It's Still a Donut

In the US: Krispy Kreme unveils whole-wheat doughnut

Krispy Kreme Doughnuts Inc., still recovering from the low-carb diet craze that starved the company's earnings, unveiled a whole-wheat doughnut Monday. The 100 percent whole-wheat doughnut - with 180 calories - has a caramel flavoring and is covered with the doughnut maker's original glaze.

This is what happens when "whole grain" is "healthy"...

In the UK: Public want food 'traffic lights'

...simple red, amber and green guide to nutrition.

Under the scheme, cheese gets a red light; avocados get a red light; and a lot of boxed foods (read processed, refined foods) get green lights. One more example of a government pushing processed foods on the public.

Women Beware: Heart Disease & Stroke Risk

Fox News Nine, out of the Twin Cities headlined 90 Percent of Women at Risk for Heart Disease, Stroke on the heels of the American Heart Association release of updated guidelines for women at risk for heart disease and stroke.

The article opens with an ominous warning, "Michelle Bartell, 43, looks too young and too healthy to have had two heart attacks, and that is exactly the point of a new warning. It happened to her and it will happen to countless others. A new American Heart Association study shows 9 out of 10 women are at risk for heart disease or stroke."

Just nine out of ten?

Truth be told every last person is "at risk" for heart disease or stroke, just as every last person is going to die, life itself comes with a sure "risk" of death - we just don't know when.

The scare tactic headlines get your attention, but do little to help our understanding of real risk, over a lifetime, for women when it comes to heart disease and stroke.

Sadly the updated guidelines are little more than a "how to" manual to initiate drug therapy in every woman in America, as early as age 20 - the age they call for an initial risk assessement and start of intervention and treatment.

Even the recommendations, Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women - 2007 Update, published in Circulation, state that, "...nearly all women are at risk for CVD, which underscores the importance of a heart-healthy lifestyle."

Is it any wonder when you consider the criteria to be found "at risk" and therefore in need of intervention?

Have just one of the following in your initial risk assessment:

• Cigarette smoking
• Poor Diet
• Physical Inactivity
• Obesity, especially central adiposity
• Family History of premature CVD (in a male or female relative)
• Hypertension
• Dyslipidemia
• Evidence of subclincal vascular disease
• Metabolic Syndrome
• Poor exercise capacity on treadmill test and/or abnormal heart rate recovery after stopping exercise

Basically no woman will be found who are not at risk if we look at the list above, and then also consider what qualifies as "optimal risk" to remove one from the "at risk" category - a Framingham Global Risk score of less than 10% AND a "healthy lifestyle" AND no risk factors above.

So then we're off and running straight into the lifestyle modifications and intensive medical intervention.

Ah, yes, the lifestyle intervention - it pales in comparison to the intensive pharmacological intervention to be intiated as early as age 20; the treatment algorithm includes diet and exercise, underscored with a true lifestyle change - taking an assortment of drugs for the rest of your life!

This is "prevention"?

This is "risk reduction"?

This is the AHA "solution" to cardiovascular disease in women?

They have the gall to call this "evidence based"?

Just like the recent ADA update for diabetes, we find the AHA is now on the bandwagon to drug America - women in America - for the rest of our lives.

Not only that, they're also intent on getting public policy in line with their insanity, "Population-wide strategies are necessary to combat the pandemic of CVD in women, because individually tailored interventions are likely insufficient to maximally prevent and control CVD. Pulic policy as an intervention to reduce gender-based disparities in CVD preventive care and improve cardiovascular outcomes among women must become an integral strategy to reduce the global burden of CVD."

The media is taking this just as expected, as if it were the best thing next to sliced bread - in the WebMD section, heartwire, this was called a "bold prescription for the prevention of CVD;" and "with the goal to widen the window of opportunity for women to fight their number-one killer..."

A bold prescription? Interesting use of words there since it truly is a bold way to make every woman - healthy or otherwise - a target candidate for lifelong dependancy on prescription drugs!

"All women 20 years and older need initial CVD risk evaluation (medical history, physical exam, fasting glucose, lipids) and Framingham risk assessment; women with CVD need depression screening."

The dietary recommendations are a guaranteed recipe to induce every symptom needed to score as "at risk" of cardiovascular disease - a low-fat diet, limiting meats and animal foods, that is rich with carbohydrates and completely fails to meet essential nutrients.

The recommendation reads, "[w]omen should consume a diet rich in fruits and vegetables; choose whole grain, high-fiber foods; consume fish, especially oily fish at least twice a week; limit intake of saturated fat to less than 10% of energy, and if possible, less than 7%; cholesterol to less than 300 mg/day; alcohol intake to no more than 1 drink per day and sodium intake to less than 2.3g/day (approximately 1 tsp salt). Consumption of trans-fatty acids shoudl be as low as possible (eg, less than 1% of energy)."

ahem....this is "evidence based"?

Within the statement we find "the summary of evidence used by the expert panel can be obtained online as a Data Supplement at http://circ.ahajournals.org/cgi/content/full/CIRCULATIONAHA.107.181546/DC1.

Oddly, on this page referenced as the one to look to for additional information on the data presented in the statement - Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update - there isn't any file to read to evaluate the so-called evidence used for the development of the dietary recommendations.

Wonder why?

It's because there are no studies that can be used to support the dietary recommendations in the statement!

At the end of the paper we find "Appendix - Bibliography by Topic" and within that section, "Dietary Modification" with a laundry list of studies supposedly supporting the recommendations in the paper, that is followed by "Dietary Modification Meta-Analysis" with one citation as supportive.

This gives any reader the impression that there are mountains of data to support the recommendations.

How about we take a look?

• Abbott et al investigated magnesium in the diet and the risk of cardiovascular disease.
  Nope, not evidence to support a low-fat diet.
• Willett et al investigated the relationship between calcium intake from diet or supplements and risk of ischemic heart disease in MEN.
  Nope, not evidence to support a low-fat diet.
• Bazzano et al reported results from a national survey of fiber intake and reduced risk of heart disease.
  Nope, not evidence to support a low-fat diet.
• Boniface et al reported on 16-year coronary disease mortality in Britain and fat intake.
  Intriguing , but nope, not evidence to support a low-fat diet.
• Dauchet et al looked at fruit and vegetable consumption.
  Nope, not evidence to support a low-fat diet.
• Ellingsen et al investigated smoking and dietary advise in MEN.
  Nope, not evidence to support a low-fat diet.
• Erikka et al looked at vitamin K levels as a potential marker for heart disease, not stroke, in women.
  Nope, not evidence to support a low-fat diet.
• Howard et al - the Women's Health Initiative null findings from last year are here?
  Nope, not evidence to support a low-fat diet.
• Hu et all appears in three separate citations - one for overall dietary pattern in MEN, one for alpha-linolenic acid and one for dietary protein.
  Nope, not evidence to support a low-fat diet.
• Jensen et al was on whole grain intakes
  Nope, not evidence to support a low-fat diet.
• Knoops looked at the Mediterranean dietary pattern and risk
  Nope, not evidence to support a low-fat diet.
• Kromhout et al looked at alcohol, fish, fiber and antioxidant vitamins and risk - funny, but the title includes that these "do not explain population differences in coronary heart disease mortality"
  Nope, not evidence to support a low-fat diet.
• Lee et al looked at vitamin C supplementation and risk
  Nope, not evidence to support a low-fat diet.
• Liu et al at fruit and vegetable intake, and in a second citation at breakfast cereal intake in MEN
  Nope, not evidence to support a low-fat diet.
• McCullough et al investigated adhering to the dietary guidelines and risk
  Nope, not evidence to support a low-fat diet.
• Mukamal et al looked at coffee consumption
  Nope, not evidence to support a low-fat diet.
• Nestel et al was a drug trial
  Nope, not evidence to support a low-fat diet.
• Osler et al was a study to look at dietary scoring used in studies
  Nope, not evidence to support a low-fat diet.
• Sesso et al looked at flavonoid intakes and risk
  Nope, not evidence to support a low-fat diet.
• Steffen et al looked at whole and refined grains, fuits and vegetables to assess risk
  Nope, not evidence to support a low-fat diet.
• Trichopoulou et al is cited twice - both studies looking at survival among patients with CHD and the mediterranean diet in Greece
  Nope, not evidence to support a low-fat diet.
• van der Schouw et al looked at phytoestrogens from diet and risk
  Nope, not evidence to support a low-fat diet.
• Yano et all looked at coffee and alcohol related to risk
  Nope, not evidence to support a low-fat diet.

Notice a pattern here?

How about the Meta-Analysis citation, perhaps that one is convincing enough?

Huxley et al, looked at studies to see the effects of dietary flavonol intake and CHD mortality - and once again, nope, not evidence to support a low-fat diet.

Twenty-nine references cited as supportive evidence for the low-fat diet recommendation within the document - not one actually shows such a diet will prevent cardiovascular disease or stroke in women.

Yet to any casual reader, this list in impressive and is assumed to be support for the recommendations within the document; that's because it's assumed citations are used properly, in context to what's written and because they support of statements.

It's also assumed those writing have the integrity to utilize the evidence accurately and truthfully.But after looking at the citations it's clear this is not the case.

We have before us "evidence-based recommendations" without foundation in the science; without support in the data; being foisted upon us to follow without question because the AHA says it's evidence-based.

As a woman, I am highly offended by these recommendations - they're nothing more than a sure-fire way to make sure every woman in America is classified "at risk" so that intensive intervention and therapy may be initated to "save her" from herself and her poor diet, inactivity and get her on her lifelong pharmaceutical program early.

Scare Tactics to Bolster Grain Consumption

Be afraid, very afraid - if you don't eat plenty of folic acid enriched grain products each day, you'll have children with birth defects.

That's the explicit message hot off the press, Could low-carb diets lead to birth defects?

"Blood levels of folate in young women are dropping, a disturbing development that could lead to increased birth defects and may be due to low-carb diets or the popularity of unfortified whole-grain breads."

[...]

"Diet trends may have been be another factor, said Dr. Joseph Mulinare, a CDC epidemiologist who was the study's lead author.

He noted that in 1998, the Food and Drug Administration began requiring that folic acid be added to breads, cereals and other products that use enriched flour. Whole-grain breads were not under that mandate because they already contain some folate.

Low-carb diets increased in popularity during the early 2000s. Women who avoided flour and bread products because of their carbohydrates may have also taken in less folic acid, Mulinare said.Eating certain foods also helps, especially breads, cereals and other products containing enriched flour."

If you could see my face right now, you'd notice a very big eye roll as I shake my head at the insanity of this. Never mind that the survey didn't actually look at the diet of those whose blood samples were found low in folate; never mind this is simply one more excuse to push eating processed grains; and never mind real whole food - vegetables, beans, fruits and some cuts of meat are exceptional foods to meet folate requirements.

One only needs to look at foods routinely consumed on a low-carbohydrate diet and compare them to the "miracle" folic-acid enriched grain products promoted in the above article to see the sham of this scare tactic designed to make you eat more processed grains!

World's Healthiest Foods provides a comprehensive list of foods "rich" with folate - notice the top ten are NOT whole grains or enriched grains, but are real whole foods; in fact, in the longer list toward the bottom of the page, not one of the "excellent sources" are a grain or grain product, not one of the "very good" or even "good" sources are either - they're ALL whole foods - meats, fruits, nuts, vegetables, roots, mushrooms, beans - with almost all of them not only allowed, but encouraged and mandatory in a carbohydrate restricted diet.

On the other hand, the Partnership for Essential Nutrition, an organization that is highly critical of carbohydrate restricted diets includes these foods as good choices to eat:

Bread, enriched white 1 slice 27
Breakfast cereals 1 ounce (approx 1 cup) Approx. 100-400. Check the label
Pasta, enriched ½ cup 53
Rice, white enriched ½ cup 54

No thanks, with just 2 cups romaine, 1 cup cooked spinach I'll easily meet the 400mcg requirement without even specifically trying - if I add in tomatoes, cucumbers, some chickpeas and some more veggies and I can easily double that with real whole food that also come complete with an abundance of other essential nutrients without any added sugars, vegetable oils or processed grains!

UPDATE 02/21/07: A reader emailed with more foods as listed in the USDA Nutrient Database:

Liver – chicken – pan fried per 100mg: Folate, food mcg 560
Chicken liver pate: Folate, food mcg 321

compared with the "wonder" food:
Whole-wheat bread per 100mg: Folate, food mcg 50

The Big Fat Joke of our Dietary Recommendations in the US

I've received a number of interesting emails the last few days; asking everything from "where are you going with this?" to "that's not a plant-based diet, and most definitely not a vegetarian diet, so what's your point?"

Patience grasshopper, patience!

My point is this - over the last thirty-odd years we've been repeatedly told to limit meat, consume fewer eggs, choose low-fat dairy, use vegetable oils instead of animal fats for cooking, take the skin off our chicken and eat more chicken and fish; advised to have a few "vegetarian nights" for dinner; told to spread margarine, not butter, on our bread; pressured restaurants and fast food outlets to use partially hydrogenated oils to reduce saturated fat; reminded to eat more grains for fiber; and, at the end of the day, bought - hook line and sinker - the message that how we used to eat was bad, bad, bad and a diet with more plant-based calories was better for us.

Slowly but surely we have modified our diet and more calories now, than ever before, 73% in fact, come from plant-based sources; and we've grown obese, diabetic and disabled with increased incidence of degenerative disease. We're also a nation slowly becoming dependent on prescription medications to relieve the symptoms of our poor dietary habits while we're repeatedly told our health would improve if we just ate less meat, eggs, butter, saturated fat, and cholesterol.

Folks, these are not the problems in our diet.

Oh, we have modified our calories to consume more plant-based sources of calories, but we're not eating closer to a vegetarian diet (nor do I think we have to).

What we're eating is more and more processed foods with the majority of calories coming from three nutritionally poor, calorie dense sources - added sugars, added vegetable oils and refined grain products.

In fact, these three things - added sugars, added vegetable oils and processed grains - made up more than 60% of our daily calories in 2000. By 2004, little changed over four years, these three items still provided more than 60% of our daily calories.

These three items, that are providing most of our calories each day, aren't really "foods" but are better thought of as "ingredients" since no one will readily sit with a sugar-bowl and eat spoon after spoon of sugar, take slugs from a bottle of corn syrup, chow down over a big bowl of flour, or pour a nice big glass of soybean oil to sip at the end of the day.

These ingredients however litter our food supply and are found in virtually all processed foods - those you'll likely find in a box, jar, can or bag; those with a nutrition label on them detailing the fat, carbohydrate, fiber and protein, followed by the ingredients; frozen, refrigerated or stable on the shelf, these foods contain the ingredients that provide the majority of our calories each day.

As the past couple of posts highlighted, the devil is in the details - it's not what you're eating per se that appears to be a problem; but it's what's in what you're eating that is adding not only significant calories each day, but a significant burden on your metabolism.

With more than 60% of calories from nutritionally bankrupt ingredients that provide little more than energy, should we be surprised we're growing obese, diabetic and suffering an increase of degenerative disease?

Take a close look at what our diet looks like from the ERS data - in 2000 averaged 2,739-calories, with those calories coming from:

• dairy, 285-calories (10.4%);
• fruits 80-calories (2.9%);
• vegetables, including potatoes and legumes, 133-calories (4.9%);
• nuts, including peanuts, 90-calories (3.3%);
• eggs 27-calories (1%);
• meats, poultry and fish combined provide 374-calories (13.6%)
  red meats, including beef, pork, lamb and veal, 248-calories (9%);
  poultry, including chicken and turkey, 110-calories (4%)
  fish 16-calories (less than 1%)
• grains, 634-calories (23%)
  whole grains, 32-calories (1.1%)
  refined grains, 602-calories (21.9%)
• added sugars, 502-calories (18.3%)
• added fats, 650-calories (23.7%)
  vegetable oils (mostly soybean), 276-calories (10%)
  shortening, 238-calories (8.7%)
  margarine, 40-calories (1.5%)

To determine the ratios of whole grain versus refined grain, I based the above calorie intakes on a 2002 Nutrition Research Newsletter that included the following, "Grains account for approximately 25% of energy consumption in the United States. However, an estimated 95% of grain available for consumption is refined."

Our diet is appalling - not because we eat too much meat, not because we can't give up eggs, and not because we love our butter...but because we're replacing "real food" with processed foods rich with added sugars, added vegetable oils and refined grains!

And we're eating like this thinking we're choosing healthy foods because we're told these foods are healthier for us - when we reach for the whole grain crackers, whole grain breads, ready-to-eat breakfast cereals touting whole grains, reduced fat salad dressings, and other "foods" we're encouraged to eat - almost all contain one, two or all three of the offending ingredients.

Want an example of just how we're encouraged to eat foods with these ingredients? The Mayo Clinic says "For a healthy breakfast on the go, munch dry, ready-to-eat cereal with a banana and drink a small carton of low-fat or skim milk. The best cereals are those that are higher in fiber. If counting calories, choose cereals that are lower in calories."

Among the options suggested by the Mayo Clinic?

Basic Four
INGREDIENTS include: Sugar, Rice, Brown Sugar, Crisp Rice (Rice Flour, Malt Extract, Sugar, Salt),Corn Syrup, Partially Hydrogenated Soybean Oil, Corn Syrup Solids, Dextrose, Malt Syrup, Dried High Maltose Corn Syrup, and High Maltose Corn Syrup

With 200-calories per serving, 41.5% of those calories are from added sugars and added vegetable oil (partially hydrogenated vegetable oil); if 50% of the grains are refined, as the ingredients suggest, than another 12.5 grams of carbohydrate, or 25% more of the calories, are from refined grains, bringing the total calories from three ingredients - added sugars, added oils and refined grains - to 66.5% of the total calories in a serving.

It's not just the Mayo Clinic serving up advice that leads directly to higher than anticipated consumption of added sugars, added vegetable oils and processed grains.

The 2005 Dietary Guidelines for Americans maintains a document "Food Groups to Encourage" that reads "Consume 3 or more ounce-equivalents of whole-grain products per day, with the rest of the recommended grains coming from enriched or whole-grain products. In general, at least half the grains should come from whole grains;" an implicit nod to continue eating processed foods, now just look for whole grain in the ingredients!

The American Heart Association makes the same recommendation and even offers manufacturers an opportunity to have the AHA Heart Check Mark on their products for consumers to identify those that are "heart healthy" - among those promoted as "heart healthy" - breads with added sugars and partially hydrogenated oils; ready-to-eat breakfast cereals including Lucky Charms, Cocoa Puffs, Berry Berry Kix, and Trix; chocolate and strawberry flavored milks; microwave popcorn; and reduced fat crackers. The No-Fad Diet, an AHA publication, specifically includes donuts, fast food bacon biscuits and other fare as "healthy" when it is clearly the opposite!

And yet we blame Americans for being unable to make good choices?

The American Dietetics Association, in their Nutrition Facts Sheets, maintains a document, targeted toward the consumer, titled "Whole Grains Made Easy" - within it, a weeks menu with granola bars, pretzels, cornbread, ready-to-eat cereal, graham crackers, tortilla chips, veggie burgers and waffles; all included as "whole grain" foods to choose each day! Ignore that each is processed and includes one or more of the three ingredients above.

The American Diabetes Association (ADA) includes sugar, processed foods and copious amounts of vegetable oils in their advice to those at risk for or diagnosed with diabetes. In their latest update to their Nutrition Recommendations and Interventions for Diabetes - 2006, they specifically state a low-carbohydrate diet (less tahn 130g of carbohydrate each day) is to be avoided and that "Individuals at high risk for type 2 diabetes should be encouraged to achieve the U.S. Department of Agriculture (USDA) recommendation for dietary fiber...and foods containing whole grains (one-half of grain intake);" and "people with diabetes are encouraged to choose a variety of fiber-containing foods such as legumes, fiber-rich cereals..., fruits, vegetables, and whole grain products because they provide vitamins, minerals, and other substances important for good health."

More food products, with added sugars, added vegetable oils and refined grains, encouraged as good choices.

And yet we blame Americans for being unable to make good choices?

While we're repeatedly told to limit our consumption of red meat, butter, eggs and other animal foods, we're also specifically encouraged to consume processed food products disguised as "healthful" because they're a "source" of whole grains, low-fat, no cholesterol.

Ignore the added sugars, ignore the vegetable oils, ignore how much of a product is not whole grain...just don't eat animal foods!

Our current diet is wrecking havoc on our metabolism; its nothing more than excessive sugars, oils and processed grain products, which leave our bodies wondering what its supposed to do with these calories coming in that do not include much in the way of essential nutrients to work with.

We're reminded it's all about calories, without much said about meeting essential nutrient requirements; we're reminded to limit saturated fat, without much said about the detriments of excess polyunsaturated fatty acids providing excess omega-6 and the nutrient deficiency risk when limiting or replacing one type of food with another; and when we hear "food" mentioned by experts, it's often a "food product" with little distinction between real whole food versus processed foods.

We're left totally confused within the grocery store as more and more packages have labels touting their food product as superior to another because "insert health claim here;" manufacturers and retailers are gearing up to confuse us further with in-store promotions of whole grain products and other such "healthful" selections, totally ignoring the added sugars, vegetable oils and processed grains in those products you'll be directed toward because they're "healthier" for you.

Nutrition advice in the United States is a total joke, yet no one is laughing at the consequence of our folly that has resulted in an explosion of obesity, diabetes and other degenerative diseases.

Yet we continue down the path, warning incessantly about the terrible things in real whole food - saturated fat in meats and coconut oil; cholesterol in animal foods, especially eggs and butter; too much fat in nuts and seeds, too much fat in milk and cheese; while encouraging the consumption of vegetable oils, processed grains, fruits & vegetables and legumes; in a continued attempt to modify our dietary habits to include more plant-based foods, more vegetarian selections and include even fewer animal foods each day.

Just get with the program and all with be well.

But if you look at our food intake, and look at where it was forty years ago, thirty years ago, even twenty years ago, we're eating similar levels of animal foods - what we've increased, significantly, is added sugars, processed grains and vegetable oils.

We do this without much thought, eat without realizing just how much more we are consuming calorie-wise, because added sugars, vegetable oils (soybean) and processed grains do not offer satiety or a level of nutrients our metabolism can use; all these ingredients offer is additional calories which short-circuit our metabolism and cause a host of problems from insulin resistance, high blood pressure, dyslipidemia, high triglycerides, elevated blood sugars and more.

Over time these disturbances lead to diabetes, heart disease and some cancers.

If we seriously want to halt the trends in obesity, reverse the epidemic of diabetes and stop the continued rise in degenerative diseases, we must - must - stop promoting processed food products as "healthful" options; better for us than real, whole foods that happen to include meat, dairy, eggs, oatmeal, qunioa, vegetables, fruits, nuts, seeds, etc.

For over thirty years we've been sold a bill of goods that is directly causing our poor health and growing obesity - processed foods that contain added sugars, vegetable oils and processed grains - are adding significant hidden calories to our diet and not providing for essential nutrients that are critical for our health.

The experts wring their hands over the obesity epidemic while they refuse to consider the source of our inability to regulate appetite; they blame the population for making poor choices and lacking willpower; and they ignore that the foods they're specifically encouraging are the problem. Until the powers that be have the guts to address the issue of processed foods and the damaging effects of excess ingredients in packaged foods, little is going to change regarding obesity or diabetes.

But you - you can read the consumption data yourself and begin to see exactly how our eating pattern has changed in ways no one is talking about. You can see with your own eyes just how much more added sugars, vegetable oils and processed grains we're consuming in this country and then look at the various recommendations being made to consume that foodstuff.

Then, you can evaluate your own diet - see where you can make improvements to eliminate these ingredients adding calories, these foods that are not healthful to you and begin to eat a diet that truly is healthy....one rich with nutrients, rich with real, whole foods.

Diet Pattern from Another Perspective

The Economic Research Service of the USDA released food consumption data that provided the following in the overview, "In 2002, total meat consumption (red meat, poultry, and fish) amounted to 200 pounds per person, 23 pounds above the level in 1970. Americans consumed, on average, 18 pounds less red meat (mostly less beef) than in 1970, 37 pounds more poultry, and 4 pounds more fish. The types and amounts of food an individual chooses to eat not only affect his or her well-being, but also have implications for society as a whole."

In the spreadsheets online, the ERS data for 2000 includes calorie consumption of 2,739-calories each day (not including alcohol). Because the data is presented differently than the FAO data I used in a previous post, it's not an easy cut & paste into a spreadsheet to see where the calorie differences are found. After reviewing both sets of data however, the ERS data shows consumption of significantly less calories than FAO data for these items:

Added sugars ERS = 502-calories - FAO = 666-calories
Cereal GrainsERS = 635-calories - FAO = 869-calories
DairyERS = 285-calories - FAO = 387-calories

Other food consumption differences are minor, like butter is listed in the FAO data as 55-calories per day and 32-calories in the ERS data; FAO says fish in the US is 30-calories a day, the ERS says 16-calories a day.

The discrepancy is due to the calculation methods - the FAO calculates consumption based on production, imports, exports, wholesale waste and clearance from supply chain; the ERS takes that a step further and calculates estimated plate/kitchen waste along with surveys from eating habits (like what percentage of the population is known to toss egg yolks before making an omelet). In addition, unlike the FAO data which assumes, for example, "dairy is dairy" globally, the ERS bases the consumption estimate on type of dairy consumed (whole, low-fat, skim, etc.), so it more refined than the FAO data.

So, before I continue, I'm also going to present a quick scenario of a day of eating created from the ERS data since it also works out to 73% of calories from plant-based sources and 27% of calories from animal foods. Interestingly, if we use the ERS data, the calories from added sugars, cereal grains and vegetable oils now exceeds 60% of total calories per day.

So, based on the ERS dataset, the menu for a day might look like this:

Breakfast
1 serving frozen waffles
Pancake syrup
2-oz pork sausage
Coffee with sugar and non-dairy creamer
1 cup orange juice

Snack
Low-fat fruit yogurt
Bottled water

Lunch
1 cup mixed salad greens, tomatoes, slice onion, salad dressing (composite to type)
Roast beef (3-oz) sandwich with mayonnaise, 1 slice nonfat american cheese
1 cup potato salad
1 can regular soda

Snacks/Beverages
1 apple
8 reduced fat Wheat Thins
1.5 tablespooon peanut butter

Dinner
2.5-oz chicken breast, skinless, sauted in vegetable oil (soybean)
1 cup broccoli with margarine
1 cup brown rice (long grain)
1 cup lemonade (from powder mix)

Total Calories = 2738
Fat = 102g (34%)
Carbohydrate = 370g; Fiber = 23g; Net = 347g (51%)
Protein = 99g (15%)

The above menu is off by 3-calories, and like the FAO data menu is exact for meat, poultry, eggs, etc.

Like the previous menu, it is startlingly "healthy" if we measure healthfulness based on dietary guidelines in America - it contains low-fat dairy, reduced fat crackers, lean meats and favors margarine and vegetable oil for cooking.

Yet, it too is a nutritional nightmare - deficient now in Potassium, Vitamin D, and Vitamin K; with excessive intake of sodium (63% more than recommended) and contains less fiber than recommended.

It also contains an unacceptably high 7.48g of trans-fatty acid - but hey, saturated fat only provides 8% of total calories.

I've added this post to add to our understanding of how we eat in the United States and to begin the next step of analysis of why this type of eating pattern may be directly related to our obesity epidemic and exploding prevalence of metabolic syndrome and diabetes.

We'll begin to tackle that issue next week!

What Does our Diet Look Like?

On Wednesday I ended my post with:

The changes in our diet over the last forty years begs an important question - how are we able to consume copious and increasing amounts of sugar, vegetable oils and cereal grains while continuing to eat a similar level of animal foods?

Just what is going on in our metabolism that even makes that possible?

That was written after detailing how our diet changed between 1961 and 2000 - changes that included an increase of 934-calories; 80% of them from increased consumption of added sugars, cereal grains and vegetable oils; all while we ate less red meat, butter, and eggs.

The shocker - as a nation we consumed an average 3,817-calories per person each day in 2000.

So, I had to wonder, what does 3,817-calories in a day look like?

Using the FAO data for each food group and type, I pulled a menu together in an attempt to reach 3,817-calories with, as per the consumption data, 156g of fat, 115g of protein, 20g of alcohol and 450g of carbohydrate.

In the process I had to choose foods rich with soybean oil, added sugars and include an adequate level of cereal grains to try to match the consumption pattern suggested in the data; I also limited animal fats and proteins to align with the data to reach the dietary pattern the FAO data suggests we consumed each day in 2000.

Lastly, I attempted to make this menu as realistic as possible, where an individual might think they're eating healthy since recent surveys show the majority of people - 75% - actually do think they're eating healthy.

What does such a day of eating potentially look like if we create a menu based on the consumption data from 2000?

Breakfast
1 serving frozen pancakes, microwaved
2.5 small brown-and-serve pork sausage links
Pancake syrup
Coffee with sugar and non-dairy creamer
1/2 cup orange juice

Morning Snack & beverage
Low-fat Fruit Yogurt
Lemonade

Lunch
1 cup mixed greens salad, 1/2 cup diced tomatoes, 1 medium slice onion
2 TBS salad dressing (composite to type, soybean oil based)
2-oz lean roast beef, 1 slice american cheese (plastic wrap type), 2 regular slices rye bread, mayonnaise
3/4 cup potato salad
1 small apple
Lemonade (made from powdered mix)

Afternoon Snack(s) & beverages
1-ounce tuna in water mixed with mayonnaise
6 reduced fat Wheat Thins
1 can regular soda
1 peanut butter cookie (packaged, soft style)
Lemonade
Bottle of water

Dinner
3.9-oz chicken, white meat, skinless (vegetable oil, soybean, used in pan to saute chicken)
1 cup noodles, 1 tsp butter
1 cup green beans with onions, from frozen, margarine in ingredients
7.5 ounces red or white wine

After Dinner Snack
1 cup skim milk
Pretzels, reduced fat dip

Total Calories = 3,830
Fat = 152g
Carbohydrate = 472g; Fiber 21g; Net 451g
Protein = 125g
Alcohol = 20g

Just a bit over the estimated calorie intake (+13 calories), but the menu is exact for intake of beef, fish, poultry, pork, butter and eggs; notable is that there isn't an egg on the menu, it's in the prepared foods.

In this menu, the cereal grains, added sugars and soybean oil is very very close to the consumption estimate from the FAO.

Overall, in the above menu, almost 57% of the calories come from three things - cereal grains, vegetable oils and added sugars.

Yet it doesn't look like there are 4.5-tablespoons of soybean oil or a bit more than 3/4 of a cup of added sugars and with seven servings of grains, it's well within the dietary recommendation of six to ten servings each day.

It's also within the recommendation to keep saturated fat intake at or below 10% of calories, coming in with just 9% of calories from saturated fat.

But consider this - even with this level of calorie intake, the above menu does not meet the recommended intake for Potassium, Vitamin A, Vitamin D, Magnesium or Fiber! All those calories and anyone eating it is still deficient for essential nutrients, and even would consume 2.75-times the sodium without adding one shake of salt at the table!

And, while this menu contained just 9% of calories from saturated fat - a target most agree is desirable, no one would say the almost 12g (11.58g) of trans-fatty acids are acceptable, yet the above menu contains that much trans-fat!

This is but one scenario of a typical day's menu that might align with the consumption data for the United States in 2000; few eat all types of meat and fish in one day; the FAO data and ERS data is based on consumption averages - so while in the real world one day may be chicken and fish and another day beef or pork, over a week or month we consume an average number of calories from those foods.

The scary thing is the above menu isn't unreasonable for an average person to consume throughout the day, and many of the items I selected are considered "healthier" choices as per the dietary recommendations - the lowfat yogurt, wheat thins, tuna, rye bread, pretzels, skinless chicken breast, salad and green beans with onions, non-dairy creamer, skim milk, lean roast beef, and an apple - yet this menu is a nutritional nightmare - is it any wonder What We Eat in America, a report compiled using NHANES data, found chronic population-wide nutrient deficiency when published in 2005?

Which brings us to the second question asked above - just what is happening in our metabolism that allows us to eat that many calories?

We'll explore that question next week...

Time Crunch...

Yesterday I wrote that I'd continue with a follow-up to my post - for those awaiting that post, please forgive my delay, an unanticipated schedule change here means I won't be able to complete the post until later tonight!

Thanks for your patience!

Do we need more plant-based calories in our diet?

Eat a plant-based diet.

It's a message we're bombarded with almost daily in the media and from health experts.

Carefully packaged within the message are subtle cautions about our omnivore ways - meat is loaded with "artery clogging" saturated fat, so are dairy products; eggs are rich with that deadly stuff called cholesterol; and, my favorite, we eat too much protein anyway, so limiting or eliminating animal foods will somehow resolve this problem in our diet.

A recent article in Pipe Dream, sums up our wayward diet nicely, "we are here to tell you to relax and put down the t-bone, as you're probably getting enough protein to feed a small family...of lions.

[...]

Although protein is an essential macronutrient which plays many key roles in the way our bodies function, we do not need huge quantities of it...Given the content of a Western diet, getting enough protein is no challenge. Unlike carbohydrate centered diets of China and Italy, protein is a huge part of our diet. From pork chops to hamburgers to filet mignon, meat is everywhere...You don't have to become a vegetarian to combat the protein craze, but consider rethinking the amount of animal protein you ingest."

Another site, The Body Fat Guide, explains that "Looking first at the role of animal fat in producing disease, one comes across a contradiction to the conventional wisdom: the French Paradox. If eating animal fat produces heart disease, why do the French, who eat plenty of saturated animal fat, have lower rates of heart disease?

The explanation that is consistent with the research on animal protein is that the French consume animal fat largely in the form of butter and cream, which is very low in animal protein. When considering the overall diet of the French, one sees that it is much lower in total animal protein then the Western diet, even though it is higher in animal fat."

Articles like these try convince you that the problem in our diet is animal foods - and that if we eliminate or limit animal foods, we'll see better health because we'll be eating less animal protein and animal fat.

The question then is, are we really eating too much animal protein and fat?

In order to answer that question, we need to first look at our dietary habits before the "diet-heart theory" (aka the lipid hypothesis) took off in the popular media; before the messages to eat less fat really took hold in the minds of the American public; to a time when people just ate their food and didn't think much of it other than did it taste good?

To do that we'll look back at data from the 1960's - the period right before health organizations and the government sought to modify our eating habits toward a plant-based diet....so let's look at the year, 1961 - the earliest date available for complete data from the Food and Agriculture Organization (FAO) of the UN.

From the food balance sheets (which calculates production, exports, imports, waste, spoilage and other factors that determine final consumption of a given population) we find that in 1961 the calories in our diet came from mostly plant-based foods; 65% of total calories were plant-based and 35% were animal-based sources.

Of the 2882.50-calories each day, we consumed 13.2% of our calories from protein, 34.4% from fat, 48.7% from carbohydrates and 3.7% from alcohol.

Of those calories, animal protein accounted for 8.7% of our total calories and also accounted for 66.1% of our total protein intake.

Animal fats provided 21.7% of our total calories, and also accounted for 66% of our total fat consumed.

Pretty shocking, isn't it?

By today's dietary standards, that's a diet that's going to kill you - and given the level of noise about our "poor diet" these days, we must be eating more animal fat and protein - so you'd think?

Well, we're most definitely eating more calories - in 2000 we consumed an average of 3816.71-calories each day; an increase of 934.21 calories over 40-years.

Where things get interesting though, is how our diet has changed in those years.

By 2000, however, our diet looked very different from the sixties; in fact, our dietary intake from plant-based foods increased to account for 73% of our calories each day, animal food sources provided just 27% of our calories.

Must make the "plant-based diet is all that" crowd pretty darn happy - we've most definitely migrated toward eating more calories from plant-based foods than animal foods!

But, in 2000 we did eat more calories - we consumed just 12% of our calories from protein, 36.7% from fat, 47.3% from carbohydrate and 4% from alcohol.

Shifts in protein consumption also are found in the data - where before 8.7% of our total calories were from animal proteins, in 2000, just 7.6% of calories came from animal protein; and animal protein now accounted for 63% of our total protein versus 66% previously.

So while we're told we're in the middle of an obesity epidemic, an explosion of diabetes and a healthcare crisis - remember this fact: while the powers that be are trying desperately to convince you to restrict or eliminate animal foods - today we're eating less protein as part of our total diet than other countries with less heart disease - including Japan!

In countries with enviable low mortality rates from heart disease, protein accounts for

• 13.2% of calories in Japan
• 13.2% of calories in Sweden
• 13.1% of calories in France
• 12.5% of calories in Italy
• 13.1% of calories in Spain
• 13.5% of calories in Greece

We consume just 12% of our calories each day from protein - and here's an interesting fact: we're not eating more red meat or eggs.

In fact, consumption of both red meat and eggs has decreased over 40-years, along with consumption of butter.

In 1961 red meat (beef, lamb, and goat) provided about 140-calories each day; in 2000 these same foods now provided an average of 123-calories a day. Pork consumption didn't change much, but poultry consumption increased significantly - in 1961 poultry accounted for an average 64-calories a day; by 2000 it accounted for 186-calories a day.

So, while we're eating less red meat and about the same amount of pork, we're eating a heck of a lot more poultry!

Eggs used to provide an average 67-calories a day (about six eggs a week on average per person); in 2000 that had declined to 55-calories a day (less than five eggs a week on average per person).

And, butter - that "bad boy" everyone keeps insisting we must eat less of - well, we are...a lot less. In 1961 we averaged 65-calories a day from butter (about 4.5 tablespoons a week) - in 2000 that was down to just 40-calories a day (about 2.8 tablespoons a week).

So, while we're eating the same calories from animal fat - most of it today is from poultry, not butter, eggs and red meat - and 36 more calories from animal protein, is again from increased consumption of poultry, not red meat or eggs.

But still, if you're advocating a plant-based diet, that's not much of an "advance" toward a "healthier" diet is it?

And, well, we are eating 934 more calories a day! That can't be a good thing.

So, if just 36 of those calories are from animal foods, what the heck explains the other 898-calorie increase?

Sugar, vegetable oils and cereal grains.

Yes, a full 80% of our calorie increase - 750.48 calories - comes from just three sources: sugar, vegetable oils and cereal grains.

Over the period of 40-years, we've increased our added sugars by about 30%, adding 150-calories a day (from 515.75 calories to 665.82 calories); increased our consumption of vegetable oils almost two-fold, adding 358.78-calories a day (from 276.15 calories to 634.93 calories); and increased our consumption of cereal grains by 38%, adding 241.7-calories a day (from 627.32 calories to 869.05 calories).

Sugar, vegetable oil and cereal grains - the base ingredients of many packaged, processed foods in America.

The changes in our diet over the last forty years begs an important question - how are we able to consume copious and increasing amounts of sugar, vegetable oils and cereal grains while continuing to eat a similar level of animal foods?

Just what is going on in our metabolism that even makes that possible?

Those questions will be explored tomorrow!

Adaptive Thermogenesis Can Impede Weight Loss

A calorie is a calorie is a calorie; so we're told.

Calories in - calories out matter when it comes to our weight; so we're told.

Eat less and move more, reduce calories and increase calories used, the secret to weight loss; so we're told.

Back in 2004, Drs. Feinman and Fine offered up a paper, published in Nutrition & Metabolism, "A calorie is a calorie" violates the second law of thermodynamics.

Within that paper, it was noted that, "A review of simple thermodynamic principles shows that weight change on isocaloric diets is not expected to be independent of path (metabolism of macronutrients) and indeed such a general principle would be a violation of the second law. Homeostatic mechanisms are able to insure that, a good deal of the time, weight does not fluctuate much with changes in diet – this might be said to be the true "miraculous metabolic effect" – but it is subject to many exceptions. The idea that this is theoretically required in all cases is mistakenly based on equilibrium, reversible conditions that do not hold for living organisms and an insufficient appreciation of the second law. The second law of thermodynamics says that variation of efficiency for different metabolic pathways is to be expected. Thus, ironically the dictum that a "calorie is a calorie" violates the second law of thermodynamics, as a matter of principle."

While the paper has been cited a number of times over the years, no other major study or paper has challenged the idea that weight loss is mostly dependent on "calories in calories out" - so lacking is any question of this belief that many continue to hold the not-so-subtle idea that if someone isn't losing weight on a calorie restricted diet, then they are not restricting calories enough or they're cheating and just won't admit it.

Well folks, get ready to read an eye-popping study published this month in the International Journal of Obesity, Clinical significance of adaptive thermogenesis. (full text)

The conclusion?

In conclusion, based on studies that have shown a greater than predicted decrease in EE under energy restriction circumstances, this review presented arguments in support of the potential of adaptive thermogenesis to impede obesity treatment on a short- and long-term basis, at least in some individuals. In some cases, the adaptive decrease in thermogenesis was shown to be significantly related to a single cycle of body weight loss and regain, an increase in plasma organochlorine concentration following weight loss, and a lower than predicted EE was also shown to be associated with severe nocturnal oxygen desaturations in OSAS. This suggests that energy metabolism might be sensitive to stimuli of different physiological nature and that adaptive thermogenesis could be quantitatively more important than what is generally perceived by health professionals and nutrition specialists. However, from a clinical point of view, several issues remain to be investigated in order to more clearly identify adaptive thermogenesis determining factors and to develop strategies to cope with them. Along these lines, it is concluded that unsuccessful weight loss interventions and reduced body weight maintenance could be partly due, in some vulnerable individuals, to the adaptive thermogenesis, which is multicausal, quantitatively significant, and has the capacity to compensate for a given prescribed energy deficit, possibly going beyond any good compliance of some patients. [emphasis mine]

Weight loss impeded, even with restricting calories and good compliance?

Who'da thunk it possible?

Gluten-Free Labeling, Proposed Rules, Open Comment Period

On January 23, 2007 the FDA opened a comment period on proposed rules for labeling products 'gluten-free'. The agency accepting comments and feedback from consumers on several issues relating to a gluten-free diet and how individuals make choices about gluten-free products.

If you would like to comment, the page is HERE.

The proposed rule summary was published as follows:
2005N-0279 - Food Labeling; Gluten-Free Labeling of Foods
FR Type: Proposed Rules
Action: Other
RIN Number: 0910-ZA26

SUMMARY: The Food and Drug Administration (FDA) is proposing to define the term "gluten-free" for voluntary use in the labeling of foods, to mean that the food does not contain any of the following: (1) an ingredient that is any species of the grains wheat, rye, barley, or a crossbred hybrid of these grains (all noted grains are collectively referred to as "prohibited grains"); (2) an ingredient that is derived from an prohibited grain and that has been processed to remove gluten (e.g., wheat flour); (3) an ingredient that is derived from a prohibited grain and that has been processed to remove gluten (e.g., wheat wheat starch), if the use of that ingredients result in the presence of 20 parts per million (ppm) or more gluten in the food; or (4) 20 ppm or more gluten. A food that bears the claim "gluten free" or similar claim in its labeling and fails to meet the conditions specified in the proposed definition of "gluten free" would be deemed misbranded. FDA also is proposing to deem misbrand

In Brief...

Discover Magazine
The Ancient Atkins Diet

Because European settlements from around 10,000 B.C. are primarily found along coasts and rivers, archaeologists assumed their inhabitants survived mostly on fish and plants. The latest look at Mesolithic menus suggests, however, that people back then were a lot more interested in steak than salad niçoise. Archaeologist Glyn Davies of the University of Sheffield in England recently performed a detailed chemical and physical analysis on an 8,000-year-old thighbone unearthed along a river in central England. He focused on patterns of nitrogen and carbon isotopes that can distinguish plant eaters from meat eaters. "We know the bone belonged to a woman who ate an almost exclusively carnivorous diet, only occasionally supplemented with berries or plants," Davies says. Cut marks seen on the bones of wild cattle, aurochs, and deer found nearby corroborate that view. The research raises new questions about Europe's inhabitants after the last ice age. "Everything we know from that period suggests that this woman probably lived in a small family group that traveled seasonally between inland hills and the coast," Davies says. "But no fish and plant remains suggests she stayed put, doing more hunting than gathering."

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FREE eBookNutrition & Physical Degeneration, Weston A. Price

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FREE full-text of the original 1930 publication of the Steffanson & Andersen Bellevue Experiment

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New York Times
One in Eight Adults in NYC has Diabetes
"One in eight adults in New York City has diabetes, and nearly twice as many appear to be developing it — a picture even grimmer than that of the nation as a whole, according to the city’s first attempt to definitively measure the rate of the disease."

Metabolic Syndrome Doubles Risk - Now What?

A study, Metabolic Syndrome and Risk of Incident Cardiovascular Events and DeathA Systematic Review and Meta-Analysis of Longitudinal Studies, was recently published in the Journal of the American College of Cardiology. Researchers evaluated the findings of thirty-seven studies which evaluated associations between MetS and cardiovascular events or mortality and concluded "the best available evidence suggests that people with MetSyn are at increased risk of cardiovascular events. These results can help clinicians counsel patients to consider lifestyle interventions, and should fuel research of other preventive interventions."

Metabolic syndrome isn't a disease per se; rather it is a clustering of multiple metabolic abnormalities - abnormal cholesterol (elevated triglycerides, low HDL), central adiposity, high blood sugar, and high blood pressure - that when occuring together increase the risk of cardiovascular disease and death.

Some background first - in recent years the diagnosis of MetS has been under fire since two major health organizations - the American Diabetes Association (ADA) and the American Heart Association (AHA) - disagreed about the clinical utility of the diagnosis. The ADA issued a joint statement with the European Association for the Study of Diabetes (EASD) that the syndrome should not be considered a separate disease; the AHA followed up with a statement that it should.

As I wrote back in August 2005, the major sticking points addressed in the ADA statement included: there was no agreement for definition of the syndrome, a lack of understanding of the pathogenesis of MetS, no agreement about course of treatment for those diagnosed, no agreed upon standards of care for those diagnosed, and no agreed upon strategies to help prevent MetS. The AHA shot back with a statement in September 2005 to clarify and justify the diagnosis.

In June 2006, the two organizations seemed to harmonize their positions when they issued a joint statement that emphasized agreement between the organizations. It placed an emphasis on treating "a core set of risk factors (pre-diabetes, hypertension, dyslipidemia, and obesity)" as well as smoking. The statement sidestepped the genesis of the still-simmering disagreement—a dispute that neither group tried to hide—the definition of metabolic syndrome.

Why this background is important is because while the two organizations squabbled, a number of papers were published that shed light on preventing and reversing Metabolic Syndrome. The most important of these was in December 2005; when a study published in Nutrition and Metabolism, Carbohydrate restriction improves the features of Metabolic Syndrome. Metabolic Syndrome may be defined by the response to carbohydrate restriction, connected the dots between diet and development of Metabolic Syndrome.

As Jeff Volek, PhD, RD, lead researcher from the University of Connecticut, Storrs said, "Make a list of the features of metabolic syndrome, then, make a list of the things that carbohydrate restriction is good at fixing. They're the same list. Somehow, we never really noticed that. We know the cause of metabolic syndrome is often linked to disruption of insulin. Thus, the key to treating metabolic syndrome is to control insulin, and carbohydrates are the major stimulus for insulin."

So while HeartWire summed up the findings from the paper in the Journal of the American College of Cardiology, as "new meta-analysis show that the syndrome is more than the sum of its risk factors - and that it may pose a higher risk to women than to men...[m]etabolic syndrome...nearly doubled a person's risk of developing CVD...[t]he overall relative risk for cardiovascular events and death for people with the metabolic syndrome was 1.78 (95% CI 1.58-2.00), the study found. Cardiovascular events were about 33% higher for women than men;" and noted that the "findings are applicable to clinical practice: clinicians can use this evidence to motivate patients when counseling them to reduce risk factors;" we still find nothing but a big question mark when it comes to prevention and treatment!

Basically, the paper quantifies the risk of Metabolic Syndrome and the AHA notes that until its publication "clinicians were getting a mixed message about the utility of making the diagnosis."

So now we have jusification to diagnosis Metabolic Syndrome, but the question remains - what is a clinician to do with the data? The meta-analysis found a significant increase in risk - but what exactly are physicians to do with that knowledge when they have a real live patient standing before them and a diagnosis of metabolic syndrome?

Well if they look to the AHA for guidance they'll find the TLC (Therapeutic Lifestyle Changes) diet is recommended and is as follows:

TLC Diet in ATP III
Total Fat 25–35%
Saturated Less than 7%
Polyunsaturated Up to 10%
Monounsaturated Up to 20%
Carbohydrate 50–60% of total calories
Protein Approximately 15%
Cholesterol Less than 200 mg per day
Total Calories Balance energy intake and expenditure to maintain desirable body weight and prevent weight gain

These guidelines ignore Level 1 evidence that points to a more effective dietary approach and dismisses the importance of the paper Carbohydrate restriction improves the features of Metabolic Syndrome.

They also ignore, from the AHA journal Circulation, a paper published four years ago - Diets and Clinical Coronary Events: The Truth Is Out There

As the researchers noted in that paper, everything is "bad" according to the recommendations, "[f]ats are considered "bad" because they lead to cardiovascular events. However, one of the alternative energy sources, carbohydrates, is "bad" because it increases the risk of diabetes, and the other, protein, is "bad" because of increased burdens on the liver and kidneys."

So they asked, What, then, can be done to give patients a simple answer to their most frequent question: "What can I eat that will keep me from dying, having a heart attack, or having a stroke?"

After reviewing the evidence they concluded that "The time has come to apply to diet research the same level of evidence required for other interventions. We believe that indications or claims made for weight loss or health improvement via diet—whether made by authors, the government, or associations—must be supported by 3 types of evidence: proof that the diet provides essential nutrients in actual patients, efficacy studies, and randomized, controlled trials with clinical events as end points....Until then, the public will continue to be subject to speculation and potentially hazardous extrapolation from putative biological surrogates to clinical outcomes."

Remarkably, four years later, we still have a lack of convincing evidence to eat a low-fat, mostly plant-based diet; but that hasn't stopped the AHA from revising their recommendations late last year, nor stopped them from recommending the TLC diet for those at risk.

In an editorial I featured here, Dr. Gil Wilshire, MD, FACOG expressed his outrage over the lack of "gold standard" evidence to support the revisions in the AHA dietary recommendations. In part, his words parallel those of the researchers back in 2003:

Show me some high-quality data. Show me that someone has bothered to properly test the 50 year-old hypothesis.

In the absence of this information, I would like to make the following recommendation:

AN IMMEDIATE MORATORIUM ON ALL POPULATION-WIDE DIETARY RECOMMENDATIONS THAT LACK SUPPORT FROM WELL-PERFORMED, PROSPECTIVE, EVIDENCE-BASED HUMAN STUDIES.

Sanity in this field will only come out of a complete overhaul. We need to tear down the current edifice of confusion to its most basic foundations, and rebuild it from the bedrock up.

...

While today we now have a meta-analysis to point to that finds a significant increase in risk for cardiovascular disease and death in those with Metabolic Syndrome, thus a justification to utilize it as a diagnosis; we still do not have dietary recommendations based on evidence to help those at risk for or diagnosed with Metabolic Syndrome!

I consider this a national shame, especially when you consider that one-third of our population is believed to have or are developing features of Metabolic Syndrome.

The American Heart Association is failing us and it's time we speak up and hold them accountable for their continued dismissal of evidence that clearly points to carbohydrate restriction as a scientifically supported, valid dietary approach to treat those with Metabolic Syndrome!

If you've seen improvements from a controlled-carb diet or feel the AHA must review the data available for carbohydrate restricted diets - tell the AHA here!

Eat Right, Get Sick?

When you're doing everything "right", you expect results, right?

An interesting study, Nutrient Intake, Body Composition, Blood Cholesterol and Glucose Levels among Adult Asian Indians in the United States, published in this month's Journal of Immigrant and Minority Health, found that "[d]espite having a dietary intake that meets the National Cholesterol Education Program, Adult Treatment Panel III recommendations, this group [adult Asian Indians] was at a higher risk for chronic disease, by virtue of increased BMI and % BF along with an altered metabolic profile (high BP and TC and low HDL-C)."

Their dietary habits were impressive and much better compared with the Standard American Diet - fat intake was just 25% of calories, protein 14% and carbohydrates provided 64% of calories. Their BMI was an average 25.5, just a tad "overweight" for the group as a whole.

Alarming however were findings that body fat percentage was higher than desired (20% men, 36% women); Total Cholesterol-to-HDL ratios were high (4.86 men, 4.11 women), blood glucose was elevated (122mg/dL men, 105mg/dL women), and their blood pressure was high.

This was, again as the researchers concluded "depite having a dietary intake that meets the National Cholesterol Education Program, Adult Treatment Panel III recommendations."

The researchers couldn't bring themselves to connect-the-dots to their subjects' diet contributing to - even causing - the metabolic disturbance; of course it has to be something else, it couldn't be their diet; afterall, their diet met the NCEP-ATPIII recommendations!

Down the Rabbit Hole of WLS for Children

Get ready for our adventure down the rabbit-hole today as we explore the solution to childhood obesity in Wonderland.

The Chicago Tribune reported yesterday, [a]s the popularity of stomach surgery has skyrocketed among obese adults, a growing number of doctors are looking at children as possible candidates.

A group of four hospitals...are starting a large-scale study this spring examining how children respond to various types of weight-loss surgery. They include gastric bypass, in which a pouch is stapled off from the rest of the stomach and connected to the small intestine...[and]...a procedure called laparoscopic gastric banding, where an elastic collar installed around the stomach limits how much someone can eat.

The study was approved by the FDA after surgeons at New York University Medical Center published findings in the Journal of Pediatric Surgery this month. In that study, 53-children, aged 13 to 17, underwent bariatric surgery; they lost nearly half their excess weight over 18-months post-op.

The Chicago Tribune highlighted the "success" of one teen, Crystal Kasprowicz, who shed 100-pounds after the surgery, but didn't mention any of the teens who faced additional surgery or other complications after their surgery.

In the abstract of the study we find some numbers to give us an idea of the complications:

• 2 patients had band slips that required laparoscopic repositioning
• 2 patients developed a symptomatic hiatal hernia that required laparoscopic repair
• 1 patient developed a wound infection requiring incision and drainage
• So, of 53 subjects, 10% required additional surgery

• 5 patients experienced hair loss
• 4 patients experienced iron deficiency
• 1 patient developed nephrolithiasis and cholelithiasis (kidney stones and gallstones)
• 1 patient develpped gastroesophageal reflux
• So, of 53 subjects, 21% experienced a complication that didn't require additional surgery

In total, 30% of all the patients experienced a complication. Funny how the media fails to report that, huh?

When Britain recently approved weight loss surgery for children, I included a list of complications we know happen in adults in UK Solution to Childhood Obesity - Surgery & Drugs:

Short Term Complications (in the first 3 to 14 days)

• Bleeding Leak
• Abscess and Infection
• Pulmonary Embolus Death
• Severe Nausea and Vomiting
• Narrowing or ulceration of the connection between the stomach and the small bowel has been reported in one series in about 20% of all patients undergoing gastric bypass
• Bile Reflux Gastritis occurs when bile flows back into the stomach
• Fistulas, (an abnormal passage leading from one hollow organ to another) abscess and infection have been seen in gastric bypass operations
• Dumping Syndrome
• Gallstones
• Adhesions, scar tissue caused by healing after surgery
• Diarrhea

Long Term Complications

• Vitamin and Mineral Deficiencies - Decreases in iron, vitamin B12, and/or Folate levels were detected eight months to eight years (median, two years) after the operation
• Peripheral neuropathy (disorders resulting from injury to the peripheral nerves) has been reported after operation
• Osteoporosis and Bone Loss
• Gastric bypass procedures carry the highest risk of multiple micronutrient deficiencies, that may supervene despite close medical follow-up
• Patients with a gastric bypass have a greater frequency of microcytosis and anemia, more frequent subnormal serum levels of vitamin B12, and impressive failure to absorb food vitamin B12
• Gastrointestinal bleeding from a duodenal ulcer four years after having a gastric bypass procedure for obesity
• Symptomatic gallstones requiring cholecystectomy
• Abdominal Wall Hernia
• Pregnancy Complications

But let's set aside the complications for a moment and read what one surgeon tells his patients (adults) before surgery:

The “two by two” lecture is legendary. After prepping more than 900 patients for bariatric procedures since 1998, Gus Slotman, MD, a School of Osteopathic Medicine (SOM) professor of surgery, can move through his advance warnings for obese patients with lightening speed. “I say this all day long,” he laughs, joking that as a baby boomer himself, his mantra might just be helping him stay as thin as he was back in school.

Without pausing for a single breath, he can rattle off the dietary rules for life after surgery: “Two ounces of protein every two hours, or eight times a day. That’s two by two and take 15 minutes to finish. I tell them they have to commit themselves to eating no more than two ounces at a time. And there will be no room for anything but meat, fish, chicken, vegetables, fruit, dairy products, eggs and other proteins. Say goodbye to bread, potatoes, rice, pasta, noodles, pretzels, chips, cheez doodles, crackers, junk cereal and all those starch-carbs.”

Yes, you've just stumbled down the rabbit hole.

In the real world, pre-surgery, we're told repeatedly a carbohydrate restricted diet is dangerous and no one wants to eat that way anyway; in Wonderland, post-op, a carbohydrate restricted diet is mandatory for success and maintaining health.

So after you pony up $25,000 to have your surgery, face the very real (and often expensive) risk of complications, it's not only safe, but necessary to follow a carbohydrate restricted diet.

Funny, but the media doesn't seem too keen on reporting this either. What they are keen on is selling us the idea that weight loss surgery is the answer to the growing problem of childhood obesity.

I don't buy it, and neither should you.

Statin Briefs

Lancet, Jan 20, 2007
Are Lipid-Lowering Guidelines Evidence-Based?
To sum it up: No studies have shown statin cholesterol-lowering drugs to be effective for women at any age, nor for men 69 years of age or older, who do not already have heart disease or diabetes. More than 50 adults have to take a statin drug for 1 patient to avoid a fatal heart attack, and that figure only applies to high-risk patients. Cholesterol treatment guidelines need to be revised.

This is London, UK, Jan 23, 2007
To sum it up: Dr. Malcolm Kendrick has published a book, The Great Cholesterol Lie; who likens the lipid-hypothesis and heart disease to an amazing beast. "The closer you look the more you find that the cholestrol hypothesis is an amazing beast. It is in a process of constant adaptation in order to encompass all contradictory data without keeling over and expiring."

HeartWire Jan. 27, 2007
Dr. James M Wright of the University of British Columbia, Vancouver
"If you take a male who is 50 years old, a smoker, with high blood pressure, who eats the worst diet in the world . . . then if I were an honest physician, I would tell him that maybe he should be taking a statin. And if he asked how much would that reduce his risk, I would have to tell him that it would only reduce his risk by 2% over the next five years. If he understood that information, he would say, You're expecting me to take a pill everyday for five years? And it's going to cost me two dollars a day? You're crazy! I'm not going to do it."

So, if physicians were truly honest with their patients, the doctor says, "I think there probably would be very few people being treated for primary prevention with a statin drug."

World Review Nutrition Dietetics, 96: 1–17, 2007
To sum it up: Dr. Harumi Okuyama says the direction of modern medicine needs to move away from the lipid-hypothesis of coronary heart disease. Once cases of genetic/familial high cholesterol are removed from population statistics, he claims that high cholesterol is not found to be a causal factor for coronary heart disease. High total cholesterol is not positively associated with high coronary heart disease mortality rates among general populations more than 40–50 years of age. He notes that the rate of heart attacks differs by approximately 4 to 8-fold at the same total cholesterol level in some populations.

He continues that while Western countries have accepted the lipid-hypothesis of heart disease and the use of statin drugs, "little benefit seems to result from efforts to limit dietary cholesterol intake or to total cholesterol values to less than approximately 260 mg/dL." He believes it is urgent we change the direction of current medical practice away from statins.

When is a Child Too Fat?

A recent Diet Blog entry, Fat Kid Phobia: A Personal Rant, has provoked an interesting discussion in the comments section.

The center of the debate is the recent finding, published in the October 2006 issue of Public Health Nutrition, that 90% of parents of 5 to 6-year olds did not recognize their child was overweight. As Yahoo News brutally headlined it, Parents Blind to Fat Children, Study.

Jim (author of Diet Blog) wrote, "When my daughter looks up at me with her concerned eyes and asks "Daddy is my tummy too big?" - my answer is - "You are just beautiful the way you are".

Or I could glare at her with stern eyes. I could inform her that she is in the grip of an obesity epidemic. That she had better start eating less. That I would be watching everything she puts in her mouth. That she isn't quite good enough.

I have no doubt that I could annihilate her fragile self-esteem in a few minutes with such careless words.

I'm not ignoring the fact that there is an obesity problem and that there are many very real health consequences -- but who gets to decide my child is overweight -- and by what definition? Certainly parents and families can be educated about healthier lifestyles - but is fear-mongering and guilt a good way to do this?

Do I tell my daughters that they are not allowed to have round tummies or big thighs? Because if they do it might mean they are overweight. And if they are overweight then they are... what...? Sick? Unhealthy? Lazy? Unacceptable?"

Considering the full-court-press the issue of childhood obesity is getting in the media, schools measuring the BMI of children and sending home BMI report cards, public service messages targeting parents of overweight children, mandates for wellness programs in schools, and a plethora of other initiatives to reduce the indidence of childhood obesity, Jim's question and underlying concern is valid - it isn't only adults whom are hearing and seeing the messages that children are in trouble, kids are hearing and seeing those messages each day too.

And here we have a survey confirming what many have been saying for years - parents are blind to their childrens weight problem.

I wondered, just how is it possible not to recognize a child is overweight or obese?

For that answer I had to go to the full-text to read everything rather than depend on the short abstract, which didn't provide enough information to understand the protocol of the survey or how the research team crunched the numbers to reach their conclusions.

An interesting thing emerged in the full-text - the researchers used an international set of cut-offs for overweight and obese in children, first proposed in May 2000 in the British Medical Journal; so the CDC's calculator for children and teens is not useful here. In the BMJ article we find the standard used for this survey in Table 4 which provides the BMI points of overweight and obese:

Five year old boys:
BMI of 17.41 or less = normal/healthy weight
BMI of 17.42 to 19.29 = overweight
BMI of 19.3 or more = obese

Five year old girls:
BMI of 17.14 or less = normal/healthy weight
BMI of 17.15 to 19.16 = overweight
BMI of 19.17 or more = obese

For simplicity here, let's work with girls since one fear many parents have with daughters is the worry about creating eating disorders in their future if they send the wrong messages about weight and body image.

So let's use an example of a five-year old girl who is 3' 8" - 44" tall.

At what weight does she transition from normal to overweight? At what weight does she transition from overweight to obese?

Using the CDC BMI Calculator, to enter height and weight and find BMI, here are the results:

47-pounds = 17.1 BMI (normal/healthy)

47.5-pounds = 17.2 BMI (overweight)

53-pounds = 19.2 BMI (overweight)

53.25-pounds = 19.3 BMI (obese)

Of the 134 five-year-old girls measured in the survey, 21 were found to be "overweight" and 5 were found to be "obese".

As we can see from above, a half-pound can have a profound difference - a child weighing 47-pounds is normal/healthy, a child weighing 47.5-pounds is overweight, and a child somewhere between 47.5-pounds and 53-pounds is overweight...a very small margin of just six pounds difference between normal/healthy and obese.

Six pounds - is it any wonder parents might not think a child classified as "overweight" by the BMI isn't overweight?

I really have to wonder how many of the 21 girls classified as overweight were within a pound of normal/healthy? How many were within two pounds? Three?

This is just one example of many potential scenarios for a little girl who is five years-old; she may or may not have more or less lean body mass (muscle) compared with her peers; may or may not be laying down fat to enable a growth spurt in her near future; and may or may not have the same stature of another girl of the same height, where one little girl may be "sturdy" another might be "dainty".

But, these are things the BMI cannot measure. And this is where adult judgement has to come into play.

It's noteworthy that the researchers didn't try to measure the perception of other adults, specifically pediatricians or family doctors who are tasked with keeping an eye out for problems. Perhaps they could have taken it a step further too and asked the parents of the children in the study - ask them if looking at child A, B, or C would they consider the child, who is not their own, normal/healthy weight, overweight or obese?

I think that type of insight would be useful - I know if I were trying to judge between a child who is 47-pounds and one who is 48-pounds, I'd probably not recognize the 48-pound child as overweight - it's simply not a big enough difference to be an overt difference between the two children. Even a few pounds probably wouldn't set off alarm bells for most people when they're looking at two or three children who are close to the same weight.

But with the BMI standard, those few pounds make all the difference.

Jim said it nicely, "I'm not ignoring the fact that there is an obesity problem and that there are many very real health consequences...but is fear-mongering and guilt a good way to do this?"

This is a question we all need to ask ourselves and consider as we continue to turn up the volume in an effort to convince parents to pay attention to their child's weight.

We also need to be aware of what messages we are unwittingly sending to children - often very young children - as we adults try to find a solution to reverse the trends of overweight and obesity affecting our children.

As a parent I know it's hard to objectively assess my child - in my eyes he's perfect in every way.

It's hard to the assess my neice and nephew, my young cousins, and my cousins' children too. But then, when I step beyond the circle of family into the circle of friends it's much easier to "see" a problem, but then again, if we're talking a pound here or there, no way! Quite frankly, unless the child is really way to heavy, or having trouble in daily activity it's a tough call to make, especially since we're talking about kids who are growing and always changing right before our eyes!

I don't have the answer to how to reverse the trend of childhood obesity - I do see it, I do recognize it....and I do worry that how we're going about the solution may do more harm than good in the coming years.

I know it pains me to hear my five year-old neice say she doesn't want to get fat - she's tall and slim, but just barely registering in the 10th percentile for BMI-for-age; just as it pains me to see a little girl struggling at the playground because she's carrying too much weight on her little body.

There are no easy answers here. But if we get this one wrong - what will we have done to our future generation?

What are your thoughts?

More Unhappy Meals

Michael Pollan's essay has certainly kindled a wide range of commentary from the blogosphere. For your reading pleasure:

Scientific American:
Hard to Swallow Some of Pollan's "Unhappy Meals"

Waisted In Wasteland (Low-Carb):
What Shall We Eat Today?

The Last Atkins Dieter (Low-Carb):
A National Experiment in Mainlining Glucose

Adam Campbell (Fitness/Controlled-Carb):
An Eating Philosophy You Can Live (Well) By

Nutrient-Rich (Vegetarian/Vegan):
NY Times: Michael Pollan on Nutritionism

seitan's delight:
Eat Food: It's like you have to spell it out for these people

It's All One Thing (Vegetarian/Vegan):
The wisest advice about eating

Marc Joseph Nutrition (general nutrition):
How Nutritional Science Has Ruined the Way We Eat - Michael Pollan

Joe Pastry (cooking/baking):
"Unhappy Meals"

So There

A doc in London sums it up nicely:

The Telegraph, London - Doctor's diary: James Le Fanu takes a look at obesity

No doubt reflecting the seasonal preoccupation with weight matters, there currently seem to be a lot of stories on this theme in the papers: fat dogs (and fat owners), fat South African lady stuck in a tunnel of love, MPs "alarmed" about an obesity epidemic in schoolchildren and, best of all, the claim that some people are now overeating so as to qualify for weight reduction surgery.

Meanwhile, back in the surgery, it has become a lot easier to turn down the customary New Year request for slimming pills by pointing to the physical transformation of several of the staff. They are all beneficiaries of the high-protein/low-carb approach.

The effectiveness of this type of diet is certainly a great embarrassment to the legion of medical experts who, over the past 20 years, have insisted that eating a lot of meat and dairy products is bad for the heart – quite wrongly, as it turns out.

Indeed, just six weeks ago, Dr Thomas Halton of Harvard reported in the New England Journal of Medicine the findings of a study showing it is women on the medically approved low-fat diet who have the higher risk of heart disease. So there.