Archive for January, 2013

Here we go again with the latest “Meat Kills!” study.  You may have already seen it reported in the news with headlines like Vegetarians cut heart disease risk. Here are some quotes from that article:

Vegetarians are nearly a third less likely than meat-eaters to die or be hospitalized from heart disease, British researchers report this week in another study supporting a plant-based diet.

Vegetarians have lower blood pressure and cholesterol levels, weigh less and are less likely to have diabetes, as well, the researchers report in the American Journal of Clinical Nutrition.

The study, which covers 45,000 people over an average of 11 years from the 1990s through 2009, shows that vegetarians were 28 percent less likely to develop heart disease over that time.

Well, that’s it, then.  Drop the burger, pick up the tofu meat substitute, and save your heart.

Nawww, let’s read on:

“The results clearly show that the risk of heart disease in vegetarians is about a third lower than in comparable non-vegetarians,” said Tim Key, deputy director of the Cancer Epidemiology Unit at the University of Oxford.

The researchers said they accounted for age, smoking, drinking, exercise, educational level and socioeconomic background in making their calculations. Over the 11 or so years, 1,235 of the volunteers were diagnosed with heart disease, and 169 died of heart disease – the No. 1 cause of death in both Europe and the United States.

In the disclosures section of the full study, Tim Key (quoted above) is listed as a member of the Vegetarian Society, United Kingdom.  That makes me a wee bit suspicious … although Chris Gardner of Stanford is also a vegetarian, and he conducted the clinical trial of four different diets that found the Atkins dieters lost the most weight and showed the greatest improvements in their cardiovascular risk factors.  Dr. Key isn’t necessarily biased just because he promotes vegetarian diets.

So let’s look at this particular study and ask ourselves some Science For Smart People questions:

Q: Is this a clinical study or an observational study?

A: It’s an observational study based on questionnaires and medical records.  We can’t make conclusions about cause and effect from observational studies, but at least in this case the researchers aren’t asking the study subjects to accurately remember everything they ate during the past several years.  Most people can surely give an accurate answer to the question “Have you been a vegetarian for at least the past five years?”

That being said, comparisons of vegetarians versus non-vegetarians are always likely to produce skewed results for the simple reason that vegetarians tend to be more health-conscious than the population as a whole.  That means they’re different in all kinds of ways.  Not eating meat is just one of them.

Q: Did the researchers control their variables?

A: Not really, no.  In the full text of the study, the researchers admit that the participants are not a representative sample of the British adult population.  In fact, both the vegetarians and non-vegetarians in the study population had lower-than-usual rates of heart disease.  Then there’s this little issue:

Risk factors such as hypertension, hyperlipidemia, and diabetes may be mediating factors through which vegetarianism affects the risk of IHD; therefore, the analyses were not adjusted for these variables.

In other words, since we believe meat-eating causes hypertension, hyperlipidemia and diabetes, we didn’t adjust for any of them.  When I read that sentence, I scoured the study to see if rates of diabetes were reported.  Yup … and the non-vegetarians (let’s just call them meat-eaters from here on) had more than double the rate of diabetes.

Now … since diabetics are three times more likely to die of heart disease than non-diabetics, do you think maybe we have a confounding variable here?  If you believe eating meat causes diabetes (as the vegetarian researcher probably does), then yes, you could choose to ignore that as a variable.  But if you believe diabetes is caused by excess sugar consumption, you can’t.

Since clinical studies have shown that low-carb, meaty diets can control and often reverse diabetes, I seriously doubt eating meat causes diabetes.  So what we’re likely seeing here is that the vegetarians consume less sugar than the meat-eaters – once again, comparing health-conscious people to the population as a whole.

Then there’s the age problem.  Here’s the breakdown of the study participants with their average ages at the time they were enrolled:

6,831 non-vegetarian men, average age = 49.5
22,610 non-vegetarian women, average age = 46.3

3,771 vegetarian men, average age = 41.8
11,349 vegetarian women, average age = 38.4

With a little Excel magic, I determined that the overall average age of the meat-eaters at the beginning of the study was 47 years old.  The overall average age of the vegetarians at the beginning of the study was 39 years old.

The researchers compared their medical records 11 years later.  At that point, the average meat-eater was 58 years old and the average vegetarian was 50 years old.  Now take a look at the chart below, which shows CDC figures on heart-disease deaths rates by age bracket.

The heart-disease death rate in the 55-64 year-old-bracket is more than double the rate in the 45-54 year-old-bracket.  The meat-eaters were far more likely to fall into the age group where the rate of heart-disease death more than doubles.

Ahhh, but the researchers assured us they adjusted the data for age, gender, BMI and smoking status.  Perhaps, but I have my doubts.  Those “adjustments” are where a lot of mathematical manipulations occur, as Dr. John Ioannidis has pointed out in his criticisms of observational studies.

Here’s part of the reason I have my doubts:  in the study, the researchers made this statement:

On the basis of the absolute rates of hospitalization or death from IHD, the cumulative probability of IHD between ages 50 and 70 y was 6.8% for nonvegetarians compared with 4.6% for vegetarians.

“Absolute rates” means no adjustment for age or anything else.  And yet the meat-eaters, who fall into the 55-64 age group on average, had a heart-disease rate of 6.8%, while the vegetarians, who fall into the 45-54 age group on average, had a heart-disease rate of 4.6%.

Hmmm … the CDC chart shows heart-disease deaths more than doubling as we move from one age bracket to the next (an increase of 131%), yet our older meat-eaters were just 32% more likely to have heart disease than their younger vegetarian counterparts, according to the study.  Something doesn’t feel right here.  Given the difference in average age, the difference in death rates in the non-adjusted data ought to be more dramatic.

Oh, but wait … if you read the study, the researchers weren’t comparing death rates.  They were comparing a diagnosis of heart disease – a combination of deaths chalked up to heart disease and heart-related problems such as angina.  In fact, of their 1,235 medical data points, just 169 were actual heart-disease deaths.  Which leads me to our next question:

Q: Is there any important data that seems to be missing?

A: Oh, you betcha.  The researchers had medical records for diagnoses of heart-related problems, they had medical records for heart-disease deaths, they knew who was and wasn’t a vegetarian, and they dutifully reported the differences in all heart-related problems combined for meat-eaters versus vegetarians … and yet stunningly, they didn’t report the difference in death rates – not for heart-disease deaths, and not for deaths from any cause.

Never fear.  This isn’t the first time these researchers dug into the data they collected for the purpose of publishing a paper.  Here’s the conclusion from another study using the same dataset titled Mortality Among British Vegetarians:

The mortality of both the vegetarians and the nonvegetarians in this study is low compared with national rates. Within the study, mortality from circulatory diseases and all causes is not significantly different between vegetarians and meat eaters, but the study is not large enough to exclude small or moderate differences for specific causes of death, and more research on this topic is required.

In other words, We’d like more funding so we can keep torturing the data until it tells us that eating meat will kill you.

Go enjoy your steak.

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I’ll start by commenting on the title of this post:  I don’t hate vegans.  The title comes from a headline over a letter posted on another web site.  We’ll come back to that.

I don’t even dislike most vegans.  I suspect most of them are nice people who choose that lifestyle for whatever reason and don’t concern themselves with what other people decide to eat.  Some years ago, Chareva and I went out for breakfast and ran into an actress I knew and her live-in boyfriend.  We decided to get a table for four.   I knew from previous conversations that the actress was a vegan … so imagine my surprise when her boyfriend ordered bacon and eggs.

“Uh … you eat meat?” I asked.

“Yeah, I eat meat.  Why?”

“Oh, I see what you’re asking,” the actress chimed in.  “I’m a vegan.  He’s not.”

Since these two had lived together for a long time and owned a house together, I’m pretty sure she didn’t follow him around accusing him of being a murderer or predicting his demise from all kinds of meat-induced health disasters.  She was a vegan, but clearly not a zealot.  It’s the zealots I can’t stand.

Vegan zealots are the dietary equivalent of religious zealots who show up at your door uninvited and try to convert you, warning you of hell to come if you don’t listen.  They can’t just happily keep to themselves, because they’re convinced the heathens must be saved.  I posted the follow-up section of Fat Head on YouTube last week, and sure enough (as I would have predicted), we’ve now got what the Older Brother refers to as a vegetrollian showing up to preach.

I believe low-carb and/or paleo diets can help people overcome all kinds of health problems.  That’s why I produced Fat Head. That’s why I write blog posts.  I’m happy to provide as much information as I can for anyone who comes here looking for answers – and lots of people have found answers here, judging by the comments and emails I receive.

But in spite of their successes (not to mention mine), I don’t believe everyone has to go on a low-carb diet, I don’t deny that people can become lean and healthy on other kinds of diets, and I sure as heck don’t go trolling vegetarian blogs and web sites trying to convert them and predicting their physical demise if they don’t listen to me.  I’m an advocate, not a zealot.

After some vegan zealots physically attacked Lierre Keith a few years ago, I wrote an essay on my other blog (which I’ve been ignoring lately) comparing them to what philosopher and author Eric Hoffer labeled The True Believer in his book by the same name.  Here’s part of what I wrote:

Hoffer labeled these people the True Believers.  The need to believe in something — completely, and without question — defines their lives, because fanaticism makes them feel special and important.

Not surprisingly, then, the biggest threat to their identities is doubt.  All contrary evidence must be stifled or rationalized out of existence.  All logical inconsistencies in their beliefs must be ignored.  Anyone who doesn’t share their beliefs is an enemy, and anyone who raises questions about their beliefs must be silenced. (But enough about Al Gore.)

Now, doesn’t that description sound just a wee bit like a militant vegan?  Ego boost?  Heck yes … I’m now a morally superior human being because I don’t eat animal products.  Sense of identity?  Gee, do you think?

I once asked a waitress in a restaurant if the pork chops were any good.  Turning up her nose just a bit, she replied, “I wouldn’t know.  I’m a vegan.”  I’m mildly hard of hearing, so at first I thought she said, “I wouldn’t know.  I’m a virgin.”  After some momentary confusion, mentally rifling through my old catechism lessons looking for a prohibition against virgins eating pork, I figured it out.  Either way, it was more than I cared to know about her.  “I’ve never tried them” would’ve sufficed.

And here are some quotes from Hoffer’s book:

A man is likely to mind his own business when it is worth minding. When it is not, he takes his mind off his own meaningless affairs by minding other people’s business.

In order to be effective a doctrine must not be understood, but has to be believed in. We can be absolutely certain only about things we do not understand.

The uncompromising attitude is more indicative of an inner uncertainty than a deep conviction.  The implacable stand is directed more against the doubt within than the assailant without.

In short, True Believers like to stick their noses in other people’s business and never let little annoyances like logic or observable facts shake their beliefs.  As Hoffer wrote, True Believers are impervious to facts.

The True Believer currently trolling the comments section on the video desperately needs to believe that eating animal protein makes people fat and sick.  He also desperately needs to believe that nobody ever got fat or sick on a vegetarian diet.  So he (could be a she, but I’m going with he) simply ignores the actual video, which clearly shows how much leaner I am now than I was in my 30s – when I was a vegetarian.  He also ignores the before-and-after pictures I put in the video.

One of those before-and-after shots is of a reader and occasional commenter named Rae.  Here’s part of what Rae wrote when she sent me those pictures.

I wanted you to know now I’ve lost nearly 80 lbs since Fat Head made me re-think everything I had ever learned about food and nutrition. I wish it had been around 10 years ago so I wouldn’t have wasted my 20s being an obese depressed vegetarian.

An obese vegetarian?  Eighty pounds lighter now after going low-carb?  No, no, no, that doesn’t happen.  Just ask the True Believer.

Other people have left comments like these on the video:

Fat Head the documentary and Gary Taubes changed my life. I went onto a ketogenic diet (Very strict in Carbohydrates, sub 20g a day) and lost over 40 pounds (210 to 170) in three months. The contradictory part is, I did the entire thing from June to September meaning I was not in school, had no work, and literally sat on my ass playing video games 12-13 hours a day.

I’ve lost 80 pounds after watching Fat Head (still trying to lose another 50) and I’m healthier than I’ve ever been. I can’t thank you enough Tom for making Fat Head.

Watched Fat Head on November 12th. Went low carb November 13th. Thank you — 60lbs lost / 70 to go.

Naturally, the vegan True Believer can see these testimonials right there in front of his face and still insist that low-carb diets make people fat and sick.  Tell a vegan True Believer that I was a fat vegetarian and have personally known vegans who had major health problems, and he’ll simply deny that I was ever really a vegetarian.  Same goes for anyone else who claimed to health problems on a vegan or vegetarian diet.  They weren’t really vegetarians or vegans, you see, because if they were, they’d be lean and healthy.  (I guess that explains why Linda McCartney and Davey Jones both lived to a ripe old age.)

I compare vegan zealots to religious zealots because I’m convinced the thought process is basically the same:  Everyone who eats a high-meat diet is committing a sin and must suffer – and all vegans must be lean and healthy as a reward for their virtuousness.  No one gets healthy on a meat-based diet, and no one gets fat or sick from a meat-free diet.  We know this because our vegan bible tells us so.  Scientific evidence to the contrary must be ignored.

Now, back to where I got the title for this post.  When I was logging articles and studies into my new database over the holidays, I came across a post titled See, this is why people hate vegans on a site called PassiveAgressiveNotes.com.  This particular note was written by a recently-converted vegan and left on her roommate’s beside table.  It’s a bit difficult to read on the site, so I’ve reproduced it below with my comments interspersed.

I have to say, I thought you were a lot smarter and considerate than you have proven yourself to be.  You are very well aware that I’ve been getting more and more serious about my veganism, and over the past few weeks I’ve insinuated several times that I feel uncomfortable having animal products in our house.

You became a vegan, so now your roommate has to stop bringing meat into the house?  Couldn’t you have just become an orthodox Jew and demanded she stop buying bacon?

The reason I’ve settled with merely implying these feelings is to avoid an argument, awkward conversation, or irritated note such as this one.

Notes don’t get irritated, tofu-brain.  People do … like when they receive preachy notes from their roommates.

But after seeing your latest haul from the supermarket, I have to be blunt with you.

Oh boy, here comes the sermon …

Yes, I know that we live in a world where we’re all supposed to be “tolerant.”  However, I believe we have to stick up for our beliefs and draw the line somewhere.

Is this where you announce that you’re moving out to stand up for your beliefs?

If you knew that a neighbor of yours was abusing their child, would you turn a blind eye and be “tolerant” of it?  Would you say that your neighbor simply has a different world view than your own?  I doubt it.  Same with me.

Please, feel free to call 911 and report the slaughter of pigs and cows at the nearest slaughterhouse.

I can no longer tolerate seeing meat, eggs, dairy, honey, or any other products from animals in our kitchen or anywhere else in our apartment. Do you understand?

When you try to impose your beliefs on your roommate, you come across like a member of some vegan Hezbollah, even if you underline your sentences to emphasize how important they are. Do you understand?

I’m truly disappointed by your lack of respect for my feelings and morals.  You could at the very least eat these things away from me, like when you’re out of the house.  You could have done it in your room.  That second suggestion isn’t an option anymore, though, since I told you I will not allow these foods anywhere in the house.

Way to demonstrate respect for your roommate’s feelings, tofu-brain.  Sure, I’ll allow you to eat meat – as long as you don’t do it in the house.

Why do you buy so much meat?

Uh … because it’s awesome?

You buy chicken, steaks, ground beef, and tasty “snacks” like Slim Jims, beef jerky, spam, and sardine cans.

Say, is your roommate single by any chance?  Oh, wait … I’m already married.

This is a waste.  I can guarantee that you will not eat even half of these things.

That’s because you won’t let her eat them in the house.

Please think about changing your diet.  I realize that you will probably continue being a meat eater outside of our apartment, but let that small grain of doubt lead you to a better path.  You can still have great-tasting food as a vegan.  You’ll probably want to start slow as a vegetarian and take it from there.

Nice of you to ease her into it gently when you’re demanding she switch to your belief system.

It was a long, passionate letter, but I think the appropriate reply would only require two words.  You can probably guess what they are.

And that’s why people hate vegans.

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The updated version of Fat Head I’ve mentioned a couple of times is finally available.  We received a shipment of DVDs while I was at work yesterday.  Being a cruel husband, I asked Chareva to watch it to make sure there weren’t any video flaws.  We’ll sell the DVD ourselves — I’m not making the mistake of trusting another DVD distributor.

(The good news is that you’re our number one seller!  The bad news is that we just declared bankruptcy and used the proceeds from your film to float our operations there at the end.  Sorry about the two years’ worth of residuals you’ll never see.)

Gravitas, the digital-content distributor who put Fat Head on Hulu, Netflix, Amazon Instant Play and iTunes (also the only distributor we like) will be distributing it to the same markets overseas — at long last.

Creating a version our lying-sack-of-@#$% international “distributor” can’t lock down and sit on was part of the motivation, but I’m glad I updated the film regardless.  It was due for a facelift.

I named it Fat Head: Director’s Cut, even though I’m the director and cut both of them.  To make room for a followup sequence at the end, I cut two sections from the film.  The first was the section about kids not walking to school anymore, people driving everywhere, etc.  After I learned more about the negligible effect exercise has on weight loss, I cringed a bit every time I watched that section.  What the research shows is that kids start getting fat first, then they stop moving around as much.  Before they get fat, the kids who become fat later are just as active on average as their peers.

The other section I cut is this:

I didn’t cringe what I saw that section, but it appeared late in the film and felt out of place. I dealt with Morgan Spurlock’s nonsense sufficiently in the first part of the film; no need to give him another whack near the end.  I uploaded that section to YouTube since it’s not part of Fat Head anymore.

Now, for the new stuff:  cutting the sections I mentioned above gave me time to add a follow-up section at the end.  Since I want anyone who has the old version and is considering getting the updated version to know exactly what’s been added, here it is.  The YouTube video below starts from about a minute before the new section:

We have a couple of boxes of the old version left, but I decided to retire that one.  For the past month or so, I’ve been emailing people who ordered the DVD to ask if they’d like to wait for the updated version.  Every single one said yes.  If you’ve been waiting for an order, it went out today.  We spent a big chunk of last night getting caught up.  If you order a DVD from this point forward, you get the updated version.  For those who asked recently, yes, the international version plays everywhere.  It’s the only version available.

That’s one big project out of the way.  I have another roast to write and produce before the low-carb cruise in May, then I have two more projects I hope to finish this year:  the book and companion DVD Chareva and I have been kicking around, and the Fat Head soundtrack  — if Tom Monahan and I can ever coordinate our schedules.

p.s. — Chareva’s brother and his new bride will be arriving today and staying through the weekend.  I’ll check comments, but won’t be writing another post until Monday.

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Okay, I was dishonest in the title of this post.  Not all Norwegians have heart disease.  But almost all Norwegian men are (if we believe the prevailing guidelines) at high risk for heart disease.

Like most Americans, I spend very little time thinking about Norwegians.  The great Chicago columnist Mike Royko once pointed that in the ethnic melting pot of Chicago, you can hear jokes about the Irish, Jews, Italians, Poles, African-Americans, Mexicans, Puerto Ricans, French, British, Russians and Germans.  He even remembered some jokes about Swedes.  But when he asked around, nobody could remember ever hearing a joke about Norwegians.  Royko even tracked down a Norwegian-American acquaintance who confirmed, “Naw, nobody tells jokes about us.  We’re too nice.”

I got thinking about the Norwegians this weekend while answering comments on my post about the Spanish Paradox.  I remembered logging a study about Norwegians and their risk of heart disease into my database and pulled it up.  Here are some quotes from the study:

Since the first US Framingham model for predicting heart disease risk was published in 1991, it has become ever more widely recommended that doctors in primary care carry out risk assessment by combining several risk factors for cardiovascular disease using algorithms. Until recently most risk equations have been derived from the Framingham study, but these calculations tended to overestimate risk in the European context.

Actually, the Framingham model is lousy at predicting heart disease in the American context as well.  But let’s move on.

A new European risk scoring system for cardiovascular disease, based on the first phase of the systematic coronary risk evaluation (SCORE) project, was presented in 2003. The system is based on a pooled dataset of cohort studies from 12 European countries, among these Norway, and offers a format for estimating fatal cardiovascular disease risk that is suitable for clinical practice.

After explaining those guidelines, the researchers report on the results of applying them to data collected from several thousand Norwegians.  Here’s what they found:

At age 40, 22.5% of women and 85.9% of men were at high risk of cardiovascular disease. Corresponding numbers at age 50 were 39.5% and 88.7%, and at age 65 were 84.0% and 91.6%.  At age 40, one out of 10 women and no men would be classified at low risk for cardiovascular disease.

Hmmm … people in Norway must be dropping like flies from heart disease, at least according to the prevailing guidelines for estimating heart-disease risk … you know, cholesterol levels and all that stuff.

Here again is the American Heart Association’s chart showing rates of cardiovascular disease around the world:

You’ll notice Norway is down toward the lower end of the scale – not as low as France or Spain, but lower than the U.S., U.K. or Germany.

For once, the researchers recognize that the current guidelines are poppycock.  They don’t put it quite that way, of course.  Their language is more academic and polite:

Implementation of European guidelines to prevent cardiovascular disease would label most people in an unselected Norwegian population at high risk of fatal disease from age 40

The validity of the evidence base of the guidelines is questionable and predicts practical and ethical dilemmas related to resource allocation and clinical counselling.

Any overestimation of a person’s risk for cardiovascular disease can have important implications. Apart from causing unnecessary concern, it undermines the patient’s informed choice for intervention. It is also likely to increase prescribing costs and affect life insurance premiums.

Yup.  First thing you know, your doctor is scaring the bejeezus out of you and talking you into taking statins.

Over the weekend, I also had a mini-debate on Twitter with someone who insisted the French paradox is probably a matter of genetics.  I pointed out that waves of French moved to England to become landowners after the Norman Conquest and that the French and English have been intermarrying for hundreds of years.  I doubt that there’s a big difference between French DNA and British DNA.  He didn’t buy it and tweeted a link to a document detailing the marked genetic differences among Europeans.  He apparently didn’t notice that the document he linked described differences among Europeans separated by the Alps for most of history.

Look at the AHA chart one more time.  Scotland and Ireland are near the top.  England and Wales are near the middle.  Now go find Australia.  I’ll give you minute …

… Find it?  Yup, Australia is near the bottom.  My Australian readers can correct me if I’m wrong, but I’m pretty sure we can’t explain away the “Australian Paradox” by suggesting Australians are genetically distinct from the Irish, Scots and Brits.

So we have the Spanish, who are in “poor cardiovascular health” according to current guidelines, but have a low rate of heart disease.  We have the Norwegians, nearly all of whom are at a high risk of heart disease according to current guidelines, but have a relatively low rate of heart disease.

I’m thinking the problem is with the current guidelines.  Nice to see some researchers say as much.

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I don’t have the best hearing in the world, so when I watch TV after Chareva and the girls go to bed, I wear headphones.  The advantage is that I can hear dialog, gunshots, explosions and other important parts of the story without straining.  The disadvantage is that I don’t hear much of anything else.

Last night I finished watching a movie called Freelancers around midnight, then took off the headphones.  As soon as I did, I was aware of what sounded like several coyotes having one hell of a fight in either our front yard or front pasture.  Lots of what sounded like yelps of pain.  I looked out the window but couldn’t see anything — when it’s dark in the country, it’s DARK.

When Chareva went to tend to the chickens today, she found that something had dug a hole under the fence that surrounds the chicken barn.  Then she noticed a couple of feathers.  Then she noticed that our last remaining guinea fowl, which we moved to the chicken yard after coyotes killed its nine flock-mates, was nowhere to be seen.

Later she found what remained of the guinea fowl:

She found those in the front yard.  I took a picture from our front porch to show the distance from the house.  The circle is where Chareva found the feathers.  It’s also probably where coyote rumble occurred.

So I’m pretty sure a coyote got into the chicken yard and snatched the guinea fowl, then a small pack of coyotes fought over the booty.

We bought guinea fowl — one flock of 10, then another when the first flock disappeared — because we’d read that they’re tough, almost prehistoric fighters.  They’ll swarm predators, according to articles on the internet.  They’ll eat ticks.  They’ll roost in the trees.

Well, not the ones we bought.  They were, I’m sorry to say, quite obviously rather stupid.  Not one managed to fly away from coyotes.  The last remaining guinea fowl apparently didn’t even have the good sense to roost up high in the chicken barn, away from danger.  The chickens did.  They’re all still alive and well.

No more guinea fowl for us.  I’m not buying birds to feed the local coyotes.

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An article with the title No Room for Complacency in Face of Spanish CV Paradox showed up on Medscape today.  Let’s take a look at some choice bits:

The first study to report population-based data on cardiovascular health across an entire European country has found that the nation in question, Spain, is not performing particularly well and in fact is on a par with the US.

Boy, I’m sorry to hear the Spanish aren’t performing particularly well when it comes to cardiovascular health.  I spent part of my honeymoon in Barcelona and loved the place … the scenery, the food, the friendly people.  If they’re on a par with the U.S., they must have nearly as many people dropping dead of heart attacks as we do.

Surveying a cross-section of Spanish adults, Dr Auxiliadora Graciani (Universidad Autonoma de Madrid, Spain) and colleagues measured “ideal cardiovascular health”–as described by the AHA–and found that only 0.2% of the 11, 408 subjects attained ideal values for all seven CVD health metrics: nonsmoker, body-mass index (BMI) <25 kg/m2, physical activity at goal, diet consistent with recommendations, untreated cholesterol <200 mg/dL, untreated BP <120/80 mm Hg, and untreated fasting glucose <100 mg/dL in the absence of clinical CVD and diabetes. Of those surveyed, 3.4% attained ideal values for at least six of the metrics and 15.4% for five, they note in their report published online January 8, 2013 in Circulation: Cardiovascular Quality and Outcomes.

Wow, that’s just awful.  Barely one-fifth of one percent of the Spanish adults meet the American Heart Association’s ideal values for cardiovascular health.  And I thought the people I saw falling down in Barcelona were just party animals who’d had too much sangria.  Now I realize they were having heart attacks.  In retrospect, I feel guilty for clapping.

“This is the first study to report information on cardiovascular health from Spain, a European country with low coronary heart disease mortality compared with many Western countries,” observe the authors. However, the level of cardiovascular health in Spain “is as low as in the United States, primarily due to poor lifestyles, especially lack of ideal diet,” they note.

Um … uh … but … did I read that correctly?  The Spanish have a low level of cardiovascular health but also low coronary heart disease mortality?  Isn’t that a bit like saying they’re in poor physical condition, but can run for miles and bench-press their own body weights?  I don’t know about these researchers, but I define “good cardiovascular health” as “not dying from cardiovascular disease.”

Although the CHD mortality rate is low in Spain, recent research shows the prevalence of angina there is high, suggesting that atheromatous plaques are stable, the doctors say. Research is needed as to why these plaques do not rupture, translating into a high incidence of acute MI, as is seen in other countries, they state.

Oh, okay.  Got it.  The researchers are speculating that thanks to their stubborn refusal to adopt the American Heart Association’s definition of good health and a good diet, the Spanish actually do have lots of plaque buildup … but for some reason, plaques don’t rupture in Spain.  Must be the weather.  I’m surprised they didn’t say it’s because the Spanish drink wine.

This “paradox” of low CHD mortality and poor cardiovascular health in Spain could be explained by several things other than traditional CV risk factors, such as sedentary behavior, specific dietary components (eg, wine consumption and the Mediterranean diet), psychosocial factors (such as family support), and quality of medical care, among others, say Graciani et al.

Head.  Bang.  On.  Desk.

I see.  So the Spanish suffer from a “lack of ideal diet,” they have poor cardiovascular health because they don’t meet the American Heart Association’s criteria, but they don’t die from heart attacks because they eat a Mediterranean diet.  They have a lousy diet, but their diet saves them from heart disease.   Oh, and because they drink wine.  And because of the quality of medical care.  I guess that means they get treated for their high cholesterol.

And because lifestyles appear to contribute far more heavily than biological factors to poor cardiovascular health in Spain, there is a great need to strengthen the role of public-health efforts in the management of CVD there, they observe. Health services also need to improve, they add, noting that five out of every 10 people with elevated cholesterol are not being treated, and half of those with BP >140/90 mm Hg are unaware of this.

Head.  Bang.  On.  Desk.

So, to sum up … The Spanish are in poor cardiovascular health because of their lifestyle and lack of an ideal diet, which means there’s a great need to strengthen government efforts in the management of cardiovascular disease.  But they don’t die of heart attacks because of their diet and high-quality medical care.

I want to know how any researcher can make those arguments in a paper without reading what he wrote and thinking, “Wait a minute … I sound like a flippin’ moron here.”

By coincidence, I received a copy of the most recent report from the American Heart Association around the time I was reading the Medscape article.  Naturally, the report includes the AHA’s recommendations on cholesterol  levels:  over 240 is classified as poor, 200-239 is classified as intermediate (with a recommendation to “treat to target”) and less than 200 is classified as ideal.

Let’s look at a graph from one of the American Heart Association’s own documents.  This shows rates of death from cardiovascular diseases (heart attack and strokes combined) for men in several countries, ranked from worst to best.

Notice Spain down there near the bottom?  Notice France down there below Spain?  Now take a look at the top of the chart, where you’ll find Russia with the highest rate of cardiovascular deaths.

A couple of years ago, I downloaded data from the World Health Organization’s MONICA study, which tracks cholesterol levels and cardiovascular death rates around the world.  The average cholesterol level in Russia is 189.  In France, it’s 210.  Romania (near the top of the chart) and Spain (near the bottom) have the same average cholesterol level:  197.  When I ran the correlation function in Excel on all the countries and their rates of cardiovascular deaths, the result was -0.25.  In other words, there’s almost no correlation, and the slight correlation that exists points to cardiovascular deaths going up as cholesterol levels go down.

And so the paradoxes just keep on coming …

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