Archive for September, 2010

The following is a transcript of an online debate between me and someone who works at a medical center and is either a nutritionist or has great respect for the advice they dole out.  This should give you an idea of what sick people are being told about diet.  My mom received the same advice from a nutrionist, but between my lectures and the books by Drs. Eades & Eades, she was persuaded otherwise.

Nutritionist comments are in italics, mine are plain text.

it’s not wise to cut grains out completely. your body needs varieties of different foods, grain included.

Humans lived without grains for 99% of their time on earth. Many native cultures still live without eating grains, which require processing to be edible. On what are you basing your claim that it’s “not wise” to cut out grains completely? (I have, and all that’s happened is several ailments have gone away.)

well good for your individual results. humans have been eating grains for at least 10,000 years, some evidence found it going way further back. granted it only seems like a blink of the eye, but it a significant amount of time nonetheless.

basically you need carbs to function. you need them for your brain and also to exercise. i’m not saying go out and eat a bunch of white bleached and enriched bread, just eat healthy grains.

Evolution doesn’t work that quickly. Some humans have adapted to grains, but many have not. No humans NEED grains to be healthy, and grains can have negative effects on health. The lectins in grains can lead to autoimmune diseases, to name just one. Nor do we need carbohydrates to exercise (I exercise frequently) or for brain function (I write, do standup comedy, and program software all without benefit of carbohydrates other than vegetables). Look up gluconeogenesis.

you actually do need carbs for lots of things, including the central nervous system, the kidneys, brain and muscles (including the heart). you need it cause it’s your main source of energy. without carbs your body will consume protein from your muscles. you also get carbs from fruit and veggies. and again, i’m not saying go eat a bunch of refined carbs, but brown rice, whole grain pasta, and multigrain breads should be a moderate part of your diet.

With all due respect, you’re simply stating an opinion with no facts to back it up. If you consume enough fat and protein, your body will not digest your muscles. I’ve gained quite a bit of muscle since cutting carbs. Carbs are the “main source of energy” as a matter of convenience in grain-growing societies, not as a biological necessity. Most of your body will happily burn fat for fuel — that’s why your body stores energy as fat. (Kind of makes sense, doesn’t it?)

your body will burn muscle and fat as a last resort, it’s a survival mechanism. and with all due respect, you don’t know my educational background, therefore are not qualified to call my opinion just that. an opinion, and with no facts nonetheless. i don’t know if you’re promoting this film for someone or if it’s your film, but arguing on youtube is not a good way to endorse a product.

What is your scientific basis for the “last resort” theory? Without fat or protein, you’ll die. Without carbs, you’ll live just fine, as many hunting and fishing tribes throughout history did. My ancestors lived in Ireland. Pre-agriculture, how did they manage to get all that “essential” carbohydrate? No potatoes, no grain farming, no wild fruits or vegetables except in season. The idea that we evolved to “need” grains and starches a mere few thousand years later is absurd.

it’s a well known medical fact in the order in which the body burns its resources. first carbs, then fat, then muscle. therefore, it’s a last resort. if you didn’t know that then i suggest you take a nutrition class.

Let’s see … biologically, we evolved to “need” foods that are new to the human diet, that were mostly unavailable before agriculture and transportation, and require extensive processing to be edible. (Try plucking wheat and eating it.) But the foods that were abundant and can be eaten immediately and raw — game meats and fish — are “last resort” sources of fuel, and our bodies chose a “last resort” form of storing calories, a.k.a. fat. Wow, evolution is strange indeed.

We burn carbs first to avoid the biological emergency of high blood sugar, which is toxic — therefore, it’s a survival mechanism — not because carbs are the body’s preferred fuel. If you didn’t know that, I suggest you take a biochemistry class.

[NOTE:  It occurred to me later that our bodies will burn alcohol before anything else.  According to the nutritionist's logic, that makes alcohol our preferred fuel.  All in favor a 60% alcohol diet, raise your hands.]

funny, i always though eating meat raw was dangerous as well. believe what you must, but stop telling everyone to alter their diet when you’re obviously not a doctor nor a nutritionist.

Your lack of knowledge is becoming more apparent. Eating a fresh kill isn’t dangerous, and humans did it for ages. Bear Grylls does it on Man vs. Wild and lives to tell. Cooking provided an advantage by allowing meat to be kept longer without spoiling.

No, I’m not a doctor or a nutritionist, which is why I don’t offer lousy, unscientific, because-my-nutrition-textbook-­said-so advice such as “you need grains.” (Works for doctors … then they can prescribe arthritis drugs.)

“No, I’m not a doctor or a nutritionist” then stop pretending you know what people need. what works for you may not work for someone else.

Gosh, yes, because only a doctor — who is trained to prescribe drugs and spends a scant few hours in nutrition classes during all of medical school — can talk intelligently about nutrition. Certainly people who merely read dozens of books and hundreds of academic papers and regularly interview researchers aren’t qualified. As for not telling other people what to eat, you’re the one who felt compelled to encourage people to eat grains — which will make many of them ill.

but a nutritionist is specifically trained to be able to tell certain people how they should eat, unlike you who bunch everyone together and say no grain for you. asians are the healthiest people on earth, what is one of the staples in their diet? rice. hello. it’s a grain. if you would pay attention to what i said at the beginning you would understand that i’m not saying people should eat refined carbs, but veggies, fruits and beans, and whole wheat are needed in your diet.

Nutritionists are trained to follow the food pyramid, which isn’t based on science. It’s based on the USDA’s desire to sell grains.

Rice is the least problematic grain, but can still cause blood-sugar spikes for people whose ancestors didn’t come from rice-eating areas. Nobody “needs” rice or especially whole wheat, which can be disastrous. Read Loren Cordain’s paper on grains, lectins and diseases or Dr. William Davis’ posts on wheat … then tell me we need whole wheat.

they do not only follow the food pyramid, they use common sense. you wouldn’t give everyone 6-7 servings of grain. the USDA isn’t out to get us, neither are the majority of doctors and by encouraging people by saying eating tons of fast food isn’t bad for you is ridiculous. come work where i do at a dialysis center for one day and you’ll figure out why.

It isn’t common sense to promote a food pyramid with a base built on a food — grains — that cause health problems for many people. It isn’t common sense to tell people in a population where insulin resistance is rampant to consume 300 carbs per day. That’s partly why dialysis centers are necessary.

High blood sugar damages kidneys. High-carb diets spike blood sugar. The last thing people with kidney problems need is advice from carb-promoting nutritionists.

dialysis patients don’t need to limit grains, and some are encouraged because they need to gain weight. however, because of levels of phosphorus, whole wheat shouldn’t be consumed. but they’re encouraged to eat white, rye and sourdough bread. continue to argue if you must. it’s not the way to win customers.

So you encourage dialysis patients to eat white bread, a sure-fire way to spike blood sugar?!!  Lord help us.  Business must be booming.

white bread doesn’t have as much phosphorus, therefore better for them then whole wheat. again, don’t try to understand something you have no education in.

I see … because “don’t eat bread or other foods that raise your blood sugar” would kill them outright.

High blood sugar damages kidneys. White bread spikes blood sugar. Which part of this equation am I failing to understand because I did’t attend nutritionist school?

too much carbohydrates can result in high blood sugar levels, and too little can result in low blood sugar levels. you need to go to your nutritionist to see the amount you need. dialysis patients can’t eat a lot of foods as it is, so moderately eating white bread is needed to keep their weight up. that’s what you’re failing to understand.

Well, that make sense. After damaging their kidneys with foods that spike blood sugar, dialysis patients need white bread to raise their blood sugar and keep their weight up. And this therefore proves your original contention that all humans require grains in their diets, especially the whole grains that dialysis patients can’t eat because it would further damage their kidneys.

I stand corrected.

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Time to clean out the bookmarks in my browser again.  Here are some of the items I saved in recent months but never found worthy of a full post:

Diet Purists Are Mentally Unbalanced

All this time, I’ve been thinking I changed my diet to improve my body. Turns out I was just losing my mind.  “An obsession with healthy eating” has been labeled as a “serious psychological condition” and (this is the really important part) given a Latin-sounding name — orthorexia nervosa.  Once you give an otherwise benign behavior or condition a Latin-sounding name, that makes it an official disease … like when “married for 35 years” was renamed erectile dysfunction.  Here are the symptoms of orthorexia nervosa:

Orthorexics commonly have rigid rules around eating. Refusing to touch sugar, salt, caffeine, alcohol, wheat, gluten, yeast, soya, corn and dairy foods is just the start of their diet restrictions. Any foods that have come into contact with pesticides, herbicides or contain artificial additives are also out. The obsession about which foods are “good” and which are “bad” means orthorexics can end up malnourished.

If untreated, the disease can apparently lead to all kinds of crazy behaviors:

“It’s everywhere, from the people who think it’s normal if their friends stop eating entire food groups, to the trainers in the gym who promote certain foods to enhance performance, to the proliferation of nutritionists, dieticians and naturopaths who believe in curing problems through entirely natural methods such as sunlight and massage.”

That means nutrition fanatic /  massage therapist /sun-worshipper /carb avoider  Dana Carpender is officially wacko.  I could’ve sworn she’s just spunky.

The article didn’t specify, but I’m guessing treatment involves a strict regimen of beer, pizza, Little Debbie Snack Cakes, corn dogs, fructose-sweetened soy milk, frappucinos, and Chunky Monkey ice cream. Oh, and statins too, since they cure pretty much everything.

Give me a break. If you eliminate foods you believe are bad for your health, you’re not nuts; you’re conscientious.  If you post dozens of 1000-word essays in the comments section of a blog because you believe it’s your mission to convert all non-believers to a “plant-based diet,” then you’re mentally unbalanced.

Exploding Heads

What’s the best way to calm people who have a stress-related condition? I vote for naming the condition Exploding Head Syndrome.

“Any idea what could be causing this, doctor?”

“Nothing to worry about.  Looks to me like a simple case of Exploding Head Syndrome. ”

“Whaaaaat?!!”

“Now, don’t get excited it’s just a  … would you mind moving away from that vase?  The shards could be dangerous.”

Marie Raymond sometimes wakes up in the middle of the night, heart pounding, freaked out by the sound of her name being shouted loud and clear. Other times she’ll be awakened by the sound of a huge crash, as if someone has broken a window or knocked over a set of dishes. After dealing with it off and on for the last several months, Raymond believes she may have exploding head syndrome.

As strange as the name sounds, exploding head syndrome is actually a rare and relatively undocumented sleep phenomenon. While sleeping or dozing, a person with the condition hears a terrifically loud sound in their head, such as a bomb exploding, a clash of cymbals or a gun going off.

I know how Ms. Raymond feels. In college, I once jerked awake after hearing banging, breaking glass, and my name being shouted.  Turned out it was just my roommate coming home after night of experimenting with illegal substances.

But I do wake up now and then after hearing my name called out while I’m sleeping. (Seriously, I do.)  It’s never really freaked me out, though — except for the one time I decided to answer.

“Tom!”

“Uh … yeah?”

“Just seeing if you’re still alive. Guess we have to wait awhile longer.”

“Excuse me?!”

“Nothing.”

Plains Indians Were Tall And Healthy

The buffalo-hunting Indian tribes were the tallest people in the world at time, according to a recent study:

The average adult male Plains Indian stood 172.6 centimeters tall — about 5 feet 8 inches. The next tallest people in the world at that time were Australian men, who averaged 172 centimeters. European American men of the time averaged 171 centimeters tall, and men living in European countries were typically several centimeters shorter.

These results contradict the modern image of American Indians as being sickly victims succumbing to European disease, said Richard Steckel, co-author of the study and professor of economics and anthropology at Ohio State University.

This study shows that despite the many technological advantages that the European-American settlers had over the American Indians, the Plains tribes enjoyed better health, at least nutritionally.

While the reasons for the general good health of the Plains Indians compared to whites has not been extensively studied, Steckel said several plausible theories exist. For one, the Plains Indians ate a varied diet that included a variety of native plants, as well as buffalo and other game that typically roamed the Great Plains.

That’s the good news.  The bad news is that Indians’ diet didn’t include sugar, salt, caffeine, alcohol, wheat, gluten, yeast, soya, corn, dairy foods, pesticides, herbicides or artificial additives … so while they were tall, they suffered from extremely high rates of orthorexia nervosa.

Bribery Lowers Health-Care Costs

I expect the current administration to jump all over this idea:

It has long been one of the most vexing causes of America’s skyrocketing health costs: people not taking their medicine. One-third to one-half of all patients do not take medication as prescribed, and up to one-quarter never fill prescriptions at all, experts say. Such lapses fuel more than $100 billion dollars in health costs annually because those patients often get sicker.

Now, a controversial and seemingly counterintuitive effort to tackle the problem is gaining ground: paying people money to take medicine or to comply with prescribed treatment. The idea, which is being embraced by doctors, pharmacy companies, insurers and researchers, is that paying modest financial incentives up front can save much larger costs of hospitalization.

I can’t believe it took the health experts so long to reach this conclusion.  All they have to do is read a few books on economic history and they’d learn that health-care costs were a heck of a lot lower 50 years ago because everyone was taking six or seven prescription drugs.  Now most adults only take two or three, and look where that’s gotten us.

Aetna has begun paying doctors bonuses for prescribing medication likely to prevent problems: beta blockers to prevent heart attacks, statins for diabetes sufferers. Currently, 93,000 doctors are in Aetna’s “pay for performance” program; bonuses average three percent to five percent of a practice’s base income. Even the new federal health care overhaul includes incentives, expanding a program paying pharmacists extra for helping some Medicare patients learn to take pills correctly.

So that’s how we bring down runaway health-care costs: give pharmacists federal dollars to do their jobs.

The 2010 Dietary Guidelines also suggest using financial incentives to encourage people to follow the advice. Perfect. Let’s pay farmers to produce lots of whole grains, soy products and vegetable oils, then pay people to eat them. Then when those people become fatter and sicker, we can pay pharmacists to show them how to take their medications, then pay the patients to take the medications.

While we’re at it, we should also pay psychiatrists to prescribe anti-psychotics for people who refuse to eat whole grains, soy products and vegetable oils, then pay pharmacists to mix the drugs into some grass-fed hamburger patties.

Canadian Bacon

According to a recent survey, 43% of Canadians prefer bacon over sex.  I’m not sure what to make of this one.  I can only assume the bacon is very, very good or the sex is very, very British.  Since the bacon-over-sex preference dropped significantly in French Quebec, it’s probably the latter.

As far as I know, I’ve only had sex with one Canadian, which is too small of a sample to make statistically significant comparisons to bacon.  I’d apply for a grant to conduct more research into the matter, but I’m pretty sure my wife would rescind my bacon privileges for life.

Research Endowment

Another study I wouldn’t want to explain to my wife … conducted in France (of course), with an abstract (I’m not making this up) on PubMed:

To test the effect of a woman’s bust size on the rate of help offered, 1200 male and female French motorists were tested in a hitchhiking situation. A 20-yr.-old female confederate wore a bra which permitted variation in the size of cup to vary her breast size. She stood by the side of a road frequented by hitchhikers and held out her thumb to catch a ride. Increasing the bra-size of the female-hitchhiker was significantly associated with an increase in number of male drivers, but not female drivers, who stopped to offer a ride.

Now ya tell me.  If my car ever breaks down and I need to hitchhike, I’m going to regret going low-carb and losing my boobs.  I’m not a big fan of drawing conclusions from associations, but in the case of this study, I’m pretty sure we’re looking at cause and effect.

Cow Farts Exonerated In Global-Warming Caper

I don’t know if this is good news or bad news.  I was really hoping those “Meatless Mondays” at Harvard would save Manhattan from sinking into the ocean 20 years from now.  Our only hope now is to switch to fluorescent bulbs and give our homes the warm, relaxing ambience of gas-station mini-marts.  Here’s the story:

In the past environmentalists, from Lord Stern to Sir Paul McCartney, have urged people to stop eating meat because the methane produced by cattle causes global warming. However a new study found that cattle grazed on the grasslands of China actually reduce another greenhouse gas, nitrous oxide.

Authors of the paper, published in Nature, say the research does not mean that producing livestock to eat is good for the environment in all countries. However in certain circumstances, it can be better for global warming to let animals graze on grassland. The research will reignite the argument over whether to eat red meat after other studies suggested that grass fed cattle in the UK and US can also be good for the environment as long as the animals are free range.

Free-range animals are actually good for the environment?  Well, I am shocked.  Next they’ll discover that ruminant animals have been roaming the planet for millions of years without destroying it.

Lierre Keith already figured this stuff out, but somebody needs to inform Dean Ornish.

Door-To-Door Meat

Here in my home state of Tennessee, a man was arrested for swallowing a half-burned marijuana cigarette when police stopped him for questioning.  That’s not the weird part.  The weird part is that he was selling meat door-to-door. From what I can gather, he wasn’t a successful door-to-door meat salesman, but that’s clearly due to having a lousy territory.  He should’ve been selling in Canada.  That would’ve allowed him to work a sales pitch like this:

“Good morning, ma’am.  I’m here in the neighborhood offering housewives like yourself a once-in-a-lifetime opportunity to have sex with me.”

“What?!  Go away, you pervert, eh?”

“Or we could smoke a joint and eat some of this fine bacon.”

“Listen, ya hoser, I’ll call the … oh. Would you like to come in?”

Meat Is Murder, So Murder The Meat

I guess the door-to-door meat salesman was lucky he didn’t ring this guy’s bell:

A knife-wielding man was arrested earlier this week in what police called a meat massacre at a south-central Indiana supermarket. When officers arrived, they found meat scattered everywhere in what Edinburgh police called one of the most bizarre cases they had ever investigated.

Police said Anthony Coffman, 28, used a hunting knife to cut through meat packages, throwing open containers of raw beef on the floor. He then poured dog food over some of the meat in hopes of contaminating it so it couldn’t be sold, said Edinburgh police Deputy Chief David Lutz. A store employee tried to stop Coffman, but gave up when he threatened the employee with the knife, police said.

Whoa, there, buddy!  You don’t want to stab a human!  They’re almost the metaphysical equals of cows.

Coffman told police that he is a vegetarian and gets upset when others consume beef, telling the employee that God sent him to ruin the meat and that he was trying to save little girls from food he believes would make them “chubby.”

Police think an argument earlier in the day prompted the incident. “He’d got into it with his grandmother. She was preparing a pot roast … and he was upset over that,” Lutz said. “Him and her had a few words, and then a couple hours later, he’s down there at the Jay C Food Store doing this.”

Good thing the guy doesn’t eat meat, or he might’ve become mean and aggressive.  Coffman is clearly out of his gourd.  Meat doesn’t make girls chubby … it just causes global warming.

The article didn’t say if the knife-wielding vegetarian would serve time in prison.  If so, I suspect he’ll lobby for internet privileges and occupy himself leaving 1000-word comments on my blog.

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The latest “Low-Carb Diets Are Deadly!” study, the topic of my previous post, was based on data extracted from about a dozen food questionnaires mailed out over a 20-year span.  Because so many studies rely on these questionnaires to draw headline-grabbing conclusions about associations between diets and disease, it’s important to understand just how lousy the accuracy rate is.

Twenty-five years ago, I completed one of those questionnaires as part of a wellness program sponsored by the company that employed me.  (In fact, we were all required to complete one.)  Many of us ended up laughing at the stupidity of the thing.  Imagine being a young, single male who eats at least half his meals outside the home.  Now try to accurately answer this question:

How many servings of ground beef did you consume in the previous month?

The truthful answer would’ve been “I have no friggin’ idea.”  But I was required to answer the question.  So my method of guesstimation went something like this:

Let’s see … I think I ate lunch at McDonald’s three times last week … no, wait … was it four times?  Did I have Thai food with Frank last Friday, or was that the week before?  Ah, hell, let’s say four lunches at McDonald’s.  Okay … I think maybe I had the chicken sandwich once.  No, it was twice.  No, it was once.  So I’ll say I had burgers three times.  Did I get the Double Quarter Pounder that one day?  I think I skipped breakfast and ended up eating the double.  So that’s … well, if one burger patty is a serving, I must’ve had four patties.  No idea about the whole month, so I’ll multiply four times last week by four weeks in a month and say I had sixteen burger patties.  Maybe Mexican food twice, I might’ve had beef and broccoli once … Okay, I’ll just round it to up 20 servings of beef for the month.

By the time I was halfway through the questionnaire, I was so annoyed by all the guesstimation required, I just started filling in numbers that sounded sort of believable.  I know several co-workers did likewise, because we talked about it later.

Here’s another example posted on the Diabetes Update site:

I know first hand how inaccurate the standard food frequency questionnaire is because several years ago I was a subject in a long term study that used the standard nutritionist designed food intake questionnaire. During this time I was logging my actual food intake, with weighed portions, trying to understand my own pattern of weight loss, so I knew exactly what I was eating during any given day or month.

The nutritionist associated with the study emailed me the nutritional breakdown that I had supposedly eaten, based on my answers to the standard food frequency questionnaire. It bore no relationship at all to what I had eaten either in terms of calories or the percentages of my diet represented by protein, carbs, or fat. When I offered to send the study my actual food intake, I was told that the questionnaire they were using had been carefully validated and was standard in all nutritional studies and that there was no point in looking at what I had actually eaten.

Some questionnaires lump all red meats into a single category — in other words, a fresh steak and a highly-processed frozen beef lasagna dinner are counted the same — and some even put butter and margarine into the same category … natural butter fat, artificially processed corn oil, hey, makes no difference if they both spread nicely on your dinner roll.

From this kind of data, researchers at Harvard believe they know what people ate over a 20-year period.  And since he likes their conclusions, Dean Ornish believes it too.

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I was all set to spend part of today pointing out the many flaws in the latest “Low-Carb Kills!” study, but Denise Minger beat me to it.  She wrote pretty much what I would’ve written, so I’ll let her do the talking on that subject.  I’ll save my comments for an article written by Dr. Dean Ornish, who of course jumped all over this lousy study as proof that we should all live on low-fat  vegetarian diets.

But first, in case you missed them, here are some of the headlines and lead paragraphs generated by media reporting on the study:

Low-carb, high meat diet has high risks

Comparing the health effects of two diets over more than two decades, researchers from Harvard School of Public Health and the University of Singapore found consumption of a low-carbohydrate, vegetable-based plan resulted in reduced rates of death from cardiovascular disease and cancer, and a lower rate of all-cause death overall, whereas animal-based low-carbohydrate diet were associated with a higher risk for overall mortality.

“You can have the initial Atkins-type of low-carb diet, which is loaded with sausages, bacon, steaks, and you can have healthy versions of the low-carb diet with more vegetable- or plant-based protein and fat,” said Dr Frank Hu, lead author of the study, published in the Annals of Internal Medicine.

Low carb diets might be deadly

A big concern about low carb diets is the source of fat and protein. Researchers say emphasis on fat and protein is associated with higher mortality from all causes of death in both men and women.

Vegetable-based low carb diets, on the other hand, are associated with lower mortality rates. Researchers say while the idea behind the diets are similar, the differences that affect mortality lie in specific fatty acids, protein, fiber and other vitamins.

Okay, you get the idea.  An Atkins-type diet loaded with meat will kill you.  Now here’s some of what Denise Minger — the same young blogger who recently shredded the China Study — had to say about the study:

Some of these “low carbers” were eating up to 60% of their diet as carbohydrates (first decile), which-last time I checked-is kind of not low-carb. Even the lowest low-carb eaters were still eating over 37% of their calories from carbohydrates. Whoever decided to call this study “low carbohydrate” is nuttier than a squirrel turd.

Folks in the Animal Group were more likely to smoke and had higher BMIs than adherents of the Vegetable Group. Along with influencing mortality outcomes, this suggests the Animal Food group, in the aggregate, may have been somewhat less health-conscious than the dieters lumped into the vegetable category. And that’s the type of thing that has repercussions for other diet and lifestyle choices that weren’t measured in the study.

The Vegetable Group was nowhere near plant-based: They derived almost 30% of their daily calories from animal sources (animal fat and animal protein), versus about 45% for the Animal Group. If we compare the middle (fifth) decile, the Vegetable Group was eating a greater percent of total calories from animal foods than the Animal Group was. D’oh!

For the Vegetable Group, cancer and cardiovascular mortality was lower in the tenth decile than the first decile, even though both deciles ate exactly the same amount of red meat and nearly the same amount of total animal foods. This suggests animal products aren’t the driving force behind differences in mortality rates.

Similarly, at the fifth decile, the Vegetable Group had a lower cardiovascular mortality hazard ratio than the Animal Group (0.99 versus 1.21), even though the Vegetable Group was eating a slightly greater proportion of animal foods (33.3% versus 29.9% of total energy for women; 32.9% versus 31% for men).

Bottom line: In this study, when you look closer at the data, differences in mortality appear to be unrelated to animal product consumption. Changes in cancer and cardiovascular risk ratios occur out of sync with changes in animal food intake.

I’ve read the full study, and it’s a joke.  In addition to what Ms. Minger wrote, the first thing I noticed is that the researchers used food questionnaires to determine who was on a (ahem, ahem) “low-carb” diet.  One group answered a total of 14 questionnaires between 1980 and 2002, and another group answered 10 questionnaires between 1986 and 2002.  From this, the researchers supposedly can make very specific conclusions about total intakes of animal protein and fats versus vegetable proteins and fats.

Then there’s old missing-data problem.  You can pretty much guess how they handled that:

A multiple imputation procedure was used with 20 rounds of imputation and included all covariates to account for missing dietary and covariate data. The analysis was repeated by using noncumulative updating of dietary information, in which we used the most recent diet data to predict mortality rate.

Same as in the recent low-fat vs. low-carb study:  they performed mathematical magic to fill in the missing data.  As Dr. Mike Eades like to say, if you torture the data long enough, it will tell you whatever you want to hear.  This data appears to have been water-boarded until it screamed “Yes! Yes! Animal foods are deadly!”

So naturally, Dean Ornish decided this is the kind of unimpeachable study that proves he’s been right all along, as he wrote in the Huffington post under the dramatic headline:

Atkins Diet Increases All-Cause Mortality

I’ve got to hand it to you, Dr. Ornish … most anti-fat hysterics manage to write at least a paragraph or two before they start misconstruing the facts.  But you told a whopper right there in the headline.  The Atkins Diet?  Say what?

As I noticed immediately and Ms. Minger pointed out as well, even if we grant that the researchers could accurately determine dietary intake from a dozen questionnaires mailed out over 20 years, these people weren’t on anything close to the Atkins diet.  At the high end, their diets were 60% carbohydrates.  At the lowest end, the diets were 37% carbohydrates. According to the study tables, the average calorie intake was right around 2000 calories per day (which sounds low to me, but we’ll roll with it). So let’s do the math:

(2000 * .37) / 4 = 185 carbohydrates per day … for the lowest carb group.

Could you please point out a page in any of the Atkins books where he recommends consuming 185 carbohydrates per day? The Atkins diet starts at 20 grams per day and gradually increases the carbs until weight-loss slows down — which for most of us is well under 100 grams per day. I rarely consume more than 50.  That makes my diet less than 10% carbohydrates.

Dr. Ornish, whenever yet another clinical study demonstrates that people on low-carb diets experience greater improvements in cardiovascular markers than people on low-fat diets, you immediately say the results are illegitimate because the low-fat dieters didn’t restrict their fats as much as you recommend.  Okay, fair enough:  if they get 20% of their calories from fat, it’s not really the Ornish diet.

But when people in an observational (not clinical) study consume 185 carbs per day — at least three times what most Atkins dieters consume — that somehow becomes the Atkins Diet. Very consistent of you.

However, all-cause mortality rates as well as cardiovascular mortality rates were decreased in those eating a plant-based diet low in animal protein and low in refined carbohydrates. Although this plant-based diet was called an “Eco-Atkins” diet, it’s essentially the same diet that I have been recommending and studying for more than 30 years.

No, Dr. Ornish, you recommend a very low-fat (10% of calories) vegetarian diet.  As Ms. Minger pointed out (and as the study data clearly shows), people in the group labeled “plant-based low-carb” were getting 20% to 30% of their calories from animal products.  They consumed more than twice as much animal protein as vegetable protein, more animal fat than vegetable fat, and got nearly 30% of their overall calories from fat — and yet, according to the study, they experienced lower-than-average mortality rates.  So if you believe this study is accurate, it doesn’t support the diet you recommend at all.

In many debates with Dr. Atkins before he died, I always made the point that it’s important to look at actual measures of disease, including mortality, not just risk factors such as HDL cholesterol. This is the first study that examined mortality rates in those consuming an Atkins diet, and it confirms what I’ve been saying all along: an Atkins diet is not healthful and may shorten your lifespan.

I can see why you’re pooh-poohing cardiovascular markers these days, since the Atkins diet keeps winning that battle in clinical research.  (Although let’s be honest:  you spent a lot of years bragging how your diet lowers LDL.)  And I agree that what matters is longevity and health, not an impressive lipid panel.

But once again, this study has zip to do with the Atkins diet.  These folks were consuming between 185 and 300 grams of carbohydrates per day.  So “the first study that examined mortality rates in those consuming an Atkins diet” did no such thing.

And of course, it’s nothing more than an observational study based on food questionnaires and a fair amount of “imputed” data.  It’s not a controlled study, so the results don’t tell us anything conclusive.  If animal fats and proteins caused cardiovascular disease, we’d see those results repeated consistently around the world.  But we don’t … that’s why there’s a French Paradox, a Spanish Paradox, a Swiss Paradox, an Indian Paradox, etc.

Your body makes HDL to remove excessive cholesterol from your body. Eating a stick of butter will raise HDL, but butter is not good for your heart. Pfizer discontinued a study of its drug, torcetrapib, which raised HDL but actually increased risk of heart attacks.

So let me get this straight … excess cholesterol causes heart disease, HDL removes cholesterol from your body, but foods that raise your HDL aren’t good for you.  And we know this because a drug that artificially raised HDL produced a higher heart-attack rate.  Makes sense.  But I noticed you conveniently failed to mention that the Pfizer drug also dramatically lowered LDL.  So using Ornish logic here, a diet that lowers my LDL isn’t good for me.  That means I should avoid the Ornish diet.

Or here’s another possibility:  artificially raising or lowering any type of cholesterol with drugs is pointless and possibly harmful.  It’s not the same as improving lipid profiles through a better diet, because the high HDL is just a biomarker for good cardiovascular health, not health itself.  Since you’re such a fan of observational studies, you can’t ignore the observation that HDL is strongly associated with a reduced risk of heart disease.  The Atkins diet (the real Atkins diet, that is) raises HDL.  It’s a diet, not a drug.

And if butter isn’t good for the heart, I guess that explains the screamingly high rate of heart disease in France, where they consume four times as much butter as Americans.  No, wait … didn’t I just mention something called the French Paradox?  Well, it’s probably because of all those other good health habits practiced by the French, such as higher rates of drinking, smoking, and visiting your mistress for an hour or two before going home for dinner.

By the way, Dr. Ornish, if you’ve done the research, you’re aware of the many intervention studies that attempted to lower rates of heart disease through low-fat diets, but failed miserably.  You claim you succeeded (of course, you also had your subjects give up sugar and flour, quit smoking, exercise, and take stress-reduction classes).  Perhaps so.  But if the results aren’t consistent and repeatable, they’re not scientifically valid.  As Karl Popper would say, if your theory is that all swans are white, it doesn’t matter how many white swans you show me; as soon as I point out some black swans, your theory is invalid.

Conversely, a whole foods plant-based diet that’s also low in refined carbohydrates may reverse coronary heart disease and beneficially affect the progression of prostate cancer and even improve gene expression despite reductions in HDL.

A whole-foods diet of any kind that’s low in refined carbohydrates will prevent disease.  Make it a balanced whole-foods diet instead of a vegetarian whole-foods diet, and you can keep your HDL high, too.

Finally, what’s good for you is also good for our planet. Livestock consumption causes more global warming than all forms of transportation combined. It takes 10 times more energy to produce animal-based protein than plant-based protein.

I’m not at all surprised you’ve swallowed the vegan nonsense about how meat production causes global warming and uses 10 times the energy to produce.  The figures about how much energy is required to raise cattle are, as Lierre Keith pointed out, based on the notion that cattle are supposed to eat grains. They’re not. Cattle are supposed to eat grass.

I’ll bet you’re also blissfully unaware of how much fossil-fuel fertilizer is required to grow an acre of soybeans.  Not your fault, really:  the United Nations, which originally made the absurd statement about cattle being responsible for global warming (based on nothing resembling actual evidence), managed to ignore that one as well. In fact, a recent book written by a former editor of The Ecogolist concludes that vegetable oils leave a larger “carbon footprint” than animal fats.  If we really want to save the planet by changing our food preferences, the answer is to raise our animals in pastures and stop farming grains.

But thanks for making it clear to us where you’re really coming from, Dr. Ornish:  you believe eating meat is wrong.  Just admit it.  This isn’t about science for you; it’s about your version of morality.  That’s why you’re able to ignore every bit of clinical evidence that doesn’t support your beliefs, then embrace one lousy observational study as if it were handed down on stone tablets from on high.

Now if you’ll excuse me, my steak is nearly done.

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Darrel Francis, the “McStatin” researcher who replied to a post last week, has read your comments and written another reply covering various topics raised.  I’m posting it here instead of leaving it in the comments, where it’s likely to be missed.

Side effects
Many correspondents have discussed side effects. These are common in people taking statins. But they are almost exactly as common in people who are given blank tablets and asked the same questions (have a look at the major trials). It is that which made me said that the power of suggestion is large, and larger than we might think from everyday living. Ironically, it is the strength of our belief in the powers of medicine that makes it able to exert a large nocebo effect too.

Tracee
Good question, and we did not pick on one manufacturer of junk food, or on one item, other than as an example that would be familiar to anyone. Yes it would apply to any unhealthy food. Of course (as all correspondents have agreed) the sensible thing is to not eat unhealthy food and to exercise healthily. But unfortunately many people do not do this. Telling people what to do doesn’t work (neither you nor I like being on the receiving end of nannying) but giving people a choice might sometimes work.

Salt being a necessity
True but not in little packets of extra salt. I contest whether the salt in packets is ever needed to keep anyone alive in the developed world. There is plenty already included in every processed meal and probably in every fresh meal (since plants and animals themselves normally contain salt too)

Shops being forced
Nobody should force shops to hand out anything. All I am doing is highlighting the contrast between what they choose to hand out, and what they choose not to.

Whether fat is the evil element in junk food
I do not believe it is just the fat, or just the sugar, or just the salt, in junk food that makes it unhealthy, and I am sorry if in the paper if it appeared I was implying that if we could leave out one element, everything would be fine. But I don’t think anybody on this board, or anywhere else for that matter, thinks junk food is particularly healthy. And as a cardiologist, it is heart attacks that I am concerned about.

Whether statins prevent heart attacks caused by high blood pressure
Strangely, it seems they do, regardless of your baseline cholesterol and blood pressure. Weird but true: anyone can check it for themselves, for example in an analysis of 90,000 patients that is now available free: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2805%2967394-1/fulltext

Exercise
Ned Kock – I agree with you fully – exercise does work in improving cardiovascular health but (I am sorry to say) ADVISING people to do exercise does not work. That is not because exercise does not work, but because there is a block between receiving the advice and acting on it: free will.

“Free” salt
I only meant without additional charge: I realise it does cost the shop something. It would be interesting if they charged a little, even a few cents. I bet that would have a small healthy effect…

Dave Wilson re CORONA and GISSI
These two trials were at the opposite end of the risk spectrum to primary prevention. In these, patients had advanced heart failure and many died from that process which was not significantly slowed by prevention of myocardial infarction. But in people who did not have advanced heart failure – like the 90,000 enrolled in trials described above, there was a distinct effect in reduction of heart attacks. Not perfect prevention, and not a magic bullet but, for those who value not having a heart attack higher than being free of tablets, worthwhile.

Sugar in diabetes
I apologise if I have given the impression that sugar is uniquely bad for diabetics, and apologise even more if I have implied that it is the cause of diabetes. That was not my intention. I was only using it as an example of excess calories in an environment (junk food shop) in which calories are hardly in shortage. Your correspondents and the ADA are quite right that any calories in excess of what the body needs for the level of exercise it does, are unneccesary and potentially harmful.

Tom – mother’s muscle pains
I am sorry for your mother’s muscle pains and I am glad they resolved. In that context I suppose you took very unkindly to my attribution of this to imagination. But all I request you do is have a look at the muscle pain count in the placebo arms of all the statin trials. It makes horrific reading. Did the placebo tablet itself cause that, or was it the act of asking? I am not uncaring for people who experience side effects – they are real. Its just that they occur almost as often in the patients getting blank tablets.

Prescription only
Yes I can see that from the USA point of view, where statins are prescription only, this seems like a crazy idea (just as it seems in UK crazy to talk about antihypertensives etc being provided in that way). But an old, off-patent statin is available in the UK off prescription (simvastatin), so it does not seem so immediately crazy here. No license is required from the inventors of the drug to make it, so there are many manufacturers and the government obtains it cheaply (~5c/day, according to wikipedia).

Food/Medicine
I do agree that randomly applying medications to oneself has risks – but this is the case with aspirin (acetylsalicylic acid), paracetamol (acetaminophen) and ibuprofen, as well as with many others (sorry if the names are unfamily – I am using the UK generic names). And I think that salt, sugar, etc escape the net because they are tasty and hence classified as food. But they affect metabolism, generally adversely. If I suggested we limit freedom to eat unhealthy food, I would be chased through the streets by raging mobs; so I took the approach of pointing out that medication may be safer than the food or its associated condiments. I think there may be a common thread in your feeling as with mine, although obviously I am approaching things differently.

If my spelling is imperfect, this may be partly because I am in the UK. For my grammar I have no excuse.

Finally Tom, thank you for quoting me in entirety and being courteous and fair in your criticism. If some way is ever found (that works even in people who have no interest in their health, unlike the correspondents here) to help people actually be cardiovascularly healthy, naturally without medical interference, by eating and behaving healthily, we will both be able to rest easy.

Thank you, Dr. Francis.  I’m pretty sure we’ll have to agree to disagree on the overall benefits of statins. Nonetheless, I enjoy debates (a bit too much at times, according to some) and appreciate your replies.

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You may have already seen this video, How To Become Diabetic In Six Hours, produced by a doctor who’s selling yet another low-fat, Ornish-style diet. I don’t expect any low-carb types to be fooled, but give it a look just for fun and then we’ll analyze the bologna.

A quick recap in case you couldn’t play the video: Dr. Delgoofy tells us that dietary fat causes insulin resistance and diabetes. To prove the point, he swallows a half-cup of olive oil and – horrors! – his triglycerides nearly double. Then he consumes a big ol’ sandwich and some pizza and – double horrors! – his triglycerides rise to 214, and his glucose shoots up to 131. This, he assures us, proves that dietary fat causes diabetes.

As I often say about journalists after reading slanted news stories, I can’t tell if this guy is intentionally dishonest or merely stupid.

Let’s start with that shocking rise in triglycerides after Dr. Delgoofy cannonballs a half-cup of olive oil. The horror music was a nice touch, but the result is about as horrifying as drinking a gallon of water and then discovering that the volume of urine in your bladder has doubled an hour later. In fact, if you ever swallow a half-cup of oil and your triglycerides don’t rise dramatically, check yourself into a hospital pronto and ask them to find the blockage in your digestive system.

The reason you find a long list of “essential fatty acids” listed in biochemisty textbooks is that — surprise! — your body needs fats. Your hair, your nails, your brain, your nervous system, your cell walls, your hormones, etc. — they’re all fat-dependent. Now, I suppose in theory you could fill a hundred syringes with fat and inject the stuff where it’s needed, but that would probably hurt. Plus your body likes to break nutrients down into little-bitty pieces before using them.

Consequently, most of us prefer to get our essential fats by eating them. The digestive system then does the work of breaking them down into itty-bitty pieces and packaging them as triglycerides — three fatty acids bound up with a glycerol molecule. Then the triglycerides are delivered to your tissues through your bloodstream.

So when Dr. Delgoofy showed us that the triglycerides in his blood doubled after a big belt of oil, all he proved is that his liver and bloodstream are in working order. If Dr. Delgoofy is a real doctor, then he surely knows that eating always raises triglycerides. That’s why doctors measure your triglycerides after a 12-hour fast. To give you an idea of how dramatically eating a meal can affect the measurement, here’s a tidbit I found online:

My blood triglyceride level was alarmingly high 497 mg/dL. It turned out to be a false result. A nurse sent to my home by my life insurance company had taken my blood sample just a few hours after I ate lunch. When my doctor drew my blood after an overnight fast during my annual physical a few months later, my triglyceride level was 97.

Larry Lindner
Tufts University School of Nutrition Science & Policy

If your fasting triglycerides are high, then you do have a problem. But it’s not dietary fat that causes high fasting triglycerides. Rather than explain it myself, I’ll quote Dr. William Davis:

One of the most common triglyceride myths is that eating fats increases triglyceride. But that’s only a half-truth, since fats do indeed increase triglycerides – but only if triglycerides are measured after eating. Depending on the quantity of fat consumed and other factors, triglyceride levels can reach around 300 mg/dl after a fat-containing meal, only to descend rapidly.

In contrast, carbohydrates can increase triglyceride levels many times higher, increasing levels to 300, 400, 500 mg/dl or more, even occasionally in the thousands, after many weeks to months of carbohydrate-excess. But carbohydrate excess leads not just to after-eating high triglycerides, but high triglycerides all the time.

The real story is that fats in the diet decrease triglycerides – at all other times except after a meal. The higher the fat content of your diet, the lower your triglycerides will be in a fasting blood draw. This has been well-established in numerous diet trials comparing low-fat with low-carbohydrate diets.

After demonstrating a perfectly normal rise in triglycerides after swallowing olive oil, Dr. Delgoofy continues his anti-fat demonstration by chowing down on a big sandwich and some pizza. Lots more fat, of course, but now he’s also consuming a heapin’ helpin’ of refined flour. Surprise, surprise … when he checks his blood levels awhile later, his triglycerides are up again, and so is his blood glucose level.

Once again, if he’s a real doctor, he knows perfectly well the rise in glucose was caused by the bread and the pizza crust, not the cheese and the meats. If he wanted to prove fat spikes blood sugar, he could’ve simply shown us a glucose reading after the olive oil. But nope … he stuffs himself with white flour, measures his glucose, then hopes to fool us into blaming the fat.

After seeing Dr. Davis give a lecture on the low-carb cruise, I got into the habit of checking my glucose after meals. Meats, eggs and cheeses barely cause a blip. But one white potato pushed my blood sugar up to 162. A small serving of pasta kicked it up to 174. After reading the latest book by Drs. Eades & Eades, my mom was finally persuaded to go on a low-carb diet. A few weeks later, her fasting glucose was down by 20 points. Her blood pressure and triglycerides dropped as well.

If her current diet is going to cause type 2 diabetes, I’d sure like for Dr. Delgoofy to explain the biochemistry of how that’s going to happen. I’d also like for him to point out the people who ate low-carb, high-fat diets and became diabetic in the process. I can certainly point to type 2 diabetics who were able to stop taking insulin shots after going low-carb.

Dr. Delgoofy tells us we should limit our dietary fat to 15% of total calories. Let’s back up to the beginning of his presentation and see how that’s working for him. Take at look at the fasting blood-work he showed us before consuming the olive oil:

 

The triglycerides are impressively low, so I’m guessing he doesn’t eat much sugar or other refined carbohydrates. But his HDL is an anemic 37. Mine was 64 last time I had it measured. As I found while digging through the American Heart Association’s data some months back, it’s low HDL that’s associated with heart disease, not high LDL. Here’s what the AHA itself says about HDL:

With HDL (good) cholesterol, higher levels are better. Low HDL cholesterol (less than 40 mg/dL for men, less than 50 mg/dL for women) puts you at higher risk for heart disease. In the average man, HDL cholesterol levels range from 40 to 50 mg/dL. In the average woman, they range from 50 to 60 mg/dL. An HDL of 60 mg/dL and above is considered protective against heart disease.

So even according to a kindred-spirit, fat-phobic organization, Dr. Delgoofy’s HDL is too low. Mine’s great. That’s because I eat plenty of fat. While we’re at it, let’s compare more of our cardiovascular markers.

Dr. Delgoofy told us his LDL is too low to be measured. The word to describe that claim rhymes with “tullpit.” Unless you want to spend a lot of money for a complicated lab test, LDL isn’t measured; it’s calculated by something known as the Friedewald equation, which looks like this:

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

The reason we didn’t get an LDL reading for Dr. Delgoofy is that his triglycerides were inconclusive and simply shown as < 45. Dr. Eades and others have pointed out that the Friedewald equation tends to overestimate LDL for people with triglycerides below 100, but with that caveat in mind, let’s estimate Dr. Delgoofy’s LDL. For the sake of argument, I’ll assume his triglycerides are 40. We know his total cholesterol is 182 because his cholesterol ratio (total cholesterol/HDL) was listed as 4.9.

182 – 37 – (40/5) = 137

His LDL is probably lower than that because of the limitations of the Friedewald equation. But if he walked into a doctor’s office and had his lab work done, he’d be told his LDL is too high and his HDL is way too low. Meanwhile, here’s how my LDL would be calculated:

203 – 64 – (70/5) = 125

Mine would also over-estimated. But going by the standard tests, I win that contest. Now let’s look the other ratios commonly used to predict heart trouble.

LDL / HDL
Dr. Delgoofy: 137 / 37 = 3.7  (average risk)
Fat Head: 125 / 64 = 1.95  (low risk)

Total Cholesterol / HDL
Dr. Delgoofy: 182 / 37 = 4.92  (average risk; over 5.0 isn’t good)
Fat Head: 203 / 64 = 3.17  (very low risk; anything below 3.5 is excellent)

Triglycerides / HDL
Dr. Delgoofy: 40 / 37 = 1.08
Fat Head: 70 / 64 = 1.09

A virtual tie on the last one. But on every other ratio, the guy whose diet is more than 50% fat is kicking the pants off the guy who tells us to limit our fat to 15%.  And by the way, my fasting glucose level is better too. His was 96. To prepare for this post, I checked mine this morning. It was 85.

Given his low triglycerides, Dr. Delgoofy’s heart is probably healthy. I sincerely hope so. But after seeing this video, I have doubts about his brain.

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