Archive for the “Study Spotlight” Category

Greetings Fat Heads!

Well, still here. Hope you had a great Memorial Day weekend. Special thanks to all vets and their families. Tom and family are back from the 2017 Low Carb Cruise, happily exhausted. I’m looking forward to getting the full report. I told him if he wanted to wait until next week, I’d fill in Thursday with an “evidence-based” rant.

Anyway, when I left off at the last post, Jimmy Kimmel’s son was doing great and I was in a bad mood. Not about Mr. Kimmel’s son of course. That was the wonderful part. The level of care we have available in this time and in this country is beyond the imagination of what was available to the richest people and kings even a few decades ago.

I wasn’t even particularly stirred up over Mr. Kimmel’s making the availability of the miraculous procedure that saved his son somehow tied in with keeping Obamacare intact. Between being a dad just past a major health scare and living in La La Land among the economically illiterate (seldom right, but never in doubt) I’m okay with him calling it any way he wants. I put it in there with the “all brides and babies are beautiful” protocol. It accomplishes nothing to argue, and it’s just plain rude.

The rest of the Idiocracy, however, deserves no so respect. Instead of politely giving Jimmy’s emotional description props and then moving on, they treated his completely sincere and completely uninformed comments on insurance and Obamacare as the Magnum Opus of the health care debate.

At any rate, I stated toward the end “It’s not like we don’t have major issues with the health care system in the good old U.S. of A. But the issues are with the availability of dollars, not doctors, …”

There are issues with dollars. As I mentioned, I was aware of Kimmel’s son’s condition because The Oldest Grandson had the same thing – and the same miraculous treatment – when he was born just about ten years ago (yes—before Obamacare).

His mom, my daughter-in-law, pointed out that back then just his hospital tab was over $300,000, which would break anyone without insurance, not to mention that he’s facing at least two more surgeries. Under insurance as it mostly existed prior to the current debacle, there could be real issues with lifetime spending caps and him trying to get health insurance as an adult with that type of pre-existing condition.

To paraphrase an old politician, $300,000 here, $300,000 there – pretty soon you’re talking real money! Definitely a dollars issue.

So what’s a libertarian to do? Is there a solution other than “I’m sorry, Mr. Kimmel, there’s nothing we can do?” That’s what you would hear in most of those countries where it’s “free.” Don’t we want to save babies in this country? Wouldn’t it be nice to be able to do that and not go broke? How can we do that today, and still be able for that kid to afford reasonable health care later?

Fortuitously, Dr. William Davis’ new book – “Undoctored” came out just recently, and Tom did a book review.

[Confession time – I don’t read Tom’s book reviews any more. When I see he’s written one, I just save myself the time and buy the damned book.]

Now, if you want a great book on the disastrous macro-economics of our health care system, and policy proposals to address insurance and health system availability at a national level, don’t buy this book. That’s totally not what it’s about.

What it is about is you getting control of your health, which Dr. Davis reiterates throughout is not particularly connected to medical care. In fact, unless you get yourself informed and proactive, medical care can often be inversely related to your health. Although he doesn’t do a deep dive on the economic history of the health care system, he does do a great job illuminating how the money and incentives in the current system don’t line up with attaining real health as an individual. Then you’re off on a terrific primer in how to evaluate, improve, and monitor your health, in conjunction with health care professionals who will work with you and at your direction when needed.

Seriously, buy the book.

Okay, so how’s that tie in with the subject at hand? Well, the idea that the medical industry is more responsive to money than patient outcomes was nothing new to me – or probably any Fat Head, really. “Have a $tatin with that hearthealthywholegrain muffin” vs. “have the bacon and eggs and take a walk,” right? So, I was already on board with the concept.

Right in the introduction to “Undoctored,” Dr. Davis noted that we spend (endlessly pointed out with delight by the single-payer cheerleaders) over $3 trillion dollars a year – 17% of our GDP — on health care. Which I also already knew.  But this time when I read it I’d been thinking about Kimmel’s performance, and my daughter-in-law’s point, and then pretty close in to the beginning of the book Davis points out that:

“The system is ready and willing to commit you to a life of taking drugs and injectable insulin for diabetes, … providing “education” designed by people who put commercial interests first, while no one provides the handful of inexpensive health strategies that have been shown to reduce, even fully reverse, type 2 diabetes.”

Once again, nothing I didn’t already know, but it kind of all came together at that point and I thought, “well, just how the hell much do we spend on all of this crap?!?”

So I looked it up.

I tend to do that. I just stopped reading and went Googling for info on how much money we spend on the various medical substitutes for good habits. I’d like to think it’s due to my insatiable inquisitiveness when I’ve got an intellectual conundrum, but it’s probably just ADD.

I struck gold fairly quickly when I found a JAMA paper from 2016 titled “US Spending on Personal Health Care and Public Health, 1996-2013.” They collected seven years of data from 183 sources and sorted them into 155 conditions. The numbers, which, once again, we’ve probably all heard at different times, are stunning when you look at the whole picture.

The total spending for 2013 – the last year in the study – was $2.1 trillion. The estimate for 2014 was $2.9 trillion, so Dr. Davis’ $3 trillion seems to line up well with the reports info, and it would be safe to assume that the numbers I’ve got increased proportionately.  So, pretty much every number I’ve got has likely gone up by 50%. But here are some of the things we see:

Right off the bat, “diabetes had the highest health care spending in 2013, with an estimated $101.4 billion in spending, including 57.6% spent on pharmaceuticals…”

Keep in mind, that’s more like $150 billion today. One hundred and fifty billion dollars. A year. For a “disease” that’s easily 90% treatable by just stepping away from carbs.

Heart disease – the one that Dr. Davis put himself out of business from treating by getting people to change their lifestyles vs. post factum medical treatment — was $88.1 billion, so I’m calling it $130 billion.  I’m not saying no one would ever have a heart attack if we all stopped cooking with vegetable oil and started taking an evening walk, but it wouldn’t be an industry that by itself would rank in the top quarter of the rest of the world’s GDP’s.

Plus, that $130 billion does NOT include treatment for hyperlipidemia (i.e., statins) which earns itself $52 billion ($75B?) all by itself, or high blood pressure.

Here’s some other big ticket items, almost all of which the case studies of folks in “Undoctored” either completely reversed or substantially improved – often within weeks – of making the simple changes that Dr. Davis promotes:

Blood Pressure:  $84 Billion

Back & neck pain (think largely obesity and sedentary lifestyle related, so I’m counting it): $88 Billion

Depression (think mood disorders and gut biome dysbiosis. Not considered are other “mental” health issues – ADD, bipolar, etc): $70 Billion

Dental (tooth decay, inflammation): $66 Billion

Skin conditions: $55 Billion

Alzheimers and other dementias (i.e., Type III diabetes): $36.7 Billion

The 2013 numbers for all of those come up to about $469 Billion, which scales up to over $700 Billion in today’s spending. Mostly avoidable by straightforward, understandable lifestyle modification.

Like I said, some people will still have heart attacks, or pull a back muscle, or get depressed and need some help so you don’t have a 100% savings on the table; but the largest part of these diseases are self-inflicted and self-treatable.

I also left out other categories (Osteoarthritis – $47.9B; Asthma – $32.5B; Endocrine, metabolic, and immune disorders – $19.6B; and cancers, which were disaggregated into 29 separate conditions); so there’s some pickup available from the same lifestyle changes in areas I’m not counting. The point is that nearly one quarter of our health care spending is going to conditions that we have the capability of exerting a large degree of control over. Quickly.

Preterm birth complications, BTW, ranked 73rd at just under $5 Billion, so it seems like if we could get a handle on our grain and industrial foods habit, Jimmy Kimmel’s son and my grandson shouldn’t cause too much financial discomfort to the system.

After thinking about this, I had an epiphany.

I know Tom and many others, including myself, have compared the various and sundry mandatory coverages — dictated via Obamacare and other legislated and regulatory bodies — to requiring your auto insurance provider to include free oil changes, tire rotation, tune-ups, etc.  in your policy. The point being that these are known conditions that are a routine part of automobile ownership. Inclusion in a policy would only increase overhead and incentivize over-utilization, resulting in inevitable, recurring premium increases.

We completely misrepresented the argument. It’s correct as far as it goes, but it stops so short of reality that I count it as a huge error.

Our entire medical cost reimbursement system, as currently comprised, is like requiring that all auto insurance companies include DUI coverage in your policy.

It was stupid that my health insurance covered the two or three doctor office visits for the ear infections we knew The Sons were each going to get each year when they were toddlers. Same for the bottle of pick stuff we’d pick up at the pharmacy after each visit.

But it’s insane that insurance would pay for insulin for the 90% of people who could avoid the pharmacy if they’d stop blasting their system with sugar in all its forms. Same with all those other diseases of civilization driving a quarter of our spending. We’re making it convenient and cheaper for people to engage in behavior that’s harming them.

Add in the USDA budget with its massive grain subsidies and the SNAP (food stamp) program, and it’s like after adding the DUI coverage, we then pass out free booze to the people with the worst driving records.

So what about this — I say we should remove mandated coverage of all of those lifestyle diseases – Type II diabetes, blood pressure, non-emergency heart disease treatment, etc.

Companies would be free to make them available, but they’d be add-on items to a base policy and they’d also be rateable. I’m not interested in preventing someone from purchasing diabetes “treatment” coverage with their insurance, but I don’t want to be forced to “chip in.”

Rateable means they could adjust the premium, for example, based on a periodic A1C, fasting insulin, or some other marker to account for the risk and behavior of the policy owner. Behavior instantly gets coupled to economic consequences.

So people could pay higher premiums for diabetes treatment coverage, pay out of their own pocket for drugs and medical attention, or eat more veggies and fat and cut back on the sugar. I predict immediate, dramatic changes.

I don’t see why we couldn’t reduce medical spending by half a trillion dollars, plus another $100 billion a year by driving a stake through the USDA’s heart.  Putting money aside for just a moment, can you begin to imagine the quality of life improvements people would get?

Of course, I do see why we can’t. Politics. Money. Bureaucracy. Power. The usual suspects. But that doesn’t mean it’s not technically possible or the right thing to do.

It also doesn’t mean that you can’t get started, or step up your game so that you can limit your interaction with the medical system as much as possible. Just because you have to sacrifice them your money doesn’t mean you have to sacrifice your health, too!

Cheers,

The Older Brother

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Here’s another one of those studies that produced an eye-rolling moment for me.  Actually, it wasn’t the study itself.  The study was fine, which is why I didn’t have a head-bang-on-desk moment.   It was the conclusion – which is the only part of a study many media health reporters read — that produced the eye-rolling.

Here’s part of the abstract:

OBJECTIVE:
The physicochemical properties of soluble oat fiber (β-glucan) affect viscosity-dependent mechanisms that influence satiety. The objective of this study was to compare the satiety impact of oatmeal with the most widely sold ready-to-eat breakfast cereal (RTEC) when either was consumed as a breakfast meal.

METHODS:
Forty-eight healthy individuals ≥18 years of age were enrolled in a randomized crossover trial. Following an overnight fast, subjects consumed either oatmeal or RTEC in random order at least a week apart. The breakfasts were isocaloric and contained 363 kcal (250 kcal cereal, 113 kcal milk). Visual analogue scales measuring appetite and satiety were completed before breakfast and throughout the morning. The content and physicochemical properties of oat β-glucan were determined. Appetite and satiety responses were analyzed by area under the curve (AUC).

So they compared people eating oatmeal to people eating ready-to-eat cereal.  Surprise!  The people who ate oatmeal reported feeling less hungry later in the day.  No kidding.  Ready-to-eat-cereal takes your blood sugar on a wilder roller-coaster ride than oatmeal.

Now here’s the study’s conclusion:

Oatmeal improves appetite control and increases satiety. The effects may be attributed to the viscosity and hydration properties of its β-glucan content.

Oatmeal improves appetite control?  Well, I can already picture the additional sales pitch on boxes of Quaker Oats, right there next to Can Help Reduce Cholesterol! Now they’ll be adding Improves Appetite Control!

Here’s the Science For Smart People question:  Compared to what?

Compared to ready-to-eat-cereal, oatmeal produced greater satiety.  But what if there had been a third group that ate eggs for breakfast?

I haven’t seen a study with a direct oatmeal-to-eggs comparison, but I did find an eggs-to-bagels comparison in my study files.  Here’s part of that abstract:

OBJECTIVE:
To test the hypotheses that among overweight and obese participants, a breakfast consisting of eggs, in comparison to an isocaloric equal-weight bagel-based breakfast, would induce greater satiety, reduce perceived cravings, and reduce subsequent short-term energy intake.

SUBJECTS:
Thirty women with BMI’s of at least 25 kg/M2 between the ages of 25 to 60 y were recruited to participate in a randomized crossover design study in an outpatient clinic setting.

DESIGN:
Following an overnight fast, subjects consumed either an egg or bagel-based breakfast followed by lunch 3.5 h later, in random order two weeks apart. Food intake was weighed at breakfast and lunch and recorded via dietary recall up to 36 h post breakfast. Satiety was assessed using the Fullness Questionnaire and the State-Trait Food Cravings Questionnaire, state version.

The results showed that the women who had eggs for breakfast ate smaller lunches than the bagel-eaters:  574 calories for lunch vs. 738.  They also reported feeling fuller, even though both breakfasts contained the same number of calories.

I’d like to see a head-to-head comparison with four heads:  eggs, bagels, oatmeal and ready-to-eat cereal.  I’d put my money on the eggs for the greatest satiety and appetite control.

But if someone conducted that study and the egg producers slapped a big Helps Reduce Appetite! label on their cartons, I bet somebody at the FDA would get very upset.

NOTE:  The Older Brother will be taking over the blog next week.  I’m giving a speech on Thursday and plan to spend the early part of the week rehearsing and putting the finishing touches on my slides.

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A reader asked me for some information on cancer and sugar, so I pulled up some items from my research database.  As long as I had the articles in front of me, I thought I’d share them.

Nothing listed here proves absolutely that sugars drive cancer or that a ketogenic diet will prevent cancer, but taken together, the articles do paint a picture.  Let’s take a look.

Cancer cells slurp up fructose, US study finds

Pancreatic tumor cells use fructose to divide and proliferate, U.S. researchers said on Monday in a study that challenges the common wisdom that all sugars are the same.

Tumor cells fed both glucose and fructose used the two sugars in two different ways, the team at the University of California Los Angeles found.

They said their finding, published in the journal Cancer Research, may help explain other studies that have linked fructose intake with pancreatic cancer, one of the deadliest cancer types.

“These findings show that cancer cells can readily metabolize fructose to increase proliferation,” Dr. Anthony Heaney of UCLA’s Jonsson Cancer Center and colleagues wrote.

“They have major significance for cancer patients given dietary refined fructose consumption, and indicate that efforts to reduce refined fructose intake or inhibit fructose-mediated actions may disrupt cancer growth.”

I found some suggested meal plans on the USDA’s official My Plate site, which I’ll share in another post.  Whole milk isn’t on the meal plan for breakfast, but orange juice and strawberry-flavored (i.e., sugary) skim milk are.  Remind me again … which of those drinks contains fructose and which doesn’t?

Compound That Blocks Sugar Pathway Slows Cancer Cell Growth

Scientists at Johns Hopkins have identified a compound that could be used to starve cancers of their sugar-based building blocks. The compound, called a glutaminase inhibitor, has been tested on laboratory-cultured, sugar-hungry brain cancer cells and, the scientists say, may have the potential to be used for many types of primary brain tumors.

The Johns Hopkins scientists, inventors on patent applications related to the discovery, caution that glutaminase inhibitors have not been tested in animals or humans, but their findings may spark new interest in the glutaminase pathway as a target for new therapies.

Glutaminase is an enzyme that controls how glucose-based nutrients are converted into the carbon skeleton of a cell. Additional enzymes that help construct the so-called “bricks” of the carbon skeleton are controlled by a gene called IDH1. In some brain cancer cells, IDH1 is mutated and the resulting enzyme grinds up the bricks into nutrients that feed cancer cells.

Yes, yes, I know what you’re thinking:  if blocking the glucose pathway slows cancer growth, why not just tell people to stop eating foods that spike glucose?  Well, I’m pretty sure the answer lies in the fact that scientists have applied for patents.  You can’t patent dietary advice, but you can patent a drug.

Diabetes Medication May Get New Life as Cancer Treatment

The drug metformin, a mainstay of diabetes care for 15 years, may have a new life as a cancer treatment, researchers said.

In a study in mice, low doses of the drug, combined with a widely used chemotherapy called doxorubicin, shrank breast-cancer tumors and prevented their recurrence more effectively than chemotherapy alone.

The findings add to a growing body of evidence that metformin, marketed as Glucophage by Bristol-Myers Squibb Co. and available in generic versions, could be a potent antitumor medicine.

In the report, being published in the Oct. 1 edition of Cancer Research, a journal of the American Association for Cancer Research, researchers said the combination of metformin and doxorubicin killed both regular cancer cells and cancer stem cells.

In contrast, doxorubicin alone had limited effect on the stem cells.

Mice that grew tumors generated from human breast-cancer cells have remained tumor-free for nearly three months on the combined treatment, while tumors have recurred in those not given the diabetes remedy.

Researchers said the results have potentially broad implications for cancer treatment.

Hmmm, now why would a drug given to type 2 diabetics be effective against cancer?  You have to read pretty far down the article to find out:

How metformin affects cancer isn’t certain, but one possibility is that it deprives tumor cells of sugar.

“Cancer cells are gluttons for glucose,” said George Prendergast, president and chief executive officer of Lankenau Institute for Medical Research, Wynnewood, Pa. “It is likely that metformin is taking advantage of this gluttony of the cancer cell in order to attack it.”

Cancer cells are gluttons for glucose … I’ll be sure to think about when I’m drinking my USDA-approved skim milk with added sugar.

Dietary glycemic load and colorectal cancer risk

The link above is to an observational study based on food questionnaires, so it doesn’t exactly meet the gold standard for research.  Nonetheless, here’s the conclusion:

The positive associations of glycemic index and load with colorectal cancer suggest a detrimental role of refined carbohydrates in the etiology of the disease.

The next time some vegan zealot trots out an observational study showing a weak association between meat and cancer, you can reply with this one and explain that since glycemic load is strongly associated with colorectal cancer, you’re sticking with a low-glycemic diet – meat included.  If the vegan zealot starts quoting the China Study, you can reply with this (sort of) China study of Chinese Americans:

Carbohydrates and colorectal cancer risk among Chinese in North America

Here’s the conclusion:

These data indicate that increased eCarb (non-fiber carb) and total carbohydrate consumption are both associated with increased risk of colorectal cancer in both sexes, and that among women, relative risk appears greatest for the right colon, whereas among men, relative risk appears greatest for the rectum.

So get T. Colin Campbell’s high-carb diet out of my face.

Effects of a ketogenic diet on tumor metabolism

This one isn’t a study; it’s a case report from 1995 of two pediatric cancer patients put on ketogenic diets.  Here are some quotes from the abstact:

OBJECTIVE: Establish dietary-induced ketosis in pediatric oncology patients to determine if a ketogenic state would decrease glucose availability to certain tumors, thereby potentially impairing tumor metabolism without adversely affecting the patient’s overall nutritional status.

So all the way back in 1995, at least some doctors suspected that depriving cancers of glucose might help.  Sheesh.  Anyway …

RESULTS:  Within 7 days of initiating the ketogenic diet, blood glucose levels declined to low-normal levels and blood ketones were elevated twenty to thirty fold. Results of PET scans indicated a 21.8% average decrease in glucose uptake at the tumor site in both subjects. One patient exhibited significant clinical improvements in mood and new skill development during the study. She continued the ketogenic diet for an additional twelve months, remaining free of disease progression.

Improvements in mood and skill development?  No, no, no … low-carb diets make you depressed and irritable.  I know that’s true, because I read it on Yahoo Health.

Glucose deprivation activates feedback loop that kills cancer cells

Compared to normal cells, cancer cells have a prodigious appetite for glucose, the result of a shift in cell metabolism known as aerobic glycolysis or the “Warburg effect.” Researchers focusing on this effect as a possible target for cancer therapies have examined how biochemical signals present in cancer cells regulate the altered metabolic state.

Now, in a unique study, a UCLA research team led by Thomas Graeber, a professor of molecular and medical pharmacology, has investigated the reverse aspect: how the metabolism of glucose affects the biochemical signals present in cancer cells.

In research published June 26 in the journal Molecular Systems Biology, Graeber and his colleagues demonstrate that glucose starvation — that is, depriving cancer cells of glucose —activates a metabolic and signaling amplification loop that leads to cancer cell death as a result of the toxic accumulation of reactive oxygen species, the cell-damaging molecules and ions targeted by antioxidants like vitamin C.

Hey, I don’t care if it’s an amplification loop that does the job or if the cancer cells just die off from a lack of fuel.  The point is, once again we see that depriving cancer cells of sugars can kill them.

Keep starving those cancer cells, folks.

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I explained in yesterday’s post that I wasn’t going to do a full analysis of the latest “meat kills!” study because it’s full of the same old garbage I’ve covered in previous posts about other “meat kills!” studies.

If you’d still like to see a full analysis, Zoe Harcombe gave the study a well-deserved pounding. You can read her analysis here.

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A reader sent me a link to a blog post claiming that paleo types who advise against eating grains are scaring people for no reason.  (No, I’m not going to link to it.)  Grains are good for us, you see, because the Mayo Clinic, the USDA and numerous other experts say so.  That’s the main evidence offered:  a mindless appeal to authority.

The writer acknowledges that the number of people diagnosed with celiac disease has gone up, as have claims of gluten intolerance, but suggests the increases are a matter of increased awareness.  In other words, we’ve been scared into the thinking wheat is bad for us, so we’re reporting more problems with wheat.

The reported increase in celiac isn’t due to better diagnosis, however.  As Dr. William Davis explained in Wheat Belly, the rate of celiac disease really and truly has gone up – it’s quadrupled, in fact.  We know that because researchers found blood samples taken from soldiers 50 years ago and compared them to blood samples taken from soldiers today.  Sure enough, today’s soldiers were four times more likely to have celiac antibodies in their blood.

As for the argument that gluten intolerance is all in our heads, perhaps a double-blind study would answer that.  You know, feed some subjects foods containing gluten, feed other subjects similar foods without gluten, with neither group knowing which foods they’re eating.  If only someone had conducted such a study …

… oh, wait.  It’s been done, as reported in a New York Times article about gluten sensitivity:

Crucial in the evolving understanding of gluten were the findings, published in 2011, in The American Journal of Gastroenterology, of an experiment in Australia. In the double-blind study, people who suffered from irritable bowel syndrome, did not have celiac and were on a gluten-free diet were given bread and muffins to eat for up to six weeks. Some of them were given gluten-free baked goods; the others got muffins and bread with gluten. Thirty-four patients completed the study. Those who ate gluten reported they felt significantly worse.

So gluten intolerance isn’t all in people’s heads.  It’s in their guts too.  At least that was the case in this study.

Ahh, but if you eliminate grains, you’ll miss out on all the health benefits who grains provide, the blogger assured us.  Oodles of studies have shown that whole grains are good for us.

I’ve written about those studies many times.  Every time I tracked down a study purporting to prove the benefits of whole grains, the comparison was between people consuming whole grains and people consuming white flour.  All we can determine from those studies is that whole grains aren’t as bad for us as white flour.  To prove whole grains have real benefits, we’d have to compare people who eat whole grains to people who eat no grains.

Ask the USDA, a doctor, a dietitian, or almost anyone who writes health articles for the mainstream press, and they’ll go on and on about hearthealthywholegrains.  Well, here’s one study that actually measured changes in heart-disease risk factors after feeding subjects whole grains:

A total of 316 participants (aged 18-65 years; BMI>25 kg/m2) consuming < 30 g WG/d were randomly assigned to three groups: control (no dietary change), intervention 1 (60 g WG/d for 16 weeks) and intervention 2 (60 g WG/d for 8 weeks followed by 120 g WG/d for 8 weeks). Markers of CVD risk, measured at 0 (baseline), 8 and 16 weeks, were: BMI, percentage body fat, waist circumference; fasting plasma lipid profile, glucose and insulin; and indicators of inflammatory, coagulation, and endothelial function. Differences between study groups were compared using a random intercepts model with time and WG intake as factors.

120 grams of whole grains … that’s a lot of hearthealthywholegrain goodness.  Now let’s look at the results:

Although reported WG intake was significantly increased among intervention groups, and demonstrated good participant compliance, there were no significant differences in any markers of CVD risk between groups. A period of 4 months may be insufficient to change the lifelong disease trajectory associated with CVD. The lack of impact of increasing WG consumption on CVD risk markers implies that public health messages may need to be clarified to consider the source of WG and/or other diet and lifestyle factors linked to the benefits of whole-grain consumption seen in observational studies.

Yes, I’d say the public-health messages regarding whole grains need to be clarified.  Here’s my version of the clarification:

Sorry … turns out we were wrong about the whole-grain thing.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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