Sunday, March 25, 2012

The Nutrition Debate: Interlude, On a Personal Note

I started this column in 2010 at the invitation of the publisher of a small weekly newspaper. Last week, the publisher notified me that “…we probably have done enuf on carbs and fats. We want to move on.” Folks, I’ve been cashiered from the print world. Well, change is good, and I’m ready to move on too.

I am grateful to The Millbrook Independent for publishing the majority of the first 40-odd columns (that became this blog), and for tolerating my low-carb message for as long as they did. It turns out my column was a place-holder for an occasional feature page on Health and Wellness, a much broader category than dietary nutrition, or at least one with a more mainstream view of it. Anyway, I am going to have to change both my Facebook and Twitter profiles, and I thought you (my cadre of blog readers) should be the first to know.

Meanwhile the list of subjects in the nutrition debate that interests me is increasing at an accelerating pace. I am currently eight nine columns ahead of myself in writing, and the list of subjects that I want to write about is increasing at an even more rapid rate. I may have to start editing myself with respect to subject area, as I think one column a week is right for both me and my indispensible online editor, who suggested I blog, and who has a very busy life of her own.

The blog recently crossed the 3,000 hit mark -- a very modest level by today’s standards but nevertheless quite satisfying to me. It also reminds me to be responsible in what I write – I’m talking about people’s health here – things that affect wellness and lifespan. Of course, my readers know that I am not a doctor or a scientist (biologist or other), and that the views I express in my blog are my opinions or those of the doctors and scientists to whom I attribute them.

I see my role as an intermediary – someone between the cutting edge practitioners and researchers/thinkers/bloggers out there who see the nutrition debate from the back (dark) side of the mirror. The upside for me personally is that I stay engaged and motivated 1) to follow the course of action (with respect to diet) that has immeasurably improved my own general health and my specific medical conditions (Type 2 diabetes and hypertension), both associated with my (former) morbid obesity, 2) to continue to take a very strong interest in my own health and what to do about it, and 3) to continue to educate myself, and through this blog others, among them my friends and relatives and now hundreds of total strangers from around the world. I am very grateful to have had, and to continue to have, this opportunity.

The mainstream views are on the reflecting side of the mirror. For a variety of reasons, not least of which is their credibility. (“Gee, folks, I’ve been wrong for all these years. Now, follow me while I change course 180 degrees.”)They are the well-meaning ‘old school’ practitioners who were educated under the influence of the lipid hypothesis and who receive their continuing education from the drug companies (big pharma), and agri-business and the processed food manufacturers, the AHA and the ADA, and big government agencies who fund most of the self-fulfilling ‘research.’ That’s why they get the money. They apply for funding to show the government’s politically derived/influenced position to be right and until the rules were changed in 2005, they only released the results from trials that upheld their views. And they call that science. They are the big stake holders (besides us, the consumer) and they are all vested in the perpetuation of the wrong-headed public health policies that got us into this situation in the first place.

Anyhow, among the subjects you will see in the coming weeks are “How to Treat Heart Disease Risk” (a doctor’s prescription), “Testing for Heart Disease Risk,” “Inflammation and Atherosclerosis,” “The Dietary Causes of Inflammation,” “Free Radicals and Oxidative Stress,” “Dietary Cholesterol,” and “The Thermic Effects of Food.

”After that, subjects that I am interested in writing about includes: “Supplementation,” “A Vitamin Primer,” and “Essential Minerals.” Other subject areas are “Energy Homeostasis Systems,” “Food Reward” and “Hedonistic Eating” as described by Stephan Guyenet in a recent Boing, Boing post. If you can’t wait, check out his “Whole Health Source” blog.

Other things of interest are Ageing, Low Calorie Diets and Lifespan, Small Meals, Pemmican Cupcakes, The Potato Diet, Obese Mother/Malnourished Child, Epigenetics and the 1944 Dutch Famine, and Taste: Bitter, Sweet, Sour, Salty and Savory. If my readers have any suggestions or thoughts, please offer them in the comments section provided after every post. And please also consider becoming a “follower,” or add this blog to your Google Reader or RSS feeds. Thanks.

Sunday, March 18, 2012

The Nutrition Debate #45: Do You Need to Lower Your Cholesterol?

“We have all been led to believe that cholesterol is bad and that lowering it is good,” posted Mark Hyman, M. D. on his website in May 2010. This belief is almost universal. And the most sure-fire way to lower Total Cholesterol is to lower LDL cholesterol by prescribing one of the ubiquitous statin drugs: Crestor, Lipitor, Zocor or its generic Simvastatin.

“But on what scientific evidence is this based?” and “what does the evidence really show?” Dr. Hyman asks. Many health professional have asked similar questions, but Dr. Hyman in his blog post lists a concise yet comprehensive (and familiar to me) summary of findings in the medical literature that question the rationale and justification for prescribing statins:

• If you lower bad cholesterol (LDL) but have a low HDL (good cholesterol), there is no benefit to statins.
• If you lower bad cholesterol (LDL) but don’t reduce inflammation (marked by a test called C-Reactive Protein), there is no benefit to statins.
• If you are a healthy woman with high cholesterol, there is no proof that taking stains reduces your risk of heart attack or death.
• If you are a man or a woman over 69 years old with high cholesterol, there is no proof that taking statins reduces your risk of heart attack or death.
• Aggressive cholesterol treatment with two medications (Zocor and Zetia) lowered cholesterol much more than one drug alone but led to more plaque build-up in the arteries and no fewer heart attacks.
• 75% of people who have heart attacks have normal cholesterol
• Older patients with lower cholesterol (<180) have higher risks of death than those with higher cholesterol.
• Countries with higher average cholesterol than Americans such as the Swiss or Spanish have less heart disease.
• Recent evidence shows it is likely statins’ ability to lower inflammation that accounts for the benefits of statins, not their ability to lower cholesterol.

“So for whom do the statin drugs work anyway?” he asks. His answer: “They work for people who have already had heart attacks to prevent more heart attacks or death. And they work slightly for middle-aged men who have many risk factors for heart disease like high blood pressure, obesity or diabetes. And that data also shows that treatment really only works if you have heart disease already. In those who don’t have documented heart disease, there is no benefit.”

“So why did the 2004 National Cholesterol Education Program guidelines expand the previous guidelines to recommend that more people take statins (from 13 million to 40 million) and that people who don’t have heart disease should take them to prevent heart disease? Could it have been that 8 of the 9 experts on the panel who developed these guidelines had financial ties to the drug industry?,” he asks rhetorically. “Thirty-four other non-industry experts sent a petition to protest the recommendations to the National Institutes of Health saying the evidence was weak. It was like having a fox guard the chicken coop,” he answers.

Yet, at a cost of over $20 billion a year, 75% of all statin prescriptions are for exactly this type of unproven primary prevention. “If these medications were without side effects, then you may be able to justify the risk – but they cause muscle damage, sexual dysfunction, liver and nerve damage and other problems in 10-15% of patients who take them. Certainly not a free ride” says Dr. Hyman. But Dr. Hyman is just a private practitioner in Lennox, MA. How about this?

William Castelli, MD, Director of the famous Framingham Study said, “In Framingham, Massachusetts, the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower people’s serum cholesterol…we found that the people who ate the most cholesterol, ate the most saturated fat, ate the most calories, weighed the least and were the most physically active.”

And George Mann, ScD, MD, former Co-Director of The Framingham Study, said, “The diet-heart [lipid] hypothesis has been repeatedly shown to be wrong, and yet, for complicated reasons of price, profit and prejudice, the hypothesis continues to be exploited by scientists, fund-raising enterprises [AHA], food companies and even governmental agencies. The public is being deceived by the greatest health scam of the [last] century” [both brackets added by me].

Finally, the famous heart surgeon Michael DeBakey, MD, said, “An analysis of cholesterol values …in 1,700 patients with atherosclerotic disease revealed no definite correlation between serum cholesterol levels and the nature and extent of atherosclerotic disease.”

So, if lowering cholesterol is not the great panacea that we thought, how does one treat heart disease risk? Read on.

© Dan Brown 3/18/12

Sunday, March 11, 2012

The Nutrition Debate #44: Joslin Clinic Fights Back

The Joslin Diabetes Center in Boston is “the world’s largest diabetes research center, diabetes clinic, and provider of diabetes education,” according to Wikipedia. It came as no surprise, therefore, when on February 8th Joslin shot back at comments made by Richard Kahn, Ph.D., former Chief Scientific and Medical Officer of the American Diabetes Association. This Dr. Kahn is not to be confused (I think) with Richard Kahn, Ph.D., “anarchist educator” and core faculty member of Antioch University in Los Angeles, although their Ph.D.’s in my view are equally worthless.

Dr. Kahn the former ADA executive had said “even though weight loss can prevent or delay the onset of diabetes, the failure of patients to maintain weight loss beyond an average of four years makes diabetes prevention programs a ‘waste of resources,’ and the health system should focus instead on reducing the likelihood of complications once patients have been diagnosed with diabetes.” He made these remarks at a briefing for public health advocates and diabetes researchers entitled “Confronting the Growing Diabetes Crisis” on February 7th by the journal Health Affairs.

Joslin’s rebuttal was that their extensive “experience with innovative weight management programs…is showing that patients can maintain healthy weight levels well past four years.” Edward S. Horton, M. D., Professor of Medicine at Harvard Medical School (with which Joslin is affiliated), and past President of the American Diabetes Association said, “There is a legacy for the initial weight loss even if people cannot maintain it. The 10-year follow up of the patients who completed the diabetes prevention program showed that people who initially lost weight continued to develop diabetes at a lower rate over 10 years than those who did not lose weight, even if they gained part of that weight back.”

This internecine battle demonstrates clearly that overweight and obesity is the problem, as well as the surest predictor of incipient Type 2 diabetes, and that losing weight is the first line of defense against it. Type 2 diabetes is also associated with a host of associated Diseases of Civilization (CVD, CHD, stroke, Alzheimer’s and some cancers). A recent NY Times story reported, “Researchers found diabetes was associated with a higher overall risk for colon, rectal and liver cancers among both men and women. In women, diabetes was most strongly associated with a higher risk of stomach, anal and endometrial cancers. In men, diabetes was most likely to raise risk for pancreatic and bladder cancers.

The battle also illustrates the difficulty of losing weight and keeping it off. Even the Harvard Medical School defenders of Joslin’s programs, in remarks posted in Public Health and Policy (issue 612) one day after Dr. Kahn’s controversial statement, appear to disagree. Enrique Caballero, M. D., said, “Not having a full answer on what to do in the long term does not mean that efforts to identify these strategies and translate them to clinical practice model should be abandoned.” On the other hand, Martin Abrahamson, M. D., Chief Medical Officer at Joslin Diabetes Center and an Associate Professor of Medicine at Harvard Medical School, said, “Since we know which weight management programs will work in the fight against obesity, the challenge is to find ways to implement them in communities, which we at Joslin are working hard to do” (emphasis added in both quotes).

The problem is that Joslin’s “innovative” weight management programs, referring to the Horton quote above, are not innovative enough. Joslin and Harvard both still cling to the Diet-Heart or Lipid Hypothesis promulgated first by Ancel Keys in the early 1960’s and later the American Heart Association: Saturated fat and dietary cholesterol are bad for you. Although increasingly recognized as unproven, this hypothesis still dominates in the medical establishment and suffuses public health policy. Government intervention began with the ill-conceived McGovern Commission in 1977; this resulted in the HHS/USDA's Dietary Guidelines for Americans produced in 1980 and updated every 5 years to the present day.

This misguided prescription for public health is promulgated and abetted by a corrupt consortium of big pharma, big agribusiness and big processed food manufacturers. The effects of this cartel on our health have been devastating, both in the last 50 years in the United States and increasingly worldwide as the Western Diet proliferates. My stock in McDonalds just passed 100 dollars a share, doubling in the last 5 years, in large part due to their success overseas.

Until this “corrupt bargain” is broken, our health will continue to decline as rates of obesity and diseases of civilization such as diabetes rise. The Way of Eating advocated in this column, The Nutrition Debate, is a solution. My views, although personal, reflect a growing movement of individuals including many “new age” health professionals, both Ph.D.’s and M. D.’s, from whom I take hope and glean edification. If I sound angry, it is only at leaders like Joslin, and patients like Paula Deen (see last week’s column,) who do not see the damage that high carb diets can do. Or who are fatalistic about the rising prevalence of obesity and diabetes – who think there’s nothing to be done but pop a pill. Perhaps, like “the other Dr. Richard Kahn,” I too am an “anarchist educator” (sans Ph.D.).

© Dan Brown 3/11/12

Sunday, March 4, 2012

The Nutrition Debate #43: Paula Deen, Lessons Learned?

A few weeks ago syndicated columnist Mike Luckovich nailed Paula Deen in one of his brilliant cartoons. In the first panel the blurb says, “I got diabetes from the unhealthy recipes I peddle. Now I’m spokesperson for a diabetes drug…” In this panel she is surrounded by boxes and bags labeled ‘lard,’ ‘butter,’ ‘high fat grease,’ ‘salted sugar,’ and ‘buttered sodium.’ In the second panel the blurb says, “…plus there’s my new book….,” which she’s holding. The title is, “Have Your Cake and Eat It Too.” It’s hilarious, even if it is the completely wrong message. Luckovich probably doesn’t know it is the wrong message, but he has to find the message that resonates with the reader, or it isn’t funny in the ridiculous way it needs to be. His humor is about ridicule.

Paula Deen, on the other hand, is criticized for apparently withholding the news of her condition for a couple of years until she could get her drug company endorsement and book deal lined up. Still others, especially in my school of nutrition, criticize her for not using her celebrity status and fan base to educate the public on what caused her to develop Type 2 diabetes. She has released a video on her web site addressing her diabetes, but she is inexplicably silent about which foods were responsible. One wonders if she knows. One wonders if she has not obtained the best advice or if it is just not advantageous (and I mean financially) to advocate a Way of Eating that is not supported by the packaged food industry and big pharma. I hate to be cynical, and I dislike piling on, even if I am just about the last on top of this pile….but Paula Deen is missing a giant opportunity to really do some good and the chance to control her blood sugar without an expensive medication with some scary side effects.

First of all, fat alone didn’t make Paula fat; carbs did: simple sugars and refined carbohydrates. The body is designed to use ‘sugars’ (glucose) before fat. So, if you are burning carbohydrates for energy, any fat you eat that isn’t needed for energy gets stored. That’s the way the body saves energy for intermittent (involuntary) fasting, crop failures, and even occasional famine. We didn’t always have a year-round food supply. Berries and other fruits were seasonal and not nearly as sweet as modern hybrids. My maternal grandparents, who were farmers, kept a root cellar, canned and pickled vegetables, and ‘put up’ preserves to eat during the non-growing season.

Consumption of sugary foods and drinks, like her famous Southern ‘sweet tea,’ puts a big load on the liver (to deal with the fructose in sugar) but also causes the pancreas to work hard to produce enough insulin to deliver glucose to cells. If this glucose is not used through activity and exercise, insulin resistance slowly rises, first in the liver and then in the muscles. Her fat build-up resulted from insulin resistance in the cells to which too much glucose (from the carbs) was being transported by the insulin. Eventually the pancreas gets burned out, and the beta cells that make insulin die. At this point, 80% of all T2’s are obese. It’s good for everyone not to over work their pancreas, even if they are slender.

I’ve never seen the Paula Deen show -- only the video I mentioned – but she is getting a bad rap. Actually, it is the foods that are associated (by Luckovich and the mainstream media) with developing diabetes that are getting the bad rap. Luckovich is only playing to the popular perception that fat makes you fat and diabetic. The truth is fat makes you fat only if you eat it with lots of ‘sugars’ (both simple sugars and refined carbohydrates). And it’s the sugar and refined carbs that over work the pancreas and make you diabetic. But, the federal government (HHS/USDA) still recommends the Standard American Diet (ironically SAD): 60% carbohydrates (300 grams), 10% protein (50 grams), and 30% fat (+/-65 grams) on a 2000 calorie a day diet. That’s way too many carbs.

Cutting carbs back by half or even two-thirds would be good, to 150 or 100 grams of carbohydrate a day, or 30% or 20% of a 2,000 calorie diet, versus 60% in the SAD. Low-carb (LC) could be defined as 50 grams a day, and very low carb (VLC) as 20 or 30 grams a day. Type 2 diabetics (and pre-diabetics) should eat in the VLC range for optimum blood sugar control and easy weight loss. When you eat carbohydrates at that level, all you ‘Paulas’ out there, you can eat butter and cream for energy, feel good and look great. Plus, you will save $500 a month on meds, and avoid the ever increasing list of possible side effects. I made my own oyster stew for lunch guests yesterday (a 1 cup serving: it’s filling), with lots of butter, heavy cream and whole milk. Yum!

© Dan Brown 3/4/12