Dietitians Want Their Bad Advice To Be The Only Advice: A Tale of Three Twitties

Actually, this post is about three tweets, but A Tale of Three Twitties is catchier.

I came across the three tweets on the same day, and together they tell the story of what’s wrong with the current dietary advice and The Anointed who promote it.

The first tweet included a link to a recent study in which a low-carbohydrate diet was used to treat type 2 diabetics. Here’s a quote from the summary:

The purpose of this study was to evaluate if a new care model with very low dietary carbohydrate intake and continuous supervision by a health coach and doctor could safely lower HbA1c, weight and need for medicines after 1 year in adults with T2D. 262 adults with T2D volunteered to participate in this continuous care intervention (CCI) along with 87 adults with T2D receiving usual care (UC) from their doctors and diabetes education program. After 1 year, patients in the CCI, on average, lowered HbA1c from 7.6 to 6.3%, lost 12% of their body weight, and reduced diabetes medicine use. 94% of patients who were prescribed insulin reduced or stopped their insulin use, and sulfonylureas were eliminated in all patients.

Lower blood sugar, lower body weight, and 94% of the patients reduced or even eliminated the need for insulin treatment.  Awesome. All patients were able to discontinue sulfonylureas, which are drugs that stimulate the pancreas to produce more insulin. Since all drugs have side effects, I looked up the side effects of sulfonylureas. Here’s what I found on a UK diabetes site:

Sulphonylureas are not recommended for people who are overweight or obese, as their mode of action (increase in insulin production and secretion) means that weight gain can be a relatively common side effect.

Funny, isn’t it? The fact that elevated insulin triggers weight gain seems to be accepted as a given by everyone except many (ahem) weight-loss experts.

I doubt the results of this study surprise you.  Quite a few clinical studies, like this one and this one, have shown similar results.

If you’ve got high blood sugar because of insulin resistance, cutting way back on the carbs can work wonders. I know it, you know it, countless personal trainers know it, everyone who’s read a book on low-carb diets knows it, gazillions of people who’ve done their own research online know it. Seems as if the only people who don’t know it are a helluvalotta doctors and nearly all dietitians.

Which brings us to the second tweet. That one included a link to a Dear Dietitian column in a county newspaper. If you have a tendency to bang your head on your desk when reading incredibly stupid advice from registered dietitians, you might want to don a helmet before continuing.

Okay, you were warned. Here goes:

Dear Dietitian,

I was recently diagnosed with diabetes. I’m trying to watch my diet, and have cut out most carbs, but if I eat a slice of white bread, my blood sugar goes up to 200! What gives?

Dear Frustrated,

First of all, try to be patient. This is a major lifestyle change, and it cannot be accomplished in a couple of weeks. It will take at least six weeks to become accustomed to the new diet, and it won’t be perfect. Secondly, there is no need to remove carbs from your diet. Carbs are a great source of energy and are very satisfying. Anyone who has diabetes should be able to consume 12 to 15 servings of carbohydrate foods each day while maintaining healthy blood glucose levels.

Head. Bang. On. Desk.

How the @#$% is someone with type 2 diabetes supposed to maintain a healthy glucose level while eating 15 servings of carbohydrate per day?! Well, you know the answer to that one:

Another important component for good diabetes management is to obtain the right medicine to lower your blood glucose levels.

Eat your 12 to 15 servings of carbohydrate per day (a great source of energy!), then beat down your blood sugar with more insulin. That’s how dietitians are trained to think. When Chareva’s father was in the hospital for surgery some months back, he was of course given meals approved by the staff dietitian. For breakfast, he was served pancakes with maple syrup … but no butter on those pancakes, because butter will kill ya, doncha know.

These registered imbeciles believe that if you shoot enough insulin to beat your blood sugar down to the normal range, it means you’re okay now — same as if you kept your blood sugar in the normal range by cutting back on the carbs instead.

No. No, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, damnit, it’s not the same.

If you’re a type 1 diabetic and you need injections to achieve a normal level of insulin, that’s fine.  You’re just replacing what your body fails to produce.

But if you’re a type 2 diabetic and you have to inject yourself with extra-high doses of insulin so you can eat those great source of energy carbs, there are consequences. High insulin triggers weight gain. It thickens your arteries. It screws up the balance of your sex hormones. It likely promotes the growth of tumors. Telling insulin-resistant people to eat all those carbs and then shoot ever-higher doses of insulin is insane.

But that’s what dietitians are trained to recommend, which is why so many fat, sick, frustrated people are going elsewhere for dietary advice. Naturally, The Anointed don’t like it when the masses refuse to listen to them.

Which brings us to the third tweet. That one included a link to a video posted by the president of the Academy of Nutrition and Dietetics. Here’s the official description:

President Lucille Beseler, MS, RDN, LDN. CDE, FAND, offers members ways to protect the public’s health (and the nutrition and dietetics profession) from “disruptors” – competitors who offer lower-quality care and less-comprehensive services.

I’d prefer to embed the video in the post, but can’t. You can watch it on this page — and please don’t leave any snarky comments here or elsewhere about Ms. Beseler’s size. No need to go for the cheap shot.

Ms. Beseler is encouraging members to keep an eye out for people who give non-approved dietary advice and report these “disruptors” to state licensing boards … to protect the public’s health, of course.

Yes, because lord only knows what will happen to the millions of type 2 diabetics in the country if they aren’t told to eat their 12 to 15 servings of carbohydrates per day and then shoot up with more insulin.

Let’s take the official description of the video and edit it to reflect the true purpose:

President Lucille Beseler offers members ways to protect the nutrition and dietetics profession from competitors.

This is nothing new, mind you. As Adam Smith pointed out way back in 1776 when he wrote The Wealth of Nations, regulations that are supposedly passed to protect the poor, helpless public are often nothing more than a means to stifle competition — which screws the poor, helpless public.

In what has to be the most outlandish example I’ve ever seen, Illinois passed a regulation requiring anyone who braids hair for a fee to first obtain a cosmetology license. (If you think I’m kidding, read this.) Apparently the regulation was passed after hundreds of people were rushed to emergency rooms suffering from badly-braided hair.

Here’s how it should happen in a supposedly free country: People who give dietary advice that works attract more customers who are willing to pay them. People whose dietary advice doesn’t work lose customers. A license granted by The Anointed shouldn’t figure into the equation either way. If health coaches, personal trainers and other “disruptors” are giving advice that doesn’t work, then the Academy of Nutrition and Dietetics has no cause for concern. Word will get around.

But of course, that’s the problem: the word has gotten around. Dietitians are still telling diabetics to eat their carbs and shoot more insulin — perhaps because the Academy of Nutrition and Dietetics receives generous support from the makers of industrial foods. Their advice is garbage, so people are seeking and finding alternative advice that actually works — as demonstrated by clinical studies and the experiences of millions. That makes the alternative advice a threat, so the dietitians want government licensing boards to stifle the “disruptors” who offer it.

And that’s where we’re at.  A Tale of Three Twitties tells pretty much the whole story.

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Jane Brody And The American Heart Association Bravely Admit They’ve Been Right All Along

The strategy is clear now. The American Heart Association, terrified that the Wisdom of Crowds effect is causing more and more people to reject their arterycloggingsaturatedfat! nonsense, has decided to leverage what Josef Stalin referred to as useful idiots — i.e., people who can be counted on to swallow and spread the party’s propaganda.

Step one: produce a Presidential Advisory Report that concludes we were right all along about the dangers of saturated fats.

Step two: do interviews with media types who have been on the anti-fat bandwagon for years … because if we were right all along, it means they were right all along too. They’ll dutifully promote the message without asking pesky questions.

For decades, one of the biggest cheerleaders for the low-fat diet has been Jane Brody of the New York Times. Gary Taubes mentioned her several times in Good Calories, Bad Calories. I wrote a post about her battle with “high” cholesterol back in 2009. You can read the post for the full details, but these quotes capture Ms. Brody’s apparent immunity to cognitive dissonance:

Ms. Brody’s cholesterol panic began when a routine test revealed her total cholesterol to be 222. (So much for a low-fat diet keeping cholesterol down.) Since she just knows that a “heart healthy” level should be below 200, Ms. Brody dutifully stopped eating cheese and went on a diet to lose a few pounds.

But – horrors! – when she underwent another test a few months later, her cholesterol had risen to 236, and her LDL had gone up, not down. Now, you’d think someone with a functioning brain would pause at this point and wonder if perhaps the whole low-fat diet theory is load of bologna. But not Ms. Brody. After all, she’s been telling her readers for decades to cut the fat, cut the fat, cut the fat.

So she cut the fat. She stopped eating red meat, switched to low-fat ice cream, took fish oil, and increased her fiber intake. In other words, she did just about everything she’s been telling her readers they must do to prevent heart disease.

And boy, what wondrous results! Her next test revealed that her cholesterol had risen to 248, and her LDL was up yet again.

If this were a horror movie, we’d all be screaming at the screen, “Don’t go through that door, you freakin’ idiot! Everyone who went through that door ended up hanging on a meat hook!”

But Ms. Brody went through the door. Mere paragraphs after recounting how her low-fat diet failed utterly to bring down her cholesterol, she reminded her readers how important it is to exercise more and cut the saturated fat from their diets. She even informed us that a former roommate lowered her cholesterol by becoming a vegetarian. (“See, this diet made my cholesterol worse, but I know someone who had good results, so you should do exactly what didn’t work for me. Okay?”)

Finally, Ms. Brody reported that despite having some reservations, she began taking a cholesterol-lowering drug. And lo and behold, her cholesterol went down! (At this point in the story, you are allowed to scream, “Of course your cholesterol went down! That’s why it’s called a cholesterol-lowering drug!”)

Perfect example of the phenomenon described in Mistakes Were Made (but not by me). Her own experience demonstrated that restricting saturated fat (which she believes is good for the heart) caused her cholesterol to shoot up (which she believes is bad for the heart). That’s the point where a person blessed with a healthy capacity for skepticism would question the entire theory. But Brody can’t question the theory because she’s been a very public promoter of it. So she dutifully took a statin and declared victory over the cholesterol monster.

Yup, if I were the American Heart Association and needed a useful idiot to explain why we were right all along, that’s who I’d choose. So let’s look at some quotes from the useful idiot’s article, which appeared recently in the New York Times.

The media love contrarian man-bites-dog stories that purport to debunk long-established beliefs and advice. Among the most popular on the health front are reports that saturated fats do not cause heart disease and that the vegetable oils we’ve been encouraged to use instead may actually promote it.

Ah, I see. The belief that saturated fats aren’t the problem is just a man-bites-dog story … instead of, say, the result of new research. Or of countless people learning through experience that low-fat diets didn’t work for them. (Hey, Ms. Brody, remember what happened to your cholesterol numbers when you kept cutting the saturated fat from your diet?)

So before you succumb to wishful thinking that you can eat well-marbled steaks, pork ribs and full-fat dairy products with abandon, you’d be wise to consider the findings of what is probably the most comprehensive, commercially untainted review of the dietary fat literature yet published. They are found in a 26-page advisory prepared for the American Heart Association and published last June by a team of experts led by Dr. Frank M. Sacks.

Ms. Brody thinks the American Heart Association produced the most commercially untainted review yet? You mean the organization whose very existence depends on generous support from the makers of low-fat foods? The organization that will dry up and blow away the day after the arterycloggingsaturatedfat! theory dies?

Pardon me while I go laugh my @$$ off for several minutes …

… Okay, I’m back. Let’s continue:

As documented in the new advisory, misleading conclusions that saturated fats do not affect the risk of developing and dying from cardiovascular diseases have largely resulted from studies that were done in good faith but failed to take into account what people who avoided saturated fats ate in their place.

For example, in a study of 252 British men who had suffered heart attacks, following a low-fat, high-carbohydrate diet reduced cholesterol levels by a meager 5 percent and had virtually no effect on future heart attacks. The carbohydrates they ate were mainly refined, low-fiber flours and sugars that promote weight gain and diabetes, two leading risk factors for heart disease.

In North America and Europe, the team noted, the effect of lowering saturated fat was essentially negated by people’s consumption of more “refined grains, fruit juice, sweet desserts and snacks, sugar-sweetened beverages, and other foods” that hardly promote good health.

Wait … you mean when people cut back on saturated fat, they consumed more refined grains, fruit juices and sugars? Boy, I don’t know how people could have gotten the AHA’s advice so very wrong.

Yes, it’s true: the AHA has finally stopped putting its logo on sugar-laden cereals and other sugary foods. Only took them a few decades. But let’s think about this …

The AHA jumped on the arterycloggingsaturatedfat! bandwagon after Ancel Keys joined the organization’s board. Keys, as you probably know, waged a very bitter and very personal war of words against British researcher John Yudkin throughout the 1970s. Why? Because Yudkin insisted it was sugar causing heart disease, not saturated fat. Keys replied over and over, in paper after paper, No, damnit, the problem isn’t sugar, it’s saturated fat!

Here’s a quote from Keys himself:

It is clear that Yudkin has no theoretical basis or experimental evidence to support his claim for a major influence of dietary sucrose in the etiology of CHD; his claim that men who have CHD are excessive sugar eaters is nowhere confirmed but is disproved by many studies superior in methodology and/or magnitude to his own; and his “evidence” from population statistics and time trends will not bear up under the most elementary critical examination.

There you have it. The man who steered the American Heart Association onto its anti-saturated-fat path insisted that sugar doesn’t cause heart disease and the very idea had already been disproved.

So now that cutting back on saturated fat has failed to reduce heart disease in several clinical studies, how does Dr. Frank Sucks … er, Sacks and the American Heart Association explain away the embarrassing results? Like this:

Uh, yeah, but … uh … ya see … uh, that only happened because when people cut back on the saturated fat, they ate more sugar.

In an interview, Dr. Sacks said the advice derived from the best research “is pretty straightforward: consume few saturated fats like butter, full-fat dairy, beef and pork fat, and coconut, palm and palm kernel oils and replace them with natural vegetable oils high in polyunsaturates – corn, soybean, safflower, sunflower, peanut, walnut and grapeseed oils.” Also healthful are canola and olive oil, rich in both monounsaturates and polyunsaturates.

The “best” research, of course, consists of the four studies Dr. Sucks managed to cherry-pick that support the AHA’s position. He somehow found methodological problems with all the others.

And as for this part:

… replace them with natural vegetable oils high in polyunsaturates – corn, soybean, safflower, sunflower, peanut, walnut and grapeseed oils.

If you can explain to me how it’s natural for humans to consume oils from corn and soybeans, I’m all ears. Silly me, I tend to think the natural fats are the ones that don’t require industrial processing.

As for coconut oil, Dr. Sacks said, “It’s the nutritional fat du jour but it has not been proven to be healthful.”

Ah, I see. Dr. Sucks only recommends foods that have been proven to be healthy. I guess that explains this paragraph in Brody’s article:

Alas, the advisory team noted, there have been no trials to date testing the cardiovascular benefits of replacing dietary fat with “healthful nutrient-dense carbohydrates and fiber-rich foods such as whole grains, vegetables, fruits and legumes that are now recommended in dietary guidelines.”

No trials proving the cardiovascular benefits of replacing dietary fat with whole grains, vegetables, fruits, and legumes … and yet that’s exactly what the American Heart Association tells us to do. And Ms. Brody echoes that advice in her article:

In other words, if you are truly concerned about preserving good health over all, focus on a Mediterranean-style diet heavy on plant foods and unsaturated vegetable oils, with whole grains like brown rice and bulgur, fruits and vegetables as the main sources of carbohydrates.

Fortunately, useful idiots in the media no longer shape public opinion as effectively as they once did. Here are few choice comments on Brody’s article left by readers:

I sport climb with guys in their sixties and seventies who are as fit as super-heroes. They, to the man, get their nutrition information from Youtube and not their doctor. This article’s laundry list of failed studies and misleading conclusions by the experts is the reason why.

—-

I really can’t sit here and read any more AHA fraud articles about health. I find it impossible to believe NYT can’t write any other articles about the consumption of fats without citing these people who rampantly skew data.

—-

Yes, Dr. Sacks, well over 70 years old, ignored literally hundreds of studies over the last 50 years in this latest diatribe to go back to the incorrect studies of the 1960s. News flash: In the 50 years since, science has advanced! Turns out fats are actually generally good for you, not bad for you. And saturated fats are basically neutral. This is what hundreds of better, more modern studies say.

—-

The comments are much more informed on the subject than the author.

Indeed they are. That’s why the author is a useful idiot.  I suspect we’ll hear from more useful idiots as the AHA continues trying to save itself from the inevitable.

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One Of Those Weeks …

      40 Comments on One Of Those Weeks …

The fun part of being a programmer is creating something new, especially something that saves the end-users a lot of tedious work.  I was quite happy, for example, when I managed to find a way to extract data from PDFs and spreadsheets with different layouts.  Until I came up with that one, people at our office processed the data by looking at the PDF or spreadsheet and keying the information into a database screen.  Very, very time-consuming.  I received a lot of kudos (and some free drinks) when my solution worked.

The not-so-fun part of being a programmer is when I have to take over maintaining a big-ass system I didn’t create in the first place.  Then I have to read through reams of code and try to figure out what the @#$% the original programmer was thinking … or more likely, what the previous three or four programmers were thinking.  I always leave copious comments in my code explaining what I’m doing and why.  Some of my predecessors weren’t so kind.

A system was dumped in my lap recently, and the programmer who designed much of it is long gone.  So of course, that system decided to misbehave this week, probably because the Super Bowl is coming up in a few days.  During Super Bowl week a few years ago, I had to fix a different misbehaving system on a tight deadline.  I ended up coding right up until kickoff, watching the game, then jumping back into the coding.

I’d like to avoid a repeat of that weekend, so I’ll be working late instead of writing a post … again.

 

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Blood Pressure, Sodium, Drugs and Diets

      45 Comments on Blood Pressure, Sodium, Drugs and Diets

In my previous From The News post, I mentioned that the definition of “high” blood pressure will soon be lowered from 140/90 to 130/80. (The systolic, or top number, is when your heart is contracting. The diastolic, or lower number, is when your heart is between beats.) I also said I believe the redefinition is likely driven by a desire to sell more drugs.

A couple of you commented that the drugs might be necessary. Okay, maybe that’s true for some people. I’ve never had high blood pressure, so I’ve had the luxury of not being personally concerned with the subject. Nonetheless, I thought I’d dig through my database of articles and studies to explain why I’m not convinced that most people diagnosed with “high” blood pressure need drugs.

The best way to treat a health problem is to treat the root cause, not the downstream effect. So what causes high blood pressure? Many of the so-called experts still insist the problem is sodium. (They’re generally the same so-called experts who insist saturated fat causes heart disease.)

Dr. Frank Sucks … er, Sacks – the same researcher who wrote the American Heart Association’s we were right all along about saturated fat! presidential advisory report – has been a long-time champion of low-salt diets. He believes he proved lowering salt will save our hearts with his famous DASH trial. Here’s what his Harvard profile says about it:

These multi-center National Heart Lung and Blood Institute trials found major beneficial additive effects of low salt and a dietary pattern rich in fruits and vegetables on blood pressure.

Actually, that’s not what the DASH trial showed at all. You have to read the study carefully (and I have) to get the true picture, but here’s the brief summary: Sacks put people on either a standard American diet that included plenty of sugar and other junk, or on a low-fat DASH diet that included no sugar and no junk. Then he had them consume versions of those two diets that were high in salt, medium in salt, or very low in salt.

In order to claim he’d proved restricting salt is beneficial, Sucks had to compare the blood-pressure differences between people on the high-salt/junk diet and people on the low-salt/DASH diet. That’s akin to comparing people on a high-salt/high-whiskey diet to people on a low-salt/high-water diet, then declaring that restricting salt prevents liver damage.

Within each diet group – junk food vs. DASH – restricting salt by a whopping 75% only produced a blood-pressure drop of about three points. Whoopee.

Other researchers have found similar results (and unlike Dr. Sucks, reported them honestly). Here are some quotes from a 1998 meta-analysis titled Effects of Sodium Restriction on Blood Pressure, Renin, Aldosterone, Catecholamines, Cholesterols, and Triglyceride:

In 58 trials of hypertensive persons, the effect of reduced sodium intake on systolic blood pressure was 3.9 mm Hg, and on diastolic blood pressure was 1.9 mm. In 56 trials of normotensive persons, the effect of reduced sodium intake on systolic blood pressure was 1.2 mm Hg.

Once again, restricting sodium produced a teeny drop of a few points.

These results do not support a general recommendation to reduce sodium intake.

Gee, do ya think?

Here are some quotes from a 2008 E Science News article:

Contrary to long-held assumptions, high-salt diets may not increase the risk of death, according to investigators from the Albert Einstein College of Medicine of Yeshiva University.

They reached their conclusion after examining dietary intake among a nationally representative sample of adults in the U.S. The Einstein researchers actually observed a significantly increased risk of death from cardiovascular disease (CVD) associated with lower sodium diets.

“Our findings suggest that for the general adult population, higher sodium is very unlikely to be independently associated with higher risk of death from CVD or all other causes of death,” says Dr. Hillel W. Cohen, lead author of the study and associate professor of epidemiology and population health at Einstein.

And here are some quotes from a Food Navigator article about a Cochrane review of sodium-restriction studies:

The authors, led by Professor Rod Taylor from Peninsula College of Medicine and Dentistry in the UK, found no strong evidence to support the idea that salt reduction reduces cardiovascular disease or all-cause mortality in people with normal or raised blood pressure.

People with normal or raised blood pressure at baseline showed no strong evidence of benefit from salt intake restriction. Salt restriction did, however, increase the risk of death from all causes in those with congestive heart failure, reported the authors.

I found that article amusing because it provided a perfect example of The Anointed in action. The researchers concluded that given the results, we need to conduct more research before governments jump in to set lower targets for salt intake.

But as we know, The Anointed don’t believe they should be bothered with providing evidence before instituting a Grand Plan. So here’s how a spokesperson for a U.K. organization calling itself the Consensus Action on Salt and Health replied to the Cochrane review:

Campaign director Katharine Jenner told FoodNavigator that it is “very disappointing” to see the message from the review indicates that salt reduction may not be beneficial.

“This is a completely inappropriate conclusion, given the strong evidence and the overwhelming public health consensus that salt raises blood pressure which leads to cardiovascular disease,” said Jenner.

Whenever you hear The Anointed insist that by gosh, there’s a consensus and therefore the debate is over, you know they’re peddling junk science they don’t want examined.

Jenner told FoodNavigator that “there is no sense in waiting for further trials before progressing with an international salt reduction programme, which will immediately save many thousands of lives.”

Of course not. Because when The Anointed devise a Grand Plan, it must always be implemented RIGHT NOW or people will die … and it will be your fault for insisting on evidence before proceeding.

Salt restriction is the standard dietary advice, but it doesn’t do much. So after concluding that your low-salt diet just isn’t working for some reason, your doctor will reach for the prescription pad. The drugs do lower blood pressure. But do they save lives?

That’s where it gets a bit murky. In Doctoring Data, Dr. Malcolm Kendrick stated that there’s no convincing clinical evidence that blood-pressure medications reduce mortality for most people with “high” blood pressure.

Here are some quotes from an article on the Whitaker Wellness Institute website:

Another hypertension myth is that it is a silent killer that sets us up for strokes and heart attacks and knocks about five years off life expectancy. Although this is true for patients who have very high blood pressure and/or existing cardiovascular disease, diabetes, or kidney disease, the picture is considerably different for mild hypertension, which is defined under current guidelines as 140-159/90-99.

Scientific data published in top medical journals over the past few years makes it clear that mild hypertension does not confer these risks. For example, reevaluation of data from the renowned Framingham Heart Study shows that deaths related to hypertension barely budge until systolic blood pressure reaches 175 and mortality rates climb significantly only above 185. In other words, malignant hypertension is a killer. Uncomplicated mild hypertension is not.

Sixty percent of hypertensive Americans fall into the mild category. Nevertheless, more than half of them are treated with medications. And that’s the real tragedy.

There is no convincing scientific evidence that treating basically healthy patients with mild hypertension provides any benefits. In a groundbreaking recent study, researchers reviewed all the clinical trials in the medical literature comparing drug treatment of mild hypertension with placebo or no treatment. They found no differences in heart attacks, strokes, and deaths between treated and untreated individuals. But they did find that the drugs caused a lot of misery.

Maybe the drugs provide life-extending benefits for people with very high blood pressure. For people merely in the “high” range of 140 to 159, I’m not convinced. It seems the drugs merely treat a symptom.

As I said earlier, the best option is to treat the root cause. Several studies have hinted at the root cause, or at least one of them. Here are some quotes from a 2010 WebMD article:

A new study shows that a low-carbohydrate diet was equally good as the weight loss drug orlistat (the active ingredient in Alli and Xenical) at helping overweight and obese people lose weight, but people who followed the low-carb diet also experienced a healthy drop in their blood pressure levels.

“I expected the weight loss to be considerable with both therapies but we were surprised to see blood pressure improve so much more with the low-carbohydrate diet than with orlistat,” researcher William S. Yancy, Jr., MD, an associate professor of medicine at Duke University Medical Center, says in a news release. “If people have high blood pressure and a weight problem, a low-carbohydrate diet might be a better option than a weight loss medication.”

In the study, published in the Archives of Internal Medicine, 146 obese or overweight adults were randomly divided into two groups. Many of the participants also had chronic health problems, such as high blood pressure or diabetes.

The first group was advised to follow a low-carbohydrate, ketogenic diet consisting of less than 20 grams of carbohydrates per day, and the second group received the weight loss drug orlistat three times a day, plus counseling in following a low-fat diet (less than 30% of daily calories from fat) at group meetings over 48 weeks.

The results showed weight loss was similar in the two groups. The low-carb diet group lost an average of 9.5% of their body weight and the orlistat group lost an average of 8.5%. Both weight loss methods were also not significantly different at improving cholesterol and glucose levels.

But when researchers looked at changes in blood pressure, they found nearly half of those who followed the low-carbohydrate group had their blood pressure medication decreased or discontinued during the study, compared to only 21% of those in the orlistat group.

Plenty of doctors who prescribe low-carb diets have said the same thing: many of their patients end up ditching the blood-pressure medication. In fact, if the patients combine a low-carb diet with the medication, they can actually become dizzy from low blood pressure.

A study published waaaay back in 1985 suggests why a low-carb diet can lower blood pressure:

Both systolic and diastolic blood pressure were found to be significantly related to fasting serum insulin level even when age, weight, and serum glucose level were controlled. The relation between serum insulin and blood pressure was more pronounced in those women with a family history of hypertension. These data indicate that insulin may play a major role in the regulation of blood pressure in obesity and that the previously accepted relation of weight to blood pressure may depend on blood levels of insulin.

So there you go. High blood pressure, like so many other aspects of metabolic syndrome, is apparently driven by chronically high insulin. It’s the high insulin that needs fixing, not the symptoms it produces.

The Whitaker Wellness article provides some practical advice as well:

We would all be better served by shifting the focus to safe, natural, proven therapies that not only lower blood pressure but, unlike antihypertensive drugs, also improve multiple aspects of health.

Regular aerobic and resistance exercise, which reduces systolic blood pressure as effectively as many medications, rejuvenates every system in your body. Losing as little as 10 pounds or 5 percent of your total weight provides significant all-around benefits. Relaxation techniques, meditation, yoga, acupuncture, and neurofeedback reduce stress’s adverse effects on blood pressure, health, and quality of life.

Cutting out high-glycemic sugars and starches lowers blood sugar, lipids, insulin resistance, and other aspects of metabolic syndrome as well as helping to lower blood pressure. Beets, leafy greens, and other nitrate-rich foods boost synthesis of nitric oxide (NO), which dilates and protects the arteries.

Magnesium has powerful effects on blood pressure because it relaxes and reduces pressure on the arteries; that 75-80 percent of Americans fail to get the RDA of magnesium is a likely contributor to our high rates of hypertension. Coenzyme Q10 has positive effects on blood pressure and the entire cardiovascular system.

Cut the refined carbs, eat some leafy greens, get some exercise, and supplement your diet with magnesium and CoQ10. Sounds a lot better than taking medications if you ask me.

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From The News …

      48 Comments on From The News …

Interesting items from my inbox and elsewhere …

Sugar finally getting the blame for cancer

We’ve been told since the 1980s that we should all be on low-fat diets to prevent cancer. Evidence has been mounting that sugar is the more likely culprit (I wrote about that in a 2013 post), but I haven’t seen much to that effect in the major media outlets.

So I was pleased to see an article in the Los Angeles Times pointing the finger at refined carbs:

In August of 2016, the New England Journal of Medicine published a striking report on cancer and body fat: Thirteen separate cancers can now be linked to being overweight or obese, among them a number of the most common and deadly cancers of all — colon, thyroid, ovarian, uterine, pancreatic and (in postmenopausal women) breast cancer.

I know what you’re thinking: If they’re linking cancer to obesity, they’re going to say it’s because people just eat too much or eat too many cheeseburgers. Wait for it …

The studies reflect whether someone is overweight upon being diagnosed with cancer, but they don’t show that the excess weight is responsible for the cancer. They are best understood as a warning sign that something about what or how much we eat is intimately linked to cancer. But what?

It’s a pleasant surprise when a newspaper article points out that correlation doesn’t prove causation.

Lewis Cantley, the director of the cancer center at Weill Cornell Medicine, has been at the forefront of the cancer metabolism revival. Cantley’s best explanation for the obesity-cancer connection is that both conditions are also linked to elevated levels of the hormone insulin. His research has revealed how insulin drives cells to grow and take up glucose (blood sugar) by activating a series of genes, a pathway that has been implicated in most human cancers.

Hallelujah. A researcher sees a connection between a disease and obesity and doesn’t immediately blame the obesity. And there I was, getting psyched up to bang my head on my desk.

The problem isn’t the presence of insulin in our blood. We all need insulin to live. But when insulin rises to abnormally high levels and remains elevated (a condition known as insulin resistance, common in obesity), it can promote the growth of tumors directly and indirectly. Too much insulin and many of our tissues are bombarded with more growth signals and more fuel than they would ever see under normal metabolic conditions. And because elevated insulin directs our bodies to store fat, it can also be linked to the various ways the fat tissue itself is thought to contribute to cancer.

Having recognized the risks of excess insulin-signaling, Cantley and other metabolism researchers are following the science to its logical conclusion: The danger may not be simply eating too much, as is commonly thought, but rather eating too much of the specific foods most likely to lead to elevated insulin levels — easily digestible carbohydrates in general, and sugar in particular.

Cancer, diabetes, heart disease … for years, almost all the diseases of civilization were blamed on animal fats. Lots of the (ahem) “experts” still want to blame fats (just read the previous post for an example), but it’s nice to see the tide turning.

She doesn’t eat animal fats, but she’s too annoying for the Swiss

Honestly, really and truly, I don’t care if people choose to be vegans. I only care when they won’t shut up about it. (Q: how can you spot the vegan in the room? A: Don’t worry, she’ll tell you.) Apparently the Swiss share my aversion to the preachy types:

A Dutch vegan who applied for a Swiss passport has had her application rejected because the locals found her too annoying. Nancy Holten, 42, moved to Switzerland from the Netherlands when she was eight years old and now has children who are Swiss nationals.

Does that make her a Vegan Dreamer?

However, when she tried to get a Swiss passport for herself, residents of Gipf-Oberfrick in the canton of Aargau rejected her application.

Ms Holten, a vegan and animal rights activist, has campaigned against the use of cowbells in the village and her actions have annoyed the locals. The resident’s committee argued that if she does not accept Swiss traditions and the Swiss way of life, she should not be able to become an official national.

I bet when she heard the news, she shouted something like Gipf Oberfrick!!

Ms Holten told local media: “The bells, which the cows have to wear when they walk to and from the pasture, are especially heavy. The animals carry around five kilograms around their neck. It causes friction and burns to their skin.”

Let’s see … a cowbell weighs about 11 pounds, and the average cow weighs 1,600 pounds. Yeah, I can see how that would really be a burden.  It would be like asking a human to carry a set of keys, a smartphone and a wallet all at the same time.

Ms Holten, who describes herself as a freelance journalist, model and drama student, has also campaigned against a number of other Swiss traditions like hunting, pig races and the noisy church bells in town.

Boy, I just can’t imagine why the local Swiss don’t want her as a fellow citizen.

Give it time, we’ll all have “high” blood pressure

In Fat Head, I described how members of the National Cholesterol Education Campaign (Dr. Frank Sucks … er, Sacks was one of them) redefined “high” cholesterol in the 1980s so that most of us fall into that category – which created millions of instant patients for statins.

Now new blood-pressure guidelines will apparently redefine millions of people as hypertensive:

New guidelines lower the threshold for high blood pressure, adding 30 million Americans to those who have the condition, which now plagues nearly half of U.S. adults.

Okay, stop right there. If nearly half of U.S. adults have “high” blood pressure and we’re about to add another 30 million, doesn’t that once again mean that average is being defined as high, just like with cholesterol?

High pressure, which for decades has been a top reading of at least 140 or a bottom one of 90, drops to 130 over 80 in advice announced Monday by a dozen medical groups.

“I have no doubt there will be controversy. I’m sure there will be people saying ‘We have a hard enough time getting to 140,'” said Dr. Paul Whelton, a Tulane University physician who led the guidelines panel.

But the risk for heart disease, stroke and other problems drops as blood pressure improves, and the new advice “is more honest” about how many people have a problem, he said.

Perhaps. But my suspicious side wonders if these new guidelines are appearing just in time for a new wonder drug to hit the market – the process Dr. Malcolm Kendrick described in his book Doctoring Data.

For people over 65, the guidelines undo a controversial tweak made three years ago to relax standards and not start medicines unless the top number was over 150.

Now, everyone that old should be treated if the top number is over 130 unless they’re too frail or have conditions that make it unwise.

Uh-huh. Sorry, but I think this is about selling drugs. And by the way, Dr. Kendrick also stated in Doctoring Data that no clinical studies have proved that lowering blood pressure actually saves lives.

Finally, a good use for Crisco

When the Bears went to the Super Bowl in 1986 and 2007, I was delighted. Excited. Ecstatic. But it never occurred to me to climb a city light pole to express my enthusiasm. Apparently that’s a potential problem among Eagles fans, and Philly officials found a good way to deal with it.

As the Philadelphia Eagles geared up for a championship playoff game at their home stadium on Sunday, the police were preparing to keep the city’s boisterous football fans safe.

They put up barricades, Capt. Sekou Kinebrew, a spokesman for the Philadelphia Police Department, said in an email. They assigned officers to patrol on foot, on bikes and on horses. And they broke out cans of Crisco, slathering up street poles to try to stop people from climbing them.

The Guy From CSPI would no doubt approve. If city officials slathered those poles with lard, CSPI Guy would be out there with a megaphone and yelling, “Stop! The arterycloggingsaturatedfat will soak into your skin and give you heart disease!”

And of course, people with good taste would be licking the poles. So Crisco it is.

By the way, after I finished watching yesterday’s games, Alana showed me a note she saved to her iPad in November. She had asked me which two teams I’d pick to be in the Super Bowl if I had to place a bet. I told her the Patriots and the Eagles, and she saved the prediction as note, perhaps to wave in my face if I turned out to be wrong.

So I got that right. That’s the good news. The bad news is that I’m in a four-man football pool and ended up in last place this season. Obviously I’m better at predicting the final outcome of a season than the individual games.

Nonetheless, I’ll predict the winner of the only remaining game: Eagles.  I want as much Crisco as possible to end up on light poles instead of in the food supply.

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The Guy From CSPI And The Guy from AHA Bravely Agree They’ve Been Right All Along

Back in June, the American Heart Association released a Presidential Advisory Report that I covered in posts titled The American Heart Association Bravely Admits They’ve Been Right All Along, part one and part two.

The lead author of the report was Dr. Frank Sucks … er, Sacks, who is a fine example of a scientist too firmly wedded to a particular hypothesis to ever be objective. Sucks was chairman of the AHA’s Nutrition Committee back when they were releasing guidelines warning us that saturated fats will kill us and vegetable oils (and Cocoa Puffs!) will save our lives.

He was the lead researcher on the DASH trial, which concluded that restricting salt produces “major” benefits for hypertension … even though the study’s own data showed that reducing salt intake by 75% led to a measly three-point drop in blood pressure.

Sucks .. er, Sacks was also a member of the National Cholesterol Education Program (the folks who decided we should all have a total cholesterol score below 200), and a member of the Whole Grains Council, which is generously supported by the grain industry.

In other words, you’d be hard-pressed to find someone more personally invested in the arterycloggingsaturatedfat! and hearthealthywholegrains! nutrition advice than Dr. Frank Sacks … with the possible exception of The Guy From CSPI. So naturally, The Guy From CSPI (or his organization’s newsletter, to be exact) recently interviewed Dr. Sacks to explain why they’ve both been right all along.

Here are some quotes from a CSPI article titled A refresher on fats:

Q: How strong is the evidence that saturated fat in foods like meat, butter, and cheese is harmful?

A: The evidence that saturated fat causes atherosclerosis and heart disease is compelling. It’s consistent across randomized trials, large observational epidemiologic studies, and animal studies.

This is, of course, complete poppycock. Consistent across randomized trials and epidemiologic studies?! Not even close. I’ve written about the glaring inconsistencies in the evidence in this post and many others.

Q: Why have some people heard that the evidence on saturated fat has gotten weaker?

Actually, CSPI Guy, the evidence hasn’t “gotten weaker.” It was never strong to begin with. But let’s see what Sucks has to say on the matter.

A: Some of the more recent studies take a standard epidemiologic approach, which is inadequate. Saturated fat seems to be harmless in those studies because it’s being compared, by default, to the typical American diet, which is high in refined, junk-food carbohydrates. They’re also linked to a higher risk of heart disease.

Ahh, I see! Recent studies – and apparently only recent studies – took a standard and therefore inadequate epidemiological approach! Gee, it’s nice to see a Harvard researcher finally speak out against drawing conclusions from observational evidence. Too bad Harvard spent decades scaring the hell out of people based on crappy observational studies.

Q: Why inadequate?

A: Let’s say you give someone advice to reduce their saturated fat. Well, what do they eat instead? If they just reduced their saturated fat, they’d lose weight, because they’d be getting fewer calories. That’s unlikely. So what do they actually do? In many cases, people who eat less saturated fat eat more refined carbohydrates.

Yeah, that tends to happen when you tell people bacon and eggs will kill them and then put the American Heart Association seal of approval on boxes of Cocoa Puffs. And Dr. Sacks was a big muckety-muck at the AHA back when that was happening.

A: But Walter Willett and Frank Hu—my colleagues at Harvard—devised a new epidemiology based on food substitutions that would occur in real life. And that’s really innovative.

Allow me to interpret that: Willet and Hu spent lord-only-knows how much time finding a new way to crunch the numbers so they can continue believing that 1) observational studies based on food surveys tell us anything meaningful, and 2) saturated fat is the killer they’ve always said it is.

Q: Didn’t you re-examine the clinical trials from the  1960s that assigned people to diets with different fats and then measured heart disease rates?

A: Yes. We separated them into core and non-core trials, because some were superb in quality, and some were kind of dreadful. So we set out uncontroversial criteria for a good clinical trial.

Allow me to interpret that as well: we looked at all the clinical trials and decided the ones that showed higher rates of heart disease after switching to vegetable oils just HAD TO WRONG, DAMNIT! So we put those in the ‘dreadful’ category. Then, after digging like crazy, we found a whopping four trials that seemed to suggest that switching to vegetable oils reduces heart disease. We labeled those ‘superb in quality.’ And our criteria are uncontroversial because we all agreed with ourselves.

Q: Is large LDL safer than small LDL, as some people argue?

A: No. It’s basically a non-issue. If you have a lot of big LDL, it’s no better than a lot of little LDL. In fact, big LDL is probably worse, because it’s loaded up with more cholesterol.

Q: Do high triglyceride levels cause heart disease?

A: We don’t have proof with triglycerides the way we have proof that LDL cholesterol causes heart disease. But the evidence linking triglycerides to heart disease is getting stronger.

Fascinating. Dr. Sacks believes we have proof that LDL causes heart disease, but don’t yet have proof triglycerides cause heart disease. Perhaps he missed this study and its conclusion:

Stepwise higher concentrations of nonfasting triglycerides were associated with stepwise higher risk of heart failure; however, concentrations of low-density lipoprotein cholesterol were not associated with risk of heart failure in the general population.

I suppose Sacks could dismiss the study as dreadful, but that could be embarrassing since it was published by The American Heart Association.

Q: What about coconut oil?

A: Some of the short-chain saturated fatty acids in coconut oil don’t raise LDL cholesterol. But they don’t counteract the effects of the oil’s longer-chain fatty acids, which do increase LDL cholesterol. So coconut oil raises LDL cholesterol in the same way that, say, butter does.

Ah, yes, in the Presidential Advisory Report, Dr. Sacks assured us that coconut oil is even worse for our hearts than butter because it’s higher in saturated fat. But Dr. Michael Moseley recently conducted a small study in which volunteers added 50 grams of butter, olive oil or coconut oil to their diets. A BBC article describes the results:

As expected the butter eaters saw an average rise in their LDL levels of about 10%, which was almost matched by a 5% rise in their HDL levels.

Those consuming olive oil saw a small reduction, albeit a non-significant drop, in LDL cholesterol, and a 5% rise in HDL. So olive oil lived up to its heart-friendly reputation.

But the big surprise was the coconut oil. Not only was there no rise in LDL levels, which was what we were expecting, but there was a particularly large rise in HDL, the “good” cholesterol, up by 15%. On the face of it that would suggest that the people consuming the coconut oil had actually reduced their risk of developing heart disease or stroke.

But there I go again, digging up contrary information. Dr. Sacks and The Guy From CSPI are worried that people like me are causing confusion:

Q: How can people avoid confusion?

A: If you want to sort out what is good scientific knowledge and what is speculation or biased, look at guidelines produced by the American Heart Association, American Diabetes Association, or American Cancer Society.

Riiiight. Because organizations whose very existence depends on generous contributions from the makers of vegetable oils and grain products couldn’t possibly be biased.

So what’s going on here? Are people like Sucks … er, Sacks and the The Guy From CSPI just pathological liars? Are they intentionally dishonest?

Actually, I don’t think so. I think we’re seeing yet another example of the phenomenon described in an excellent book I haven’t mentioned in quite a while: Mistakes Were Made (but not by me). The subtitle is Why We Justify Foolish Beliefs, Bad Decisions, and Hurtful Acts. That pretty much captures the subject matter.

The authors give many examples of the same basic behavior:

DNA evidence exonerates someone who spent 15 years in prison for murder, but the district attorney still insists he didn’t prosecute an innocent man. The lab screwed up, or someone tainted the samples, or the guy in prison must have had an accomplice whose DNA ended up on the victim.

A doctor’s procedure kills a patient, but the doctor insists the procedure was correct.  Some complication that was impossible to predict caused the death.

A therapist prods a young patient into “recovering” memories of sexual abuse that were supposedly repressed, but are later proven to be false.  The therapist insists the memories are accurate and rationalizes away all evidence that the abuse couldn’t have happened.

A woman stays married to a physically abusive husband, insisting to her friends and family that he’s really a sweet guy at heart and his behavior is his employer’s fault, or his parents’ fault, or whatever.

A researcher accepts generous funding from a pharmaceutical company, then fudges a few numbers in a study concluding that the company’s newest drug is wonderful, but tells himself the drug really is wonderful and the fudged numbers simply enhance the truth.

A boy who moves to a new school district and wants to fit in somewhat reluctantly joins a pack of bullies in tormenting a fat, weak kid … and the more he participates in the bullying, the more convinced he becomes that the fat, weak kid deserves every bit of it.

As the authors explain, humans are naturally inclined to engage in self-justification as a means to reduce cognitive dissonance. Most of us believe we’re basically decent and competent, and we selectively filter information and rewrite memories to support that belief. (People with low self-esteem do likewise to confirm their negative opinion of themselves, but that’s another matter.)

The result is that once we’ve chosen a path or a position, we’re quite brilliant at convincing ourselves the path or position is correct … and the longer we’re on that path, or the more public the position, or the more consequential the action, the more we’re psychologically driven to justify it.

DNA says the guy didn’t do it? That can’t be right! I’m a good person, and a good person wouldn’t railroad an innocent man, so he had to be involved in that murder.

The patient died the family are blaming me? That can’t be right! I’m a good doctor, and a good doctor wouldn’t make a mistake that killed a patient. It wasn’t my procedure; it was something else.

Does fudging a few numbers make me a dishonest researcher? No, I’m a good scientist. Those numbers were outliers, and I had to smooth them over so this life-saving drug can be approved and help people who need it.

I picked on a weakling just to fit in? No, that would make me a bad guy, and I know I’m a good guy. The weakling is pathetic and annoying and not a good person, so he had it coming to him.

You get the idea. I’m a good and competent person, but I made a stupid or harmful decision creates cognitive dissonance. So we convince ourselves the decision wasn’t stupid or harmful. We do that largely through confirmation bias; that is, by latching onto any evidence that we were right and ignoring or dismissing evidence that we were wrong.

So imagine you’ve spent decades very publicly promoting grains and vegetable oils as the key to health while warning people away from saturated fats. Imagine you’ve also received generous donations from the makers of grains and vegetable oils – which is fine, you tell yourself, because those funds merely help you fulfill your life-saving mission.

Now imagine the science is turning against you. New (and old but recently discovered) studies suggest that vegetable oils and grains are harmful to health, while animal fats and other saturated fats are either neutral or beneficial.

You only have a couple of choices. You can look in the mirror and say to yourself, “Oh my god. I’ve spent 30 years giving out advice that helped turn countless people into fat diabetics suffering from inflammation and autoimmune diseases they didn’t need to have.” Or you can tell yourself you’re a good scientist, the advice you’ve been handing out is actually beneficial, and those new studies can be ignored because they were conducted by people who are incompetent.

As the authors point out, Americans tend to forgive and sometimes even rally to support public figures who admit to their mistakes, take the blame, and sincerely apologize. Nonetheless, most public figures and organizations don’t go that route. They can’t admit to themselves that they were wrong, so they double down. They rationalize. They attack the critics. And so the correction, whatever it is, almost always happens as the result of outside forces.

That’s why whenever I receive one of those email petitions demanding that the AHA or USDA change their dietary advice, I toss it. They’ll never announce that they were wrong because their heads would probably explode as a result. All we can do is convince more and more of the public to stop listening to them. I’m pretty sure that’s already happening — even if Dr. Sacks and The Guy From CSPI have a psychological need to convince themselves we’re just confused.

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