What the dangerous low-fat diet looked like

Low-fat diet advice

Low fat

The low-fat diet just lost another huge trial, resulting in significantly more heart disease than a higher-fat Mediterranean diet. It lost badly enough that the trial was stopped in advance, as it was considered unethical to let the low-fat diet group continue to eat like that.

When I wrote about it yesterday I was criticized in the comments. Calling this study low fat was labeled “simply absurd and intellectualy inappropriate”. I disagree.

Above are the dietary guidelines for the low-fat group. It’s a regular low fat diet, like it’s been practiced and taught during the last few decades.

Is it a strict vegan-Ornish low-fat diet, that only a select few manage to actually eat long term? No. This is much worse. These are the common low-fat guidelines that hundreds of millions of people have been trying to follow for decades, as they’ve been told it would protect them from heart disease.

Unfortunately this is just the latest in a long line of studies proving that the regular low-fat diet is not only useless to people. It’s actually harmful.

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More about failed low-fat diets

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63 comments

  1. LDL-Richard
    Andreas,

    There were 109 events in the low fat-group, 96 in the olive oil group, and 83 in the nut group. Some of the authors are funded by the nut & alcohol industries.

    The so-called "low-fat" group managed to reduce their fat intake from 39% to 37%. We are not even close to AHAs standards here. Had the controls eaten the way they were recommended, they'd not having close to 40% fat intake. What are the odds the olive-oil group sponsored Spanish scholars were interested in providing decent counselling for their controls?

    If the scholars were interested seeing their controls eating a low-fat diet perhaps they would have eager to invite Dr Ornish to provide the counselling, or why not someone from Okinawa.

  2. LDL-Richard
    I must add that I started eating very low-fat, whole-food starch based diet the moment I understood the science behind it. If eating such a diet would be unbearable then we would not see the (currently spending) large-scale studies by Ornish (prostate cancer trial) and Esselstyn (over 200 CHD patients included) taking place. I love eating whole-grain porridge, rye-bread with little bit tahini on top of it, potatotoes, whole-grain pasta, etc. I have spectacular cholesterol profile, low blood-pressure and perfect blood glucose digits; and I am energetic all day long thanks for the ~80% carbohydrate diet.
    Reply: #14
  3. Looking at table S7 in the appendix supplement http://www.nejm.org/doi/suppl/10.1056/NEJMoa1200303/suppl_file/nejmoa...
    the food records show:

    Low Fat Control Diet - Less calories consumed overall with more calories from Carbs compared to Fat

    MeDiet - More calories consumed overall with more calories from Fat compared to Carbs

    The MeDiet is relatively more calories, lower in Carbs and higher in Fats compared to the low fat control diet.

    This looks like a comparison of a low carb high fat diet (LCHF) vs a low fat diet! Although the fat used is MUFA rather then SFA, the odds ratios show a benefit in favor of the LCHF group.

    So difficult are feeding trials!

    Reply: #56
  4. LDL-Richard
    PREDIMED give arise to loads of questions as Dr Esselstyn summarized.

    All three dietary groups had almost equal facility promoting the growth and clinical appearance of cardiovascular disease in those who at study onset did not have this illness. The single exception was the control group which had a significantly higher stroke rate; however at baseline, they also appeared to have a greater BMI, waist circumference, hypertension, anti- hypertensive agents and diuretics suggesting a cohort at greater risk for strokes.

    1. No one lost weight or reversed their diseases while on the Mediterranean Diet

    2. Most of the participants were overweight & remained on statins, anti-hypertensive & diabetes medications in spite of the diet.

    3. The so-called 30% drop in cardiovascular risk looks like this. About 8 people in 1000 on the Mediterranean diet, compared to 11 people in 1000 on the "control" diet.

    The epidemiologic ultimate confirmation of the power of plant based nutrition to prevent cardiovascular disease is best demonstrated in T. Colin Campbell’s China Study. In a rural province in China over a three year period examination of over 250,000 death certificates, not one death was attributable to cardiovascular disease.

    Reply: #5
  5. FrankG
    You need to read the whole story Richard...

    http://rawfoodsos.com/the-china-study/

  6. Richard, no one doubts that you have success, and congratulations. But in terms of an logical argument, you are committing an error of generalizing your personal results, which is not a really scientific or even logical. We are talking about general trends which can be empirically observed, and that is the major point about the whole low-fat vs low-carbohydrate diet approach. It's not about facts being argued, but about pre-conceived notions superseding factual evidence and assumptions that are applied categorically and moralistically. (meat is categorically bad, milk is categorically bad) with bad logic to boot!

    The fact is that low-carbohydrate doctors have been routinely villainized and marginalized and even had their medical licensed threatened because of a cabal of so-called 'scientists' who believe that above all fat is bad, and in addition, they use arguments, like environmental arguments (you know, beef is bad for the earth, etc) which have no relevance to the facts that they are bringing to bear (their diet is healthy or not compared to another diet).

    What they argue is by that line of reasoning is that, even if you are sick and unhealthy and on diabetic medications, you are saving the 'environment'.

    It is not a sound argument. If someone presupposes that their is an ideal diet, that seems like a big mistake because if their diet were 'ideal', then humans would not thrive the way that they do in almost every part of the planet. But the facts bear out (if you choose to agree on the metric and not then skew the argument in favor of the 'environment' or 'moral' or 'your oen personal experience which is contradictory' considerations) that low-carbohydrate diets work well for most people and they are safe and effective.

    Likewise, if you really believe in human freedom (which I have seen a lot more in low-carb circles than low-fat circles) instead of a world that has to be determined by surrogate 'experts' then you understand that (a) people can eat a low-fat diet if they want to (b) people eat for a lot of different reasons, some of which are moral and religious and even eat bad things that they know that are bad for them but taste good and (c) that's okay.

    But let's not confuse the arguments.

  7. LDL-Richard
    @St. Andrei Ostric,

    if I had chronic illness such as diabetes or CHD, I'd want to have to the best evidence based treatment available, or atleast I would like to have all the options carefully explained to me. I believe this is the fundamental right of every patient. Not informing the patient about the most powerful evidence based treatment for chronic ailments, whole-food plant-based diet, is not good medicine. Whether the patients chooses to follow this kind of therapy is up to the individual patient. Don't confuse medicine to religion.

    This Nashville based cardiologist practices conservative and evidence based medicine.

    Local Cardiologist Touts Plant-Based Diet for Optimal Heart Health
    http://nashville.medicalnewsinc.com/local-cardiologist-touts-plant-ba...

    Reply: #8
  8. FrankG
    I DO have a chronic illness such as Type 2 Diabetes and I have had great success with a "plant-based" diet... it's just that most of my "plants" have been eaten by the cows and pigs that I eat :-)

    To be more precise my diet is "solar-based" as ultimately all the energy comes from the sun.. plants, animals: we are all part of the same genome... the same tree of life.

    But without being flippant -- having done my due diligence evidence-based reading and self-experimentation -- I can say that I have never been healthier than I am today; eating a real whole food diet, which is naturally LCHF :-)

    I just wish that my health care providers had offered LCHF as an option when I was first diagnosed; instead of my having to find this out for myself.

  9. Andreas, if you look at what the study reports that the participants actually ate, it's almost identical between the two diets. I don't see how they (or anyone) can claim that a 2% reduction in fat consumption in one group, and a 2% increase in another group, can have such a large effect on mortality.

    While I agree with your position that a low-fat diet is not a great option, I don't think that this study supports that position, as the low-fat group WAS NOT eating low-fat, and the Med group was eating almost identically to the low-fat group. Even the sub-types of fat were almost identical, so both groups were eating almost the exact same amounts of SUFA, MUFA, and PUFA, as well as PUFA sub-fractions.

    I don't see anything in the data behind this study that would account for the difference in outcomes. It looks, to me, like it's just a badly-done study.

    Reply: #10
  10. Dr. Andreas Eenfeldt, MD Team Diet Doctor
    Badly-done studies usually don't end up in The New England Journal of Medicine...
  11. 50-90% percent of all medical studies are badly done. A large percentage of the stuff in NEJM is either bogus or unconfirmed. To cite another highly-regarded journal:

    "Results: Of 49 highly cited original clinical research studies, 45 claimed that the intervention was effective. Of these, 7 (16%) were contradicted by subsequent studies, 7 others (16%) had found effects that were stronger than those of subsequent studies, 20 (44%) were replicated, and 11 (24%) remained largely unchallenged. Five of 6 highly-cited nonrandomized studies had been contradicted or had found stronger effects vs 9 of 39 randomized controlled trials (P = .008)....

    "Conclusions: Contradiction and initially stronger effects are not unusual in highly cited research of clinical interventions and their outcomes...."

    "Contradicted and Initially Stronger Effects in Highly Cited Clinical Research"
    http://jama.jamanetwork.com/article.aspx?articleid=201218

    NEJM is one of the journals studied. I don't think it's safe to assume any study is well done until it's been confirmed a few times, given the high rates of poor research that is published.

    And given that this one isn't even measuring what it says it's measuring, it's highly suspect.

    Reply: #15
  12. You tell em' Doc!!!! I am so sick and tired of this lie that people believe! Low fat diet's ruin your health. PERIOD! I tried this and guess where it got me? Type 2 Diabetes for my efforts! A low carb diet rich in good oils and protein is the only way to live a healthy lifestyle! PERIOD!
  13. Richard, to your point, why then are the 'plant based gurus' supportive of the diet that I have seen so many people lose weight and cure their diabetes with that is high fat and low carb?

    Like I said, more power to you...people eat diets for all sorts of reasons, and if you feel great, fine.

    But the fact stands that 'plant based gurus' don't support high fat diet because it cause them to have to re-evaluate the premises of why their diets work (ie remove sugar, processed food, seed oils, etc.) and that simply doesn't fit with their pre-conceived ideas.

    Anything is better than an anti-SAD diet, even a calorie restricted Twinkie diet, but the question is: A low fat diet vs the (often villified) Atkins' style diet. Which is actually better?

    Look, Richard, let's be clear here: Plant based diets do not taste good, either, and that is one of the reason people eat. They like to. You can argue all you want, but it's a fact, people will continue to eat food that taste good, and plant based diets, unless you add some dairy, sauces, fish, etc. are things people don't want to eat. You end up making your lentils into a hamburger ANYWAY!

  14. Sabine
    @LDL-Richard. May I ask how old you are, Richard?
    HOW LONG HAVE YOU BEEN EATING 80% CARBS?
  15. Tuck - You bring up some good points especially regarding the issue of reproducibility.

    Here is a similar study done in 1994, the Lyon diet heart study
    http://europepmc.org/abstract/MED/7911176/reload=0;jsessionid=7snrDIV.... The findings were similar.

    Here is a discussion comparing these two studies http://www.awlr.org/1/post/2013/02/mediterranean-diet-trumps-low-fat-....

    Both show a reduction in CVD risk on a Mediterranean-type diet compared to control

    Reply: #19
  16. LDL-Richard
    @Sabine,

    I've posted under the nick "Richard", yes. I've been following a whole-food, high starch McDougall-style diet for about 3 years now. I am in my late 20's. My LDL cholesterol is 1.8mmol/ (69mg/dl) which is low enough to regress atheroma plaques even in people with diagnosed CHD. However, I eat some high fat foods: dark chocolate and quite a lot of nuts and even some canola oil. I hear many people following similar diets with more stringent approach have their LDLs much lower.

    My mother was diagnosed with dyslipidemia a year ago; her LDL cholesterol ran at 5mmol/l and she was put to atorvastatin 40mg therapy. I was hoping she would start a medication with lower doses, but she refused. Instead she read the Starch Solution book I gave her. Now, she's been following plant-based diet for a year and dropped 6kg's, which is quite nice. She did not carry too many extra kg's to begin with. She looks much better, her skin has much healthier tone, even other people pay comments to improved waistline and looks. Next month she'll have her blood test redone, I really hope we are seeing some progress in that department as well. Her cholesterol profile was horrible a year ago.

  17. Sabine
    @ Richard I truly hope, that you will continue to be healthy.

    However, you are still very young, and things may change, even for you, as you get older.
    I too used to follow the conventional dietary advice (high-carb/low-fat) in order to improve my health. This was around your age. I had to do this for many years, and although cutting out real junk, like candy etc. had a positive effect, doing this diet (low-fat and high carb with lots of starches and also pretty vegetarian) eventually gave me diabetes and heart disease, not to mention all the other problems.
    A high-fat/extremely low-carb animal based diet fixed all my health problems and my ever increasing weight. The weight gain really only took off once I reached the age of forty, with a vengeance.
    (My take on it: It takes a long time to really damage yourself beyond repair. You may like to read Lierre Keith's book, who just about killed herself over the course of about 20 years).

    Nevertheless, I hope you, and your mother, will be exceptions, and remain healthy despite your diet.

  18. Janknitz
    Whether the study is inherently flawed or not, my favorite quote about the study in this morning's paper was from Dr. Steven Nissen, who is chairman of cardiovascular medicine at the Cleveland Clinic Foundation. He said "low-fat diets have not been shown in any rigorous way to be helpful, and they are also very hard to maintain."

    Low fat isn't dead yet, but the chinks in the armor are certainly widening.

  19. @Dr. Gerber: I'm familiar with the Lyon Diet-Heart Study. I was quite excited to see it be confirmed.

    But in the Lyon Diet-Heart Study, there were material differences between the two diets. Potentially one of the key differences was that the "MeDiet" group in Lyon was counselled to lower thier intake of linoleic acid (an omega-6 fatty acid) to below 4%.

    So one of the first things I did in looking at this study was to see if they made the same change. They did not. Both groups ate similar amounts of this and every other component of the diet.

    I frankly don't see how this study actually tells you anything, except that the placebo effect of the term "Mediterranean" is large...

    I just find it incredibly hard to believe that going from 39% fat to 37% fat is going to have a deleterious effect on health, as much as I'm a fan and practitioner of the LCHF diet myself.

    Stephan Guyenet did a great series on the Lyon study, the most interesting part (to me) is here:

    http://wholehealthsource.blogspot.com/2009/06/lyon-diet-heart-study.html

    Reply: #20
  20. There's an amusing point in Stephan's post that I'd forgotten about, speaking to the veracity of the NEJM:

    "This is an important point: the Lyon Diet-Heart trial wasn't an ordinary trial comparing the average person's diet to a different diet. It was a bare-knuckle showdown between the [American Heart Association] prudent diet and a modified version of the Mediterranean diet! I believe that's part of the reason it was rejected by the prestigious New England Journal of Medicine, although there's another reason I'll get to later."

    Reply: #23
  21. Alan
    I found it interesting that the authors recommended "Bread, potatoes, pasta, rice" to the control diet (low fat) but they didn't say anything about these foods in the two treatment groups (olive-oil-Med; and nut-Med)! The authors claim that the low-fat diet, despite the seemingly miniscule macronutrient variation among diets (see Table S7), caused more major cardiovascular events than the olive-oil-Med and nut-Med diets.

    How would you feel about encouraging high carb diets in diabetics and prediabetics?!

    Should the authors conclude that it was the fat rather than the carb that was driving the significant results?

    Do most Europeans eat ~42% carb, ~41% fat, and ~17% protein (Table S7)? Or is this a biased sample because they were diabetic or prediabetic? An estimate of what people in the USA eat from the year 2000 is: 53% carb, 33% fat, and 14% protein.

  22. I love the term evidence based medicine, implying that all evidence is all axiomatically good evidence and all the implications for that evidence suggest no alternative viewpoints so that the implications suggested must be followed. This is where all the correlation/causation errors and 'is implies ought' fallacies occur as well as the question often not asked which any evidence should always elicit, but often doesn't 'Compared to what?'.
  23. Tuck - I was also surprised to see that Linoleic acid (omega 6) consumption was at 12.2% and 16% of energy at the end of the trial.
  24. Sandra
    I was diagnosed with Type 2 diabetes a year ago. I live in the Uk. I was told by my GP and Health adviser to follow a Mediterranean diet. I actually did it for a couple of months, i followed the diet strictly. During the time i was on a Mediterranean diet, i put on weight, blood sugar levels were always unstable. Even though i followed the diet rigorously, it was difficult for me to understand why i couldnt control my blood sugar levels.
    I have been on a LCHF diet for a while, i have been losing weight and my sugar levels are stable ! I was taking Metformin 3x a day, i now take once a day ( breakfast ) ! I feel great, loads of energy !
    I will stick to LCHF diet , its no dead yet for me!
    If carbs are transformed into glucose, why do i need to be on a diet which i stuffed myself with carbs ? I dont need it, THANKS !
    LCHF is doing miracles to my case.
    To be hones i dont trust in medical " experiements"! I remember back in the day when there was a big advert to not eat sardines, cause their fat was not good for the heart and caused cholesterol and a few years later the doctors started to advice people to eat sardines, cause their fat was good !!! Go figure !
    When studies ( experiments ) like those are done, they should show people's weight before and after the studies. There are loads of things they didnt mention.
    In my opinion we should stick to a diet that works for us... I found mine its LCHF !
  25. Wade Henderson
    Andreas, I think it is disingenuous to keep referring to the "results" as proving that a "low-fat" diet has such and such a outcome, unless you provide a definition of low-fat.

    Had you been asked a week ago what, in terms of percentage of calories from fat, is the definition of a "low-fat" diet, even YOU would never have indicated that 37% fat was inside of your definition of a "low-fat" range.

    From the Harvard School of Public Health, the following descriptions:
    "The traditional Mediterranean-style diet is higher in fat (about 40 percent of calories) than the typical American diet (34 percent of calories , but most of the fat comes from olive oil and other plant sources."

    So we have the average American eating a diet that is 3% lower fat than this study's 37% version of "low-fat".

    How can you expect to maintain objectivity and credibility when you keep promoting such a distortion in your debating the results

    Sure, it is quite alright to show that in this study, the Mediterranean version did show a significant reduction in strokes. That is a valuable piece of information for doctors and patients to know.

    You might even say the following, "People cannot or will not follow even the standard "low-fat" diet so they certainly won't follow the more extreme "low fat" diets such as those promoted by Ornish and McDougall.
    All of that would be acceptable for you to say.

    But, again, it is disingenuous of you to say that this study proves that "low-fat" diets cause more cardiovascular events.

    While the subject is in the news, it is time for the Diet Doctor to give his definition of exactly what constitutes a "low -fat" diet, complete with the your own range of fat as a percent of calories.

    Come now, that can't be difficult.

    Tell us what it is. 5% to 45%... is that low fat?
    OK... too high.. How about 5% to 40%... OK?
    How about 5% to 35%...
    How about the 30% of the American Heart Association
    The DASH diet says 27%
    From Livestrong.com low fat is 20% to 30%

    Or how about from Circulation, the journal of the American Heart Association and their definition of "very low fat" which is
    "defined as one in which ≤15% of total calories are derived from fat"

    So Andreas, if you will just give us your definition of "low-fat" then it would clear up much of the back and forth discussion. We would then all be talking about apples and apples rather than apples and oranges.

    How about it, give your definition of the acceptable range of a "low-fat" diet in terms of percentage of calories from fat.

    That is a fair request to a science based doctor.

    Reply: #26
  26. Dr. Andreas Eenfeldt, MD Team Diet Doctor
    I'm not that interested in drawing arbitrary lines in the sand.

    I'm a pragmatist. I'm interested in what works, and what does not work. Obviously low-fat dietary advice, á la the advice above, does not work for preventing heart disease. If anything it has the opposite effect.

    For me the definition of low-fat dietary advice is simply about actively discouraging people from eating natural healthy fat. Again, like in the advice above.

  27. "For me the definition of low-fat dietary advice is simply about actively discouraging people from eating natural healthy fat. Again, like in the advice above."

    OK, fine. But that's not what this study does. If you read throug the dietary advice in the study, they're advocating that both arms eat low-fat foods. Which is probably how they wound up having about the same fat intake:

    "Registered dietitians were directly responsible for all aspects of the dietary
    intervention at each site."

    That explains a lot. From the Mediterranean arm:

    "Negative recommendations are also given to eliminate or limit the consumption of cream, butter,
    margarine, cold meat, pate, duck, carbonated and/or sugared beverages, pastries, industrial
    bakery products (such as cakes, donuts, or cookies), industrial desserts (puddings, custard),
    French fries or potato chips, and out-of-home pre-cooked cakes and sweets.... Limited consumption (≤1 serving per week) was advised for cured ham, red meat (after removing all visible fat), and cured or fatty cheeses."

    Clearly this is not LCHF. No cream? Horrors!

    From the Control arm:

    "In the Control group, advice on vegetables, red meat and processed meats, high-fat
    dairy products, and sweets concurred with the recommendations of the Mediterranean diet,
    but use of olive oil for cooking and dressing and consumption of nuts, fatty meats, sausages,
    and fatty fish were discouraged."

    http://www.nejm.org/doi/suppl/10.1056/NEJMoa1200303/suppl_file/nejmoa...

    Now having the Med arm cut back on "industrial" foods alone could account for the health benefits, but eliminating "trans" fats from your diet is not LCHF, it's just smart.

    Andreas, it's time to throw in the towel on this one. You, like me, got taken in by what was reported as a study that favored our prejudices. We need to not make the mistakes that the low-carb advocates have made.

    I don't think you're being disingenous, but this study doesn't really make the argument that LCHF is good, while it does make the argument that avoiding junk food is healthy.

    Reply: #28
  28. Dr. Andreas Eenfeldt, MD Team Diet Doctor
    I never said that LCHF was tested in this study.
    Reply: #30
  29. Sabine
    Hello all you people who would like to know about a natural level of fat intake.
    Mammals (and yes, this includes cows and gorillas) have a sweet-spot of about
    75-80% of calories from fat. For plant-eaters (like cows) the conversion happens in their huge digestive tracts via fermentation by bacteria (it is actually the bacteria who eat/process the plants, and the cows live on the predominantly medium chain saturated fatty acids these produce).
    Non plant-eaters, or predators (us and other non-herbivores, who do NOT have fermenting stomachs), eat the fat of other animals, and we are also needing about the same amount of fat to thrive (75-80%).
  30. "I never said that LCHF was tested in this study."

    No, not explicitly. But you did say:

    "R.I.P. low-fat diet. Welcome back, fat."

    Which could lead to that conclusion. :)

    Reply: #31
  31. Dr. Andreas Eenfeldt, MD Team Diet Doctor
    Yes. And before that I also mentioned a number of other studies supporting that conclusion. This is just the latest nail in the coffin. But it's a big fat one, with a hugely relevant hard endpoint.
  32. Alan
    Sabine, where did you get your information on fat consumption in primates (gorillas)? Do you have a source? Leonard, Snodgrass, and Robertson 2010 say that gorillas eat: 3% fat; 24% protein, and 73% carb.

    http://www.ncbi.nlm.nih.gov/books/NBK53561/

    Just curious and interested.

    Reply: #33
  33. What enters the gorilla's digestive tract is very different from what enters its blood stream from the digestive tract.

    "Should all animals eat a high-fat, low-carb diet?"
    http://www.second-opinions.co.uk/should-all-animals-eat-a-high-fat-lo...

  34. Sabine
    @Alan Gorillas, like other plant eaters have large fermenting digestive tracts, where bacteria convert the plant-matter into something that mammals can actually live on, mostly fat.
    Gorillas have very large intestines and small brains. Our large brains do not lend themselves to living like an herbivore. We have now very large brains and very small intestines (not much fermentation there, and too much fermentation upsets our health).

    You may want to start with this video: http://www.second-opinions.co.uk/weston-a-price-seminar-march-2010.ht...

    (This is a good starting point, Barry is a very smart man, who did his research.)
    More information can be found on-line, the numbers vary slightly, for cows, for example (it depends on what they eat, grass, soy???, grains???)

    http://www.drmyhill.co.uk/wiki/Fermentation_in_the_gut_and_CFS

    http://www.ultimateungulate.com/cetartiodactyla/Rumination.html

    Herbivores derive nutrients from fiber in two ways. Some, like cattle, sheep, and deer, are foregut digesters. They have multiple stomachs that serve as fermentation tanks where fiber is broken down by bacteria. The dead bacteria then provide short-chain fats that nourish the animal. I took this picture showing the digestive system of a bison in a museum in Montana this past summer. The four stomachs are numbered.

    Animals like rabbits, pigs, horses, and GORILLAS are hindgut digesters. They absorb some nutrients through the stomach and small intestine in the same way carnivores do, but the fiber in their diet is fermented to produce short-chain fatty acids (saturated fats) in the cecum and the colon. These fats are then used as fuel.

    This is just an abstract: http://link.springer.com/article/10.1007%2Fs10764-011-9559-y

    And this: The macronutrient profile of this diet would be as follows: 2.5% energy as fat, 24.3% protein, 15.8% available carbohydrate, with potentially 57.3% of metabolizable energy from short-chain fatty acids (SCFA) derived from colonic fermentation of fiber.
    From here: http://jn.nutrition.org/content/127/10/2000.full (the authors semm to forget that we have small colons compared to gorillas, and that we cannot spend our days chewing and nothing else, it is just not efficient to live on fermenting fibre.

    "Then there is this paper J. Nutr. 127: 2000–2005, 1997 showing how the gorilla diet is actually a high fat diet, with the fat provided as short chain fatty acids from colonic fermentation of fiber. The leaves themselves are relatively high in protein and low in fat and carbs, but when acted on by the gorilla's body, fat is produced. The paper is comical in its fat phobia and the authors fail to contemplate that perhaps humans would thrive on a high fat diet (since we don't have quite the fermentation apparatus that gorillas do), but the careful analysis is interesting."

    "Native gorilla vegetation has an extremely high fiber content, which cannot be digested in the
    stomach or small intestine but mat be fermented in the large intestine by gut microbes to produce
    short chain fatty acids (SCFA), carbon dioxide, and methane. Gorillas have an enlarged hindgut for
    harboring such bacteria (Stevens, 1988), and SCFAs are likely used by gorillas and even humans for
    energy production and colonic health." http://nagonline.net/HUSBANDRY/Diets%20pdf/Gorilla%20Nutrition.pdf

    http://www.nagonline.net/Technical%20Papers/NAGFS00797Primates-JONIFE... This article also has a ton of references.

    There is much more easy to find on-line information.

  35. Alan
    Thank you Sabine, and Tuck. I just finished watching Barry's talk. I read all of the links and papers. Thank you for sharing your knowledge. The importance of the microbiome and SCFA from fiber is very interesting.

    My wife, who is from India, popped in and heard Barry mention the smaller brains of the vegans...she dismissed him with a few smart quips....I defended Barry's overall talk and said that I wanted to read the article that he mentioned. Of course, it is interesting that Indians have quite a bit of brain power and India has the oldest vegetarian and vegan ways of eating. Bigger brains are not everything...wrinkled brains, connectivity (and more) are important too.

  36. Alan
    I am participating in the American Gut project in which scientists will sequence my microbiome from a sample of stool.
    http://www.indiegogo.com/americangut
    They recommended that participants record what they eat. So I used myfitnesspal to record these data. I just estimated my macronutrient profile for the last month: 10.5% carb; 18.4% protein; and 71.1% fat. I know it seems crazy to keep track of this. But I want to improve my health and I want to know more about my microbiome and its potential impact on my health.
  37. Sabine
    Yes, Alan. Size is not everything when it comes to brains, brain health and wiring matter. And, just like you said, there are and have been very intelligent people from India, but not every Indian is smart. Not every meat eater is smart either. This is a very complex subject.

    It is interesting that our palaeolithic forefathers had bigger brains than we do, that there is a trend of further collective brain shrinkage, and that eating sugars shrink our individual brains every year we eat too much of them. (I can probably find the references, but do not have time right now).

    I too am excited to learn more about the bacteria that make our lives possible. I hope we will be able to learn a lot we do not yet know from this microbiome project, as it is very important to our health and survival. It is cool that you are participating.

  38. The low fat diet is absolutely insane. I wonder if people following weight watchers have experienced any health issues since the diet is all about low fat or no fat at all. Scary!
  39. LDL-Richard
    Andreas wrote:

    "I'm not that interested in drawing arbitrary lines in the sand".

    Defining fat intake is not about drawing arbitrary lines in the sand. People attempting to cut fat intake to < 30% of their calories have to cut back on foods of animal sources. People attempting to cut their fat intake to < 10% must not only eliminate foods or animal sources bur also eliminate their intake of oils and severely limit other fatty foods. I am pragmatic too, and < 10% fat, whole-food plant-based diet seem to work very well in treating people with MS (a pilot RTC is currently pending), prostate cancer, diabetes, obesity and CHD.

    PREDIMED control diet was a straw man diet, no one is recommending a diet with <25 g fiber per day, certainly not the official guidelines.

    Reply: #40
  40. Dr. Andreas Eenfeldt, MD Team Diet Doctor

    < 10% fat, whole-food plant-based diet seem to work very well in treating people with MS (a pilot RTC is currently pending), prostate cancer, diabetes, obesity and CHD.

    That would actually not surprise me. It's all about what you DON'T eat. If you avoid processed high-carb food and soda you're probably better off than most people, whatever else you choose to eat.

    The problem with generic low-fat advice is that it tends to make people eat more bad carbs, because that's what's easily available everywhere.

  41. LDL-Richard
    "The problem with generic low-fat advice is that it tends to make people eat more bad carbs, because that's what's easily available everywhere".

    Well, that's where I am coming into the picture and trying to educate people to eat good carbs. Please, Andreas, feel free to support my efforts.

    The Greek islands are known for their delicious stone-ground whole-wheat bread. Whole-grain rye bread and potatoes has been the staple food in Eastern Europe. Violet sweet-potatoes make-up the bulk of the calories in Okinawa. Brown rice has been the staple food in rural China. Sorghum, maize & Cassava roots are the foods of Central-Africans. Millet fueled the Varangian guard :) Gladiators were referred as the "barley men".

    Reply: #42
  42. FrankG
    Right.. because what the "great uneducated masses" need is even MORE advice to to eat "hearthealthywholegrains" and their 8-10 daily servings of fruits and veg! Like we haven't heard that one lately.

    Your view of presenting balance seems decidedly one-sided, if you ask me.

    What people have eaten out of necessity, is hardly a recommendation for the optimal human diet so please don't confuse "not as bad as the SAD" with "good for you".

    Good luck with what works for you but please take your veggietrollian advice elsewhere :-)

  43. Maxx
    I don't think we can compare the Okinawans, Kitavans or Gladiators to modern westeners that sit in an office all day. LFHC diet would probably work for many people, if they would get constant exercise throughout the day and if there would be no fast food, candy etc. readily available everywhere.

    An then we have centenarians that smoke and drink. Some people are able to function even with 80+ % carbs, some live to be 100 by smoking and drinking. But many people get sick by eating carbs even if they could control for over eating. Many people are just not able to follow a fat <10% diet. Carbs to some are like alcohol to alcoholics.

    This is what McDougall is complaining at his site - that he'd need studies in successful dieters. There are so few people that would be able to follow that kind of diet, that it is just not feasible. It's like saying that running a marathon in 3 hours once a month is healthy and prevents cardiovascular disease. Might be, but so few people are able to do it, that it is better to do something that works better. Like LCHF and sprinting and moving a lot in slow pace + lift heavy things. This is something that more people are able to follow and it makes them healthy. I agree that even LCHF is not for everyone, as there have been studies where terminal cancer patients have put on ketogenic diet, but most have dropped out and rather enjoyed their candy and soda, rather than have the chance to avoid death.

    That tells something about people's ability to adhere to a certain diet. And since the LFHC has been marketed for centuries, yet obesity rates are exploding, isn't it time to face the facts and admit that we need to try something else? And Richard, you might be one of those few that are able to follow consistently a LFHC diet, but you might also be able to run a marathon in 3 hours each month. As Sabine pointed out earlier, you might be healthy now. Many people are healthy in their late twenties, but by 60 they eat 8 different medications, because they have been following the dietary advice. (some might have even succeeded, most have not). 3 years is a good time to follow a diet, but the diet should be followed at least 30-60 years.

    My n=1 was that I had high cholesterol, which freaked me out to avoid all saturated fat and eat exactly to the dietary guidelines. My cholesterol dropped to 3.7, but at the same time my health deteriorated so much that I was barely functioning. When starting paleo, I was back "online" in couple of months and feel better than ever. Cholesterol is now higher, yes, but I feel healthy and don't get flu's or other ailments anymore. It's now been 2 years with low carb / ketogenic Paleo.

    You might ask, why does one think a paleo diet is something one can follow for decades? First of all - men have followed it for hundreds of centuries and it truly is not a diet as in weight watchers or Ornish - you just eat a lot of good delicious food. There is no self deception involved, like convincing yourself that you suddenly like to eat only vegetables or you don't want to have olive oil with your salad. Or that you suddenly are in complete control how much pasta or rye bread you eat.

    It's a bit different for the people like Clinton to follow an Ornish diet, they have someone prepare each meal and control what they eat and anyway, they do not have to follow that diet for decades anymore.

  44. Sabine
    All you carb lovers, you may want to read this:
    http://eatingacademy.com/nutrition/how-do-some-cultures-stay-lean-whi...
    I think especially point 2 sums it up nicely: If you eat a high percentage of carbs then cut your calories/eat very little food overall. Have fun being hungry, having shorter/smaller children.......
  45. Margaret
    Yeah, but has anyone noticed that no one in the study eating the Med diet lost weight in the 5 years studied? So simply eating whole, unprocessed food doesn't guarantee weight loss. Just sayin.
  46. Sabine
    http://www.ncbi.nlm.nih.gov/pubmed/10600044

    The whole world lives on carbs......it is scary how it rots our brains....
    I agree with Stephany Seneff here, the LACK OF ANIMAL FATS gives us a lot of chronic health problems.
    http://people.csail.mit.edu/seneff/EJIM_PUBLISHED.pdf

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2367001/
    https://www.google.ca/url?sa=t&rct=j&q=&esrc=s&so...

    http://www.deepdyve.com/lp/elsevier/the-neuroprotective-properties-of...

    I care less about weight and more about health. But if you live very low-carb ketogenic, then weight is not an issue anyway.

  47. yuma
    20 years ago I went into the Ornish diet. Not only did I feel like s**t all the time, I also developed ED.

    My wife wasn't happy with the last one so back came the fat and I haven't looked back.

    The LF diet is good for population control, and although it won't increase your longevity, life will seem longer.

  48. Sabine
    I should correct my previous post to say: eat whole animals, fat and all.

    “One death feeds many. It is very high altitude here. We need to eat meat and fat to survive.”
    Said by a Tibetan monk. It is from this blog: http://www.bulletproofexec.com/steve-jobs-dr-dean-ornish-and-vegetari...
    He is discussing the Ornish diet.

  49. Wade Henderson
    Clearly people who need to find "bedrock" can find it in abudance regardless of whether they choose LFHC or HFLC eating. There is an abundance of science to prove either side correct to the extent the individual needs "evidence".
    There is modern evidence and there is ancient evidence.
    I've seen solid "facts" on both sides.

    It is really amazing how the human mind seems to have a need to find the answer, then exclude and taint all the contrary evidence of the other side.
    Humans are highly skilled at that endeavor. From diet to politics to religion we find ways to prove those people over there have it all wrong. Sometimes we call them evil, sometimes just misguided.

    I think it would do well for anyone completely convinced about diet, to just assume some of what they are certain about will no doubt be proven wrong in the future.

    Worst of all the leaders of each side feel the need for ever more purity.
    Thus on one side, even a drop of oil in a product, or a spray of PAM, is akin to starting down the road to hell. And on ther other side, a staple like white rice, eaten by a billioin slender people is made out to be a near poison.

    At least almost everyone agrees on a few points.

    That almost all veggies are good and should be consumed in large quantities
    That a fair amount of fruit is healthy,
    That the carbs you eat should be good carbs ( as opposed to Twinkies)
    That sugar in excess is bad.
    That Sugar drinks are worse
    That cakes, cookies, pies and the like should be eaten in tiny quantities and infrequetly.
    That transfats are bad,
    That milk should not be consumed in large quantities.

    i'd bet that with just those points and perhaps a few others I've overlooked, that about half the nations "excess" weight would gradually go away over a decade or so.
    Diabetes would be cut by half and heart disease would decline

    Throw in the above and add in some minimal exercise, say, walking for 30 minutes a day, and the nation could cut the health care bill by 25%

    But we humans like purity and extremism, so we will continue to go down the path where the extreme versions of dietary intake must be proven correct.
    Neglecting to acknowledge vast numbers of people on both ends who seem to be living in excellent health.

    Perhaps if we focused on the similarities of those two groups and chose what they both do in common, then we could give some valuable guidance.

    In the mean time, the battle for the minds of the other 90% rages on as they are whipsawed back and forth, each time adding a new notch to their belt.

  50. Maxx
    Great post Wade. A lot of good points. Reading these blogs it has become more and more evident that one just cannot change the way people think. People will just dig up more and more proof to prove their point.

    But isn't it a bit pot blaming the kettle black when you call LCHF or LFHC diets extremism and suggest that obesity would not be a problem, if people would just follow YOUR way of thinking, by having "everything in moderation" and eating the foods YOU list or think that people agree on?

    What we need is people who can really turn 180 degrees and admit they have been wrong. Luckily there are examples like Loren Cordain admitting he was wrong about vegetable oils being healthy or some other cases like a vegan admitting that the diet was not healthy. Of course there are Paleo followers turned Ornish dieters, too.

    I've personally jumped ship a couple of times and will be happy to do it again, if I get adequately reasonable proof that the way mankind has been eating for 100 000 years, is not suitable anymore and we need industrial seed oils and we need to avoid eating meat.

    There are a lot of examples in current original cultures where they still eat either LCHF or LFHC and if you ask them, it's not extreme. Context is everything. They current official dietary recommendations are extreme in many ways.

    With the LFHC crowd it seems to be a bit like being born again christian. We have been taught from children that low fat is the way to go and when one finally takes the plunge and starts eating low fat, it must feel like born again christian, that now you are finally following the rules that you were taught. Add the illusion that now you also are not killing any animals, it feels even more righteous. (Sorry if this comes across as hurtful - not intended, but I felt it was such a good analogy)

    But what is absolutely required in these blogs, is the debate (that does not turn into trolling).

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