An organization called NuVal has come up with a simplified system for telling us which foods we should eat. Instead of continuing to strain our brains by counting grams of fat, carbohydrates, sugar, fiber, and protein, we can now just read the NuVal score, which ranges from 1 to 100. Check it out:
After watching the video, I couldn’t quite figure how the NuVal people assign scores to foods, so I went to their web site for the answer.
The NuVal(tm) Nutritional Scoring System is powered by the Overall Nutritional Quality Index (ONQI(tm)), a patent-pending algorithm for measuring the nutritional quality of foods and beverages based on the influence they have on overall dietary goals.
That’s a great start. I’ve always believed choosing quality foods requires at least one algorithm and a patent or two. As you probably know, archeologists have found several algorithms etched into the walls alongside Paleolithic cave paintings. There’s even a theory that Neanderthals died out because their primitive tools were incapable of producing the symbol for division.
Developed by a team of leading nutrition, public health, and medical experts, the ONQI algorithm uses the Institute of Medicine’s Dietary Reference Intakes (DRIs – quantitative reference values for recommended intakes of nutrients) and the Dietary Guidelines for Americans (advice from the Department of Health and Human Services and the U.S. Department of Agriculture about how good dietary habits can promote health and reduce risk for major chronic diseases) to quantify the presence of more than 30 nutrients – including vitamins, minerals, fiber, and antioxidants; sugar, salt, trans fat, saturated fat, and cholesterol.
So they’re using the USDA’s dietary guidelines to create the algorithm. That would explain some of the foods that receive a high NuVal score:
Chicken Breast (boneless) – 39
Pork Tenderloin – 35
Turkey Breast – 31
Ground Sirloin (Beef 90/10) – 30
Ham – 27
Coconuts (husked) – 24
But I figured there must be more to a patent-pending algorithm than USDA recommendations, so I called the NuVal people and asked for an interview. One of them agreed to speak to me on the condition that I wouldn’t reveal his name.
Fat Head: Back in the 1990s, the FDA mandated a standardized food label that promotes a high-carb, low-fat diet, and since then we’ve gotten fatter. Why did you decide American consumers need a simplified version of the same advice?
NuVal: The FDA and USDA did a pretty good job of helping millions of people to become obese and diabetic, and we applaud their efforts. But if you look at the statistics from recent years, rates of obesity and Type 2 diabetes are starting to level off somewhat. We concluded that the government’s plan to fatten up the population has run into an unforeseen barrier.
Fat Head: And what’s that?
NuVal: Mathematical illiteracy. As often happens with the federal government, one branch didn’t know what the other was up to. So while the FDA and USDA were working to make people fatter by offering detailed nutrition advice, the Department of Education was busy making sure millions of Americans can’t do math.
Fat Head: I’m not sure I see how that —
NuVal: Let me give you an example. We’ve been telling people to get at least 60 percent of their calories from carbohydrates, because we know that will produce runaway blood sugar for a whole lot of them, right?
Fat Head: Right.
NuVal: Okay, so you’re looking at a food label, and it says 60 carbohydrates, 30 grams of fat, and 10 grams of protein. I bet you think that means 60 percent of the calories come from carbohydrates.
Fat Head: No, because fat has more than twice as many calories per gram than carbohydrates. So it’s more like 43 percent carbohydrates.
NuVal: How did you … ? Never mind. The point is, a lot of people aren’t eating enough carbohydrates to jack up their blood sugar because they’re lousy at math. Plus that whole “gram” thing doesn’t make sense to anyone except the drug addicts, and they eat plenty of carbohydrates already. We needed something simple.
Fat Head: I see. So that’s why it’s called “A Food System for Dummies” on your web site.
NuVal: Exactly. Now people can just choose foods that rank high on the NuVal scale and keep their blood sugar jacked up all the time, without all that math.
Fat Head: But I noticed you also give sugary foods a low score and green vegetables a high score. That would seem to undermine your goal of turning more people into diabetics.
NuVal: True, but we also discourage people from eating anything with adequate amounts of animal protein or fat, so we know they’ll be hungry and fill up on carbohydrates eventually. Besides, the system has to look credible when it comes to vegetables or no one will use it.
Fat Head: Let’s talk about that scoring system a bit. In your algorithm, you give foods a high score for certain nutrients, but then you divide by what you consider bad nutrients: trans fat, sugar, sodium, saturated fat and cholesterol.
NuVal: It’s complicated, but yes, that’s basically it.
Fat Head: That’s where I’m getting confused. Trans fat and saturated fat have different chemical structures and different effects in the body. Trans fats lower HDL, while saturated fat raises it. Trans fats weaken cells, while saturated fats make them stronger. Recent studies show zero association between saturated fat and heart disease. So how did saturated fat become what you call a denominator?
NuVal: We consider them biochemically equivalent because our algorithm showed that if you take all the letters that are common to both trans fat and saturated fat, you can create a long list of the same words.
Fat Head: But that doesn’t seem like a good way to–
NuVal: Fat Rats, Fast Rat, Fat Arts, Fat Star, Star Aft, and my favorite, Sat Fart.
Fat Head: I see. So biochemically, you’d consider Tom Naughton the equivalent of a Math Nut Goon.
NuVal: Yes. Or a Homo Gnat Nut.
Fat Head: I also don’t see why cholesterol and sodium are denominators. Your site says the inputs for the algorithm are based on broad scientific research. Can you actually point to any research that proves cholesterol and sodium are bad for us?
NuVal: We conducted an exhaustive review of the literature and found that in nearly every case, the federal government said cholesterol and sodium are bad.
Fat Head: Your algorithm is also supposed to take the glycemic index into account, according to your web site. I was pleased to see white bread receive a low score, for example. And yet Silk Chocolate Soy Milk received a score of 68, despite containing nearly as much sugar per cup as Coca-Cola. What’s that about?
Fat Head: Excuse me?!
NuVal: We love boobs. The isoflavones in soy are chemically similar to estrogen, so if we can get kids drinking a lot more soy milk, we won’t have to wait until they’re teenagers to see some boobs.
Fat Head: But …you realize that can happen to the boys too, right?
NuVal: I consider myself very open-minded.
Fat Head: Well, as someone who developed boobs as a boy, I don’t think that’s healthy, physically or mentally, unless you enjoy having other boys call you names.
NuVal: Like “Homo Gnat Nut”?
Fat Head: No, but you’re in the ballpark. The point is, why the heck would you give anything made out of soy a high score? How is soy milk a healthier option than a slice of ham or a chicken breast?
NuVal: Don’t say breast. It makes me think of b-
Fat Head: Thank you for your time.
So there you have it: A simple system to help people choose a low-fat, high-carb diet based on processed grains and soy, while limiting perfectly natural proteins and fats. Obesity, diabetes, autoimmune diseases, and premature puberty made easy.
The only bright spot is that NuVal is a commercial enterprise, so if they fail, they’ll probably go away. If they were a government health agency, failure would be an excuse to double their budget.
Readers and friends frequently send me links to online articles. Some become blog material, while others are interesting or funny but don’t quite merit a full post. I’m busy with programming work for the next few days, so instead of writing a long post, I thought I’d just share a few articles from my stash …
Researchers Nominated For Fat Head’s 2010 “DUH” Award
A group of researchers apparently conducted a 20-year study to reach the following conclusion:
A combination of four unhealthy behaviors — smoking, lack of exercise, poor diet and substantial alcohol consumption — greatly increases the risk of premature death, a new study has found.
I found this study amazing for two reasons: 1) Somebody found it worth funding, and 2) it was published in the Archives of Internal Medicine. No doubt the editors believed doctors needed to be informed of these ground-breaking observations as soon as possible. The doctors who’ve been counseling their patients to spend all day smoking and tossing back boilermakers while sitting on the sofa are really going be embarrassed. (For their next project, the researchers will attempt to determine if walking outside naked in the winter is associated with a greater risk of hypothermia.)
The only interesting part of the online article was the sub-headline: People who smoke, drink, rarely exercise, and skimp on fruits and veggies die earlier than usual, study finds.
If I’ve said it once, I’ve said it at least twice: Researchers find all kinds of associations between particular foods and health that are essentially meaningless — because all we’re actually seeing is the difference between health-conscious people and people who don’t give a hoot. So skimping on fruits and veggies is bad for you? Maybe, but it’s more likely that the people who ignore the “Eat Five!” advice just have lousy health habits overall. Which leads me to the next article …
Five-a-day has little impact on cancer
So what happens if you conduct a large study on the supposed benefits of fruits and vegetables and actually adjust the data to account for variables such as smoking? You get a conclusion like this:
Eating more fruit and vegetables has only a modest effect on protecting against cancer, a study into the link between diet and disease has found. The study of 500,000 Europeans joins a growing body of evidence undermining the high hopes that pushing “five-a-day” might slash Western cancer rates. The international team of researchers estimates only around 2.5% of cancers could be averted by increasing intake.
The team, led by researchers from the Mount Sinai School of Medicine, in New York, took into account lifestyle factors such as smoking and exercise when drawing their conclusions. But writing in the Journal of the National Cancer Institute, they said they could not rule out that even the small reduction in cancer risk seen was down to the fact that the kind of people who ate more fruit and vegetables lived healthier lives in many other respects too.
The World Health Organization, the U.S. government and governments all over Europe have been pushing various “Eat Five!” programs for years. I don’t have anything against vegetables (except celery), but they’re not some magic bullet to fight cancer. If governments really want to improve health, they should start a world-wide program titled Ignore Everything We Said Previously About Avoiding Fat And Basing Your Diet On Grains.
Do toddlers need cake as well as carrots?
That was the headline for an article published on the BBC News site. Allow me to answer the question posed by the headline: No, for @#$% sake, kids don’t need cake! Here’s the lead paragraph of the article:
A new survey shows some nurseries are giving children too much in the way of fruit and vegetables, and not enough starchy carbohydrates to meet their energy needs. Have healthy eating messages left us in a state of confusion about what children should be consuming?
I’ll take a stab at that one: yes, people are confused. They’re also scared. As the article points out, some parents are so worried their kids will become obese, they’re trying to make the little tykes get by on lowfat everything. On that topic, at least, the article actually makes several good points:
Parents are aware of the importance of ensuring their child eats healthily to avoid obesity and health problems in later life, but this can sometimes lead to parents making requests that their child follows a strict diet, such as skimmed milk and low-fat foods,” says its chief executive Purnima Tanuku. “Children under five have specific needs, and should not have low-fat diets as their growing bodies need fat and carbohydrates.”
Studies have shown that children burn fat much faster than adults – and so skimmed milk and other low-fat dairy products should remain off the menu until they are much older.
I agree. Let’s not put skimmed milk and low-fat dairy products on the menu until the kids are at least 90.
A nutritionist quoted in the article actually suggests parents shouldn’t be worried about red meat. Yee-hah! Unfortunately, she also believes that kids need the extra calories from foods like custards and puddings. Why, for Pete’s sake, would kids need anything containing sugar? If they need extra calories, serve them real foods with plenty of fat.
Cocktails For Carnivores
So if we’re going to finally stop worrying about red meat, how can we get more of the stuff into our diets? Here’s an idea: put meat in our drinks.
In this meat-happy era, when diners serve bacon doughnuts and every menu item comes with an option of adding chicken, one cannot expect to consume alcohol without killing an animal. Fat-washed cocktails, as drinks with meat-infused liquor are called, are popping up at lots of swanky bars. Sirio Ristorante at Las Vegas’ new Aria hotel, for example, makes a $14 vodka drink called Bring Home the Bacon, which contains beef bouillon and is garnished with a deep-fried bacon-wrapped olive. And a prosciutto-stuffed olive. And a cream-cheese-and-bacon-stuffed olive.
Awesome. On hot summer days, nothing tastes better than a bratwurst washed down with a cold beer. The trouble is, there’s a lot effort involved … pick up the bratwurst, take a bite, set it down, pick up the beer glass, take a sip, set it down, pick up the bratwurst … very tiring. It never occurred to me that I could simply put the bratwurst and beer in the same glass. Now if I can just talk my wife into cutting the bratwurst into bites for me, I won’t have to expend any effort whatsoever.
Richard Nikoley of Free the Animal apparently got himself in trouble with the paleo purists by noting in a recent post that he’s added potatoes back into his diet:
I really don’t get it. Now, if for some reason you must stay low-carb; say, for weight loss, diabetes or other health or well being reasons, then fine. But if not, what’s the deal? Potatoes are Real Food. Sure, the various white varieties are a neolithic introduction, but c’mon, so is virtually every fruit and vegetable we consume. Most in no way, shape, form, fiber content, nutrient makeup, or sugar content resemble pre-domesticated versions. So why pick on the white potato?
One purist was so disgusted, he dropped Free the Animal from his blogroll. Give me a break. We laugh at militant vegans for being the Hezbollah of the food world; do we really need to start imitating them? Should Richard start looking over his shoulder, wondering if some paleo fanatic will smash a meat pie into his face?
Paleo or not, I don’t eat white potatoes for a good reason: my blood-sugar meter informed me I don’t get along with them. The small red-skinned potato I consumed on St. Patrick’s Day pushed my glucose all the way up to 164 mg/dl. It’s not just a matter of staying below a particular carb count for the day; I don’t want my blood sugar reaching that level, period.
However, Richard also linked to a four-part series by Don Matesz on Primal Potatoes that’s quite an interesting read. (Part one, part two, part three, part four.) Don makes a convincing case that tubers such as sweet potatoes have been in the human diet for a very long time (unlike grains or sugar) and on balance are probably good for us.
Well, maybe. I understand some native peoples ate a lot of sweet potatoes, were healthy, and didn’t become fat and diabetic … but then again, they didn’t wreck their metabolisms with sugar and white flour, either. I did, at an early age, so starches of any kind may have a more dramatic effect on me. How I would react to sweet potatoes today if I’d never discovered Captain Crunch as a child is irrelevant at this point.
But since I’m still testing which foods cause my blood sugar to skyrocket, I decided to experiment with a medium-sized sweet potato. I also decided to make it count by putting together a meal I knew I’d enjoy — after all, if it pinned the needle on my glucose monitor afterwards, this would be my last sweet potato in a long time. So, as you can see from the pictures, I cooked up a skillet of home fries and eggs.
Between the sweet potato and half of a red onion, the meal included about 30-35 carbohydrates. I fried the potato slices and onions in some Kerry Gold butter until they were on the crispy side, then added four eggs, salt, pepper, and some thyme. When the eggs were firm, I folded the whole thing over onto a plate, added a dollop of sour cream, and enjoyed.
Yes, it was delicious. I used to make home fries and eggs nearly every weekend, but with white potatoes. Not knowing any better at the time, I assumed sweet potatoes were full of sugar. Why else would they taste sweet? But in fact, a sweet potato has a glycemic index of 44, whereas a red-skinned potato comes in at 88 — putting it up around pure-glucose territory.
However, the glycemic index is an imperfect guide. We’re all different, so if you want to know how a particular food affects your blood sugar, you have to measure. Spaghetti, for example, has a glycemic index of around 40. But when I added a wee bit of it to some meatballs and a half-cup of marinara awhile back, I ended up with a blood-sugar reading of 174 mg/dl an hour later. Yikes. So while I wasn’t exactly afraid of the sweet potato, I prepared myself to see quite a glucose spike.
Didn’t happen. An hour after breakfast, the meter showed my blood sugar was at 128 mg/dl. Not great, but not bad either. After two hours, the reading was 87 mg/dl, which means my body brought my blood sugar back to normal without much trouble. By contrast, I was still around 120 mg/dl more than two hours after the spaghetti. Pasta just doesn’t agree with me, no matter what the glycemic index says.
So wheat and wheat products are definitely out. But it looks like a “paleo potato” is okay now and then. Next time, I’ll bake it and top it with butter and sour cream … with a medium-rare steak on the side.
p.s. — For some reason I was unable to upload a new post all day yesterday and this morning. I guess my web provider fixed the issue.
I have a fantasy in which I’m allowed to conduct a nationwide experiment lasting several years. It would work like this: First, I get to select a harmless food I don’t like very much and wouldn’t mind giving up. I think I’ll go with celery.
Then, working in cahoots with several prominent health organizations, I get to convince the American public that my selected food causes premature death. Given the current state of nutrition and health journalism, this wouldn’t be a difficult task. We could just trumpet a few studies showing that 75% of all heart attack victims consumed celery in the previous year, for example. Eventually the media would be full of headlines warning people to cut celery from their diets. TIME magazine would run a major article titled Sorry, It’s True … Celery Is A Killer. (Subtitle: party trays will never be the same.)
Now for the really fun part … a dozen years or so later, I would conduct a large epidemiological study comparing celery consumption with death rates. And I can already guarantee the result: people who eat a lot of celery tend to die younger. This would, of course, prove that celery is a health hazard, right?
Of course not. All it would prove is that health-conscious people had heeded the warnings and were dutifully avoiding celery. Or, to look at it another way, it would prove that people who choose to ignore the dire warnings about celery are what doctors call non-adherers … or what I call people who don’t give a @#$%. It would prove absolutely nothing about the actual health effects of celery.
But that’s not how most of the public or (sadly) most health professionals would see it. The health professionals would avoid the stuff and counsel their patients to do likewise, citing my study as proof. CSPI would blitz the media with press releases warning about the high celery content of take-out Chinese food. (A heart attack in box!) Joy Bauer would demonstrate how to use carrots instead of celery to scoop up fat-free ranch dressing.
Finally, for the big punchline, I’d get to announce that the whole thing was a joke, preferably on national TV. “Fooled ya, folks! There is not and never has been anything dangerous about eating celery. Ha-ha!”
But by then, no one would believe me. I’d be accused of being a flack for Big Celery. I don’t care … I don’t like celery anyway.
Okay, that’s my fantasy. (And yes, you are allowed to make wisecracks at this point … something about the wild fantasies of a 51-year-old computer geek should do the trick.) Now here’s why I thought of it again today:
Some of you are familiar with Jason Sandeman, the Well Done Chef, because he’s written a couple of guests posts to share his recipes. Jason was recently diagnosed as a diabetic — first as a Type 2, but then as a Type 1. Over the weekend, I asked how he’s adjusting. He replied today:
I have impressed the doctors and the nurses with how fast I have gained control, mainly by ignoring their advice. I am sure it is well intentioned, but misguided … I was directed to this study by a “helpful” diabetes nurse.
The study the nurse wanted Jason to read (actually, she wanted him to read an article summarizing it) is one that came out a couple of years ago and was reported all over the media with headlines such as Seven or more eggs a week raises risk of death. Several bloggers with functioning brains took it apart at the time (I wasn’t blogging yet), but it’s worth another look, if only because it’s a perfect example of how demonizing a food can lead to exactly the kind of associations my anti-celery campaign would produce.
The Harvard team studied 21,327 men taking part in the much larger Physicians’ Health Study, which has been watching doctors since 1981 who have agreed to report regularly on their health and lifestyle habits. Over 20 years, 1,550 of the men had heart attacks, 1,342 had strokes, and more than 5,000 died.
“Egg consumption was not associated with (heart attack) or stroke,” the researchers wrote. But the men who ate seven eggs a week or more were 23 percent more likely to have died during the 20-year period. Diabetic men who ate any eggs at all were twice as likely to die in the 20 years.
Okay, this study already has problems. Why were we all told to avoid eggs? Because they’ll give you heart disease, by gosh! And yet the authors noted that egg consumption was not associated with heart disease — just with premature death in general. Hmmm … so how exactly are the eggs killing all those doctors? Are the doctors spilling eggs on the floor, then slipping on them?
I looked up the full study and found other problems as well. The egg-consumption figures were compiled from food questionnaires mailed at various intervals over the course of the study: baseline, 24, 48, 72, 96, and 120 months. Those questionnaires are notoriously inaccurate.
But let’s suppose the doctors reported their egg consumption accurately. Doctors are, after all, more likely than most folks to think carefully about their diets … which leads to another flaw in the study: the participants are doctors. Most of this study took place after 1984, which is when TIME magazine scared the bejesus out everyone about cholesterol and doctors started telling their patients to cut back on cholesterol and fat. So we’re looking at a population that’s probably a bit egg-phobic to begin with. An editorial in the American Journal of Clinical Nutrition that accompanied the study pretty much says exactly that:
The egg intake pattern in this study population was extremely low: only 8% of participants were eating >= 1 egg/d. For comparison, 36% of the men in the Framingham study and 37% of men in a Japanese study with similar outcome assessments ate >=1 egg/d.
No surprise there: doctors are far less likely than the rest of us to eat at least one egg per day. That’s what they’ve been taught. In fact, in the full text of the study, the authors stated that the median consumption of eggs among the doctors was one per week.
So … what kind of doctor ignores the advice — which has been shouted from the medical rooftops since at least 1984 — to cut back on eating eggs? I can think of two kinds:
The very few doctors who know cholesterol-rich foods aren’t dangerous (Eades, Vernon, Sears, Ravnskov, etc.).
Doctors who don’t give a @#$%.
And wouldn’t you know it, that’s exactly what the study would suggest:
Men who ate the most eggs also were older, fatter, ate more vegetables but less breakfast cereal, and were more likely to drink alcohol, smoke and less likely to exercise — all factors that can affect the risk of heart attack and death.
Although the study didn’t mention it, I’ll bet you dollars to donuts the egg-eating doctors were also more likely to eat donuts and drink sodas. I don’t know many people who drink, smoke, and avoid exercise but then avoid sugar because it isn’t good for them.
The “helpful” nurse no doubt wanted Jason to read the article because of this finding:
Among male physicians with diabetes, any egg consumption is associated with a greater risk of all-cause mortality.
The editorial states that most of the diabetic doctors were probably Type 2 diabetics. So, once again, what kind of doctor is more likely to develop Type 2 diabetes? A doctor who eats a lot of sugar and starch. And since diabetics are counseled to go on very low-fat diets, which kind of diabetic doctor is more likely to eat eggs? A diabetic doctor who doesn’t give a @#$% … which means a diabetic doctor who is more likely to smoke, drink, avoid exercise, and be overweight.
To be fair to the researchers, they cited other studies that found zero association between egg consumption and premature death, and also mentioned the limitations of their own study. Here’s an example:
The fact that our sample consists of male physicians who may have different behaviors than the general population limits the generalizability of our findings.
Our study has additional limitations. We cannot exclude unmeasured confounding or residual confounding as possible explanation of the observed positive association among diabetic subjects. In particular, we were not able to examine the effects of saturated fat, markers of insulin resistance, lipids, and other nutrients or relevant biomarkers on the observed association. While in our study, the lack of detailed dietary questionnaire prevent us from controlling for energy and other major nutrients, this was not the case in the Nurses’ Health Study and the Health Professionals’ Follow-up Study, where total energy intake was accounted for.
In other words: We found an association — period. We can’t actually explain it, because there were too many unmeasured or uncontrolled variables. And by the way, several other studies found no such association. If you read the whole study, that’s the takeaway message. But take another look at the headline and lead paragraph when the study was reported in the media:
Seven or more eggs a week raises risk of death
Men with diabetes who ate any eggs at all raised their risk of death during a 20-year period studied, according to the study published in the American Journal of Clinical Nutrition.
Doesn’t using the transitive verb “raise” make it sound just a wee bit like cause and effect? You know, like a Boy Scout raising the flag? Doing it on purpose and all that?
That’s the sorry state of health and nutrition reporting. Which means my celery experiment would be a fabulous success … well, for everyone except the Chinese restaurants and the celery-farmers.
Cover graphic by Chareva Naughton, who works cheap.
You are looking at the cover from a March 1984 issue of TIME magazine that helped to ignite the low-fat diet craze in America. The article inside began with the headline: Sorry, It’s True. Cholesterol Really Is A Killer.
I remember reading that article. At the time, I found it convincing. (Cut me some slack; I was only 25 and hadn’t yet nurtured my inner skeptic. I still believed researchers were objective and journalists who wrote for major media outlets were critical thinkers.)
So, like millions of other Americans, I began trying to live on a low-fat diet. I stopped buying meat and butter at the grocery store and started eating pasta, Egg Beaters and margarine. You know how much good that did me.
I’m 51 now, and my inner skeptic is fully developed. Re-reading the article 26 years later, I’m surprised it convinced anyone, especially doctors, who should’ve seen through the nonsense. You can read the full version online, but we’ll deal with bits of it here, starting with the sub-headline:
Cholesterol is proved deadly, and our diet may never be the same
The writer got it half right. Our diets were never the same. Within a couple of years, grocery stores looked as if they’d been the scene of a tagging contest between two gangs named LOW-FAT and CHOLESTEROL FREE. As for cholesterol being proved deadly, we’ll get to that.
This year began with the announcement by the Federal Government of the results of the broadest and most expensive research project in medical history. Its subject was cholesterol, the vital yet dangerous yellowish substance whose level in the bloodstream is directly affected by the richness of the diet.
Yup, that’s how stupid Mother Nature is … she designed the body to require all kinds of substances that happen to be deadly.
Anybody who takes the results seriously may never be able to look at an egg or a steak the same way again.
Well, that’s the problem: we took the results seriously. I remember reading a funny column by Bill Granger, a Chicago Tribune writer whose work I enjoyed. He described living on his new low-fat diet, and how his wife kept taking away his bacon and eggs and making him eat cereal so his heart wouldn’t get fat. Granger suffered a debilitating stroke in 2000 at the age of 59. Maybe it would’ve happened anyway … but the guy could’ve been enjoying bacon and eggs the whole time.
For what the study found, after ten years of research costing $150 million, promises to have a profound impact on how Americans eat and watch their health. Among the conclusions:
Heart disease is directly linked to the level of cholesterol in the blood.
Lowering cholesterol levels markedly reduces the incidence of fatal heart attacks.
Basil Rifkind, project director of the study, believes that research “strongly indicates that the more you lower cholesterol and fat in your diet, the more you reduce your risk of heart disease.”
Lock that quote about the diet in your brain. You’ll see why in a moment. But first, notice the “Ornish logic” in this paragraph:
Everybody knows George Ford. Or somebody like George Ford. There he was, 52, the energetic president of a small Ohio electronics firm who “wouldn’t eat an egg unless it was fried in bacon grease” His lunches were executive size. He matched his business cronies drink for drink. He smoked “pretty heavily” and exercised with a knife and fork. In the winter of 1981 doctors informed Ford that his cholesterol levels were dangerously high; by April he required a quadruple coronary bypass operation. He emerged from the hospital determined to revise his ways radically. Today he does not smoke, he exercises four or five days a week, and he sticks scrupulously to a diet high in fiber and low in cholesterol and fat. “I haven’t had a slice of bacon in three years,” he says. He is proud and relieved that his cholesterol level is normal.
Okay, so we’ve got a guy who smoked, drank heavily, never exercised and, by the way, ate bacon and eggs. Now he doesn’t smoke, exercises, probably drinks a lot less, and lives on a low-fat diet. So if his health is better now, it therefore proves — drum roll, please — low-fat diets are good for you!
Brilliant. Tell ya what: Give me a heavy-smoking, hard-drinking, fat-gobbling couch potato and let me convince him to stop smoking, stop drinking, start exercising, and take up chewing tobacco. When his health improves — and it would — I will therefore conclude that chewing tobacco prevents heart disease.
For decades, researchers have been trying to prove conclusively that cholesterol is a major villain in this epidemic. It has not been easy.
No kidding it wasn’t easy. That’s because all the previous attempts to lower heart disease through low-fat diets failed. So did the major clinical trial conducted in the 1970s to test the first big cholesterol-lowering drug, clofibrate. The subjects who took clofibrate ended up with lower cholesterol, all right … but they had a 47% higher death rate than the placebo group. Whoops.
In 1913, Russian Pathologist Nikolai Anitschkow showed that he could produce similar deposits, or plaques, in the arteries of rabbits just by feeding them a diet rich in cholesterol.
Well, there’s a reason for that: rabbits don’t eat eggs. They also they don’t form packs of vicious hunter-rabbits to run down pigs and devour them. If you force a lion to live on carrots, by the way, it will get sick and die, thus proving that carrots are deadly.
Subsequent research further supported the connection between diet and cardio-vascular disease. Epidemiologist Ancel Keys conducted a landmark study in seven nations beginning in 1947. He discovered direct correlations between a country’s incidence of heart disease, the level of cholesterol in the blood and the amount of animal fat in the national diet.
If you’ve seen Fat Head, you know how honest Ancel Keys was. He cherry-picked seven countries out of 22. As Uffe Ravnskov demonstrated in his books, you could cherry-pick seven other countries from the same 22 and show an inverse correlation between fat and heart disease; the more fat, the less heart disease.
The experts were still not quite able to pin the blame on cholesterol, however. Explains Fred Mattson, a leading researcher at the University of California at San Diego, “We were missing a key piece of evidence: no one had ever shown that reducing the level of cholesterol in the blood did any good.”
You speak the truth, Dr. Mattson — but it wasn’t for a lack of trying. Cholesterol was successfully lowered in research studies several times. It just didn’t do any good.
Now, remember when I said to lock that quote from Dr. Rifkind about fatty diets into your brain? This is the study that prompted the TIME article:
The elaborate, ten-year program recruited 3,806 men between the ages of 35 and 59, all of whom had cholesterol levels above 265 mg per deciliter of blood (the average for U.S. adults is 215 to 220). Half the men were put on daily doses of cholestyramine, an unpleasant, cholesterol-lowering drug that was mixed with orange juice and taken six times a day. One participant likened taking it to swallowing “orange-flavored sand.” Among its side effects: constipation, bloating, nausea and gas. The other half received a similarly gritty placebo. Researchers had decided to use a drug rather than diet to lower cholesterol, because it would have been virtually impossible to control or measure the diet of so many men over so long a period. By the end of the study, the cholestyramine group had achieved an average cholesterol level 8.5% lower than that of the control group and had suffered 19% fewer heart attacks. Their cardiac death rate was a remarkable 24% lower than that of the placebo group.
So, let’s think this one through: a group of study subjects who took a cholesterol-lowering drug ended up with a slightly lower rate of heart attacks, and therefore … THIS FINALLY PROVES THAT A FATTY DIET WILL GIVE YOU HEART DISEASE!
Here’s the proper response to that leap in logic: ARRRRRRGGGGHHHHHHH!!!!!
I can’t believe I didn’t recognize this load of bologna for what it was even at the tender age of 25. First off, that “remarkable” reduction in the cardiac death rate wasn’t so remarkable if you look at the actual numbers — which, in my defense, didn’t appear in TIME. Remember, we’re talking about 3,806 men with abnormally high cholesterol. With that in mind, here are the study results:
Cholestyramine Heart Attacks:130Heart-Attack Deaths:30 Total Deaths:68
With a little Excel magic, I determined that 30 deaths versus 38 is a 24% lower death rate if you put 1940 men in the drug group and 1866 in the placebo group, which in turn gave me the actual heart-attack death rates as a percentage in each group:
Placebo: 2.04% Cholestyramine: 1.55%
Compare those figures using the magic of division, and you’ll get a 24% reduction in the rate: (2.04-1.55) /2.04 = .24. This is exactly what the statin-makers do with their data today. They use division to get impressive-sounding reductions.
But to calculate the actual difference, you use simple subtraction: 2.04% – 1.55% — which means the difference in the rate of heart-attack deaths between the two groups was (wait for it) … 0.49%. That’s right, less than one half of one percent. Put two hundred men on this drug, and you would in theory prevent (almost) one heart-attack death.
So from this miniscule difference, Rafkind came up with an astounding conclusion: Since fatty foods raise cholesterol levels in some people, and since a cholesterol lowering-drug produced a very slight drop in the heart-disease rate, fat and cholesterol in the diet must cause heart disease. Or as he put it, “The more you lower cholesterol and fat in your diet, the more you reduce your risk of heart disease.”
Dr. Malcolm Kendrick has a lovely explanation of this type of logic in his book The Great Cholesterol Con. Researchers even gave it a fancy-sounding name to make it sound legitimate: teleoanalysis. Basically, the idea is this: We can’t prove (despite years of trying) that A causes C. But if we can prove A is linked to B, and B is linked to C, then we can conclude that A causes C, despite the lack of any actual evidence.
If that sounds like decent logic to you, try applying it elsewhere. Here, I’ll get you started: Drinking a lot of water causes frequent urination. Frequent urination is linked to diabetes. Therefore, drinking too much water can lead to diabetes.
Or for a more relevant example: Adopting a low-fat diet reduces cholesterol in some people. In the clofibrate trial, the group that took a cholesterol-lowering drug had a 47% higher death rate. Therefore, low-fat diets cause premature death.
That makes just as much sense as Rifkind’s logic. All we can actually conclude about bacon and eggs from his study is that you can put them on a plate and make a reasonable facsimile of an unhappy face. But that’s not how TIME, or most doctors, or most of the scientific world saw it. At least there were few skeptics:
Other doctors are not so sure, and urge a stricter interpretation of the study. Says Dr. Edward Ahrens, a veteran cholesterol researcher at Rockefeller University: “Since this was basically a drug study, we can conclude nothing about diet; such extrapolation is unwarranted, unscientific and wishful thinking.”
Spot-on, Dr. Ahrens. Unfortunately, wishful thinking became confused with settled science.
The American Heart Association has been urging people for years to take this preventive approach. Specifically, A.H.A. experts recommend that American men limit themselves to 300 mg of cholesterol a day, and women to 225 mg, roughly the amount in a single egg. They insist that fat should make up no more than 30% (rather than its current 40%) of the diet, and no more than one-third of this should be saturated.
Yup, I really should trade my eggs for a nice, big bowl of Cocoa Puffs. The AHA says so, and they’re staffed by experts.
Because atherosclerosis develops slowly throughout life, Gotto believes that children should be started on a low-fat and low-cholesterol regimen at about the age of two.
Definitely. That way they can be taking drugs for ADD by the age of eight.
Many Americans have already heeded the A.H.A. gospel. Over the past 20 years, the nation’s consumption of butter has dropped 30%, egg consumption has declined 14%, and the average intake of animal fat has plummeted 60%.
I guess that explains the remarkable improvements in the nation’s health we’ve seen since 1984.
Over the same two decades, deaths from heart disease have declined 30%.
For Pete’s sake, lady! Smoking dropped by nearly 50% over the same period! Think maybe those two are related in some way?
Even so, not everyone agrees with the A.H.A. on dietary reform. The drop in mortality, some scientists point out, is partly due to better treatment for heart disease and to a decline in smoking among middle-aged men.
Sorry. My bad.
“I have an aversion to this cholesterolphobia,” scoffs Purdue Cardiologist Story. “Why treat everybody? We don’t give everybody insulin out of fear of diabetes.” According to Rockefeller University’s Ahrens, who has spent nearly 40 years studying cholesterol metabolism, individuals differ greatly in their response to dietary fat and cholesterol. “To deny everyone red meat could mean taking away the joy of life unnecessarily,” he says. “And as an inexpensive source of good nutrition, there is nothing more glorious than the egg.”
Thank you, Dr. Story. I wish more people had listened to your scoffing.
The food manufacturers who oppose the Heart Association’s dietary recommendations have come in for widespread criticism. “Instead of making excuses, they ought to be adopting the long-range goal of making better products,” says Dr. John LaRosa, an internist at George Washington University Medical School.
Don’t worry, Dr. LaRosa, they heard you. They stopped making excuses and started making Snackwells, which became a $490 million business by the early 1990s. Eat all the sugary treats you want — they’re fat-free!
Saturated fat, usually in the form of coconut oil, lurks in most commercially baked breads and cakes, in nondairy creamers, on the oiled surface of frozen French fries, and even in wholesome granola.
Coconut oil: lurking in our food. Granola: wholesome. American Heart Association: experts, giving us the gospel. People who don’t agree with the AHA: scoffers, coming in for widespread criticism. Man, it’s inspiring to watch an unbiased journalist at work. At least the good folks at CSPI managed to get all that lurking coconut oil replaced with hydrogenated soybean oil.
The trends of the past two decades give cause for optimism. Medical researchers generally believe that Americans will become increasingly willing to change to a healthier diet and a more sensible lifestyle. By the year 2000, they say, heart disease could cease to be the leading cause of death in America.