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.