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“I Was Wrong, You Were Right”

Taubes

Not many things impress me more than a scientist who dares to change his opinion. An excellent example is the influential Danish scientist Arne Astrup.

After earlier believing that fat was bad and carbs (even high-GI carbs) were good Astrup has now changed his mind. One of the reasons is the large DIOGENES study that he published in The New England Journal of Medicine recently.

The study proved that a diet with more protein, less carbs and a lower GI is better for maintaining a weight loss. Advice similar to the official guidelines (with more carbs) made participants regain the most weight.

Carbs and obesity

Astrup used to be critical of Gary Taubes (who has long maintained that too much carbs is the villain behind the obesity epidemic). But now he did not mind admitting that he had changed his mind. I was there when they met at the ASBP obesity conference in San Diego yesterday. Astrup said “I was wrong, you were right” to Taubes, regarding carbs and obesity. He didn’t mind me quoting him on that either.

To clarify, Astrup does not believe that a strict low-carb diet is a good idea for the entire population. A little less carbs with a lower GI, and a bit more protein would be sufficient he believes. But Astrup had nothing against stricter low-carb diets for treating obesity etc.

Saturated fat

I thought that Astrup would still be afraid of natural saturated fat, but he has updated his position here as well. After all the recent studies showing that refined carbs are worse for the heart than saturated fat, and now even that polyunsaturated omega-6 fat is worse, Astrup believes that focusing on saturated fat is wrong.

If there’s any benefit in replacing saturated fat with monounsaturated or omega-3 fat it’s hardly of any major importance. There are much more important things to focus on, such as eating less refined carbs (sugar and white flour), enough protein and avoiding trans fats. Natural saturated fat is nothing to be afraid of.

When people like Astrup manage to update their opinions there’s plenty of hope for the future. Let’s hope more and more experts will follow in his footsteps.

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24 Comments

Top Comments

  1. FrankG
    That is the mark of a scientist: when, in the face of new evidence, they can accept they were wrong.
    Read more →
  2. I left this comment on FB:

    This could be a good thing but I would be very wary. It sounded like he was already back-tracking with refined carbohydrates. My history with him is a little discouraging. I was invited to speak in a “controversy” session at the 2009 conference of the European Association for the Study of Diabetes. I pointed out in my talk that there was no controversy in the science only in the politics. Astrup told me at the break that “diabetes is a disease of carbohydrate intolerance so, of course, a low-carbohydrate is best for diabetes” and that we were in agreement. He later told a reporter that low-carbohydrate diets were fads. The reporter didn’t use the comment but did show me what Astrup had told him. And before that he invited Jeff Volek and me to submit a review for his journal. We wrote it and he had it refereed and we made changes. He then rejected it. A real no-no in academic circles. You don't invite a paper and then turn it down. I would watch your back with this guy. I predict in one month he will claim that he invented low carb ("Taubes? Taubes who? Volek? Volek who?").

    Read more →

All Comments

  1. moreporkplease
    " Astrup does not believe that a strict low-carb diet is a good idea for the entire population. A little less carbs with a lower GI, and a bit more protein would be sufficient he believes. But Astrup had nothing against stricter low-carb diets for treating obesity etc."

    Astrup appears then to be in denial about the Danish population. They binge drink beer, they eat potatoes with sugar year-round now, and they are replacing traditional foods with more and more processed foods. They have high depression rates, use more SSRIs than any country in the world per capita, and suffer from declining productivity. More and more workers are claiming disability due to illness.

    They bicycle a lot & most appear largely normal weight, but there need to be studies done to confirm the hunch that the majority are actually already insulin resistant from so much alcohol. The real T2D explosion is probably just a few years into the future.

    Will Astrup recognize this, study it, and act to prevent it?

    Reply: #3
  2. FrankG
    That is the mark of a scientist: when, in the face of new evidence, they can accept they were wrong.
  3. Asbjørn
    They bicycle a lot & most appear largely normal weight, but there need to be studies done to confirm the hunch that the majority are actually already insulin resistant from so much alcohol. The real T2D explosion is probably just a few years into the future.

    I'm not convinced the situation is that bad. The danes drink more than the average nordic person, but they also have some food habits with positive effects on their livers :-) Connect the dots (bet this will be trapped in the spam filter for a while):

    The threat: http://en.wikipedia.org/wiki/List_of_countries_by_alcohol_consumption

    The hypotesis: http://blog.cholesterol-and-health.com/2010/11/sweet-truth-about-live...

    The cure #1?: http://animalscience.ucdavis.edu/avian/PerCapitaEggConsumptionbyCount...
    The cure #2?: http://en.wikipedia.org/wiki/Leverpostej

  4. I left this comment on FB:

    This could be a good thing but I would be very wary. It sounded like he was already back-tracking with refined carbohydrates. My history with him is a little discouraging. I was invited to speak in a “controversy” session at the 2009 conference of the European Association for the Study of Diabetes. I pointed out in my talk that there was no controversy in the science only in the politics. Astrup told me at the break that “diabetes is a disease of carbohydrate intolerance so, of course, a low-carbohydrate is best for diabetes” and that we were in agreement. He later told a reporter that low-carbohydrate diets were fads. The reporter didn’t use the comment but did show me what Astrup had told him. And before that he invited Jeff Volek and me to submit a review for his journal. We wrote it and he had it refereed and we made changes. He then rejected it. A real no-no in academic circles. You don't invite a paper and then turn it down. I would watch your back with this guy. I predict in one month he will claim that he invented low carb ("Taubes? Taubes who? Volek? Volek who?").

  5. Arne Astrup has been on a slow retriet from the high carb diet to some GI/Meditarrainian like diet and I think the delayed new edition of the Nordic Nutritional recommendations is heading the same way. There has been attempts to launch the concept of a "Nordic Diet" or "Baltic Sea Diet" consisting of loads of whole grains, fruits,veggies, lean meats and fish and some Canola oil.

    They are not going to step down from thier stand on arthery clogging saturated fats. And I think that's their major problem. What people exept for the very most health conscious would eat such a diet long term? Ther is a reason for why the GI diet fad is fading away now in the Nordic countries. You will not see people ordering whole grain rye pizzas. If you want to get Swedes and the Nordic people to eat more whole grain sauerdough bread and more veggies, the only realistic way to accomplish that is to add... butter!

    And there is a limit to how much vegetable oils like olive oil and Canola you can persuade Nordic people to consume. We simply don´t have that Mediterranian food tradition. Adding a lot of nuts to the diet is also unrealistic not merly because of food traditions but also because there is at least one kid in every school with severe allergy to nuts, so it can't be served.

  6. Pro-Darwin Ricki
    1) A quite fresh paper from Denmark (2013) was published in regards to SFA's. The data subjects were military recruits.

    High dietary intake of saturated fat is associated with reduced semen quality among 701 young Danish men from the general population

    "Results: A lower sperm concentration and total sperm count in men with a high intake of saturated fat was found. A significant dose-response association was found, and men in the highest quartile of saturated fat intake had a 38% (95% CI: 0.1%, 61%) lower sperm concentration and a 41% (95% CI: 4%, 64%) lower total sperm count than did men in the lowest quartile. No association between semen quality and intake of other types of fat was found".

    http://ajcn.nutrition.org/content/early/2012/12/23/ajcn.112.042432

    2) Anyways, the Nordic guidelines are probably not going to change in regards to SFA. A paper co-authored by Astrup's was referred by 13 most of prominent European diet-heart scholars led by the Norwegian Pedersen. They weren't too taken by Astrup's contribution. After all, scientists are bound to the darwinian foundation of our current biomedical research paradigm. The AHA decided recently to promote even lower levels of SFA consumption than they've done previously.

    "Elevated levels of apo B containing cholesterol-rich lipoprotein particles drive the development of atherosclerosis in humans and in experimental animals, even in the absence of other known risk factors(18). Accumulation of these LDL particles in the intima and binding of apo B to the extracellular proteoglycans appear to be the initial step in atherosclerosis(19) with further triggering of inflammatory reactions(20). The amount and type of dietary fat to a large extent determines the number of circulating LDL particles and blood levels of total cholesterol. Moreover, SFA with 12–16 carbon atoms are the most potent LDL- or total-cholesterol-raising fatty acids"

    Pedersen JI, James PT, Brouwer IA, et al. (2011) The importance of reducing SFA to limit CHD. Br J Nutr 106, 961–963

    3) The same authors (Pedersen et al) replied to cholesterol denialism that their original article provoked.

    Response to Hoenselaar from Pedersen et al.
    http://journals.cambridge.org/download.php?file=%2FBJN%2FBJN107_03%2F...

    Brown & Goldstein:

    "If the LDL receptor hypothesis is correct, the human receptor system is designed to function in the presence of an exceedingly low LDL levels. The kind of diet necessary to maintain such levels would be markedly different from the customary diet in Western industrial countries (and much more stringent than moderate low-cholesterol diets of the kind recommended by the American Heart Association). It would call for total elimination of dairy products as well as eggs, and severely limited intake of meat and saturated fats".

    http://www.ncbi.nlm.nih.gov/pubmed/6390676

  7. Pro-Darwin Ricki
    Sorry,

    the link provided by the response article by Pedersen et al in regards to SFAs did not work. Please, in order to view the whole article, choose the PDF-format.

    "Consequently, the primary target for risk reduction by dietary fat should still be LDL- or total cholesterol(7), thus reinforcing the overwhelming importance of reducing the intakes of SFA”.

    http://journals.cambridge.org/action/displayAbstract?fromPage=online&...

  8. FrankG
    I predict in one month he will claim that he invented low carb ("Taubes? Taubes who? Volek? Volek who?").

    I'm all for giving credit where it is due but on the other hand there are going to be a great many academics, researchers, physicians, politicians, policy-makers etc... who will be trying to save face rather than frankly admitting they were wrong. If the end result is a healthier general population and better dietary advice then perhaps that is more important than acknowledging who came up with the idea first?

  9. Pro-Darwin Ricki #6
    Pedersen seems to be quite an extremist on saturated fats but he is joined by a lot off Finnishs experts that hold the same position on SFA. That's probebly why the Nordic Nutritional Recommendation has been delayed by moore than a year, inspite people like Astrup gradually modefyling there stand om SFA.

    In a way I somewhat hopes that Pedersen and the Finns wins this war. Nordic dietery guidelines that call for total elimination of dairy products, eggs and most of the meat would probebly speed up the process of a major public uprising to guidelines in total disconnect with ancestral food traditions in the North.

  10. Darwin-Riche
    @Per Wikholm,

    I whole-heartedly agree with you in regards to public uprising. People want to hear good news about their bad habits. Throw in some appeal-to-nature fallacy on "natural fats" together with some anti-goverment rhetoric's and you'll have a best-selling book.

    If I may elaborate, Pedersen et al referred to the large IMPACT-models conducted in many countries. These are similar models that are used in econometrics. The most extreme examples comes from Finland and New Zealand as pointed by Pedersen et al in their second article. In Finland the age-adjusted mortality from CHD has plummeted 80% (from 1960s to 2000s). Around 50% of this change is explained by the drop in mean serum cholesterol levels out. This is again explained mostly by the drop in the intake of SFAs (from ~20% to ~13% calories). Similar observation from New Zealand and (in less radical form) from all developed nations. At the height of CHD epidemic in Finland, the consumption of trans-fats, coca-cola, big-macs etc were minimal if not non-existent. However, "natural fats" were consumed in abundance. For example, as pointed by Keys, in the 1960s the consumption of sugar was significantly higher in Sweden compared to Finland. Yet, Sweden had only 1/2 of the age-adjusted CHD mortality compared to Finland. The intake of SFAs were lower in Sweden.

    “That replacement of SFA by a variety of carbohydrate-containing foods also reduces CHD risk may be inferred from ecological studies, e.g. in Finland. CHD was also almost non-existent in rural China when mean cholesterol levels were approximately 3·5 mmol/l (1350 mg/l), with total fat intakes only about 15% of energy and extremely low intakes of SFA(10,11). These observations, replicated in many other countries, should not be ignored even if meta-analyses of prospective cohort studies suggest no independent associations of SFA intake with CHD risk(2). The null results of the latter studies(2) probably reflect measurement error, residual confounding, over-adjustment by covariates on the causal pathway and large variations in plasma cholesterol compared to variations in intake of dietary fat(3,12 – 15). The role of SFA risks may also be overlooked, given the strong emphasis on TFA(16) and the incorrect proposition that the CHD epidemic in affluent societies has been primarily linked to a high consumption of TFA(17)”

    Pedersen et al refer to the well-established ecologic evidence together with top-snotch mechanical models that are used to demonstrate cause & effect. Moreover, Pedersen et al refer to the articles by Kromhout et al, Scarborough 2011, Katan et al 2011 and Stamler 2010 to show the futility of the meta-analysis by Siri-Tarino et al. In their second article, they demonstrate the futility of the HDL cholesterol-sales pitch. Modulating HDL-C is probably not going change your CHD risk since it's very questionable whether HDL-C is causally linked to CHD in the first place. While there are several biomarkes in the lipid-fraction that are associated with the risk of CHD, the causal relationship of these markers to the risk of CHD has only been established in regards to LDL cholesterol (see Heiss and Tyroler criteria of causality). This has been demonstrated through multiple lines of evidence (mechanical models, surgical trials, mendelian randomization trials with 300 000 genotypes, statins, bile-acid sequestrants and prospective cohorts, especially those that have paid attention to regression dilution bias). Since it is very established that LDL-C cholesterol is causally related to the risk of not only to CHD but aggressive prostate cancer as well, and SFAs increase the level of cholesterol in the blood, it follows that the advice to reduce the intake of SFAs is well justified. This advice does not exclude the advice to decrease the consumption of refined carbohydrate and sugars.

  11. Darw-Richie
    ^The above citation was from the first article by Pedersen et al. If one wants to put it through some nationalistic framework, we can conclude that Norse, Dutch, British and Finnish scholars refuting bunch of Danish nonsense.

    The importance of reducing SFA to limit CHD.
    http://journals.cambridge.org/action/displayAbstract?fromPage=online&...

  12. yuma
    Would a low GL diet (10 or less) , such as the one advocated by this doctor:

    http://www.alsearsmd.com/glycemic-index/

    be considered HFLC? Or does the doctor's diet still contain too many carbs?

    Thanks!

  13. FrankG said "I'm all for giving credit where it is due but on the other hand there are going to be a great many academics, researchers, physicians, politicians, policy-makers etc... who will be trying to save face rather than frankly admitting they were wrong. If the end result is a healthier general population and better dietary advice then perhaps that is more important than acknowledging who came up with the idea first?"

    A healthier general population can only follow from the science. Real scientists go with the data. If some of the academics, etc. feel they have lost face, that's why we have psychiatrists. It is not just who came first, it is avoiding re-doing poorly what Volek has done well which means citing and following-up on Volek's work. But it is the work not the person. Volek is a power-lifter. The work comes first.

  14. Zepp
    Im with FrankG.. I dont care who get the credits.. as long as it gonna be a radical change in the scientific comunity!

    And we know there gonna be some other that get the credits of Voleks job.. he is a fore runner, fighting in the front.. but some general in the back get all the credits!

    And did you know.. Astrup did get his money from Danisko before.. the Nordic sugar industry.. but now he get his foundings from Arla and the dairy industry!

    http://erhverv.ku.dk/virksomheder/forskere/effekter/introtilcases/case6/

    I dont know.. but somtimes one say.that its better to have those influential person in the tent kicking outward, then outside kicking inward?!

    There is a need for a lot of fore runner befor one get a major shift in the scientific comunity.. and it is that guy, that get big foundings to prove it, that gonna get all the credits!

    Its how its works, and there is no justice!

  15. Josh
    Reply: #17
  16. Josh
    common mistakes people make in nutrition, especially as it relates to sugar.
    1) Bandwagon - Everyone knows sugar is bad
    2) Anecdote – I know because I gained weight when I ate sugar
    3) Appeal to Authority – well Dr. Oz said it, it must be true. He’s an expert.
    4) The Texas Sharpshooter – ever heard ‘fructose is poison’ or red meat causes cancer?
    5) False Dilemma – either I binge or I abstain, there is no middle ground.
  17. murray
    Thanks Josh, the "sugar addiction cycle" is hilarious. Tehe line about sugar being as addictive as H2O lloks like it comes straight from the Big Tobacco disinformation playbook from the 1960s. Nice heads up on the crap we are going to see from Big Sugar, as Coke and others start to feel the pinch of science and public policy.
  18. I'm all for the warm cuddle-sessions of "experts" relenting and admitting they were wrong, but why were they "experts" in the first place if they were wrong?

    I reserve my respect for those who don't speak out until they know what they're talking about, or at least acknowledge that what they know of is still unknown.

  19. Stan Slonkosky
    I saw on the conference brochure that one of the topics to be discussed at the Nutrition Metabolism Society's symposium was

    "Impact of Saturated Fats vs. Carbohydrates on Blood Lipids & CVD Risk (Patty Siri-Tarino, Ph.D.)
    A review of the impact of saturated fat, polyunsaturated fat, and carbohydrates on cardiovascular disease risk, including recent data suggesting that saturated fat’s effects on blood lipoproteins vary according to its food sources."

    I am particularly curious about the last item. Is there a difference in the effects if your saturated fat comes, for example, from butter (or meat) or coconut oil. Is one to be preferred over the other. Most of my saturated fat comes from dairy and beef. I did buy some coconut oil but haven't figured what to do with it yet.

    Recently, my doctor suggested, because my total cholesterol was a bit high, I might want to consider taking statins. I declined. I don't remember my total cholesterol numbers, but HDL was 72 and triglycerides were 50. I looked up the advice on the American Heart Association's web site and those numbers seem rather good. I don't remember what the LDL numbers were, but I do know that they did not measure particle size.

  20. Relevant here are the 2 trans-palmitoleic studies by this group: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056495/

    These seem unusually tightly designed for dietary epidemiological studies. They don't rely on food questionaires, and they use a real disease diagnosis (DM2) not just markers as endpoints. They're multiethnic, prospective, and high-powered.
    The obvious interpretation of the results is that the consumption of ruminant fats gives protection against the development of type 2 diabetes that is not only statistically significant, but that should be highly significant clinically too.
    Last time I looked, a diagnosis of DM2 was a bigger risk factor for heart disease than a high LDL reading.

  21. I think that people who are claiming that saturated fats and carbs are good for fat loss are just trying to drive controversy. There are bloggers who do that (sadly), but I won't mention them out of privacy reasons. I can't stand a particular blogger who's every post is against the truth =.=
    Reply: #22
  22. Harj
    I have not seen any sites that claim saturated fats and carbs help with fat loss. Plenty say a high intake of saturated fats combined with a low intake of carbs help with fat loss.

    If people think it is controversial when you tell them how great you feel and the ease with which you lose weight then so be it. The evidence is snowballing everyday and eventually it will be impossible to ignore.

    Not everyone will be convinced of course and the low fat believers be likened to the flat earth society.

  23. Heidi
    Wow. It's a rare Dane who will admit he's wrong. My hat's off to the doctor!
  24. craig
    He may just need a good astrup whipping.

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