The Nutrition Debate #297: “Obesity in Remission,” a short series

“Obesity in Remission” is a new lexeme in my vocabulary. I discovered it in this long and provocative (for me) comment in Lancet Diabetes and Endocrinology published online (login req’d). A link to the Lancet summary and to the full text of the comment was provided by this Medscape Medical News piece. Why it was provocative for me will be the subject of Part 2 of this series. This post is a long excerpt from the beginning of the comment to explain in context “Obesity in Remission.”

“Many clinicians are not adequately aware of the reasons that individuals with obesity struggle to achieve and maintain weight loss,¹ and this poor awareness precludes the provision of effective intervention.² Irrespective of starting weight, caloric restriction triggers several biological adaptations designed to prevent starvation.³ These adaptations might be potent enough to undermine the long-term effectiveness of lifestyle modification in most individuals with obesity, particularly in an environment that promotes energy overconsumption. However, they are not the only biological pressures that must be overcome for successful treatment. Additional biological adaptations occur with the development of obesity and these function to preserve, or even increase, an individual's highest sustained lifetime bodyweight. For example, preadipocyte proliferation occurs, increasing fat storage capacity. In addition, habituation to rewarding neural dopamine signaling develops with the chronic overconsumption of palatable foods, leading to a perceived reward deficit and compensatory increases in consumption.⁴ Importantly, these latter adaptations are not typically observed in individuals who are overweight, but occur only after obesity has been maintained for some time.³ Thus, improved lifestyle choices might be sufficient for lasting reductions in bodyweight prior to sustained obesity. Once obesity is established, however, bodyweight seems to become biologically stamped in and defended. Therefore, the mere recommendation to avoid calorically dense foods might be no more effective for the typical patient seeking weight reduction than would be a recommendation to avoid sharp objects for someone bleeding profusely.

“Evidence suggests that these biological adaptations often persist indefinitely, even when a person re-attains a healthy BMI via behaviourally induced weight loss.³ Further evidence indicates that biological pressure to restore bodyweight to the highest-sustained lifetime level gets stronger as weight loss increases.⁵ Thus, we suggest that few individuals ever truly recover from obesity; individuals who formerly had obesity but are able to re-attain a healthy bodyweight via diet and exercise still have ‘obesity in remission’ and are biologically very different from individuals of the same age, sex, and bodyweight who never had obesity.^3, 5 For most individuals, these biological adaptations need to be addressed for weight loss to be sustained long-term. We believe these mechanisms largely explain the poor long-term success rates of lifestyle modification, and obligate clinicians to go beyond mere recommendations to eat less and move more.”

“Individuals who formerly had obesity but are able to re-attain a healthy bodyweight via diet and exercise still have ‘obesity in remission’ and are biologically very different from individuals of the same age, sex, and bodyweight who never had obesity.” Boy, who among us (overweight and obese) cannot relate to this statement? The authors of this “comment” in Lancet, who are all recognized, distinguished authorities in Obesity, have explained in understandable terms the dilemma that so many of us have experienced. I commend them for their efforts to share their understanding with other clinicians, urging that they should “go beyond mere recommendations to eat less and move more. For this: “Bravo,” as far as it goes.

These distinguished experts in obesity have described how “these mechanisms,” specifically “these biological adaptations,” “need to be addressed for weight loss to be sustained long-term.” I love that it that they think it should “obligate clinicians” to go further, and I look for them to explain how. My hopes soar with phrases like “promotes energy overconsumption” and “increases fat storage capacity” that suggest they might know the mechanism, but then they associate “avoiding calorically dense food” with a means of “seeking weight reduction.” Alas, my hopes are dashed. See Part 2 next to see how they did it.

The Nutrition Debate #296: Another Nail in the Coffin of the Dietary Guidelines

Zoe Harcombe, popular author and obesity researcher, got her first piece in the British Medical Journal’s Open Heart recently. The BMJ is perhaps the world’s most discriminating arbiter of medical science. Its Open Heart organ is an “open access, peer reviewed, online-only journal dedicated to publishing research in all areas of cardiovascular medicine.” This piece fit the requirements, and the conclusion was earthshaking. The title tells it all: “Evidence from randomised controlled trials did not support the introduction of dietary fat guidelines in 1977 and 1983: a systemic review and meta-analysis.”

Harcombe conceived of this original research article and collaborated with several other credentialed authors in the data extraction, meta analysis and writing of the manuscript. All the authors were involved in the critical evaluation of content and reported no competing interests. The article has 32 linked references and was externally peer reviewed by the BMJ.

The full-text article came to my attention from a piece in Diabetes in Control: “Government Dietary Fat Guidelines Did Not Have Sufficient Supporting Evidence.” The subtitle restates the CONCLUSION of the Abstract of the paper: “Dietary recommendations introduced for 220 million U.S. and 56 million UK citizens by 1983 did not have sufficient supporting evidence from randomized controlled trials.” To be clear, the RCT studies evaluated were all published before 1983.

For the uninitiated, 1977 was the year where in the U.S a Senate Select Committee called the McGovern Commission held a few hearings and subsequently published the Dietary Goals for the United States. That document, prepared by Senate staffers, was the precursor to the 1980 Dietary Guidelines for Americans, which was revised and republished every five years thereafter. The Brits followed with their own dietary standards in 1983. These events have been chronicled in many places including briefly in The Nutrition Debate #4, “Big Government, Big Pharma and Poor Little Dr. Atkins.”

The dietary recommendations introduced in the U.S (1977) and in the UK (1983) were to reduce overall fat consumption to 30% of total energy intake and reduce saturated fat consumption to 10% of total energy intake. The protein recommendation was set at a meager 10% and the carbohydrates at a whopping 60%. That’s why starting around 1980 we (as a population) started to get fatter. That’s why diabesity skyrocketed and heart disease and many other diseases of “malnutrition” (for lack of fat-soluble vitamins from animal based foods) have plagued our nations.

In recent years, we have come to realize that the American public are participants in the largest uncontrolled experiment in history. This experiment hasn’t turned out very well, and we are still suffering the consequences. So, now the Titanic is slowly changing course. The limitation on the total percentage of fat in the diet has been omitted (#294), and now, hopefully (#295), in the 2015 Dietary Guidelines, cholesterol will “no longer be considered a nutrient of concern for overconsumption.” Think about it: All the shrimp, egg yolks, butter, etc. you have given up over the years, needlessly.

 I suspect the BMJ piece is but one of several initiatives in the non-conflicted medical and nutrition community to influence the members of the 2015 Dietary Guidelines Advisory Committee (DGAC). This group has had to endure a barrage of testimony from powerful Agribusiness. This list of oral presenters from 1 day of the 2^nd of 7 public hearings of the DGAC is just the tip of the iceberg and illustrates the immense pressure they are under. I’ve got my fingers crossed for their integrity.

The Nutrition Debate #295: Cholesterol: no longer “…considered a nutrient of concern…”

“NBC’s ‘Today Show’ had a story about dietary cholesterol,” my wife said at breakfast yesterday. Later we both heard a similar story on PBS’s “All Things Considered” as we drove to our separate engagements. So, today I did a Google News search on “dietary cholesterol” (the cholesterol in food, like eggs and shrimp, that we eat). The first story that came up was from Fox News. It wasn’t very good. The author puffed it up with off-message “contributions” from the AP and Reuters.

Still, the essence was that Marian Neuhouser, chair of the relevant subcommittee of the 2015 Dietary Guidelines Advisory Committee, announced a decision to the full DGAC committee at its final meeting in December 2014. She said it is their recommendation that dietary cholesterol no longer be ‘considered a nutrient of concern for overconsumption,’ according to the Fox News Report. A 6hr. 57min. indexed video of the full meeting, #7 (December 15), is online and can be seen here.

The final report, “2015 Dietary Guidelines for Americans,” will be published by the USDA/HHS later this year. “While those agencies could ignore the committee’s recommendations, major deviations are not common,” The Washington Post said.

“Five years ago, I don’t think the Dietary Guidelines diverged from the committee’s report,” Naomi K. Fukagawa, the 2010 vice chair, told The Washington Post. Fukagawa says she supports the change on cholesterol. “Walter Willett, chair of the nutrition department at the Harvard School of Public Health, also called the turnaround a ‘reasonable move,’” The Post reported. “There’s been a shift of thinking,” he said. (“…a shift of thinking”? Incredible that he said that!)

Well, la-di-da, the Titanic IS really changing course. (See: The Nutrition Debate #12: “Turning the Titanic,” also #162, #189, #202, and #292). And this is MAJOR, except that, with this report, saturated fat is left behind; it is still one of the bad guys. But it’s good news for people who long for shrimp. I actually know a few, including medical doctors, who have passed up shrimp being passed as h’ordeuvres at a cocktail party, and others who eat egg whites instead of whole eggs for breakfast. (See: The Nutrition Debate #176, “Eggs, Cholesterol and Choline,” #211, “Eggs and Satiety,” and #225, #228 and #265.

The danger, of course, with the Titanic changing course, is whether it is turning to port or to starboard. If it turns to starboard, it will run into a sea of ice flows and eventually solid sea ice. Think eroded endothelial layers, advanced glycation end products (AGEs), and clogged arteries from the rancid and oxidized LDLs (oxLDL) in overused and overheated vegetable and seed oils. (See: The Nutrition Debate #21, “The Dangers of Polyunsaturated Fats,” also #20, #22, #23, #24, and #49.)

That’s the outcome that can be expected 1) from the 2013 AHA/ACC recommendation that the target for total dietary fat consumption be omitted to allow fat to replace the formerly much too high Dietary Guidelines recommendation for carbohydrates, both simple sugars and highly processed carbs; and 2) that saturated fat consumption be further reduced from the previous 7% - 10% of total calories to 5% - 6%. With this 1-2 punch the resultant recommendation will be that we consume more Mono and Polyunsaturated fats. But, while monounsaturated fats are good, most PUFAs are BAD.

That’s exactly where the Titanic is headed, with the blessing of Robert Eckel, current co-chair of the ACC/AHA guidelines committee and past president of the American Heart Association. While he conceded that there is “insufficient evidence” to make a recommendation to support dietary restrictions of cholesterol, he said “a three-to four-egg omelet isn’t something I’d ever recommend to a patient at risk for cardiovascular disease.” Some myths die hard. 

The Post story recalls the origins of the cholesterol myth. A Russian scientist at the Czar’s Medical Institute in St. Petersburg fed cholesterol to rabbits for four to eight weeks in 1913 and saw that the cholesterol harmed them. Then in the 1960s an American graduate student, Lawrence Rudel, noted that when the Russian fed cholesterol to white rats, it had no effect. Later, Ancel Keys acknowledged the difference between obligate herbivores (rabbits) and mammals (rats and humans). In 1997, Ancel Keys, father of the diet/heart hypothesis (saturated fat + cholesterol → heart disease), infamously said:

“There’s no connection whatsoever between the cholesterol in food and cholesterol in the blood. And we’ve known that all along. Cholesterol in the diet doesn’t matter at all unless you happen to be a chicken or a rabbit.”

Then there’s this: Updated findings of the famous Framingham Study, published in Archives of Internal Medicine (2009):

“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.” Quote from Dr. William Castelli, Director.

The Nutrition Debate #294: “Saturated Fat and CAD: It’s Complicated”

Tricia Ward, Editorial Director of theheart.org at Medscape Cardiology, took on a challenging assignment with this long survey piece. I’m taking on the assignment too, but I will shorten and steer my review using my “selection bias.” The Medscape review is a good piece, generally, designed to educate doctors. It gets a lot of the basics about SFAs right and introduces the busy physician to many aspects of newer concepts from evidence-based-science. That’s a catch phrase that’s all the rage these days. It was deployed here, I think, to draw a stark contrast with the now widely disparaged diet/heart hypothesis.

The setup: “Dietary guidelines for the prevention or treatment of coronary artery disease (CAD) have emphasized a reduction in the consumption of saturated fat since the 1960s.” Here a footnote links to a 1961 piece in Circulation, the journal of the American Heart Association (AHA). Note: 1961 was the year that Ancel Keys, father of the diet/heart hypothesis, appeared on the cover of Time magazine and joined the board of the AHA. The setup continues: “Dietary saturated fat increases blood levels of low-density lipoprotein cholesterol (LDL-C) and subsequent risk of CAD, or so goes the conventional wisdom.” The “doubting Thomas” tone is appropriate, and an encouraging start.

The tension rises: “The disparate findings have led to calls to stop demonizing saturated fat and equally vocal cries to proceed with caution before we let lard back into the menu.” Now, the plot starts to thicken; Introducing the “bad” guys:

“Meanwhile, the 2013 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines on lifestyle management to reduce CVD risk omitted a target for total dietary fat but did recommend a goal of 5%-6% of calories from saturated fat.” Three points: 1) The lead author of the ACA/AHA guidelines is Robert Eckel, professor of medicine at the University of Colorado. He is one of the protagonists in this story but is not introduced by name into the narrative until more than half way through; 2) Note the significant omission of a target for total dietary fat. It was previously less than 30% of total calories; and 3) Note the limitation of SFAs to 5%-6%. It was previously 7%-10%. That’s a significant reduction. (This is about 11g or 2.25 teaspoons of butter for a person eating 2000 calories a day.)

The other protagonist in this set piece is Dariush Mozaffarian, dean of the Friedman School of Nutrition Science and Policy at Tufts University in Boston. He gets most of the science right (IMHO) – and I cannot emphasize that enough – but just cannot walk through the open door provided by the ACA/AHA’s omission of a target for total dietary fat. Instead, Ward quotes him as saying, “polyunsaturated fats are beneficial…” Perhaps this comment is taken out of context by Ward and reflects her personal bias. And by doing so, she becomes a third protagonist, representing the PUFA contingent.

Mozaffarian does disagree with Eckel’s 5%-6% limit on SFAs. “To derive a conclusion that saturated fat should be 5% of calories [from the DASH study, as Eckel does] is not evidence based,” he says. Other Mozaffarian gems include: “The School Lunch Program allows chocolate skim milk and banned whole milk. That’s absurd.” Another: “…the biggest driver of de-novo lipogenesis [where the liver makes body fat from large slugs of liquid or other highly processed carbs] is the dose and speed that the carb is delivered.” Ward explains, “In terms of foods, a bagel or soda consumed in isolation is more likely to trigger [the liver making fat] than a small amount of potato mixed with vegetables and oil.”

Mozaffarian’s comment that “The U.S. view on saturated fat is totally based on the effects on LDL-C, and that’s why we have dietary guidelines to lower our saturated fat intake…” begins a good discussion of LDL-C particle size, concentration, HDL-C and triglycerides.” The article gets into the weeds a bit but it's good and, as I said, it is written for a technically savvy reader.

My biggest gripe, and personal bias, besides giving Eckel and the ACA/AHA guidelines so much play, was Ward’s transparent injection of her own POV about PUFAs. I think she pushes both Eckel and Mozaffarian, and Marion Nestle whom she quotes a few times, toward the Mediterranean “dietary pattern” touted by the 2010 Dietary Guidelines for Americans. It and the ACA/ADA guidelines are widely expected to be repeated in the 2015 Guidelines due out in less than a year. Why, you ask?

Alice H. Lichtenstein, D. Sc., is Vice-chair of the 2015 Dietary Guidelines Advisory Committee and is in charge of drafting the document. Lichtenstein was also the lead author on the AHA’s current “Diet and Lifestyle Recommendations.” And she also served on the AHA committee in which Robert H. Eckel, M.D. was co-chair and lead author of the above mentioned “2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk. Together, they are a formidable force today.

On a lighter note, my favorite part of this Medscape piece is the comment section. You can link to it here.

The best one, from Dr. J M, was: “Will the ghost of Ancel Keys ever be exorcised?” There’s also a very good one by Dr. Robert Hansen on “replacing SFA with PUFA [will] result(s) in increased oxLDL and increased Lp(a) in humans.” BRAVO! Take a look, if you feel up to it. In my opinion, Hansen got it right, but alas, his is still just a voice in the wilderness.

So, there’s evidence out there that there are a few doctors who are paying attention to the evolving story of (dietary cholesterol), saturated fat and CAD, and many, sadly, who are not. The story, I think, is perhaps more complex than complicated.

The Nutrition Debate #293: The HEAL Clinics: Diabetes and Medical Weight Loss

As I said in #292, I am not angry at doctors, blah, blah, blah, “even though they are aware that how they are required to treat [Type 2 diabetic patients] will trap patients in a lifelong regimen of drug management, obesity and escalating diabetes.”  These clinicians, I said, “are in a tough spot.” But, there exists on the fringes of mainstream medicine a few doctors who have broken from the pack. Among them are academics (what have they got to lose?), and a few lone wolves/mavericks. Until now.

Individual practitioners, even those working in an academic setting (research/teaching/clinic), can have only a limited influence. Frequent submissions to peer-reviewed journals and writing popular books can add to the effect. Leadership in professional organizations where you can “set the agenda” helps too. But the real impact – the “cavalry to the rescue” impact ala Jeb Stuart – can only be realized by someone who leads a band of raiders effectively attacking from the rear.

The army of sheep – the obese, pre-diabetic and diagnosed Type 2s out there who are being herded into a “lifelong regimen of drug management, obesity and escalating diabetes” – are ready to be rescued. And the rear guard today, the physicians who know that they “are in a tough spot” because they follow “the current treatment protocol” that the medical establishment has ordained as the “standard of care,” and know it doesn’t work for the majority of patients, are ready too. Many of these physicians are looking, as we are, for a “rescue.”

Well, the time may be right. Or the fruit ripe. There’s certainly plenty of it “low-hanging.” ;) It’s time to introduce to the “partisans” (all of us who are trapped with similarly aligned clinicians) someone known to all of us “LC followers” who have been looking for answers and leadership. It is Eric Westman, MD, MHS, Associate Professor of Medicine at Duke University and Director of the Duke Lifestyle Clinic. He is perhaps best known to “our crowd” as the co-author of both “The New Atkins for a New You” and “Cholesterol Clarity.” He is also currently president of the American Society of Bariatric Physicians.

Dr. Westman’s newest venture is as Co-founder, President and Chief Medical Officer of HEAL Clinics, a start-up being developed by Bruce Rossiter, Co-founder, CEO, Chairman and chief fund-raiser. Rossiter has startup and venture capital experience to balance Westman’s medical expertise. The heretofore unattributed quote (“will trap patients in a lifelong regimen of drug management, obesity and escalating diabetes”) is lifted from the Private Placement Memorandum (6-pages) at the Investors tab at healclinics.com. The best part from a “sufferers” POV is Dr. Westman’s 2 ½ page Manifesto titled, “Benefits of HEAL Clinic’s Low-Carb Lifestyle – Putting Diabetes in Remission.” The remainder of this blog post is selected quotes from the PPM. I encourage you to click on this link and read about HEAL.

“Type 2 diabetes occurs when a person consistently eats too many carbohydrates. All carbohydrates (except for the fiber content and small amounts of vitamins and minerals) convert to blood sugar (glucose). When one consumes excessive carbs, the pancreas produces excessive insulin. It is both the excessive levels of glucose and insulin that produces harmful and chronic inflammation, damaging our cells and organs.”

“Excessive carbohydrate consumption is encouraged by the U. S. Dietary Guidelines and the food industry, which provides tens of thousands of highly processed, sugar and other carb-laden foods to entice us. Studies show that sugar is more addictive than cocaine. It is this combination of our own desire to eat excessive carbs and the food industry’s desire to sell carb-filled products that has created our obese and unhealthy population….”

“Many people not yet diabetic or pre-diabetic are asymptomatically obese, meaning they are obese but do not have symptoms yet, though they are at high risk of developing pre-diabetes and subsequently diabetes by consuming excessive carbohydrates. A segment of our population is normal in weight but still suffers from Type 2 diabetes or pre-diabetes.”

“Since excessive eating of carbohydrates can cause Type 2 diabetes, it can be put into remission by following a Low-Carb lifestyle. The HEAL Low-Carb Protocol is far more preferable than doctors prescribe medications and insulin that are expensive and have potentially dangerous side effects. It is well documented that the standard ‘pills-and-needles’ treatment method rarely puts diabetes into remission. However, it is certain that following HEAL’s Low-Carb Protocol will put almost every person with Type 2 diabetes into remission.”

“A Low-Carb lifestyle is not the medical establishment’s standard of care for Type 2 diabetes even though it is a safe, effective, and well-researched way to put the disease into remission. Perversely, many of the prescribed medications, such as insulin, cause weight gain and increase food cravings, making it difficult for a patient to lose weight. Most of the blood sugar control medications have side effects, many of them serious. The current treatment protocols trap patients in a lifelong regimen of drug management, obesity and escalating diabetes.” [The emphasis was added by me, of course.]

The Nutrition Debate #292: Type 2 Diabetes: Doctors in Transition

First off, let me be clear. I am not angry at doctors, in general. Neither am I an apologist for them, although examples of both have occurred in my 291 previous posts. Let’s face it: clinicians who treat Type 2 diabetes are in a tough spot. They are like passengers on the Titanic, cruising along in the dark, comforted by the knowledge that what they were taught in medical school is still the current treatment protocol. They are also aware, however, that how they are required to treat “will trap patients in a lifelong regimen of drug management, obesity and escalating diabetes.”

The Nutrition Debate #12: "Turning the Titanic", written 4 years ago, was a flop (only 30 page views). I guess people aren’t interested in abstract metaphors and allusion. They want concrete solutions. Well, folks, please don’t wait for the medical establishment to substantially change the standard of care for Type 2 diabetes. There are too many forces in play now. I don’t need to go into them all in detail. (It would just be a rant!) Suffice it to say the entire field of “healthy eating” today is dominated by the powerful food processors and manufacturers (“Agribusiness”) and drug manufacturers (“Big Pharma”). They in turn influence public health policy and corrupt drug research. To close the loop, their ads enrich the media and "miseducate" the public.

There are, of course, notable exceptions. In the modern era, Robert Atkins, MD, raised awareness of the benefits of low carbohydrate nutrition. He was attacked by the medical establishment as “a dangerous fraud” (The Nutrition Debate #4). Then, in 2008 Gary Taubes, the 3-times Science in Society award winning journalist, wrote, “Good Calories – Bad Calories” (“The Diet Delusion” in Britain). That book had a huge impact, especially (although less than he’d hoped) on medical practitioners. One MD, Kurt Harris, publicly acknowledged the influence that GC-BC had on him.

Dr. Harris was the creator of the “Archevore” protocol and “PaNu,” but he has since taken down his websites. Interested readers, however, can find some of Harris’s writing at Psychology Today here and The Nutrition Debate #19. Another book I’d recommend is Volek and Phinney’s “The Art and Science of Low Carbohydrate Living.” A very good online site where I “went to school” is Dr. Bernstein’s Diabetes Forum. It’s full of friendly and very helpful people.

Attempts by doctors and others to escape from the current treatment protocol and reach a wider audience via individual practice are by definition very limited. Blogs and other media do reach more people but are not very remunerative. Some have done that anyway with considerable success. The “Diet Doctor,” Andreas Eenfeldt, MD, is one such. “Authority Nutrition,” created by Kris Gunnars, a medical student, is another. And of course long-time blogger Jimmy Moore has a very popular website and many podcasts under his belt. Recently, he’s added a couple of books with Eric Westman, MD, from Duke University.

There are many other emerging "practitioners" who have seen the light, of course, most of whom have now written books, some reviewed here. A recent favorite book, and an easier read than GC-BC, is Nina Teicholz’s “The Big Fat Surprise.” She’s obviously riffing off Taubes’s earth-shaking New York Times July 7, 2002, Magazine cover story, “What If It's All Been a Big Fat Lie.” My internist read Taubes’s piece and suggested I try Atkins Induction. That’s how it all started for me.

Then, last summer, the American Diabetes Association (ADA) officially issued a Position Statement. Their “New Nutritional Guidelines,” state clearly, “It is the position of the American Diabetes Association (ADA) that there is not a “one-size-fits-all” eating pattern for individuals with diabetes.” It concluded, ““This Position Statement was written at the request of the ADA Executive Committee, which has approved the final document.” My response was, “Cowabunga, the ADA makes the turn” (#155). This “patient centered manifesto” would change everything! One problem: the document was written by, for and from the perspective of the Medical Nutrition Therapist, not the ADA doctor members. Did they even read it?

So, what will it take for more doctors to make “the turn”? If the Titanic is going to “stay the course,” would there not be a business opportunity for enterprising doctors and entrepreneurs to chart another course on a different “ship”? A course that will NOT “trap patients in a lifelong regimen of drug management, obesity and escalating diabetes.” Is there not a business opportunity for a medical practice, led by a recognized leader and backed by solid science, to multiply and expand using existing, established medical groups as well as digital marketing?

Well, such a business plan does exist, in a nascent stage.  In #293 I will tell you more about the HEAL Clinics.

The Nutrition Debate #291: Salad Dressing Oils: The Good, the Bad and the Ugly

While reading the MyFitnessPal article linked to here and in The Nutrition Debate #290: “My Healthy, Homemade (Vinaigrette) Salad Dressing,” I noted their choice of salad dressing oils included “olive oil, grape seed oil, sesame oil, nut oils and avocado oil.” Also, two of the three recipes featured used “olive oil” and the third, the Asian Vinaigrette, “vegetable oil.” To their credit, they did not mention either soybean oil or canola oil, the vegetable oils now most used (previously it was corn oil) in the processed food industry’s bottled salad dressings. So, I decided to do a lipid analysis of the oils they did include, using the very useful USDA's National Nutrient Database. My research produced the following table:

Salad dressing oils (%)	PUFA	Mono	SFA	n-6	n-3	n6/n3
Olive oil	10.5	73.0	13.8	9.8	0.8	12.3
Avocado oil	13.5	70.6	11.6	12.5	1.0	12.5
Canola oil	28.1	63.3	7.4	18.6	9.1	2.0
Peanut oil ('nut oil')	32.0	46.2	16.9	32.0	0.0	∞
Sesame oil	41.7	39.7	14.2	41.3	0.3	137.7
Corn oil	54.7	27.6	12.9	53.2	1.2	45.8
Soybean oil	57.4	22.8	15.7	50.4	6.8	7.4
Walnut oil (nut oil)	63.3	22.8	9.1	52.9	10.4	5.1
Grapeseed oil	69.9	16.1	9.6	69.6	0.1	696.0

For my analysis I have arranged all the oils listed in ascending order of their polyunsaturated fatty acids (PUFAs), The second column is monounsaturated fat content and the third the saturated fatty acid content. Then I list the Omega 6 percent, the Omega 3 percent and the ratio of Omega 6 to Omega 3. Omega 6s and Omega 3s are PUFAs and are “essential fatty acids.”

If you are reducing your consumption of Omega 6s, and improving your Omega 6/Omega 3 ratio, or balance, you are no doubt aware that you should avoid foods fried in vegetable or seed oils, and store-bought baked goods made with these oils. For the same reason you should avoid virtually all popular brand bottled salad dressings. See table below for details.

To make your own salad dressing (see #290), which oil then should you use? Well, olive oil (EVOO) is the clear winner, equally for the reason that it is both highest (73%) in monounsaturated fat (the “good” fat) and lowest (10.5%) in PUFAs (the “bad” fats). Avocado oil and Macadamia nut oil, the latter not listed in the USDA Database, are both very good but also very expensive. Canola oil isn’t bad, but is contains almost 3 times as many PUFAs (and about 10% fewer Mono’s) as olive oil. Besides, Canola Oil is made from a GMO dominated crop (see additional citation about the GMO issue below).

Peanut oil and sesame oil are up to four times as high in PUFAs as olive oil and have ugly n-6/n-3 ratios. (Peanuts are not nuts actually, but legumes.) And corn oil and soybean oil have five times as many PUFAs and only a third as much Mono as olive oil, so why would anyone (except a processed food manufacturer) ever dream of using them?

Walnut oil is laden with over six times as much PUFA as olive oil and less than one third as many monounsaturated fats as olive oil, and then grapeseed oil is the ugliest of them all: almost 70% PUFA with a n-6/n-3 ratio of almost 700.

Popular Brands of Salad Dressing and the oils they use:

Hidden Valley Ranch (The Clorox Company), all varieties*: soybean and/or canola oil

Kraft Salad Dressings (Kraft Food Group), all varieties*: soybean oil

Wish Bone (Unilever), all varieties*: soybean oil

Annie’s Naturals (General Mills), all varieties*: expeller expressed canola and/or sunflower oil

Brianna’s Homestyle (Del Sol Food Co.), Real French Vinaigrette: canola oil

Newman’s Own (Newman’s Own Fndn.), most varieties*: soybean and/or canola oil

Newman’s Own Balsamic Vinaigrette: soybean and/or canola oil, then EVOO

Newman’s Own Olive Oil & Vinegar: Olive oil blend (OliveOil/EVOO), then soybean and/or canola oil

Ken’s Steakhouse (Ken’s Foods): most varieties*: soybean or soybean and/or canola oil, then HFCS

Ken’s Steakhouse: Red Wine Vinaigrette: olive oil, then soybean and/or canola oil, then HFCS

Ken’s says they are “the number three manufacturer of salad dressings in the United States behind Kraft Foods and Wish-Bone,        including contract manufacturing for companies such as Newman's Own.” What happened to Hidden Valley, I wonder?

*  except “lite” and “fat free,” in which corn syrup or HFCS (sugars) are substituted for vegetable oils (soybean and/or canola).

So, why doesn’t Kraft, et al., use olive oil in all their industrially processed bottled salad dressings? Could it be that we don’t grow olives commercially here in the U. S., and we grow lots of soybeans and corn? Could it be that soy bean and canola oil are cheaper than olive oil? Canola oil is produced from a low-acid cultivar of rapeseed, a member of the mustard family. As of 2005, 87% of the canola grown in the US was genetically modified (GMO). That reminds me of a favorite quote:

“People are fed by the FOOD industry, which pays no attention to HEALTH and are treated by the HEALTH industry, which pays no attention to FOOD.” The quote is from Wendell Berry.