The American Heart Association, American College of Cardiology, et. al. issued new clinical practice guidelines for the management of blood cholesterol. This revision makes progress; it individualizes care and softens some recommendations surrounding obligatory use of statins for primary prevention. Cardiologist Bret Scher takes a look at the detailed new guidelines and gives us his impressions about what they get right and where there is still room for improvement.
Newspaper headlines about the lifesaving potential of a tax on red and processed meat were plentiful last week, thanks to a thought-experiment-turned-modeling-study out of the University of Oxford, published in PLOS. A meat tax is based on the idea that red meat contributes to increased rates of chronic disease. This hypothesis relies on weak epidemiological evidence, a type of evidence that needs to be tested in randomized clinical trials to establish causation. These trials have never been conducted. There are other problems with the idea of a meat tax, like its regressive nature and likely unintended consequences.
The American Diabetes Association (ADA) and the American Heart Association (AHA) are teaming up to bring the connection between diabetes and heart disease into focus. The joint initiative, “Know Diabetes by Heart,” was launched last Thursday, with its own, dedicated website, including resources for patients and practitioners. Given the ADA’s medication-heavy leanings, we were not surprised that the new initiative’s sponsors — all large pharmaceutical companies — are featured prominently on the “Know Diabetes by Heart” website. Notably missing from the new website is any mention of how, for many or even most motivated patients, a low-carb diet can reverse type 2 diabetes while at the same time improve cardiovascular risk factors.
The Milken Institute, a non-profit, non-partisan think tank, released a report on the real economic costs of obesity and overweight in the United States. The estimates in the report include both direct health care costs that are caused by obesity and overweight, and indirect costs associated with lost productivity borne by patients and their employers. The total number is staggering: $1.72 trillion each year. Separately, an Atkins-funded policy paper suggests that if just 20% of patients with type-2 diabetes improved their condition with low-carb nutrition, the annual savings would approximate $10 billion.
In a show of knee-jerk support for all things mainstream, Sarah Bosely, the health editor of The Guardian, pens an opinion piece, “Butter nonsense: the rise of the cholesterol deniers.” Cardiologist Bret Scher unpacks Bosely’s article, pointing out that silencing healthy debate and ignoring the nuance and complexity revealed by the entirety of the scientific record isn’t the way to go, either.
Dr. George Lundberg, a self-described “ultimate [medical establishment] insider” and former (longtime) Editor-in-Chief of the Journal of the American Medical Association (JAMA), recently issued a Medscape opinion piece entitled, “Could it be the sugar?” In it, Lundberg explains: “The next and current big battle is over diabetes mellitus, insulin resistance, and obesity. How are they related? What can be done to stem the worldwide epidemic and prevent it from worsening? The stakes are very high, including the lives of millions of human beings and hundreds of billions of dollars.” You can watch the 7 minute video or save a little time and read the transcript provided.
A new study, published in Cell Metabolism, looks at the “metabolome” — a collection of metabolic markers in blood — and finds that it is more powerful than weight for predicting future metabolic health. “Normal weight individuals with an unhealthy metabolome ‘had a 50% greater chance of becoming obese over the next ten years and had a 200-400% increased risk of heart disease’ [than those with a healthy metabolome]. They also found that overweight individuals with normal metabolome blood tests were at a much lower risk for insulin resistance and heart disease.”
In a widely reported anti-obesity move, the New York City Health Department (NYCHD) intends to lead a voluntary campaign to get food and beverage companies to reduce the amount of sugar in their products. Specifically, the NYCHD will seek a commitment from food manufacturers to reduce average sugar levels in packaged foods by 20%, and a commitment from beverage manufacturers to cut sugar in sweet beverages by 40%.
CNN reports on a detailed study, published in The Lancet last week, forecasting life expectancy changes across 195 countries between 2016 and 2040. Spain is predicted to edge out Japan for the longest lifespan — 85.8 years. Study authors believe the United States is likely to fall from 43rd to 64th place in the rankings of high income countries. The authors note that although most drivers of health are forecast to improve, “for some drivers such as high body-mass index (BMI), their toll will rise in the absence of intervention.”
The FDA makes it official, finalizing the complete elimination of artificial trans fats from America’s food supply. Politico reports that the FDA will “revoke all prior sanctioned uses” of partially hydrogenated oils.
Very good news. The American Diabetes Association and European Association for the Study of Diabetes added a new therapeutic option for patients with diabetes: a low-carb diet. This change serves as an official acknowledgement of the strong evidence in the literature for the effectiveness of low-carb and ketogenic regimens in the fight against diabetes.
Another new, pro dairy fat review hits, this one out of Tufts. It shows an association between higher rates of dairy fat consumption and lower rates of type 2 diabetes. Senior author Dariush Mozaffarian states, “Our findings, measuring biomarkers of fatty acids consumed in dairy fat, suggest a need to re-examine the potential metabolic benefits of dairy fat or foods rich in dairy fat, such as cheese.” Note that this study was a large, observational analysis (a meta-analysis of prospective cohort studies), so causation is not shown. A smaller analysis that linked more dairy fat with less CVD and stroke made headlines in July.
Doctors in Canada publish a case report documenting how three men with type 2 diabetes used intermittent fasting to eliminate insulin and most other medications, while also improving their blood sugar control. The subjects fasted for 24 hours 3-4 times per week. On other days, they practiced time-restricted feeding, eating only lunch and dinner. Patients were monitored and medications were withdrawn under close medical supervision. This is another example of the power of diet, not drugs, to reverse type 2 diabetes.
Dr. Georgia Ede pens a thought provoking piece for Psychology Today entitled "Obesity: Stop shaming, start understanding." In it, she fingers insulin resistance as a root cause of obesity, and encourages readers to be curious enough to take a second look at the not-so-plausible mainstream assumptions about overweight and obese patients. Ede includes a companion piece for doctors where she asserts that a better understanding of insulin resistance is critical for improved patient care.
A new review, published in Molecular Psychology, analyzed 41 observational studies, and finds that subjects eating a Mediterranean-style diet experienced lower rates of depression. The study also finds that those eating other diets (characterized as either anti-inflammatory by the Dietary Inflammation Index or conforming with the Healthy Eating Index) also experienced lower rates of depression. Observational, of course, but interesting.
Both The Atlantic and The New York Timescover the latest scandal in nutrition research. High-profile and prolific Cornell Food Lab scientist Brian Wansink resigned after serious questions emerged about the scientific integrity of his work. Journals retracted over 13 of his papers. How many other researchers might also fail the careful scrutiny that Wansink received? How do we know which nutrition research should be believed?
Are there "major doubts" about the safety of keto? In spite of clickbait news headlines, there is no convincing evidence that eating carbs makes you live longer. Clinical trials show improvements in outcomes for those reducing carbohydrate intake.
The diabetes epidemic rages on, as evidenced by the numbers in the new report based on National Center for Health Statistics data, released this week by the CDC. A shocking 14%of American adults have diabetes. In 2014, this rate was pegged at 12.2%. Rates are worse among men (16% vs. 12% for women); worse among those over 60 (28%); worse among Hispanic Americans (20%); worse among those with obesity (21%).
Last week, The Houston Chronicle ran a bold opinion piece by cardiologist Bret Scher favoring low-carb diets and debunking the purported heart health risks of eating red meat.
The Wall Street Journal runs an op-ed entitled "Carbs, Good for You? Fat Chance!" by NYT bestselling author Nina Teicholz on the harm done by the recent observational study published in Lancet Public Health (and the misleading headlines that followed). She writes, "defenders of the nutrition status quo continue to mislead the public and put Americans’ health at risk." For a longer, fully referenced piece, check out Teicholz's Medscape article.
More PURE results, this time on whole fat dairy foods, are published this weekin The Lancet. This observational data shows better health outcomes for those who ate more full-fat dairy. Both The New York Timesand Newsweeksummarize the questions raised by the study. The American Heart Association's dogmatic response is captured in MedPage: "Currently with the evidence that we have reviewed, we still believe that you should try to limit your saturated fat including fat that is coming from dairy products." #WillfulBlindness
The Guardian reports that Britain's NHS will begin a staged rollout of a trial prescribing a very low-calorie liquid diet to reverse diabetes. While It is terrific to see physicians and health systems treating type 2 diabetes as a reversible condition rather than a progressive chronic disease, remission with this approach is highly dependent on maintaining weight loss. Over the long term, maintaining weight loss by restricting calories has a very poor track record indeed. What makes more sense for reversing type 2 diabetes? Carbohydrate restriction.
The CDC updates obesity data. What's the number? Forty percent. 40% of US adults age 20-74 were obese in 2016. That number, in 1960, was just 13.4%. For children, between 2014 and 2016, both overweight (16.6%) and obesity (18.5%) continue to rise... across all age groups and both genders, with one exception — teenaged girls saw a slight improvement.
The New York Times investigates an all-too-common problem in science: that could bias authors' perspectives. "One of the world’s top breast cancer doctors failed to disclose millions of dollars in payments from drug and health care companies in recent years, omitting his financial ties from dozens of research articles in prestigious publications like The New England Journal of Medicine and The Lancet." Corporate influence is a huge problem affecting not just drug studies, but nutrition research as well.
The U.S. Departments of Agriculture and Health and Human Services seek nominations for the 2020 Dietary Guidelines Advisory Committee. What can we do to encourage a seat at the table for a member of the low-carb community?
Dr. George Lundberg, "ultimate insider" and former (longtime) Editor-in-Chief of JAMA, delivers an 8 minute soliloquy entitled "It's Not the Fat That Makes Us Unhealthy." How the mainstream medical and public health communities got it wrong.
Gary Taubes explains an emerging technique called Mendelian randomization, which uses genetics to mimic clinical trials. This number crunching tool could save researchers the time and expense of drug development and RCTs testing a promising association—like higher HDL and less CVD—that genetics can tell us is unlikely to be causal.
Stanford scientist John Ioannidas calls for radical reform of nutritional epidemiology in this viewpoint piece published in JAMA. "[S]tudies of nutritional epidemiology continue to be published regularly, spuriously affect guidelines, and confuse the public through heated advocacy by experts and non experts," writes Ioannidas.
The Guardian runs an op-ed by George Monbiot that sets out to debunk many of the common myths about obesity."It’s not that we’re eating more, that we exercise less, or that we lack willpower. The shaming of overweight people has to stop."
A new, large cohort study of Swedish patients with type two diabetes finds that managing five risk factors—elevated glycated hemoglobin level (HbA1c), elevated low-density lipoprotein cholesterol level, albuminuria, smoking, and elevated blood pressure—into the normal range eliminates most excess risk for illness and death. Treating patients with diabetes with a low-carb diet has been shown to normalize HbA1c and blood pressure in RCTs.
Does carefully following our Dietary Guidelines for Americans (DGA) work to improve blood sugar control and blood lipids? This 8 week RCT, testing a near-ideal DGA diet versus a typical American diet, suggests the answer is "NO." "Fasting insulin, glucose, triglycerides, oral-glucose tolerance, and indexes of insulin resistance were not affected by either of the diets." The only improvement was a reduction in blood pressure.
Cutting back on salt? Why bother? MedPage reports that new PURE study results, published in this week's The Lancet, show, for those consuming less than 4g sodium/day, reducing salt is associated with MORE heart events. (Average US consumption is 3.4g/day.)
NYT reporter, Anahad O'Connor, reports on another dietary advice switcharoo. The American Heart Association rolls back its longstanding advice to eat a variety of foods. Now, its researchers recommend a focus on quality and less worry about variety. Because sometimes, more variety means more bad choices.
Stanford Medicine announces results of a stunning new study showing diabetic-level blood sugar excursions in healthy volunteers. The study utilized CGM (Continuous Glucose Monitoring) technology to document post-meal blood sugar levels. Senior author, Dr. Michael Snyder, explains: “We saw that some folks who think they’re healthy actually are misregulating glucose — sometimes at the same severity of people with diabetes — and they have no idea... We saw that 80 percent of our participants spiked after eating a bowl of cornflakes and milk. Make of that what you will, but my own personal belief is it’s probably not such a great thing for everyone to be eating.”
New York Times reporter Anahad O'Connor takes a look at time restricted feeding, also known as intermittent fasting. His piece, "When We Eat, or Don't Eat, May Be Critical for Health" explores the growing body of research that suggests we experience better health when we align our eating patterns with our circadian clocks. Hint: no more bedtime snacks.
Nippon reports that a survey conducted by Japan's Ministry of Health, Labor, and Welfare found record levels of diabetes. Among Japanese adults, 16.1% of men and 9.3% of women have diabetes. Note that the article incorrectly states, "Once a person has contracted diabetes there is no cure." Experts now believe that for many patients with T2D, carbohydrate restriction can resolve their condition.
A new Cochrane systematic review shows that fish oil (Omega 3) supplements do NOT improve health or longevity. The review encompassed 79 randomized trials and included over 112,000 subjects. Lead author Dr. Lee Harper states, “The review provides good evidence that taking long-chain omega 3 (fish oil, EPA or DHA) supplements does not benefit heart health or reduce our risk of stroke or death from any cause. The most trustworthy studies consistently showed little or no effect of long-chain omega 3 fats on cardiovascular health."
Fiona Godlee, editor in chief of The BMJ, pens an op-ed entitled "Pills are not the answer to unhealthy lifestyles." In it, she writes, "... Pills can’t be the answer to diseases caused by unhealthy living. As well as unsustainable cost for often marginal benefit, they always cause harm. Rather than medicating almost the entire adult population, let’s invest our precious resources in societal and lifestyle change, public health, and prevention." Amen.
Stanford scientists John Ioannidis and John Trepanowski write a prescription for improved nutrition research in review journal Advances in Nutrition. A key recommendation is pooling resources for larger randomized trials. "Pivotal megatrials with tens of thousands of participants and lifelong follow-up are possible in nutrition science with proper streamlining of operational costs."
Not all carbs are created equal. Harvard's prolific Dr. David Ludwig illuminates the connection between carbohydrate quality and health, this time in BMJ. A key message: "Replacing processed carbohydrates with unprocessed carbohydrates or healthy fats would greatly benefit public health."
The BBCruns a 5 minute feature on UK Deputy Labor Leader Tom Watson, who has lost 96 pounds in eleven months by cutting out sugar and starch and eating more fat. Given his personal transformation, Watson asks if government should be giving dietary advice when there is such scientific controversy surrounding nutrition.
One of the world's leading oncologists, Dr. Siddhartha Mukherjee of Columbia University Medical Center (and The Emperor of All Maladies fame), set to launch human trial of ketogenic diet therapy as an accompaniment to drug therapy in specific types of cancer treatments. Recent mouse studies demonstrate the efficacy of administering ketogenic diets—which lower insulin levels—while treating some types of cancer.
Are ketones the "fourth macronutrient" and can a ketone supplements make you run faster? Runner's World reports on the trendy ($99 for three 2.2oz bottles) supplement. Warning: "I liken the flavor to a mixture of raspberry-flavored vodka, cough syrup, and nail polish remover; others have described it as a mix of rubbing alcohol and toilet cleaner with a hint of fruit."
FDA Commissioner, Scott Gottlieb, announces new steps to improve health through nutrition. The FDA reportedly regulates 80% of America's food supply, so potential to make a difference seems real. But announcement underwhelms, with bureaucratic double-speak and little, if any, meaningful innovation. Dr. Gottlieb pins his "Nutrition Innovation Strategy" on modernized nutrition labels, better ingredient lists, and resolving issues of 'identity' (as in should an almond beverage be called "milk"). Public comments may be submitted and a public hearing is set for July 26.
Pittsburgh area politician, John Fetterman, loses ~150 pounds by cutting out sugar/grains and walking more. Will this mayor and Democratic nominee for LT Governor help bring the message of reducing processed sugar and starch for better health to the people of Pennsylvania?
Former FDA Commissioner, Dr. David Kessler, argues with food pundit Marion Nestle about what we really know about healthful eating: "I think we have failed in giving nutritional advice to people. If diet & exercise were the answer, we'd all do it & there wouldn't be a problem...I would try to get answers to very basic questions...Is a calorie a calorie?" Unfortunately, NuSI's crusade to address this sort of question has been diminished.
Professor Tim Noakes, a leading scientist in the field of sports medicine, acclaimed author of The Lore of Running, and now advocate for low-carb diets, was found innocent of endangering the public and unprofessional conduct for the second time. The Nutrition Coalition covers the ruling and the story behind it. Congratulations, Professor Noakes!
California mayor, Sean Wright, is sharing his success with a keto diet for weight loss, reversing prediabetes, and resolving fatty liver. He invites fellow residents of Antioch to learn more and join him in a journey to better health.
Problems with sugar start early and get worse. According to reports on a new CDC study, American toddlers build up to 7 teaspoons added sugar per day by age 2. "High amounts of added sugar can be hidden in seemingly healthy food: a single-size serving of yogurt with fruit at the bottom can contain up to six teaspoons of sugar. In a regular 8 ounce serving of apple or orange juice, there are 5.5 teaspoons of sugar, on average."
Author Nina Teicholz's op-ed in the LA Times asks why our government has enacted new regulations that require chain restaurants to post calorie counts on menus when the science doesn't support the notion that this will make a difference in the battle against obesity.
New study shows lifestyle advice to "eat less, exercise more" fails to meaningfully reduce the progression from prediabetes to a type 2 diabetes diagnosis.
A medical mystery: What happened to US healthcare spending, beginning around 1980? The New York Times documents how US spending has escalated relative to peer countries, but life expectancy gains have fallen behind. Could the low-fat, grain-heavy diet, introduced in the late 70s, be playing a role?
"Our livers are in trouble." Read more about The Hidden Liver Crisis in America and how a lower-carb, higher-fat diet can turn things around.
The New York Times (and MedPage) report on a new survey out of Boston Children's Hospital, published in AAP's Pediatrics, demonstrating exceptional glucose control in patients (both adults and children) with T1 diabetes consuming a very low-carb diet and using less insulin. These patients also report fewer adverse events like hypoglycemia. This was not an RCT, but is nonetheless very encouraging data that documents an otherwise unheard of phenomenon: normal blood glucose levels for those with Type 1 diabetes.
Given the failure of our national dietary prescriptions to reduce levels of chronic disease, it is no wonder that the "nutrition debate" continues. In the latest volley, nutritional epidemiologist Dr. Dariush Mozaffarian argues in the BMJ that nutrition science can indeed be relied upon to improve our understanding of the connection between food and health. But Gary Taubes and Nina Teicholz disagree, and make a strong case for "caution and humility" when interpreting epidemiological data for the purposes of population-wide dietary strategies for prevention of chronic disease.
On a related note, back and forth we go with epidemiological studies. The New York Times reports on a new Swedish analysis, published in Heart, which makes the case that when fully adjusted for confounding variables, nuts aren’t as heart healthy as previously reported. Case in point, the sameNYT reporter published an article entitled, "Nuts may lower your risk of heart disease" in November, 2017. Similarly, the Star Tribune reports that many older Americans are paying for vitamin supplements that may cause harm, as early exuberance for vitamins outpaces the evidence and consumers can't keep up with the ever-changing recommendations.
Virta Health, a Silicon Valley startup reversing type 2 Diabetes with a virtual clinic model and strict, low-carb diet, receives a shot in the arm from the VC community—$45 million in additional funding to help bring its model to scale. This is a strong endorsement of Virta's excellent results.
Can a healthier diet help battle depression? The Wall Street Journal reports on a new field: nutritional psychiatry. Recommendations center around replacing sugar and processed foods with real, whole foods.
A new, Czech epi study (a large-scale ecological analysis) of cardiovascular disease risk across 158 countries points the finger at dietary carbs, not fat. "Results... identify high carbohydrate consumption (mainly in the form of cereals & wheat) as the dietary factor most consistently associated with the risk of CVDs." For a thoughtful analysis of this study, see The Nutrition Coalition's post.
The CDC releases a new report on diabetes prevalence in US adults. The National Health Interview Survey was expanded to include questions about type 1 (0.55% of adults) vs. type 2 (8.6% or adults) and insulin status, so this report includes more robust information. Non-hispanic black adults have highest diabetes prevalence: 11.52%.
The "obesity paradox" is debunked once again. A large cohort study (of white Europeans) shows lowest risk of CVD events/death at BMI of 22-23. "Any public misconception of a potential ‘protective’ effect of fat on CVD risk should be challenged."
While on the topic of food and blood sugar management, Dr. Robert Lustig posts a pdf of a fantastic letter from a UK Member of Parliament to the British Prime Minister. The MP testifies to the potential of low-carb, full-fat eating for improved health, especially among citizens with diabetes. "My blood sugars are not only more stable, but I have managed to reduce my insulin requirements by almost 50%."
The New York Times reports on a new JAMA study (based on NHANES data) that confirms Americans are still getting heavier. Between 2007/8 and 2015/16, obesity rates among adults climbed from 33.7% to 39.6%. Meanwhile, The Hill reports on new data from NCHStats which shows that over the last 12 yrs (as obesity has escalated) more Americans are exercising. Now over 53% of American adults meet activity guidelines, versus just 41% in 2005. Something is not working, here.
This plate is very low carb and takes about 30 minutes to prepare the veggies. (Turkey roasting time varies depending upon size and method; a rotisserie chicken is a good substitute for a quicker meal.)
The NYT reports on a new comprehensive scientific review that found optimal protein levels for people over 40 trying to gain muscle mass are roughly twice our federal recommendations. And remember, many women do not even get the recommended level of ~46g/day.
A concise opinion piece by Ben Greenfield in The Hill on why the dietary guidelines are failing Americans, and why Congress needs to act to change them to align with modern science. Case in point, a retired special ops combat controller asks, in an op-ed in The Dallas Morning News, why so many of our troops struggle with weight? It's not lack of exercise. His answer? It's the food... controlled by our dietary guidelines.
A small clinical trial, ongoing in overweight men with recurrent prostate cancer, shows a keto diet leads to significant weight loss. At six months, patients averaged 28 lbs lost on keto versus 0 lbs in control group. BMI was reduced by an average of more than 4pts. Unclear if diet/weight loss deters cancer growth (trial ongoing). Similarly, a small prospective pilot study of patients placed on a 4 week ketogenic diet to prepare for bariatric surgery showed "highly significant decreases in body weight (− 10.3%, p < 0.001, in males; − 8.2%,p < 0.001, in females), left hepatic lobe volume (− 19.8%, p < 0.001)" and a resolution of micronutrient deficiencies.
A clinical report, published inCell Metabolism, finds that carbohydrate restriction delivers "rapid and dramatic reductions of liver fat and other cardiometabolic risk factors" in patients with nonalcoholic fatty liver disease (NAFLD). No pill can do this for you.
Diabetes, Obesity, and Metabolismpublished a study that demonstrates how fasting glucose creeps up gradually, often tied to chronic insulin resistance. Authors argue for early detection and intervention to prevent progression.