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Bill Clinton’s Diet

Bill Clinton loved hamburgers from McDonald’s. He used to eat a typical American high calorie, high fat, meat-based diet. No more. He had a heart attack and a quadruple bypass in 2004. Recurrent blockages required placement of two stents in February 2010. This got his attention and he went on a strict new diet, losing 24 pounds to get back down to what he weighed in high school.

He is now a vegan.

I live on beans, legumes, vegetables, fruit. I drink a protein supplement every morning — no dairy, I drink almond milk mixed in with fruit and a protein powder so I get the protein for the day when I start the day up.

I did all this research, and I saw that 82 percent of the people since 1986 who have gone on a plant-based, no dairy, no meat of any kind, no chicken, no turkey — I eat very little fish, once in a while I’ll have a little fish — if you can do it, 82 percent of people have begun to heal themselves.

Dean Ornish

The 82% apparently refers to this 1998 study by Dean Ornish. He started with 48 patients with angiographically documented coronary artery disease and randomized 28 of them to an experimental group (a 10% fat vegetarian diet, stopping smoking, stress management training, and moderate exercise) and 20 to a usual-care group. Only 20 experimental and 15 control patients completed the 5 year study. The diameter of the coronary arterial stenoses improved by 3.1 percent in the experimental group and worsened by 11.8 percent in the usual care group. Overall, 82% of experimental-group patients had an average change towards regression. They had about half as many cardiac events: 25 in the experimental group versus 45 in the usual care group.  None of the experimental subjects were on any cholesterol-lowering medication, but the usual care group allowed cholesterol-lowering prescriptions, and after 5 years the LDL levels of both groups were the same. In short, only 20 patients were on the diet, and it was not a trial of diet alone, but of intensive lifestyle management involving several other interventions. The study has not been replicated.

T. Colin Campbell

In addition to Ornish, Clinton’s other gurus are T. Colin Campbell (author of The China Study), and Caldwell Esselstyn, author of Prevent and Reverse Heart Disease.

Campbell did not study any interventions. He collected epidemiologic data from China and based on those observations, his own laboratory studies, and his own interpretation of the medical literature, he claimed that we could prevent or cure most disease (heart disease, cancer, diabetes, autoimmune diseases, bone, kidney, eye and other diseases) by eating a whole foods plant-based diet, drastically reducing our protein intake, and avoiding meat and dairy products entirely. Critics have questioned whether the data support his conclusions and a re-examination of his raw data found serious flaws in his methodology and his reasoning.

Caldwell Esselstyn

Esselstyn did an uncontrolled interventional study of patients with angiographically documented severe coronary artery disease who were not hypertensive, diabetics, or smokers. He wanted to test how effective one physician could be in helping patients achieve a total cholesterol level of 150 mg/dL or less, and what effect maintaining that level would have on coronary disease. Patients agreed to follow a plant-based diet with <10% of calories derived from fat. They were asked to eliminate oil, dairy products (except skim milk and no-fat yogurt), fish, fowl, and meat. They were encouraged to eat grains, legumes, lentils, vegetables, and fruit. Cholesterol-lowering medication was individualized.

There were originally 24 patients: 6 dropped out early on, 18 maintained the diet, one of these 18 died of an arrhythmia and 11 completed a mean of 5.5 years followup. Repeat angiography showed that of 25 coronary artery lesions, 11 regressed and 14 remained stable. At 10 years, 11 patients remained: 6 continued the diet and had no further coronary events; 5 resumed their pre-study diet and reported 10 coronary events. 

In a 12 year followup report, the 6 who had maintained the diet at 10 years and the 5 who had gone off it and had coronary events had apparently somehow morphed into 17 patients who had remained adherent to the diet and who had had no coronary events. I couldn’t understand the discrepancy in numbers; perhaps readers can explain it to me if I missed something.

Esselstyn has claimed that

A plant-based diet with less than 10% fat will prevent coronary disease from developing, halt the progress of existing disease, and even reverse the disease in many patients.

He also says

If you eat to save your heart, you eat to save yourself from other diseases of nutritional extravagance: from strokes, hypertension, obesity, osteoporosis, adult-onset diabetes, and possibly senile mental impairment, as well. You gain protection from a host of other ailments that have been linked to dietary factors, including impotence and cancers of the breast, prostate, colon, rectum, uterus, and ovaries.

To accomplish this astounding feat, here are the rules. You must not eat:

  • anything with a mother or a face (no meat, poultry, or fish)
  • dairy products (but subjects in his original study were allowed skim milk and non-fat yogurt!?)
  • oil of any kind, not a drop, not even olive oil
  • nuts or avocados

 You can eat a wonderful variety of delicious, nutrient-dense foods:

  • all vegetables (leafy green vegetables, root vegetables, veggies that are red, green, purple, orange, and yellow and everything in between)
  • all legume *beans, peas, and lentils of all varieties)
  • all whole grains and products, such as bread and pasta, that are made from them — as long as they do not contain added fats
  • all fruits (except avocado)

His website claims:

It works. In the first continuous twelve-year study of the effects of nutrition in severely ill patients, which I will describe in this book, those who complied with my program achieved total arrest of clinical progression and significant selective reversal of coronary artery disease.

That’s misleading. He was not studying diet alone; his patients were also taking cholesterol-lowering medication. With no control group, how do we know the results were due to the diet rather than to other factors, like the intensive counseling or the medications they were taking? Statin therapy alone has been shown to cause regression of coronary lesions.   I would like to see controlled studies comparing statins to diet to a combination of both, or comparing Esselstyn’s strict diet to another, less strict, diet that controls calories, ensures good nutrition, and produces weight loss.

He says

Campbell et al., in the Cornell-China study, reports hundreds of thousands of rural Chinese going years without a single coronary event.

But that doesn’t tell us anything.

Esselstyn’s book allegedly

…explains, with irrefutable scientific evidence, how we can end the heart disease epidemic in this country forever by changing what we eat. Here, Dr. Esselstyn convincingly argues that a plant-based, oil-free diet can not only prevent and stop the progression of heart disease, but also reverse its effects.

No, not irrefutable. Not convincing. Hype that goes far beyond the evidence.

What Does It All Mean?

Ben Goldacre, in Bad Science, said:

The most important take-home message with diet and health is that anyone who ever expresses anything with certainty is basically wrong, because the evidence for cause and effect in this area is almost always weak and circumstantial…

 
Ornish, Campbell, and Esselstyn are all certain that they have found a dietary solution for coronary artery disease, but they have not found the same solution. If you look closely you will realize that their programs are far from identical. And the evidence to support any of their programs is pretty skimpy. And others disagree strongly: Gary Taubes wrote the huge, extensively referenced tome Good Calories, Bad Calories to debunk the alleged certainty that dietary fat has anything to do with cardiovascular disease, and also to expose the colorful history of nutrition science and how surprisingly little good diet research has actually yet been done.

A systematic review found that

3 dietary strategies are effective in preventing CHD: substitute nonhydrogenated unsaturated fats for saturated and trans-fats; increase consumption of omega-3 fatty acids from fish, fish oil supplements, or plant sources; and consume a diet high in fruits, vegetables, nuts, and whole grains and low in refined grain products. However, simply lowering the percentage of energy from total fat in the diet is unlikely to improve lipid profile or reduce CHD incidence.

 A 2010 systematic review concluded 

The evidence base for multifactorial lifestyle interventions is weak.

Most sources of diet advice agree that eating more fruits and vegetables, less red meat, and fewer calories is a good idea. Total avoidance of meat is not supported by any reliable evidence. Esselstyn quotes Roberts, agreeing with him that the only true risk factor for coronary artery disease is a total cholesterol above 150 mg/dI. This is debatable to say the least! It would throw The International Network of Cholesterol Skeptics into conniption fits, and most science-based doctors would disagree vehemently. What about smoking, diabetes, and family history, for a start? The evidence shows that LDL cholesterol is more significant than total cholesterol. Opinions vary on whether LDL cholesterol can be adequately lowered with diet alone, whether statins are the only practical solution, or whether diet and statins should be used together.

Such drastic diet restrictions must be tested more carefully before any widespread adoption can be recommended. Are these people getting adequate nutrition? Does the diet increase the risk of other diseases? Is the benefit worth the difficult lifestyle modifications? What is the number needed to treat (NNT) to prevent one heart attack? What NNT would compensate for giving up the enjoyment of favorite foods for the rest of your life? Never again tasting ice cream? Or a juicy steak? Or an avocado?

I think Bill Clinton’s diet is based more on hope and desperation than on solid scientific evidence. I have to admire his self-discipline in sticking to a difficult diet; I only wish he had displayed the same level of self-discipline in his encounters with White House interns.

Posted in: Nutrition

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56 thoughts on “Bill Clinton’s Diet

  1. I’ve been wondering about the Clinton/Ornish/Esselstyne diets myself. Thanks for saving me some time.

    I wonder if coronary artery disease has some natural tendency to regression in a few cases, even without statin therapy. [After all, we know that some clots causing acute heart attack will dissolve (lyse) spontaneously.] That’s one reason control groups are so important.

    It’s interesting that the 2010 systematic review is from the “Competence Centre of Complementary Medicine and Naturopathy.” Doesn’t sound like a typical source for Science Based Medicine!

    You’re right that not all studies support heart-healthy claims for fruits and vegetables. See Dauchet L., Amouyel, P., and Dallongeville, J. (via MedScape). Fruits, vegetables and coronary heart disease. Nature Reviews Cardiology, 6 (2009): 599-608. doi: 1011038/nrcardio.2009.131

    Please consider the possibility that consumers of whole grains (2.5 servings a day) have 20% less heart disease than non-consumers. See Mellen, P.B, Walsh, T.F., and Herrington, D.M. Whole grain intake and cardiovascular disease: a meta-analysis. Nutrition, Metabolism and Cardiovascular Disease, 18 (2008): 283-290.

    -Steve

  2. ConspicuousCarl says:

    > You must not eat:
    > oil of any kind, not a drop, not even olive oil
    > [....]
    > You can eat a wonderful variety of delicious, nutrient-dense
    > foods:
    > all vegetables (leafy green vegetables, root vegetables,
    > veggies that are red, green, purple, orange, and yellow
    > and everything in between)
    > all legume *beans, peas, and lentils of all varieties)

    So when I eat the allowed soybeans, am I supposed to spit out the prohibited soybean oil?

  3. wertys says:

    As Perry from SGU (a skeptic of some note) once said

    ‘The years gained from switching to a vegetarian diet are in direct proportion to the horror of those years’

    or something like that !

  4. ConspicuousCarl,
    The Ornish diet is described as 10% fat (meaning 10% of calories from fat). There’s that much fat already in a varied diet of low-fat foods. As soon as you start adding fat – like a little olive oil – you’ve gotten yourself over 10%.

    Harriet Hall,
    I really don’t think that dig at Clinton was necessary. The “scandal” about Bill Clinton’s impeachment was a manufactroversy. It’s common for politicians to have sex with people they aren’t married to, sometimes a lot. What is uncommon is for anyone to particularly care. I don’t blame Clinton. I blame Kenneth Starr. Kind of like I don’t blame mercury or aluminum for vaccine refusal even when it is undoubtedly present. I blame Jenny McCarthy.

  5. zoe says:

    Would anyone take equally seriously research that showed abortion caused cancer, if it were undertaken and supervised by hardline pro-lifers?

  6. weing says:

    “It’s common for politicians to have sex with people they aren’t married to, sometimes a lot. What is uncommon is for anyone to particularly care.”

    I knew the former, but I wasn’t aware of the latter. Gary Hart, John Edwards, and Larry Craig readily come to mind.

  7. weing says:

    “Would anyone take equally seriously research that showed abortion caused cancer, if it were undertaken and supervised by hardline pro-lifers?”
    I thought we were all pro-lifers. Who is pro-death?

  8. David_Brown says:

    In my opinion, the key to preventing heart disease lies in consuming a diet that is adequate, appropriate, and low in Omega-6 (lenoleic acid or LA for short) and fructose.

    There’s lots of interest in the fructose problem of late, but not LA. Ask a couple hundred people what they know about omega-6 fats and chances are the vast majority will say, “Nothing” or “Never heard of it.” And most of those who think they know something about omega-6 are thinking of omega-3 (fish oil).

    It’s almost as if there’s a media blackout regarding LA research. For example, Susan Allport approached Oprah magazine with an idea for an article about the effects of increased omega-6 intake. Allport experimented on herself for 30 days and had experts monitor the deterioration. Google: Case Study: 30-Days of High Omega-6 Diet–Stiffens Arteries and Increases Belly Fat. Oprah magazine paid for the article but declined to publish it.

    Another example. I subscribed to Consumer Reports on Health for a year to gain access to their archives. The previous five years were available on the Internet. I perused every issue and found numerous articles about omega-3s but no mention of omega-6s.

    This lack of interest is strange because as far back as 1999 National Institutes of Health scientists were recommending reduced omega-6 intake in conjunction with increased omega-3 intake to prevent chronic inflammatory conditions. Here’s what they said:

    “One recommendation deserves explanation here. After much discussion consensus was reached on the importance of reducing the omega-6 polyunsaturated fatty acids (PUFAs) even as the omega-3 PUFAs are increased in the diet of adults and newborns for optimal brain and cardiovascular health and function. This is necessary to reduce adverse effects of excesses of arachidonic acid and its eicosanoid products. Such excesses can occur when too much LA and AA are present in the diet and an adequate supply of dietary omega-3 fatty acids is not available. The adverse effects of too much arachidonic acid and its eicosanoids can be avoided by two interdependent dietary changes. First, the amount of plant oils rich in LA, the parent compound of the omega-6 class, which is converted to AA, needs to be reduced. Second, simultaneously the omega-3 PUFAs need to be increased in the diet. LA can be converted to arachidonic acid and the enzyme, {Delta}-6 desaturase, necessary to desaturate it, is the same one necessary to desaturate LNA, the parent compound of the omega-3 class; each competes with the other for this desaturase. The presence of LNA in the diet can inhibit the conversion of the large amounts of LA in the diets of Western industrialized countries which contain too much dietary plant oils rich in omega-6 PUFAs (e.g. corn, safflower, and soybean oils). The increase of LNA, together with EPA and DHA, and reduction of vegetable oils with high LA content, are necessary to achieve a healthier diet in these countries.”

    The above excerpt is from an article entitled “Workshop on the Essentiality of and Recommended Dietary Intakes for Omega-6 and Omega-3 Fatty Acids” which was published in Journal of the American College of Nutrition, Vol. 18, No. 5, 487-489 (1999)

    I once asked Gary Taubes why he didn’t investigate the omega-6 problem and in his response he noted that there just aren’t any trials to speak of in which omega-6 intake was deliberately reduced.

    I eventually found an article in which the authors noted that “The only long-term trial that reduced n-6 LA intake to resemble a traditional Mediterranean diet (but still higher than preindustrial LA intake) reduced CHD events and mortality by 70%. Although this does not prove that LA intake has adverse consequences, it clearly indicates that high LA intake is not necessary for profound CHD risk reduction.”

    The article was entitled “Dietary Fat Quality and Coronary Heart Disease Prevention: A Unified Theory Based on Evolutionary, Historical, Global, and Modern Perspectives.”

    Some people seem to thrive using a low-fat vegan or vegetarian approach. Perhaps President Clinton is one of those. Others are obligatory omnivores. I suspect the majority of us fall into that category. However, vegan or omnivore, everyone is vulnerable to the effects of excessive omega-6 intake. Google: 1 of 4 Bill Lands to find out why.

  9. “I only wish he had displayed the same level of self-discipline in his encounters with White House interns.”

    WTF? Do you really want to undermine your point about the lack of science behind these diets and any appearance of neutrality, just to get in a old and overused Bill Clinton jab? Please.

  10. “To accomplish this astounding feat, here are the rules. You must not eat:

    * anything with a mother or a face (no meat, poultry, or fish)”

    I can’t help pointing out that even plants have a mommy and a daddy*, it’s the method of reproduction and rearing of offspring that differs. Maybe the rule should be ‘anything that does not require the direct intervention of bees, other insects, birds or the weather to become a mommy. That is not so catchy, though.

    *well, sometimes they are both mommy and daddy.

  11. lillym says:

    I’m not sure about hope and desperation -I think a big influence is Chelsea who is a vegan (for ethical reasons I believe). While I agree the studies are flawed Bill Clintn is eating much healthier than he was before.

  12. addisontree says:

    I always thought the best thing to do to combat coronary disease was to drop extra pounds. Seems like any diet (and some exercise) that one can stick to in order to stay at a healthy weight would accomplish most of what can be done without prescriptions.

    Am I in error about this?

  13. jwray says:

    “and consume a diet high in fruits, vegetables, nuts, and whole grains and low in refined grain products. However, simply lowering the percentage of energy from total fat in the diet is unlikely to improve lipid profile or reduce CHD incidence.”

    i.e. high fiber. “Whole grain” probably has no effect whatsoever if you control for total fiber intake. Fiber is proven to have very large effects on one’s hunger-regulating systems and is the single easiest way to promote weight loss.

  14. weing – “I thought we were all pro-lifers. Who is pro-death?”

    Quite a few years ago, I used to belong to a goth newsgroup. Some of those folks were kinda pro-death. good times. Wonder what they’re up to now. ;)

  15. weing,

    Since the 1980s the public US attitude toward sex has been very unusual. People didn’t actually care about Gary Hart either, but because his sex life was allowed to take over the media coverage he lost the ability to campaign.

    The issue for Larry Craig is that he worked against gay rights.

  16. BobbyG says:

    I have to agree with a couple of other commenters that the closing shot at Clinton’s White House long-ago dalliance with Monica Lewinksi was inappropriately gratuitous, and just detracted from the article. I come here for the science. There are plenty of other places to get my high-political-cholesterol doses of tired ad hominem attacks.

  17. tuck says:

    @Harriet Hall: Phenomenal post.

    You might also be interested in an analysis of T. Colin Campbell’s claims in his book “The China Study” versus what his epidemiological study says.

    http://rawfoodsos.com/2010/07/07/the-china-study-fact-or-fallac/

    And to Harriet’s critics about that last line: I’m no fan of Clinton, but there’s nothing wrong with wishing he’d handled himself better during his presidency; it would have been a much more successful presidency if he’d had better self control, as Harriet points out. Clinton lost his law licence over this issue, it was hardly manufactured by his enemies.

    If you’re going to be scientific, be consistent in the application, at least.

  18. lillym says:

    If this post had anyting to do with Clinton’s presidency or even politics in general I could see making a comment about his behavior in office.

  19. passionlessDrone says:

    Hello friends –

    The irony is that the exact same problem; a very real paucity of quality data regarding dietary intake and health, could just as easily be asked of the agencies that distribute the lobbyist friendly ‘food pyramid’ to every elementary school in the country.

    While the very strict veganism suggested here is extreme, I think it is salient to remember that for the vast majority of human history, eating five servings of meat and/or dairy products is very unusual unusual. Meat is expensive in labor, land, and dollars; as is dairy. It is only with the advent of industrialized animal production that we have come to a point where we could even consider feeding every American this much animal protein. Does anyone really believe there is enough grassland and fresh water on the planet to raise enough cattle so that everyone in India, China, and Indonesia can adopt our animal protein rich food pyramid? [That isn't to say they won't try, as their incomes increase.]

    Just because our cleverness has allowed us to have healthy portions of meat and dairy at any and every meal for a few generations doesn’t mean that it is a good idea.

    @David Brown – Very nice. I’d love to see a SBM regarding the change in Omega3/Omega6 ratios in industrialized diets.

    - pD

  20. splicer says:

    Good post with some excellent info on what is claimed and what is backing up or not backing up those claims.
    Now I just need to get in there and defend the interns a little as I believe there is no evidence to support that there was more than one White House intern involved in the scandal.

  21. Harriet Hall says:

    Lighten up, folks! I thought my last sentence would make people laugh. I was only trying to add a bit of fun to a serious subject. I didn’t think it was inappropriate to mention other kinds of self-discipline in a post about following a difficult diet that requires great self-discipline. I thought even Clinton’s strongest supporters would agree that he could have saved himself a great deal of grief by exerting more self-discipline in his sex life. I think Clinton himself would agree with that.

    Please remove the chips from your shoulders. Relax, think about the rest of the post and try to ignore the part that offends you. I’m going to leave it there for those who have a sense of humor.

  22. Harriet Hall says:

    splicer said “there is no evidence to support that there was more than one White House intern involved in the scandal. ‘

    I didn’t mean to suggest there was. I said I only wish he had displayed the same level of self-discipline in his encounters with White House interns. He encountered several White House interns. If he had displayed self-discipline in all those encounters, there would have been no scandal.

  23. Harriet Hall says:

    tuck,

    You suggested I might be interested in the Rawfoods analysis of Campbell’s China Study. Apparently you didn’t realize I had included a link to that very analysis in my post.

  24. Mhops says:

    Intriguing post, Dr. Hall. I think this is an area that deserves more attention and more skepticism — thanks for writing.

    It is silly that such a significant portion of the comments have been about the Clinton joke. So what?! Is that really worth any time at all? How about the 99% of content above it?

  25. Josie says:

    I like to add EXTRA saturated fats to my diet. Medium chain saturated fats that is.

    A nice pork chop pan fried in coconut oil is delish.

    It’s true, there is much conflicting “evidence” about nutrition and the target ideal diet changes continuously based on whatever fad nutrient has the spotlight at the moment.

    I basically try to eat a little meat, a lot of veggies, make fresh bread weekly and train for running events.

    Most of all I focus on foods that are tasty, that satisfy and that allow me to feel good. That cuts out a lot of the pseudo-food available in prepacked boxes.

  26. David Gorski says:

    Lighten up, folks! I thought my last sentence would make people laugh. I was only trying to add a bit of fun to a serious subject. I didn’t think it was inappropriate to mention other kinds of self-discipline in a post about following a difficult diet that requires great self-discipline.

    Agree 100%. I found your last comment amusing. Made me chuckle, it did.

    The point was well-taken. Regardless of what you think about Kenneth Starr, through his dalliance with a then 25-year-old intern, at the very least Bill Clinton did show an incredible lack of self-control and amazingly poor judgment to boot. It is indeed interesting to contrast Clinton’s lack of discipline with respect to his carnal desires then with his current apparent level of self-control with regard to his diet, regardless of how weak some of the evidence is supporting that diet. The contrast is a bit amusing.

  27. Joe says:

    Josie on 23 Nov 2010 at 11:57 am wrote “It’s true, there is much conflicting “evidence” about nutrition and the target ideal diet changes continuously based on whatever fad nutrient has the spotlight at the moment.”

    I think you will find that recommendations from well-informed doctors and dietitians are relatively stable. Everything in science is provisional; but not so volatile as the diet recommendations one sees in the popular literature (you are right about that). It is the bogus sources of dietary information that are so capricious.

  28. Angora Rabbit says:

    Dr. Hall, this is a great article. You’ve nicely encapsulated the criticisms and limitations of these particular dietary claims. I’d like to emphasize an additional point about these diets that isn’t always appreciated and factors into their efficacy. Both Dr. Hall and Addisontree allude to this, and I thought it merited additional emphasis.

    When people pay attention to what they eat, they often consume fewer calories. In a controlled trial of Atkin’s several years ago, the weight reduction could be attributed to the patient’s overall calorie reduction. It wasn’t a magical effect of X in the food. While the very low fat / low protein diets are efficacious in reducing both CVD risk and weight loss, a major player especially early on is the caloric reduction. This is especially true for Ornish, because its high fiber has a high satiety index.

    Dr. Hall is right – the correct comparison is to a diet that provides good behavioral intervention and controls for caloric intake.

    I’d like to add that there isn’t a lot of conflicting evidence in among nutrition professionals on how to eat and modify disease outcomes. The confusion originates in large part from the media and self-proclaimed guru$ with the latest diet claim to line their pocketbooks.

  29. Godshopped says:

    Journalistic neutrality is largely a myth. As a reader, I would rather have writers state their biases up front, openly. It is a more efficient use of my time when choosing articles to read instead of sleuthing out so-called neutral objectivity which may or may not exist in your favorite publication.

    Thank you.

  30. Harriet Hall

    “Lighten up, folks! I thought my last sentence would make people laugh. I was only trying to add a bit of fun to a serious subject.”

    Oh, sorry. I didn’t realize that repeating the same tired joke that’s been going around for the last twelve years was a genuine attempt at humor. My side, my side.

  31. dr.cosa says:

    These debates are critical by virtue of the topic: food. we all need it and it can have tremendous impact on our overall health depending on our approach to food.

    The greatest difficulty with the current uncertainty in nutritional research is that much of what passes for nutrition information is either unduly influenced by out-moded/bogus-science or personal/corporate agendas.

    Studies purporting a diet of “low fat” vs. “low-carb” are too broad and neglect co-factors that could be the real key to better health outcomes.

    Is a reduction in fat part of a broad process away from refined foods (ie: if you avoid macdonalds hamburgers because of the saturdated fat, are you receiving a double benefit because you miss out on the carbohydrates and surgar in the bun, fries and drink?)

    Studies aside, having been a long time low-carb eater that for virtually any otherwise healthy but slightly chubby person if they simply reduce carb and surgar intake to a bare minimum (ie: 20 grams a day or less) and replace it with fat and protein until the are full to a reasonable amount, they will very likely experience some weight loss, and quite possible dramatic weight loss if they can stick to it.

    (having quit smoking I can attest to the ridiculousness of the notion that such a diet is invalid because it is difficult to avoid carbs because they are everywhere. so was smoking at one time and it required a herculean effort to stop in the face of a group of people lighting up, but it was worth it)

    We also know that the markets of ill health such as low HDL, high LDL and triglycerides, BP and the like even if lowered on a low-carb diet have done nothing to silence the nay-sayers because of long held beliefs that vegetables are good for us an meat is in some way “bad”. This appears to be due more to social constructs that eating meat is a sign of gluttony and excess especially because most people viscerally enjoy meat to some extent.

    Our society is too acclimated to the idea that our vegetables, those things most of us detested as kids are healthy and no amount of study will break the association because we tend to associate pleasurable foods with guilt and ill-health. In some ways its true, but as a low-carb eater I only feel this towards grains- that beautiful massive bowl of pasta with over 120 grams of carbohydrate is my liver’s worst nightmare compared to a nice steak with steamed broccoli.

    Far from proclaiming my diet to be superior to all others, I simply find it interesting if Bill Clinton had claimed to shun all carbs he would have been labeled a bad influence and any future health ailments would have been surely blamed on his dietary ways. A heart attack now will be considered as occurring in spite of his “heart healthy” diet.

    If anyone has the chance to see the documentary “Fat Head” http://www.fathead-movie.com/ it is a great take on the “super size me” nonsense, where basic nutritional myths are tackled.

  32. shawmutt says:

    Screw the vegan diet, I’m going on the twinkie diet!

  33. VRAlbany says:

    Harriet,

    1. Anyone who tries to tell me that I shouldn’t eat avocados ever again instantly loses my respect.

    2. I am a Bill Clinton fan, yet I found your joke to be objectively funny. Don’t worry about those who were sidetracked by it.

    3. Great post!

  34. moderation says:

    @ micheleinmichigan

    I don’t find references to Bill Clinton’s lack of self-control any more tired than:

    G. W. Bush is an idiot
    Jimmy Carter was incompetent
    Ronald Reagan was asleep at the wheel
    Gerald Ford was a klutz

    When done right they are all they can all be funny.

  35. nory says:

    I think those who get emotionally involved in this or any other hot topic should remember what Scott Gavura said, so nicely, in his recent post “Improving Our Response to Anti-Vaccine Sentiment”?
    http://www.sciencebasedmedicine.org/?p=8007

    Anyway, I’m very interedted to know what do you all, people from SBM, think of ADA’s position on vegetarian diets. Thanks.

  36. VRAlbany – objectively funny? Isn’t humor’s very nature subjective? How can something be objectively funny?

  37. Moderation, I don’t mean to be rude by not replying directly to your comment, but I’ve stated my opinion well enough to be understood. I think that for me to continue the conversation would be beating a dead horse verging on trolling.

  38. rork says:

    Very nice post.
    Maybe the public needs to pay for more diet research, since who else stands to gain. Public health is not very fun research (for me), but maybe it’s important.

    The ecology is the main motivator in reducing my consumption of cow, pig, poultry, eggs. As King I would invent taxes to make the prices better reflect the true costs of the destruction, and then some, and could subsidize some other calories with the winnings. Fish are a very touchy matter too.

  39. Ben Kavoussi says:

    On the politics of fat free diet, read my post “The Science Fiction of Nutritional Genomics,” at http://www.sciencebasedmedicine.org/?p=1591 .

    Ben

  40. VRAlbany says:

    Michele in MI
    RE: “objectively funny”

    Yes, you are right. But please note that my use of the word “objectively” was meant to be taken “tongue in cheek”, as another joke.
    I’m sorry you haven’t taken to any of those here.

  41. Roadstergal says:

    ‘The years gained from switching to a vegetarian diet are in direct proportion to the horror of those years’

    I meandered my way to a veggie diet, and it’s actually quite awesome – the food is varied and tasty, I don’t miss the taste of meat (the smell still makes me feel vaguely ill), and I don’t miss that heavy feeling it would give me after eating it.

    My rule is ‘no CNS’ – it works way better than ‘mommies’ and ‘faces’ and such.

    I hate folk who over-claim for a veggie diet; it makes veggies look bad, and it doesn’t advance the science. I believe there are more moderate benefits to the individual partaking in it than the woo-meisters claim, and that there are definite environmental and ethical benefits, and that’s good enough for me – but I want better data.

    I thought even Clinton’s strongest supporters would agree that he could have saved himself a great deal of grief by exerting more self-discipline in his sex life.

    I think he would have saved himself a great deal of grief by saying, “Yes, she gave me a BJ.” The repercussions were for the lie, not the act.

    I think we can all agree that a rather tired joke deralied a good article on an important topic, however. :)

  42. Ian says:

    “science based nutrition” should probably be its own site, there’s so much bunk out there, its quite hard to separate out the chafe.

    Re: Bill Clinton’s diet, a vegan diet is actually a pretty good way to lower your calories. If you avoid meats and cheese you’re pretty much set around here. And its easier to say “I’m a vegan” then “I don’t want to eat your shitty fatty food”. That’s important for someone like Clinton who probably gets wined and dined a lot.

    Nothing wrong calling him out on citing ambiguous studies though.

  43. BobbyG says:

    Happy Thanksgiving, everyone. Whatever you choose to eat.

  44. BobbyG – I believe there is a pumpkin pie recipe for any dietary preference*, so let the feasting begin.

    VRAlbany – I am quite smiley face dependent when it comes to short ironic statement. But we have, at least, a love of avocados in common.

  45. oh sorry, for the orphan asterisk. Please take him home and raise him with kindness.

  46. VRAlbany says:

    Well, OK, Michele, I’ll give you that. I sometimes forget that straight sarcasm often does not translate well on the internet.
    And yes, avocados and pumpkin pie are both awesome, and we should rightly mistrust anyone who would tell us otherwise.

    I’m completely serious about that.

    ;-)

  47. DevoutCatalyst says:

    “Re: Bill Clinton’s diet, a vegan diet is actually a pretty good way to lower your calories.”

    It perhaps can be. I’ve been a vegan for 20 years, and last year I had an attack of gout. Even vegans musn’t pig out (there may another explanation for that event, but pigging out is what I had been doing.) The cues for satiety as a vegan seem different from what I recall from my distant meat eating past.

  48. David Gorski says:

    I think we can all agree that a rather tired joke deralied a good article on an important topic, however.

    I don’t. Quite honestly, I thought a bit of hyper-serious, hypersensitive commenters derailed the discussion of an excellent article.

  49. steven512 says:

    Thank you for the informative post.

    And thank you for sticking to your guns about the Clinton remark, there was nothing wrong with it.

  50. tuck says:

    “You suggested I might be interested in the Rawfoods analysis of Campbell’s China Study. Apparently you didn’t realize I had included a link to that very analysis in my post.”

    Guess I should have followed *all* the links. Duh.

  51. brown says:

    Excellent blog – and frustrating at the same time. In the 1980s, fat was the bad food. In the first decade of the 2000s, fiber was added to all sorts of food. Lately, protein seems to be the newest holy grail.

    So much information out there and yet my knowledge of nutrition is really lacking.

    So I am eating more veggies and fruit, generally decreasing the trans & sat fats / increasing the good fats, usually choosing whole foods over processed foods, and getting regular exercise. Yes, once in a while I eat french fries. Am I on the right track? Who knows, not me. I’m just an average consumer trying to be smart about nutrition.

    If I had reliable information about nutrition, I would follow it. That is what makes this whole subject so frustrating.

    Again, great blog.

  52. BillyJoe says:

    lillym

    “While I agree the studies are flawed Bill Clintn is eating much healthier than he was before.”

    But if the studies are flawed (as you agree) how would you know he is eating healthier?

  53. BillyJoe says:

    Angora Rabbit

    “a major player especially early on is the caloric reduction.”

    I dunno. If I start training for the marathon I’m going to be increasing my calorie intake, but I think I’m going to be better off. Perhaps you meant net calories?

  54. BillyJoe says:

    Godshopped

    “Journalistic neutrality is largely a myth.”

    But some journalist at least strive for it whilst others don’t even pretend to. I think that makes a difference.

  55. Scott says:

    And yes, avocados and pumpkin pie are both awesome, and we should rightly mistrust anyone who would tell us otherwise.

    Personally, I can’t stand either. In both cases, the texture makes my skin crawl.

  56. evergreen517 says:

    “Such drastic diet restrictions must be tested more carefully before any widespread adoption can be recommended. Are these people getting adequate nutrition? Does the diet increase the risk of other diseases? Is the benefit worth the difficult lifestyle modifications? What is the number needed to treat (NNT) to prevent one heart attack?”

    Drastic diet restrictions? Which Nutrients is Dr. Hall worried about? Protien?

    According to the American Dietetic Association:
    “It is the position of the American Dietetic Association that appropriately planned vegetarian diets, including total vegetarian or vegan diets, are healthful, nutritionally adequate and may provide health benefits in the prevention and treatment of certain diseases. Well-planned vegetarian diets are appropriate for individuals during all stages of the life-cycle including pregnancy, lactation, infancy, childhood and adolescence and for athletes.”

    I’ve read the china study, and his emphasis is not on avoiding animal based foods because of the specific type of protein. It’s because of the overall nutritional characteristics of animal products. As you go from animal foods and refined plant foods (oil, sugar) to whole plant foods,(with a few exceptions such as coconuts) in general you decrease saturated fat intake, decrease overall fat intake, increase fiber and antioxidants, and complex carbohydrates…isn’t it logical that this would lead to better health? The ADA seems to think so. TCC just goes one step further than we are comfortable with in our society, saying that there is no health benefit to including animal products in our diet.

    Apparently TCC’s course “Plant Based Nutrition” is now available for Continuing Medical Education Credit at Cornell University. So I wonder if the people on this blog are using the term “pseudoscience” a bit to liberally. There seem to be a lot of reputable people out there that find The China Study reasonable. Dr. Hall mentioned Peta, Oprah and her favourite doctors, but she didn’t think mentioning these people was in the public interest?
    Frank Rhodes, Ph.D., President (1978-1995) Emeritus, Cornell University
    Robert C. Richardson, Ph.D., Nobel Prize Winner,
    Professor of Physics and Vice Provost of Research,
    Cornell University
    Marilyn Gentry, President, American Institute for Cancer Research
    Sushma Palmer, Ph.D., Former Executive Director, Food and Nutrition Board, U.S. National Academy of Sciences

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