shilling, 1993) and the imperative of personal health care and risk management (Lupton, 1995) produces active health identities (Fox and Ward, 2006), which however do not all adhere to established forms of expertise. Alternative dietary regimes challenge the authority of mainstream medicine and nutritional science. Such regimes typically include lay epidemiologies (Davison et al., 1991), which draw from medical theories but also media discourses and observations arising from individual lifeworlds.

In this article, I want to argue that the laypersons involved in the LCHF-debate are engaged in what I call the social construction of competence. My approach takes cue from the rich literature on the social construction of ignorance (e.g. McGoey, 2012; Smithson, 1989). This concept can denote, first, rhetorical moves in science to justify research. For example, funding proposals are typically accompanied by claims of entering uncharted territories and erasing knowledge gaps. Second, ignorance can be ‘a strategic tool mobilized in the service of private interests’ (Stocking and Holstein, 2009: 24), for example, when a branch of industry manufactures uncertainty about established scientific facts that are threatening its economic interests (e.g. Oreskes and Conway, 2010; Proctor, 1995). Third, the concept refers to situated identity practices, where people reflexively judge and adjust their level of knowledge. Laypersons are capable of reflecting upon the epistemological status of their knowledge, in which they draw upon social and political contexts of science-making and their relation to these contexts. From this perspective, opting not to know can be a conscious strategy justified by the laypersons’ social situation. For example, a study on nuclear plant workers revealed that they chose to remain ignorant about the risks of radiation in order to avoid anxieties produced by the knowledge affecting their work or as a token of trust to the experts with whom they were working in the same company (Michael, 1996; Wynne, 1995: 379–380).

The social construction of competence mirrors this last meaning. It refers to lay people’s ‘self-ascriptions of competence’,³ in which they present their position as grounded in science and stylize themselves as lay experts. However, in scientific controversies such as the LCHF-diet, the two other meanings derived from the literature on ignorance are implicated as well. Part of the strategies to construct lay competence are attempts to present the scientific knowledge supporting the dominant doctrines as inconclusive and marred by vested interests. Thus, advocates of the LCHF-diet both justify new research and manufacture uncertainty about the established facts in order to bolster their own position.

Next, I present the research data and method of analysis. The four following sections describe two ideal types of argumentation supporting the LCHF-diet and criticizing the prevailing nutritional recommendations, one extrapolating from personal experience, the other engaging in a form of scientific debate. I focus on the critical voices, since the comments in defence of the prevailing nutritional recommendations largely replicated expert positions. In order to sharpen the contrast, I will, however, also introduce arguments from the latter group. I conclude the article by reflecting on the relationship of these two types of criticism to science and expertise.

2. Data and method

The data consist of contributions to a webpage that invited viewers to comment on a talk show broadcast on the health dangers of animal fats screened by the Finnish public service broadcaster YLE September 2010.⁴ The talk show followed immediately after the programme that caused the initial stir and started the debate. The talk show pitted against each other representatives of the official nutritional doctrine and its critics. The former were Pekka Puska, then the General Director of the National Institute for Health and Welfare in Finland, and Mikael Fogelholm, Director of the Health Research Unit at the Academy of Finland, currently Professor in Nutrition at the University of Helsinki. The other camp consisted of Kari Salminen, a retired research professor at the Valio dairy company, and vascular surgeon Taija Somppi, who is a vocal proponent of the LCHF-diet. The principal topic of the talk show was the health effects of dietary fats and carbohydrates. As usual, a day before the broadcast, the network opened a webpage advertising the upcoming programme and giving viewers the opportunity to participate in the studio discussion online. The webpage remained active several months after the broadcast. Altogether 1388 comments were published on the webpage between 15 September and 7 November 2010. This can be considered a high number, since most talk-shows did not generate any or only a few comments.

In Finland, 90% of the 5.4 million population used the Internet regularly in 2012, which in European comparison represents a high average (SVT, 2012), and it is an important source of health information to Finnish citizens (Helakorpi et al., 2008: 173). However, Internet discussions do not directly represent the voice of the public. There are limits to Internet access, since all citizens do not have the required computer skills or equipment or the ability to express themselves in written form. The most active participants are often those who hold a special interest in the discussed topic, which tends to highlight the extreme viewpoints. Due to Internet anonymity, the identities and demographics of the discussion participants typically remain hidden. The objective of this article is not, however, to assess how common the views presented in the discussion are among the public at large, but to describe the relationship to expert knowledge of people who maintain a critical attitude towards the prevailing nutritional recommendations and a positive attitude towards the LCHF-diet. For this purpose, the data are well suited.

The online discussion was moderated by the editorial staff. The participants could flag unsuitable comments, too. Participation required registration. However, about one-half of the participants used the name ‘Guest’, which made it difficult to distinguish individual commentators. Judging from the avatars, there were some active commentators, but most used the website as a bulletin board to leave their comment. Some participants indicated through their user name or in their comment that they were professionals in the field of nutrition and health, such as doctors, nutrition researchers or dieticians. Some comments (around 10%) were reactions to earlier postings, but most of them were singular, addressing the programme or the topic in general. This reflected the structure of the discussion forum, which did not divide comments into sub-threads but presented them as a continuum. (It was however possible to quote an earlier message as part of one’s own comment.) For these reasons, I have not analysed individual commentators or discussion threads, but have dealt with the postings as a single pool consisting of singular comments. I regard all participants in the discussion as laypersons unless otherwise stated, that is, the commentator has mentioned their professional relationship to health and nutrition.

I used ATLAS.ti software to code the data. First, I removed all postings that were unconnected to the topic, incomplete or otherwise faulty (n = 39). Then, I grouped the remaining comments according to their viewpoint to the topic. The two main groups were comments with a critical view on the prevailing nutritional recommendations (LCHF-proponents) and comments in defence of the recommendations. The former group amounted to around 60% of the remaining comments, and the latter to around 22%.⁵ The debate was led by the critics on whose postings the defenders would then comment. This was consistent with the script of the talk show. Around 18% of the comments could not be placed in the two main groups. Among those, I distinguished three smaller groups of ‘neutral’ comments: ‘confused’, ‘fatalistic’ and ‘arbitrating’, which each accounted for 2%–6% of the pool of comments. Confused comments would ask for clarification on healthy diets: ‘What is “poison margarine”?’ and ‘What are healthy fats?’ Fatalistic comments wrote off the whole disagreement as pointless, ‘since we will all die one day anyhow’. Sometimes such comments subscribed to libertarian values that contested the legitimacy of state dietary guidance. The arbiters, in turn, endeavoured to overcome or question the disagreement. They would commonly remark that people should pay attention to both the quality of fats and the amount of fast carbohydrates in their diets, and also consider a number of other factors contributing to a healthy lifestyle (exercise, stress, smoking, etc.).

In the second phase, I categorized the discussion under themes. I left out comments that only addressed the performance of the four experts in the talk show without containing more general viewpoints on fats and carbs (n = 54). Such comments were usually very short expressions of support (e.g. ‘Well said, Somppi!’) or denial. In the categorization, as in the discussion, themes concerning the scientific grounds for the different dietary theories and the credibility of the experts dominated. I used the themes to describe in more detail the content of the different positions outlined above. The same themes were suitable for analysing both the critical and defensive comments. For example, both sides addressed themes such as the vested interests, commitment and credibility of the experts or the relationship between personal experience and scientific information.

In the third phase of the analysis, I identified two basic argumentation types for the LCHF-proponents. The first is based on the commentator’s or some other person’s positive experiences of the LCHF-diet, from which general recommendations for the authorities are deduced. The second type focuses directly at the scientific information and experts supporting the prevailing nutritional recommendations, which are scrutinized critically. The data do not completely fall under these two types, nor do the types always appear as pure. They do, however, describe some essential features of how the LCHF-proponents relate to science and expert knowledge and construct themselves as competent participants in the debate. The following two sections describe the first type and the subsequent two sections the latter type of argumentation.

3. From experience to recommendations

Conversion stories

The core of the first type of argumentation is a story of personal experience with the LCHF-diet. The subject is usually the narrator, sometimes a relative or a friend. The stories typically include a before/after structure, with a sudden turn in-between. First, the teller follows a diet adhering to the prevailing norms, but does not feel good and gains weight, until she switches for an LCHF-diet. The shift is often described as dramatic and accompanied by insight leading to conviction, which is why I call these accounts ‘conversion stories’, comparable to a religious awakening. Here is an example:

I’m a 50-year-old woman. I tried for years to eat low-fat foods with very little result. My waist measured over 90 cm, my weight kept going up and down, I had all this flabby fat around my stomach, buttocks and thighs, I was tired and depressed. For 5 years now I’ve been eating pure butter, meat, fatty cheeses, full-fat milk, cream and other pure fat products, and I’ve stopped eating any wheat products, any light products or any white sugar, and today I feel remarkably well. My waist measures 76 cm, my cholesterol is 4,6 (good 2,8 and bad 1,8), I eat fish and safflower oil, olive oil doesn’t suit me, but Finnish safflower oil is OK. I eat fruit, root vegetables and other vegetables, and try to eat products that have been grown here in the north or in Holland, those suit me the best. The worst foods are fast carbohydrates, and it’s quite amazing that people haven’t noticed it sooner.

The stories are very formulaic, containing the same elements. They, almost without exception, describe illnesses and ailments for which relief has been found, changes in risk factors (usually weight and cholesterol levels, sometimes waist measurement and blood pressure) and the time it took for the change to occur. Detailed descriptions of the followed diet – what foods are favoured or avoided, when one eats what – are also common.

Overweight is one of the key complaints for which the followers of the LCHF-diet describe they have found relief. One of the mentioned advantages of the diet is that the weight loss happens without a constant craving for food or internal struggle. Many of the proponents stress that they had succeeded in losing weight without having to increase the amount of exercise they get or without exercising at all. Some have managed to lose weight remarkably effectively (‘nearly 15 kg in a year’; ‘a kilo per week’), but the proponents also include people who have been following the LCHF-diet for a long time and have stabilized their weight with it. The comments also often give an impression that the weight loss has been permanent.

The second repeatedly mentioned positive effect is normalization of blood counts and blood pressure, with the different cholesterol types and triglyceride levels carefully listed. Positive development in blood sugar levels is also frequently mentioned. The exact numbers are important for the argumentation, as they give the changes objective clout, past the subjective experience. Many of the proponents also state that the diet has enabled them to stop taking blood pressure and cholesterol medication and to stabilize their blood sugar levels.

Other commonly mentioned advantages concern gastric health and general wellbeing. The commentators write that they have stopped suffering from gas and swelling of the stomach, or tiredness and lack of energy. In addition, there were numerous other conditions mentioned, such as skin problems, stiffness and pain in joints, sleep apnoea and symptoms of fibromyalgia.

The stories were without exception positive or out-and-out jubilant; none of them described failure with the new diet. Some comments defending the prevailing doctrine were similarly structured, albeit with a less jubilant tone. They were also based on personal experience, but the content emphasized losing weight and gaining positive health effects by following the official doctrines. Often, such commentators had survived a bypass operation or a serious heart condition, which had installed in them a firm belief in official health advice and medicine.

Suggestions for reform

Most of the conversion stories, although based on personal experiences, included recommendations for others as well. Some commentators took an individual perspective, pointing out how important it is to listen to one’s own body and find a diet that best suits oneself. Many writers addressed also wider issues. They criticized the prevailing nutritional recommendations, demanded balanced research into the LCHF-diet or worried about the lack of room for individual variation in recommendations and research.

Many of these commentators called for a reform in the official nutritional doctrine. They argued that the prevailing recommendations must be unsound, since the LCHF-diet departed radically from them but had worked well for them personally and many others. There were also demands to follow the Swedish example and review the amount of carbohydrates in the current dietary advice for diabetes patients (Gunnarsson and Elam, 2012: 316). This would potentially reduce the costs of medication in treating the disease, it was argued.

Other comments were more moderate, requesting for population-level studies on the LCHF-diet, with the presumption that their advantages are not known because they have not been researched sufficiently:

We are talking about a large number of people who have had similar experiences. Wouldn’t this call for research? That is, to produce studies, in equal numbers, to bring it to the same level [with the cholesterol theory]? The LCHF-diet has, on the basis of observations, worked well in practice. Don’t these observations have anything to do with empirical science?

The argumentation inspired by personal experiences could sometimes also turn into a critique of the prevailing research methods supporting the dietary norms, which were accused of underrating people’s experiences: ‘So research results are seen as more important than the experiences and opinions of patients and citizens, no matter how abundantly they prove something opposite. I just can’t understand’. Norms based on population-level studies were seen as too rigid and not applicable to individual cases.

These comments were based on a set of juxtapositions that tended to confound the differences between research, recommendations and treatment. Positioned in one camp, there were ‘the patients’ own experiences and ‘health experiences of the general public’, but also practical doctors engaged in ‘real patient work’. This was the group of experts most favourably regarded by the critics. Practical doctors have the most ‘field experience in working at individual level’, and they are best able to offer personalized ‘precise treatment’, idealized by the critics:

That’s the whole basis of treating patients → to find a kind of treatment that REALLY works!!!! The examined person is an individual and not a part of some study carried out somewhere abroad. Patient care should be systematically holistic and not treatment of some specific symptoms.

Positioned in the other camp were ‘belief in experts’, ‘book learning and studies primed by money and personal gain for the authors’ and health care bureaucrats and ‘desk-jockey doctors’ who see ‘the patients as some kind of a statistical mean value’. This juxtaposition explains the enraged reactions to the statement made by Pekka Puska in the studio discussion that individual cases are not of medical significance. Many commentators expressed disbelief to what they felt to be belittling of individual experiences: ‘[Even] if a doctor sees tens or even hundreds of individual patients, who get better with the same precise treatment, our highest health authorities still don’t give it any importance. What kind of a country do we live in?’

Commentators defending the prevailing doctrine instead typically kept apart the recommendations based on scientific research and the experiences and treatment of individuals. In their view, the critics have got the different levels confused when assessing the population-level norms on the basis of personal experiences. The recommendations can only be based on statistically verified population research, it was argued. A person who smokes can feel healthy, but this does not overrule the harmful health effects of smoking on population level. Similarly, cardiovascular diseases develop slowly and may be symptomless for years. One comment pointed out that the subjects of population research are also individuals; there are only more of them, and the evidence is thus more conclusive than that of any singular individual experience.

Finally, there were some comments taking a mediating position that sided with nutritional science but admitted the significance of individual differences. In this line of thought, medical science is still unable to distinguish small sub-groups of people whose metabolism may be different from that of the mainstream population. This goes to say that there are people who may well benefit from alternative diets.

4. Engaging in scientific debate

Critique of nutritional science and alternative models of explanation

The first type of critical argumentation proceeds from personal experience, whereas the second focuses directly at the scientific facts behind the prevailing nutritional recommendations and at the experts representing them. If personal experiences are mentioned at all, they remain in a subordinate role. Typical of this line of argumentation is the presentation of various alternative conceptions and theories concerning human physiology, effects of nutrients and aetiology of diseases in the spirit of lay epidemiology. The proposed theories and arguments follow the teachings of well-known ‘fat critics’, such as Antti Heikkilä in Finland or Uffe Ravnskov in Sweden, who the LCHF-proponents regard as experts in the field. The comments are often supported by links to websites or literary references, for example, to review articles in medical journals that question the connection between animal fats and cardiovascular diseases.

Since the context of the discussion was the critique of the cholesterol-doctrine, fats and carbs dominate it. The LCHF-proponents strive to prove the favourable effects of animal fats on the one hand, and point out the harmful effects of fast carbohydrates, on the other. Protein has a subordinate role in the discussion, considered to be a natural part of the LCHF-diet. Fats are presented as vital building blocks of the human body, essential for human survival and health. Fat deficiency is said to, for example, hinder vitamin absorption and cause problems in the functioning of the brain and nervous system, leading to increases in depression, attention deficit hyperactivity disorder (ADHD) symptoms and Alzheimer disease among the population.

The carbohydrate theories of the LCHF-proponents entail an alternative view on the causes of cardiovascular diseases and other chronic conditions, arguing that they have an inflammatory origin exacerbated by carbohydrates. For example, according to one participant,

Asthma, allergies, diabetes. All chronic states of inflammation in the human body. What maintains this state of inflammation? The white fat accumulated in the body. What accumulates as fat in the body: carbohydrates. Where do they come from? Bread, pasta, potatoes and sugars.

Some of the arguments in favour of LCHF-diets are based on epidemiological reasoning. It is argued that the replacement of fats with carbohydrates in order to prevent heart diseases has resulted in a serious obesity problem and diabetes epidemic. Similarly to how in the early stages of cardiovascular disease research mortality and morbidity statistics were connected with statistics on the consumption of animal fats, the critics establish a causal relationship between the upturn of obesity rates and the increased consumption of fast carbohydrates.

When the time horizon is stretched, the epidemiological reasoning becomes merged with evolutionary theories and narratives of societal decline (see Rudiak-Gould, 2014). Wheat-based and low-fat foods are presented as latecomers in human evolution, and thus contrary to our basic biological nature: ‘Humans have eaten animal fats throughout their history and never been as sick as now since they started eating margarine’. Butter and other animal fats are constructed as natural and organic products. This ‘nutritional primitivism’ (Knight, 2012b) builds up an idealized image of how people used to originally eat in the past, which is contrasted to today’s fast-food culture and industrial production of food. LCHF-proponents are especially antagonized by low-fat light products, which both replace fats with carbohydrates and are industrially produced.

The LCHF-proponents also reject the calorie theory according to which the relation between the energy intake and output directly determines the amount of weight gained or lost. In their view, different nutrients have different effects on the human body. Since fats and proteins ward hunger off more effectively than carbohydrates, a diet rich in carbohydrates leads to constant eating and weight gain. In this reasoning, weight gain is interpreted as a consequence of a kind of carbohydrate addiction.

Other arguments by the LCHF-proponents include structural changes in society and the shift to an urban lifestyle, which they claim have caused the heart disease epidemic, and genetically induced differences in individual response to nutrients, which are seen to undermine nutritional recommendations aimed at the entire population. Thus, LCHF-proponents’ arguments make up an eclectic brew of many ingredients. They espouse several overlapping theories on the effects of different nutrients, diet-related causes of illnesses and proper diet in health care that are grounded in a wide selection of sources.

Those defending the prevailing nutritional recommendations are strongly committed to their founding principles, especially the calorie theory and the harmful effects of animal fats to health. Many of the defenders also argue that even the prevailing recommendations do not encourage people to eat sugar or other fast carbohydrates. Sometimes, this is mentioned in a more conciliatory spirit: Since the two camps are in fact quite close to each other, they should together focus on fast carbohydrates instead of arguing about the health effects of fats.

Vested interests

The first step in the second type of critical argumentation is to refute the science behind the prevailing nutritional recommendations. The second step is to seek reasons for why the recommendations deemed faulty prevail. Here, the experts’ financial interests and scientific prestige are brought into the picture.

It is argued that health and nutrition scientists uncritically support the cholesterol theory in order to secure their funding and scholarly status. In its most extreme form, they are accused of sacrificing scientific truth for economic security: ‘the Finnish scientific community doesn’t represent the truth but the aspirations of its funders. The researchers are forced to make a choice between funding (scholarly career) and the presentation of true research results’. However, some of the comments discuss the logic of science in a more sophisticated manner: Research is committed to paradigms, senior figures act as gatekeepers to a scientific field, and researchers are required to specialize. As a result, certain research topics become established, and alternative theories are left without attention.

Health authorities, too, are accused of only securing their own status. The critics argue that since many of them in Finland have made their career researching and promoting the cholesterol theory, it has become untouchable to counter-arguments. These comments are targeted mainly at the then Director General of the National Institute for Health and Welfare Pekka Puska, who has given a face to the Finnish fat debate. According to the critics, because of this background, the higher health authorities do not tolerate diversity and are covering up true information on healthy eating.

The bleakest interpretations of the situation resort to conspiracy theories, a typical feature of current scientific controversies (Mackenzie, 2011). Thus, it is claimed that researchers and health authorities knowingly deny the proven health benefits of the LCHF-diet, because they are co-operating with the pharmaceutical and food-processing companies manufacturing cholesterol medicines, margarines and industrial low-fat foods. Such comments are fuelled by the fact that a large part of medical research today is dependent on funding from the pharmaceutical industry.

In these comments, unbiased research is both used as a yardstick and presented as a remedy to the current situation. According to the critics, the task of science is to question established truths. This requires openness and impartiality on the part of the scientists:

A researcher should be open to new ideas and research findings and interested in seeking support to various claims, not only aiming with blinders on to the desired result. Good research is impartial and independent and not on the lead of a pharmaceutical factory.

The comments defending the prevailing doctrine point out that also the cholesterol critique and the LCHF-diet involve financial interests. Both critical participants in the talk show are presented as examples: Kari Salminen’s made his career in the books of the Valio dairy company, a leading butter producer in Finland, and Tarja Somppi has connections to the nutritional supplement industry. The latter is also criticized for being only a regular vascular surgeon and thus not qualified to assess the health effects of fats, that is, she is not accepted as an expert. These commentators resort to their own version of scientific logic vis-à-vis nutrition research and dietary advice. They argue that since the recommendations must be based on carefully measured data, they necessarily lag behind research and are slow to change. Creating a scientific consensus and a platform for practical action takes time, and they should not be dismantled just because some tentative research findings are pointing to another direction.

5. Conclusion: Positions on science and expertise

There are two types of argumentation in the critical camp. The first is grounded in the commentator’s own positive experiences of the LCHF-diet, and goes on to call for research and recommendations that more adequately reflect these and other people’s similar experiences. Similar to the users of alternative medicine, the prevailing health doctrines are criticized for not taking into account individual differences or responding to the need for personalized treatment (Murray and Shepherd, 1993). The second targets the scientific expertise and the expert statements that inform current nutritional recommendations. It highlights gaps in the research that has shown the dangers of saturated fat and high blood cholesterol, offers evidence in support of an alternative line that emphasizes the effect of carbohydrates and discusses the reliability of experts. Thus, the critique extends from scientific contents (‘fat is good, carbs are bad’) to method (‘individual experience in relation to epidemiological research’) and institutional factors (‘vested interests’).

Yet, both critical positions believe in science, but in a different way. Although the first tends to rely on subjective trials with the LCHF-diet, it stipulates that the positive experiences should not only be cherished as an alternative clue to better nutrition and health but supported scientifically and incorporated into dietary recommendations. The second type of critical argumentation attempts to engage in serious scientific debate. The arguments do not necessarily always stand up to scientific scrutiny, but their structure follows the model of science. The commentators are committed to the ideal of independent science, according to which researchers should be free from outside influences and the best argument should win.

Thus, the framing provided by the deficit model does not correspond to the positions of the LCHF-proponents in the debate. First, they do not promote anti-science, and their faith in science has not necessarily faltered. Yet, while they present science as the final judge in questions of health and eating, their trust in its representatives is under trial. The debate reflects the devaluation of traditional expertise, which however is decoupled from the valuation of science. Neither does the other accusation deriving from the deficit model, ignorance, apply to the LCHF-proponents. The participants in the online discussion expressed a wide range of views, but many of them seemed quite knowledgeable in questions of nutrition. They presented literary references in support of their arguments and aimed to invalidate the opponents’ arguments on factual grounds.

Rather than rejecting science as the foundation for nutritional recommendations, the LCHF-proponents endorse it. In fact, the LCHF-proponents are vigorously advertising their competence in the field of nutrition and health. This competence is constructed differently respective to the type of argumentation. In the first type, what is endorsed is a bodily competence based on personal experience. This bodily competence is presented as scientifically relevant, since it needs to be integrated into research. To some commentators, this is simply a question of investing more to studies of the LCHF-diet in order to put knowledge on carbs on equal footing with fat science, but some extend the criticism to the prevailing research methods and want to expand the scope of clinical or population research to better incorporate personal experiences. In the second type of argumentation, competence is about the ability to converse in the dominant idiom of nutrition science and medicine, flanked with an understanding of the social commitments of science and experts. This outlook is often hard-nosed, bordering on cynicism with regard to the public image of science. Behind the scientific consensus presented to the naive general public is constructed a more sinister world of intrigue and vested interests, which is transparent only to the initiated.⁶

The focus on competence suggests that the LCHF-proponents are not only aiming to legitimate a dissenting position with the help of science, a typical move in contemporary science controversies (e.g. Lysaght and Kerridge, 2012), but are engaged in a project of identity building. However, their way of engaging with science and expertise differ somewhat from those described, for example, by Fox and Ward (2006). Yes, they resemble proactive ‘expert patients’ in their ability to navigate medical knowledge, but they do not stay within the established doctrines. And yes, they share with ‘resisting consumers’ the tendency to ‘fabricate a health identity around lay experiential models of health’ (Fox and Ward, 2006: 461), but they still subscribe to the idealized values of scientific medicine.

Stressing competence makes it evident that it is counterproductive to characterize the critics as sceptics, denialists, irrational or ignorant. As Wynne (1995) has remarked, ‘by constructing the public as ignorant, when that public may in its own idiom be expressing legitimate concern or dissent, scientific institutions inadvertently encourage yet more public ambivalence or alienation’ (pp. 364–365). The observation is fitting to the LCHF-proponents, who are committed to the principles and ideals of science and very reflective of scientific practices. In fact, they are trying to express their concerns not (only) in their own idiom but that of science. Many LCHF-proponents are also very committed to a healthy lifestyle and willing to find out about the factors affecting their health. In this sense, they are paradoxically, in many ways, the very kind of health-conscious citizens idealized by the public health authorities. For such groups, repeated reassurances about the experts possessing indisputable information is likely to appear belittling and paternalistic. A more reflexive stance from the nutritional establishment (Wynne, 1993), which lays out the principles on which the recommendations rest and openly discusses the margins of error and unknowns in current knowledge, would create better understanding between the parties. Vocal publics taking part in disputes and controversies involving scientific knowledge are thus potentially fruitful test cases for public health authorities to enhance their science communication and develop recommendations targeted at various citizens groups.

Footnotes

Funding

The research has been supported by Finnish Academy grant nr. 251845.

Notes

Author biography

Mikko Jauho is a Sociologist and Senior Researcher at the National Consumer Research Centre Finland. His areas of research are the role of biomedical and nutritional knowledge in government and public engagement with health risks.

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