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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37 Responses to “Studies The American Heart Association Doesn’t Want You To Read”
  1. Jeff B says:

    Damn you, Tom. Stop using facts and logic! ;)

    BTW, an aside: you mentioned in the movie (and other posts) you do software development. What languages do you use?

    SQL Server, VB, C#, ASP.NET, Javascript, JQuery. In my current contracting job the databases are DB2 and Oracle, but I don’t create them, just build front-end systems to work with them.

  2. Stephanie says:

    Good breakdown.

    Thank you.

  3. Lily says:

    I think it’s just hard to see out of the box once you’re trapped inside. It’s like this with low-carb, too. Once you believe in CICO, nothing else could be explained otherwise:

    - Eat low carb and lose weight -> “Oh! It’s because you cut out bread and pasta, therefore, you cut calories!”
    - Fasting and lose weight -> “Oh, it’s because you skip meals, you cut calories!”
    - Eating within a time window -> “Oh, it’s because you snack less, you consume less calories overall and you lose weight!”

    Nevermind that a calorie of carb behaves very differently from a gram of fat/protein in the body. Eat less and move more, people!
    Sigh.

    Too true.

  4. JasonG says:

    Yesterday, while checking out at Party City, I was asked for a donation to the AHA. I declined saying, “I strongly support heart health, and that’s why I refuse to give them money.”

    I’ll be that drew some looks.

  5. Dave Wilson says:

    On the last study, I wonder if they performed due diligence and tested the olive oil for its purity. We are now finding out that so many oils marked EVOO and being sold at a premium contain other oils and not much if any olive oil at all. An interesting thought at least.

    Perhaps, but I’ve mostly heard of olive oil being mixed with canola oil, which was developed in the 1970s. This study was conducted in the early 1960s

  6. Jill says:

    Lions and tigers, away from humans, eat fat and protein. They don’t become overweight or sick. Domestic dogs and cats eat left over human food…

  7. Sean says:

    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.

    Yep, totally nailed it. “Body of evidence” claims usually come up in noisy and, of course, politicized fields, like economics, climate, health, etc. Also, very notably, in the courtroom, a decidedly unscientific arena. While “scientific consensus” is not science, it can point the way forward when there is a valid null hypothesis and when the scientific field in question is willing and open to having their theories and hypotheses falsified.

    This is why possible evidence of FTL photons is greeted by physicists the world over and makes headlines, whereas the news of a study that shows the lipid hypothesis or the diet-heart hypothesis is false simply disappears down the rabbit hole. Assuming that study can even make it past peer review. Consensus, or body of evidence in such fields is worse than meaningless.

    Indeed, it was a “consensus panel” that gave us the notion that everyone’s cholesterol should be below 200. It was a made-up figure based on nothing, except perhaps the desire to sell statins.

  8. Stefan says:

    Just re. the charities and giving: a fundraiser told me their charity for helping addicts was really great, really successful. I said great, and you know a meaningful change has to last more than a couple of years, so do you follow up? They guy said they didn’t collect that data, but anyhow, it was really great work. Eventually another fundraiser gets interested and phones her boss. He didn’t know either, they don’t collect that data. First guy is still insisting it really really works. I suggest it would look great on their literature if they could show some people were still clean a couple of years later. Then he seemed puzzled I wasn’t giving them any money.
    All I can say is once you start to question one conventional wisdom, you start to question other things too. It is like starting to think or something.

    I guess “successful” means they raised a lot of money.

  9. Elenor says:

    Tom, would you consider adding (to this or your next scathing dis-assembly of the dangerous foolishness of these studies) the pix you used in Science for Smart People — showing how the Barbies and Kens being sorted into different study groups affects (completely changes!) the ‘results’? I just inflic… er… showed (yeah!) your “Science for Smart People” (from the cruise, the one with the slides) to a friend on Tuesday, so your excellent ‘graphical lessons’ are very fresh in my mind….

    The astonishing ‘aha!’ moment that comes from: “Oh! If they’re studying fat, Barbie gets counted in THIS group, which results in “significant” results; but if they’re studying sugar, she’d go in THIS group, which makes those other results non-existent!” is just … well, a total and telling highlight, in a video full of highlights!

    Graphics do help. I’ll keep in mind when I can use them.

  10. Jim Butler says:

    See…those so-called black swans? those aren’t really swans, so they don’t count. They’re just large, black birds, with long graceful necks, that look VERY SIMILAR to swans, but they’re not swans, because they’re black, and as we’ve shown, swans are white.

    It always amazes me when a supposed scientific body starts talking about consensus. Consensus is anti-science. How they can even speak the words totally baffles me.

    Jim

    “The debate is over. We have a consensus.” But enough about Al Gore.

  11. Nads says:

    I wonder if the unpublished pro sat fat studies could be brought into the light of day. Or do studies need to be published to be recognised as any good?

    If they’re not published, we’ll likely never know about them.

  12. Tom Welsh says:

    I can’t resist repeating the old joke about the three friends who were travelling by train from England to Scotland. As they crossed the border, the engineer pointed to a black sheep standing on a hillside and remarked, “It looks as if the sheep in Scotland are black!” The philosopher replied pedantically, “No, all this tells us is that at least one sheep in Scotland is black”. The mathematician looked up from his book and set them right. “Actually, all we know is that at least one sheep in Scotland is black on at least one side”.

    Like that one. Reminds me of: three statisticians are out duck hunting. A duck flies overhead, and the first statistician shoots and misses left. The second statistician shoots and misses right. The third statistician yells “We got him!”

  13. Tanny O'Haley says:

    One of my favorite black swans from you is the UCLA study where 75 percent of the people who suffer heart attacks have “normal” LDL levels and nearly half have “optimal” LDL levels. Not a 50 year old study and from a “reputable” organization. They can’t say that UCLA is a group of quacks like they do with groups that support a LCHF diet. If 75 percent of the people who have heart attacks have good to low cholesterol levels what does cholesterol have to do with heart attacks?

    http://www.fathead-movie.com/index.php/2010/03/02/ldl-nonsense-is-taxing-my-sanity/

    A new national study has shown that nearly 75 percent of patients hospitalized for a heart attack had cholesterol levels that would indicate they were not at high risk for a cardiovascular event, based on current national cholesterol guidelines.

    Specifically, these patients had low-density lipoprotein (LDL) cholesterol levels that met current guidelines, and close to half had LDL levels classified in guidelines as optimal (less than 100 mg/dL).

    The bad news: your husband died of a heart attack. The good news: his LDL levels were impressive.

  14. Tanny O'Haley says:

    BTW, my doctor told me if it wasn’t for my “good” cholesterol that I’d have a stroke. You see my family has genetically high cholesterol. My 77 year old mom has a total cholesterol of over 300, eats mostly vegetarian and has never had a heart attack. My sister is way up there and eats a “normal” diet.

    I asked my doctor to prove it so he sent me to have my arteries checked out by some machine. The woman administering the test thought there was something wrong with the machine because according to her my arteries where “super clear” and that couldn’t be because my cholesterol was to high.

    A friend of my mom’s goes through that over and over with her doctor. Her cholesterol is near 300, so he keeps checking her arteries and finding them clear as a whistle. Then he gets on her to lower her cholesterol.

  15. Paul cunningham says:

    Tom, you’ve done it again! I have several friends, very “scientific minded” friends, that keep telling me that they are worried about me, and why I am keeping up this ‘experimental’ diet. They want to see the science as they basically think I’ve been duped. I’m trying my best to not just repeatedly link to this site, and instead have chosen to ‘dump’ as many low carb studies in their email in box as I can find. So far I’ve not had a response, but to be honest, I expect the next response to be ‘we’re worried about your diet, where is the proof that it’s right?’ .

    Why is it that the science of nutrition feels more akin to religious arguments than actual science?!?

    That’s a darned good question. I think the people pushing what’s now conventional wisdom meant well, but rushed to judgment instead of waiting for the evidence to come in. Once the paradigm took hold and industries built up around it, it was nearly impossible for them to change their minds.

  16. Dorian says:

    Is there a way to produce a scatterplot showing cholesterol level (either total or LDL) on the x-axis and something bad (e.g. CHD, CVD, early death) on the y-axis to help visualize the (presumably weak) correlation? The studies used to determine so called optimal cholesterol levels, as well as Framingham, have data, and I was always curious to see what the data looked like before others make conclusions. My regression professor said to always look at data before running a linear regression (and calculating the associated correlation) — if your data looks like a smiley face (parabola), drawing a straight line through the data is rather silly.

    I did one of those in this post:

    http://www.fathead-movie.com/index.php/2009/09/07/jimmy-and-monica-a-tale-from-the-heart/

  17. Larry AJ says:

    Check out this chart – TOTAL CHOLESTEROL LEVELS vs MORTALITY DATA from 164 COUNTRIES – found at;
    http://metabolichealing.com/assets/pdf/cholesterol-mortality-chart-1.pdf

    Then there is this:

    “But what Gary Taubes didn’t know was that there was a political decision being made on the floor of the NIH (Building 10) Mazur Auditorium that day in December 1984. The decision would allow the National Heart Lung and Blood Institute (NHLBI) to have yet another even more extensive long-term “trial” to work on. The NHLBI could not get more money from Congress for more large trials such as the MRFIT or LRC and they were developing the National Cholesterol Education Program. With the cutoff number at the lower end of the normal range (200 mg/dl), they could include all of the healthy normal citizens in the range that would need treatment with diet, and since the diet would never work to permanently lower those normal levels (eg, 200 mg/dl to 240 or 260 mg/dl) to below 200 mg/dl, they could recommend that all these people should go onto cholesterol-lowering medications.

    The three men who were heading the NHLBI (Cleeman, Lenfant, and Rifkin) were standing together in the Mazur Auditorium just before the Cholesterol Consensus Conference began. They were discussing the cutoff level of serum cholesterol to put into the consensus report. One said to the other two, “but we can’t have the cutoff at 240 [mg/dl]; it has to be at 200 [mg/dl] or we won’t have enough people to test.” Several of us from the University of Maryland Department of Chemistry Lipids Research Group were standing directly behind them and within clear earshot. We looked at each other and of course were not surprised when the final numbers came out. This small chat did not get onto the tapes that Taubes reviewed. ”

    A quote from Mary Enig, PhD found at
    http://www.second-opinions.co.uk/enig_chol.html

    If you could get Mary to tell you who she was with at the Cholesterol Consensus Conference who also over heard that conversation, it would be good to get conformation from at least one other of them since it is “hearsay” which is not usually acceptable especially in legal proceedings. I wish that Cleeman, Lenfant, and Rifkin could be prosecuted for fraud of something! At least “outed” for their collusion.

    I spoke to Dr. Kilmer McCulley on the phone when I was writing the script for Fat Head. (I wanted to make sure the story I heard about Harvard forcing him out was accurate.) He was also at the “consensus conference” and told me the lack of scientific rigor and push to reach a “consensus” despite the lack of evidence was disgusting.

  18. Dee Casey says:

    Hi Tom, thanks for the article. Until the nanny government gets their hands out of their deep pockets and stop funding these organizations that spin the studies to suit their needs, organizations like the American Heart Association and CSPI will continue to march forward with their false scientific studies.

    Here is an short study that debunks the American Heart Associations egg/cholesterol theory and how they cause heart disease. http://www.diabetesincontrol.com/index.php?option=com_content&view=article&id=14137&catid=1&Itemid=17

    They’re powerful and well-funded, but I believe the Wisdom of Crowds effect will win out over time.

  19. This is the only group of people in recent times to follow such a diet.

    Really? Maybe the rest of the study adds some context, but they’re sure as hell not the only people eating that way.

    If 75 percent of the people who have heart attacks have good to low cholesterol levels what does cholesterol have to do with heart attacks?

    Oh. My. God. It means we need to lower the “normal” cholesterol number even more!

    Yup, now the explanation is that LDL should be below 70. No thanks.

  20. johnny says:

    I’m in awe and speechless of your uncanny ability to read, analyze and dismantle, when necessary, scientific studies.

    I wish more professional scientists were like you.

    Can you please suggest what I need to do to analyze studies like you?

    Thanks!

    My Science For Smart People Speech is a pretty good wrap-up how I approach studies:

    http://www.youtube.com/watch?v=y1RXvBveht0

  21. Dana W says:

    In my case the arterycloggingsaturatedfat did raise my total cholesterol number, but only because my HDL went up 20 points. All the AHA-approved vegetable oil I was consuming when my cholesterol was checked a few years back did lower my cholesterol, but only because my HDL was so low (it was 54! Despite all those healthy oils!). My LDL did not budge with the change to a diet high in saturated fat (plenty of fatty meat, butter, and coconut oil).

    I’ll be your LDL particle size increased too.

  22. D says:

    No, but, wait… but, that can’t be! You’re so wrong, man!

    So all those chemicals in my “heart healthy” oil spray are bad?
    No f**king way!

    Crazy as it sounds, natural fats appear to be better for us than chemically-extracted fats.

  23. Devin says:

    I just found out my friend who’s transgender is being refused transitional treatment because in his currently female body, his LDL cholesterol is 20 points above the recommended range. It pisses me off that he’s being caused so much more pain over something so stupid and arbitrary based on such bad science.

    And of course to lower it he’s following his doctor’s recommendation of cutting the fats and eating more whole grains. I’ve been trying to convince him otherwise, but he’s basically written me off as a conspiracy theorist…

  24. Rae says:

    Earlier this month I was at Walgreens and I was asked to give money to the AHA. It gave me a great deal of pleasure to decline! It takes so much to support my butter habit that I can’t really spare any money for a bunch of hacks handing out bad advice.

    I felt the same way when AHA was sponsoring a walk-a-thon and recruiting people at my workplace. I’d rather walk to a restaurant and order bacon and eggs.

  25. Marilyn says:

    @Larry AJ: I love that 164 countries chart. I have it from another internet source, and have shared it with my friends when they are being pressured to take statins.

  26. Sonia says:

    Hi- do you know if there has been any comment by the AHA on the recently published ‘rediscovered’ Sydney Diet Heart Study?

    I haven’t seen an official comment from them.

  27. Marilyn says:

    And the beat goes on — the beat-up-on-low-carb, that is. A recent issue of a women’s magazine had a little blurb about a study comparing two diets — one a “low-carb” diet which had 300 calories for breakfast, and the other a “high protein, high carbohydrate” diet which had 600 calories for breakfast. The high carb breakfast included dessert foods (the illustration was a cupcake with sprinkles). The “high-protein, high carb” diet was reported to have won hands-down, and the people on the low carb diet to have gained back nearly twice as much after the diet. Was the low carb diet also hight fat? high protein? truly low carb? Who knows? We’re told nothing further about it. I guess I shouldn’t be surprised. The only weight-loss diet suggested in the editorial of the magazine was Weight Watchers.

    That figures.

  28. Laura F says:

    I enjoyed reading this while dipping my buttery ham in the yolk of a fried egg over easy. I hope it was OK that I washed it all down with a glass of raw milk.

    It’s certainly okay by me.

  29. Sky King says:

    I think you forgot to mention one other thing at the end of your exposé:

    Head. Bang. On. Desk.

    ;0)

    I’m going to a father-daughter dance with my daughters tonight and didn’t want to have forehead bruises.

  30. If you look at “the totality of the evidence” for flying saucers, there is a lot of evidence, a lot of evidence. Indeed, so much weak evidence that a cynic might wonder why, with flying saucers flocking to earth in such numbers, there is not any strong evidence.

    I’m pretty sure the people who claim to have seen flying saucers are only giving us observational evidence.

  31. Oke says:

    The commenter also seems to have forgotten that the (well-published) “fringe study” (probably one of the few decent n6 studies ever) included a complimentary metastudy. He should take a look at the results – they are… Interesting.

    Indeed.

  32. Norman says:

    “With the cutoff number at the lower end of the normal range (200 mg/dl), they could include all of the healthy normal citizens in the range that would need treatment with diet, and since the diet would never work to permanently lower those normal levels (eg, 200 mg/dl to 240 or 260 mg/dl) to below 200 mg/dl, they could recommend that all these people should go onto cholesterol-lowering medications.”

    But this is exactly what I did, i.e lower my T/C from 236 in July 2011 to 220 in January 2012 to 193 in June 2012, which by the way is the same as it was when I was 41 (am 54 now). Of course, I didn’t (and don’t) follow “the diet”. My LDL dropped from 131 to 112, and my HDL went down a little less, from 97 to 85, Trigs down from 54 (January 2012) to 41.

  33. Bex says:

    I’m currently reading Bad Pharma by Ben Goldacre..he also wrote a book called Bad Science all about this sort of thing. Every time I pick it up to read more, I terrify myself, but it is an awesome book. Unfortunately I will never trust a doctor again…

    Consider that a healthy skepticism.

  34. Nowhereman says:

    Some hope that the message is getting out there. From Fox News, an article that finally gets it right:

    http://www.foxnews.com/health/2013/02/15/great-cholesterol-myth/?intcmp=features

  35. Marilyn says:

    @Bex: It’s been my impression that one of the worst things to befall the field of medicine was the approval of direct-to-consumer advertising. It has blown the money-making/marketing aspect/political control of medicines all out of proportion, crippling the actual art and practice of doctors helping people get/be well.

  36. Kristin says:

    Again it is so much fun to read the comments on your site. I hope you didn’t mind but I’ve scraped that scatterplot you did on the MONICA study data into my FB page challenging people to find a correlation. Of course I also posted the link to the Jimmy and Monica article. I’d be happy if I manage to be a vehicle to drive more traffic through your blog.

    I don’t mind at all.

  37. Derek O'Brien says:

    Brilliant, Tom, brilliant! So much bandwagon riding, selective “evidence”, looking to find supprt for preconceived ideas, it goes on and on and on.

    Australia’s National Health and Medical Reshearch Council’s just published Guidelines are hysterically funny; over 80% of the recommendations are based on class C evidence, “Suggestive Association”: “**** MAY have positive outcome on xxxxx condition! e.g salt reduction “Reducing sodium intake by about 1,000 mg/day is associated with reduced risk of cardiovascular events.” The class A evidence is :”Decreasing consumption of sodium decreases blood pressure in normotensive adults; a reduction of 1,800 mg reduces systolic blood pressure by about 2 mmHg and diastolic blood pressure by about 1 mmHg.” Gawd, what a mind-blowing lowering of bloodpressure. The rest of the guidelines follow such monumental discoveries and related advice.

    Yup, despite the evidence that even drastic reductions in sodium intake barely budges blood pressure, they insist on pushing the same lousy advice.

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