Another Biased Study? Maybe …

      82 Comments on Another Biased Study? Maybe …

If you follow other paleo or low-carb blogs, you’re no doubt aware of the recent study in which the investigators concluded that while low-carb and low-fat diets work equally well for weight loss, the low-carb diet produced greater improvements in HDL.  Jimmy Moore wrote about the study, and there were online articles with quotes like these:

Over the long term, a low-carb diet works just as well as a low-fat diet at taking off the pounds – and it might be better for your heart, new research suggests.

Both diets improved cholesterol in a two-year study that included intensive group counseling. But those on the low-carbohydrate diet got a bigger boost in their so-called good cholesterol, nearly twice as much as those on low-fat.

Given all the nonsense over the years along the lines of “Sure, you might lose weight on the Atkins diet, but all that fat will give you heart disease!” I was of course pleased to see this study make the news.  But at the same time, something about either the study itself or the reporting of it didn’t feel quite right.  We were told that the low-carb group lost more weight initially, but both diets performed equally well for weight loss after two years … and yet this bit of information didn’t make it into the Associated Press version of the story:

The 153 participants in the low-carb group followed guidelines set out in Dr Atkins’ New Diet Revolution. For the first 12 weeks, they were told to limit carbohydrate intake to 20 g per day in the form of low-glycemic-index vegetables. After this, they could gradually increase their intake of carbohydrates by 5 g per day per week by adding more vegetables, a limited amount of fruits, and later small quantities of whole grains and dairy products until a stable and desired weight was achieved.

The 154 participants assigned to the low-fat diet limited their energy intake to 1200 to 1500 kcal per day for women and 1500 to 1800 kcal per day for men, with approximately 55% of calories from carbohydrate, 30% from fat, and 15% from protein.

Are there alarm bells going off in your head?  Notice any problems with the comparison here?  We’re looking at one group that was told to restrict fat and calories for two years, and another group that was told to strictly limit carbohydrates for just three months, then gradually raise them until a stable and desired weight was achieved! 

If you’re consuming 20 grams of carbohydrates per day at three months and then starting adding an extra 5 grams per day each week, at six months into the study you’d be consuming 80 grams of carbohydrates per day.  At 12 months, you’d be up to 210 grams per day. 

Ask anyone who’s lost weight and kept it off by restricting carbohydrates what happens if the carb count starts drifting up.  The answer:  first you stop losing, then start gaining again.  Most of us find the magic number is somewhere below 100.  So at some point in the first year, the low-carb dieters most likely hit their limit and stopped losing weight.  From then on, it was merely a maintenance diet.

Meanwhile, I couldn’t find anything suggesting that the low-fat/low-calorie group was told to start eating more once they’d achieved a stable and desired weight.  A limit of 1200-1500 calories for women and 1500-1800 calories for men sure sounds like an ongoing weight-loss diet to me, unless we’re talking about people who aren’t very big to begin with. 

But as it turns out, the study subjects were big.  After digging around and sending out distress signals, I managed to obtain a copy of the full study.  According to the researchers, the subjects all had a BMI of over 30.  Two-thirds of them were women, and yet the average starting weight was 226 pounds.  After 12 months, the average weight in the low-fat/low-calorie group was still over 200 pounds.  At that weight, a diet of 1500-1800 calories is a weight-loss diet.

So in theory, we’re comparing a low-calorie weight-loss diet that lasted for two years with a low-carb diet that reached maintenance level within a year.  Strange design for a study in which weight loss was listed as the primary outcome.  The fact that the low-carb dieters still lost the same amount of weight after two years should have been a major headline — especially since they weren’t told to count calories at any point in the study.  But in his press interviews, lead researcher Gary Foster seemed to determined to give low-fat/low-calorie and low-carb diets equal ratings:

Foster, the study leader, said dieters should be less concerned about which diet to use, and focus on finding the support or technique – like writing down what they eat – that keeps them on track.  “It doesn’t make a difference for weight loss how you get there,” he said.

When I read the statistical analysis part of the paper, I ended up scratching my head and trying to make sense out of gobbledygook like this:  (Don’t give yourself a migraine trying to interpret.  I’ll get to that.)

A parallel longitudinal model structure based on main effects for visit, treatment group, and baseline value and visit-treatment interactions was implemented with logistic regression for binary outcomes. We did estimates by using generalized estimating equations under the logistic regression model for correlated longitudinal binary outcomes implemented in the GENMOD procedure in SAS, version 9. Predicted values for each treatment and visit combination at the mean level of the baseline outcome, with corresponding lower and upper confidence bounds, were produced under each model for the figures. The previously mentioned longitudinal models preclude the use of less robust approaches, such as fixedimputation methods (for example, last observation carried forward or the analysis of participants with complete data [that is, complete case analyses]). These alternative approaches assume that missing data are unrelated to previously observed outcomes or baseline covariates, including treatment (that is, missing completely at random). The longitudinal models implemented for this study relax this missing-completely-at-random assumption in different ways.The generalized estimating equation- based longitudinal logistic models assume that missing data are unrelated to previously observed outcomes but can be related to the treatment because it is a covariate in the model. (that is, covariate-dependent missing completely at random) (18). The likelihood-based mixed-effects models further relax the covariate-dependent missing-completely-at-random assumption by allowing missing data to be dependent on previously observed outcomes and treatment (that is, missing at random). To assess departures from the missing-atrandom assumption under informative withdrawal-that is, the missing weights are informative for which patients chose to withdraw or continue to participate in the study-we present sensitivity analyses. As such, we assume that all participants who withdraw would follow first the maximum and then minimum patient trajectory of weight under the random intercept model.

I thought I knew what they were saying, but to make sure, I asked someone who deals with statistics.  My suspicions were confirmed.  Here’s what all that Engfish means:

WE INCLUDED THE DROP-OUTS IN OUR NUMBER-CRUNCHING BY ESTIMATING WHAT THEIR DATA POINTS WOULD HAVE BEEN.

Yup … they guessed.  So at the end of the day, we’ve got them declaring that low-fat/low-calorie and low-carb diets produce equal weight loss after two years based on estimating the values for the people who quit the study.  Nowhere in the paper do we find statistics based solely on the subjects who actually finished.  Nowhere in the paper do we find any statistics at all on the actual calories or carbohydrates consumed.  Did the low-carb group adhere to the low-carb diet?  Did the low-calorie group keep their calories restricted?  Since both groups regained some weight between the first and second year, the answer to both questions is almost certainly No. 

But the data isn’t there for us to read.  That makes me a little suspicious.  I couldn’t help but wonder if these people set out to prove the superiority of low-fat diets, didn’t care much for the results, then got creative with their statistical analysis to blur the lines.  So I put Google Scholar to work and looked up previous papers by the same researchers.  What I found were studies written by people who clearly believe that weight loss is all about calories and that low-fat diets are the best way to keep calories in check.  Here are some choice quotes.  (I’m not going to italicize them because it’s a lot of text to read.)

“These results show that energy intake increases as dietary fat content increases across the usual range of dietary fat consumed in the United States. Even small reductions in dietary fat could help in lowering total energy intake and reducing weight gain in the population.”

“Our current food supply is high in fat, and high fat diets have been suggested to promote obesity by increasing energy intake, thus increasing the probability of positive energy balance and weight gain.”

“Although there are many environmental factors promoting excess energy intake and discouraging energy expenditure, it is clear that consumption of a high fat diet increases the likelihood of obesity and that the risk of obesity is low in individuals consuming low fat diets. On the basis of the available data, the current public health recommendations to lower dietary fat intake appear to be appropriate.”

“Despite changes in the diet over time, the variables associated with long-term maintenance of weight loss were the same: continued consumption of a low-calorie diet with moderate fat intake, limited fast food, and high levels of physical activity.”

“People definitely lose weight on low-carbohydrate diets. However, there is no evidence that the weight loss can be sustained over time. In addition, there are concerns about the long-term nutritional quality and safety of the low-carbohydrate diet, especially in regards to its effects on cardiovascular health.”

“Weight loss occurs with low-carbohydrate diets because people restrict caloric intake on these diets, producing a short-term negative energy balance. It is less clear whether they can stay with these diets in the long term and maintain their weight loss. It is also not clear whether the diets are safe to use for years at a time.”

“Control of portion size, consumption of a diet low in fat and energy density, and regular physical activity are behaviors that protect against obesity, but it is becoming difficult to adopt and maintain these behaviors in the current environment.”

“Using data from national surveys, we estimate that affecting energy balance by 100 kilocalories per day (by a combination of reductions in energy intake and increases in physical activity) could prevent weight gain in most of the population.”

Read that last one again.  Cutting just 100 per calories per day would do the trick, because it’s all about the calories, right?  Now read this one:

“To determine the optimal energy intake of very-low-calorie diets, 76 obese women were randomly assigned, in a double-blind fashion, to one of three liquid-formula diets: 420 kcal/d, 660 kcal/d, or 800 kcal/d. Weight, body composition, symptoms, mood, and acceptability of the diet were assessed throughout the 6-mo study. There were no significant differences in weight losses or changes in body composition among the three dietary conditions at the end of treatment.”

The difference between 420 calories per day and 800 calories per day for six months is 69,000 calories.  If you believe every 3500 calories equals a pound of fat, the women in the 420-calorie group should have lost an extra 20 pounds.  But they didn’t.  So obviously the body can adjust, which means cutting 100 calories per day isn’t the solution to obesity.  Those last two conclusions are from two different authors on the Low-Fat vs. Low-Carb study.  Perhaps they should get together for a drink and compare previous findings.

I know I’m getting long-winded here, but bear with me.  Given this group’s previous enthusiasm for low-fat diets, I doubt they were excited about the new study’s results, which clearly favored low-carb.  That’s why I’m suspicious that the low-carb group ended up on what amounted to a maintenance diet within a year, and it’s why I’m doubly suspicious that the two-year results included estimates for dropouts.

So just for fun, let’s compare the results at 6 months.  At that point, the dropout rate was still low, both groups were trying to lose weight, and the low-carb group would have been on a true low-carb diet.

Weight Loss:
Low-fat:  25 pounds
Low-carb: 27 pounds

That result alone should be a wake-up call.  We’re talking about people — two- thirds of them women — who weighed an average of 226 pounds.  A 1500-calorie diet is pretty restrictive for someone that heavy.  And yet the low-carb group, with no calorie restrictions at all, lost a bit more.  Did they end up eating less even without a calorie limit?  We don’t know, because the investigators didn’t tell us.  But if they did eat less, that should tell us something about which diet controls appetite naturally, and if they didn’t eat less, somebody owes the country a huge apology for telling us to count calories.

Triglycerides:
Low-fat:  -24.3
Low-carb: -40.06

HDL:
Low-fat:  + 0.89
Low-carb: + 6.21

Those two results should have been the final nail in the coffin of the Lipid Hypothesis and the low-fat diet.  Total cholesterol and LDL are lousy predictors of heart disease and always have been.  But the ratio of Triglycerides/HDL is actually a pretty decent predictor, most likely because it serves a proxy for large vs. small LDL.  The lower the ratio, the larger and fluffier your LDL. Ideally, that ratio should be less than 2.0.  (Mine was 1.1 at last checkup.)  Here is the change in that ratio at six months for both groups:

Low-fat at baseline:  124 / 45.4 = 2.73
Low-fat at 6 months:  99.7 / 46.3 = 2.15

Low-carb at baseline:  113 / 46.2 = 2.44
Low-carb at 6 months:   73 / 52.4 = 1.39

After six months, the group not counting calories and eating unlimited amounts of “artery-clogging saturated fat” lost more weight and showed a much more dramatic improvement in cardiovascular markers.  After 12 months, the results still favored the low-carb group, although both groups backslid a bit. 

And then wouldn’t you know it, by the end of two years, results were similar across the board, except for the HDL.  And all the investigators had to do to achieve that convergence was instruct the low-carb group to increase their carbs and include estimated results for all the drop-outs.

I can’t help but wonder if they did that for a reason.

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82 thoughts on “Another Biased Study? Maybe …

  1. kib

    I’d like to address something written by Paul451:

    “… also shows the following BIAS built-in to those who ran it, and that is: “Geeez, sooner or later you HAVE to bring carbs back into your diet; they’re too important for good health to leave out for very long!”

    Yes, I see the exact same premise. The only thing LC diets lack are frugality, because grain and sugar based carbs are CHEAP fillers. We have had about 100 years of glorifying the value of grain in the diet, but it’s NOT for nutritional reasons, unless the population at some point was starving from lack of calories. By and large, grains are easy to grow, easy to store and easy to manipulate, which makes them ideal vehicles for corporate use / profit. Now we’ve added the incentive of farm subsidies to make grain-based carbs even more of an economic staple. “Eat Your Wheaties” is *not* a statement of nutritional necessity, it’s an advertizing slogan!

    Reply
  2. kib

    Edit to above: I considered corn a “grain”, which isn’t technically correct, but corn can be lumped in with grain-based carbs for the purposes of my post.

    I believe wheat and corn are both technically grasses.

    Reply
  3. Lori

    Re: frugality, I don’t know about anyone else, but I’m saving over $900 a year eating a low-carb diet. I spend $13 a month more on groceries, but I’m saving money on prescription acid blockers, skin products and trips to the chiropractor for aches and pains that suddenly disappeared when I cut the carbs. The details are on my blog: http://relievemypain.blogspot.com/2010/06/is-low-carb-expensive-diet.html

    Likewise here. No painkillers, no antacids, no psoriasis creams. We moved to Tennessee a year ago, and I haven’t even bothered to find a doctor yet.

    Reply
  4. Lori

    Re: frugality, I don’t know about anyone else, but I’m saving over $900 a year eating a low-carb diet. I spend $13 a month more on groceries, but I’m saving money on prescription acid blockers, skin products and trips to the chiropractor for aches and pains that suddenly disappeared when I cut the carbs. The details are on my blog: http://relievemypain.blogspot.com/2010/06/is-low-carb-expensive-diet.html

    Likewise here. No painkillers, no antacids, no psoriasis creams. We moved to Tennessee a year ago, and I haven’t even bothered to find a doctor yet.

    Reply
  5. Bruce

    Tom,

    I didn’t know how to send you this, other through comments.

    From “Marks Daily Apple” weekend links.

    http://www.geekologie.com/2010/08/mmmm_meaty_skiny_the_kfc_skinw.php

    I know we had spoke (written) of this before. Finally, a commercial use for the chicken skin!! You had said that this is your daughters favorite part also. Rejoice!

    Your timing is impeccable. My wife just decided this past weekend to fry up some chicken skins. She used a bit too much salt on the first attempt, so we’ll have to try again next we remove the skin from some chicken.

    Reply
  6. Laurie

    J. Swift “It is useless to attempt to reason a man out of a thing he was never reasoned into”. I think the Ornish trolls are seeking comfort and explanations for why they feel so cr@ppy (just like I was BT- before Taubes), and no amount of reasoned argument will convince the ‘carbo-brain’ addled to stop eating neolithic ‘foods’. It is sad really, but I have enough work running my own (better now) life and cannot waste time arguing for high animal fat fat fat fat diets. The poorly concluded observational studies are worthless and there is a vast sea of informative, intriguing studies and papers linking hyperinsulinemia to diseases of civilization, leaky blood-brain barriers, allowing opioid addictive compounds in wheat (which can get across that once thought inviolable BBB) to penetrate the brain, that wheat proteins stimulate insulin secretion, insulin can cause artery cells to convert to BONE cells (osteoblasts), and etc.
    That, and much much more information, is totally more compelling than any ‘study’ confirming the ‘carbs-are-essential-to-human-health-in- the- 21st-century’ error. YOU CANNOT REALLY PROVE A POSITIVE. You can get closer and closer to the most likely cause of DOC’s, and you can absolutely DISPROVE a positive. The ‘lipid causes heart disease hypothesis’ is DEAD, disproven, moribund, wrong. We need to move on to greener pastures for more fruitful research ideas and let the ruminants eat those grasses instead of us and let the fruit bats eat the fruit because the grasses are driving humans (the ones still eating those unfit for human consumption cereals) insane and killing the rest by a thousand slow, debilitating cuts.

    It’s kind of amusing the way these vegetarian evangelists keep showing up and 1) spouting the same old poorly-designed observational studies as some kind of proof, and 2) expecting (apparently) that they’ll convert me to vegetarianism. Considering that I already tried vegetarianism and only got fatter and sicker as a result, citing a handful of biased studies conducted by other vegetarian evangelists isn’t going to convince me to repeat that mistake.

    Reply
  7. Dan

    Speaking of flawed studies and flawed actions, I recently saw two articles at Diabetes Health. The first was a government-sponsored healthy kids program that failed to produce any difference in weight loss over the “control” schools.

    http://www.diabeteshealth.com/read/2010/08/08/6802/obesity-intervention-study-produces-mixed-results/

    Of course, even though one government intervention failed, our elected representatives in the senate voted unanimously to start another “healthy eating” program for schools.

    http://www.diabeteshealth.com/read/2010/08/09/6801/healthy-hunger-free-kids-act/

    What do you expect????

    I also want to add that Diabetes Health does publish low carb stories and information along with low fat, so it is a good resource. On the same page is an article about a successful low carb study.

    http://www.diabeteshealth.com/read/2010/08/07/6800/lower-carb-diet-better-than-low-fat-for-obese-insulin-resistant-women-/

    Too bad our elected representatives didn’t see that. However, I wish the government would just get out of the nutrition business.

    Like I’ve said before, when a government program fails, they treat it as evidence that we need to do the same thing again, only bigger.

    Reply
  8. Paul451

    I hate to comment twice on the same thread, but I have to say the exchange with “T” was worth at least the price of admission! (lol).

    Note to T: Please, please, please read “Good Calories, Bad Calories”.

    Reply
  9. T

    Diets that focus on the macronutrient content of a diet such as low carbohydrate diets or low fat diets are doomed to fail as the focus of these diets do not tend to incorporate micronutrient density, and fail to encourage people to consume foods that are dense in micronutrients, which is why many studies simply end up merely comparing two rubbish dumps. Unless an effort is made to focus on the nutrient density of the carbohydrates being consumed in diets high in carbohydrates, studies are generally just comparing patients who consume a large percentage of their calories from low-nutrient refined carbohydrates, such as flour and sugar, not micronutrient dense foods like tomatoes and berries. Many studies place all carbohydrate rich food together despite significant differences that different types of carbohydrates rich foods play in the role of weight loss and human health.
    One of the reasons so many bloggers and advocates of carbohydrate restricted diets believe they can significantly limit carbohydrates is because they are simply looking at whether the macronutrients are essential part of the diet, and fail to understand the important role in prevention of disease played by tens of thousands of micronutrients including photochemicals, antioxidants and carotenoids, nutrients that are exclusively found in plant foods, of which contain at least modest amount of carbohydrates. For example, “a 60-year study of 4,999 participants found those who consumed more fruit in their childhood (highest quartile) were 38 percent less likely to develop cancer of all types as adults.” [1]

    A study published by Joel Fuhrman, MD, author of the best seller “Eat to Live”, took a micronutrient dense vegetable based approach, that had tremendous success with patients who adhered to the diet, with an average weight loss of 53 pounds (24kg) over the period of two years, with none of the patients ever gaining weight over the entire period of the study. [2] Not only has the diet advocated by Dr Fuhrman shown to decrease LDL cholesterol greater than what is achievable with other diets, it can also decreases LDL further than what is achievable with cholesterol lowering statins. [3]
    Joel Fuhrman is also about to publish a peer-reviewed study in a medical journal carried out in conjunction with researchers from the University of Sothern California, called “The Changing Perception of Hunger Study” with over 700 participants, of which 90% who followed this diet 90% of the time reported a change in perception of hunger, and over 500 reported a loss of the addictive drive to overeat. More information about this study, including the reasons to why a high nutrient diet is the most effective way to lose and keep weight off can be viewed in the following presentation: http://www.livestream.com/drfuhrman/folder?utm_source=lsplayer&utm_medium=ui-more-videos&utm_campaign=drfuhrman&utm_content=drfuhrman
    Joel Fuhrman MD will also soon be publishing a study on patients following his recommended diet that “demonstrated that 9 out of 10 diabetics were able to come off all medications and have normal glucose readings “. More information can be found here: http://www.diseaseproof.com/archives/diabetes-diabetes-alert.html

    Once again, you are taking the benefits of giving up sugar and white flour and ascribing them to a “plant-based diet.” Yes, it’s important to eat nutrient-dense foods. So any diet that eliminates garbage like sugar and white flour will produce improvements. That’s not proof that “plant-based diets” are superior. It’s proof that giving up garbage foods is a great idea, and exactly what we recommend here.

    You are also assuming, based on nothing whatsoever, that proponents of paleo or low-carb diets recommend giving up all plant foods. We don’t. (You might try reading a book or two by paleo-diet authors.) We recommend giving up sugar and grains, certainly, but encourage people to eat a wide variety of low-starch vegetables and low-sugar fruits.

    If Furhman’s diet truly drives LDL levels very low, to me that’s a reason to avoid his advice. I don’t want my LDL level low. I kind of enjoy having a body that’s highly resistant to infections, despression, stroke and cancer. I want my LDL nice and high. I also want my LDL to be the large, fluffy variety … and given my very low triglycerides and very high HDL, that’s almost certainly the case.

    Reply
  10. Bruce

    Tom,

    I didn’t know how to send you this, other through comments.

    From “Marks Daily Apple” weekend links.

    http://www.geekologie.com/2010/08/mmmm_meaty_skiny_the_kfc_skinw.php

    I know we had spoke (written) of this before. Finally, a commercial use for the chicken skin!! You had said that this is your daughters favorite part also. Rejoice!

    Your timing is impeccable. My wife just decided this past weekend to fry up some chicken skins. She used a bit too much salt on the first attempt, so we’ll have to try again next we remove the skin from some chicken.

    Reply
  11. Laurie

    J. Swift “It is useless to attempt to reason a man out of a thing he was never reasoned into”. I think the Ornish trolls are seeking comfort and explanations for why they feel so cr@ppy (just like I was BT- before Taubes), and no amount of reasoned argument will convince the ‘carbo-brain’ addled to stop eating neolithic ‘foods’. It is sad really, but I have enough work running my own (better now) life and cannot waste time arguing for high animal fat fat fat fat diets. The poorly concluded observational studies are worthless and there is a vast sea of informative, intriguing studies and papers linking hyperinsulinemia to diseases of civilization, leaky blood-brain barriers, allowing opioid addictive compounds in wheat (which can get across that once thought inviolable BBB) to penetrate the brain, that wheat proteins stimulate insulin secretion, insulin can cause artery cells to convert to BONE cells (osteoblasts), and etc.
    That, and much much more information, is totally more compelling than any ‘study’ confirming the ‘carbs-are-essential-to-human-health-in- the- 21st-century’ error. YOU CANNOT REALLY PROVE A POSITIVE. You can get closer and closer to the most likely cause of DOC’s, and you can absolutely DISPROVE a positive. The ‘lipid causes heart disease hypothesis’ is DEAD, disproven, moribund, wrong. We need to move on to greener pastures for more fruitful research ideas and let the ruminants eat those grasses instead of us and let the fruit bats eat the fruit because the grasses are driving humans (the ones still eating those unfit for human consumption cereals) insane and killing the rest by a thousand slow, debilitating cuts.

    It’s kind of amusing the way these vegetarian evangelists keep showing up and 1) spouting the same old poorly-designed observational studies as some kind of proof, and 2) expecting (apparently) that they’ll convert me to vegetarianism. Considering that I already tried vegetarianism and only got fatter and sicker as a result, citing a handful of biased studies conducted by other vegetarian evangelists isn’t going to convince me to repeat that mistake.

    Reply
  12. Dan

    Speaking of flawed studies and flawed actions, I recently saw two articles at Diabetes Health. The first was a government-sponsored healthy kids program that failed to produce any difference in weight loss over the “control” schools.

    http://www.diabeteshealth.com/read/2010/08/08/6802/obesity-intervention-study-produces-mixed-results/

    Of course, even though one government intervention failed, our elected representatives in the senate voted unanimously to start another “healthy eating” program for schools.

    http://www.diabeteshealth.com/read/2010/08/09/6801/healthy-hunger-free-kids-act/

    What do you expect????

    I also want to add that Diabetes Health does publish low carb stories and information along with low fat, so it is a good resource. On the same page is an article about a successful low carb study.

    http://www.diabeteshealth.com/read/2010/08/07/6800/lower-carb-diet-better-than-low-fat-for-obese-insulin-resistant-women-/

    Too bad our elected representatives didn’t see that. However, I wish the government would just get out of the nutrition business.

    Like I’ve said before, when a government program fails, they treat it as evidence that we need to do the same thing again, only bigger.

    Reply
  13. k_the_c

    Example of someone giving up veganism:

    http://tynan.net/ieatmeat

    “Why?

    The main reason I made the switch is this: there are too many people an each side of the fence. Half of nutritional scientists say that meat is the best thing ever for you. The other half say that it will kill you. On the other hand, EVERY nutritional scientist says that refined carbohydrates will kill you.”

    Well done.

    Reply
  14. Paul451

    I hate to comment twice on the same thread, but I have to say the exchange with “T” was worth at least the price of admission! (lol).

    Note to T: Please, please, please read “Good Calories, Bad Calories”.

    Reply
  15. T

    Diets that focus on the macronutrient content of a diet such as low carbohydrate diets or low fat diets are doomed to fail as the focus of these diets do not tend to incorporate micronutrient density, and fail to encourage people to consume foods that are dense in micronutrients, which is why many studies simply end up merely comparing two rubbish dumps. Unless an effort is made to focus on the nutrient density of the carbohydrates being consumed in diets high in carbohydrates, studies are generally just comparing patients who consume a large percentage of their calories from low-nutrient refined carbohydrates, such as flour and sugar, not micronutrient dense foods like tomatoes and berries. Many studies place all carbohydrate rich food together despite significant differences that different types of carbohydrates rich foods play in the role of weight loss and human health.
    One of the reasons so many bloggers and advocates of carbohydrate restricted diets believe they can significantly limit carbohydrates is because they are simply looking at whether the macronutrients are essential part of the diet, and fail to understand the important role in prevention of disease played by tens of thousands of micronutrients including photochemicals, antioxidants and carotenoids, nutrients that are exclusively found in plant foods, of which contain at least modest amount of carbohydrates. For example, “a 60-year study of 4,999 participants found those who consumed more fruit in their childhood (highest quartile) were 38 percent less likely to develop cancer of all types as adults.” [1]

    A study published by Joel Fuhrman, MD, author of the best seller “Eat to Live”, took a micronutrient dense vegetable based approach, that had tremendous success with patients who adhered to the diet, with an average weight loss of 53 pounds (24kg) over the period of two years, with none of the patients ever gaining weight over the entire period of the study. [2] Not only has the diet advocated by Dr Fuhrman shown to decrease LDL cholesterol greater than what is achievable with other diets, it can also decreases LDL further than what is achievable with cholesterol lowering statins. [3]
    Joel Fuhrman is also about to publish a peer-reviewed study in a medical journal carried out in conjunction with researchers from the University of Sothern California, called “The Changing Perception of Hunger Study” with over 700 participants, of which 90% who followed this diet 90% of the time reported a change in perception of hunger, and over 500 reported a loss of the addictive drive to overeat. More information about this study, including the reasons to why a high nutrient diet is the most effective way to lose and keep weight off can be viewed in the following presentation: http://www.livestream.com/drfuhrman/folder?utm_source=lsplayer&utm_medium=ui-more-videos&utm_campaign=drfuhrman&utm_content=drfuhrman
    Joel Fuhrman MD will also soon be publishing a study on patients following his recommended diet that “demonstrated that 9 out of 10 diabetics were able to come off all medications and have normal glucose readings “. More information can be found here: http://www.diseaseproof.com/archives/diabetes-diabetes-alert.html

    Once again, you are taking the benefits of giving up sugar and white flour and ascribing them to a “plant-based diet.” Yes, it’s important to eat nutrient-dense foods. So any diet that eliminates garbage like sugar and white flour will produce improvements. That’s not proof that “plant-based diets” are superior. It’s proof that giving up garbage foods is a great idea, and exactly what we recommend here.

    You are also assuming, based on nothing whatsoever, that proponents of paleo or low-carb diets recommend giving up all plant foods. We don’t. (You might try reading a book or two by paleo-diet authors.) We recommend giving up sugar and grains, certainly, but encourage people to eat a wide variety of low-starch vegetables and low-sugar fruits.

    If Furhman’s diet truly drives LDL levels very low, to me that’s a reason to avoid his advice. I don’t want my LDL level low. I kind of enjoy having a body that’s highly resistant to infections, despression, stroke and cancer. I want my LDL nice and high. I also want my LDL to be the large, fluffy variety … and given my very low triglycerides and very high HDL, that’s almost certainly the case.

    Reply
  16. k_the_c

    Example of someone giving up veganism:

    http://tynan.net/ieatmeat

    “Why?

    The main reason I made the switch is this: there are too many people an each side of the fence. Half of nutritional scientists say that meat is the best thing ever for you. The other half say that it will kill you. On the other hand, EVERY nutritional scientist says that refined carbohydrates will kill you.”

    Well done.

    Reply
  17. Jae

    Thanks for this excellent analysis. This is probably my favorite of your posts so far. Keep them coming!

    Reply
  18. Merope

    “T” accuses “low-carb advocates” about “flaming about how good they feel on their fad diet”, but neglects to acknowledge that he is, himself, flaming.

    His very long text, unbroken by any kind of editing to make it easier to read, which would at least have been a polite thing to do, seems to have been authored in one piece and then inserted into the comments area according to how many words were allowed at a time.

    I wonder, if I search for his phrases, will I find that he routinely posts them to all the low-carb-friendly blogs and sites he finds?

    I had to chuckle when he referred to low-carb as a “fad” diet. Grains and sugar have been part of the human diet for a tiny fraction of our time on earth. If anything is a “fad” diet, it’s the low-fat diet.

    Reply
  19. Janice H

    Here’s a little background on my “healthy diet” that I ate for years. After I got married I put on about 20 pounds which slowly crept up. I always had digestion issues, constipation, canker sores, chronic muscle pain, edema, high blood pressure and the list goes on. Gosh I did have really low cholesterol though!
    I tried the low fat diet for years where I would eat plates of rice (yes even brown) with chicken breast and topped with salsa. I exercised. I still had these issues.
    Now that I am 53 my issues have worsened. I did start reading up on the issues I have been dealing with and a bell finally went off in my head. Good Calories, Bad Calories made me cry. This could be from grain not from fat and meat. So I started slowly shifting over and what did I find? My edema, high blood pressure, canker sores, muscle pain have either totally gone away or lessened. Unfortunately I did not find out in time & found out I have osteopenia & also just found out I have celiac disease. I’m convinced that it’s not just me that shouldn’t eat wheat, it’s everyone. I can’t tell you how many people around me (family & friends) have the same symptoms. My SIL has fibromyalgia and is in chronic pain. She has bone loss everywhere, especially in her jaw. I have tried to talk to her about the danger of wheat/gluten but is on overload with so much conflicting info out there. So she continues her “healthy diet”.
    My parents had similar symptoms: muscle pain, edema, diabetes, canker sores, high blood pressure and then unfortunately they both died way too young from cancer. I pray I’m not too late to have their fate & can turn this around. I’m tired of the bad information shoved down our throats by people who don’t know what they are talking about. We’ve been doing the so called healthy diets for years and look at us all. We’re a mess.

    That’s the real shame of it: the people who want to be healthy, try hard to be healthy, but have been given the wrong information.

    Reply
  20. Merope

    “T” accuses “low-carb advocates” about “flaming about how good they feel on their fad diet”, but neglects to acknowledge that he is, himself, flaming.

    His very long text, unbroken by any kind of editing to make it easier to read, which would at least have been a polite thing to do, seems to have been authored in one piece and then inserted into the comments area according to how many words were allowed at a time.

    I wonder, if I search for his phrases, will I find that he routinely posts them to all the low-carb-friendly blogs and sites he finds?

    I had to chuckle when he referred to low-carb as a “fad” diet. Grains and sugar have been part of the human diet for a tiny fraction of our time on earth. If anything is a “fad” diet, it’s the low-fat diet.

    Reply
  21. Janice H

    Here’s a little background on my “healthy diet” that I ate for years. After I got married I put on about 20 pounds which slowly crept up. I always had digestion issues, constipation, canker sores, chronic muscle pain, edema, high blood pressure and the list goes on. Gosh I did have really low cholesterol though!
    I tried the low fat diet for years where I would eat plates of rice (yes even brown) with chicken breast and topped with salsa. I exercised. I still had these issues.
    Now that I am 53 my issues have worsened. I did start reading up on the issues I have been dealing with and a bell finally went off in my head. Good Calories, Bad Calories made me cry. This could be from grain not from fat and meat. So I started slowly shifting over and what did I find? My edema, high blood pressure, canker sores, muscle pain have either totally gone away or lessened. Unfortunately I did not find out in time & found out I have osteopenia & also just found out I have celiac disease. I’m convinced that it’s not just me that shouldn’t eat wheat, it’s everyone. I can’t tell you how many people around me (family & friends) have the same symptoms. My SIL has fibromyalgia and is in chronic pain. She has bone loss everywhere, especially in her jaw. I have tried to talk to her about the danger of wheat/gluten but is on overload with so much conflicting info out there. So she continues her “healthy diet”.
    My parents had similar symptoms: muscle pain, edema, diabetes, canker sores, high blood pressure and then unfortunately they both died way too young from cancer. I pray I’m not too late to have their fate & can turn this around. I’m tired of the bad information shoved down our throats by people who don’t know what they are talking about. We’ve been doing the so called healthy diets for years and look at us all. We’re a mess.

    That’s the real shame of it: the people who want to be healthy, try hard to be healthy, but have been given the wrong information.

    Reply
  22. Be

    I appreciate that you gave T the air space here. Of course I am perplexed that he cited footnotes that never followed. Nah – not really as we all know most of the studies he cites and know how flawed and contradictory they are. For the life of me I can’t understand how even the scientifically curious mind can ignore facts and reality to support their pet positions (or “fad” diets). Real scientists question everything, but most of all those things they hold to be most self evident. These Diet-Heart, Low Fat, Vegans, et al are gonna have to come up with something more that scientifically explains their position let alone overrides what so many of us know from anecdotal life experience. Have you ever met a vegan who even LOOKED healthy? I haven’t and those I know have horrid health issues.

    It’s the True Believer mindset. In real science, you consider contradictory results as evidence that there’s something wrong with your hypothesis. True Believers simply sweep the contradictory evidence under the rug and focus on the few studies that support their beliefs.

    Honestly, does anyone think Joel Fuhrman and John McDougall would admit to being wrong at this point in their lives, no matter how overwhelming the proof?

    Reply
  23. Be

    I appreciate that you gave T the air space here. Of course I am perplexed that he cited footnotes that never followed. Nah – not really as we all know most of the studies he cites and know how flawed and contradictory they are. For the life of me I can’t understand how even the scientifically curious mind can ignore facts and reality to support their pet positions (or “fad” diets). Real scientists question everything, but most of all those things they hold to be most self evident. These Diet-Heart, Low Fat, Vegans, et al are gonna have to come up with something more that scientifically explains their position let alone overrides what so many of us know from anecdotal life experience. Have you ever met a vegan who even LOOKED healthy? I haven’t and those I know have horrid health issues.

    It’s the True Believer mindset. In real science, you consider contradictory results as evidence that there’s something wrong with your hypothesis. True Believers simply sweep the contradictory evidence under the rug and focus on the few studies that support their beliefs.

    Honestly, does anyone think Joel Fuhrman and John McDougall would admit to being wrong at this point in their lives, no matter how overwhelming the proof?

    Reply
  24. Carol Bardelli

    I bet whoever started the old adage “your brain needs carbohydrates,” and that equally nonsensical “you can’t cut out a whole macro nutrient group,” were big agricultural lobbyists. Our it might have been, “The Guy From CSPI!”

    Reply
  25. Carol Bardelli

    I bet whoever started the old adage “your brain needs carbohydrates,” and that equally nonsensical “you can’t cut out a whole macro nutrient group,” were big agricultural lobbyists. Our it might have been, “The Guy From CSPI!”

    Reply
  26. Debbie

    It seems they keep changing the criteria too. My own HDL (just measured last week) is decent – 66. And you can’t argue with my triglycerides – 49. But no total cholesterol number has jumped up to 280 in the past year and has my doctor just about in hysterics to get me on statins. And now suddenly LDL numbers are becoming the big players. She finally agreed to do an NMR test for me when I kept insisting that the LDL particle type was more important than the numbers. And the test showed that 90% of my LDL particles are the large, fluffy, pattern A, benign sort. But now she is saying that my ABSOLUTE NUMBER of LDL particles is what matters far more than what type they actually are. And that my LDL-P total particle count of 2018 puts me in a major high-risk category for heart disease REGARDLESS of my HDL, triglycerides, or percentage of pattern A LDL. And on it goes, until your head starts to spin and you don’t know who or what to believe.

    I’m guessing your doctor’s information on the matter was supplied by a statin-maker. They sponsor many of the continuing-education seminars. If you need more assurance that you’re not developing heart disease, perhaps you should get a plaque test.

    Reply
  27. Debbie

    It seems they keep changing the criteria too. My own HDL (just measured last week) is decent – 66. And you can’t argue with my triglycerides – 49. But no total cholesterol number has jumped up to 280 in the past year and has my doctor just about in hysterics to get me on statins. And now suddenly LDL numbers are becoming the big players. She finally agreed to do an NMR test for me when I kept insisting that the LDL particle type was more important than the numbers. And the test showed that 90% of my LDL particles are the large, fluffy, pattern A, benign sort. But now she is saying that my ABSOLUTE NUMBER of LDL particles is what matters far more than what type they actually are. And that my LDL-P total particle count of 2018 puts me in a major high-risk category for heart disease REGARDLESS of my HDL, triglycerides, or percentage of pattern A LDL. And on it goes, until your head starts to spin and you don’t know who or what to believe.

    I’m guessing your doctor’s information on the matter was supplied by a statin-maker. They sponsor many of the continuing-education seminars. If you need more assurance that you’re not developing heart disease, perhaps you should get a plaque test.

    Reply
  28. Richard David Feinman

    In answer to the suggestion of Dr. Richard Tamesis, M.D., I submitted my original ITT paper (http://www.nutritionandmetabolism.com/content/pdf/1743-7075-6-1.pdf) to Annals of Internal Medicine. Abstract of that version included this summary:

    It is argued here that because the idea is counter-intuitive it requires justification in individual cases. In addition, there is an inherent statistical fallacy leading to wide misuse. In these case, ITT tends to reduce information by collapsing independent variables, compliance and effectiveness, into a single variable without necessarily demonstrating that they are linked. ITT is appropriate in large epidemiologic trials where all that is known is the assignment or identification with a particular group, but here it needs no special name. Because misuse is so common and has the consequence of making an effective treatment look worse, ITT should probably never be used.

    This is stronger but probably more accurate than my recent post http://wp.me/16vK0.
    I couldn’t find the reply from Annals but, while they didn’t say I was a crank, neither were they inclined to publish the paper. Foster’s paper was in Annals which tells you something.

    Reply
  29. Richard David Feinman

    In answer to the suggestion of Dr. Richard Tamesis, M.D., I submitted my original ITT paper (http://www.nutritionandmetabolism.com/content/pdf/1743-7075-6-1.pdf) to Annals of Internal Medicine. Abstract of that version included this summary:

    It is argued here that because the idea is counter-intuitive it requires justification in individual cases. In addition, there is an inherent statistical fallacy leading to wide misuse. In these case, ITT tends to reduce information by collapsing independent variables, compliance and effectiveness, into a single variable without necessarily demonstrating that they are linked. ITT is appropriate in large epidemiologic trials where all that is known is the assignment or identification with a particular group, but here it needs no special name. Because misuse is so common and has the consequence of making an effective treatment look worse, ITT should probably never be used.

    This is stronger but probably more accurate than my recent post http://wp.me/16vK0.
    I couldn’t find the reply from Annals but, while they didn’t say I was a crank, neither were they inclined to publish the paper. Foster’s paper was in Annals which tells you something.

    Reply

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