“Do you discuss nutrition with your patients?” the Tufts
Friedman School of Nutrition Science and Policy survey asked physicians. Three-quarters of them
replied “always” or “most of the time.” “Do you feel qualified to talk about
nutrition with your patients?” Again, 3 out of 4 said, “Yes.” To which I say to
patients, “Watch out!”
I have cause to be concerned. The Medscape article which reported the findings
links them to two pieces: 1) A “recent
study” that “associates…a
sub-optimal diet” with “a substantial proportion of deaths in the United States
due to heart disease, stroke and diabetes,” and 2) another that nudges
physicians to “know what advice to give.” It couches this advice
as “evidence-based nutritional advice” to help healthcare professionals deal
with “information overload” on diet and nutrition. It quickly becomes clear
that the whole point – the pretext for the Tufts “survey” – was to “educate”
physicians and other healthcare professionals with “know(ing) what advice to give,” i.e., Tufts’ POV.
The generalized statement that there’s an association of
“heart disease, stroke and diabetes” with a sub-optimal diet – a very strong association – is true enough. Deaths from heart disease
and stroke are much higher among type
2 diabetics and “pre-diabetics.” This association has led to the term
“cardiometabolic disease” (CMD). But, again, on which diet did they become
diabetic and develop heart disease? The Tufts answer is epidemiological: an
“association.”
The study was presented at the American Heart Association
Epidemiology and Prevention-Lifestyle and Cardiometabolic Health
(EPI-Lifestyle) 2017 Scientific Session. The findings were also commented on in
Medscape by researchers from the Johns Hopkins Bloomberg School of Public
Health and the Welch Center for Prevention Epidemiology. More epidemiology! Epidemiology suggests hypotheses, not
cause and effect!
Why is that significant? Because epidemiology can only
address “associated with” and “related to” findings. But that does not
deter the epidemiologist. This “poor diet” link, using “comparative risk
assessment models,” estimates that 45% of cardiometabolic disease (CMD)
deaths were “associated with” 10 dietary factors, and that these
factors have “‘probable or convincing evidence’ for causality” (my
emphasis). Epidemiologists are shameless in their reckless disregard for a
basic tenet of the scientific method: Correlation does not imply causation.
The “10 dietary [death] factors” ranged in descending order
from a high of 9.5% for 1) salt (“excess sodium”), to 2) low
intake of nuts/seeds, 3) high intake of processed meats, 4) low
seafood omega-3 fats, 5) low intake of vegetables, 6) low
intake of fruits, 7) high sugar-sweetened beverages, 8) low
intake of whole grains, 9) low intake of polyunsaturated fats and
finally, at 0.4%, to 10) high
intake of unprocessed red meats. Hmmm… Zero point four percent does not
strike me as statistically significant, but I guess they just had to include
red meat.
We can also be grateful that a low intake of polyunsaturated
fats (corn oil, soybean oil, etc.), at 2.3%, ranked only 8th on the
list. A higher intake, AS
THEY ADVOCATE, would, IMHO, only have RAISED THE RISK OF DEATH
GREATLY.
This is what your doctor, if (s)he was not on the golf course, is learning and says when (s)he say they know
about nutrition. To relieve “information overload,” Tufts gives these talking
points from the “know what advice to give” link.
●
Choose
foods with a wide variety of colors and textures, in their most natural forms.
[check]
●
Avoid
or dramatically minimize processed foods. [check]
●
Choose
realistic, balanced [not
low-carb] diets for weight loss and weight maintenance.
●
Consume
healthy oils for heart health: fish, olive, avocado. [good, all MONOs, no mention of soybean or corn]
●
Forego
red meat [saturated fat and cholesterol] and live longer [a
little editorializing? They just couldn’t resist!].
●
Consume
fermented foods/probiotics and fiber for gastrointestinal and overall health. [check]
This is just a plant-based, one-size-fits-all,
Mediterranean diet that the Dietary Guidelines recommends for
everyone. It doesn’t mention carbs or Type
2 diabetes, or any of the myriad metabolic conditions that plague the majority
of the population. For them (us), balanced is just wrong,
and avoiding excessive carbs and polyunsaturated fats needs to
be stressed. And I would rather embrace carnivory
than give up red meat for the claimed 0.4% increase in CMD death.
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