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Eggs and Atherosclerosis

The headline of a recent Los Angeles Times article is, “No yolk: eating the whole egg as dangerous as smoking?” The question mark is meant to convey uncertainty or surprise, or perhaps both. The article represents much of what is wrong with science and health reporting by mainstream media.

The news report is based upon an article published in Atherosclerosis – Egg yolk consumption and carotid plaque. The study is highly problematic in ways not explored at all in the LA Times article. The researchers surveyed 1,262 patients seen in a vascular prevention clinic, asking them about their egg consumption, smoking history, and other lifestyle factors. They created a measure known as “egg yolk years” – the number of egg yolks consumed on average per week times the number of years of consumption. They compared this to pack years of smoking – packs per day times number of years, a routine method of reporting smoking history.

Their conclusion:

“Our findings suggest that regular consumption of egg yolk should be avoided by persons at risk of cardiovascular disease. This hypothesis should be tested in a prospective study with more detailed information about diet, and other possible confounders such as exercise and waist circumference.”

The LA times times used this as their money quote:

“We believe our study makes it imperative to reassess the role of egg yolks, and dietary cholesterol in general, as a risk factor for coronary heart disease,” the study authors write.

The authors feel the role of dietary cholesterol needs to be reassessed  because current evidence does not support a significant role for dietary cholesterol in heart disease, but more on that below.

The weaknesses of this study include the fact that it is retrospective and based on survey data, which is notoriously inaccurate. Further, it is an observational study and therefore there are many confounding factors that are not controlled for. Perhaps people who eat more egg yolks also eat more bacon, or have a generally poorer diet, or don’t exercise as much. The authors acknowledge this in their last line about needed a prospective study that controls for possible confounding factors.

But the data in the study is even more problematic, in my opinion. The article itself is behind a paywall, but here is table two containing the key data.

 

A B C D E
Egg yolk years <50 50-110 110-150 150-200 >200
Age at first visit 55.70 57.97 56.82 64.55 69.77
Eggs per week 0.41 1.37 2.30 2.76 4.68
Total cholesterol 4.93 4.94 5.00 4.90 4.81
Triglycerides 1.88 1.84 1.96 1.94 1.85
HDL 1.34 1.33 1.33 1.29 1.35
LDL 2.76 2.75 2.81 2.73 2.67
BMI 27.62 27.42 28.71 27.00 26.31
Smoking (pack years) 14.14 14.37 16.57 13.88 17.00
Female 48.60% 51.70% 44.80% 45.00% 46.70%
Diabetic 11.80% 14.50% 11.80% 13.40% 14.60%
Plaque area (mm2) 101.45 110.35 113.58 135.76 175.77

The table does indeed show a significant increase in carotid plague, the build up of cholesterol on the inner lining of the main arteries that feed the brain, with increase in egg yolk years. There are significant confounders and contradictions in the data as well, however. The most glaring to me is that total cholesterol, triglycerides, HDL and LDL do not vary significantly across the egg yolk years columns. Apparently what the authors have shown (which is consistent with previous data) is that eating lots of eggs does not increase total cholesterol or bad cholesterol (LDL) nor does it decrease good cholesterol (HDL). In my mind this leaves the authors completely without a mechanism to explain a causal relationship between egg consumption and carotid plaque. This strongly suggests the association is not causal but is incidental or spurious – unless an alternate mechanism can be proposed and supported by evidence.

Further, egg yolk consumption was associated with increased age at first presentation (a known significant risk factor) and pack years of smoking (although inconsistently). The authors say that the association between egg yolks and carotid plaques remained significant even after adjusting for risk factors and for age. However, these associations suggest the probable existence of other factors not controlled for.

Overall the data are not very compelling. The lack of correlation with cholesterol is most damning, in my opinion.

The story of eggs, cholesterol, and vascular disease is actually a bit complex. Recent studies are all over the place in terms of correlations. This recent study, for example, shows that eating eggs increases HDL and improves the cholesterol profile. A recent review also concludes:

Egg intake has been shown to promote the formation of large LDL and HDL subclasses in addition to shifting individuals from the LDL pattern B to pattern A, which is less atherogenic. For these reasons, dietary recommendations aimed at restricting egg consumption should be taken with caution and not include all individuals. We need to acknowledge that diverse healthy populations experience no risk in developing coronary heart disease by increasing their intake of cholesterol but in contrast, they may have multiple beneficial effects by the inclusion of eggs in their regular diet.

Another study found no association between egg consumption and cholesterol or mortality in men but did find an increase for women. And yet another study finds an increased risk for vascular disease from high cholesterol and lipid diets in the older population, especially diabetics.

A 2001 BMJ systematic review of fat and cardiovascular disease concluded:

There is a small but potentially important reduction in cardiovascular risk with reduction or modification of dietary fat intake, seen particularly in trials of longer duration.

A 2012 review concluded:

The findings are suggestive of a small but potentially important reduction in cardiovascular risk on modification of dietary fat, but not reduction of total fat, in longer trials. Lifestyle advice to all those at risk of cardiovascular disease and to lower risk population groups, should continue to include permanent reduction of dietary saturated fat and partial replacement by unsaturates. The ideal type of unsaturated fat is unclear.

My conclusion is that the topic is very complicated and the current data is a bit unclear. There does seem to be a consistent signal in the research data that high LDL and triglycerides and low HDL are risk factors for vascular disease, especially when combined with other risk factors. Improving the lipid profile through diet, exercise, and medication is beneficial to vascular risk.

The dietary recommendations are a bit complex, though. Reducing total fat 1980s style is probably not a good idea, as the reduction in good cholesterol probably more than outweighs the reduction in bad cholesterol. Further, the dietary contribution to lipid profile for most people is probable mild (unless you have an extreme diet). Avoiding trans fats and minimizing saturated fats seems to be supported by the evidence.

Overall, if you have a balanced diet and avoid extremes and exercise regularly you are probably OK. Further tweaking your diet is unlikely to produce large health benefits. If you are in a high risk group, such as diabetics, you need to be more specific about your eating habits, and should consult with your physician.

With respect to eggs specifically, it seems that moderate consumption of eggs are not a health risk and may even be beneficial. It is reasonable, based on the data, to avoid extreme high egg consumption – but you can probably say that about most things.

When it comes to diet the rule of thumb, everything in moderation, seems to be a good first approximation of the scientific data.

Posted in: Nutrition

Leave a Comment (162) ↓

162 thoughts on “Eggs and Atherosclerosis

  1. weing says:

    I want my eggs Benedict.

  2. mattyp says:

    “When it comes to diet the rule of thumb, everything in moderation, seems to be a good first approximation of the scientific data.”

    Seems to be one of the most sensible things I’ve read all year.

    Alarmingly (and OT), a friend of mind was espousing the “paleo-diet” to me, where apparently you remove all dairy and all wheat/grain products and I argued the “everything in moderation” response in opposition. Their response was, “so nicotine, heroin and arsenic in moderation too?”

    Make of it what you will, but I antagonised them by replying with “of course”…

  3. Dietary recommendations of avoiding trans- and saturated fatty acids, and consuming PUFAs and MUFAs are *very* scientificcally supported (I feel that “seems” under qualifies it.) We know that all things being equal, if you replace trans and saturated fats with PUFAs and MUFAs we get a dose-relationship decrease in cardiovascular disease. The “messyness” comes in when you start comparing high carbohydrate diets to high trans-/saturated fatty-acid diets, because high carb diets are equally unhealthy and are an independent risk for cardiovascular disease. In fact, that is a confusion in earlier studies – that they looked at decreaseing trans/saturated fatty acid consumption, but instead of replacing them with MUFAs or PUFAs, they consumed carbohydrates in their place, and they wouldn’t find much, if any, cardiovascular disease benefit.

    Moral of the study? Never eat trans fats, and try your best to avoid saturated fats, but minimal consumption is ok. Exercise. Eat low calorie diets. Don’t visit a chiropractor for any neck adjustments.

  4. wdygyp says:

    “When it comes to diet the rule of thumb, everything in moderation, seems to be a good first approximation of the scientific data.”

    This is a phrase that intuitively sounds reasonable but actually is almost meaningless as people can define “moderation” however they want according to their personal and cultural preconceptions.

  5. Janet Camp says:

    Studies a lot like this one appear regularly in the NY Times “Well” blog–often concerning nutrition. The columns are always followed by hundreds of comments that display an appalling ignorance of science and nutrition–usually touting the latest pop-science(y) book on diet. I usually take the time to comment of the shortcomings of the study (when I can spot them–thanks to all of you), but I am a lone voice other than the occasional MD who takes the time to post.

    Almost everyone makes the mistake of “what” you eat versus “how much” you eat–within reason, of course.

  6. BenE says:

    More researchers unable to admit their research found nothing interesting because of fears of losing their research budget and career prospects.

  7. windriven says:

    Commenting on the tabular data: “Further, egg yolk consumption was associated with increased age at first presentation”

    This struck me as well. I read that as suggesting that those who first presented later in life and with more plaque may generally not have been health conscious throughout their lives. Perhaps they did eat a lot of eggs. But what other confounders might there have been? Red meat consumption? Alcohol? Butter? Exercise?

    What about bacon? When I eat eggs they are often accompanied by bacon or sausage, both of which are fatty and preserved with nitrites. Or in weing’s case a dollop of hollandaise, a tasty concoction of egg yolks and lots of butter.

  8. Angora Rabbit says:

    Oh, arrrgh. (Sound of me hitting head on computer desk)

    As you beautifully point out, Steve, this is always the problem with this epi studies – correlation is not causation. Note how the mean increases across the quintiles – that is going to be a much bigger factor than dietary patterns. Diabetes rises too. Convince me which is cart and which is horse (meaning the authors). You are exactly right in pointing out that the total cholesterol levels don’t change – it ain’t the eggs.

    The study and media reports also ignores that egg cholesterol content has actually decreased significantly in the past 20 years. Producers got the message and reductions are as low as 30% – and not all dietary tables have been adjusted to reflect this.

    Moreover, egg yolk is an outstanding source of choline and growing data demonstrate that many people (apart from childbearing age women, there’s an estrogen effect) don’t make sufficient choline. There is also genetic variance in choline synthesis. Search Steven Zeisel at UNC on PubMed to learn more; lovely research.

    Speaking for the nutrition community, eggs are a great choice. I certainly eat mine regularly! (And I have gorgeous HDL, LDL, although that’s anecdote not data)

  9. Javeux says:

    I don’t think it’s right to mention MUFA and PUFA as if they’re equally safe alternatives to saturated fat. Where can you buy vegetable oil or fish oil that isn’t already oxidised, and how many people consume n-3s and n-6s in a reasonable ratio or amount with enough of the antioxidants necessary to avoid the kind of inflammatory damage associated with PUFA intake? Even fat’s golden child DHA doesn’t appear to be free from some pretty concerning dangers.

    Maybe I sound pedantic, but consumers picking up 5l bottles of corn oil and supermarket fish oil capsules don’t seem to be aware of these issues, believing they’re doing their hearts a favour. That’s when they’re not roasting their potatoes in olive oil at 220-degrees C. Lipid profiles are all well and good, but shouldn’t we be giving more attention to the oxidation and inflammation that causes a lot of the damage? This also makes me wonder how accounting for poached vs scrambled eggs would’ve affected the outcome of this study.

  10. DavidRLogan says:

    ^^^^^I’m curious about the same thing (notice I said “curious” not “I’m right”) regarding PUFA’s and etc.

    Chemists originally used the PUFA’s for varnish because they obviously form a hard surface in the presence of oxygen. This stopped because of the affordability of petroleum etc. in the painting industry. I’m from a big (probably the biggest) AG school…prof. of mine suggested the feeding of PUFA’s to animals was originally to fatten them up. Oxidation would happen faster in the body than on a shelf, I think.

    I remember there was the big meta-analysis AJCN supposedly exonerating a tiny bit of the stuff against saturated fats…if I remember Skeptical Health thought it was a bad study but I can’t remember why (would love to hear your thoughts, SH):

    http://www.ajcn.org/content/early/2010/01/13/ajcn.2009.27725.abstract

    I won’t pretend to know more about treating heart disease than Skeptical Health…I just have lots of cognitive dissonance on this matter…sunflower oil is (supposedly) one of the best ways to give mice diabetes in studies. DHA and EPA are even more unstable than some of the other PUFA’S…I suspect their protection, if they have it, is because they degrade so rapidly they can’t help to form some of the inflammatory prostaglandins. Also if I remember the PUFA’s harm the carrier protein for thyroid, inhibit thyroid production, etc. (will be happy to post studies if anyone…probably NYB or SH…wants to engage these matters).

    But again, I’m coming from a chemistry perspective not a perspective of someone who has been through med school and really treated people. All respect to SBM and Skeptical H who is one of the most entertaining/knowledgable poster on the board. I just can’t get over my own skepticism that PUFA’s are better than Sat’s. Would love to hear more.

  11. DavidRLogan says:

    If anything, my posts on this topic can show the rest of you why a lay person might be skeptical of the conventional view about saturated fats…and then maybe how to correct it (I mean that sincerely).

  12. Halitosis says:

    Read the book The Great Cholesterol Con – it lists pages and pages of research studies whose results do not support the view that high cholesterol (total, ldl, hdl, tri, etc) causes cardiovascular disease or increased mortality. In fact a number of large scale studies have shown that the opposite holds, ie that low cholesterol is associated with increased mortality.

    Why is there so much cholesterol in the yolk of an egg? Because it takes a lot of cholesterol to make a chicken.

  13. weing says:

    @Halitosis,

    Something stinks. Rotten eggs? Do you think you were conned by that book? Why or why not?

  14. Halitosis says:

    Something stinks all right. Note the conflict of interest disclosure attached to the article:

    CONFLICT OF INTEREST: None of the authors receives funding from purveyors of margarine or eggs. Dr Spence and Dr Davignon have received honoraria and speaker’s fees from several pharmaceutical companies manufacturing lipid-lowering drugs, and Dr Davignon has received support from Pfizer Canada for an annual atherosclerosis symposium; his research has been funded in part by Pfizer Canada, AstraZeneca Canada Inc and Merck Frosst Canada Ltd.

    Me thinks Spence and Davignon will struggle to produce results that do not support the cholesterol hypothesis. They are unfortunately not the exception.

  15. weing says:

    “Me thinks Spence and Davignon will struggle to produce results that do not support the cholesterol hypothesis.”
    And you think it’s only because of COI? Anyway, were you or were you not conned by that book? Why or why not?

  16. @DavidLogan,

    Good question! What I wrote is that studies that look at replacing trans/saturated fats with PUFAs and MUFAs show the dose-response relationship of decreased cardiovascular risk.

    The question that you raised is actually answered in the full text of the study you posted (available free from your link.) Read through at least the introduction and conclusion of the study and it is answered. In short, the study notes that it is only looking at the relationship of reported saturated fat intake vs cardiovascular risk. I wouldn’t expect the study to find much, if anything, because we are only looking at a (likely) poorly reported value, in a patient with a diet of unknown quality. Meaning, there are no dietary controls. It’s similar to looking at people who consume massive amounts of artificial sweetener, who are already on weight gaining trajectories, and blaming aspartame for their weight gain (when in reality they are eating supersized fast food meals, overestimating their caloric savings from having a diet coke vs a regular coke.)

    The study itself, in the introduction and conclusion, notes that cardiovascular benefit was found in patients who replaced trans/saturated fats with PUFAs and MUFAs. It also notes that very little benefit is found when you replace saturated fats with carbohydrates, which is expected because a high carbohydrate diet is a separate risk factor for cardiovascular disease.

    I think several conclusions can be drawn. First, a bad diet is a bad diet. So if you’re eating tons of saturated fats vs tons of carbohydrates, you’re still at risk for cardiovascular disease. You may have a slightly less risk of fatal myocardial infarction one way or the other, but ultimately a bad diet is bad. The other is that *improving* the diet yields the benefit. And this is easy to apply to real life: when you go out to eat, instead of putting butter on your bread, dip it in olive oil. And instead of eating a 16 oz T-bone, try a 6 oz filet. If you want something tasty on your food, put some avocado, not a creamy sauce.

    So, yeah, that study you posted actually backs up what I wrote. The problem to me is the way the media would report it: “Study finds saturated fats are not bad for you!” – That couldn’t be further from the truth! I haven’t followed the references in your linked study to see exactly which articles its referencing when it defends my point, but when I get access to my Sente database I’ll happily post over a handful of the really big, controlled dietary fat studies that demonstrate the dose-response relationship for decreasing risk with a change in dietary fat consumption. (I forget the numbers now, but it’s like for every 1% change it’s a 3% decrease in risk, or a 3% change it’s a 1% decrease in risk. Something like that.)

  17. DugganSC says:

    Reminds me of that old saying that “You know you’re old when you remember when bacon, eggs, and sunshine were all good for you.”

  18. The role of reducing intakes of saturated fat in the prevention of cardiovascular disease: where does the evidence stand in 2010?
    Am J Clin Nutr 93:4, 684-8 (2011)
    Astrup, A, Dyerberg, J, Elwood, P, Hermansen, K, Hu, FB, Jakobsen, MU, Kok, FJ, Krauss, RM, Lecerf, JM, LeGrand, P, Nestel, P, Risérus, U, Sanders, T, Sinclair, A, Stender, S, Tholstrup, T, and Willett, WC

    “Current dietary recommendations advise reducing the intake of saturated fatty acids (SFAs) to reduce coronary heart disease (CHD) risk, but recent findings question the role of SFAs. This expert panel reviewed the evidence and reached the following conclusions: the evidence from epidemiologic, clinical, and mechanistic studies is consistent in finding that the risk of CHD is reduced when SFAs are replaced with polyunsaturated fatty acids (PUFAs). In populations who consume a Western diet, the replacement of 1% of energy from SFAs with PUFAs lowers LDL cholesterol and is likely to produce a reduction in CHD incidence of ≥2-3%. No clear benefit of substituting carbohydrates for SFAs has been shown, although there might be a benefit if the carbohydrate is unrefined and has a low glycemic index. Insufficient evidence exists to judge the effect on CHD risk of replacing SFAs with MUFAs. No clear association between SFA intake relative to refined carbohydrates and the risk of insulin resistance and diabetes has been shown. The effect of diet on a single biomarker is insufficient evidence to assess CHD risk. The combination of multiple biomarkers and the use of clinical endpoints could help substantiate the effects on CHD. Furthermore, the effect of particular foods on CHD cannot be predicted solely by their content of total SFAs because individual SFAs may have different cardiovascular effects and major SFA food sources contain other constituents that could influence CHD risk. Research is needed to clarify the role of SFAs compared with specific forms of carbohydrates in CHD risk and to compare specific foods with appropriate alternatives”

  19. mousethatroared says:

    Ummm, You know I think I followed that article okay, but about half way through the comments my head was spinning.

    I just feel really lucky that my cholesterol levels have always been good, cause Transfat, Saturated Fat, PUFA, MUFA’s….it’s just a heck of a lot more technical than I like to think about when I’m cooking.

    I will say, why cook potatoes in olive oil @ 200 degrees? If you give them a good dose of salt and cook them at 450, they will be nice and crispy.

    Don’t get me wrong. I’m happy you all are thinking about this stuff, but I’m hoping if I ever really need to alter my fat consumption, you come up with something a little simpler. How about Happy Fat, Sad Fat and Average Fat.

    That would be double plus good.

    Regarding eggs. Any simple ideas on whether the Omega 3 vegetarian fed chicken eggs are actually enough more healthy to off-set the extra buck.

  20. mousethatroared says:

    No, I take that back.mI don’t like happy fat, sad fat, average fat. To wrought with moralistic values…I hate that in my food. Maybe something that relates more to where the fat is from. Like the old fashion animal fat, vegtable fat, fish fat descriptions? Purely for communicating with members of the public that are not very technically inclined.

  21. Haha :) Basically the better it tastes, the worse it is for you. Kidding. That article was just demonstrating some of the numbers I was unable to remember in the prior message.

  22. daedalus2u says:

    In the abstract, the differences reported are tiny.

    “Plaque area in patients consuming <2 eggs per week (n = 388) was 125 ± 129 mm2, versus 132 ± 142 mm2 in those consuming 3 or more eggs per week (n = 603); (p < 0.0001 after adjustment for age).”

    I don't care what the p value is. I have a very hard time believing that the difference, 7 mm2 is clinically significant, considering that the standard deviation is greater than the value. If 7 mm2 is clinically significant, then some of the outliers a couple sigma higher (i.e. 250 mm2) should already be dead.

    This is the first thing that just jumped out at me.

  23. tmac57 says:

    My question is where did they get all of those people with a BMI under 30? Must not have been done in the U.S.

  24. DavidRLogan says:

    @Skeptical Health

    Thanks for the reply! OK I see that: too much is self-reported and there aren’t adequate controls…plus what you say about the study’s own admissions. Thanks!

    I’m going to carefully read the one you posted sometime soon…my questions are probably answered by actually reading it.

    I still feel really weird about this. But I am now in total agreement with you over the original link I posted. Unfortunately you didn’t point this out last year when I pompously told everyone I knew saturated fats were OK :)

    Have a good night.

  25. BillyJoe says:

    A cooking show some decades ago when the rot was starting to set in:

    Jacques proceeded to flay the skin off his fish, informing the viewers in his thick French accent that removing the skin was healthy since it contained the fat. Julia then fixed him with a withering glare and exhorted: “Jacques, salmon is not medicine!”

    The last thing I think about when I’m eating: Is it good for me?
    Of course, I don’t discount the science, I’m even happy to read about it, but I’m still going to enjoy my food.

  26. mousethatroared says:

    BillyJoe – LOL – I think I will make Julia Child my new idol.

  27. IMO the most pressing question of this entire discussion has been lost in all the noise. This: how much bacon constitutes a “moderate” amount? What’s the upper limit of my personal dose? At what frequency? I’m disappointed that Dr Novella ignored this one critical component of the discussion….

  28. morris39 says:

    @daedalus2u
    Sorry off topic again. I am unable to post on your blog for some reason. Perhaps you can send me a post card: 3219 Sunset Pl, W.Kelowna, BC, V4T1S3, Canada. Thanks, Morris

  29. BillyJoe says:

    AU: ” how much bacon constitutes a “moderate” amount? ”

    Somewhere between nothing and nothing but.
    Having enough while leaving enough for everything else.
    A bit of everything but not eating everything.

  30. physicsmum says:

    Dr. David Spence was interviewed on CBC Wednesday morning. When the host recalled hearing of recent studies showing that eggs weren’t all that unhealthy, Dr. Spence got very angry and said those studies were all funded by egg marketing companies, and who should we believe, a big expert like him or someone selling eggs?! He seems utterly convinced that eggs are quite evil, and his anger was quite impressive.

    At that point my husband poked his head in the kitchen and asked whether those eggs I was scrambling had any yolks. He was quite pleased with my affirmative response, not to mention the accompanying sausage :-)
    (True story – it was the morning show, after all)

  31. jwray says:

    The data doesn’t really even show you should avoid the “extreme” of 4 eggs per week. Despite the girl scout effect, that group had the highest age of first visit (meaning they went longer before having health problems, or perhaps were set in their ways of egg-eating before the completely unfounded media blitz about cutting dietary cholesterol) lowest triglycerides, lowest LDL, highest HDL, and lowest BMI which are all good signs (lower BMI is expected for their age group though). The only bad sign is if you cherrypick one datum: plaque area. But that could be explained by the fact that they are older, and smoking was more common in the past, they smoked more pack-years because they were older, and the plaques had more time to accumulate. Perhaps differences in sugar/alcohol consumption mediated by the girl scout effect contributed to the plaque difference. I doubt there would really be any extra plaque due to 4 eggs a week if you controlled for smoke, age, and the “girl scout effect”. And even if it were linked to greater plaque area, that doesn’t even have very good specificity as a predictor of heart disease.

  32. jwray says:

    > My question is where did they get all of those people with a BMI under 30? Must not have been done in the U.S.

    Definition of obesity is a BMI of 30 or higher. On those maps of the percentage of obese people in each US state, even the fat southern states have less than 40% obesity. So the center of the bell curve is below 30. BMI of 25 is still kinda fat. 6-pack territory is generally well below 20.

  33. Purenoiz says:

    @DavidRLogan
    2 Things
    1)Oxidation of PUFA’s and HUFA’s can be prevented by oil extraction and processing in an oxygen free environment. Some manufacturers of fish oil do this. While freezing fish on boats also reduces oxidation of the highly reactive lipids.

    2) Clinical outcomes speak louder than theorizing. The International Society for the Study of Fatty Acids and Lipids has said as much. From their website.
    http://www.issfal.org/statements/hooper-rebuttable
    In our view, the weight of the evidence available in May of 2006 is sufficient to conclude, even in light of the Cochrane analysis, that EPA and DHA reduce risk for cardiovascular diseases. Not only do we feel so, but also the American Heart Association/American College of Cardiology 15 , the European Society for Cardiology 16 , a systematic review conducted for the Agency for Healthcare Research and Quality at the NIH 17 , the Harvard Center for Risk Analysis 18 , and a number of other national and international bodies 19-22 .
    Taken together, we see no reason why ISSFAL should revise its previous (2004) statement on omega-3 fatty acids and cardiovascular disease in light of the Cochrane analysis.
    Signed:
    Clemens von Schacky, Medizinische Klinik und Poliklinik Innenstadt, University of Munich, Munich, Germany
    William S Harris, South Dakota Health Research Foundation, University of South Dakota,Sioux Falls , South Dakota ,USA
    Dariush Mozaffarian, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School ,Boston ,MA,USA
    Penny M. Kris-Etherton, Department of Nutritional Sciences, The Pennsylvania State University, University Park,Pennsylvania,USA

  34. DavidRLogan says:

    Hi Purenoiz,

    Thanks a bunch for the comment/links, I appreciate your time. Here’re my thoughts on those points, if you care (I concede the AJN-article point to Skeptical Health)…

    1) That’s helpful, but they can’t stay away from oxygen in the body, right? I agree there’re manufacturing protocols than can get them from the boat to your body. My concern was the initiation/propagation of radicals once they’re in the body (also the mitochondria need those oxygen molecules!)…the painting industry’s use for them is just an illustration of their instability. I agree it doesn’t mean squat next to clinical stuff.

    2) Thanks for that link. It does an AWESOME job showing exactly what the bar needs to be for my worries to clear (as it says, focus on biomarkers). I’ll see what I can come up with and probably post more, later. I will try to focus on those issues from here on out (issues from the “other concerns” part)

    To be clear with you, I would HAPPILY defer to you or the others on here for actually treating someone in danger (it’d be criminal if I gave advice to a sick person). However, relevant to what I shove down my own pie-hole, I feel so weird about these fats! As your link said (though it intended it differently) when background conditions are different (Europe vs. Japan) it’s not clear what we ought to make of risk reduction. Maybe (theorizing again) the extreme instability of these fats keeps them from forming the inflammatory prostaglandins…that would be helpful for at-risk patients but, as a psycho-health-nazi, I’d rather do without that until I know better (better ways imo to reduce inflammation). So I’m worried more about myself than risk-groups (famous last words, probably…) Looking forward to hearing more from you…

    Have a good Sunday!

  35. Interestingly, I was looking around UpToDate today and was browsing the “Whats New” section and came across this:

    A large randomized trial in patients at increased risk for cardiovascular disease because of dysglycemia found no effect of fish oil supplementation on total cardiovascular events, all-cause mortality, or coronary heart disease (CHD) mortality [17]. While earlier large trials of fish oil supplementation had shown benefits for CHD mortality, more recent trials have not. One possible explanation is that a beneficial effect of omega-3 fatty acids in reducing the risk of sudden cardiac death may be diminished in patients already receiving aggressive pharmacologic risk factor management for secondary prevention of CHD. It is currently uncertain whether fish oil supplementation has any major effects on nonfatal or total CHD events. (See “Fish oil and marine omega-3 fatty acids”, section on ‘CHD death and sudden cardiac death’.)

    If you have access to UTD, check out the article it references at the end (See “…”). It’s pretty dang interesting.

  36. ^ Just to note, they are specifically addressing the use of fish oils in high risk individuals, and it seems that in people who are already maximally medically managed, the addition of a fish oil doesn’t do much, if anything. They’re good for you, but don’t expect a great benefit if you’re already a high risk patient taking a handful of medications.

  37. estockly says:

    Dr. Novella,

    Just a few things: Saturated fat is good for you. It’s trans-fats that are the bad fats. But any fat is bad for you on a high carb diet, and replacing saturated fats with high carb food is the worst.

    As to cholesterol, the latest science has moved beyond what you’ve presented here.

    HDL is still considered good cholesterol. But the negative impact of LDL is not as clear. If the LDL particle size is small and dense, then it’s still bad, but if the LDL particle size is large and “fluffy” (not dense) then LDL is not a risk factor for CVD. You can estimate LDL particle size by looking at the ratio between HDL and triglycerides. If HDL is high and triglycerides are low then LDL particle size is likely large and fluffy.

    The best profile for HDL, Triglycerides and LDL particle size comes from eating a Low Carb High Fat diet.

    LCHF also helps lower blood pressure and decreases risk factors from other chronic diseases, including Type II Diabetes and some forms of cancer.

    We need dietary fat to survive. We also need protein to survive. But we do not need dietary carbohydrates. None whatsoever.

    If you have adequate fat and protein, your body makes all the glucose you need for energy, and you’ll metabolize fat directly and through ketosis.

    So when you advocate a balanced diet you’re balancing two macro-nutrients that are essential for survival with a third, that’s not only not needed but also increases blood sugar and insulin levels, causing excess fat storage and leads to obesity. Many carbs also stimulate appetite.

    So better simple advice would be: When you’re hungry, eat. When you’re full, stop. Eat plenty of fat, moderate protein and keep carbohydrates down to a minimum (less than 20 grams per day, most coming from vegetables). Stay active.

    Below are a few links to studies and a page with other links to support these arguments, and a note about the authors of the egg study.

    ES

    Saturated Fat

    A Systematic Review of the Evidence Supporting a Causal Link Between Dietary Factors and Coronary Heart Disease

    “Insufficient evidence of association is present for intake of … saturated or polyunsaturated fatty acids; total fat … meat, eggs and milk.”
    http://archinte.jamanetwork.com/article.aspx?articleid=1108492

    Reduced or modified dietary fat for preventing cardiovascular disease. Cochrane Database Syst Rev. 2001] – PubMed – NCBI

    “There were no clear effects of dietary fat changes on total mortality or cardiovascular mortality…”
    http://www.ncbi.nlm.nih.gov/pubmed/11687015

    Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease

    “…no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD.”
    http://www.ajcn.org/content/91/3/535.long

    European Journal of Nutrition

    “The observational evidence does not support the hypothesis that dairy fat or high-fat dairy foods contribute to obesity or cardiometabolic risk…”
    http://www.springerlink.com/content/1665l525j917h055/?MUD=MP

    Here’s a page with these and more related links:
    http://www.dietdoctor.com/science

    Also, there is some question about the bias of the authors of the study. I don’t want to get into an ad hominem, but these researchers are vegans, and seem to have a bias against eggs.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989358/

  38. Patohaz says:

    @estockly

    Got to fat-head blog for a more informative and entertaining blog, although I must say this one is good for a laugh now and again, between the monotonous (but justified) criticism of homeopathy.

    Also, have a look at the later meta-analysis that Dr. Novella linked to (a 2012 review, probably an update of the one you cite). The WHI was added. The paper is open access from JAMA: Howard et al., Low-Fat Dietary Pattern and Risk of Cardiovascular Disease – The Women’s Health Initiative Randomized Controlled Dietary Modification Trial , JAMA, February 8, 2006—Vol 295, No. 6.

    http://www.ncbi.nlm.nih.gov/pubmed/16467234

    The WHI was the largest study in the meta-analysis and it (the WHI) found nothing, except for women with a history of CVD:

    “After women with history of CVD at baseline were removed (n=1656 [3.4%]), HRs (95% CIs) for major CHD, composite CHD, stroke, and total CVD were 0.93 (0.83-1.05), 0.94 (0.86-1.02), 1.02 (0.90-1.17), and 0.96 (0.89-1.03), respectively. The HR for the 3.4% of women with CVD at baseline was 1.26 (95% CI, 1.03-
    1.54). We considered the potential confounding effects of changing medication use during the trial by examining use of statins, aspirin, and angiotensinconverting enzyme inhibitors at year 6. All differences in medication use between groups were less than 1%.”

    So, reducing/ modifying fat intake: 26% increased risk! What is also interesting is that they had predicted the outcome (which was woefully wrong):

    “After a mean of 8.1 years of follow up, the observed incidence rate for major CHD(MI/CHD death, 3.6 per 1000 person- years) in the comparison group was 30% lower than projected in the design. ”

    They did what appears to be data-dredging, too.

    If you like calories in – calories out, have a look at the weight change compared to calories in tables 2 and 3. That dog don’t hunt (if you believe in the first law of thermodynamics and reject the second law, as most dieticians and physicians do, that is if they know about the second).

    If you are worried about cholesterol levels, move to Norway. But be warned, the price of butter could cause a heart attack.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3303886/

  39. RD says:

    Most people don’t eat food JUST for their nutrients. If only there was a profession that could work with each person and develop individualized nutrition recommendations (science based of course) that helped with creating balance and moderation….

  40. estockly says:

    @RD

    >>If only there was a profession that could work with each person and develop individualized nutrition recommendations (science based of course)

    If only…. I assume RD you are referring to “Registered Dieticians” and I’m guessing by your initials that may be your profession.

    Unfortunately, what’s RD’s learn is not based on science. RD’s are taught to follow the USDA nutritional guidelines, and although they claim they are based on science, in reality they are not. The primary role of the USDA, by the way, is to promote US Agriculture. No surprise that the base of the pyramid and the bulk of the new plate is comprised of the very grains that form the backbone of Agriculture in the US.

    If only there were such a profession, indeed!

    ES

  41. RD says:

    @estockly
    You caught me! I am a dietitian…good for you! I sense you have a negative understanding of dietitians, and I am sorry if you had a bad experience with one. If only that is all we had to learn to become an RD, oh wait, then we would be like all the other ‘nutrition experts’ flooding the media. Before I respond, just a quick question, are you an RD, because you seem very confident in knowing what education we receive….you may want to look into that a bit more if you are not an RD (or else I took way more courses then I needed!?!?). In all of my course work, I do not recall a course titled “Explaining and following the USDA nutritional guidelines”.

    My initial post was more to emphasize individualizing nutrition recommendations vs the black and white approach to eating that the media likes to create. Several comments mentioned finding balance and moderation with foods, including eggs. A dietitian does not fall victim to the latest eating trends, but uses the same research talked about in this blog to develop recommendations.

  42. Of all the professions that attempt to tell me how to eat, I would trust a RD the most.

  43. mousethatroared says:

    My mom taught me how to eat. It wasn’t that hard once I learned to use a knife, you know, put food on fork, insert into mouth. Although sometimes I get the salad fork mixed up…

    Sorry.

    Actually, I’m curious what a registered dietician does. My son has one on his cleft team (I think, but sometimes I get the nutritionists, registered dietician mixed up) But it seems his diet is pretty good because she hasn’t had to give anything more than cursory recommendations.

  44. RD says:

    @SkepticalHealth- Thanks!!

    @Mousethatroared- LOL- I should hope your mother taught you how to eat! I think that would be basis for neglect if she hadn’t….wouldn’t it? As for the mechanical aspects of eating, that would be more under the physical, occupational, and speech therapies.

    So what does an RD do? There are many avenues that an RD can take, I will stick to the clinical since that is the area I am in. A very short response is a dietitian helps people make food choices to help support THEIR health goals. Like other health professions, many RD’s are specialized, some work with just renal and dialysis patients some work with just oncology patients, some are CDE’s working with people with diabetes. Some work strictly with nutrition support, others may work with the pediatric population. Some conditions such as celiac disease and food allergies treatment is more food focused, other conditions, food changes along with other lifestyle changes, can help decrease symptoms. I have not worked in the hospital for awhile, so things could have changed….but certain conditions and disease states need to have a nutrition assessment for insurance. If there is no nutrition concern, then the RD probably won’t provide a whole lot of info. If there is a concern, depending on the facility, the RD may talk to the person themselves, or they may work through the doctor treating the pt. In the hospital, the dietitians work is more behind the scenes, looking at labs, medications, and MD assessments. In an outpatient setting, the dietitian provides more education to patients. In the past, the dietitian used more of a diet approach, but now dietitians use more of a therapy approach in counseling patients.

  45. RD says:

    @mousethatroared
    Thank you for your question….you for sure are not alone in not knowing the difference between dietitians and nutritionists. The main difference is education and qualification. For example, if someone was titled instructor, it does not provide any explanation of education/certifications etc. Some facilities may require certain requirements for their instructors, but across the board, it is a vague term. However, if someone is titled Professor, there is a better understanding of a minimum education of being a professor. Same with dietitians and nutritionists, the title nutritionist is vague and offers no explanation of minimum education they have received. To be a dietitian, a person needs a minimum food/nutrition/dietetics BS degree, internship, and to pass a national exam. For some of you that question if dietetics is science based, just a sample of some of the courses needed to receive the degree include: cell biology, Human Anatomy and Physiology, microbiology, Genetics and molecular biology, Chemistry, Organic Chemistry, Biochemistry, Statistics, Advanced nutrition, Lifecycle nutrition, food science, Medical nutrition therapy, Quantity foods, Community nutrition, Developmental psych, social psych, Health psychology.
    Hope this answers your questions!!

  46. mousethatroared says:

    Hey RD – Thanks! That’s very interesting. I’m always curious about all the different fields within medicine, when I come across a new profession I like see what it’s about. Sometimes the information actually ends up being helpful in conversation or when a young person is looking about for potential careers.

  47. Chris says:

    RD, you might find these videos amusing (and they explain what it takes to be a dietitian):
    https://www.youtube.com/user/frugaldietitian/videos

    (And as far as doing something about food fads, I want to ban cilantro… I have no interest in soap flavored food!)

  48. estockly says:

    @RD

    Thanks for your response. Here’s a couple quick questions:

    >> I do not recall a course titled “Explaining and following the USDA nutritional guidelines”.

    So do you not follow the USDA guidelines in your practice?

    You mention a test, does it not reflect the USDA guidelines?

    >>A dietitian does not fall victim to the latest eating trends, but uses the same research talked about in this blog to develop recommendations.

    Do you generally recommend a so-called “balanced” diet, balancing macro-nutrient proportions (fat/carbs/protien)?

    ES

  49. @estockly, I’ll go ahead and jump in. You’re trying to bait RD into a completely pointless debate. If you have specific questions, ask them, but don’t be so vague. If you have some weird diet you follow that you have convinced yourself is scientifically sound, go ahead and describe it and let informed people comment.

  50. mousethatroared says:

    I think estockly might be from a Terry Gilliam movie…or is it Kafka.

  51. estockly says:

    @SkepticalHealth

    What could be more specific than asking if the advice follows USDA guidelines or recommends a “balanced diet.”

    As you may note from my first comment, the diet I advocate for obesity and general health is a Low-carb high-fat diet. And I was convinced that it is scientifically sound by the numerous RCTs and other studies I linked to in my first post.

    What I’m wondering is how and why people have been convinced that the USDA guidelines or the “balanced diet” models are sound, since they do not have actual studies to show their safety and effectiveness.

    ES

  52. RD says:

    @Chris-HAhahaha- this was great!
    @SkepticalHealth and mousethatroared- You are awesome! You must know a great RD :)
    @estockly- I hope to answer your questions sufficiently. Actually I am honored you have so much interest in our profession. It feels good to maybe help decrease some of the rumors/stereotypes people have about dietitians.
    I would love to set up an appointment with you to discuss your individualized nutrition recommendations. Unfortunately I don’t have one pre-made, black and white nutrition plan that is appropriate for everyone, including the ‘choosemyplate’. There are many factors that can influence a person’s nutrition status including willingness to change. Yes, in general Americans don’t eat enough fruits and vegetables, they tend to eat more refined grains then whole grains, majority of meat consumed is highly processed, and they eat out way more than cooking at home (and when I say cooking, I don’t mean frozen pizzas or hamburger helper type items)…..but I can’t assume that is the case with each person I visit with. I am sorry, you seem to want black and white answers to very grey questions!

    I do tend to be skeptical with nutrition information, primarily because of the Oz personalities that people find are ‘all knowing’, but I am not threatened by new information. Also like skepticalhealth mentioned, some of your questions are vague and hard to answer. You ask about a balanced diet with the macronutrients. Are you implying equal percents of intake with pro, fat and cho totals for the day? Or are you asking about balancing nutrients throughout the day or per meal? You provide some interesting reading on high fat/low cho diets. Just curious, what would be an example day on your diet (using actual foods)? Honestly, I don’t know if the general population can easily follow 20g of cho a day for a long time! I guess that’s where the fiber supplements can come in handy, only consuming 20g of cho a day, and whoa to the person that doesn’t like vegetables (thank goodness for Andrew Weil’s supplement program!)!?!? I have found that people who over restrict certain foods or specific macronutrients are more prone to overeat/binge on them at a later point. Is this a healthy way to eat? Restrict/overeat, restrict/overeat etc. Why do so many diets fail? So yes, finding a balance of macronutrients is important for sustained healthy eating changes long term. Instead of focusing so much on finding a perfect ratio of the macronutrients (is there one), I encourage people to look at what food sources are providing the macronutrients. It is fine to want to cut down on cho intake, but if a person stops drinking milk, stops eating fruit, and has their allotted cho intake from candy…..is this truly a healthy change? Nutrition includes more than just macronutrients. After working with people, you also soon realize that even though nutrition information looks good on paper and in a lab setting, it’s a different story for people making changes. Like the saying goes, ‘You can lead a horse to water, but you can’t make them drink.’ With healthy eating, I look at it as a progression of changes (lifestyle changes) vs following perfect recommendations ( dieting).

    As for the exam….it was awhile ago. I honestly don’t remember any questions on the USDA nutrition guidelines! Doesn’t mean there weren’t any. The questions I remember were slightly more complicated, citric acid cycle, sodium/potassium pump, nitrogen balance, and case study type questions looking at labs and meds….but there easily could have been a USDA nutrition guideline question mixed in the loop. I think the questions were testing us for our professional knowledge, and not so much on consumer information.

  53. estockly says:

    @RD

    >>I would love to set up an appointment with you to discuss your individualized nutrition recommendations.

    I think I would find that very interesting.

    >>Unfortunately I don’t have one pre-made, black and white nutrition plan that is appropriate for everyone

    Good. Do you have a default diet? One for healthy people of normal weight with no medical conditions?

    Do you also have a default weight-loss diet, one which you would use for overweight people with no other medical conditions?

    When you recommend a diet do you look at things like serum cholesterol, blood pressure and lipid profiles?

    >>Yes, in general Americans don’t eat enough fruits and vegetables, they tend to eat more refined grains then whole grains, majority of meat consumed is highly processed, and they eat out way more than cooking at home (and when I say cooking, I don’t mean frozen pizzas or hamburger helper type items)…..

    Maybe not the fruits, but definitely the veggies.

    I see the differences between refined grains and whole grains similar to the difference between unfiltered cigarettes and filtered cigarettes. Neither one is good for you and your better off without either.

    By highly processed meat, do you mean hot-dogs and sausages? Spam? With meat I don’t think the “majority” of the meat consumed is “highly” processed. But I might be misunderstanding. If you include hamburger meat with lots of additives, or things like chicken nuggets, then yes, I agree.

    >>but I can’t assume that is the case with each person I visit with.

    >>Also like skepticalhealth mentioned, some of your questions are vague and hard to answer. You ask about a balanced diet with the macronutrients. Are you implying equal percents of intake with pro, fat and cho totals for the day? Or are you asking about balancing nutrients throughout the day or per meal?

    The “balanced” diet is basically the food pyramid diet, now the plate. It generally has 50 to 60% of calories from carbs; 15 to 20% from protein and the rest from fat.

    >>You provide some interesting reading on high fat/low cho diets. Just curious, what would be an example day on your diet (using actual foods)?

    Breakfast: Bacon and eggs and whatever stir-fry is left over from dinner added to omelet.
    Lunch: Salad, sometimes with chicken
    Dinner: Meat (chicken beef or pork), salad, veggies, usually stir fried.
    Snacks: Occasionally nuts; pork rinds

    No bread; no sugars; no starchy veggies; no pasta; no rice; no corn. Basically less than 30 g of net carbs (net carbs = total carbs – carbs from fiber). I’m still losing weight.

    That’s a fairly typical LCHF diet. (Not totally anecdotal)

    >>Honestly, I don’t know if the general population can easily follow 20g of cho a day for a long time!

    On the Atkins diet, for example, you restrict yourself to <20g net carbs for only the first two weeks, then gradually increase your carb count for as long as you continue to lose weight. (Although you have the option of staying very low if you have a lot of weight to lose.)

    I don't believe any LCHF diet plans keep you at >I guess that’s where the fiber supplements can come in handy, only consuming 20g of cho a day, and whoa to the person that doesn’t like vegetables (thank goodness for Andrew Weil’s supplement program!)!?!?

    On low-carb, fiber doesn’t count, since it does not raise blood sugar. (Anecdotally, I hated veggies before I started Atkins, once I lost the taste for sugar I started to enjoy them more.)

    >>So yes, finding a balance of macronutrients is important for sustained healthy eating changes long term.

    As I asked Dr. Novella in my first comment, you need a certain amount of fat in your diet, and a certain amount of protein. But you don’t need any carbohydrates in your diet. None whatsoever.

    So why “balance” essential macronutrients with an inessential macronutrient?

    Aside from the little you ingest with veggies, why include carbs in the diet at all?

    >>It is fine to want to cut down on cho intake, but if a person stops drinking milk, stops eating fruit, and has their allotted cho intake from candy…..is this truly a healthy change?

    No, but that’s not what LCHF diet plans recommend. When you cut carbs the very first recommendation on all LCHF diets is to eliminate simple carbs. Sugars (candy) and refined flours.

    >>As for the exam….it was awhile ago. I honestly don’t remember any questions on the USDA nutrition guidelines! Doesn’t mean there weren’t any.

    Fair enough. My suspicion is that if you were to compare what was on the exam (and in your text books) in terms of consumer information or dietary guidelines for schools, hospitals, etc, with what’s in the USDA guidelines you’d find many similarities and very few, if any, differences. They may not have spelled out USDA in the test or examples, but the substance is the same, I suspect.

    I’m also curious about how much you learned about the blood sugar/insulin fat storage cycle and insulin’s role in the storage of fat.

    ES

    (I appreciate the tenor and tone of this conversation)

  54. @estockly, are you arguing that a diet high in saturated fats is healthy?

  55. nwtk2007 says:

    I doubt a diet high in saturated fats would be good, but if you’re going to eat a lot of fats, they (saturated fats) might be better than a diet rich in hydrogenated oils.

    Its always amazed me how many diets there are. I would also say that the programs the nutritionists and dieticians go through are interesting, but in the end, its all about reasonable amounts of the various food groups, not too much of one over the other, plenty of ruffage (fiber) and reduced caloric intake combined with reasonable activity levels.

    To be honest, its always seemed to me, based upon the bio-chemstry, that a diet higher in carbs and lower in proteins and fats would be a cleaner fuel system. Especially if processed foods are avoided as well as foods contaminated with chemicals. You just have to keep the consumption down.

    And just how many diets are actually successful outside of true lifestyle changes? Not many. Ultimately its easier to change someone’s religion or convince SH of the goodness of chiropractic than it is to change peoples diets. IMHO.

  56. estockly says:

    @SkepticalHealthon 29 Aug 2012 at 2:55 pm

    >>are you arguing that a diet high in saturated fats is healthy?

    Yes, when also low in carbohydrates and with moderate protein.

    In general, saturated fats are healthy.

    ES

  57. nwtk2007 says:

    By the way, the best obesity diet is reduced intake, increased activity and motivation. And like alcoholism, there needs to be the realization that there is a problem and a desire to take charge of the problem.

    I’ve always been fascinated by the obese person swearing on their mothers grave that they don’t eat much. Right.

  58. @estockly, you are wrong. Saturated fats are not “healthy.” If you’ll even read back through this thread, you will see studies that demonstrate a dose-response decrease in mortality when saturated fats are replaced with unsaturated fats. You may be losing weight on your diet, but do not fool yourself into thinking that saturated fats are healthy. That is, quite honestly, a deadly mistake.

    I’m sure you’re going to link me the Paleo diet book, or you’re going to link one weird study, or misconstrue a handful of other studies. Facts are, the best evidence shows that replacing saturated fats with unsaturated fats reduces mortality greatly. Every 1% of saturated fats that are replaced with unsaturated fats reduces coronary heart disease by 2-3%. Look for my post from August 15th.

    @nwtk2007

    By the way, the best obesity diet is reduced intake, increased activity and motivation. And like alcoholism, there needs to be the realization that there is a problem and a desire to take charge of the problem.

    Holy crap. You and I agree on something! I can’t count how many patients tell me they eat healthy, and then reveal that they drink an entire 12 pack of Dr. Pepper each day.

  59. @nwtk2007,

    It is always interesting seeing people justify bad dietary behavior. Ie, they want to eat unhealthy meals, and instead of being honest with themselves saying “hey, this probably isn’t the best idea”, they will instead “choose” denial and misinterpret data to support their bad behavior. Of course I’m not saying that everyone should eat healthy every single meal. I’m the first one to drink too much or eat the occasional heart attack on a plate. But I at least recognize that it’s unhealthy. I completely agree with you that the first step is realizing there’s a problem. Sadly it seems a lot of people deny the problem and instead justify it with flimsy science.

  60. estockly says:

    @nwtk2007

    >>I doubt a diet high in saturated fats would be good

    I used to think so too. Saturated fat has gotten a bad rap over the years, and it turns out it was wrongly vilified.

    What happened was in the ’60s doctors were making great advances in the diagnosis and treatment of cardio vascular disease and they noticed that many of the worst patients had high serum triglycerides and cholesterol. So, they assumed that dietary fat and dietary cholesterol increased risks for CVD.

    Turns out the opposite is true. But they began making dietary recommendations based on unscientific, erroneous assumptions. That’s why we began replacing fat with carbs.

    >>I would also say that the programs the nutritionists and dieticians go through are interesting, but in the end, its all about reasonable amounts of the various food groups, not too much of one over the other, plenty of ruffage (fiber) and reduced caloric intake combined with reasonable activity levels.

    I don’t blame you for saying that, it’s been the mainstream policy for about 50 years now. It’s just wrong, and too slow to change.

    >>To be honest, its always seemed to me, based upon the bio-chemstry, that a diet higher in carbs and lower in proteins and fats would be a cleaner fuel system.

    The problem with carbs, especially simple carbs (sugars and processed flours) is that they raise blood sugar, which raises insulin levels. Insulin is the hormone that regulates fat storage, so when insulin levels are high, you store more fat.

    The obesity epidemic is an epidemic of too much stored fat. That’s caused by too many carbs in the diet.

    >>Especially if processed foods are avoided as well as foods contaminated with chemicals.

    BTW, processed foods generally tend to be higher in simple carbs.

    >>You just have to keep the consumption down.

    On a low-carb high fat diet the instruction is keep carbs low. Eat moderate amounts of protien, and all the fat you want. When you’re hungry eat, when your’re full stop.

    It’s not about the calories, it’s about the carbs.

    ES

  61. @estockly,

    That is pure conjecture, with almost no truth to it. It is not about the carbs, it is about the calories. In fact, we have much data that shows us either a high fat or a high carb diet are equally unhealthy. As I already stated, the health benefit is gained when we replace unhealthy fats (saturated) with healthy fats (MUFAs and PUFAs.) Your “history” of carbs, fats, and cholesterols is inaccurate, too. Yes, medicine incorrectly believed that dietary cholesterol was the most important thing. We slowly learned that it was dietary fat intake, specifically trans (the worst) and saturated (2nd worst), that are what raise blood cholesterol (LDL) levels.

    BTW, if anyone hears the myth that medicine said “Eat a low fat diet and you’ll be healthy”, that is completely false. Medicine advised “eat a low fat, low calorie diet, and get plenty of exercise.”

    If you want any further discussion, please backup your text with respecatble studies.

  62. * I’d be interested in where you are getting your information from.

  63. * (One more thing, when I wrote “calories vs carbs”, it was in reference to weight gain, etc. But what I’m trying to convey to you is that saturated fats are not healthy, and there isn’t some vast conspiracy where we are all dumb to that and that you’ve uncovered some mysterious information.)

  64. mousethatroared says:

    estockly – you don’t eat bread OR drink alcohol? No scones?

    I suppose I could possibly cope with that for a really good reason, like if I had celiac disease, but…bummer.

  65. I have a kegerator built into my kitchen island :)

  66. Patohaz says:

    @SkepticalHealth

    You say that there is proven dose response for replacement of SFA with PUFA, and cite an article:

    The role of reducing intakes of saturated fat in the prevention of cardiovascular disease: where does the evidence stand in 2010?
    Am J Clin Nutr 93:4, 684-8 (2011)

    The evidence cited on PUFA replacing SFA in this article appears to be based on two references; one is a meta-analysis:

    Mozaffarian D, Micha R, Wallace S. Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: a systematic review and meta-analysis of randomized controlled trials. PLoS Med 2010;7:e1000252.

    This article found 7 RCT, of which two (Finnish Mental hospital study – subgroup men, subgroup women barely significant; Oslo Diet-heart study also barely significant) found statistically significant correlations for replacing SFA with PUFA on various CHD outcomes. Cool to see the Oslo Diet-heart study there too, which found no statistical significance of smoking, although death rate for smokers was higher. One might note the following from the meta-analysis:

    “Evaluating total mortality due to all causes (2,472 events), the pooled RR was 0.98 (95% CI 0.89–1.08).”

    What was the replacement of SFA with PUFA causing to bring the total mortality back up to virtually par? Odd this little tidbit did not make it into the abstract.

    The second reference cited in the AM J Clin Nutr article was really interesting. I usually read the body and only skim the abstract, but in this case the abstract caught my attention.

    Lloyd-Williams F, O’Flaherty M, Mwatsama M, Birt C, Ireland R, Capewell S. Estimating the cardiovascular mortality burden attributable to the European Common Agricultural Policy on dietary saturated fats. Bull World Health Organ. 2008 Jul;86(7):535-541A.

    From the abstract:
    “A spreadsheet model was developed to synthesize data on population, diet, cholesterol levels and mortality rates. A conservative estimate of a reduction in saturated fat consumption of just 2.2 g was chosen, representing 1% of daily energy intake. The fall in serum cholesterol concentration was then calculated, assuming that this 1% reduction in saturated fat consumption was replaced with 0.5% monounsaturated and 0.5% polyunsaturated fats. The resulting reduction in cardiovascular and stroke deaths was then estimated, and a sensitivity analysis conducted.”

    Wow, they made some estimates that they put them in a model and put the output of the first model into a second model. Really? This is what they have to cite as evidence?

    I also enjoyed the description at the beginning of the Am J Clin Nutr article:
    “The symposium was held at the Department of Human Nutrition, The Faculty of Life Sciences at The University of Copenhagen, Denmark, 28–29 May 2010, as a closed consensus meeting of invited scientists.”

    Nothing like a closed consensus meeting! If one were paranoid, you’d think the organizers would invite only people they know agree with them. Perish the thought – bad troll – bad troll.

    One last thing:

    Calories in-calories out is a platitude of the first law of thermodynamics. Please provide one study which measured calories out, or at least tried to estimate. Just one.

    @estockly

    I hope somebody starts on about the dangers of ketosis. That would be fun. Any takers?

  67. So… Basically no argument?

  68. Patohaz says:

    @ SkepticalHealth

    No argument. You are free to hold your own opinion that the rubbish you cite is convincing evidence that PUFA replacing SF is healthy, and that calories in – calories out is a meaningful expression.

    Found a paper in your database that measured calories-out yet?

  69. I wonder, if in the history of man, if anyone has gained weight after stopping eating. We need a new term for CAM dieting. CAD? FCAD? (Frequently Changing Alternative Diets?)

    Your baseless rebuttal of PUFA vs SFA implies that you are a cholesterol denier. I’m not going to enter the same debate I already did earlier in this thread, especially because you haven’t made a point or supported your opinion with a single fact. You are free to believe whatever you want, but I hope you understand your denial of science will directly lead to the worsening of your health and possible adverse outcomes. There’s a tragic story of one of the “board members” of the Weston A. Price Foundation (a pro-saturated fats, cholesterol denying group) who died at age 39 of a heart attack. He wrote how he enjoyed his (completely unhealthy) lifestyle, which consisted of consuming massive amounts of SFAs. It was a sad, preventable death. But its hard to get through to people who are in denial.

  70. WilliamLawrenceUtridge says:

    Any time someone cites “conspiracy” as an argument, automatically loses the argument.

    Anyone who claims to be smarter than an entire body of experts is probably wrong.

    Anyone who asks for “just one study” will find a reason to ignore that study.

    Anyone who spends their time attacking others’ positions rather than supporting their own probably has a weak position.

    I would be interested in any studies indicating a high fat, high protein, low carbohydrate diet led to long-term weight loss. I don’t think that one study will convince me, but it will be interesting. And probably unsustainable.

  71. Alia says:

    @nwtk2007
    “By the way, the best obesity diet is reduced intake, increased activity and motivation. And like alcoholism, there needs to be the realization that there is a problem and a desire to take charge of the problem.”

    That’s my case. I used to be overweight or even obese, I don’t know. I did some exercise but I ate a lot. A lot. And then one day I looked into my mirror and said to myself “this can’t go on, in a few years’ time you will be a cripple” (joint problems run in my family). And then I started to think what I eat, how much I eat and WHY I eat. I started eating less and better, kept my exercise routine and suddenly I started losing weight. And when I saw that it was working, that I was losing weight, it gave me enormous positive feedback. I lost 50lb in a year. I may have regained about 5 but no more. My blood test results are great and I feel great.

    My diet changes were slight. Eat LESS. Eat less saturated fats (no butter on my sandwiches now). Eat wholemeal bread and pasta. Eat more fruit and vegetables. No sweet, carbonated drinks and highly processed snacks. And that’s about all.

    This does not mean that I don’t sin against healthy diet sometimes, I love chocolate and ice-cream – but it’s not one bar and one liter in one sitting anymore.

  72. It sounds like you did a really good job, and did it in a really healthy manner! Congratulations on your weight loss.

  73. nwtk2007 says:

    I agree with SH, you did really well because it ain’t easy. And like so many things, when you do sin against the healthy stuff, the sinful stuff tastes just that much better having stayed away from it so long.

    @SH, just because we agreed on something don’t mean we are going to be taking hot showers till the wee hours of the morning together. (spoken by Clint Eastwood – who is rumored to be the secret speaker at tonight’s RNC where the finest of open liars have gathered for a liar’s orgy.)

  74. jhawk says:

    SH,

    you said to nwtk2007: “Holy crap. You and I agree on something!”

    I would like to say the same about your posts on this thread, Holy crap. You and I agree on something! Not that you care coming from a chiropractor :)

    Also, you seem to be rather pleasant to this guy/gal that is saying Calories in, Calories out does not matter! Is this not basic physiology/exercise phys?

  75. mousethatroared says:

    @WLU – regarding conspiracy theories. – I don’t know, what about antibiotic use in livestock? As I understand it, scientists at the FDA have been saying since the 70′s that it was a danger to humans due to antibiotic resistance, but the farm/livestock industry has convince congressmen to discourage any constraints. Sure it’s not a conspiracy that requires keeping a secret, but we still have government making recommendations that go against the science and not really being honest about the risks being taken.

  76. fledarmus1 says:

    @mousethatroared… “we still have government making recommendations that go against the science and not really being honest about the risks being taken”

    If that was all it tooks to be a conspiracy, I’m afraid democracy raises conspiracy to the new normal. I think we’re going to have to hold lawmakers to the standard of actively trying to hide things for the sake of unavowed purposes rather than just ignoring or lying about things to stay in office before we can declare it a conspiracy

  77. WilliamLawrenceUtridge says:

    Interesting and relevant (to the discussion, not to the original post) at Scientific American on diet and calories:

    http://blogs.scientificamerican.com/guest-blog/2012/08/27/the-hidden-truths-about-calories/

    MTR, I would say that’s not a conspiracy, that’s scientific incompetence from our political leaders (no surprise coming from a country where public office holders must be religious and often creationists to survive in certain jurisdictions). A conspiracy would be congresspersons, the livestock industry and doctors (veterinarians?) colluding to deny or conceal the fact that antibiotics in cattle pose a problem to public health. They don’t need to, because the average citizen doesn’t realize the importance of antibiotics and basic public health measures. Because the results are hidden, attenuated and have no direct, obvious impact, there’s no motivation from citizens to adopt science-based guidelines. If it were something like smallpox or polio, I’d like to say that things would be different. I’d be wrong, if course, because even when smallpox and polio were ubiquitous there was still resistance to vaccination.

  78. RD says:

    @skepticalHealth- CAD and FCAD work for me ;)
    @estockly- Way to go on your weight loss on the Atkins diet! ( I am being sincere!) How long have you been following it and do you mind me asking how much you have lost? About 80% of the patients I see for weight loss have also been on atkins type diets, and they also have been able to lose weight, but unfortunately they all have gained weight back, if not more within 3-6 months of being on it. Why is this? Although it seems to be working for you, I would not generalize that the entire population would find this a successful approach. What would you suggest for people that are finding it hard to adhere to such strict guidelines?

    Also, your description of insulin and sugars in the body comes across as overly simplified and I am afraid people that are not familiar with the process may develop an unnecessary fear of insulin. Please don’t feel that I am picking on you, but your understanding of weight gain is again overly simplified if you believe insulin is the only hormone involved in weight gain. If only our body was so simple! You have failed to mention several other key functions of insulin including amino acid uptake and the modification of activity of several enzymes. The truth is, without insulin, we would become comatose and eventually die. Insulin is not a bad guy. The concern is when people become insulin resistant. This is usually a result of inactivity (heavy emphasis) and weight gain. No medical professionals are encouraging a high refined cho diet! But a person does not have to become so restricted to have a healthy balance of insulin and glucose. Random thought here….. Does anyone else find it interesting that a mother’s milk would contain a nutrient that is not necessary for human consumption?
    Can other items increase insulin sensitivity of cells besides medication? Why, I am glad you asked, in fact one of magnesium’s function is with the insulin receptors and can help the cells become more insulin sensitive. Americans must consume enough magnesium in their diets, right? Another great question, actually 9 out of 10 Americans do not consume enough magnesium. Food sources of magnesium would be legumes, whole grains (yikes CARBS), beans like kidney/black/pinto etc (yikes, more CARBS, but wait, there is fiber so it doesn’t count as much, but WAIT those pesky bacteria in our gut are secretly poisoning us by making sugar out of some of the fiber!).

    Since it is common knowledge that most fad (or FCAD diets thanks to SH) diets that are restricted in calories work temporarily with weight loss (regardless of macronutrient combination), the challenge becomes, how do people maintain wt loss.
    Info from the National Weight control registry can provide a look at what people that MAINTAIN weight loss have done. http://www.nwcr.ws/

    @Alia- Way to go! You rock!

  79. estockly says:

    @SkepticalHealth

    >>It is not about the carbs, it is about the calories.

    Take one step back in your logic. It’s not about weight, it’s about fat storage. Obesity is excess stored fat. Weight is only a symptom.

    Insulin regulates storage of fat. If there is no insulin no fat is stored (T1Diabetes). If insulin is low little fat is stored and stored fat is released into circulation. If insulin is high more fat is stored and stored fat is locked in.

    Insulin responds almost exclusively to blood sugar. When blood sugar is low, insulin is low and when blood sugar is high, insulin is high.

    It’s very easy to manipulate the storage of fat in the human body. Simply reduce carb intake to 5 to 10% of total calories and eliminate nearly all simple carbs.

    >>In fact, we have much data that shows us either a high fat or a high carb diet are equally unhealthy.

    That is not true. There is no evidence that a low-carb high fat diet is as unhealthy as a high carb diet. In fact, there is plenty of evidence the opposite is true.

    >>I would really like to see the evidence you are referring to.

    Here’s a good collection of studies:

    http://www.dietdoctor.com/science

    >>As I already stated, the health benefit is gained when we replace unhealthy fats (saturated) with healthy fats (MUFAs and PUFAs.)

    A few issues with the study you referred to. First, they did not control for carbs. The most unhealthy diet is one that is high in simple carbs and high in fat. Any fat. (There is consensus that transfats are the worst.)

    The study showed a correlation, sometimes correlations imply causation, but sometimes not. It’s entirely plausible that many of those eating a diet high in SFA are not as careful with their health as those eating a diet with little or no SFA and more UFAs.

    People who eat lots of steak and hamburgers; bacon and pork; donuts and butter have more heart attacks than people who eat lots of fish and nuts. Is it possible that those two groups of people may have other things in common that may make one group more likely to have heart attacks and one less? There may be a large proportion of smokers, they may eat lots foods high in simple carbs.

    Many foods high in SFA have a high carb content or are served with foods high in simple carbs. Steak and pork are often eaten with bread and potatoes; hamburgers, buns and fries; donuts are simple carbs and fat; butter is usually spread on carbs.

    Also, the authors got the issue of LDL cholesterol wrong. They claim that since LDL levels went up with SFA intake that increased risks for CVD. It might, but it might not.

    The real issue with LDL is particle size. When LDL particle size is small and dense, that increases risk factors for CVD. When it’s large it reduces risks for CVD.

    The best profile for triglycerides and cholesterol comes from eating a low-carb high fat diet. It increases HDL; lowers serum triglycerides; has little change on total LDL, but increases LDL particle size. (Also improves blood pressure.)

    >>Your “history” of carbs, fats, and cholesterols is inaccurate, too.

    One more thing about that same study you linked to. It reinforces exactly what I was saying about the history. For years mainstream medicine has been arguing that we should replace saturated fat in the diet with carbs.

    Yet this study found no benefit. The advice to replace saturated fat with carbs was not based on good science.

    >>Yes, medicine incorrectly believed that dietary cholesterol was the most important thing.

    Yes. That belief was not based on science, medicine incorrectly recommended people reduce dietary cholesterol.

    >>We slowly learned that it was dietary fat intake, specifically trans (the worst) and saturated (2nd worst), that are what raise blood cholesterol (LDL) levels.

    First, you’re imprecise in your language here. Blood cholesterol levels are HDL and LDL.

    You are claiming that saturated fat raises LDL. But you are ignoring HDL and ignoring LDL particle size. And serum triglycerides. If you’re going to assess risk factors for CVD you need to look at all of those.

    The best science shows that all of those (HDL, triglycerides, LDL particle size) all improve on a low-carb high-fat diet.

    >>Medicine advised “eat a low fat, low calorie diet, and get plenty of exercise.”

    Yeah, so how has that worked out over the last 50 years? I guess you think 70% of Americans just don’t listen and it’s their own fault that they’re overweight or obese.

    70 percent. Something’s not working.

    The reality is that we did cut fat, replacing it with carbs, we met the official targets for per capita calorie consumption and still piled on the pounds. We even exercise more now than we did 30 years ago. And we still gain weight. There are obese marathon runners.

    >>If you want any further discussion, please backup your text with respecatble studies.

    You sent me back to look at your earlier comment and I do the same.

    I listed several studies specifically on Saturated fat and a link to another page with numerous published studies, mostly RCT’s that support the LCHF theory.

    Please have a look.

    >>>I’d be interested in where you are getting your information from.

    “Good Calories Bad Calories,” by Gary Taubes, was a good starting point for the failure to follow good science in the field of diet and nutrition.

    I could provide a complete reading list if you like.

    >>(One more thing, when I wrote “calories vs carbs”, it was in reference to weight gain, etc. But what I’m trying to convey to you is that saturated fats are not healthy

    I’m trying to convey to you that it’s the carbs that are not healthy. The simple carbs are the worst. Eliminate simple carbs cut way back on the rest and you can eat all the saturated fats you want while improving our health and reducing the risk for cvd. (We probably agree that transfats are not healthy, but they are not as bad as carbs).

    >>and there isn’t some vast conspiracy where we are all dumb to that and that you’ve uncovered some mysterious information.

    I’ve never claimed a conspiracy. There are two relevant aspects. First, I think it’s just bad science. Once the cardiologists uncovered the strong correlations between serum cholesterol / serum triglycerides and CVD, they acted in good faith, supported by science that turned out to be biased (Keyes) and developed bad recommendations.

    From there, the Government got involved and developed the USDA guidelines. Those guidelines are influenced, somewhat, by political and economic interests, but those who develop those guidelines believe in what they are doing. At this point the bias against fat and in favor of carbs is institutionalized.

    It’s just not supported by good science.

    ES

  80. estockly says:

    @mousethatroaredon
    >>you don’t eat bread OR drink alcohol? No scones?
    >>I suppose I could possibly cope with that for a really good reason, like if I had celiac disease, but…bummer.

    I had an even better reason. Obesity. I thought it would be a bummer too, and I missed a lot of foods for the first few weeks. But no more. I don’t miss being obese, either.

    I started having wine after a bit, but now I’m trying to lose another 20 pounds or so. So no wine until I’m at my target weight.

    ES

  81. estockly says:

    # SkepticalHealthon
    >>Your baseless rebuttal of PUFA vs SFA implies that you are a cholesterol denier.

    That is not a rational or logical argument. It’s an ad hominem.

  82. estockly says:

    @WilliamLawrenceUtridgeon

    >>Any time someone cites “conspiracy” as an argument, automatically loses the argument.

    Yeah, that’s why Nixon was re-elected. Woodward and Bernstein lost the argument. I’m not claiming a conspiracy. But I’m just pointing out the fallacy of that position.

    >>Anyone who claims to be smarter than an entire body of experts is probably wrong.

    Yeah, but somehow Einstein and Darwin got published. Not claiming I’m smarter than anyone, or comparing myself to those two, I’m just pointing out the fallacy of your argument.

    >>Anyone who asks for “just one study” will find a reason to ignore that study.

    Asking for just one study is another way of saying there are no good studies that support that argument. How many times have you heard skeptics ask for just one study that supports homeopathy? Again, not making any claims, just pointing out the fallacy of your argument.

    >>I would be interested in any studies indicating a high fat, high protein, low carbohydrate diet led to long-term weight loss. I don’t think that one study will convince me, but it will be interesting. And probably unsustainable.

    No one is advocating that diet. A LCHF diet has moderate protein. The variables in the intervention are fat and carbs. Replace carbs with fat.

    Look at the first link on this page and scroll down to the links to studies at the bottom.
    http://www.dietdoctor.com/science

    Oh, heck, just look at all the studies.

    While you’re at it, show me the studies that show long term success of a low fat high carb diet or a low fat calorie restricted diet.

    Not just one, show me all the studies!

    ES

  83. estockly says:

    @RD
    >>Way to go on your weight loss on the Atkins diet! ( I am being sincere!) How long have you been following it and do you mind me asking how much you have lost?

    Thanks! I hate discussing anecdotes, especially my own, because they distract. I was 245 in May 2010, when the doctor told me I had to do something. I cut out all sugars (including HFCS and foods that contain it) and lost about 10 pounds in three months. No more weight loss until I started Atkins, Jan. 3, 2011. I was 235 and I am now 185 lbs. Most weight loss in first 5 months. I had been between 190 and 195 for about a year, but have started to lose weight again. I did blood tests before the dieting started and new tests a couple months ago, and every one of my risk factors for CVD has improved dramatically. Triglycerides were cut in half.

    >>About 80% of the patients I see for weight loss have also been on atkins type diets

    Don’t know what’s meant by Atkins-type. It’s either Atkins or it’s not. Unless you meant the Chet Atkins diet?

    >>they also have been able to lose weight, but unfortunately they all have gained weight back, if not more within 3-6 months of being on it.

    What does that mean? “of being on it”? Are you saying that while they are on Atkins-type diets they gain weight or they gain weight after they go off the Atkins-type diet?

    >>Why is this?

    Do “Atkins-type” diets allow lots of simple carb consumption? That might be it. Atkins doesn’t!

    >>Although it seems to be working for you, I would not generalize that the entire population would find this a successful approach. What would you suggest for people that are finding it hard to adhere to such strict guidelines?

    Atkins, LCHF. There are many support groups and interventions that help. Compared to other weight loss interventions people do better on it and stay with it longer. I wish more RDs would use it as their default diet. If they supported it with their clients as much as they do their own diets, their clients would do much better.

    One of the goals of some of the studies I linked to was to find interventions that work. One of the things the studies have found is that people who lose weight on LCHF stick to LCHF longer than those who lose weight on other diets stick to those diets.

    >>Also, your description of insulin and sugars in the body comes across as overly simplified and I am afraid people that are not familiar with the process may develop an unnecessary fear of insulin.

    Insulin regulates fat storage. By adjusting carb intake you can control how much fat is stored and how much stored fat is released. There is no fear involved. Yes, there are many other factors, but insulin is the key

    >>…your understanding of weight gain is again overly simplified if you believe insulin is the only hormone involved in weight gain.

    I don’t believe that. There are many involved. Some directly some indirectly. But insulin is the hormone that regulates fat storage.

    And let’s be more precise in our language. The issue with insulin is not weight. The issue is stored fat. Insulin regulates storage of fat. Not weight, but storage of fat.

    >>If only our body was so simple! You have failed to mention several other key functions of insulin including amino acid uptake and the modification of activity of several enzymes.

    Yes, insulin is a very busy and necessary hormone. I didn’t mention them because they are irrelevant to storage of fat and obesity. Insulin also regulates uptake of glucose into cells, which provides energy and lowers blood sugar. (That is relevant).

    >>The truth is, without insulin, we would become comatose and eventually die.

    Yes, as I said, that is type one diabetes. Which kills. One way it kills is through the inability to store fat when there is no insulin.

    >>Insulin is not a bad guy.

    Right. It protects us from blood sugar. Too much blood sugar is the bad guy. The way the body is designed, as soon as blood sugar goes up, insulin goes to work to lower blood sugar by making less fat available for metabolism (storing fat) and burning glucose.

    >>The concern is when people become insulin resistant.

    Insulin resistance is something that begins on a cellular level. Some cells stop responding to the presence of insulin. Fat cells don’t take in fat; muscle and other lean tissue doesn’t take in glucose. When enough cells become insulin resistant blood sugar doesn’t go down and the body produces more and more insulin, which, after time, forces the IR cells and other cells to take in fat and glucose. When all that insulin finally works to lower the blood sugar, the excess insulin lowers it too much and you get those blood sugar swings. That’s when you are considered insulin resistance. This leads to Type II diabetes.

    >>This is usually a result of inactivity (heavy emphasis) and weight gain.

    Those are involved in insulin resistance, but what causes IR is not as clear as you are presenting it. There is good evidence that insulin resistance is caused by spikes in insulin which is caused by spikes in blood sugar which is caused by heavy consumption of simple carbs, but the science is not settled on the issue of what causes insulin resistance. It may have many causes. Insulin resistance may cause inactivity and weight gain.

    >>No medical professionals are encouraging a high refined cho diet!

    Except the ones who recommend “whole wheat” breads and “whole grain” pastas, etc. Turns out many of those carbs are nearly as simple as refined flour and sucrose.

    >>But a person does not have to become so restricted to have a healthy balance of insulin and glucose.

    The healthiest balance comes when you cut dietary carbs to a bare minimum and the body makes all the glucose you need. There is no health benefit to dietary carbs.

    >>Random thought here….. Does anyone else find it interesting that a mother’s milk would contain a nutrient that is not necessary for human consumption?

    Mother’s milk has saturated fat and lactose. A good combination if you want to store fat, which is a good idea if you an infant.

    Does anyone find it interesting that mother’s milk contains saturated fat? Does anyone find it interesting that the stored fat in our bodies is also saturated fat?

    Seriously, once fat is released from fat cells it circulates as FFA and the fat you’re now burning that had been on your belly or your butt is no different than the saturated fat you get from butter or steak or mommy’s breast. So, the fat stored in our own bodies is bad for us? Our own mothers are giving us heart disease?

    >>Since it is common knowledge that most fad (or FCAD diets thanks to SH)…

    The Atkins diet (LCHF) has been around for about 50 years. That’s some fad.

    >>diets that are restricted in calories work temporarily with weight loss (regardless of macronutrient combination),

    Diets that work, work only for as long as you stay with them. If you go off Atkins and return to your “balanced diet” you’ll put the weight back on.

    >>Info from the National Weight control registry can provide a look at what people that MAINTAIN weight loss have done.

    http://www.nwcr.ws/Research/published%20research.htm

    The NWCR criteria for long term weight loss is 10% of your body weight for 1 year. (I got that beat!)

    By that standard, the LCHF diet is the champ according to this recent study found on the NWCR site.

    Three-Year Weight Change in Successful Weight Losers Who Lost Weight in a Low-Carbohydrate Diet

    http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17925473&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

    ES

  84. ^ I particularly enjoyed the part about a mysterious connection between people eating cheeseburgers and bacon having more heart attacks but saying it must be somethig else, not their unhealthy lifestyle.

    I also enjoy that you said “there’s no evidence that high carb v high fat are equally unhealthy”, web in fact such studies were already posted in this thread.

    Troll harder, lipid denier :)

  85. estockly says:

    >>I particularly enjoyed the part about a mysterious connection between people eating cheeseburgers and bacon having more heart attacks but saying it must be somethig else, not their unhealthy lifestyle.

    Nice straw man. The point you are missing is that it’s not the burger, it’s the bun and the fries and the soda that come with it. It’s not the steak, it’s the bread and the baked potato. It’s not the fat, it’s the carbs. That’s what raises the risks for CVD. Nothing mysterious about it. The study simply did not control for carbs.

    >>I also enjoy that you said “there’s no evidence that high carb v high fat are equally unhealthy”, web in fact such studies were already posted in this thread.

    Just went back and looked again. No such studies are in this thread or on pub med. Unless I’m misunderstanding what you’re saying.

    To be clear, my argument: The low-carb high-fat weight loss diet is more effective and healthier than low-fat high carb diets.

    Where is your evidence to the contrary?

    ES

  86. nwtk2007 says:

    estockly, you said, “The healthiest balance comes when you cut dietary carbs to a bare minimum and the body makes all the glucose you need. There is no health benefit to dietary carbs.”

    What would be the bare minimum carbs and when the carbs run out or get low, how does the human body make glucose to maintain blood glucose levels?

  87. estockly says:

    @nwtk2007

    >>>estockly, you said, “The healthiest balance comes when you cut dietary carbs to a bare minimum and the body makes all the glucose you need. There is no health benefit to dietary carbs.”

    >>What would be the bare minimum carbs

    In the diet less than 20g net carbs per day, mostly complex carbs from veggies and very little simple carbs. Depending on the individual that’s generally below 10% of calories from carbs.

    In the blood, a fasting blood glucose of roughly between 75 and 90 mg/dl.

    >>when the carbs run out or get low, how does the human body make glucose to maintain blood glucose levels?

    Gluconeogenesis.

    http://medical-dictionary.thefreedictionary.com/gluconeogenesis

    Glucose is made from protein. Also when your body begins to release stored fat, the triglycerides in the fat cells breakdown into free fatty acids and glycerol and he liver also makes glucose using the glycerol.

    (Those are basic descriptions of complex processes)

    ES

  88. nwtk2007 says:

    Thanks for the link. I’m very familiar with the process. Are you familiar with the byproducts of gluconeogenesis from proteins/glycerol? Additionally, the maintenance of effective levels of oxaloacetate generally depend upon carbohydrate metabolism. It kind of primes the pump for Kreb’s to be able to burn the fats, which is really, the true goal of dieting, true?

  89. Oh man, estockly is a Paleo-dieter. I truly feel sorry for anybody that is a patient of dietdoctor.com’s. It’s a shame there isn’t a better way to protect patients who are patients of doctors who push fad and unhealthy diets on people.

  90. estockly says:

    >>I’m very familiar with the process.

    So that was a test, did I pass?

    >>Are you familiar with the byproducts of gluconeogenesis from proteins/glycerol?

    Not intimately.

    >>Additionally, the maintenance of effective levels of oxaloacetate generally depend upon carbohydrate metabolism.

    That’s one of the reasons the body makes glucose and maintains sufficient glucose in the blood. Humans evolved in a low-carb environment.

    Also, don’t not forget ketosis and the direct metabolism of FFA in muscles and organs.

    >> It kind of primes the pump for Kreb’s to be able to burn the fats, which is really, the true goal of dieting, true?

    The true goals of dieting should be (in this order):

    Maintain or improve health, which includes reducing the risks for chronic disease

    Metabolize stored fat while preserving lean tissue

    Allow for a normal active lifestyle

    Maintain a stable weight with a healthy body fat composition in the long run

    ES

  91. estockly says:

    @ SkepticalHealthon

    >>Oh man, estockly is a Paleo-dieter.

    Another ad hominem. I’d expect more from someone with skeptic in their name.

    >> I truly feel sorry for anybody that is a patient of dietdoctor.com’s. It’s a shame there isn’t a better way to protect patients who are patients of doctors who push fad and unhealthy diets on people.

    You know, in Sweeden the government now recommends HCLF diets.

    And in the US, the American Diabetic Association recommends LC diets for weight loss.

    What exactly do you want to do about that?

    BTW, I am not a paleo dieter. I was going to make my own web page with links to published studies on low-carb dieting when I found dietdoctor, and his page had links to full text studies that I hadn’t found.

    Rather than copy his work, I link to his page.

    Once you get past the ad hominem, and actually look at the studies published in peer reviewed journals, maybe you’ll overcome your bias?

    Or is it important to protect people from diets that reduce risks for CVD and are more effective at burning fat?

    ES

  92. WilliamLawrenceUtridge says:

    Yeah, that’s why Nixon was re-elected. Woodward and Bernstein lost the argument. I’m not claiming a conspiracy. But I’m just pointing out the fallacy of that position.

    Yeah, but somehow Einstein and Darwin got published. Not claiming I’m smarter than anyone, or comparing myself to those two, I’m just pointing out the fallacy of your argument.

    Nixon’s conspiracy was found out. You’re claiming a successful conspiracy of hundreds of thousands of doctors and researchers, and that’s why you’re wrong. I’m not sure what your point is about Einstein and Darwin; Einstein’s work was accepted almost immediately, was it not? Same with Darwin, whose work now forms the central dogma of biology. Their work united and explained, and was expanded upon by thousands of scientists in millions of papers since then. You’re claiming that you’re smarter than all the people who actually work and do research in the area, using objective measures like cardiac events and deaths to indicate success or failure of interventions, based on you losing weight and reading a book by a science journalist. A respected one, but still – I’m ill-inclined to think a journalist is smarter than so many real scientists.

    Asking for just one study is another way of saying there are no good studies that support that argument. How many times have you heard skeptics ask for just one study that supports homeopathy? Again, not making any claims, just pointing out the fallacy of your argument.

    A fallacy is claiming that “just one study” will overturn an entire body of literature. Skeptics, at least here, don’t ask for “just one study”. They point out that far more than “just one study” ever could, the existing body of literature on physics, chemistry and biology are what support homeopathy not working. Here skeptics point out that “just one study” proves almost nothing. I think you are confusing “there are no good studies” with “I don’t agree with an equivocal and complicated body of literature”. And that’s fine, it’s your opinion, but it’s more honest to say “it’s equivocal and confusing” rather than the absolute statement “all doctors are idiots and I know the TRUTHTM”. That’s the core of why your approach overall fails.

    Oh, heck, just look at all the studies.
    While you’re at it, show me the studies that show long term success of a low fat high carb diet or a low fat calorie restricted diet.
    Not just one, show me all the studies!

    Not having the time or inclination to do so, I think instead I will defer to the body of knowledge accumulated and interpreted by genuine experts – not someone posting screeds in the comments section of a website. I’ve made the following point before. Mark Lehner went to study the Pyramids as a disciple of Edgar Cayce, the sleeping nutter. I mean prophet. After years of study, he realized Edgar Cayce was a nutter and the Pyramids were the legacy of a bureaucratic monarchy that developed over hundreds of years within a well-understood historical context. He’s now a staunch defender of conventional Egyptology, convinced by the evidence. He actually studied the material and changed his mind.

    If you want to be Mark Lehner, study the topic before deciding it’s wrong. Go get a PhD, then I might give you some credibility.

    I’m not sure what you’re trying to say about long-term success of diets – that they reduce weight, or cardiac event risk? That they’re hard to stick with? What do you mean by “success”? Pretty much every diet, which is a form of calorie restriction, will lower weight and with it cardiac risk factors. But diets don’t work over the long term, because you can’t keep losing weight or you’ll die of anorexia. What is really needed is a lifestyle change, which can also be hard – but not as hard as maintaining an extreme restriction diet for your entire life. Plus, it just doesn’t seem necessary – dogmatism in this area seems dumb, just follow recommendations. Eat less processed food, eat lots fresh fruits and vegetables, exercise. That seems much more reasonable than eliminating an entire type of food, particularly in the absence of scientific consensus. But whatever, good luck with that. Now I think I’ll have a slice of bread. Just one though.

  93. Harriet Hall says:

    This seems to be a rehashing of Gary Taubes’ ideas. I wrote about it at http://www.sciencebasedmedicine.org/index.php/why-we-get-fat/
    Taubes himself admits that his ideas must be tested. One of my major criticisms of him is that he is asking us to follow his recommendations before they have been adequately tested, exactly what he criticizes everyone else for doing in the low-fat movement.

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