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.
Dr. David Ludwig pens a grim reality check on rising obesity rates in kids, published last month in Pediatrics. Ludwig writes: "The second, more fundamental lesson is that our public health approach to the epidemic has largely failed so far." Fortune reports briefly on the same study to which Ludwig was responding, which looks a NHANES data from 1999-2016.
The obesity paradox—the idea that obesity might protect patients with heart disease and help them live longer— has been debunked. The LA Times explains why a new study published in JAMA Cardiology demonstrates that excess weight can mean younger onset of CVD and, thus, fewer years of disease free life.
Looking for a comprehensive list of over 70 clinical trials that compare lower-carb, higher fat diets to higher-carb, lower-fat diets? This list was put together by Virta Health's Dr. Sarah Hallberg, and in virtually every trial, the lower-carb regimen does as well or better than the lower-fat arm on one or more of the following measured outcomes: weight loss, blood sugar control, and CVD risk factors. So for those who think lower-carb eating is just a fad, think again.
Which comes first? High insulin levels or obesity? A new genetic study from Dr. David Ludwig’s team shows high insulin levels predict weight gain, not the other way around.
Yale News reports on a new study, published in Cell, that “has identified leptin — a hormone made by fat cells — as a key mediator" in the body's switch from burning carbs to burning fat during fasting.
JAMA publishes an important summary of the growing interest in ketogenic diets for weight loss and type 2 diabetes in its theme issue, "Reimagining Obesity in 2018."
The Atlantic reports on a new study that illuminates the startling association between high blood sugar—INCLUDING pre-diabetic levels—and cognitive decline. Results suggest “Alzheimer’s is another potential side effect of a sugary, [starchy] Western-style diet.” Also this month, The BMJ published a new essay by Gary Taubes: “What if sugar is worse than just empty calories?” It explores the (still ambiguous) science and policy implications.
Time reports on a study that shows obesity shaves almost a year from US life expectancy. "Drug and alcohol abuse are often blamed for reductions in life expectancy... [but] the country faces multiple challenges when it comes to longevity and public health," including record rates of obesity.
Last week in The Globe and Mail, Gary Taubes asks if anecdotal evidence of the efficacy of low-carb diets should be taken more seriously, especially given the unfortunate across-the-board lack of rigorous science in the realm of nutrition.
In The Dallas Morning News, Dr. Jake Kushner asserts "Government is helping to feed the diabetes crisis in Texas," by perpetuating out-of-date, low-fat dietary advice. Kushner writes, "Despite all the new research exonerating fats and implicating carbohydrates, leading nutritionists refuse to reconsider entrenched norms of a healthy diet." Indeed.
Sugar industry deceit is back in the news. The New York Times reports that "the sugar industry funded animal research in the 1960s that looked into the effects of sugar consumption on cardiovascular health — and then buried the data when it suggested that sugar could be harmful, according to newly released historical documents." Forbes weighs in on the ethics of this intentional obfuscation.
A new study out of Washington University takes aim at ultra-processed food. "This review shows that ultra-processed foods, in particular products made from substances extracted from whole foods, particularly oils, flours and sugar, were not part of evolutionary diets and may be a main driver of malnutrition" including over-nutrition (obesity). Back to basic whole foods, folks.
Understanding the cancer-sugar-obesity link: The LA Times reports that science points to cancer risk resulting not just from eating too much (or weighing too much), but from eating too much refined carbohydrate, especially sugar. Fortune reports on a curious interaction between a cancer gene and a sugar molecule that may begin to explain how sugary diets contribute to cancer risk. Plus, the CDC reports on the rise of incidence rates for cancers linked to obesity.
The Endocrine Society puts the story of a dangerous imbalance caused by the omega-6-rich vegetable oil in our food supply on the cover of Endocrine News. These processed oils are inflammatory and contribute to obesity... so back to butter.
New obesity statistics were reported by the CDC. It's official— 39.8% of American adults are now obese. And, a new study, published in The Lancet,shows a ten-fold increase, worldwide, in the number of obese children over just four decades.
Also in The Lancet, Senior Executive Editor Stuart Spencer endorsed Nina Teicholz's 2014 bestseller, The Big Fat Surprise. Better late than never. Spencer writes: "Researchers, clinicians, and health policy advisors should read this provocative book."
Mainstream podcast, Revisionist History's "The Basement Tapes," tells the story of recovering data from an old (1960s and 70s era) study that, when reanalyzed, showed corn oil was worse for health than butter. While working on the story, podcast host, Malcolm Gladwell, read and endorsed Nina Teicholz's book, The Big Fat Surprise.
Doctors Demasi, Lustig, and Malhotra put their heads together to write an opinion piece for Clinical Pharmacist entitled, "The cholesterol and calorie hypotheses are both dead — it is time to focus on the real culprit: insulin resistance." Great reading.
Doubling down, the American Heart Association reaffirms its counterintuitive advice to replace whole, full-fat food with refined, processed seed oils in this Presidential Advisory published in Circulation. Investigative journalist Gary Taubes parses the AHA's Advisory, and the actual science, in a quick but effective takedown. Meanwhile, a new meta-analysis by Hamley, just published in Nutrition Journal, concludes there is no benefit to replacing saturated fats with PUFA's, and adds, "the suggestion of benefits reported in earlier meta-analyses is due to the inclusion of inadequately controlled trials."
Virta Health continues to slay diabetes. The VC funded firm, dedicated to reversing diabetes in 100 million people by 2025, shared some preliminary results. At one year, 82% remained in the trial, and body weight was down an average of 13.6%. WOW. Additionally, 97% reduced or halted insulin use; oral meds, excluding metformin, were reduced by 84%. 👍
“'It’s a disgrace' that so little is known [about diabetes drugs and their efficacy], said Dr. Victor M. Montori, a diabetes expert at the Mayo Clinic." That's The New York Times reporting on the failure of the medical community and pharmaceutical companies to study and understand the affects of diabetes drugs on patient outcomes, especially real endpoints like heart disease mortality. “'Daunting' is how Dr. JoAnn Manson, the chief of preventive medicine at Brigham and Women’s Hospital, describes the situation for patients and their doctors. She explained the options and uncertainties in a recent commentary in JAMA."
The New York Times reports that the American Academy of Pediatrics revised its guidance on fruit juice, now advising NO juice in a child's first year. Finally—this recommendation should have been made years ago. Further, according to the AAP's report, fruit juice “has no role in healthy, balanced diets of children.” Amen. For more on this topic, check out ETB post, "Juiced on Juice" from the archives.
Baylor researchers report a low-carb diet is associated with less weight gain after menopause. Specifically, the analysis showed that post-menopausal women "who consumed the fewest carbohydrates had a significantly reduced risk of gaining 10 percent of their body weight over an eight-year period, whereas those who consumed the least fat had a significantly increased risk of gaining more than 10 percent of their body weight over that time period." Their report was published this month in the British Journal of Nutrition."
Do the 2015 Dietary Guidelines remove the upper limit on dietary fat? It has been widely reported that the current set of guidelines remove the fat limit, but an intrepid RD MPH (repeatedly) asked the USDA to confirm this... and apparently the 35% upper limit still stands. Get the Alternative Fa(c)ts directly from Ms. Hite.
Three prominent cardiologists contend that saturated fat does NOT clog arteries in an opinion piece in the British Journal of Sports Medicine. Instead of obsessing about the naturally occurring fat in food, the doctors advise us to eat real, whole food and walk 22 minutes each day. The CBC reports on the controversy, here. And we Iove this easy summary of mainstream and alternative reactions from Treehugger. For a more technical look at the controversy, Henderson and Schofield have you covered.
Professor Tim Noakes, a sports medicine doc with expertise in endurance sports and metabolism, ignited a low-carb-high-fat revolution in South Africa, with millions following his lead. He was finally exonerated from a trumped up Twitter incident that was a huge distraction. Hopefully the attention paid to the scientific evidence (during the lengthy trial) will move the conversation forward. Congratulations, Prof!
Forbes reports on a recent study that shows obesity and diabetes are killing even more Americans than our death statistics suggest. Also in Forbes is a report on the association between high sugar consumption and poorer memory and lower brain volume.
Big news out of Silicon Valley. VC funded Virta Health opens it doors to the public. Virta is an online specialty medical clinic that reverses type 2 diabetes without medications or surgery. Forbes reports on Virta's toolbox—a ketogenic diet and a supportive, virtual clinic model ideal for treatment from any location. A preliminary study, documenting 10-week results, shows impressive 48% of subjects achieve HbA1c below 6.5% (no meds or Metformin only) and mean weight reduction of 7.2%.
In spite of record obesity rates, Time reports fewer Americans are trying to lose weight. Lesson (IMO)—conventional 'eat less, exercise more' advice is failing people. It doesn't work so many are giving up. Time for a new paradigm.
Prominent Canadian cardiologist, Dr. Yusuf, President of the World Heart Federation, delivered a breakout lecture, presenting new PURE study findings on the connection between diet and heart disease. Excellent summary here. Yusuf asserts saturated fat consumption is neutral to protective, high carbohydrate intake is bad for heart health, salt intake guidance is far too low, and vegetables are not really that important. Mic drop.
Exactly what are Americans eating? USDA released a report on the food available to Americans, and how it has changed since 1970. A big deal, as this data is only issued every 10 years. Get the CliffsNotes version in this short post from Nina Teicholz. But basically, as instructed by our dietary guidelines, we are eating more fruits and vegetables, more grains, more lean meat (chicken), more fish/seafood, more low-fat dairy, and way more vegetable oil. And we are eating less red meat, fewer eggs, and less animal fat (butter and lard). And it is NOT WORKING. (Obviously.) We are eating far too much refined grains and oils—they are in everything processed... Again, not real food.
The New York Times reports that soda tops grocery purchases in SNAP households... then Kristin Lawless counters that this is true in most households. While some call for regulation, cooler heads voice concernabout punishing the poor and a 'nanny state.' Separately, CSPI sues Coke for obfuscating soda's role in diabesity, and a new CDC study shows 60% of US kids have at least one sugary drink each day.
A shocking analysis by FAIR Health of a pool of over 21 billion health claims shows pediatric claims for type 2 diabetes doubling between 2011 and 2015, and claims with a diagnosis of obesity up 154% for 19-22 year olds in the same period.
BMJ (British Medical Journal) stands up for author/journalist Nina Teicholz, refusing to retract her 2015 article, "The scientific report guiding the US dietary guidelines: is it scientific?" BMJ Editor in Chief, Dr. Fiona Godlee, explains: “We stand by Teicholz’s article with its important critique of the advisory committee’s processes for reviewing the evidence, and we echo her conclusion: ‘Given the ever increasing toll of obesity, diabetes, and heart disease, and the failure of existing strategies to make inroads in fighting these diseases, there is an urgent need to provide nutritional advice based on sound science.’” The WSJ reports on Teicholz's victory in this 3.5 min video, "The Battle of Butter."
American life expectancy is officially on the decline for the first time since 1993. The National Center for Health Statistics announced a small but statistically significant decline, as death rates for most chronic diseases climbed.
Low-carb rebel, physician, and prominent sports scientist, Tim Noakes, believes "a fat-rich diet helps people lose weight, reduces insulin resistance, and staves off diabetes." Outside Magazineprofiles this outspoken leader from South Africa, and explores why he and his ideas have been put on trial.
CEO of Sloane Kettering Cancer Center says dietary fat level is not linked to cancer rates. But overfeeding dietary carbs dramatically increases cancer rates. (60s clip.)
A new Canadian study casts doubt on serving low-fat milk to kids. The New York Times reports that "the higher the fat content of the milk they drank, the lower the children’s B.M.I. and the higher their vitamin D levels." For more about milk and why whole, unsweetened milk is best for kids, check out Eat the Butter's post, Got Milk?
The Globe and Mail reports that the Heart and Stroke Foundation of Canada has (finally) reversed it's advice about restricting dietary saturated fat. "The organization is also urging Canadians to stop fixating on one particular aspect of food – such as fat, sodium, calories, sugar – and instead focus on eating unprocessed, whole foods." Amen.
Butter sales up 40% in Korea due to popular TV documentary about LCHF diets and social media sharing.
How did Big Food stifle food movement reforms during Obama's tenure? A long read with some sobering insights about Washington realities by the always articulate Michael Pollan. A Forbes contributor and 'food realist' asserts more was accomplished than Pollan admits. Not sure we can agree that MyPlate was an accomplishment, but the ban on trans fats certainly counts.