Like I said, the insomnia comes and goes.  Up all night over the weekend, then the past two nights I’ve crawled into bed and fallen asleep with no problems.  Eight or nine restful hours, woke up feeling fine and dandy.

Just no pattern to it that I can spot.

I read a study over the weekend that I planned to pick apart today, but I don’t have the mental energy to write about it.  I’m prone to occasional bouts of insomnia, and the past few nights I’ve been thoroughly bouted.  Friday night I slept perhaps a half-hour.  I went to bed, took what amounted to a brief nap, then popped awake.  That’s usually how it starts.  I tried to convince my brain I was still sleeping by lying still with my eyes closed.  My brain didn’t fall for it.

So I went downstairs and worked on a programming project until about 10:00 a.m.  Then I finally fell asleep and stayed asleep until mid-afternoon.  Saturday night I fell asleep around midnight and slept until noon.  Last night I tried to sleep, couldn’t, and gave up.  I crawled back into bed at 6:00 this morning and woke up five hours later.

This has happened on and off for decades.  I’ve tried without success to spot a pattern, but apparently there isn’t one.  I’ve had insomnia on low-fat diets, low-carb diets, and when not dieting at all.  It’s happened when I haven’t had a drink for months, and it’s happened after a night of drinking beer or wine.  (That’s the worst:  feeling loopy and wide awake at the same time.)  I’ve gone to bed hungry and had insomnia.  I’ve gone to bed feeling full and had insomnia.  I’ve stopped drinking caffeine in the afternoon, but it hasn’t helped … which shouldn’t have surprised me, because I once I gave up caffeine completely and that didn’t help either.

All I know is that on some nights, my brain refuses to shut down.  Sometimes I’m thinking about a specific problem — programming challenges when I’m in the middle of a project are pretty much a guaranteed sleepless night.  You’d be surprised how often the eureka! moment comes at 3:00 a.m.  When it does, I don’t really have any choice except to go downstairs and try the solution.  If it works, then I usually sleep.

But on other nights, I’m relaxed, happy, not feeling any pressure, yet my mind seems to be a conveyor belt of random thoughts.  I watch them go by almost as a neutral observer.  “Hmm, that one’s interesting.  I haven’t thought about Doug Watkins since fourth grade.  I wonder what kind of guy he turned out to be.  That was cool when his mom took us the dolphin show.  Amazing.  Too bad his parents had that awful poodle.  That reminds me, the girls don’t want a boxer anymore.  What was that breed they said they liked?  I’m not getting a dog without a fenced-in back yard, though.  Hey, when was the last time the van had an oil change?  Was it Christmas?  We really should clean out the garage so we can park the van in there on hot days.”

Usually this goes on for a night or two, and then I’m over it.  However, in my mid-twenties, I once went five days without sleeping, save for brief naps.  Towards the end of that week, I was walking home from a diner two blocks from my apartment — I was too tired to cook — and stopped at the corner of Clark and Fullerton, a busy intersection in Chicago.  I looked to my right and saw a WALK sign, then responded by stepping off the curb onto Fullerton.  Someone behind me grabbed my belt or jacket and yanked me backwards just as a car zoomed past.  The car missed me by perhaps 12 inches.  I turned around and mumbled “thank you.”  To this day I can’t tell you anything about who saved me … male, female, young, old, nothing.  My brain had stopped processing information.

If there’s such a thing as an natural night-owl, I’m one of them.  I know paleo types believe in waking up with the sun and falling asleep well before midnight, but that’s never seemed to fit with my natural body clock.  I do most of my creative thinking at night.  Always have.  If I’m tired during the day, I start to feel better when the sun goes down.

I was perfectly happy with my sleep schedule during my days as a traveling comedian, when I rarely went to bed before 3:00 a.m.  If I finished a show at midnight and was within 200 miles of Chicago, I’d just drive home.  Once I drove from Nebraska to Chicago after realzing I wasn’t going to sleep.

This could be a bit genetic.  I’ve had a few bipolar relatives on my dad’s  side of the family.  Perhaps I caught a touch, but just enough to be occasionally unipolar.  I get wired up at times and can’t sleep, but fortunately I don’t get the depressions afterwards.  I just go back to being more or less normal.

I suppose the upside is that I’m capable of working around the clock if I have to.  While editing Fat Head, I was facing a deadline to deliver a sample cut to a distributor, and my computer decided to torture me by crashing several times per day.  (This was before I bought a Mac Pro with Final Cut, so you Apple fans can relax.)  I ended up working for three days and nights, leaving my office only for coffee and food, plus two quick trips home for a shower.  I delivered the hard drives to FedEx a half-hour before the last deadline, then went home and slept for 18 hours.

At times like this, I’m hugely grateful to be self-employed.  When I had office jobs, I had to just suck it up and go to work without sleep.  If the boss says working hours are 9:00 to 5:00, that’s what they are.  Now clients hire me to write programs and deliver them some weeks later.  They don’t know when I work and don’t care, as long as the software is finished on time.  So if I pop awake at 2:00 a.m. and know I’m going to be awake all night, I just go downstairs and work.  If I end up sleeping away most of the next day, no big deal.  My wife suspects I may be part vampire, but she’s understanding.

Anyway, I’m going to relax tonight, stay away from the programming so I don’t discover any problems that need solving, and try to fall asleep by midnight.  Wish me pleasant dreams.

I don’t blame Ronald McDonald for the rise in obesity and diabetes.  I made that clear in Fat Head.  But if he starts handing out statins with the burgers and fries, I may have to track him down and punch him right in his red nose.

No, scratch that.  It wouldn’t actually be Ronald’s fault.  I should track these people down and punch them in the nose instead:

Fast food outlets could provide statin drugs free of charge so that customers can neutralise the heart disease dangers of fatty food, researchers at Imperial College London suggest in a new study.

In a paper published in the American Journal of Cardiology, Dr Darrel Francis and colleagues calculate that the reduction in cardiovascular risk offered by a statin is enough to offset the increase in heart attack risk from eating a cheeseburger and a milkshake.

Those must’ve been some amazing calculations.  After several major clinical trials that lasted for years and cost hundreds of millions of dollars, researchers have been left with contradictory results.  At best, they can say that among people with previously identified heart disease — and no one else — statins might prevent one heart attack for every 100 people who take them.

And yet this group in Britain fired up a copy of Excel and precisely calculated that one dose of statins offsets the coronary damage from a Double Quarter Pounder and a chocolate shake.  Their study (ahem, ahem) should’ve been laughed into instant oblivion.  Instead, it appeared in the American Journal of Cardiology (which next month will publish a study examining the heart-protecting effects of standing outside naked and howling at passing aircraft).

Good grief.  We’re finally seeing major media outlets like the Los Angeles Times openly question the supposed benefits of statins, and in the same week we’ve got doctors suggesting Ronald McDonald should serve them as a side dish … at least in Britain, where statins are already an over-the-counter drug.  Here’s part of what they wrote in their paper:

Routine accessibility of statins in establishments providing unhealthy food might be a rational modern means to offset the cardiovascular risk. Fast food outlets already offer free condiments to supplement meals. A free statin-containing accompaniment would offer cardiovascular benefits, opposite to the effects of equally available salt, sugar, and high-fat condiments.

Yeah, fabulous idea:

“Salt?  Ketchup?  Statin?” 

“How much is the statin?”

“They’re free, sir.”

“Really?  They cost money at the pharmacy.  Give me a dozen.”

An article about the study (ahem, ahem) in today’s Science Daily was so full of bologna, I ingested three days’ worth of saturated fat merely by reading it.  Here are some quotes:

Statins reduce the amount of unhealthy “LDL” cholesterol in the blood. A wealth of trial data has proven them to be highly effective at lowering a person’s heart attack risk.

What “wealth of trial data” would that be, exactly?  Let’s review what the Los Angeles Times said on the topic:

In the first of three studies published in the Archives [of Internal Medicine] last month, medical researchers found that, contrary to widely held belief, statins do not drive down death rates among those who take them to prevent a first heart attack.

Perhaps those researches forgot to limit their study group to people who’d just consumed a Big Mac.  But it’s not just the Archives of Internal Medicine that’s knocking statins lately.  In a paper published in a French medical journal, researchers examined the clinical trials and came to same conclusion:  several recent studies have been conducted to test the effects of cholesterol-lowering drugs.  Most were disappointing or inconclusive, some were stopped early (and never published) because the results weren’t flattering, and the only one that declared a clear benefit for statins — JUPITER — is highly suspect.  That’s the one where the investigators moved their end-point back in time to get a result they liked.

But back to the Science Daily article:

“It’s ironic that people are free to take as many unhealthy condiments in fast food outlets as they like, but statins, which are beneficial to heart health, have to be prescribed,” Dr Francis said.

Doctor, I’m going to step out on a limb here and suggest that any substance that messes with your basic biological functions probably ought to be prescribed.  And if they aren’t prescribed, people should be given all the information about them.  Before we put a dish of statins next to the ketchup dispenser, can we at least talk about side-effects?

Statins have among the best safety profiles of any medication. A very small proportion of regular statin users experience significant side effects, with problems in the liver and kidneys reported in between 1 in 1,000 and 1 in 10,000 people.

AAAARRGGHHH!!  No, damnit, I mean the real side effects!  One in a thousand?  Are you kidding me?  Dr. Beatrice Golomb has been tracking statin side-effects for years and says the rate could be closer to 30%.  Most doctors just don’t attribute the side effects to the statins they’re handing out.  My mom’s doctor certainly didn’t.

Studies have shown a clear link between total fat intake and blood cholesterol, which is strongly linked to heart disease.

So we’re back to that same old @#$%.  If A is linked to B and B is linked to C, then A must cause C.  Just one little problem:  nobody can produce a single study that shows that eating saturated fat causes heart disease.  Recent studies have concluded exactly the opposite:  there is no link between the two.

Recent evidence suggests that trans fats, which are found in high levels in fast food, are the component of the Western diet that is most dangerous in terms of heart disease risk.

No kidding.  Too bad the goofs in white coats convinced us we had to stop frying in tallow and lard … you know, like we did back when heart disease was rare.

Even if you buy the theory that saturated fat raises cholesterol and elevated cholesterol causes heart disease, this proposal is still almost charmingly stupid.  Heart disease is a chronic condition.  It develops over years.  To the minor extent that statins prevent a second heart attack, they do it over the long term.  They’re not condoms for your arteries. If you have the occasional one-nighter with a milkshake, you can skip the protection without receiving a surprise phone call a few months later.

But apparently these researchers are convinced that saturated fat clogs your arteries the way tobacco stains your teeth:  a little bit with every dose.  Eat a burger, grow some plaque — unless, by gosh, you pop a statin immediately to halt the process.

If, heaven forbid, we start serving fast food with a side of statins, here’s what will happen:  five or 10 years from now, you’ll see headlines about a new study that links fast-food consumption to muscle weakness, depression and memory loss.  The blame, of course, will be assigned to the burgers.  Michael Jacobson of CSPI will seek out the nearest TV camera and declare Quarter Pounders “Alzheimer’s in a bun.”

The researchers note that studies should be conducted to assess the potential risks of allowing people to take statins freely, without medical supervision.

This is coming from the same people who think it’s “ironic” that we dispense free ketchup in restaurants but require a prescription for statins?  What a nice little note of caution.

They suggest that a warning on the packet should emphasise that no tablet can substitute for a healthy diet, and advise people to consult their doctor for more advice.

No thanks.  The way doctors give out statins these days, I think white coats should come with a big warning label on them.

I’ve been working on a software project for the past 13 hours, and I’m too fried to write much of a post.  But a reader brightened my evening by sending me a link to an article in the Los Angeles Times that’s bad news for statin-makers.  When the big newspapers start picking up on this stuff, the pharmaceutical companies have reason to worry.  Here are some quotes and comments:

At the zenith of their profitability, these medications raked in $26.2 billion a year for their manufacturers.  The introduction in recent years of cheaper generic versions may have begun to cut into sales revenues for the brand-name drugs that came first to the market, but better prices have only fueled the medications’ use: In 2009, U.S. patients filled 201.4 million prescriptions for statins, according to IMS Health, which tracks prescription drug trends. That’s nearly double the number of prescriptions written for statins in 2001, four years after they arrived on the American pharmaceutical landscape.

It’s nice to know people can permanently weaken their muscles now without spending too much.  I knew people were popping statins like they’re tic-tacs, but 201 million prescriptions?!  That’s disturbing.  Worse, the statin-makers want doctors to prescribe these poisons to kids. 

But in recent months the drugs’ touted medical reputation has come under tough scrutiny.

Better ten years too late than never.

Statins were initially approved by the Food and Drug Administration for the prevention of repeat heart attacks and strokes in patients with high cholesterol who had already had a heart attack. And used for that purpose - called “secondary prevention” - the drugs are powerful and effective medications, driving down patients’ risk of another heart attack or stroke by lowering their levels of LDL (or “bad”) cholesterol.

AAARRGGHH!!  No, for @#$% sake, lowering cholesterol is just a nasty little side effect.  To the extent that statins do any good, they do it by lowering inflammation.  You can lower inflammation by cutting the garbage out of your diet.

Then physicians came to believe statins could also reduce the risk of a first heart attack in people who have high LDL cholesterol but are nonetheless healthy. This use of statins - called “primary prevention” - has driven the growth in the market for statins over the last decade.

It’s amazing what you can believe when a hot little pharmaceutical rep in a tight skirt gives you a sales pitch.  When we’re giving drugs to people who are “nonetheless healthy,” something is very, very wrong.

Today, a majority of people who use statins are doing so for primary prevention of heart attacks and strokes. It is this use of statins that has come under recent attack.

“There’s a conspiracy of false hope,” says Harvard Medical School’s Dr. John Abramson, who has cowritten several critiques of statins’ rise, including one published in June in the Archives of Internal Medicine. “The public wants an easy way to prevent heart disease, doctors want to reduce their patients’ risk of heart disease and drug companies want to maximize the number of people taking their pills to boost their sales and profits.”

False hope?  But Dr. Abramson, those Lipitor commercials are so convincing.  Every time I see the one where the guy is pleading with his older brother to take statins, it brings a tear to my eye.  (If I ever told my older brother to take statins, it would be to weaken him to the point that I could finally beat him in arm-wrestling.  But I don’t want to win that badly.)

Heart patients and their physicians are not the only ones to pin their hopes on statins. The drug companies that brought statins to the market have explored the medications’ benefits in prevention or treatment of such conditions as Alzheimer’s disease, rheumatoid arthritis, prostate and breast cancer, kidney disease, macular degeneration and diabetic neuropathy. Although clear proof that statins could forestall or treat any of these diseases might bring in millions of new, paying customers, results have largely been mixed, inconclusive or disappointing.

Well, I am just stunned that beating down your liver’s ability to produce cholesterol hasn’t turned out to be a cure for damned near everything.  Perhaps we need to start removing livers completely.  Tonsils at age 5, then livers a year or so later.  We’ll lie to kids and tell them they can rub all the ice cream they want on their bellies afterwards.

In an ideal world, debate over the clinical virtues or vices of a drug would be long settled by the time the medication saw a meteoric rise in use. But in a healthcare system that relies on commercial incentives to spur drug development, prescription medications are a product like any other.

Yeah, that’s bound to be a problem with our current system of direct-to-consumer sales by pharmaceutical companies.  If only we could place some kind of responsible intermediary between them … perhaps someone in a white coat.

Sometimes, by the time the deliberate pace of medical research and debate suggests that a drug is not all it’s been cracked up to be, it’s already become a bestseller.

That’s why I refer to Dane Cook as the Lipitor of comedy.

And yet, the relationship between cholesterol-lowering and heart disease is not perfectly understood.

Well, there’s an explanation for that.  I’ll use an analogy to clarify:  You could spend dozens of years and millions of dollars trying to understand the relationship between me and Salma Hayek and not get anywhere.  The reason?  We don’t have a relationship … other than the one time we passed each other in a hallway at Disney.

In the first of three studies published in the Archives last month, medical researchers found that, contrary to widely held belief, statins do not drive down death rates among those who take them to prevent a first heart attack.

And yet they lower cholesterol rather dramatically.  Hey, I’m starting to wonder if high cholesterol causes heart disease at all …

A second article cast significant doubt on the influential findings of a 2006 study, called JUPITER, that has driven the expansion of statins’ use by healthy people with elevated blood levels of C-reactive protein, a measure of inflammation. A third article suggested potential ethical, clinical and financial conflicts of interest at work in the execution of the JUPITER study and concluded the widely hailed trial was “flawed” and raises “troubling questions concerning the role of commercial sponsors.”

I’ve read critiques of JUPITER written by skeptical doctors who crunched the data.  Bottom line is that it’s one of worst studies ever.  Here’s just one example:  At one point, the statin-takers showed slightly better results.  Later, the difference between statin-takers and placebo-takers began to shrink to nothing.  So the researchers conveniently chose to place the study’s “end point” at a time when there was still a difference.  Those are the numbers they reported.

As many as three-quarters of patients currently taking statins haven’t yet had a stroke or heart attack; they have diabetes or high LDL cholesterol, conditions widely thought to put them at high risk of having one.

Those patients largely joined the ranks of statin consumers after 2001, when the National Heart, Blood and Lung Institute adopted guidelines on the treatment of patients with high cholesterol. The guidelines, updated again in 2004, suggested that as many as 36 million Americans should take statins - essentially tripling overnight the potential American market for the drugs. Of the nine experts involved in drafting the cholesterol treatment guidelines, the National Institutes of Health later acknowledged that eight had substantial financial ties to statin makers - links that may have predisposed them to view evidence of statins’ benefit in its most positive light.

I think that last sentence pretty much says it all.

If the federal government’s influence over food choices were limited to releasing dense and unreadable Dietary Guidelines every five years, it wouldn’t be much to worry about. Unfortunately, that’s not the case. Schools, the military, prisons and other government facilities are required to follow those guidelines.

And in case that’s not enough, they’re doing their best to harangue us into following the guidelines at home as well. Check out this video:

The Apps for Kids official website describes the competition:

The Apps for Healthy Kids competition is a part of First Lady Michelle Obama’s Let’s Move! campaign to end childhood obesity within a generation. Apps for Healthy Kids challenges software developers, game designers, students, and other innovators to develop fun and engaging software tools and games that drive children, especially “tweens” (ages 9-12) - directly or through their parents - to eat better and be more physically active.

Tools and games should be built using the USDA nutrition dataset recently made available to the public through the Open Government Initiative. The dataset provides information on total calories, calories from “extras” (solid fats and added sugars), and MyPyramid food groups for over 1,000 commonly eaten foods. We are seeking innovative and creative tools and games that use the USDA dataset to deliver nutrition and health concepts in a fun and engaging way.

Great … now kids can be brainwashed by the USDA while playing games. The only saving grace here is that the government officials in charge will probably select games no self-respecting kid would actually find interesting.

A few days ago, we decided we’d better do some summertime family activities before summer is gone, so we took the girls to play miniature golf and visit a children’s discovery center in a nearby town. It was a lovely drive through the hills and rolling countryside, where we saw several ranches with cows roaming around the pastures and eating grass … just like Mother Nature Intended.

The discovery center was actually pretty cool. Lots of interesting science, nature and technology exhibits for kids. Here’s my six-year-old getting up close and personal with some turtles:

Unfortunately, the USDA apparently rents a small section of the museum. An entire corner was dedicated to the wonders of the Food Pyramid and health advice based on it.

So this is what we’re up against. Dietary guidelines in the schools, dietary guidelines being programmed into educational games, dietary guidelines being quoted as gospel by health reporters in the media, dietary guidelines on display in museums, and of course dietary guidelines on your food packages. No wonder people give you a strange look if you tell them you avoid grains and eat lots of animal fats.  It’s been pounded into their heads over and over that a diet like that will kill you. 

Grains and soybean oil … lovely. Anyone out there really believe the U.S. Department of Agriculture is pushing those foods because they’re just soooooo good for you?

While I was pulling these pictures off my wife’s camera, I found a few others that are relevant. Apparently one of us wanted to remember breakfast one morning and took this one:

That’s a typical breakfast around here. Cheese and onion omelet (cooked in Kerrygold butter) with sour cream on top, bacon, avocado, a bit of fruit. No grains, and no godawful soybean oil to ruin it.

In the pictures above and below, you can see how a diet that rarely includes bread, pasta, cereal, or any of the foods at the base of the Food Pyramid has turned my six-year-old into a listless little weakling. These were taken at a fair in downtown Franklin. A bunch of other kids her age and older also tried to climb to the top of the wall, where they could push a buzzer to announce their success. Not one made it during the time we were watching.  But she did.

We also finally got around to finding a local dentist and all had our first checkups in over a year.  Four people, zero cavities.  So I think I’ll continue ignoring the USDA and their Dietary Guidelines.

After finishing a big programming project this weekend, I spent a good chunk of today reading the last big section of the 2010 Dietary Guidelines, a 65-page document titled Fatty Acids and Cholesterol.  The final 30 pages or so were dedicated to reviewing evidence that nuts, omega-3 fats from fish, and chocolate might be good for your heart.  The committee’s conclusion:  Maybe, but we can’t really say.

But in the first 30-plus pages, the committee makes it clear they’re pretty darned positive saturated fat and cholesterol will kill you.  Saturated fat, as it turns out, will not only clog your arteries and stop your heart, it will give you type 2 diabetes as well. 

For more than 30 years now, we’ve been told to limit saturated fat to no more than 10% of our calories.  We’ve actually come pretty close:  according to the committee’s data tables, saturated fat makes up 11.4% of the average American’s intake.  Since we’ve also become fatter and more diabetic in the past decades, the committee put their academic heads together and came up with the obvious answer:  we’re still consuming too much saturated fat.  So in the 2010 guidelines, they tell us to reduce saturated fat to just 7% of our calories. The committee even suggests putting kids on fat-restricted diets to protect them from diabetes:

The growing data to support a risk of T2D from SFA consumption indicates the need for fat-modified diets in persons with pre-diabetes, including those with metabolic syndrome, and with established diabetes. Since the ages of onset of T2D now include childhood, studies from adolescence through middle age would be useful to define when SFA-reduced diets would be most effective.

I found the whole document so biased and contradictory, I managed to get the entire Dietary Guidelines Advisory Committee (DGAC) on the phone so I could ask them to explain themselves.  Here is a transcript of the conversation:

Fat Head:  Thank you for taking the time to answer a few questions.

DGAC:  No problem.  We’re glad to help.

Fat Head:  Wow … I’ve never heard a roomful of people say the exact same words at the exact time before.

DGAC:  So you don’t attend Sunday mass anymore?

Fat Head:  I, uh … I mean I’ve never heard people do that without knowing the words ahead of time.  It’s pretty amazing.

DGAC:  Well, as we made clear in our document, it’s important for policymakers to speak with one voice on nutrition.  We’ve been practicing.

Fat Head:  You’re very good at it.

DGAC:  Thank you.

Fat Head:  To get started, I want to just clarify your overall position on dietary fat.  You stated that the federal government should continue recommending we limit our fat intake to 30% of total calories.  But in your document, you also made these statements:

Currently, several lines of evidence indicate that the type of fat is more important in decreasing metabolic and CVD risk than the total amount of fat in the diet.

The effects of dietary fat, as well as the other macronutrients, and intermediate risk factors, are diverse and highly dependent on other factors such as physical activity and life style habits, and, importantly, individual genetic predisposition that is based on underlying genetic polymorphisms.

However, in the 2002 IOM report on macronutrient requirements there was the adoption of an AMDR of fat intake of 20-35 percent of calories because there were no clear differences in health outcomes in populations consuming dietary fat within this range.

DGAC:  Sounds like you’re speaking Italic.

Fat Head:  I am, but only when I’m quoting you directly.  It’s for the benefit of my readers.

DGAC:  Fair enough.

Fat Head:  The point is, you gave a pretty specific limit for fat intake, then stated elsewhere that it’s the type of fat that really matters, and that there are wide variations in fat intake within healthy populations.  So why give us a limit, then more or less say the amount of fat isn’t all that important?

DGAC:  Because we wanted to work the term underlying genetic polymorphisms into the text.

Fat Head:  But that doesn’t seem–

DGAC:  We’re highly educated and like using a fancy term like that, but just try dropping it into a casual conversation.  It’s nearly impossible.

Fat Head:  Let me try this another way:  Why recommend a 30% limit at all?  What would happen if a large population consumed, say, a diet that was 40% fat?

DGAC:  AAAAAARGGGHHHH!!!

Fat Head:  Geez!  I’ve never heard people scream in unison like that.

DGAC:  What about the first Halloween movie?

Fat Head:  Yeah, but not as a reaction to a simple question.

DGAC:  Well, the very idea!  Don’t you know eating fat causes diabetes?!  A population that eats that much fat would have so many amputees, they’d look like a reunion of Civil War veterans.

Fat Head:  Or like a bunch of Americans when I was in grade school.

DGAC:  Don’t be silly.  The last Civil War veteran died in 1956.

Fat Head:  I’m merely pointing out that according to your own data tables, the average American diet was more than 40% fat in the 1970s.  So where was all the type 2 diabetes?

DGAC:  Well … obviously it was sitting there, like a bomb waiting to explode.  Look what’s happened since then.

Fat Head:  You mean since we started eating less fat and more carbohydrates?

DGAC:  Clearly a case of too little, too late.

Fat Head:  Diabetes in America has doubled in the past 10 to 15 years.  You stated that according to the evidence, saturated fat makes us more likely to develop heart disease and diabetes, while monosaturated fats and polyunsaturated fats appear to prevent both.  Here’s how you put it:

In contrast to CVD, T2D is clearly increasing in prevalence and incidence. T2D is a strong risk factor for atherosclerotic disease, but also carries a high burden of disability and healthcare costs, with diabetic nephropathy, retinopathy, and neuropathy as major sequelae. Because of this, T2D and T2D risk were included as disease outcomes related to fatty acid and cholesterol consumption.

Strong evidence indicates that intake of dietary SFA is positively associated with intermediate markers and end point health outcomes for two distinct metabolic pathways: 1) increased serum total and LDL cholesterol and increased risk of CVD and 2) increased markers of insulin resistance and increased risk of T2D. Conversely, decreased SFA intake improves measures of both CVD and T2D risk. The evidence shows that 5 percent energy decrease in SFA, replaced by MUFA or PUFA, decreases risk of CVD and T2D in healthy adults and improves insulin responsiveness in insulin resistant and T2D individuals.

DGAC:  Yes, according to the studies that met our criteria, that’s true.

Fat Head:  But I’m looking at the report here, and you also said this:

 The consumption of harmful types and amounts of fatty acids and cholesterol has not changed appreciably since 1990.

Fat Head:  Meanwhile, according to your data tables, the only fats we increased in our diets during the span when diabetes went through the roof were monosaturated and polyunsaturated.  Since you’re big fans of observational evidence, what do you make of that observation?

DGAC:  Nothing.

Fat Head:  Why not?

DCAG:  Because we didn’t make that observation.

Fat Head:  I see. Well, here’s another one for you:  Compared to Americans, the French consume far more saturated fat, but far less polyunsaturated fat.  They also have a lower rate of heart disease, and according to what I can find online, their rate of diabetes is less than half of ours.  How do you explain that?

DGAC:  It’s got to be the wine.

Fat Head:  I knew you’d say that, but as it turns out, there are other countries where people drink just as much wine, but have a lot more heart disease than the French.

DGAC:  Do the people in those other countries drink French wine?

Fat Head:  Well … I don’t think so.

DGAC:  There you go.

Fat Head:  All throughout your document, you write about saturated fatty acids and trans fatty acids as if they’re the same.  Here are a few examples:

The potential negative effects of dietary cholesterol are relatively small compared to those of SFA and trans fatty acids.

The relationship between dietary saturated fat, trans fat and cholesterol and deleterious health outcomes at the population level has long been recognized, with recommendations for modification of total fat, SFA, and cholesterol dating back to the 1980 Guidelines.

Strong and consistent evidence indicates that dietary PUFA are associated with improved blood lipids related to CVD, in particular when PUFA is a replacement for dietary SFA or trans fatty acids.

DGAC:  What’s your point?

Fat Head:  You are aware, aren’t you, that saturated fat and trans fat are two completely different substances?  In your search for all the relevant data, did you notice that heart disease didn’t become an epidemic until we started replacing lard and tallow with Crisco and corn-oil margarine and other trans fats?

DGAC:  Look, saturated fat and trans fat are both solid at room temperature.  And if they’re solid at room temperature, they’re solid inside your body, so they clog your arteries.

Fat Head:  How do you know that?

DGAC:  Dr. Oz explained it on Oprah.

Fat Head:  But–

DGAC:  And saturated fat intake is clearly associated with heart disease.

Fat Head:  The American Journal of Clinical Nutrition published a study recently concluding that there’s no association whatsoever between saturated fat and heart disease.

DGAC:  That one didn’t meet our selection criteria.

Fat Head:  Yeah, I noticed you didn’t mention it.  So what exactly were your selection criteria?

DGAC:  Well, if you read the report carefully, you’ll see a lot of sentences that begin something like “A systematic review identified 12 studies that met the selection criteria …”

Fat Head:  Which means?

DGAC:  It means we selected the studies we identified, okay?  Including several that showed an association between saturated fat and heart disease.

Fat Head:  I wanted to ask you about those.  Elsewhere in the document, you listed the top sources of saturated fat in the American diet.  That list included pizza, grain-based desserts, dairy desserts, Mexican dishes, pasta dishes, corn chips, potato chips, candy and fried potatoes.  So isn’t it fair to say that in the observational studies that met your criteria, people who ate more saturated fat also ate more pizza, grain-based desserts, dairy desserts, Mexican dishes, pasta dishes, corn chips, potato chips, candy and fried potatoes?

DGAC:  Uh … yeah, but … all that fat, you see … it’s …

Fat Head:  I’ve never heard people stammer in unison before.  That’s freaky.

DGAC:  The takeaway here is that people who eat a lot of saturated fat have more heart disease. 

Fat Head:  Perhaps because they also eat a lot of junk that’s full of refined carbohydrates?

DGAC:  Carbohydrates have nothing to do with it!

Fat Head:  That’s strange.  Let me quote your document:

In all cases of isocaloric SFA or trans fatty acid substitution, there is a decrease in CHD risk. However, it should be noted that when MUFA or PUFA are substituted by any kind of carbohydrates, CHD risk increased.

Fat Head:  So replacing two different types of fats with any kind of carbohydrate increased the risk of heart disease.  It’s right there in your report.  And so is this:

High MUFA intake, when replacing a high carbohydrate intake, results in improved biomarkers of glucose tolerance and diabetic control.

DGAC:  Those monosaturated fats are truly wonderful.

Fat Head:  Don’t you think maybe reducing carbohydrates figured into it?

DGAC:  Of course not.  Carbohydrates are good for you.  It’s the fat intake you need to watch.

Fat Head:  But you stated in your report that carbohydrate is the only macronutrient that makes up a bigger portion of our diets now than it did 30 years ago.  Then you wrote about the dramatic rise in metabolic syndrome, and how it’s characterized by high blood pressure, high triglycerides, high blood glucose, obesity and low HDL. You quoted research that fat raises HDL. And a ton of other research shows that carbohydrates raise blood pressure, blood sugar and triglycerides. 

DGAC:  So?

Fat Head:  So I’m trying to figure out why you’re still recommending we limit our fats and eat a lot of carbohydrates.  That was your big conclusion in another section of the report:   Healthy diets are high in carbohydrates.

DGAC:  That’s right.

Fat Head:  What?!

DGAC:  Correct.  You got it, Mister. 

Fat Head:  So you’re still saying–

DGAC:  Cut th fat.  Eat your carbohydrates.  Live long and prosper.

Fat Head:  And you don’t see any contradictions there?

DGAC:  No.  That’s why we’re speaking with one voice.

Fat Head:  Thank you for clearing things up.