I occasionally check for reviews of Fat Head by Googling the title and my name.  Surprisingly, new reviews still come along now and then.

As you’d expect, some reviewers liked the film, some didn’t.  That’s showbiz. I don’t usually fuss over the negative reviews.  Art is subjective, and the reviewers are expressing their subjective opinions.  I even thought some of the criticisms had merit. 

But a couple of reviews that caught my attention require a response – one because the reviewer managed to completely misunderstand the point I was trying to make (in fact, he got it backwards), and the other because he mangled the science about cholesterol levels.

Here’s an excerpt from the “missed the point” review:

A large part of the problem is that Naughton believes the public-especially those who have watched Super Size Me-are stupid.  In street interviews, Naughton can’t help but look down his nose at common people and their faulty “common sense” beliefs about fatty food.

This rather interesting interpretation left me flabbergasted.  The sequence he’s referring to goes like this:

  • I recount how Morgan Spurlock was concerned that a nutrition menu listing calorie counts wasn’t available in every McDonald’s he visited.
  • I point out that nutrition information is easy to find online, in books, etc., and wonder if people are really getting fat on fast food without knowing why.
  • I conduct a series of street interviews in which I show people a double quarter-pounder with cheese, a large order of fries and a large Coke, then ask if that’s a high-calorie meal or a low-calorie meal.  They all say it’s a high-calorie meal – which it is.  When I ask what would happen if you ate a meal like this all the time, they all reply “You’d get fat” – which you probably would.  I conclude that the ability to recognize high-calorie food seems to be universal.
  • I point out that people who loved Super Size Me seem to share a common and dearly-held belief that poor people are too stupid to know what’s good for them.
  • Dr. Eric Oliver appears to say that he was struck by the paternalistic attitude in Super Size Me, and that he disagrees with the idea that poor people can’t think for themselves and need McDonald’s to look after them.

I thought it was clear as a bell that I was criticizing Morgan Spurlock for assuming people are stupid.  The street interviews were intended to demonstrate that most people do in fact have common sense – and therefore don’t need Ronald McDonald to inform them that a double-quarter pounder, large fries and large Coke is a fattening meal.

Here’s another quote from the same review:

As expected, people view his tray of fast food as high in fat, but Naughton knows better because he’s done the math and knows his lunch is within the recommended daily intake of calories.

Wowzers.  I didn’t ask anyone if the meal was high in fat; I asked if it was high in calories.   I also didn’t say this particular meal would fall within the recommended calorie intake, because it wouldn’t.  Large fries and a large Coke?  Are you kidding me?  A major portion of Fat Head is dedicated to explaining the fattening effect of sugar and starch. 

Being misinterpreted is merely annoying.  Now here’s an excerpt from the review where the writer – who reviewed several films dealing with diet and health – mangled the science:

Naughton also selectively edits out discussion of his LDL (bad cholesterol) both in his baseline and in his final checkup. From the information he does share we can determine that his starting LDL was 170 (231 total cholesterol – 61 HDL = 170 LDL) which is regarded as high risk for heart disease and stroke by the American Heart Association.

I didn’t waste screen time talking about my LDL score because it stayed exactly the same: 156.  I also don’t care what my LDL score was, for reasons I’ll explain shortly.  But what made me chuckle was the reviewer’s formula: 

LDL = Total cholesterol – HDL

That’s not how LDL is determined.  LDL can measured directly in a lab, but it requires a time-consuming and expensive test, so most of the time it’s calculated.  If it’s calculated, the equation is:

LDL = Total Cholesterol – HDL – (Triglycerides / 5)

This is known as the Friedewald equation.  It’s quick and inexpensive, but it’s also nearly meaningless.  As Richard Nikoley pointed out in one of his many excellent blog articles, the LDL equation actually rewards you for having high triglycerides – which is a bit nutty, considering that high triglycerides are strongly associated with heart disease. 

Suppose your total cholesterol is 200, HDL is 60 and triglycerides are 70.  (This happens to be nearly identical to my most recent lipid panel.)  In that case, your calculated LDL is 126.  Your doctor will probably suggest a lowfat diet and perhaps even a statin … by gosh, that evil LDL should always be below 100!

But if your triglycerides are 300 – which is dangerous – your calculated LDL would only be 80.  Your doctor will probably congratulate you, even as your elevated triglycerides are running around your body, torching and burning your arteries and re-enacting Sherman’s march to the sea.

And there’s an even bigger problem with the equation: it can wildly over-estimate your LDL, especially if your triglycerides are below 100 … which mine were, both before and after my fast-food diet.

As I was working on this article earlier today, Dr. Mike Eades happened to put up his own post debunking the LDL equation.  (Great minds thinking alike?)  Since he spelled it out in detail, I won’t bother – read his article and you’ll get the full scoop.  But here are a couple of pertinent paragraphs giving an example of how inaccurate the calculation can be:

This paper is basically a case presentation of a 63-year-old man with a total cholesterol level of 263 (all results in mg/dl), an HDL of 85, a triglyceride level of 42, and an LDL level of 170.  The LDL level was, of course, calculated using the Friedewald equation.

For some unexplained reason the authors of this paper decided to repeat the lab results and got the same readings.  They then wondered if his very low triglyceride readings might be having an effect, so they measured his LDL levels directly and found that instead of the 170 predicted by the Freidewald equation, his actual LDL levels were only 126.

And even if my LDL really and truly was 170, as the reviewer believed, so what?  That’s a meaningless number, despite what the anti-cholesterol hysterics at the American Heart Association believe.  (My advice: don’t take advice from an organization that puts its stamp of approval on a box of Cocoa Puffs.)  Saying I have too much LDL is like saying I have too many cells in my body.  What kind of cells?  Brain cells?  Muscle cells?  Cancer cells?

LDL can be big and fluffy or small and dense.  People with small, dense LDL are at risk for heart disease even if the LDL score is low, because the small particles can perforate the arterial wall.  Big, fluffy LDL doesn’t do that – in fact, it may even have anti-inflammatory properties and therefore help prevent heart disease. 

I explained all this in the film.  But after incorrectly calculating my LDL, the reviewer repeated the bologna that high LDL equals bad.  Once again, I was flabbergasted.  He either took a potty break during that sequence, didn’t understand it, or simply refused to believe it. 

The most accurate measure of heart-disease risk is the ratio of triglycerides divided by HDL.  The higher the ratio, the more likely you are producing small, dense LDL.  Ideally, the ratio should be 2.0 or less.  If it’s above 4.0, you’re in trouble.  If it’s above 6.0, start putting your affairs in order.

Here are my triglyceride/HDL ratios before the fast-food diet, after the diet, and today:  before: 1.15, after: 1.63, today: 1.17.

So my ratio went up a bit after a month of eating fast food that included some starch and trans fats.  That’s why I don’t eat them anymore.  But even then, my ratio was excellent.

For those of you who haven’t seen the film, eating natural fats (including saturated animal fats) raises your HDL.  Frankenstein fats, such as processed and hydrogenated vegetable oils, lower your HDL.  Cutting back on sugar and starch lowers your triglycerides.  So if you want a good triglyceride/HDL ratio, the simplest way to achieve it is to ignore the American Heart Association and get most of your energy from natural fats.

And whether you’ve seen the film or not, trust me on this:  I don’t think the vast majority of you are stupid.

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15 Responses to “Let’s Review Some Bologna”
  1. Cynthia says:

    How disappointing to have people screw it up by being dense and misunderstanding your message. Let’s just hope most viewers are not as obtuse and misinformed as those reviewers. Part of the problem is that this misinformation is ubiquitous; it’s part of the common culture of accepted wisdom about fat, cholesterol, and fast food, so when people hear something different from what they expect, they may interpret it in a way that fits their (incorrect) beliefs. And as more and more people hear about carb restriction to lose weight and improve health, that will become part of the accepted wisdom, even though the belief systems will be in direct conflict!

    On the plus side, it’s opportunity for more poking fun and maybe even a follow up movie? Certainly the transition in our society’s diet and health beliefs (slow though they are) is fodder for more social commentary! It’s not all funny though- I had a friend vehemently tell me that her late husband’s heart disease couldn’t have been prevented or reversed, and he ate a healthy (lowfat) diet, so she didn’t want to hear anything more from me on the topic of diet and health! If your efforts help to reach people, then I say keep up the good work!

    It just struck me as particularly odd that a reviewer would quibble (incorrectly) about my LDL without mentioning that the film stated that LDL scores are meaningless. Even if he doesn’t agree, that would’ve been the honest approach.

    Now that I’ve finally grasped what carbohydrates do to us and now natural fats were unfairly demonized — to our great detriment — I will never stop pushing this message.

  2. Francis says:

    Hi Tom,

    You should set up a Google Alert – http://www.google.com/alerts – for your name and the film and then, whenever Google picks up a mention of either, they’ll send you an email.

    I enjoy your blog.

    Francis

    I wasn’t aware of those … thanks for the tip!

  3. Matt Brody says:

    I find it mind boggling that MDs are not up to speed on tg/hdl ratio, but push statins to people with a “high” total cholesterol. They’re MDs. They’ve studied science, and understand it.

    So is it a failure to participate in some ongoing learning? A failure to realize they are being conned by drug manufacturers? A disinterest because they are well off and don’t want to change what they do? A fear that if they are anti-conventional wisdom they won’t have a job? Doctors should always question. They used to bleed you if you were ill. Now they perform chemotherapy when you have cancer. Would it be mind boggling to think that MDs 100 years from now will look back on how we treat cancer with the same outrage that MDs today look back on bleeding patients to cure them of anything?

    I believe a lot of what we do today will be scorned by doctors in the future: statins, low-fat diets, bariatric surgery, to name a few.

    It’s a shame to realize that if you talked about the Trig/HDL ratio with your average doctor, you’d be educating him. But I understand why: Doctors are busy as hell, and get much of their ongoing “education” at seminar/vacations sponsored by pharmaceutical companies. They don’t spend their evenings poring over the latest scientific studies.

  4. Matt Brody says:

    In support of my tangent and low carbohydrate principles I present you with this link courtesy Dr Jonny Bowden.

    “Carbohydrate Restriction May Slow Prostate Tumor Growth”

    http://www.jonnybowden.com/2009/06/carbohydrate-restriction-may-slow.html

    Good article. I also believe sugar feeds cancer. Not a big stretch, considering that cancer cells fed glucose in a lab proliferate wildly.

  5. Amy Dungan says:

    Sounds like this reviewer has had too many carbohydrates himself, which we all know contributes to brain fog and short attention spans. I believe your street interviews actually proved that people do know what they are consuming when they purchase these meals. Not one person in your film said “This is health food!” I can’t give you the exact calorie, fat or carb count of a deep fried snickers bar *shuddering at the thought*, but I still know it’s not healthy.

    I’m still shaking my head about that one, wondering how he managed to come away thinking I was making fun of those people. I thought the street-interview folks were great — some of them were hilarious. If I had a name and address for the lady who talked about waking up craving chicken McNuggets and hitting people, I’d send her flowers. She was a hoot.

  6. Hi Tom,

    I was also going to recommend Google Alerts, but Francis beat me to it.

    You can’t please everyone, and unfortunately, some won’t even take the time to fully understand the message before criticizing it. I appreciate the message that you’re promoting through this site and am sure that many others do too, especially with the humor mixed in.

    While stupid isn’t the appropriate term, I think the general public does deserve some of the blame for the modern trends of obesity and disease. Despite the unfortunate amount of misinformation that’s floating around, even from our government (i.e. the food pyramid), many people know that they’re living an unhealthy lifestyle and aren’t stepping up to take responsibility for themselves.

    If Amazon ever decides to ship the copy of Fat Head that I ordered, I plan on writing a review of it. :)

    I agree it’s largely about personal responsibility. People know (as the street interviews demonstrated) that fries and Cokes are fattening, yet many will order them anyway. I also believe bad government policy played a role, by turning us into a nation of sugar-eaters who crave yet more sugar.

    How long have you been waiting for your copy? Our U.S. distributor had problems with one fulfillment center and found another, so I hope the delays are over.

  7. I placed my order on the 12th and it’s supposed to ship on the 25th. I ordered a few books as well, so I’m not sure what it was specifically that held up the order. Either way, the wait isn’t a big deal.

    They list it as in-stock, which they didn’t last week, so I guess they got the missing shipment. Of course, I want them to run out of stock … then buy more.

  8. Delmoki says:

    Tom, it sounds like this reviewer was practicing intermittent napping while watching your film. I thought your message was very clear!

    I thought the message was clear as well, but as a writer, you never know. I guess it’s like the line from Cool Hand Luke: what we have here is a failure to communicate.

  9. Felix says:

    I understand how people can not understand the low-carb stuff and find it wrong and unhealthful. After all, that’s what we are all told and what all the experts believe and preach 24/7. But how people can watch your movie and get it wrong this badly is just beyond me. It’s like they didn’t see it. This is really strange.

    Must be a case of selection bias; we pay more attention to what supports our existing beliefs.

  10. Willa Jean says:

    I think Delmoki is right. The dude was sleeping. Or there’s a serious problem with HIS intelligence. Given that he feels entitled to discuss LDL calculations without knowing the formula….. I’ve seen the same thing when “experts” debate with Gary Taubes. They clearly haven’t read the book, but they know it’s all wrong, and they know why. And then they try to teach Newton without knowing what Newton said. Morons. No wonder we’re in a mess.
    I think that MD’s learn what they learn just because it’s what their professors believe. I doubt they’d get through med school if they questioned and researched everything they’re taught. There just isn’t time. And having learned all the wrong stuff, they tend to stick with it. Paradigm shifts are really tough.

    I always chuckle when nutrition “experts” try to tell Gary Taubes about the laws of thermodynamics. Taubes has a degree in physics from Harvard.

  11. Halle says:

    I’m sorry I haven’t given you an amazon review yet– I thought the movie was brilliant — and very clear. But of course you are preaching to the choir in my case. I am always fascinated when I find examples of people desperate to punch holes in something that challenges their cherished beliefs. I have news for them — I have had my belief systems turned over several times in my lifetime –and I have ALWAYS been better off when I accepted the truth about things rather than continuing to hold up some kind of philosophical banner, no matter how invested I was in that banner. So what the emperor is naked? Get over it.

    I try to be understanding with people who aren’t yet ready to accept the truth about sugar and fat in our food. But ya know — the blood sugar meter doesn’t lie — and blood tests don’t lie either (unless your using some fruitcake calculated number like that crock about LDL. OMG!) I think some people just have to get to the end of the rope before they will be emotionally/mentally ready to accept a new paradigm. I just try to be patient.

    I am of course happy the choir has enjoyed the film. We actually made some converts as well; I’ve heard from a few who saw the film on TV overseas. Amazon review happily accepted whenever you get the time.

  12. Jared Bond says:

    Hi Tom,

    First off, this blog is amazing, and so is your knowledge and dedication to this cause. But I had to write because I kinda know what that reviewer is talking about. You really do make it out like this all should be so obvious, but the crux of the weight issue is the carbs, to which the general public is still almost completely clueless about. (They, like I once did, would still probably think the Atikin’s diet is some sort of unnatural “trick” to lose weight). If you had asked those people which part of the meal was the worst for you or the most fattening, they probably would have mostly pointed to the meat in the burger. And indeed, if someone is trying to diet, that’s what they would most likely do- cut out the burger and just have the fries and soda, maybe with a salad and fruit and yogurt parfait too. If you asked someone what they thought of THAT meal, they would probably say “well, you wouldn’t get AS fat”- and that is the compromise most people are willing to make. But of course, they are grossly mistaken. Yes, people aren’t stupid, but they are ignorant. It’s not that they don’t try to lose the weight, it’s that they don’t know how. People don’t, in fact, know what’s good for them. And even if they were to look up nutritional information online or in books, they still wouldn’t find out- they’d just be counting calories. So people are largely victims and do need help with this stuff.

    While I’m writing, my other objection with the movie is all the diet soda. While I guess you showed it’s not the worst thing in the world, aren’t you worried about all the adverse effects of aspartame? Have you seen Russell Blaylock’s presentation “Excitotoxins”, about MSG and aspartame? (it’s on google video) I’d like to know what you think of it, or even just what you think of Blaylock himself.

    I agree that ignorance — in the true sense of the word, no insult intended — is part of the problem. I didn’t know any better either back when I was living on starch. My beef with the reviewer was over his statement that I think people are stupid. The people I interviewed on the street correctly identified a meal containing large fries and a large Coke as fattening. No ignorance on that issue. It’s a fattening meal and they knew it.

    I’d rather see people drink diet soda than high-fructose corn syrup, but of course that’s simply choosing the lesser of two evils. I’ve cut back quite a bit on the stuff and now treat it kind of like I do beer — a once-in-awhile indulgence. As for non-diet sodas … I literally can’t remember the last time I drank one of those.

    I tried to subscribe Blaylock’s online newsletter when I researching the film but never got it, and never could get anyone to tell me why, despite several phone calls.

  13. jcliveNZ says:

    Another NZer also hoping one day Fathead will be available here as I would use as tool to teach others (Weston Price -”you teach, you teach” etc.) Interested in your response to Jared. The whole spectrum of how we are and have been lead astray from nourishing nutrition is at once relatively simple but many pronged. I gave up sugar decades ago. Never entertained substitute sweeteners and at least decade ago printed stuff off net exposing aspartame (know now of course I was getting my “sugar” via a carb loaded diet anyway). BUT only 7 years ago did I realise was a carb addict. Went cold turkey the same day and never looked back. So we come to the various prongs at different stages.
    Having read Blaylocks “Excitotoxins” I respectfully urge you to drop the diet sodas altogether.
    Much appreciated your 1/2 hour with Nora Gedgaudas. Will use that interview. Have her book and the first thing I read was pages 140-41 the only place she touches on alcoholism. That is the prong that seems to interest me the most in recent times.
    If you or other readers are curious as to why you will see my story outlined in my letter “Greetings from New Zealand” half way down the page at http://www.orange-papers.org/orange-letters126.html

    Interesting stuff. I of course also hope Fat Head will be available on DVD in New Zealand soon, as well as around the world. Perhaps a few calls to video stores asking for it would make them pay attention.

  14. Bob Polaneczky says:

    Your comment about calculated LDL being rewarded for having High Tris is incorrect

    In it you say for a person having Total at 200 HDLs at 60 and Tris at 70 the LDL is calculated out at 126

    Then you say if the Tris went to 300 the LDLs would calculate out lower

    This is a fallacy because you are assuming the Total remains at 200
    I contend if a persons Tris would jump to 300 then his Total would also increase due to his diet changes that caused the Tris to increase

    That was a hypothetical example to show how the calculation tends to reward higher TG. If your TG went up to 300, something else would indeed likely change as well.

    But the miscalculation problem is very real. I saw an example — real guy, real measurements — where the Friedewald equation calculated his LDL to be 170; it turned out to be 126 when measured directly. That miscalculation was because the guy had very low TG– which is healthy. Quote from a study on the issue:

    “Statistical analysis showed that when triglyceride is <100 mg/dl, calculated low-density lipoprotein cholesterol [LDL] is significantly overestimated (average :12.17 mg/dL or 0.31 mmol/L), whereas when triglyceride is between 150 and 300 mg/dL no significant difference between calculated and measured low-density lipoprotein cholesterol is observed."

  15. Rebecca Foxworth says:

    More than two years after you wrote this post, I’m reading it to my eleven year old daughter. Her reply? “Um…did this guy watch it with the sound off, or something? Maybe he just watched the pictures and read the easy words printed on the screen.” Given you large ‘Poor people are stupid!’ graphic printed over a downtown building, I’m thinking that’s a distinct possibility. Maybe he muted the TV and played Pink Floyd, like they do with The Wizard of Oz?

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