The World Turned Upside Down: The Second Low-Carbohydrate Revolution by Richard David Feinman Page A
Authors: Richard David Feinman
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only
long term large scale studies are important and so we are able to
ignore
smaller studies which, because they are better controlled, actually
give you
more information. And again, there was also the assumption, never said
out
loud, that there were long-term studies supporting a low-fat diet, a
"prudent"
diet, a diet of moderation that had good success and that could be the
one for
all of us and, even better, would fix things if you did get fat. There
is no
such diet and there never was. Again, vaporware. There were long-term studies
but they had consistently failed. Not just one. Almost all failed. The
Framingham Study, the Oslo Heart Study [39,
40] ,
Western Electric Study [41] and probably two dozen
others, tabulated and explained in the irreverent style that they
deserve by
Anthony Colpo [24] including the Women's Health
Initiative [42-44] . They
showed no value in reducing
dietary fat or saturated fat for prevention of heart disease or
anything else.
And, in the biggest trial of all, the population trial, the diet of the
whole
American people during the obesity epidemic, it was increased
carbohydrate, not
fat, that was actually harmful.
Figure
4-4 . Excerpt from Steve Cooksey's blog post
and red-line by AND
(Academy of Nutrition and Dietetics).
To be fair to the nutritionists, the
doctors did their part.
Undeterred by their lack of training or experience in biochemistry or
nutrition, it was de rigeur for junior faculty in a department of medicine to write a review
trashing the
Atkins diet, now taken as the generic name for all low-carbohydrate
diets. Some
of these critiques cited, as the major flaw, that the diets failed to
conform
to the USDA or other dietary guidelines. In other words, they faulted a
diet
that thought the USDA recommendations were bad for not conforming to
those
recommendations. Using the question as part of the answer is what was
called
"begging the question" when it meant something specific. (It was
probably a
dumb phrase anyway).
Failure to accept
failure.
Stepping back and looking at the big
picture, the most striking
thing was the inability of low-fat diets even those low-fat diets that
did
lower cholesterol, to provide a significant impact on cardiovascular
outcome
or, really, anything else. Very large, very expensive clinical trials
of
low-fat dietary strategies fail. Most failed big. And they keep doing
them and
our tax dollars keep paying for them. Second, in those cases where we
didn't
have outcome data (how many people had a heart-attack and how many
died) and,
instead, had to look at the risk factors, the different cholesterol
forms, HDL,
LDL and their sub-fractions, it turned out that reducing fat was at
best
ambiguous and it was frequently dietary carbohydrate that had the major
effect.
As carbohydrates were increased, most of the risk markers got worse.
The
markers and their association with outcome were not sufficient to
attribute
cause but that had not stopped interpretation when it was low-fat that
reduced
risk factors.
As we go beyond the original idea of
total
blood cholesterol as a
major risk factor – less than half of the people who have a first heart
attack
have high cholesterol – as we look at the different forms of the
lipoprotein
particles (this is what is really measured in the clinical tests of
blood
cholesterol), carbohydrate restriction becomes the "default diet," the
remaining alternative, the one to try first for general health. At same
time,
though, while low-carbohydrate diets look better for CVD risk factors,
we have
the same problem that we have with fat: there is little in the way of
evidence
that lowering carbohydrate could actually prevent CVD. Given its
success in
treatment of the collection of health markers referred to as metabolic
syndrome
(again, our main arguing point), it would be surprising if reducing
carbohydrate did not help in prevention but at this point, what we know
is very
little. We are left with the real possibility that, not
long term large scale studies are important and so we are able to
ignore
smaller studies which, because they are better controlled, actually
give you
more information. And again, there was also the assumption, never said
out
loud, that there were long-term studies supporting a low-fat diet, a
"prudent"
diet, a diet of moderation that had good success and that could be the
one for
all of us and, even better, would fix things if you did get fat. There
is no
such diet and there never was. Again, vaporware. There were long-term studies
but they had consistently failed. Not just one. Almost all failed. The
Framingham Study, the Oslo Heart Study [39,
40] ,
Western Electric Study [41] and probably two dozen
others, tabulated and explained in the irreverent style that they
deserve by
Anthony Colpo [24] including the Women's Health
Initiative [42-44] . They
showed no value in reducing
dietary fat or saturated fat for prevention of heart disease or
anything else.
And, in the biggest trial of all, the population trial, the diet of the
whole
American people during the obesity epidemic, it was increased
carbohydrate, not
fat, that was actually harmful.
Figure
4-4 . Excerpt from Steve Cooksey's blog post
and red-line by AND
(Academy of Nutrition and Dietetics).
To be fair to the nutritionists, the
doctors did their part.
Undeterred by their lack of training or experience in biochemistry or
nutrition, it was de rigeur for junior faculty in a department of medicine to write a review
trashing the
Atkins diet, now taken as the generic name for all low-carbohydrate
diets. Some
of these critiques cited, as the major flaw, that the diets failed to
conform
to the USDA or other dietary guidelines. In other words, they faulted a
diet
that thought the USDA recommendations were bad for not conforming to
those
recommendations. Using the question as part of the answer is what was
called
"begging the question" when it meant something specific. (It was
probably a
dumb phrase anyway).
Failure to accept
failure.
Stepping back and looking at the big
picture, the most striking
thing was the inability of low-fat diets even those low-fat diets that
did
lower cholesterol, to provide a significant impact on cardiovascular
outcome
or, really, anything else. Very large, very expensive clinical trials
of
low-fat dietary strategies fail. Most failed big. And they keep doing
them and
our tax dollars keep paying for them. Second, in those cases where we
didn't
have outcome data (how many people had a heart-attack and how many
died) and,
instead, had to look at the risk factors, the different cholesterol
forms, HDL,
LDL and their sub-fractions, it turned out that reducing fat was at
best
ambiguous and it was frequently dietary carbohydrate that had the major
effect.
As carbohydrates were increased, most of the risk markers got worse.
The
markers and their association with outcome were not sufficient to
attribute
cause but that had not stopped interpretation when it was low-fat that
reduced
risk factors.
As we go beyond the original idea of
total
blood cholesterol as a
major risk factor – less than half of the people who have a first heart
attack
have high cholesterol – as we look at the different forms of the
lipoprotein
particles (this is what is really measured in the clinical tests of
blood
cholesterol), carbohydrate restriction becomes the "default diet," the
remaining alternative, the one to try first for general health. At same
time,
though, while low-carbohydrate diets look better for CVD risk factors,
we have
the same problem that we have with fat: there is little in the way of
evidence
that lowering carbohydrate could actually prevent CVD. Given its
success in
treatment of the collection of health markers referred to as metabolic
syndrome
(again, our main arguing point), it would be surprising if reducing
carbohydrate did not help in prevention but at this point, what we know
is very
little. We are left with the real possibility that, not
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