Fear, anger, chaos. My work here is almost done.

And Tom’s almost back.

I’ve mentioned what The Wife and I call Sarah’s Awesome BLT’s a couple of times, so I thought I’d finish the story before Tom gets back and fills us in on his adventures in L.A. at the Ancestral Health Symposium at UCLA.

Sarah is Sarah Workman, a friend The Wife found, like several of our friends, while the moms (mostly) waited and chatted on the after-school playground back when all of our kids were younger. Much younger. This is how communities are formed.

Besides a fellow parent, Sarah was and remains co-proprietor of Carol Jean’s Fine Cuisine with her aunt, Carol Fraase. They do some of Springfield’s finest catering and in the off-season, they do cooking schools (The Wife went to so many they told her she’d graduated!).

Sarah invited us over one night because we wanted to learn how to put together a Turducken (yeah — chicken stuffed inside a duck stuffed inside a turkey). She gave us shopping instruction beforehand, and told us not to eat first — she’d “just make some BLT’s.” Made sense. Why not something simple, basic, and easy when you’re going to spending your evening wrassling with stuffing sundry fowl inside each other.

Simple and easy was right, but we’d forgotten that Sarah never does anything basic; what’s the point, when a bit of extra effort adds so much.

Bacon 101

First of all, Sarah was just finishing up the thick-sliced bacon when we got there. In the oven. We hadn’t ever thought of that, but now it’s the only way we make bacon when we want more than a couple slices.

You just line a cookie sheet with foil, lay the bacon out on it, and pop it in a 450 degree oven for 15-20 minutes.  No turning necessary.

there’s less shrinkage, you can do a whole lot in one batch, and there’s no bacon fat splattering on the stove top. Or you.

Here’s what it looks like when you’re done. Mmmm.

Speaking of bacon fat, you can now just tip the cookie sheet up and pour it through your strainer into a container for the next time you need bacon fat. Later this afternoon, maybe.

For cleanup you just peel the foil off the cookie sheet and give it a quick cleaning. Easy.

Now you probably saw most of the other stars of this party from Veenstra’s Vegetables in my previous post — the mixed lettuce and heirloom tomatoes make up the rest of the traditional BLT, but Sarah added thinly sliced red onion (also shown here from Veenstra’s) and avocado, which adds more flavor, mouth feel, and seems to be one of the few sources of saturated fat even Ancel Keyes would be okay with.  As you can see in the foreground, instead of plain mayo, we stir in some (not too much) of the thick liquid from a can of chipotles.

If you haven’t seen the easy way to deal with an avocado, here’s a quick lesson…

Avocado 101

Start by slicing in down to the pit, then circling the pit with your knife.

Then you can twist the two halves, pulling one half away from the one where the pit stayed.

Now carefully whack the blade into the middle of the pit (if the avocado is very ripe, the pit could spin if you hit it off-center, so if you don’t have good aim, set it down first!).

Once the knife has bitten into the pit a little, you can just wiggle it side-to-side to loosen, then pop it out.

Take each half in your hand, and use the knife tip to “score” lines down through the fruit. The skin is pretty thick so you should be able to make clean cuts without stabbing yourself! If you’re going for cubes (like in my crab/avocado salad), just turn the avocado 90 degrees to make cross hatch cuts.

Now you can scoop the already sliced fruit out with a large spoon.

Nice and neat.

Now comes the dicey part for us low-carb types. What do you put all of this goodness on? I mean, we shun bread. As I explained to someone who asked, you can always just call it a cheat day, of course.

Sarah served hers on toasted potato bread, and we loved it.  We decided on a couple of compromises, so I had to go dig the toaster out of storage.

The Oldest Son decided to go with low-carb bread. Here’s how it preps up.

After final assembly, two slices of the low carb bread are only adding about 5 net carbs.

I went with one slice of the potato bread, but it scores around 18 net carbs per slice. I’m not heading off to sugar spike land, but it is more than I like to ingest on purpose.

The Oldest Son had a great idea of using a couple of the low-carb waffles from the Eade’s Six Week Cure for the Middle-Aged Middle – it uses almond flour and they’re delicious. Unfortunately, although I make batches of them at once and freeze them, they don’t last long, and I didn’t have any on hand.

Then, as this got discussed a bit in the comments on my “Shopping” post, Saline came up with a perfect low-carb solution — it’s a B (as in Bacon) LT, right?  Why not use a bacon weave as the base. Wow!

That’s why it’s a good idea to hang out with smart people! And good cooks.

If you make these and kick the humble BLT up several notches, a great side would be Dana Carpender’s “Un-potato Salad.” We made it a couple of weeks ago, and it’s one of those “why would I ever want to look a potato in the eye again” dishes. We ate that one too fast for me to get a picture.

Well, thanks again for putting up with me. See you in the comments!

Cheers,

– The Older Brother

If you wanted a clear example of how desperately some scientists (and I’m using the term loosely) will cling to a beloved theory, you couldn’t do much better this:

A recent meta-analysis of salt-restriction studies that was published in both The Cochrane Review and the American Journal of Hypertension found that cutting back on salt is pretty much worthless.  So naturally, the anti-salt hysterics had to jump in and torture the data to find some meaningless associations and try to save their reputations and careers.

You can read an abstract of the meta-analysis here, but for a plain-English version, I’d suggest reading an article published in the online version of Scientific American titled It’s Time to End the War on Salt.  Here are some quotes:

This week a meta-analysis of seven studies involving a total of 6,250 subjects in the American Journal of Hypertension found no strong evidence that cutting salt intake reduces the risk for heart attacks, strokes or death in people with normal or high blood pressure. In May European researchers publishing in the Journal of the American Medical Association reported that the less sodium that study subjects excreted in their urine—an excellent measure of prior consumption—the greater their risk was of dying from heart disease. These findings call into question the common wisdom that excess salt is bad for you, but the evidence linking salt to heart disease has always been tenuous.

I’d say labeling the evidence linking salt to heart disease as tenuous is being generous.  Non-existent would be the more accurate term, unless you engage in some major cherry-picking.  In real science, no consistency means no validity, and the associations between salt and heart disease or mortality aren’t even close to being consistent.  If anything, the associations are all over the place.

So what ignited the fear of salt in the first place?

Worries escalated in the 1970s when Brookhaven National Laboratory’s Lewis Dahl claimed that he had  “unequivocal” evidence that salt causes hypertension: he induced high blood pressure in rats by feeding them the human equivalent of 500 grams of sodium a day. (Today the average American consumes 3.4 grams of sodium, or 8.5 grams of salt, a day.)

Let’s see … some goofy scientist feeds rats the equivalent of 147 times as much salt as the average human consumes in a day, and the rats developed high blood pressure.  Well, my goodness, let’s toss those salt shakers right now!

Last time I checked, most health authorities were still recommending we consume eight glasses of water per day.  I wonder if it ever occurred to Dr. Dahl to force-feed rats the equivalent of 1,176 glasses of water per day and see how that affected their health.  If he ran that experiment, I’m pretty sure he’d end up declaring water a health hazard.  What kind of hopeless idiots could possibly be swayed by such a nonsense study?

In 1977 the U.S. Senate’s Select Committee on Nutrition and Human Needs released a report recommending that Americans cut their salt intake by 50 to 85 percent, based largely on Dahl’s work.

Ah yes, those idiots.  The same idiots who helped kick off the anti-fat hysteria by seeking “consensus” instead of truth.  George McGovern strikes again.

Scientific tools have become much more precise since then, but the correlation between salt intake and poor health has remained tenuous. Intersalt, a large study published in 1988, compared sodium intake with blood pressure in subjects from 52 international research centers and found no relationship between sodium intake and the prevalence of hypertension. In fact, the population that ate the most salt, about 14 grams a day, had a lower median blood pressure than the population that ate the least, about 7.2 grams a day.

Well, that’s just an observational study, so perhaps we’re not accounting for some confounding variables.  Surely if we restricted salt in a controlled clinical setting, we’d see some real health benefits, eh?

In 2004 the Cochrane Collaboration, an international, independent, not-for-profit health care research organization funded in part by the U.S. Department of Health and Human Services, published a review of 11 salt-reduction trials. Over the long-term, low-salt diets, compared to normal diets, decreased systolic blood pressure (the top number in the blood pressure ratio) in healthy people by 1.1 millimeters of mercury (mmHg) and diastolic blood pressure (the bottom number) by 0.6 mmHg. That is like going from 120/80 to 119/79.

You may recall that some troll who claimed to hold a PhD in science once insisted in several comments that salt is indeed bad for us, and to prove his point he sent me a link to a clinical study in which researchers produced a “significant” reduction blood pressure by drastically restricting salt.  As I explained in my Science For Smart People speech, “significant” simply means that statistically, the results weren’t likely to due to chance.  The “significant” reduction in blood pressure reported in the study that the troll sent me amounted to around three points. In other words, meaningless … all the salt-restricted dieters got out of the deal was some really bland food.

Studies that have explored the direct relationship between salt and heart disease have not fared much better. Among them, a 2006 American Journal of Medicine study compared the reported daily sodium intakes of 78 million Americans to their risk of dying from heart disease over the course of 14 years. It found that the more sodium people ate, the less likely they were to die from heart disease.

And yet various government agencies around the world are telling people to restrict salt … to prevent heart disease, of course.

For every study that suggests that salt is unhealthy, another does not.

Bingo.  No consistency, no scientific validity.  Given an honest analysis of the science, we’d have to conclude that restricting salt is pointless from a public-health standpoint, except as advice given to the few people who are hyper-sensitive to salt.

Now … let’s suppose you’re the chairman of Consensus Action on Salt and Health – kind of a British version of CSPI, only focused specifically on attacking salt in the food supply.  Now let’s further suppose stamping out salt in Britain isn’t a mission quite large enough for your ego, so you’re also the chairman of World Action on Salt and Health.  (In my opinion, if you belong to more than one organization with Action on in its name, you’re probably a menace.)  Finally, let’s suppose both of the organizations you chair depend on donations from people you’ve managed to scare witless about the terrors of salt.

Are you going let a pesky little thing like scientific evidence change your mind?  Of course not.  You’re going to get ahold of that data and (as Dr. Mike Eades would say) torture it until it says what you want to hear.  Which is exactly what Dr. Graham McGregor (who I like to refer to as Action-Action Jackson since he’s the chair of two Action organizations) did after the Cochrane Collaboration issued its report.

In a response published in the Lancet, Dr. MacGregor and Dr. Feng He revealed how they concocted a brilliant method of getting around inconvenient facts like these:

As previously reported by heartwire, Taylor et al’s meta-analysis included seven randomized controlled trials of dietary salt reduction in normotensives (three studies), hypertensives (two studies), a mixed population (one study), and one trial of patients with heart failure.

At follow-up, relative risks for all-cause mortality and cardiovascular mortality for both normotensives and hypertensives were only mildly to moderately reduced, and not to a statistically significant degree. In congestive heart failure patients, salt restriction actually significantly increased all-cause death.

Those are the inconvenient facts.  Now here’s how MacGregor and Feng He tried to fung foo all over them:

He and MacGregor, in their Comment, reanalyze the same data but combined the normotensives and hypertensives. They also omitted the heart-failure trial—a group of “very ill” patients taking large doses of diuretics in whom salt restrictions would seldom be recommended, MacGregor observed. In the combined patient analysis, they find a now statistically significant 20% reduction in cardiovascular events and a nonsignificant reduction in all-cause mortality.

Lovely.  If clinical trials don’t tell you what you want to hear, mix and match the data, toss out some data if need be, and presto! – you’ve got yourself a “significant” result … well, if you’re talking about cardiovascular events, that is.  If you’re talking about actual deaths, the results aren’t “significant.”

In layman’s terms, that means “the results are utterly @#$%ing worthless.”  But not to Action-Action Jackson MacGregor:

“We’ve done this reanalysis, and we’ve got the evidence. In fact, all the evidence about salt is overwhelming. . . . It all shows that salt is a major factor bringing up our blood pressure.”

All the evidence, really?  Like the clinical trials in which salt restriction changed blood pressure by a point or two at most?   Like the big, expensive clinical study the anti-salt troll insisted I read, in which adopting a diet with almost no salt at all caused blood pressure to drop by a whopping three points? (And that trial was conducted by researchers who wanted salt restriction to work.  They even tried to talk their way around the results in their conclusions.)

The only overwhelming evidence I see here is that some scientists are freakin’ liars.

Some interesting theories on Why We Get Fat and What to Do About It have been popping in the news lately – and no, I’m not talking about the book by Gary Taubes.  I’m talking about ideas proposed by … uh … well, let’s call them somewhat less-brilliant researchers.

A doctor in St. Louis, for example, has decided that the main cause of the obesity epidemic is pregnancy:

National experts have suggested that if a woman is obese, she should gain far less weight when pregnant than previously thought:  just 11 to 20 pounds.  But one local doctor says even that is far too much. Dr. Raul Artal, chairman of the obstetrics and gynecology department at St. Louis University School of Medicine, says an obese woman who gets knocked up shouldn’t gain so much as an ounce — and then adds that pregnancy, not an unhealthy affection for fast food and the La-Z-Boy, is “the main contributor to the obesity epidemic in this country.”

I believe the doctor is onto something.  While researching Fat Head, I was surprised to learn that back in the days when obesity was rare, the vast majority of women never became pregnant.  All the propagating of the species was accomplished by a small minority of women who then gave their babies to women who preferred to remain thin.  Pretty much every family was made up of kids who were adopted — which is how Puritans and the upper-class British managed to raise large numbers of children without ever engaging in sex.  It was also the reason that every individual bore a striking resemblance to at least 200 other individuals in their geographic area.  Sure, the gene pool was a little shallow, but people were thin and that’s what mattered.

Unfortunately, all that began to change in the late 1960s with the arrival of loose morals — which became even looser after disco music was invented in the 1970s.  Women who wanted to raise children began insisting on having their own babies, and the obesity epidemic was born.  (By pure coincidence, this was also around the time the McGovern committee told everyone to eat more grains and other carbohydrates.)

I know what you’re probably thinking:  if Dr. Artal is correct that pregnancy is the primary cause of obesity, why are so many men obese? All I can tell you is that both times my wife became pregnant, I got fatter.  I can’t explain the biological mechanism, but I expect science to provide an answer eventually.

Since women apparently plan to keep producing their own babies, the real question is what to do about all the obesity their pregnancies are causing.  A professor of bioethics has come up with a solution that was recently praised by a columnist for the Boston Globe:  we need to shame fat people into better eating habits:

“Hey, fatty! Pull that doughnut out of your pie hole! You look like a pig, and you are costing me, and every other taxpayer, billions of dollars in unnecessary health care each year!’’

How do you like my new public service ad campaign, designed to stigmatize the overweight and the obese in the same way smokers have been made to feel the knout of social opprobrium for the past quarter-century?

I got the idea when I heard Professor Daniel Callahan, the retired cofounder of the Hastings Center, a bioethics research institution, speak on a radio program about two weeks ago. Why aren’t overeaters subject to the same stigmatization as smokers?, he mused. Why not indeed?

Callahan makes a persuasive case: 67 percent of Americans are overweight, he writes. “Obesity is a leading cause of diabetes, heart disease, and kidney failure. There are some prima facie reasons for thinking about stigmatization as one more arrow in the quiver of possible solutions.

“It can hardly be said that obesity is beyond individual control,’’ he continues. “So, why not stigmatize [the obese], bringing social pressure to bear?’’

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.

I know what you’re probably thinking:  But what about all the fat babies being born these days?  Babies aren’t capable of shaming themselves … if they were, they’d  be more conscientious about where and when they fill their diapers.

Never fear.  The British government has an answer for the wee tykes:  get them to exercise more!

The British government says children under five — including those who can’t walk yet — should exercise every day. The new guidelines were issued Monday, partly to fight the obesity epidemic.

In them, the department of health says children under five who can walk should be physically active for at least three hours a day. For babies who can’t walk yet, the government says physical activity should be encouraged from birth, including infants playing on their stomach and swimming sessions with their parents.

I have to admit, I don’t know whether this advice will prove to be effective, since my only experience is with two little girls who are active even when I’d like to them slow down for a change.  Last night, for example, they grew bored with watching Man vs. Wild from a seated position and decided to construct a bridge between the sofa and an ottoman, using several household items as building materials.  When the bridge fell down under the older daughter’s weight, I thought they’d give up … but nope, they just built a new one.  When that one fell down, they changed designs and built yet another one.  When that fell down, they built another one.  I was expecting them to start whistling the theme from The Bridge on the River Kwai any minute.

But if the British government wants the “get your baby to exercise” advice to be truly effective, I’d suggest they combine it with Professor Callahan’s insights and shame babies into working out.  Then you’d have a sure-fire cure for childhood obesity.

“Come on, Junior!  Wiggle those arms!  One-two-three-four … you’re quitting at four reps?  What are you, some kind of baby?”

“Well, actually—“

“No wonder you’re so fat.  Look at you, you little butterball!  You’ve got thighs like canned hams!”

“That’s baby fat, coach!”

“Yeah, sure it is.  Listen, kid:  you’re fat because your mother listened to some old Bee Gees songs from the 1970s and then went out and got herself pregnant, so now everybody’s fat.  Well, not here in jolly old England, Butterball!  Not on my watch.  Now drop and give me twenty.”

“Twenty what?”

“Pushups!”

“WAAAAHHH!”

“Be quiet!  Hey, what did you just put in your mouth?”

“My thumb.”

“Is there any fat in that thing?”

“I’m a baby.  I’m fat all over.”

“Then take it out of your mouth, now!”

“WAAAAHHH!”

Yup, with all these brilliant new ideas being proposed, obesity will soon be nothing more than a bad memory – like disco.

In my last post, I commented on a reply from Hope Warshaw  — the diabetes educator (ahem, ahem) — to a reader of this blog in which she pooh-poohed his “experience of one” with using a low-carb diet to manage diabetes.

The same reader emailed me that he conducted an “experiment of one” in recent days to compare his blood sugar after drinking a 12-ounce Pepsi versus eating some of the foods Hope Warshaw recommends for diabetics.  Take a look:

Perhaps those numbers don’t look scary to you, but they do to me.  Here’s what Chris Kresser of The Healthy Skeptic wrote about post-meal glucose levels awhile back:

Even the American Association of Clinical Endocrinologists is now recommending that post-meal blood sugars never be allowed to rise above 140 mg/dL. Unfortunately, less informed groups like the ADA haven’t caught up with the science.

The consequences of this are severe. Nerve damage occurs as blood sugar rises above 140 mg/dL. Prolonged exposure to blood sugars above 140 mg/dL causes irreversible beta cell loss (the beta cells produce insulin). 1 in 2 “pre-diabetics” get retinopathy, a serious diabetic complication. Cancer rates increase as post-meal blood sugars rise above 160 mg/dL.

Every one of the high-carb meals produced a glucose level above 140 in my reader’s one-man experiment.  The biggest spike (173 mg/dL) was produced by two pieces of whole wheat toast and a glass of milk – a normal breakfast for a lot of people.

With those results in mind, let’s look at the advice Hope Warshaw doled out to diabetics in a Q & A article for Health.com:

Q: Do I need to pay attention to the sugars on the nutrition facts label?

A: No. Pay attention to the total carbohydrates. The sugars content includes the amount of added and natural sugar in a serving. The amount of sugars are included within the total carbohydrate count, which is the key piece of information you need for planning meals and snacks.

Well, so far so good.  She’s telling diabetics to watch their carbs.  Perhaps I misjudged the woman.  Let’s skip ahead.

Q: Are nutrition recommendations different for people who have just been diagnosed with type 2 diabetes than they are for those who’ve had diabetes for years and take insulin injections?

A: No, the Dietary Guidelines for Americans, which are supported by the American Diabetes Association, are appropriate for pretty much everyone, including most people with type 1 and type 2 diabetes: Eat more whole grains, low-fat and fat-free dairy foods, fruits, and vegetables; limit consumption of high sodium processed foods and saturated and trans fats; get more of your protein from seafood and poultry and nonmeat sources, like beans (legumes); and eat all sources of protein in portions no larger than three ounces cooked. The Dietary Guidelines for Americans also recommend getting 45% to 65% of your calories from carbohydrates (with less than 25% of your total carbohydrates from added sugar); 20% to 35% from fat; and 10% to 35% from protein.

Nope, turns out I judged her correctly after all.  We need to eat lots of carbohydrates because the USDA says so.  Never mind what happens to blood-sugar levels in living, breathing (for now) diabetics who consume the high-carb meals the USDA recommends.   Brilliant.  And can someone please explain to me why beans — which are full of carbohydrates — are better for diabetics than meats?

Q: I’ve heard there are healthy and unhealthy carbohydrates. What should I eat more of, and what do I need to limit?

A: Foods that contain carbohydrates are starches, grains, fruit, vegetables, and dairy foods. The healthiest sources of carbohydrates provide plenty of vitamins and minerals per calorie—they are nutrient-dense. Everyone should eat more fiber-rich carbohydrates, such as whole grains, fruits, vegetables, and beans (legumes). You should try to eat at least three servings or half your servings of starches as whole grains each day. Less healthy carbohydrates like candy, sweetened beverages, and ice cream pack little nutritional punch but contain plenty of calories; keep them to a minimum.

Yes, grains are more nutrient dense than a Pepsi.  But as my reader discovered in his one-man experiment, they can jack up your blood sugar just as high or higher.

Q: Is it OK for people with prediabetes and diabetes to eat some sugar and sweets?

A: Yes. People with diabetes can enjoy sugary foods and sweets in moderation.

And then take a moderate shot of insulin.

However, the amount of sweets you eat should be balanced with your diabetes nutrition goals, such as weight loss, blood glucose, and blood lipid control.

Yes, balance your diet with your goals for blood glucose.  Then eat your grains.  Then watch your blood sugar shoot up.  Then take your drugs so you can meet your blood glucose goals.

Be aware that some desserts and sweets, for example ice cream and cheesecake, are also high in fat and the fat may be the unhealthy saturated type.

You know, for a woman who told the reader not to bother her anymore unless he could quote some controlled clinical studies, Ms. Warshaw doesn’t seem to apply the same intellectual rigor to her own advice.  Can she point to any long-term clinical studies that prove saturated fat is bad for us?  Has she simply ignored all the recent studies showing that low-carb/high-fat diets produce better lipid profiles than high-carb diets?

Q: How many carbohydrates should an adult man or woman who is trying to lose weight eat each day?

A: Aim to get roughly half of your calories from carbohydrates.

Yes, be sure to do that.  Then take insulin to bring your blood sugar back down.

Head.  Bang.  On.  Desk.

For example, a sedentary woman who wants to lose weight should limit her calories to 1,400 to 1,600 a day, so she should consume 700 to 800 calories from carbohydrates daily.

Bang.  On.  Desk.  Again.

Following is a sample meal plan that would meet this guideline, along with examples of serving sizes.

• Seven starch servings (one serving is a slice of whole wheat bread, or half a medium baked potato)
• Two servings of milk and yogurt (one serving is eight ounces of fat-free milk, 2/3 cup of fat-free yogurt)
• Four servings of vegetables (one serving is one cup of salad or a half-cup of cauliflower or carrots)
• Five ounces of meat (cooked)
• Three servings of fruit (one serving is a cup of cantaloupe, 2 small tangerines, a small banana, or a small apple)
• Six servings of fat (one serving is a teaspoon of olive oil, two tablespoons of avocado, four pecan halves, or a tablespoon of reduced-fat mayonnaise)

Seven servings of starch per day, eh?  Two servings of whole-grain starch plus a cup of milk pushed my reader’s blood sugar to over 170 mg/dL.  (Thank goodness he didn’t add a banana to that meal, as Ms. Warshaw would recommend.)  So for many diabetics out there, Ms. Warshaw’s diet is an invitation to walk around with jacked-up blood sugar all day.  But of course she’s a big fan of Metformin and other drugs that lower blood sugar, so it all balances out.

Q: Since I have diabetes, do I need to prepare my food separately from my family?

A: No. The foods that are healthy choices for you will also be healthy choices for your family members who don’t have diabetes.

That’s true.  Too bad Ms. Warshaw and the ADA have no flippin’ idea which choices are actually the healthy ones.

A reader of this blog wrote to Hope Warshaw, author of the “eat your carbs and take your drugs” article in Diabetes Health that was the subject of my last post.  I didn’t see his original email to her, but he did forward me her response.  Here’s the opening:

Rather than throwing stones and continually citing Richard Bernstein, MD, who as far as I know has only written consumer books and not published one research paper on his recommendations, or discussing your own experience of one, how about providing/discussing citations of well conducted long term research studies in people with type 1 and type 2 diabetes (or even prevention trials) who more successfully manage glycemia, lipids and blood pressure and eat healthfully on an intake of carbohydrate below 40% of total calories.

I see … the reader has successfully managed his diabetes with diet, but we can simply dismiss that evidence because it’s an “experience of one.”  Ms. Warshaw apparently is convinced the reader is the only diabetic in the world who found a low-carb diet beneficial.  Therefore her advice to eat a high-carb diet is still correct.

Riiiight … except we already know it’s not an “experience of one.”  I quoted some comments diabetics posted on the Diabetes Health site regarding Ms. Warshaw’s article in my previous post.  Here are a few more:

I set out on a low carbohydrate diet and within 6 months had normal blood sugar, normal blood pressure and lost over 100 pounds. People don’t need more drugs and bad dietary advice. I think we have all see the rising rates of obesity and diabetes and you are not helping the situation. If you really want to stop the rise, tell people the truth. Low Carbohydrate diets normalize blood sugar.

As a physician with pre-diabetes I am appalled that a high carbohydrate diet continues to be promoted. I am 56 years old. For the past 5 years I have maintained normal fasting blood sugars on a low carb diet.

I have been eating low carb for almost 1 year now and my diet includes lots of non stachy vegetables, fruits(strawberries, blueberries, raspberries), lean meats, eggs, nuts and some low carb desserts occasionally. My A1C is 5.6 and I have accomplished this by diet/exercise alone.

I am a type I diabetic and I know for a fact what 45-65% of calories as carbs can do to my BG… This is absurd and border-line dangerous statement from some “best-selling author.”

On Facebook and in other corners of the blogosphere, a lot of people are complaining that they also left comments on the article, but those comments never showed up.  Perhaps Diabetes Health isn’t interested in letting the world see how many diabetics disagree with their house expert.  Whatever the explanation for the blocked comments, it’s clear that many, many people have successfully managed their diabetes by doing the opposite of what Ms. Warshaw recommends.  It’s not an “experience of one.”

Ms. Warshaw continued in her reply:

And instead of reading top line messages in resources like myplate.gov, dig into the research based information in the Dietary Guidelines Advisory Committee Report, 2010. Here’s the link: http://www.cnpp.usda.gov/DGAs2010-DGACReport.htm

A couple of quotes from the Carbohydrate Chapter:

The Institute of Medicine (IOM) (2002) set an acceptable macronutrient distribution range (AMDR) for carbohydrates of 45 to 65 percent of total calories. Thus, current dietary guidance recommends consumption of carbohydrate-containing foods, including vegetables, fruits, grains, nuts and seeds, and milk products. Carbohydrate foods are an important source of fiber and other nutrients.

Well, there you have it:  Ms. Warshaw’s dietary recommendations for diabetics must be correct because the USDA and other experts say so.  No other proof needed  — which is a rather odd position for her to take, considering how she ended her reply:

No need to write back unless you’ve got well conducted published research studies to share.

So we’ve got someone who is supposedly interested in helping diabetics, but arrogantly dismisses comments from actual diabetics who’ve achieved normal blood sugar through a low-carb diet.  You’d think she would find all those “experience of one” stories intriguing and look into the matter a little more.

Banging my head on my desk didn’t diminish my annoyance with Ms. Warshaw’s reply to the reader, so this morning I wrote to her myself:

———————————————————

Dear Ms. Warshaw –

I’ve been following your responses to people who questioned your advice to diabetics to consume a high-carbohydrate diet.  Those responses boil down to two arguments:

1.  I’m right because the USDA Dietary Guidelines say I’m right.
2.  Show me the long-term clinical studies proving carbohydrate restriction is effective for diabetics, or shut up and leave me alone.

Appealing to the authority of the USDA — whose mission is to sell the grains our government subsidizes — isn’t proof of anything.  As you may already know, one member of the committee that wrote those guidelines has already stated publicly that the guidelines aren’t based on good science.  I read the entire, mind-numbingly dense, stupefying, often-contradictory report myself, and I agree:  the guidelines aren’t based on anything resembling solid science.  So let’s set those aside and deal with actual science.

Here are links to just a few of the clinical studies that demonstrated the effectiveness of low-carbohydrate diets for managing diabetes:

The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus

Forty-nine (58.3%) participants completed the study. Both interventions led to improvements in hemoglobin A1c, fasting glucose, fasting insulin, and weight loss. The Low-Carbohydrate Ketogenic Diet group had greater improvements in hemoglobin A1c (-1.5% vs. -0.5%, p = 0.03), body weight (-11.1 kg vs. -6.9 kg, p = 0.008), and high density lipoprotein cholesterol (+5.6 mg/dL vs. 0 mg/dL, p < 0.001) compared to the LGID group.  Diabetes medications were reduced or eliminated in 95.2% of LCKD vs. 62% of LGID participants (p < 0.01).

A low-carbohydrate, ketogenic diet to treat type 2 diabetes

The Low-Carbohydrate Ketogenic Diet improved glycemic control in patients with type 2 diabetes such that diabetes medications were discontinued or reduced in most participants. Because the LCKD can be very effective at lowering blood glucose, patients on diabetes medication who use this diet should be under close medical supervision or capable of adjusting their medication.

Utility of a short-term 25% carbohydrate diet on improving glycemic control in type 2 diabetes mellitus

Compared to baseline diet, after 8 weeks of a 25% carbohydrate diet, subjects showed significantly improved glycemia as evidenced by fasting blood glucose values (p<0.005) and hemoglobin A1c levels (p<0.05). Those previously treated with oral hypoglycemic agents showed, in addition, a significant decrease in weight and diastolic blood pressure despite the discontinuation of the oral agent. When then placed on a 55% carbohydrate diet, the hemoglobin A1c rose significantly over the ensuing next 12 weeks (p<0.05).

Yes, I know:  you asked for long-term studies.  As far as I can tell from my online research, there are few if any controlled clinical studies of dietary interventions that have lasted more than a year or perhaps two at most.  So you appear to be asking your critics to quote the results of studies that have never been conducted.

But I’m clearly mistaken about that.  You obviously have access to a long list of multi-year clinical studies on carbohydrate-restricted diets.  I know this because of what you wrote in your article in Diabetes Health:

“Countless research studies do not show long term (greater than six months to a year) benefit of low carb diets on blood glucose, weight control, or blood fats.”

Since you’ve examined countless such studies, could you please provide me a list of, say, a dozen references to clinical studies in which subjects adhered to a carbohydrate-restricted diet for more than a year, but failed to achieve improved glucose control compared to a control group?  If you could point me to studies matching that description that lasted five or ten years, that would be super.  I’d like to share them with my readers.  Then we’ll all understand exactly how countless studies failed to show any long-term superiority of carbohydrate restriction for glucose control.

Also, given that you don’t like anyone to promote dietary advice that isn’t backed up by long-term clinical studies, could you please provide a list of multi-year clinical studies in which a diet of 45-65% carbohydrates produced superior glucose control and lower A1c when compared to a control group, or – better yet – when compared to a group in which carbohydrate was restricted to less than 40%?  The diabetics among my readership especially would love to see the scientific basis for your advice — after all, their lives depend on it.

Best regards,
Tom Naughton
Writer/Director “Fat Head: you’ve been fed a load of bologna”

———————————————————

I haven’t received a reply.

As the Allies were advancing in December of 1944, the Germans launched a massive counter-attack in what became known as the Battle of the Bulge.  The 101st Airborne Division was sent to hold the town of Bastogne, a vital transportation hub the Germans desperately wanted.  The “Screaming Eagles” were surrounded, out-numbered, short on ammunition, and freezing in their summer uniforms.  But when the German commander demanded their surrender, U.S. general Anthony McAuliffe sent a one-word reply:  “Nuts!” The Screaming Eagles dug in and held the town.

The Grains-and-Drugs Axis is in full counter-attack mode.  The USDA Dietary Guidelines call for greater restrictions on fat and more whole grains in our diets.  The new My Plate tells us to fill 25% of our plates with grains.  And now the dimwits at Diabetes Health magazine -– which reaches hundreds of thousands of diabetics -– are telling people with  blood-sugar issues to eat even more carbohydrates.

That advice comes in the form of an article titled Type 2 Diabetes: From Old Dogmas to New Realities.  There’s no subtitle, but there should be, and it should read:  Just give up and take your drugs, dangit!

In the last decade, dramatic changes have occurred in our understanding of the onset and progression of prediabetes. Lightning speed changes have also occurred regarding the therapies available to achieve optimal blood glucose control. Even with all of this change, however, many old dogmas hang on. It’s time to be aware of the new realities. In this article,  I focus on two common old dogmas and the new realities.

Old Dogma: Losing weight will make blood glucose levels plummet no matter how long you have had type 2 diabetes.

New Reality: Research shows that the greatest impact of weight loss on blood glucose is in the first few months and years after diagnosis… Once insulin production is on a dwindling course (particularly after 10 years with type 2), weight loss has less impact on glucose control.

The reality is that if blood glucose is out of control, it’s time to progress to blood glucose-lowering medication(s), because it’s doubtful that weight loss alone will get and keep blood glucose under control. Today, most experts, including the American Diabetes Association and American Association of Clinical Endocrinologists, agree that people with type 2 should start on a blood glucose-lowering medication that decreases insulin resistance–the core problem in type 2–at diagnosis.

Got that?  The people whose livelihood depends on writing prescriptions for drugs agree that you need drugs, so take your drugs.  I agree that weight loss alone won’t lower high blood sugar -– I’ve known some skinny type 2 diabetics –- but that doesn’t mean a change in diet can’t do the trick.  It just has to be the right kind of diet, one that won’t jack up your blood sugar in the first place.

Speaking of diet …

Old Dogma: People with type 2 diabetes should follow a low carbohydrate diet.

New Reality: Nutrition recommendations for people with type 2 diabetes from the American Diabetes Association and other health authorities echo the recently unveiled U.S. 2010 Dietary Guidelines for carbohydrate: about 45 to 65 percent of calories. (Americans currently eat about 45 to 50 percent of calories as carbohydrate–not a “high carb” intake.)

Countless research studies do not show long term (greater than six months to a year) benefit of low carb diets on blood glucose, weight control, or blood fats. People with type 2 diabetes, like the general public, should lighten up on added sugars and sweets (yes, they’re carbohydrate). They should eat sufficient amounts of fruits, vegetables, whole grains, and low fat dairy foods–all healthy sources of carbohydrate.

Well, there you have it:  the USDA and other (ahem, ahem) health authorities recommend we get 45 to 65 percent of our calories from carbohydrates, so it must be true.  We consume a higher proportion of carbohydrates now than we did 30 years ago, the rate of type 2 diabetes has skyrocketed during that same period, so what this proves is that we should eat even more carbohydrates.

As for those “countless studies” that didn’t show low-carb diets improving glucose control beyond six months to a year, there’s a reason for that:  most dietary studies last six months to a year.  So we can interpret that statement as “countless studies failed to show any benefit after the study ended and we stopped tracking the benefits.”  Over and over, we see medical authorities warning that we don’t know the long-term effects of low-carbohydrate diets.  Right … because the long-term clinical studies haven’t been conducted.

But there are plenty of doctors out there — Dr. Richard Bernstein, Dr. Mary Vernon, Dr. Steve Parker, Dr. James Carlson, to name just a few — who do know the long-term effects of a low-carbohydrate diet for their diabetic patients.  Those effects include weight loss, lower fasting glucose, reduced reliance on drugs, and even a complete reversal of diabetic symptoms in some cases.

A few people commenting on the Diabetes Health article have had the same experience:

Respectfully, this column is not helpful to diabetics and probably dangerous. I am going on 6 years of eating 30-35 carbs/day. My A1c has been in the “non-diabetic” range ever since I went this route and I feel better than I have in years.

It was not until I started a low carbohydrate diet that my blood glucose numbers fell. They fell rapidly and have been easy to maintain under such a diet.

I had awful lipids and blood sugar control on a low fat/high carb diet. Now that I have switched to a lower carb diet – all my numbers are superb.

Ordinary people get it, even if the supposed experts don’t.  As for the  experts at the American Diabetes Association, here are a few points from their own literature:

• Your digestive system turns carbohydrates into sugar quickly and easily
• Carbohydrate is the food that most influences blood glucose levels
• The more carbs you eat, the higher your blood glucose goes
• The higher your blood glucose, the more insulin you need to move the sugar into your cells
• The Food Pyramid is an easy way to remember the healthiest way to eat.
• At the bottom of the pyramid are bread, cereal, rice and pasta.  These foods contain mostly carbohydrates.
• You need six to eight servings of these foods per day

Head.  Bang.  On.  Desk.

You’d think someone writing up those guidelines might spot the contradiction.  But the contradiction is less surprising when you look at a short list of who provides the ADA with its funding:

• Abbott Pharmaceuticals
• Amylin Pharmaceuticals
• AstraZeneca
• Eli Lilly and Company
• GlaxoSmithKline
• Merck & Co.
• Pfizer Inc.
• Cadbury Schweppes (candy/soda maker)
• Kraft Foods
• J.D. Smucker Company
• General Mills

From what I read online, the publisher of Diabetes Health also sells medical devices and started the magazine to promote its products.  Like I always say, follow the money.

It’s time for those of us who don’t want more diabetics to be killed by bad advice to stand up and say “Nuts!” to the commanders of the Grains-and-Drugs Axis.  If you know a diabetic, give him or her a copy of Dr. Bernstein’s Diabetes Solution or Dr. Steve Parker’s Conquer Diabetes and Prediabetes.  Point your family and friends to books and blogs that educate people about what causes type 2 diabetes and how to avoid it.

Then join the Nutrition and Metabolism Society, one of the few organizations dedicated to fighting bad nutrition science with good nutrition science.  By joining NMS at any membership level –  from $10 on up — you will be supporting the kind of research that’s necessary to overcome years of misinformation promoted by the USDA and ADA.

Think of it as providing badly-needed weapons for the Screaming Eagles of nutrition research.  They’re surrounded, but they won’t give up.  And they will win the battle.