Wednesday, January 31, 2018

Perhaps the Final Nail in the Low-Fat Coffin

For the past 50 years the basis of nutritional advice from the medical community has been “eat a low-fat diet”.  During that time the obesity epidemic, the diabetes epidemic and growing concerns about a shortening in U.S. life expectancies has occurred. In addition, an increase in cardiovascular disease rates has occurred in 34-54 aged women and no further decrease in the rates for middle aged men.(1)

At some point it is prudent to say that if the desired effect of a policy is not occurring, the policy must be flawed.  This is the case with the low-fat diet.  The results have proven this concept highly flawed at great expense to our national health.

The idea of a low-fat diet as protection against cardiovascular and other chronic disease originated in the 1950’s based on some seriously flawed research by Ancel Keys, PhD.  He examined the carbohydrate and fat ratios in relation to cardiovascular disease rates from “all of the research” published world wide up to that time.  The infamous Seven Countries Study concluded that the analysis from the seven countries reported that higher fat consumption correlated with higher cardiovascular disease rates and began the unquestioned era of the low-fat diet as disease prevention.

Unfortunately, Key’s study did not come under independent analysis for the next 50 years.  When it did, it was revealed that he had “cherry picked” the available research including only 7 of the 22, or less than 33%, of the available studies.  Examination of Key’s data 50 years later found that the majority (66%) of the research he actually had available supported exactly the opposite of his conclusion.  Keys was opening a health spa/retreat which was to be based on the low-fat diet and biased his study to support its concept.

Several studies throughout the late 1900s and early 2000s actually demonstrated that the low carbohydrate/higher healthy fat diet actually out-performed the low-fat diet, but these studies failed to change longstanding medical advice patterns.  It however, has begun to soften very recently and perhaps a large, well done newer study will finally change this flawed advice.(2) 

The study called PURE examined the relationship between dietary patterns and disease and mortality rates from 18 countries from 2003- 2013. Subjects were divided in to groups, according to the carbohydrate/fat ratios of their diets. The data showed that compared to those consuming the lowest carbohydrate/higher fat diets, each increase level of higher carbohydrate and lower fat consumption was associated with higher cardiovascular disease rates and increased total mortality rates. Compared to those consuming the lowest carbohydrate, those in the highest quintile had a striking 30.8 % increased risk of cardiovascular disease and a 75.6 % increased risk of total mortality.

The conclusions of the authors of this new study tell the whole story; “In conclusion, we found that a high carbohydrate intake was associated with an adverse impact on total mortality, whereas fats including saturated and unsaturated fatty acids were associated with lower risk of total mortality and stroke.”

“Low-fat” had to result in “high carbohydrate”.  Humans had historically consumed only about 35-40% of their energy from carbohydrate.  In the last 100 years this has ballooned to 55-60%, an almost doubling while our metabolic “wiring” has not changed.  We have been trying to consume a diet that is incompatible with our physiology and the results been unfortunate.  Change needs to occur.  

Our blind faith that medical advances can outstrip the negative effects of human dietary behavior is proving wrong.  Unquestionably, medical therapy does help delay the adverse effects of poor diet, but it does not prevent the eventual outcome.  Good medical care can push back the complications of diabetes and overweight/obesity.  This is tempered by the fact that the average age of onset of many diseases such as diabetes have plunged.  While diabetes treatment may push back the development of complications of the disease by 15 years, the age of onset has dropped 16 years since 1970.  That math affects mortality plain and simple.

The authors final conclusion says it all: “Global dietary guidelines should be reconsidered in light of the consistency of findings from the present study, with the conclusions from meta-analyses of other observational studies and the results of recent randomised controlled trials.”  Low-fat/high carb was a grand experiment whose unfortunate outcome has cost a high price.  Time to put the final nail in and move on.

  1.    Ford, E. S. et al.  Coronary Heart Disease Mortality Among Young Adults in the U.S. From 1980 Through 2002: Concealed Leveling of Mortality Rates .J Am Coll Cardiol 2007;50:2128-2132.     
  2. Deghan et al.  Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study.  Lancet, 2017; 390: 2050–62.

Thursday, January 11, 2018

A Simple Step to Improve Diet, Weight and Mental Health

Human behavior can be a funny thing.  At times it is so complex, yet some very seemingly simple things can change it in positive ways.  A new study looking at one simple logistical factor about eating has demonstrated this point well.  The complex part of human behavior examined was trying to change eating and activity behavior to a healthier pattern. 

Almost endless government and other organizational guidelines have had little success in that area.  The same for public service messages, public health programs and more.  
This is where a very simple answer has performed better.  The study looked at the relationship between eating meals as a family during adolescence and in those who became parents during the next 17 years.  Participants were from mixed socioeconomic and racially/ethnically diverse households.

Both those who had regular family meals as adolescents and maintained that as young parents, and those who began the practice as young parents ate healthier foods, participated in more healthy weight-related behaviors such as exercise and had higher psychological well-being scores compared to those who reported never eating family meals together.

It appears that the family mutual support group reinforced by the simple practice of eating meals as a family has profound positive effects on health behaviors that a mountain of guidelines and policies have not accomplished.  Human behavior has always tended to have a “tribal” nature which is highly influential on all parties.  Try regularly getting your tribe together for meals.  It is not just an old custom but also a healthy behavior.

Berge et al.  Intergenerational transmission of family meal patterns from adolescence to parenthood: longitudinal associations with parents’ dietary intake, weight-related behaviours and psychosocial well-being. Public Health Nutrition, 2018;21:299-308. 

Wednesday, January 3, 2018

Why We use Whole Food Nutritional Supplements

The vast majority of nutritional supplements available are synthetically made.  Only a small number of companies offer supplements made primarily from whole foods in spite of several advantages associated with them.  I thought it would be appropriate to discuss the differences and particularly how these differences translate into different health outcomes.

First, it may be surprising to many that most supplements are synthetic.  This practice actually originated several decades ago from concerns about whole food sourced nutrients, concerns that we now know were unfounded.  These concerns centered around the idea that plant nutrient content can vary according to the conditions the plants are grown in.  With reasonable varying growth conditions, plant nutrient levels remain within a reasonable range.

To eliminate this varying but reasonable nutrient range, the idea of making nutrients synthetically emerged.  Unfortunately, it generates far greater variability in nutrient content and health impact than what it was supposedly trying to avoid.  The variations from whole food nutrient content that synthetic supplements create include:
  •  They are incomplete micronutrients.
  • They are devoid of the phytonutrients that always appear with micronutrients in whole food.

Incomplete micronutrients

There are 28 essential micronutrients such as vitamins and minerals.  This means that humans cannot make them from other food substances and that they must be obtained directly from food.  However, different micronutrients are “complexes” containing multiple parts.  Vitamin E is an example containing 8 tocopherols.

Unfortunately the FDA decided since the biggest piece of this 8 piece complex was alpha tocopherol that for the purpose of making a supplement, only alpha tocopherol could be included and yet it could be called “vitamin E”.  A tipoff that a supplement is a synthetic is that there will be a second term in the name which describes the synthetic form such as “d-alpha tocopherol succinate”.  This is 1 piece of the 8-piece complex made synthetically.

The collective group of tocopherols generate the health effects.  For example, different tocopherols in the group have different antioxidant properties and different abilities to suppress HMG CoA reductase, the enzyme that increases cholesterol production in the liver.  The best balance of these effects appears to come from the whole complex of tocopherols.

Devoid of phytonutrients

Vitamins and minerals do not appear in nature by themselves but rather they always appear in complexes with several phytonutrients.  For example, ascorbic acid which is part of vitamin C complex always appears with the phytonutrients called phenolic compounds such as flavonoids.  Much of the benefit attributed to vitamin C is now thought to come from these phenolics.

The FDA has allowed synthetic ascorbic acid to now be called “vitamin C” even though it is devoid of this group of phenolics that always appear with it in whole food.  While there are 28 essential micronutrients in whole food, there are about 16,000 known phytonutrients all which impart health benefits.

Several of the large studies on the impact of nutritional supplements have suggested that they provide no significant health benefits.  Most notable were 2 different arms of the Physicians Health Study which look at many health outcomes related to several lifestyle factors.  The studies used 400 IUs of synthetic alpha-tocopherol and 500 mgs synthetic ascorbic acid over a 10-year period. The conclusions of these two studies were:

“In this large, long-term trial of male physicians, neither vitamin E nor vitamin C supplementation reduced the risk of major cardiovascular events.”

“In this large, long-term trial of male physicians, neither vitamin E nor C supplementation reduced the risk of prostate or total cancer.”

These results are in contrast to many studies that look at obtaining these nutrients in greater amounts from whole food diets which have shown consistent improved health outcomes, outcomes which have been attributed to their nutrient content.

So, what generated the stark difference in the clinical trials that have looked at the benefits of nutrients in disease prevention and treatment?  It appears to be the difference in the effects between whole food complexes and isolated synthetic nutrients.  Whole food supplements are natural, complete nutrient complexes with superior health benefits. 

Sesso et al.  Vitamins E and C in the prevention of cardiovascular disease in men: the Physicians' Health Study II randomized controlled trial.  JAMA, 2008;300(18):2123-33.

Gaziano et al.  Vitamins E and C in the prevention of prostate and total cancer in men: the Physicians' Health Study II randomized controlled trial.  JAMA, 2009;301(1):52-62

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