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Comment by phrogdriver | Hacker News Reader

>Modern-day heart disease deaths were higher in states that experienced a rapid rise out of poverty between 1950 and 1980 — even when controlling for the effects of obesity, smoking and education level.

No mention of controlling for a predilection for sweet tea, fried everything, and vegetables being limited to fried okra or green tomatoes. I loved southern cuisine when living in the South, but the cultural effects seem to have a much greater impact than biological. Take as a control anyone who has the biological makeup described and grew up in the South but then moved. It seems like poor study design to me.

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Typical epi-nonsense: ignore the huge and omnipresent genetic and other confounds which lead to long pre-existing differences, find congenial event to blame as origin, then leap to the most exotic methods of transmission possible; bonus points for each mention of Holland, rats, or mice.

The South as a region is very distinct from the rest of the country: settled by different ethnic groups (no, not all 'whites' are genetically identical twins; consider the different genetic BMIs by country in http://www.nature.com/ng/journal/v47/n11/full/ng.3401.html ), different cuisines, different industrial patterns, different weather and climate... It is eyebrow-raising, to say the least, to bring in the Civil War as at all relevant and speculate even more wildly that it has intergenerational effects.

If they want to talk about that, they should be trying some sort of regression-discontinuity or other natural-experiment design involving borders or Civil War activity, not, effectively, saying 'look at how different the South is! the Civil War?!' Uh, yeah, I think we all know the South differs. That's not very helpful.

> It is eyebrow-raising, to say the least, to bring in the Civil War as at all relevant and speculate even more wildly that it has intergenerational effects.

I wonder what the results would be if you applied that method to, say, Poland, or north-eastern France.

You'll pick up a lot of post-WWII differences, but you can still try. There's an interesting paper exploiting the meandering of river-defined national borders to do a discontinuity design for long-run effects of the Austro-Hungarian Empire, for example, which is at least not obviously wrong.

>No mention of controlling for a predilection for sweet tea, fried everything, and vegetables being limited to fried okra or green tomatoes.

You left out collards, green beans, field beans, turnips, turnip greens, etc. Personally, I find the traditional southern sides as tasty as the BBQ/Fried chicken.

Dont forget non-fried Okra, Rutabaga, Pole Beans, Corn, Mustard Greens, Succotash, Lima Beans and Black Eyed Peas (these are traditionally consumed on New Years Day to bring good luck).

Its not all fried food in the South. The sides are definitely where it's at.

Chow chow, sweet potatoes, beets, corn, etc.

To me the fried stuff and BBq is the once a week or less meals that are considered reserved for a big family sit down dinner or special occasions, they aren't an everyday thing. I wouldn't say we eat more of it then say any other region eats pizza, burgers or other traditionally unhealthy foods.

That said the years of poverty does have a distinct effect on the culture and work ethic here. I wouldn't be surprised if it had an effect on diet and physiological effects.

Our dinner last night was some baked chicken with italian seasoning, and potatoes and carrots similarly baked with same seasoning. Wasn't that healthy, albeit healthier than most non-vegetarian meals, but certainly wasn't fried.

That said, I know quite a few people with heart disease, etc, and honestly, I can say diet definitely played a role in it, as well as possible smoking/drinking.

> You left out collards, green beans, field beans, turnips, turnip greens, etc. Personally, I find the traditional southern sides as tasty as the BBQ/Fried chicken.

Well traditionally those are cooked in some sort of animal fat, so yes, people seem to love them.

My father in law thought he loved Black Eyed Peas. Then as his health got worse as he got older and did less his wife tried to make food healthier so dropped the ham hock from the pot. Turns out he didn't like Black Eyed Peas at all, he just liked the taste of ham.

That's what they are talking about... the cultural effects. Not the "South vs North" cultural effects, but the socioeconomic ones.

(EDIT: I was wrong, the article is literally only talking about the biological and physiological effects. You make a good point. The cultural impact seems as important, if not more so, than any physiological one.)

For me, this idea is actually quite intuitive. When you don't know where your next meal is going to come from you don't turn down the opportunity to eat. Once you rise out of poverty you can get that opportunity steadily, but your mindset won't change so fast, so you overeat.

It takes a few generations for the hunger to be forgotten, I think.

I prefer Occam's Razor. We've already proven that food is one of the largest contributors to heart disease.

Not controlling for this is a HUGE oversight, to the point of invalidating the study.

You're saying that the problem is that the Southerners are just eating too much rich food. The article, and I, are saying that that is a symptom of an underlying problem. The underlying problem is the eating habits which are artifacts of growing up in poverty-- Poverty caused by the civil war.

Hence the leap to "Civil War --> Heart disease"

I think you are missing the point.

This is explicitly NOT what the article is talking about.

Oh wow, on closer inspection you're right. I initially skimmed the article and clearly made some assumptions. It's more focused on the biological and physiological effects of socioeconomic status on fetal development... which is actually pretty interesting.

To be fair, most of the article alludes to those factors and effects in a way indistinguishable from if he had mentioned cultural elements instead. I just assumed that one of the paragraphs I glossed over would have mentioned diet.

> No mention of controlling for a predilection for sweet tea, fried everything, and vegetables being limited to fried okra or green tomatoes.

All of which were probably intelligent adaptations to living in a post-war economic backwater. The trouble now would be that folks have enough money to drink enough sweet tea and eat enough fried foods that the formerly-subsistence-level foods are now obesity-causing.

Actually, the limited vegetables and fried everything happened much later. Before and after the civil war(up until modern times) southerners ate much more and a wider variety of vegetables. Vegetables were simply cheaper and more widely available than meat.

> Vegetables were simply cheaper and more widely available than meat.

Right... and therefore, people might have developed a cultural and perhaps even physiological preference for those foods composed of and derived from animal products. Hence, meat and fried foods.

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