More data from the Women’s Health Initiative study that shows restricting fat is a fat lot of good
Posted on 30 July 2008
Published July 30, 2008 . Filed under: Diabetes/Metabolic Syndrome, Healthy Eating, Low-Carbohydrate/Carbohydrate Restriction, Weight Loss, Women's Health
bit of a cross post, but i thnk it is fair to say there is plenty of evidence that a diet low in saturated fat can reduce CHD.
in the context of diabetics, it’s no surprise that weight loss is key to controlling typeII diabetes – but the other known health benefits to a low fat, ‘mediteranean’ type diet are important reasons to consider this diet.
And it is interesting that Tinker et al do not seem to actively recommend a high fat diet.
Some peer reviewed evidence from the literature…..
Mead et al, J Hum Nutr Diet. 2006 Dec;19(6):401-19.
This review concludes
July 30, 2008 @ 1:46 pm
Given the comments following this article below on the Israeli study, we can divide opinion in to those who follow a paleo style diet (who have low body fat and reduced risk of a whole host of ‘Western’ diseases), and those who simply refucse to acknowledge that the low fat/refined carbohydrate argument is a busted flush. Sadly those in the latter group include a sizeable portion of th emedical establishment, advisory groups (such as the BHF and various diabetic groups), and others who profit from the business of sickness.
http://tierneylab.blogs.nytimes.com/2008/07/21/good-news-on-saturated-fat/
There’s none so blind as those that will not see.
July 30, 2008 @ 3:01 pm
superburger
What you’ve offered here in support of your assertion that “there is plenty of evidence that a diet low in saturated fat can reduce CHD” are opinions and conclusions, but it’s the studies that these are based on that count.
Can you provide the actual evidence?
July 30, 2008 @ 3:42 pm
dr briffa,
I’m confused. You don’t think that the authors of these (peer reviewed) papers base their conclusions on evidence?
To pick one example, do you think Hooper (the cochrane paper) was wrong to draw the conclusion that
“….Cutting down how much fat we eat or replacing some saturated (animal) fats by plant oils and unsaturated spreads may reduce risk of heart disease, probably including fatal heart disease…..”
based on the analysis of the 37 pieces of work that fitted the previously defined selection crtieria.
Would you draw a different conclsion?
July 30, 2008 @ 4:23 pm
superburger
There’s really no reason for you to be confused: You’ve made a claim that “there is plenty of evidence that a diet low in saturated fat can reduce CHD” and I’m asking for is for you to verify this assertion with actual studies (not conclusions or opinions).
Tell me if you think that’s too much to ask.
July 30, 2008 @ 4:31 pm
I’m also confused. These are conclusions drawn from the research carried out in the listed papers. The actual studies are listed for those who wish to delve into the details of the stats. Where’s the problem?
July 30, 2008 @ 4:47 pm
Rich Scopie
There’s no need for you to be confused either Rich: superburger made a claims but has not provided the evidence to support it (just opinion at this stage). It’s not very scientific, is it?
Can you do any better, or are you content just to hold up opinions and conclusions without actually citing the science on which they are based? Because if you and superburger can’t cite the actual evidence, then the opinion and conclusions you appear to be happy to rely on don’t count for much.
Let’s not go around and around in circles: either quote the actual studies (either of you) or this will be the end of this particular discussion.
July 30, 2008 @ 5:57 pm
Perhaps Dr B you’d like to explain why you think a meta-analysis is not evidence?
July 30, 2008 @ 8:07 pm
“These are conclusions drawn from the research carried out in the listed papers.”
Citing the conclusions of researchers rather than data itself as proof does not take into account researchers who misinterpret the data because of preconceived beliefs about what it should show (happens all the time), the funding source of the research (which tends to want certain outcomes and influences researchers to interpret the data in ways favorable to the funder), how the study was set up, how long it lasted, whether it was a double-blind study, and so forth. In other words, don’t trust the conclusions of researchers in lieu of studying the actual data and having the know-how to interpret it. Dr. Briffa is asking for the facts themselves, not what someone thinks about the facts.
July 30, 2008 @ 8:22 pm
ross
“Perhaps Dr B you
July 30, 2008 @ 8:41 pm
July 30, 2008 @ 9:09 pm
ethyl-d
did you read the statement from the cochrane library about the purpose of systematic reviews? The aim is precisely to avoid the problems you allude to.
Dr briffa the Hooper meta-analyis is evidence that, if one considers the 27 RCTs which fitted the selection criteria (which I assume you agree are fair)
Table 2 in the paper lists the results of the meta-analyses, and the statistical test applied (assume you don’t disagree with these).
The conclusions are based inter alia, on these data.
Nothing particularly challenging in seeing how Hooper et al arrived at their conclusions.
Dr Briffa – lets try the yes/no asnwer approach.
do you agree with the conclusions of Hooper’s meta-analyis. Yes or No?
July 30, 2008 @ 9:26 pm
superburger and ross
In reference to post 11.
What in the summary ross has kindly provided for us do you think supports superburger’s assertion that “there is plenty of evidence that a diet low in saturated fat can reduce CHD”? The results were, to put it kindly, dismal.
I suppose it’s also worth pointing out that the review included studies where a reduction in saturated fat was not the only dietary modification. Also included were studies which did not even specifically restrict saturated fat.
I’m just not seeing how this meta-analysis can therefore be used to support superburger’s assertion that “there is plenty of evidence that a diet low in saturated fat can reduce CHD”? Which is why I asked for the specific studies, because clearly you are both seeing something I’m not.
July 30, 2008 @ 9:47 pm
Superburger,
I’m a US resident and I am on the receiving end of a lot of advice to follow a “Mediterranean diet”, whatever that is. The descriptions of that mythical diet bear little resemblance to reality. The diet that is typically described as “mediterranean”, i.e., lots of starch from pasta, bread, and legumes, and minimal meat and saturated fat, not only inaccurate, it is merely less sickening than the Standard American Diet, IMO.
This was especially apparent to me just this month, when I spent a bit over two weeks in Italy. I generally pay close attention to my diet because I tend to run higher and erratic blood glucose levels in response to eating sugars and starches, especially grain flours (even whole grain). If I avoid these BG/insulin spiking foods, my BG remains normal and fairly steady and I can avoid taking diabetes medications or insulin. I also maintain a normal weight range with this carb restricted (but not calorie or fat restricted way of eating). I do try to keep PUFAs low overall, particularly from industrial seed oils), in fact my weight and overall health improves the more naturally saturated fat I eat, because it is a good form of energy for me. My HDL/tryglyceride ratio has improved on this diet, though I do not have low cholesterol (nor would I want it as low chol is associated with cancer, dementia, and overall risk of early death). Additionally, my LDL is the light fluffy kind, not the small dense kind associate with CVD. So I don’t worry about cholesterol for a number of reasons, especially since the evidence linking cholesterol levels to CVD is so incredibly weak.
While in Italy, I shopped for food in ordinary small-town grocery stores and Siena’s outdoor market the first week while I stayed in a rural farmhouse agriturismo apartment and prepared meals for myself and my family. The grocery stores had abundant produce (however, too much was imported, underripe, or past freshness, to my surprise) and I observed a lot of processed convenience food being purchased by ordinary Italian families. We bought very nice free-range eggs from the farm where we stayed, where chickens were free to roam a large penned area and eat grasses and bugs. I mainly purchased and prepared easy meals made with fresh produce, some traditionally cured meats, fresh sausages, cheese, olive oil and vinegar dressing, butter, and eggs from the farm where I stayed, which is a pretty highly saturated fat diet and *very traditionally Italian*, therefore very Mediterranean as far as I can tell. We weren’t near the coast, so I didn’t prepare any fish. Oh yes, we enjoyed a bit of local red wine every day, too, and a fair amount of espresso with heavy cream or whole milk. I consumed no grains and only a minimal qty of refined sugars (my indulgences were some 70-85%dark chocolate squares and locally made gelato). My BG remained in my normal range, except for a few slight blips up after gelato. I even felt like I might have lost a few pounds while enjoying the bounty of the Tuscan countryside, despite a lot of time relaxing by the pool reading and leisurely strolls on the rural road (far less activity than I am accustomed to), plus a bit of touring of the hill towns center squares and museums, etc.
The second week I spent in Italian cities, without kitchen or food prep options. I walked a lot, sometimes briskly, sprinted for Metro trains, and climbed many, many stairs, often two at a time (hotel rooms on 3th and 5th floors, which really means 4th and 6th). So I would say my activity level, while not “gym” strenuous, was not nearly as leisurely as the previous week.
Our hotels provided a “continental” breakfast at a nearby caf
July 31, 2008 @ 4:08 am
Oh yes, I almost forgot the Cortadella, a very traditional Italian dish of lamb offal (heart, kidney, liver, and lung. We were clearly the only tourists at that restaurant, where they specialize in the “fifth quarter”. No one mentions those dishes when they talk about the lauded “Mediterranean diet”.
July 31, 2008 @ 4:19 am
Dr B, are you going to respond to superburger’s question?
July 31, 2008 @ 1:59 pm
Perhaps you could also explain why you think that a single study is evidence but a study of studies isn’t?
July 31, 2008 @ 2:01 pm
Dr B,
The Womens health Initiative intervention group not only reduced intake of (“harmful”) saturated fats, but also reduced intake of monounsaturated and polyunsaturated fats, which are thought to be beneficial.
In your opinion, would this have had any impact on the outcome?
July 31, 2008 @ 3:24 pm
ross
What precise “conclusions” are you referring to?
And I think we all need to note your inability or reluctance to quote the actual evidence. And superburger remains quiet on this matter too.
July 31, 2008 @ 3:34 pm
Dr Briffa,
the evidence is the meta-analysis that Hooper et all perform on the 27 pieces of work which meet their selection criteria. To say that paper X from the 27 is the evidence of Y is not an appropriate use of the meta-analysis data.
The point (as you are well aware) is that the combined results (shown in table 2) are the basis for Hooper’s conclusion – it is a systematic review of the existing literature.
So, as enquiring minds want to know,
“Do you, or do you not agree with Hooper et al’s conclusions?”
July 31, 2008 @ 4:11 pm
superburger
What conclusions, specifically, are you referring to.
Also, could I ask you again to cite the evidence that supports your assertion that
July 31, 2008 @ 4:54 pm
The (plain language summary) conclusion which Hooper et al make is
“Cutting down how much fat we eat or replacing some saturated (animal) fats by plant oils and unsaturated spreads may reduce risk of heart disease, probably including fatal heart disease. Heart disease includes heart attacks, chest pain, strokes and the need for heart surgery”
do you agree with the methodology that Hooper et al emply. Yes or No?
do you agree with the results (e.g. table 2) shown by Hooper et al. Yes or No.
do you agree with the conclusions drawn by Hooper el al, as described in their review. Yes or no.
July 31, 2008 @ 5:17 pm
superburger
“Cutting down how much fat we eat or replacing some saturated (animal) fats by plant oils and unsaturated spreads may reduce risk of heart disease, probably including fatal heart disease.”
Yes, it “may” do, and then again, it may not. And the reason is the results of this meta-analysis were dismal. Once the Oslo Heart Trial was excluded, it showed (though you must know this, no?) no statistically significant reduction in risk of CV mortality, total mortality or CV events.
In studies over two years in duration, same results, but CV events were lower. Oh, but only those deemed at high risk (not those at moderate or low risk), and only in men (no data in women).
So, what in here, superburger, supports your assertion that:
July 31, 2008 @ 5:58 pm
Hmm how long has the low fat been around? How long ago did people start getting fat? How long ago did diabetes start climbing? After 3 mild attacks doing low fat/veggie eating I’m enjoying my steaks n eggs and keep carbs <50 PER DAY….1yr so far…
July 31, 2008 @ 7:01 pm
John Briffa said of superburger,
“It
August 1, 2008 @ 12:43 am
Superburger : Plant oils as sold in supermarkets for cooking (apart from olive)are plastic and found nowhere in nature. When hydrogenated they are actually saturated as hydrogen is stuck onto the free bonds. Spreads are even worse and will block arteries and cause cancer faster than anything.
You keep quoting from a particular source as if that source is definitive proof. There are different sorts of sat fats. In fact coconut oil is highly saturated but with medium chain fatty acids and is one of the best oils.
August 1, 2008 @ 12:12 pm
Hilda says:
Superburger : Plant oils as sold in supermarkets for cooking (apart from olive)are plastic and found nowhere in nature. When hydrogenated they are actually saturated as hydrogen is stuck onto the free bonds. Spreads are even worse and will block arteries and cause cancer faster than anything.
You keep quoting from a particular source as if that source is definitive proof. There are different sorts of sat fats. In fact coconut oil is highly saturated but with medium chain fatty acids and is one of the best oils.
August 1, 2008 @ 12:12 pm
August 1, 2008 @ 12:12 pm
Personally I would appreciate seeing a tabulated comparison of what we know a low fat diet doesn’t do as against what a high carb diet does do?
August 1, 2008 @ 2:21 pm
I have posted this before – but here we go again. About two years ago I gave up a decade of vegetarianism and went ‘paleo’. My body fat has fallen to well under 10%. I sustain this with ease. I no longer get ‘hunger-shakes’ unlike when I was a grain eater. When I eat, I eat until I am full. I don’t do calorie counting or that whole dieting and chronic hunger thing.
In a typical week I will eat a whole (free-range) chicken, saving the juices and using the fat for frying and the rest of the juice as a stock for soup. I also put away two large steaks (grass fed beef), a pack of lamb’s liver, a pack of bacon, upto 12 eggs, about 10 tins of tuna/sardines/mackerel. In addition I will eat a mix of barzil, pecan, walnut and almond nuts most days (this actually forms a ‘meal’ along with some fruit). Each meal of meat is accompanied by some veggies – broccoli, caulifllower etc.. and the fish is usually eaten with a salad. I moderate fruit consumption.
What I want to emphasise here is the meat content of my diet (inclujding the chicken juices) and the absence of bread, rice, pasta, cereal, grains and potatoes. After a year of eating this way I went for a cholesterol test (judged against the Framingham templated), the results of which the doctor described as “excellent”.
I know that dietary choesterol is of little significance to your cholesterol levels, but I went for another test today as it is now about two years since my adoption of a paleo diet. I get the results on Tuesday and will post them on here.
August 1, 2008 @ 6:15 pm
All supporters of the low fat diet way of eating need to remember one thing. That our bodies are actually made up of guess what yes saturated fat!! what is natural & normal is good for us. huge amounts of grains & starches (sugars) aren’t. get over it, but by all means eat it if that is what you want. just don’t expect those of us who would rather eat grain & starch free diets to follow you down the path of obesity, heart disease, cancer & diabetes problems that the resulting low fat diet experiment over the last 30 to 40 years has produced. Now there’s a meta analysis for you the human population over the last 40 years eating the low fat diet way!!
August 4, 2008 @ 9:21 pm
Well I went low carb and it made me feel ill and full of wind! I wonder, are there any studies comparing gender differences in response to low carb diets? I think women need carbs more than men and are not so happy to eat a lot of meat. Am I correct in thinking that carbs help to create serotonin, so that low carbs means low seratonin levels?
August 4, 2008 @ 11:04 pm
My results were ‘normal’ with no further action necessary:
Serum Cholesterol 4.8
Triglycerides: 0.5
So two years in to eating a chicken (including the skin), a couple of steaks (including the fat), 8 rashers of bacon (fried in the chicken fat saved from the fowl above), one lamb’s liver and upto 12 eggs a week I have a normal cholesterol level and body fat well under 10%. I should also point out that I do not eat whole grains, pasta, rice, cereal, bread or potatoes.
I can’t understand how my diet can go against the advice from the BDA, BHF, NHS and AHA, yet my health is so good. I hope that any readers from these esteemed organsiations can explain these seemingly contradictory results.
August 5, 2008 @ 6:34 pm
SkepTicTacToe said,
“My results were
August 6, 2008 @ 10:00 am
“Well I went low carb and it made me feel ill and full of wind!”
It’s always amazing to me how many people “think” they went low carb, but actually didn’t (still consuming well over 75 gms or more of CHO per day, or LC one day, not LC the next because there was birthday cakes or something silly like that). Or that they lowered carbs for a few days or even a week or two, without realizing that the body needs a fair amount of time to convert over to burning fatty acids for fuel most of the time, instead of rarely. It is not uncommon to feel a bit out of sorts for 3-4 weeks while the metabolism makes the fuel transition. Here’s a link for an explanation of some research on this: www dot nutritionandmetabolism dot com/content/1/1/2
My husband and I actually find the “wind” increases *with starch* consumption, after our years of LC eating (I can always tell when he eats the bread at dinners out). My guess is it is due to not having the starch enzyme (amylase) production up during our regular LC diet, because it isn’t often needed in qty.
For those who tend to not eat much of the non-starchy foods, it might take time to get lipase, etc. in sufficient production, with “wind” to deal with in the transition. Use it or lose it, in essence. But it does come back, with sufficient demand.
August 6, 2008 @ 5:26 pm
Cybertiger, I broadly agree with you. IIRC Triglyceride levels and LDL Sub-type B cholesterol levels are the main indicators of risk of CHD.
As for my results – they are presented exactly as the doctor’s receptionist fed them back to me. I can’t really expand on them much more, other than to say that they compared my results against the Framingham template and in doing so, concluded that my levels were ‘normal’ – whatever that means.
I only took a cholesterol test to reassure those around me (who think I am a endangering my health by eating ‘paleo’ ), that the medical establishment may not agree with my diet, but by their own indicators, I am healthy.
August 8, 2008 @ 8:39 am
Dr Briffa,
Two questions:
I notice that many of the studies you’ve been citing (in fact, most studies of this sort) refer to weight loss and BMI but not to waist-hip ratio. I vaguely recall that in fact you’ve been a proponent of waist-hip ratio as a better indicator of health than absolute weight or BMI. Is that now yesterday’s theory, or is it just that waist-hip still hasn’t caught on, and we make do with what scientific research we can get?
My other question is about food combining. You haven’t said much about it over the past few years, but your last post suggested that anecdotally it could help those with indigestion. It does strike me that food combining has some similarities to Atkins, in that it supports a diet high in fat and protein – but restricts carbs to meals which do not include fat and proteins. Has anyone tried comparing these two diets to other diets, and indeed controls? Although current theories about GI/GL would suggest that food combining would only help for the carb-free meals, I wonder whether anyone has actually tested this. Most of the carb-heavy meals in conventional diets are high in fats (e.g. pasta with olive oil-based sauce) and would not be a good test of food combining theory.
Thanks,
JL
August 9, 2008 @ 7:39 am