Archive for February, 2013

Interesting items from my email inbox …

Dear Parents:  Your Kids Are Fat

Let’s file this under the category of we’re from the government and we’re here to help:  schools in Massachusetts are now sending letters to parents informing them that their kids are overweight.

Schools in North Andover are trying help students dealing with obesity issues, but some families say the schools are going too far.

Cameron Watson, 10, isn’t just a strong athlete; he’s also a tough fourth grader who didn’t let a “fat letter” sent to his home get him down.

“I know I’m not obese so I didn’t really care about the letter. I just crumpled it up,” Cam Watson said.

The letters were sent to plenty of homes throughout the Commonwealth.

The Department of Public Health says 32 percent of our students have a Body Mass Index that shows they’re overweight or obese, and the letters are supposed to be a helpful tool for parents.

The “helpful tools” in this case are the government officials who believe these letters have any positive effect whatsoever.  Do they really think the letters will result in conversations like this?

“Johnny!”

“Yes, Dad?”

“You’re too fat!”

“I am?  Why the heck didn’t you say something about it?”

“Well … I didn’t realize you’re fat until your school told me.”

“Wow.  I didn’t either.  Are we stupid, Dad?”

“I’m afraid so, Johnny.”

“So what do we do about this, Dad?”

“Well, you stay in school and I’ll try to read more books and–”

“No, I mean what do we do about me being fat?”

“Uh … I don’t know.  They haven’t told me yet.”

But of course, we know what advice the school will give:  more of the same eat less/move more nonsense that’s already failed.  Of course, it doesn’t help that the schools are serving meals like this (picture supplied by a reader who works in a school):

A roll, mashed potatoes, pasta, an apple and strawberry milk … all in one meal.  Yup, that’s your government-approved school lunch.

Now why the heck are so many kids fat?

Dear Person:  YOU’RE TOO FAT, YOU LAZY @#$%!!

Letters to parents may be enough to turn around the tide of childhood obesity, but we adults need stronger medicine, according to a bioethicist:

Unhappy with the slow pace of public health efforts to curb America’s stubborn obesity epidemic, a prominent bioethicist is proposing a new push for what he says is an “edgier strategy” to promote weight loss: ginning up social stigma.

Daniel Callahan, a senior research scholar and president emeritus of The Hastings Center, put out a new paper this week calling for a renewed emphasis on social pressure against heavy people — what some may call fat-shaming — including public posters that would pose questions like this:

“If you are overweight or obese, are you pleased with the way that you look?”

Callahan outlined a strategy that applauds efforts to boost education, promote public health awareness of obesity and curb marketing of unhealthy foods to children.

But, he added, those plans could do with a dose of shame if there’s any hope of repairing a nation where more than a third of adults and 17 percent of kids are obese.

“The force of being shamed and beat upon socially was as persuasive for me to stop smoking as the threats to my health,” he wrote. “The campaign to stigmatize smoking was a great success turning what had been considered simply a bad habit into reprehensible behavior.”

That same pressure could be applied to overweight people, perhaps leading to increased efforts by people to eat right, exercise  — and actually succeed in losing weight, Callahan argued.

Dr. Callahan, the people who beat up on you for smoking were clearly in the wrong.  They should have beaten up on you for being an arrogant ass.  Shaming and beating up on obese people socially will only cause them stress, which will raise their cortisol levels, which will make them fatter.  Then you’ll want to beat up on them even more.

Dr. Callahan is described in the article as a “trim 82-year-old.”  In other words, he’s never been fat and has no flippin’ idea what he’s talking about.  I wrote about his weight-loss theories in a previous post, so I’ll just repeat myself:

Boy, if only someone with Professor Callahan’s deep understanding of what causes body-fat accumulation had been around when I was becoming an obese adolescent, I would have remained lean.  When we had to play shirts vs. skins in gym-class basketball games, it just never occurred to me to feel ashamed of my fat belly, love handles and boy-boobs.  If the naturally-skinny boys in my class had cared more about me (and been armed with Professor Callahan’s insights), they could have helped me out by calling me names like Lard-Ass, Fat Boy, Pudge, Booby Boy, Porky Pig, or Butter Butt.  I now realize that with their kind-hearted acceptance of me (and the one other fat kid in class), they were inadvertently acting as enablers.

So to all you obese people out there who are happy with your bodies, it’s time to look yourself in the mirror and feel ashamed!  Don’t wait for Professor Callahan’s ideas to catch fire and inspire some do-gooders to shame you … be pro-active and take responsibility for shaming yourself.

But if we only exercised more …

Our friends down under, who have already been advised by their government to exercise to prevent obesity, are now being told to exercise even more:

Australians are now being advised to exercise for up to one hour a day, up from 30 minutes, because of the higher number of calories we’re consuming.

At least 60-90 minutes of activity a day are required to prevent weight gain in previously obese people, according to new official dietary guidelines released today.

Australians have also been told to cut their consumption of white bread, high fat milk, hot chips, take away food and cakes and biscuits amid warnings 85 per cent of males and 75 per cent of women will be obese by 2025.

The nation’s peak medical body the National Medical Research Council says we need to eat more vegetables, fruit, wholegrains, fish and low fat dairy products.

Yes, if only everyone would set aside an hour per day for exercise and stop drinking high-fat milk — just like our grandparents did back in the days when few people were obese.  (You all remember how Grandma drank her skim milk before heading to the gym for an hour, don’t you?)

If I’ve said it once, I’ve said it at least twice:  when government programs fail, government officials interpret the failure as evidence that they should do the same thing again – only bigger.

One way to avoid high-fat milk

What, you mean don’t like low-fat milk?  Well, how about if we sweeten it up for you?

Two powerful dairy organizations, The International Dairy Foods Association (IDFA) and the National Milk Producers Federation (NMPF), are petitioning the Food and Drug Administration to allow aspartame and other artificial sweeteners to be added to milk and other dairy products without a label.

The FDA currently allows the dairy industry to use “nutritive sweeteners” including sugar and high fructose corn syrup in many of their products. Nutritive sweeteners are defined as sweeteners with calories.

This petition officially seeks to amend the standard of identification for milk, cream, and 17 other dairy products like yogurt, sweetened condensed milk, sour cream, and others to provide for the use of any “safe and suitable sweetener” on the market.

They claim that aspartame and other artificial sweeteners would promote healthy eating and is good for school children.

I dare you to read that last sentence 10 times in a row while fighting the urge to bang your head on your desk.

Here’s how we get kids to drink milk:  STOP TAKING THE FAT OUT OF IT.  The last thing kids need is more sweet food to pervert their taste buds.

Wrong interpretation of an otherwise interesting study

You probably saw the headlines this week about a new study touting the benefits of a Mediterranean diet.  Here are some quotes from an online article:

Pour on the olive oil in good conscience, and add some nuts while you’re at it.

A careful test of the so-called Mediterranean diet involving more than 7,000 people at a high risk of having heart attacks and strokes found the diet reduced them when compared with a low-fat diet. A regular diet of Mediterranean cuisine also reduced the risk of dying.

The findings, published online by The New England Journal of Medicine, come from a study conducted right in the heart of Mediterranean country: Spain.

A group of men and women, ages 55 to 80 at the start of the study, were randomly assigned to a low-fat diet or one of two variations of the Mediterranean diet: one featuring a lot of extra-virgin olive oil (more than a quarter cup a day) and the other including lots of nuts (more than an ounce a day of walnuts, almonds and hazelnuts).

While lots of research has found benefits from the Mediterranean diet, many of the studies have observed what people have eaten and looked for associations. One of this study’s strengths is that it randomly assigned people at high risk of developing cardiovascular disease to diets that stood to help them.

The study was stopped early (after a median follow-up of 4.8 years) because the benefits from the Mediterranean diet were already becoming apparent. Overall, the people consuming the diets rich in olive oil or nuts had about a 30 percent lower risk of having a heart attack, stroke or dying from a cardiovascular cause.

The Mediterranean diet has become a politically correct alternative to the low-fat diet because of this commonly-held opinion stated in the article:

The Mediterranean diet is rich in fish, grains, nuts, fruits and vegetables. The diet is low in dairy products, red meat and processed foods.

Grains, fish, fruits and vegetables … heck, the USDA could almost get behind it.  Just one little problem:  people who’ve lived in the Mediterranean assure me the local diet is also high in pork and saturated fat.

I looked up the dietary protocols for this study.  All three groups were told to limit their consumption of red meat – no more than one serving per day for the Mediterranean dieters, and no more than one serving per week for the low-fat dieters.  There’s no way you can conclude from this study that cutting back on red meat improved anyone’s health.

The low-fat dieters were also encouraged to consume at least three servings of bread, pasta, rice or potatoes per day.   The Mediterranean dieters weren’t told to consume grains at all.

So the headline for this study shouldn’t be Mediterranean Diet Saves Lives.  It should be Grain-Based, Low-Fat Diet Fails … Again!

Faced with this evidence, the USDA will of course continue recommending a grain-based, low-fat diet.  And then the schools required to follow that advice will send letters home to parents telling them their kids are too fat.

Baby Boomers Living Longer, But Sicker

The baby boomers are the first generation raised to fear arterycloggingsaturatedfat! and told to eat a grain-based, low-fat diet.  So let’s see how they’re doing:

As each generation gets older they like to think that they are healthier than the previous generation, however, the baby boomers are now unable to confidently make this claim.

The new findings were published in JAMA Internal Medicine, in a study conducted by a group of researchers from the West Virginia University School of Medicine.

The study revealed that a portion of the baby boomer generation, specifically the 78 million Americans who were born in the post-war baby boom from 1946 to 1964, were less healthy than most of their parents.

Historically, the baby boomer population has been labeled the “healthiest generation”, due to their long life expectancy and their ability to take advantage of the newest medical care and public health campaigns.

However this label may no longer apply because studies are now showing that baby boomers have more elevated levels of certain conditions than the previous generation, including:

  • obesity
  • high cholesterol
  • diabetes
  • hypertension

Key findings the authors pointed out:

  • 7 percent of baby boomers used a cane or other device to help them walk, compared to 3 percent in the previous generation.
  • 13 percent of baby boomers have a type of limitation in their ability to complete daily tasks – like going up steps or mowing the lawn – compared with 8.8 percent of those in the previous generation.

Like I’ve said before, if your fifty-year-old grandfather could be transported through time to face the average fifty-year-old today in a fight or any other physical contest, I’d bet on Granpda every time.   The Greatest Generation gave birth to the Sickest and Fattest Generation, thanks in part to our government subsidizing and promoting a grain-based, low-fat diet.

Faced with this evidence, the USDA will of course continue recommending a grain-based, low-fat diet.  And then Dr. Callahan – a trim 82-year-old – will yell at the baby-boomers that they’re too fat and ought to be ashamed of themselves.

As the baby-boomers might say:  and the beat goes on …

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A friend of mine once lectured me on why I shouldn’t buy milk unless I was sure it came from a cow that wasn’t treated with hormones.  The lecture might’ve gone on longer, but she had to step outside to smoke a cigarette.  I kid you not.

When it comes to improving health, I believe in tackling the big issues first and foremost — like quitting smoking before worrying if your milk came from a hormone-free cow.  If we could just convince people to give up sugar, refined grains and chemically-extracted seed oils (the dietary equivalents of smoking, in my opinion), they’d already be far along the path to improved health, even if they buy their meats and eggs at Wal-Mart.

Moving farther down the path to health requires paying attention to the quality and nutrient density of food, but that’s where some of the food purists scare people off.  As Jonathan Bailor pointed out last week while we were recording a podcast, we want to avoid making perfect the enemy of good.  If we tell people the only way to be healthy is to eat nothing but pasture-fed meats and organic produce from local farmers’ markets, we’ll lose them.  (We’d also be lying to them.)

Aside from the purists and the orthorexics, most people simply aren’t going to do all their shopping at farmers’ markets.  But many of us who are health-conscious would happily opt for higher-quality foods if we knew how to find them in a grocery store … which leads to me a new book that teaches exactly how to do that.

Rich Food Poor Food was written by Jayson and Mira Calton, the same couple who wrote Naked Calories.  Their focus is on the importance of micronutrients, vitamins and minerals in food, and after meeting them on last year’s cruise, I’d bet their diet at home is close to perfect.  I’m happy to report, however, that this book isn’t about adopting a perfect diet.  It’s about adopting a better diet, even if you do all your shopping in grocery stores.  Most of the book, in fact, is a shopping guide – what they call their Ultimate GPS:  grocery purchasing system.

In Part One, the Caltons explain what they mean by rich foods and poor foods.  Rich foods, of course, provide the most micronutrients.  Not surprisingly, rich foods are usually unprocessed or minimally processed.  Poor foods are either devoid of micronutrients or contain additives that can potentially screw up our health … hydrogenated oils, artificial colorings, MSG, chemical preservatives and other frankenfood ingredients.  The goal of Rich Foods Poor Foods is to guide you to the rich foods – or at least the richer foods, given the choices available.

While explaining the importance of reading labels, the Caltons take a delicious swipe at the Eat This, Not That authors.  If you’ve read any of the many Eat This, Not That articles online, you know the authors promote almost any low-fat garbage over a high-fat version of the same (supposed) food.  The Caltons demonstrate what a lousy idea that is by comparing Lay’s Potato Chips to Lay’s Baked Potato Crisps.
Here are the ingredients for Lay’s Potato Chips:

  • Potatoes
  • Vegetable oil (sunflower, corn and/or canola oil)
  • Salt

A good choice?  Well, I wouldn’t eat them (and neither would the Caltons), but at least we’re talking about a mere three ingredients.  Compare those to the Lay’s Baked Potato Crisps preferred by the Eat This, Not That guys:

  • Dried Potatoes
  • Cornstarch
  • Sugar
  • Corn Oil
  • Salt
  • Soy Lecithin
  • Corn Sugar

Yee-uk.  As the Caltons write:

This lower-calorie, low-fat snack is not a healthier, smarter choice.  It is very definitely a Poor Food choice with ingredients that may be linked to cancer, diabetes, high blood pressure, obesity, infertility, compromised immunity, accelerated aging, and numerous other health conditions and diseases.  Had you purchased this product only after a review of the Nutrition Facts, you would have opened yourself up to unwanted ingredients.

When Eat This, Not That named these potato crisps their go-to choice, they boasted, “Baked Lay’s represents the classic potato chip at its absolute best.”  What?  Are they serious?  These crisps are not even made with real potato slices.  Far from the absolute best, the Baked Lay’s represents to us just how far we have strayed from natural foods onto a dangerous new path paved with highly processed, manufactured food-like substances.”

Part Two is the shopping guide, which is divided into the same sections you’ll find at a grocery store:  Dairy, Meat, Fish, Produce, Condiments, Grains, Baking Items, Snacks and Beverages.  Each section contains a brief introduction explaining what we should either seek out or avoid within that particular category, then provides two lists named Steer Here (rich foods) and Steer Clear (poor foods).

The lists are colorful, they’re easy to read, and (best of all) they name names.  You can find a perfect choice in a Steer Here list, but if perfect isn’t an option, you can also find some very good choices.  In the milk list, for example, the top choice is farm-fresh raw milk from grass-fed cows.  But if you aren’t willing or able to buy raw milk from a local farm, you can look for Organic Valley Grassmilk.  It’s pasteurized, but not homogenized, and the milk comes from grass-fed cows.  Or you could choose Meyenberg brand goat milk, which is also grass-fed and hormone-free.  You get the idea.

Early in my low-carb days, I bought Hood brand Carb Countdown milk.  (They’ve since changed the name to Calorie Countdown.)  That brand, not surprisingly, is on the Calton’s Steer Clear list:  the ingredients include cellulose gel, cellulose gum, artificial color, sucralose (aka Splenda) and acesulfame potassium.  Hmmm, doesn’t sound much like real milk, does it?

The Caltons recommend quite a few organic foods, but in the section on produce they provide a list of fruits and vegetables for which buying organic is basically a waste of money:  onions, sweet potatoes, avocados, asparagus and several others.  Apparently there’s little chance of those foods containing pesticide residues or being genetically modified.  There’s also a list of fruits and vegetables they recommend you buy only if they’re certified organic:  apples, blueberries, spinach, lettuce and several others.

Rich Food Poor Food isn’t pocket-sized, but I believe it would fit into a purse if you want to take it with you on shopping trips.  I doubt you’ll find every brand name on the Steer Here lists at your local Kroger or Wal-Mart, but I recognize many of them from the days when we lived near a Trade Joe’s and did much of our shopping there.  And of course there’s always Whole Foods … if you don’t mind paying Whole Foods prices.

Again, the goal isn’t to make your diet perfect.  The goal is to make your diet more nutrient-dense.  Rich Foods Poor Foods can help you attain that goal.

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I’m spending tonight finishing (I hope) a side project for a software client.  I also need to work a bit with Sara on a speech she’s giving next week.  Since she’s not a teenager yet, she still respects my opinions on these matters.

I’ll have a post ready tomorrow.

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As I mentioned in the follow-up sequence in the director’s cut of Fat Head, my girls have never had a single cavity.  To encourage them to keep that streak going, I made a deal with them a couple of years ago:  if you get to age 16 without a cavity, Daddy will contribute $1,000 to your “I want my own car” fund.  (Then Daddy will endure some sleepless nights when they start driving.)

Sadly, cavity-free kids seem to be increasingly rare.  Both of my daughters told me they have classmates who’ve already had several cavities.  Alana has a classmate who has already had 10 of them – at age 7.  I wondered if kids are developing more cavities these days, or if I’m just paying more attention now because I’m a dad.

Turns out kids really are developing more cavities, according to an online article with the headline Pediatric Cavities Reach An All-Time High:

In a swift-stepping society, more meals are being consumed on the move, quick bites taken on the run and fruits eaten on the fly. That translates to fast food, snack food and inordinate amounts of sugar intake, resulting in an increase in pediatric cavities that is at an all-time high, according to the N.C. Dental Society.

The research is confirmed by dentist Dr. Jerry Laws, who has practiced in Lexington since 1977.

“We are seeing that more than we used to. There are several causes, and it is preventable.”

In a press release, the Centers for Disease Control and Prevention notes that 28 percent of preschoolers in the U.S. experience decay in primary or “baby teeth.” And for the first time in four decades the number is increasing. Currently, among children 2 to 5 years old, one in five has untreated cavities.

“There are several causes (of rapid tooth decay),” Laws says, and points out that most relate to contemporary diets. “Also, children are going to bed with sippy cups. Another thing is bottled water, which doesn’t have fluoride. Children should at least have some water from the tap, which is fluoridated.”

The economy also plays a role in tooth decay, Laws said.  “A lack of insurance is a reason. Some people are out of work and without insurance, and some have to put off visits to the dentist … something that can’t be helped.”

A lack of insurance would explain why some kids end up with untreated cavities.  It doesn’t explain why they’re developing those cavities in the first place.  Our Paleolithic ancestors apparently had good teeth (more on that shortly), and they rarely purchased dental insurance.

By pure coincidence, I had a conversation with a co-worker today who speculated that he had a lot of cavities as a kid because his family’s water supply (a well) wasn’t fluoridated.  Okay, yes, that may figure into it.  But again, our Paleolithic ancestors didn’t put fluoride in their streams and springs.  Fluoride is, if anything, protection against dental decay that shouldn’t develop in the first place.

I agree with the writer of the article that sugar intake is the likely culprit for the rise in pediatric cavities over the last few decades, but I know from personal experience that it’s possible to develop cavities on a sugar-free diet.  During my vegetarian days, I didn’t consume sugar – I was, after all, a health-conscious vegetarian, and I knew sugar was bad news.  Nonetheless, I continued to develop the occasional cavity and ended up experiencing the joys of a gum graft (ouch) when my gums receded.

I didn’t eat sugar, but I did eat plenty of hearthealthywholegrains, which, according to a recent study, are probably a big part of the reason humans began developing cavities in the first place:

Mesolithic hunter-gatherers living on a meat-dominated, grain-free diet had much healthier mouths that we have today, with almost no cavities and gum disease-associated bacteria, a genetic study of ancient dental plaque has revealed.

The researchers extracted DNA from dental plaque from 34 prehistoric northern European human skeletons, and traced the changes in the nature of oral bacteria from the last hunter-gatherers to Neolithic and medieval farmers and modern individuals.

“Dental plaque represents the only easily accessible source of preserved human bacteria,” says lead author Dr Christina Adler, now associate lecturer in dentistry at the University of Sydney.

The researchers found the composition of bacteria changed with the introduction of farming and again 150 years ago during the Industrial Revolution.

In contrast to the hunter-gatherer and early agriculturist diet, a modern diet full of refined carbohydrates and sugars has given us mouths dominated by cavity-causing bacteria.

Setting aside the desire for a photogenic smile, poor dental health is often a reflection of poor health in general.  (It was a decline in dental health among his patients over the years that inspired Dr. Weston A. Price to travel the world and compare the health effects of traditional diets vs. modern diets.)  It’s a bit silly to believe that hearthealthywholegrains are protecting our cardiovascular systems even as they’re ruining our teeth.  Yet that’s what the experts have been telling us for decades.

The results will no doubt be good news for advocates of the so-called ‘paleolithic diet’ – high in meat, low in grains.

Yup, we’re smiling at the news.  I haven’t had a cavity in years now.  I also haven’t had a cold sore, canker sore, or any other kind of mouth sore.  Same goes for Chareva and the girls.  The girls also seem to be developing nice, wide jaws.  They may avoid needing braces, even though Chareva and I both had them.

I’m looking forward to forking over those $1,000 contributions.


Look, Ma, no cavities!

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When Chareva and I were first engaged, she warned me not to marry her for her cooking abilities.  At the time, it was a fair warning – not that I cared.  Considering that it took me 25 years of dating to find someone I wanted to marry, a lack of enthusiasm for cooking wasn’t exactly a deal-breaker for me.

That was then, this is now.  She’s become an excellent cook over the years, despite the restriction of preparing meals without sugars and grains.  Here’s one of my recent favorites from Chareva’s Kitchen:

Eggplant Lasagna

Ingredients:
1 lb. ground beef
1 lb. pork sausage
1 large eggplant
12 oz. ricotta cheese
1/2 cup plus 1 cup parmesan cheese
1 16 oz. bag shredded mozzarella cheese
2 eggs
1 Tbs. Italian seasoning
1 tsp. garlic powder
1 tsp. onion powder
1 Tbs. parsley
1 6 oz can of tomato sauce (canned tomato sauces tend not to have added sugar).
olive oil
salt and pepper to taste

Cut the eggplant into 1/4 to 1/2 inch thick slices. If you have the prep time, you can coat the eggplant slices with salt and let them sit for an hour to extract any bitter juices, then rinse clean and squeeze dry with paper towels.  If not, skipping this step doesn’t seem to affect the final taste much at all.

Rub both sides of the eggplant slices with olive oil. Place on cookie sheet and bake for about an hour in a 325-350 degree oven.

While the eggplant is baking, brown the ground beef and sausage together in a pan. Pour off the extra grease – nothing wrong with eating  fat, mind you, but you don’t want the lasagna to be runny.

Make the white sauce:  In a medium bowl mix together 12 oz ricotta cheese, 1/2 cup Parmesan, 2 eggs, Italian seasoning, onion powder, garlic powder, and parsley.

Remove the eggplant from the oven once it has browned on both sides. (You may need to turn the slices halfway through baking).

Build the lasagna layers:  Pour a little olive oil in a casserole dish and spread it around. Then create a layer of eggplant slices, browned meat, white sauce, tomato sauce, mozzarella cheese and a sprinkle of Parmesan cheese. Repeat. You can probably create two or three layers, depending on the size of your casserole dish.  (The dish in the picture below is 8 in. x 8 in.  There were enough leftover ingredients to make a second batch in a smaller dish.  Tom ate that second batch himself.)

Bake the lasagna for about an hour at 350 degrees. It’s ready when the top layer of cheese begins to brown. Let it cool for 15-20 minutes so it becomes firm before serving. Makes great leftovers and a very convenient packed lunch for the kids and hubby the next day.

(It’s also awesome cold – Tom)

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In my last post, I compared the organizations that have been promoting artercloggingsaturatedfat! hysteria for the past 40 years to prosecutors who refuse to believe they put an innocent man in prison — even when new evidence says that’s exactly what happened.  Never mind that pesky new DNA test, they insist. You have to look at the totality of the evidence. Someone who either works for or believes in the American Heart Association even left a comment to that effect (along with a couple of links):

You don’t take fringe studies from 50 years ago that contradict the vast majority of lipid research over the last half century and make a conclusion. You look at the body of evidence.

Well, the Sydney Diet Heart Study wasn’t exactly a “fringe” study.  It was a controlled clinical trial that ran for seven years and included 458 subjects.  Unless human biology has changed in the past 50 years, the results are still relevant.

I’ll examine that “vast majority of lipid research” the commenter linked to in a moment.  First I’d like to deal with the argument that we must consider the totality of the evidence.

No, we don’t.  Good scientists don’t consider a hypothesis to be validated unless the evidence supporting it is consistent and repeatable.  As the science philosopher Karl Popper explained, if your hypothesis is that all swans are white, as soon as I start finding black swans, your hypothesis is wrong.  It’s been falsified.  If you find 100 white swans and I only find three black ones, you might insist that the “totality of the evidence” is in your favor, and it is – but your hypothesis is still wrong.

Another reason I don’t buy the “totality of the evidence” argument is that selection bias and publication bias are both rampant in nutrition science.  I’ve read papers where the conclusions simply weren’t supported by the actual data.  Studies that don’t produce the results the investigators wanted are often buried.   If your academic paper supports conventional wisdom, it’s far more likely to be published.  As Dr. Uffe Ravnskov can tell you from personal experience, papers that challenge conventional wisdom are often rejected over and over, with little or no explanation … unless you consider “this just has to be wrong” an explanation.  So when researchers decide to do a meta-analysis of published studies, there’s a good chance they’re analyzing a stacked deck.

With that in mind, let’s start by looking at some of the “totality of the evidence” offered by the arterycloggingsaturatedfat! crowd, then move on to a few black swans.

The first link from our “body of evidence” commenter was to this study, a meta-analysis of eight studies.  And how were those studies selected?  Did the investigators go out and examine the entire body of evidence?  Hardly.  Here’s a quote from the study:

Of 346 identified articles, 290 were excluded based upon review of the title and abstract. Full texts of the remaining 54 manuscripts were independently assessed in duplicate by two investigators to determine inclusion/exclusion. Forty-six studies were excluded because they did not meet inclusion and exclusion criteria.

Most of the “body of evidence” was excluded merely by reading titles and abstracts.  I’m not claiming the investigators rejected studies that didn’t support conventional wisdom, but the potential for cherry-picking is certainly there.  Out of 346 studies they identified, they ran their analysis on just eight.

To their credit, the researchers discussed the weaknesses of the eight studies they selected:

Many of the identified randomized trials in our meta-analysis had important design limitations.  For example, some trials provided all or most meals, increasing compliance but perhaps limiting generalizability to effects of dietary recommendations alone; whereas other trials relied only on dietary advice, increasing generalizability to dietary recommendations but likely underestimating efficacy due to noncompliance. Several of these trials were not double-blind, raising the possibility of differential classification of endpoints by the investigators that could overestimate benefits of the intervention. One trial used a cluster-randomization cross-over design that intervened on sites rather than individuals; and two trials used open enrollment that allowed participants to both drop-in and drop-out during the trial. The methods for estimating and reporting PUFA and SFA consumption in each trial varied, which could cause errors in our estimation of the quantitative benefit per %E replacement. One of the trials also provided, in addition to the main advice to consume soybean oil, sardines to the intervention group, so that observed benefits may be at least partly related to marine omega-3 PUFA rather than total PUFA consumption.

Enough said about that one.

The commenter also left a link to this study, another meta-analysis published by our pals at the American Heart Association.   Here’s pretty much all you need to read to realize we’re not exactly looking at overwhelming evidence:

Several randomized trials have evaluated the effects of replacing saturated fatty acids with PUFAs on CHD events.  Intakes of PUFA (almost entirely omega-6 PUFA) ranged from 11% to 21%. In addition to the inability to double-blind these studies, many had design limitations such as small sample size (n=54), the provision of only ≈50% of meals, outcomes composed largely of “soft” ECG end points, randomization of sites rather than individuals with open enrollment and high turnover of subjects, use of vegetable oils that also contained the plant omega-3 fatty acid α-linolenic acid, and simultaneous recommendations to increase fish and cod liver oil use.

Think we have enough confounding variables there?  The “totality of the evidence” doesn’t appear to be very convincing.  I believe an intelligent jury would have to conclude there’s more than a little reasonable doubt.  So let’s move on to some black swans.

The American Heart Association’s advice is based on the belief that saturated fat raises cholesterol, and high cholesterol causes heart disease.   Replace those arterycloggingsaturatedfats with polyunsaturated or monounsaturated fats, and you’ll lower your cholesterol, thus preventing a heart attack.

Does eating saturated fat raise your cholesterol?  Perhaps, but not necessarily.  Look what happened in this study:

Multiple food allergies required a group of seven patients with elevated serum cholesterol levels to follow a diet in which most of the calories came from beef fat. Their diets contained no sucrose, milk, or grains. They were given nutritional supplements. This is the only group of people in recent times to follow such a diet. During the study, the patients’ triglyceride levels decreased from an average of 113 mg/dl to an average of 74 mg/dl; at the same time, their serum cholesterol levels fell from an average of 263 mg/dl to an average of 189 mg/dl. At the beginning of the study, six of the patients had an average high-density lipoprotein percentage of 21%. At the end of the study, the average had risen to 32%. These findings raise an interesting question: are elevated serum cholesterol levels caused in part not by eating animal fat (an extremely “old food”), but by some factor in grains, sucrose, or milk (“new foods”) that interferes with cholesterol metabolism?

When I cut the carbohydrates and increased my animal-fat intake, my total cholesterol dropped, my LDL dropped, my triglycerides dropped, and my HDL went up.  That’s what happened with the patients in this study as well.  So perhaps saturated fat, if it’s harmful at all, is only harmful in the context of diet that includes sugars and grains – exactly the point Dr. Richard Feinman has made over and over.

Switching to vegetable oils can indeed lower cholesterol levels, but that does translate to fewer heart attacks?  That’s what the American Heart Association tells us.  But once again, I see black swans in the sky.  In the Sydney Diet Heart Study that started this debate, the men who switched to safflower oil lowered their cholesterol by an average of 13%.  That means a subject whose total cholesterol was 230 (deemed unsafe by the AHA) would, on average, end up with total cholesterol of 200 – the recommended level.  And yet the men whose cholesterol was lowered by substituting polyunsaturated fats for animal fats ended up with a higher mortality rate, including higher mortality from heart disease.  I’d call that a rather dramatic black swan.

In this study, the researchers were able to lower cholesterol levels by having a control group of men switch to soybean oil.  Here are the results:

The test diet lowered the serum-cholesterol from a mean initial figure of 272 to 213 mg. per 100 ml. at six months (22% fall); the level in the controls fell from 273 to 259 mg. per 100 ml. (6% fall). Suspected relapses were assessed at regular intervals by a review committee unaware of the patient’s diet group. 62 men on the test diet suffered at least one relapse during the period of observation compared with 74 of the controls.  40 of the first relapses in the test group were major (i.e., definite reinfarctions or deaths from coronary heart-disease) compared with 39 major first relapses in the controls. The total number of men who had a major relapse at any time in the trial was 45 in the test group and 51 in the controls; of these major relapses 25 in each group were fatal. None of the differences found is significant. Relapses were not related to initial cholesterol level, to change in cholesterol level during the trial, nor, in any consistent way, to observance of the dietary regimen.

Once again, we see a dramatic fall in cholesterol levels, but no difference in heart-attack deaths.  That looks like another black swan to me.

Here’s still another clinical study in which polyunsaturated fats replaced saturated fats:

Four hundred fifty-eight men with coronary heart disease participated in a trial of secondary prevention for 2 to 7 years. Overall five year survival was 81%. For those with first heart attacks it was 86%.

From infarct to entry into the trial the majority of men had already made changes in their diet and smoking habit and has lost weight. They were allocated randomly to two dietary groups. In one group the diet consumed derived 9.8% of calories from saturated fatty acids and 15.1% from polyunsaturates. In the second group saturated fatty acids contributed 13.5% and polyunsaturated fatty acids 8.9% of total calories. Survival was slightly better in the second group. Multivariate analysis showed that none of the dietary factors were significantly related to survival.

No significant difference, and what difference there was favored the group that consumed more saturated fat.

I saved my favorite for last.  In this study, men with existing heart disease were divided into three groups:  the control group maintained their normal diet, a second group was instructed to cut back on animal fats and consume polyunsaturated corn oil, and the third group was instructed to cut back on animal fats and consume monounsaturated olive oil.  You know, olive oil – the stuff that’s supposed to prevent heart attacks.  Here’s a quote from the full text of the study:

Patients in both oil groups were instructed to avoid fried foods, fatty meat, sausages, pastry, ice-cream, cheese, cakes (except plain sponge), etc. Milk, eggs, and butter were restricted. An oil supplement of 80 g./day was prescribed, to be taken in three equal doses at meal-times. The general nature and purpose of treatment were explained, together with the fact that different patients were receiving different kinds of oil. No advice on dietary fat was give to control patients.

The men in the two invention groups were monitored and counseled every month at first, then every two months.  Investigators then tracked cardiac deaths and cardiac events for two years.  The control group, by the way, was the oldest on average:  58.8 years vs. 55 years for the olive-oil group and 52.6 years for the corn-oil group.  Considering that heart-disease rates increase dramatically as people move through their fifties, I think that’s significant.  Nonetheless, here are the results from the study:

At two years the proportion of patients remaining free of major cardiac events is greater for the control group (75%) than for the two oil groups (olive oil 57%, corn oil 52%). The likelihood that the difference between the control and corn-oil groups was due to chance is 0.05-0.1 (S.E. of difference, + 13 %). Among those patients who were followed for a third year no new trend emerged.

Strangely, the researchers concluded that corn oil isn’t a good treatment for heart disease, but said nothing about olive oil.

That study was published in 1965.  Here’s a bit of text from the American Heart Association’s current guidelines online:

Eat foods with monounsaturated fats and/or polyunsaturated fats instead of foods with high levels of saturated fats or trans fats.  Check out our Fats and Sodium Explorer tool to get your personal daily calories and fat and sodium limits.

Choose:  Vegetable oils and margarines with liquid vegetable oil as the first listed ingredient.  Examples are canola, corn, olive, peanut, safflower, sesame, soybean and sunflower oils.

Corn oil and safflower oil — two oils that produced higher cardiovascular mortality rates in clinical studies.

I rest my case.

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