Marshall Sutherland
  
Fat HeadFat Head wrote the following post Mon, 12 Feb 2018 20:07:34 -0500
Dietitians Want Their Bad Advice To Be The Only Advice: A Tale of Three Twitties
Dietitians Want Their Bad Advice To Be The Only Advice: A Tale of Three Twitties

Actually, this post is about three tweets, but A Tale of Three Twitties is catchier.

I came across the three tweets on the same day, and together they tell the story of what’s wrong with the current dietary advice and The Anointed who promote it.

The first tweet included a link to a recent study in which a low-carbohydrate diet was used to treat type 2 diabetics. Here’s a quote from the summary:
The purpose of this study was to evaluate if a new care model with very low dietary carbohydrate intake and continuous supervision by a health coach and doctor could safely lower HbA1c, weight and need for medicines after 1 year in adults with T2D. 262 adults with T2D volunteered to participate in this continuous care intervention (CCI) along with 87 adults with T2D receiving usual care (UC) from their doctors and diabetes education program. After 1 year, patients in the CCI, on average, lowered HbA1c from 7.6 to 6.3%, lost 12% of their body weight, and reduced diabetes medicine use. 94% of patients who were prescribed insulin reduced or stopped their insulin use, and sulfonylureas were eliminated in all patients.

Lower blood sugar, lower body weight, and 94% of the patients reduced or even eliminated the need for insulin treatment.  Awesome. All patients were able to discontinue sulfonylureas, which are drugs that stimulate the pancreas to produce more insulin. Since all drugs have side effects, I looked up the side effects of sulfonylureas. Here’s what I found on a UK diabetes site:
Sulphonylureas are not recommended for people who are overweight or obese, as their mode of action (increase in insulin production and secretion) means that weight gain can be a relatively common side effect.

Funny, isn’t it? The fact that elevated insulin triggers weight gain seems to be accepted as a given by everyone except many (ahem) weight-loss experts.

I doubt the results of this study surprise you.  Quite a few clinical studies, like this one and this one, have shown similar results.

If you’ve got high blood sugar because of insulin resistance, cutting way back on the carbs can work wonders. I know it, you know it, countless personal trainers know it, everyone who’s read a book on low-carb diets knows it, gazillions of people who’ve done their own research online know it. Seems as if the only people who don’t know it are a helluvalotta doctors and nearly all dietitians.

Which brings us to the second tweet. That one included a link to a Dear Dietitian column in a county newspaper. If you have a tendency to bang your head on your desk when reading incredibly stupid advice from registered dietitians, you might want to don a helmet before continuing.

Okay, you were warned. Here goes:
Dear Dietitian,

I was recently diagnosed with diabetes. I’m trying to watch my diet, and have cut out most carbs, but if I eat a slice of white bread, my blood sugar goes up to 200! What gives?

Dear Frustrated,

First of all, try to be patient. This is a major lifestyle change, and it cannot be accomplished in a couple of weeks. It will take at least six weeks to become accustomed to the new diet, and it won’t be perfect. Secondly, there is no need to remove carbs from your diet. Carbs are a great source of energy and are very satisfying. Anyone who has diabetes should be able to consume 12 to 15 servings of carbohydrate foods each day while maintaining healthy blood glucose levels.

Head. Bang. On. Desk.

How the @#$% is someone with type 2 diabetes supposed to maintain a healthy glucose level while eating 15 servings of carbohydrate per day?! Well, you know the answer to that one:
Another important component for good diabetes management is to obtain the right medicine to lower your blood glucose levels.

Eat your 12 to 15 servings of carbohydrate per day (a great source of energy!), then beat down your blood sugar with more insulin. That’s how dietitians are trained to think. When Chareva’s father was in the hospital for surgery some months back, he was of course given meals approved by the staff dietitian. For breakfast, he was served pancakes with maple syrup … but no butter on those pancakes, because butter will kill ya, doncha know.

These registered imbeciles believe that if you shoot enough insulin to beat your blood sugar down to the normal range, it means you’re okay now — same as if you kept your blood sugar in the normal range by cutting back on the carbs instead.

No. No, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, damnit, it’s not the same.

If you’re a type 1 diabetic and you need injections to achieve a normal level of insulin, that’s fine.  You’re just replacing what your body fails to produce.

But if you’re a type 2 diabetic and you have to inject yourself with extra-high doses of insulin so you can eat those great source of energy carbs, there are consequences. High insulin triggers weight gain. It thickens your arteries. It screws up the balance of your sex hormones. It likely promotes the growth of tumors. Telling insulin-resistant people to eat all those carbs and then shoot ever-higher doses of insulin is insane.

But that’s what dietitians are trained to recommend, which is why so many fat, sick, frustrated people are going elsewhere for dietary advice. Naturally, The Anointed don’t like it when the masses refuse to listen to them.

Which brings us to the third tweet. That one included a link to a video posted by the president of the Academy of Nutrition and Dietetics. Here’s the official description:

President Lucille Beseler, MS, RDN, LDN. CDE, FAND, offers members ways to protect the public’s health (and the nutrition and dietetics profession) from “disruptors” – competitors who offer lower-quality care and less-comprehensive services.

I’d prefer to embed the video in the post, but can’t. You can watch it on this page — and please don’t leave any snarky comments here or elsewhere about Ms. Beseler’s size. No need to go for the cheap shot.

Ms. Beseler is encouraging members to keep an eye out for people who give non-approved dietary advice and report these “disruptors” to state licensing boards … to protect the public’s health, of course.

Yes, because lord only knows what will happen to the millions of type 2 diabetics in the country if they aren’t told to eat their 12 to 15 servings of carbohydrates per day and then shoot up with more insulin.

Let’s take the official description of the video and edit it to reflect the true purpose:

President Lucille Beseler offers members ways to protect the nutrition and dietetics profession from competitors.

This is nothing new, mind you. As Adam Smith pointed out way back in 1776 when he wrote The Wealth of Nations, regulations that are supposedly passed to protect the poor, helpless public are often nothing more than a means to stifle competition — which screws the poor, helpless public.

In what has to be the most outlandish example I’ve ever seen, Illinois passed a regulation requiring anyone who braids hair for a fee to first obtain a cosmetology license. (If you think I’m kidding, read this.) Apparently the regulation was passed after hundreds of people were rushed to emergency rooms suffering from badly-braided hair.

Here’s how it should happen in a supposedly free country: People who give dietary advice that works attract more customers who are willing to pay them. People whose dietary advice doesn’t work lose customers. A license granted by The Anointed shouldn’t figure into the equation either way. If health coaches, personal trainers and other “disruptors” are giving advice that doesn’t work, then the Academy of Nutrition and Dietetics has no cause for concern. Word will get around.

But of course, that’s the problem: the word has gotten around. Dietitians are still telling diabetics to eat their carbs and shoot more insulin — perhaps because the Academy of Nutrition and Dietetics receives generous support from the makers of industrial foods. Their advice is garbage, so people are seeking and finding alternative advice that actually works — as demonstrated by clinical studies and the experiences of millions. That makes the alternative advice a threat, so the dietitians want government licensing boards to stifle the “disruptors” who offer it.

And that’s where we’re at.  A Tale of Three Twitties tells pretty much the whole story.

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 health
Marshall Sutherland
  
Healthy lifestyle could prevent half of all cancer deaths
If people in the U.S. adopted a healthy lifestyle—not smoking, drinking in moderation, maintaining a healthy body weight and exercising regularly—half of all cancer deaths and close to half of all cancer diagnoses could potentially be prevented, according to a new study from Harvard T.H. Chan School of Public Health.
 health
Maria Karlsen
  
What's wrong with cabbage soup? ;-)
Marshall Sutherland
  
Maybe I don't know enough about the cabbage soup lifestyle! :-)

(living in Florida, I should have used my other example -- the grapefruit diet lifestyle)
Sophie
  
My favorite is the kiwifruit diet. Everything except kiwi ;-)
Marshall Sutherland
  
Fat HeadFat Head wrote the following post Mon, 05 Feb 2018 20:13:37 -0500
Jane Brody And The American Heart Association Bravely Admit They’ve Been Right All Along
Jane Brody And The American Heart Association Bravely Admit They’ve Been Right All Along

The strategy is clear now. The American Heart Association, terrified that the Wisdom of Crowds effect is causing more and more people to reject their arterycloggingsaturatedfat! nonsense, has decided to leverage what Josef Stalin referred to as useful idiots — i.e., people who can be counted on to swallow and spread the party’s propaganda.

Step one: produce a Presidential Advisory Report that concludes we were right all along about the dangers of saturated fats.

Step two: do interviews with media types who have been on the anti-fat bandwagon for years … because if we were right all along, it means they were right all along too. They’ll dutifully promote the message without asking pesky questions.

For decades, one of the biggest cheerleaders for the low-fat diet has been Jane Brody of the New York Times. Gary Taubes mentioned her several times in Good Calories, Bad Calories. I wrote a post about her battle with “high” cholesterol back in 2009. You can read the post for the full details, but these quotes capture Ms. Brody’s apparent immunity to cognitive dissonance:
Ms. Brody’s cholesterol panic began when a routine test revealed her total cholesterol to be 222. (So much for a low-fat diet keeping cholesterol down.) Since she just knows that a “heart healthy” level should be below 200, Ms. Brody dutifully stopped eating cheese and went on a diet to lose a few pounds.

But – horrors! – when she underwent another test a few months later, her cholesterol had risen to 236, and her LDL had gone up, not down. Now, you’d think someone with a functioning brain would pause at this point and wonder if perhaps the whole low-fat diet theory is load of bologna. But not Ms. Brody. After all, she’s been telling her readers for decades to cut the fat, cut the fat, cut the fat.

So she cut the fat. She stopped eating red meat, switched to low-fat ice cream, took fish oil, and increased her fiber intake. In other words, she did just about everything she’s been telling her readers they must do to prevent heart disease.

And boy, what wondrous results! Her next test revealed that her cholesterol had risen to 248, and her LDL was up yet again.

If this were a horror movie, we’d all be screaming at the screen, “Don’t go through that door, you freakin’ idiot! Everyone who went through that door ended up hanging on a meat hook!”

But Ms. Brody went through the door. Mere paragraphs after recounting how her low-fat diet failed utterly to bring down her cholesterol, she reminded her readers how important it is to exercise more and cut the saturated fat from their diets. She even informed us that a former roommate lowered her cholesterol by becoming a vegetarian. (“See, this diet made my cholesterol worse, but I know someone who had good results, so you should do exactly what didn’t work for me. Okay?”)

Finally, Ms. Brody reported that despite having some reservations, she began taking a cholesterol-lowering drug. And lo and behold, her cholesterol went down! (At this point in the story, you are allowed to scream, “Of course your cholesterol went down! That’s why it’s called a cholesterol-lowering drug!”)

Perfect example of the phenomenon described in Mistakes Were Made (but not by me). Her own experience demonstrated that restricting saturated fat (which she believes is good for the heart) caused her cholesterol to shoot up (which she believes is bad for the heart). That’s the point where a person blessed with a healthy capacity for skepticism would question the entire theory. But Brody can’t question the theory because she’s been a very public promoter of it. So she dutifully took a statin and declared victory over the cholesterol monster.

Yup, if I were the American Heart Association and needed a useful idiot to explain why we were right all along, that’s who I’d choose. So let’s look at some quotes from the useful idiot’s article, which appeared recently in the New York Times.
The media love contrarian man-bites-dog stories that purport to debunk long-established beliefs and advice. Among the most popular on the health front are reports that saturated fats do not cause heart disease and that the vegetable oils we’ve been encouraged to use instead may actually promote it.

Ah, I see. The belief that saturated fats aren’t the problem is just a man-bites-dog story … instead of, say, the result of new research. Or of countless people learning through experience that low-fat diets didn’t work for them. (Hey, Ms. Brody, remember what happened to your cholesterol numbers when you kept cutting the saturated fat from your diet?)
So before you succumb to wishful thinking that you can eat well-marbled steaks, pork ribs and full-fat dairy products with abandon, you’d be wise to consider the findings of what is probably the most comprehensive, commercially untainted review of the dietary fat literature yet published. They are found in a 26-page advisory prepared for the American Heart Association and published last June by a team of experts led by Dr. Frank M. Sacks.

Ms. Brody thinks the American Heart Association produced the most commercially untainted review yet? You mean the organization whose very existence depends on generous support from the makers of low-fat foods? The organization that will dry up and blow away the day after the arterycloggingsaturatedfat! theory dies?

Pardon me while I go laugh my @$$ off for several minutes …

… Okay, I’m back. Let’s continue:
As documented in the new advisory, misleading conclusions that saturated fats do not affect the risk of developing and dying from cardiovascular diseases have largely resulted from studies that were done in good faith but failed to take into account what people who avoided saturated fats ate in their place.

For example, in a study of 252 British men who had suffered heart attacks, following a low-fat, high-carbohydrate diet reduced cholesterol levels by a meager 5 percent and had virtually no effect on future heart attacks. The carbohydrates they ate were mainly refined, low-fiber flours and sugars that promote weight gain and diabetes, two leading risk factors for heart disease.

In North America and Europe, the team noted, the effect of lowering saturated fat was essentially negated by people’s consumption of more “refined grains, fruit juice, sweet desserts and snacks, sugar-sweetened beverages, and other foods” that hardly promote good health.

Wait … you mean when people cut back on saturated fat, they consumed more refined grains, fruit juices and sugars? Boy, I don’t know how people could have gotten the AHA’s advice so very wrong.

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Yes, it’s true: the AHA has finally stopped putting its logo on sugar-laden cereals and other sugary foods. Only took them a few decades. But let’s think about this …

The AHA jumped on the arterycloggingsaturatedfat! bandwagon after Ancel Keys joined the organization’s board. Keys, as you probably know, waged a very bitter and very personal war of words against British researcher John Yudkin throughout the 1970s. Why? Because Yudkin insisted it was sugar causing heart disease, not saturated fat. Keys replied over and over, in paper after paper, No, damnit, the problem isn’t sugar, it’s saturated fat!

Here’s a quote from Keys himself:
It is clear that Yudkin has no theoretical basis or experimental evidence to support his claim for a major influence of dietary sucrose in the etiology of CHD; his claim that men who have CHD are excessive sugar eaters is nowhere confirmed but is disproved by many studies superior in methodology and/or magnitude to his own; and his “evidence” from population statistics and time trends will not bear up under the most elementary critical examination.

There you have it. The man who steered the American Heart Association onto its anti-saturated-fat path insisted that sugar doesn’t cause heart disease and the very idea had already been disproved.

So now that cutting back on saturated fat has failed to reduce heart disease in several clinical studies, how does Dr. Frank Sucks … er, Sacks and the American Heart Association explain away the embarrassing results? Like this:

Uh, yeah, but … uh … ya see … uh, that only happened because when people cut back on the saturated fat, they ate more sugar.
In an interview, Dr. Sacks said the advice derived from the best research “is pretty straightforward: consume few saturated fats like butter, full-fat dairy, beef and pork fat, and coconut, palm and palm kernel oils and replace them with natural vegetable oils high in polyunsaturates – corn, soybean, safflower, sunflower, peanut, walnut and grapeseed oils.” Also healthful are canola and olive oil, rich in both monounsaturates and polyunsaturates.

The “best” research, of course, consists of the four studies Dr. Sucks managed to cherry-pick that support the AHA’s position. He somehow found methodological problems with all the others.

And as for this part:

… replace them with natural vegetable oils high in polyunsaturates – corn, soybean, safflower, sunflower, peanut, walnut and grapeseed oils.

If you can explain to me how it’s natural for humans to consume oils from corn and soybeans, I’m all ears. Silly me, I tend to think the natural fats are the ones that don’t require industrial processing.
As for coconut oil, Dr. Sacks said, “It’s the nutritional fat du jour but it has not been proven to be healthful.”

Ah, I see. Dr. Sucks only recommends foods that have been proven to be healthy. I guess that explains this paragraph in Brody’s article:
Alas, the advisory team noted, there have been no trials to date testing the cardiovascular benefits of replacing dietary fat with “healthful nutrient-dense carbohydrates and fiber-rich foods such as whole grains, vegetables, fruits and legumes that are now recommended in dietary guidelines.”

No trials proving the cardiovascular benefits of replacing dietary fat with whole grains, vegetables, fruits, and legumes … and yet that’s exactly what the American Heart Association tells us to do. And Ms. Brody echoes that advice in her article:
In other words, if you are truly concerned about preserving good health over all, focus on a Mediterranean-style diet heavy on plant foods and unsaturated vegetable oils, with whole grains like brown rice and bulgur, fruits and vegetables as the main sources of carbohydrates.

Fortunately, useful idiots in the media no longer shape public opinion as effectively as they once did. Here are few choice comments on Brody’s article left by readers:
I sport climb with guys in their sixties and seventies who are as fit as super-heroes. They, to the man, get their nutrition information from Youtube and not their doctor. This article’s laundry list of failed studies and misleading conclusions by the experts is the reason why.

—-

I really can’t sit here and read any more AHA fraud articles about health. I find it impossible to believe NYT can’t write any other articles about the consumption of fats without citing these people who rampantly skew data.

—-

Yes, Dr. Sacks, well over 70 years old, ignored literally hundreds of studies over the last 50 years in this latest diatribe to go back to the incorrect studies of the 1960s. News flash: In the 50 years since, science has advanced! Turns out fats are actually generally good for you, not bad for you. And saturated fats are basically neutral. This is what hundreds of better, more modern studies say.

—-

The comments are much more informed on the subject than the author.

Indeed they are. That’s why the author is a useful idiot.  I suspect we’ll hear from more useful idiots as the AHA continues trying to save itself from the inevitable.

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 health
Marshall Sutherland
  
Here in Florida, we have had a couple of school districts close for a day to disinfect facilities in an attempt to stop the spread.
Marshall Sutherland
  
Fat HeadFat Head wrote the following post Thu, 25 Jan 2018 22:25:50 -0500
Blood Pressure, Sodium, Drugs and Diets
Blood Pressure, Sodium, Drugs and Diets

In my previous From The News post, I mentioned that the definition of “high” blood pressure will soon be lowered from 140/90 to 130/80. (The systolic, or top number, is when your heart is contracting. The diastolic, or lower number, is when your heart is between beats.) I also said I believe the redefinition is likely driven by a desire to sell more drugs.

A couple of you commented that the drugs might be necessary. Okay, maybe that’s true for some people. I’ve never had high blood pressure, so I’ve had the luxury of not being personally concerned with the subject. Nonetheless, I thought I’d dig through my database of articles and studies to explain why I’m not convinced that most people diagnosed with “high” blood pressure need drugs.

The best way to treat a health problem is to treat the root cause, not the downstream effect. So what causes high blood pressure? Many of the so-called experts still insist the problem is sodium. (They’re generally the same so-called experts who insist saturated fat causes heart disease.)

Dr. Frank Sucks … er, Sacks – the same researcher who wrote the American Heart Association’s we were right all along about saturated fat! presidential advisory report – has been a long-time champion of low-salt diets. He believes he proved lowering salt will save our hearts with his famous DASH trial. Here’s what his Harvard profile says about it:
These multi-center National Heart Lung and Blood Institute trials found major beneficial additive effects of low salt and a dietary pattern rich in fruits and vegetables on blood pressure.

Actually, that’s not what the DASH trial showed at all. You have to read the study carefully (and I have) to get the true picture, but here’s the brief summary: Sacks put people on either a standard American diet that included plenty of sugar and other junk, or on a low-fat DASH diet that included no sugar and no junk. Then he had them consume versions of those two diets that were high in salt, medium in salt, or very low in salt.

In order to claim he’d proved restricting salt is beneficial, Sucks had to compare the blood-pressure differences between people on the high-salt/junk diet and people on the low-salt/DASH diet. That’s akin to comparing people on a high-salt/high-whiskey diet to people on a low-salt/high-water diet, then declaring that restricting salt prevents liver damage.

Within each diet group – junk food vs. DASH – restricting salt by a whopping 75% only produced a blood-pressure drop of about three points. Whoopee.

Other researchers have found similar results (and unlike Dr. Sucks, reported them honestly). Here are some quotes from a 1998 meta-analysis titled Effects of Sodium Restriction on Blood Pressure, Renin, Aldosterone, Catecholamines, Cholesterols, and Triglyceride:
In 58 trials of hypertensive persons, the effect of reduced sodium intake on systolic blood pressure was 3.9 mm Hg, and on diastolic blood pressure was 1.9 mm. In 56 trials of normotensive persons, the effect of reduced sodium intake on systolic blood pressure was 1.2 mm Hg.

Once again, restricting sodium produced a teeny drop of a few points.
These results do not support a general recommendation to reduce sodium intake.

Gee, do ya think?

Here are some quotes from a 2008 E Science News article:
Contrary to long-held assumptions, high-salt diets may not increase the risk of death, according to investigators from the Albert Einstein College of Medicine of Yeshiva University.

They reached their conclusion after examining dietary intake among a nationally representative sample of adults in the U.S. The Einstein researchers actually observed a significantly increased risk of death from cardiovascular disease (CVD) associated with lower sodium diets.

“Our findings suggest that for the general adult population, higher sodium is very unlikely to be independently associated with higher risk of death from CVD or all other causes of death,” says Dr. Hillel W. Cohen, lead author of the study and associate professor of epidemiology and population health at Einstein.

And here are some quotes from a Food Navigator article about a Cochrane review of sodium-restriction studies:
The authors, led by Professor Rod Taylor from Peninsula College of Medicine and Dentistry in the UK, found no strong evidence to support the idea that salt reduction reduces cardiovascular disease or all-cause mortality in people with normal or raised blood pressure.

People with normal or raised blood pressure at baseline showed no strong evidence of benefit from salt intake restriction. Salt restriction did, however, increase the risk of death from all causes in those with congestive heart failure, reported the authors.

I found that article amusing because it provided a perfect example of The Anointed in action. The researchers concluded that given the results, we need to conduct more research before governments jump in to set lower targets for salt intake.

But as we know, The Anointed don’t believe they should be bothered with providing evidence before instituting a Grand Plan. So here’s how a spokesperson for a U.K. organization calling itself the Consensus Action on Salt and Health replied to the Cochrane review:
Campaign director Katharine Jenner told FoodNavigator that it is “very disappointing” to see the message from the review indicates that salt reduction may not be beneficial.

“This is a completely inappropriate conclusion, given the strong evidence and the overwhelming public health consensus that salt raises blood pressure which leads to cardiovascular disease,” said Jenner.

Whenever you hear The Anointed insist that by gosh, there’s a consensus and therefore the debate is over, you know they’re peddling junk science they don’t want examined.
Jenner told FoodNavigator that “there is no sense in waiting for further trials before progressing with an international salt reduction programme, which will immediately save many thousands of lives.”

Of course not. Because when The Anointed devise a Grand Plan, it must always be implemented RIGHT NOW or people will die … and it will be your fault for insisting on evidence before proceeding.

Salt restriction is the standard dietary advice, but it doesn’t do much. So after concluding that your low-salt diet just isn’t working for some reason, your doctor will reach for the prescription pad. The drugs do lower blood pressure. But do they save lives?

That’s where it gets a bit murky. In Doctoring Data, Dr. Malcolm Kendrick stated that there’s no convincing clinical evidence that blood-pressure medications reduce mortality for most people with “high” blood pressure.

Here are some quotes from an article on the Whitaker Wellness Institute website:
Another hypertension myth is that it is a silent killer that sets us up for strokes and heart attacks and knocks about five years off life expectancy. Although this is true for patients who have very high blood pressure and/or existing cardiovascular disease, diabetes, or kidney disease, the picture is considerably different for mild hypertension, which is defined under current guidelines as 140-159/90-99.

Scientific data published in top medical journals over the past few years makes it clear that mild hypertension does not confer these risks. For example, reevaluation of data from the renowned Framingham Heart Study shows that deaths related to hypertension barely budge until systolic blood pressure reaches 175 and mortality rates climb significantly only above 185. In other words, malignant hypertension is a killer. Uncomplicated mild hypertension is not.

Sixty percent of hypertensive Americans fall into the mild category. Nevertheless, more than half of them are treated with medications. And that’s the real tragedy.

There is no convincing scientific evidence that treating basically healthy patients with mild hypertension provides any benefits. In a groundbreaking recent study, researchers reviewed all the clinical trials in the medical literature comparing drug treatment of mild hypertension with placebo or no treatment. They found no differences in heart attacks, strokes, and deaths between treated and untreated individuals. But they did find that the drugs caused a lot of misery.

Maybe the drugs provide life-extending benefits for people with very high blood pressure. For people merely in the “high” range of 140 to 159, I’m not convinced. It seems the drugs merely treat a symptom.

As I said earlier, the best option is to treat the root cause. Several studies have hinted at the root cause, or at least one of them. Here are some quotes from a 2010 WebMD article:
A new study shows that a low-carbohydrate diet was equally good as the weight loss drug orlistat (the active ingredient in Alli and Xenical) at helping overweight and obese people lose weight, but people who followed the low-carb diet also experienced a healthy drop in their blood pressure levels.

“I expected the weight loss to be considerable with both therapies but we were surprised to see blood pressure improve so much more with the low-carbohydrate diet than with orlistat,” researcher William S. Yancy, Jr., MD, an associate professor of medicine at Duke University Medical Center, says in a news release. “If people have high blood pressure and a weight problem, a low-carbohydrate diet might be a better option than a weight loss medication.”

In the study, published in the Archives of Internal Medicine, 146 obese or overweight adults were randomly divided into two groups. Many of the participants also had chronic health problems, such as high blood pressure or diabetes.

The first group was advised to follow a low-carbohydrate, ketogenic diet consisting of less than 20 grams of carbohydrates per day, and the second group received the weight loss drug orlistat three times a day, plus counseling in following a low-fat diet (less than 30% of daily calories from fat) at group meetings over 48 weeks.

The results showed weight loss was similar in the two groups. The low-carb diet group lost an average of 9.5% of their body weight and the orlistat group lost an average of 8.5%. Both weight loss methods were also not significantly different at improving cholesterol and glucose levels.

But when researchers looked at changes in blood pressure, they found nearly half of those who followed the low-carbohydrate group had their blood pressure medication decreased or discontinued during the study, compared to only 21% of those in the orlistat group.

Plenty of doctors who prescribe low-carb diets have said the same thing: many of their patients end up ditching the blood-pressure medication. In fact, if the patients combine a low-carb diet with the medication, they can actually become dizzy from low blood pressure.

A study published waaaay back in 1985 suggests why a low-carb diet can lower blood pressure:
Both systolic and diastolic blood pressure were found to be significantly related to fasting serum insulin level even when age, weight, and serum glucose level were controlled. The relation between serum insulin and blood pressure was more pronounced in those women with a family history of hypertension. These data indicate that insulin may play a major role in the regulation of blood pressure in obesity and that the previously accepted relation of weight to blood pressure may depend on blood levels of insulin.

So there you go. High blood pressure, like so many other aspects of metabolic syndrome, is apparently driven by chronically high insulin. It’s the high insulin that needs fixing, not the symptoms it produces.

The Whitaker Wellness article provides some practical advice as well:
We would all be better served by shifting the focus to safe, natural, proven therapies that not only lower blood pressure but, unlike antihypertensive drugs, also improve multiple aspects of health.

Regular aerobic and resistance exercise, which reduces systolic blood pressure as effectively as many medications, rejuvenates every system in your body. Losing as little as 10 pounds or 5 percent of your total weight provides significant all-around benefits. Relaxation techniques, meditation, yoga, acupuncture, and neurofeedback reduce stress’s adverse effects on blood pressure, health, and quality of life.

Cutting out high-glycemic sugars and starches lowers blood sugar, lipids, insulin resistance, and other aspects of metabolic syndrome as well as helping to lower blood pressure. Beets, leafy greens, and other nitrate-rich foods boost synthesis of nitric oxide (NO), which dilates and protects the arteries.

Magnesium has powerful effects on blood pressure because it relaxes and reduces pressure on the arteries; that 75-80 percent of Americans fail to get the RDA of magnesium is a likely contributor to our high rates of hypertension. Coenzyme Q10 has positive effects on blood pressure and the entire cardiovascular system.

Cut the refined carbs, eat some leafy greens, get some exercise, and supplement your diet with magnesium and CoQ10. Sounds a lot better than taking medications if you ask me.

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 health
Marshall Sutherland
  


Government-Approved Workouts? The Fight Against Fitness Licensing.
by ReasonTV on YouTube

Crossfit is fighting to keep the government from regulating how Americans are taught to exercise. The health of the nation may be at stake.
 health
Marshall Sutherland
  
Fat HeadFat Head wrote the following post Thu, 18 Jan 2018 22:06:35 -0500
The Guy From CSPI And The Guy from AHA Bravely Agree They’ve Been Right All Along
The Guy From CSPI And The Guy from AHA Bravely Agree They’ve Been Right All Along

Back in June, the American Heart Association released a Presidential Advisory Report that I covered in posts titled The American Heart Association Bravely Admits They’ve Been Right All Along, part one and part two.

The lead author of the report was Dr. Frank Sucks … er, Sacks, who is a fine example of a scientist too firmly wedded to a particular hypothesis to ever be objective. Sucks was chairman of the AHA’s Nutrition Committee back when they were releasing guidelines warning us that saturated fats will kill us and vegetable oils (and Cocoa Puffs!) will save our lives.

He was the lead researcher on the DASH trial, which concluded that restricting salt produces “major” benefits for hypertension … even though the study’s own data showed that reducing salt intake by 75% led to a measly three-point drop in blood pressure.

Sucks .. er, Sacks was also a member of the National Cholesterol Education Program (the folks who decided we should all have a total cholesterol score below 200), and a member of the Whole Grains Council, which is generously supported by the grain industry.

In other words, you’d be hard-pressed to find someone more personally invested in the arterycloggingsaturatedfat! and hearthealthywholegrains! nutrition advice than Dr. Frank Sacks … with the possible exception of The Guy From CSPI. So naturally, The Guy From CSPI (or his organization’s newsletter, to be exact) recently interviewed Dr. Sacks to explain why they’ve both been right all along.

Here are some quotes from a CSPI article titled A refresher on fats:
Q: How strong is the evidence that saturated fat in foods like meat, butter, and cheese is harmful?

A: The evidence that saturated fat causes atherosclerosis and heart disease is compelling. It’s consistent across randomized trials, large observational epidemiologic studies, and animal studies.

This is, of course, complete poppycock. Consistent across randomized trials and epidemiologic studies?! Not even close. I’ve written about the glaring inconsistencies in the evidence in this post and many others.
Q: Why have some people heard that the evidence on saturated fat has gotten weaker?

Actually, CSPI Guy, the evidence hasn’t “gotten weaker.” It was never strong to begin with. But let’s see what Sucks has to say on the matter.
A: Some of the more recent studies take a standard epidemiologic approach, which is inadequate. Saturated fat seems to be harmless in those studies because it’s being compared, by default, to the typical American diet, which is high in refined, junk-food carbohydrates. They’re also linked to a higher risk of heart disease.

Ahh, I see! Recent studies – and apparently only recent studies – took a standard and therefore inadequate epidemiological approach! Gee, it’s nice to see a Harvard researcher finally speak out against drawing conclusions from observational evidence. Too bad Harvard spent decades scaring the hell out of people based on crappy observational studies.
Q: Why inadequate?

A: Let’s say you give someone advice to reduce their saturated fat. Well, what do they eat instead? If they just reduced their saturated fat, they’d lose weight, because they’d be getting fewer calories. That’s unlikely. So what do they actually do? In many cases, people who eat less saturated fat eat more refined carbohydrates.

Yeah, that tends to happen when you tell people bacon and eggs will kill them and then put the American Heart Association seal of approval on boxes of Cocoa Puffs. And Dr. Sacks was a big muckety-muck at the AHA back when that was happening.
A: But Walter Willett and Frank Hu—my colleagues at Harvard—devised a new epidemiology based on food substitutions that would occur in real life. And that’s really innovative.

Allow me to interpret that: Willet and Hu spent lord-only-knows how much time finding a new way to crunch the numbers so they can continue believing that 1) observational studies based on food surveys tell us anything meaningful, and 2) saturated fat is the killer they’ve always said it is.
Q: Didn’t you re-examine the clinical trials from the  1960s that assigned people to diets with different fats and then measured heart disease rates?

A: Yes. We separated them into core and non-core trials, because some were superb in quality, and some were kind of dreadful. So we set out uncontroversial criteria for a good clinical trial.

Allow me to interpret that as well: we looked at all the clinical trials and decided the ones that showed higher rates of heart disease after switching to vegetable oils just HAD TO WRONG, DAMNIT! So we put those in the ‘dreadful’ category. Then, after digging like crazy, we found a whopping four trials that seemed to suggest that switching to vegetable oils reduces heart disease. We labeled those ‘superb in quality.’ And our criteria are uncontroversial because we all agreed with ourselves.
Q: Is large LDL safer than small LDL, as some people argue?

A: No. It’s basically a non-issue. If you have a lot of big LDL, it’s no better than a lot of little LDL. In fact, big LDL is probably worse, because it’s loaded up with more cholesterol.

Q: Do high triglyceride levels cause heart disease?

A: We don’t have proof with triglycerides the way we have proof that LDL cholesterol causes heart disease. But the evidence linking triglycerides to heart disease is getting stronger.

Fascinating. Dr. Sacks believes we have proof that LDL causes heart disease, but don’t yet have proof triglycerides cause heart disease. Perhaps he missed this study and its conclusion:
Stepwise higher concentrations of nonfasting triglycerides were associated with stepwise higher risk of heart failure; however, concentrations of low-density lipoprotein cholesterol were not associated with risk of heart failure in the general population.

I suppose Sacks could dismiss the study as dreadful, but that could be embarrassing since it was published by The American Heart Association.
Q: What about coconut oil?

A: Some of the short-chain saturated fatty acids in coconut oil don’t raise LDL cholesterol. But they don’t counteract the effects of the oil’s longer-chain fatty acids, which do increase LDL cholesterol. So coconut oil raises LDL cholesterol in the same way that, say, butter does.

Ah, yes, in the Presidential Advisory Report, Dr. Sacks assured us that coconut oil is even worse for our hearts than butter because it’s higher in saturated fat. But Dr. Michael Moseley recently conducted a small study in which volunteers added 50 grams of butter, olive oil or coconut oil to their diets. A BBC article describes the results:
As expected the butter eaters saw an average rise in their LDL levels of about 10%, which was almost matched by a 5% rise in their HDL levels.

Those consuming olive oil saw a small reduction, albeit a non-significant drop, in LDL cholesterol, and a 5% rise in HDL. So olive oil lived up to its heart-friendly reputation.

But the big surprise was the coconut oil. Not only was there no rise in LDL levels, which was what we were expecting, but there was a particularly large rise in HDL, the “good” cholesterol, up by 15%. On the face of it that would suggest that the people consuming the coconut oil had actually reduced their risk of developing heart disease or stroke.

But there I go again, digging up contrary information. Dr. Sacks and The Guy From CSPI are worried that people like me are causing confusion:
Q: How can people avoid confusion?

A: If you want to sort out what is good scientific knowledge and what is speculation or biased, look at guidelines produced by the American Heart Association, American Diabetes Association, or American Cancer Society.

Riiiight. Because organizations whose very existence depends on generous contributions from the makers of vegetable oils and grain products couldn’t possibly be biased.

So what’s going on here? Are people like Sucks … er, Sacks and the The Guy From CSPI just pathological liars? Are they intentionally dishonest?

Actually, I don’t think so. I think we’re seeing yet another example of the phenomenon described in an excellent book I haven’t mentioned in quite a while: Mistakes Were Made (but not by me). The subtitle is Why We Justify Foolish Beliefs, Bad Decisions, and Hurtful Acts. That pretty much captures the subject matter.

The authors give many examples of the same basic behavior:

DNA evidence exonerates someone who spent 15 years in prison for murder, but the district attorney still insists he didn’t prosecute an innocent man. The lab screwed up, or someone tainted the samples, or the guy in prison must have had an accomplice whose DNA ended up on the victim.

A doctor’s procedure kills a patient, but the doctor insists the procedure was correct.  Some complication that was impossible to predict caused the death.

A therapist prods a young patient into “recovering” memories of sexual abuse that were supposedly repressed, but are later proven to be false.  The therapist insists the memories are accurate and rationalizes away all evidence that the abuse couldn’t have happened.

A woman stays married to a physically abusive husband, insisting to her friends and family that he’s really a sweet guy at heart and his behavior is his employer’s fault, or his parents’ fault, or whatever.

A researcher accepts generous funding from a pharmaceutical company, then fudges a few numbers in a study concluding that the company’s newest drug is wonderful, but tells himself the drug really is wonderful and the fudged numbers simply enhance the truth.

A boy who moves to a new school district and wants to fit in somewhat reluctantly joins a pack of bullies in tormenting a fat, weak kid … and the more he participates in the bullying, the more convinced he becomes that the fat, weak kid deserves every bit of it.

As the authors explain, humans are naturally inclined to engage in self-justification as a means to reduce cognitive dissonance. Most of us believe we’re basically decent and competent, and we selectively filter information and rewrite memories to support that belief. (People with low self-esteem do likewise to confirm their negative opinion of themselves, but that’s another matter.)

The result is that once we’ve chosen a path or a position, we’re quite brilliant at convincing ourselves the path or position is correct … and the longer we’re on that path, or the more public the position, or the more consequential the action, the more we’re psychologically driven to justify it.

DNA says the guy didn’t do it? That can’t be right! I’m a good person, and a good person wouldn’t railroad an innocent man, so he had to be involved in that murder.

The patient died the family are blaming me? That can’t be right! I’m a good doctor, and a good doctor wouldn’t make a mistake that killed a patient. It wasn’t my procedure; it was something else.

Does fudging a few numbers make me a dishonest researcher? No, I’m a good scientist. Those numbers were outliers, and I had to smooth them over so this life-saving drug can be approved and help people who need it.

I picked on a weakling just to fit in? No, that would make me a bad guy, and I know I’m a good guy. The weakling is pathetic and annoying and not a good person, so he had it coming to him.

You get the idea. I’m a good and competent person, but I made a stupid or harmful decision creates cognitive dissonance. So we convince ourselves the decision wasn’t stupid or harmful. We do that largely through confirmation bias; that is, by latching onto any evidence that we were right and ignoring or dismissing evidence that we were wrong.

So imagine you’ve spent decades very publicly promoting grains and vegetable oils as the key to health while warning people away from saturated fats. Imagine you’ve also received generous donations from the makers of grains and vegetable oils – which is fine, you tell yourself, because those funds merely help you fulfill your life-saving mission.

Now imagine the science is turning against you. New (and old but recently discovered) studies suggest that vegetable oils and grains are harmful to health, while animal fats and other saturated fats are either neutral or beneficial.

You only have a couple of choices. You can look in the mirror and say to yourself, “Oh my god. I’ve spent 30 years giving out advice that helped turn countless people into fat diabetics suffering from inflammation and autoimmune diseases they didn’t need to have.” Or you can tell yourself you’re a good scientist, the advice you’ve been handing out is actually beneficial, and those new studies can be ignored because they were conducted by people who are incompetent.

As the authors point out, Americans tend to forgive and sometimes even rally to support public figures who admit to their mistakes, take the blame, and sincerely apologize. Nonetheless, most public figures and organizations don’t go that route. They can’t admit to themselves that they were wrong, so they double down. They rationalize. They attack the critics. And so the correction, whatever it is, almost always happens as the result of outside forces.

That’s why whenever I receive one of those email petitions demanding that the AHA or USDA change their dietary advice, I toss it. They’ll never announce that they were wrong because their heads would probably explode as a result. All we can do is convince more and more of the public to stop listening to them. I’m pretty sure that’s already happening — even if Dr. Sacks and The Guy From CSPI have a psychological need to convince themselves we’re just confused.

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 health
Marshall Sutherland
  
Why American doctors keep doing expensive procedures that don’t work

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The proportion of medical procedures unsupported by evidence may be nearly half.
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Marshall Sutherland
  
We have gate-keepers that are afraid to tell people “food quality matters” and the best our healthcare providers have to offer (drink more water) appears to be at best a waste of time, at worst, it may be making the problem worse.

No, Drinking More Water is NOT Going To Improve Your Health
No, Drinking More Water is NOT Going To Improve Your Health

Ah…the beginning of an article. How to make it click-baity enough to get some eyeballs, yet actually offer value to the reader? Due to old-age or just lack of inspiration I’ve got nothing in this regard, so I’ll get to the story at hand:

A few weeks ago I had a sit-down with the dietetics staff at a medium sized, rural hospital. Super nice folks, very sincere. They deal with a population that is enormously overweight and which suffers from type 2 diabetes and all the related problems. This was a VERY interesting meeting as the folks who OWN the hospital are fully on-board with the Ancestral Health template and are huge advocates of things like the paleo and keto diets. The owners know this stuff works, they wanted to have a sit-down with their dietitians to try to get them on-board with the notion that eating strategies like paleo or keto “might” be helpful for their very sick (and expensive to treat) population. Everyone went around the table giving a bit of a bio and when it came to me I could see the eyes of the poor dietitians grow wide when they learned I’d written some paleo diet books and was a fan of low carb (for the right situations…you know, like fat loss and type 2 diabetes.)

Things got a bit…fidgety after my bio but our moderator did a great job of smoothing things over and asked the dietetics staff to go through what their process is in working with these obese and or type 2 diabetic patients. Again, I do not want to paint these folks as anything other than sincere and well meaning, but here is what they shared:

1-The MAIN item they focus on is getting folks to “drink more water.” This was mentioned and reiterated at least a dozen times.

2-Their avant garde initiative was to have families eat together, but a point was made that they “should not in any way criticize or second guess what they were eating” and yes, that IS a direct quote.

I want to unpack the second point first: I cannot think of a better basic recommendation that families should share meals together. Life is short, family is everything. Turning off the TV, putting away the smart-phones and other distractions and “talking” is a lost art these days.

THAT is awesome.

But…

In what was at least a 15 minute presentation, food-quality was not mentioned once. And upon inspection of the literature which supports this program, the claim was made that this mindful family eating was THE route to reversing weight and health issues that are dietary in nature.

Community IS one of the four pillars of health (along with sleep, movement and….food) but what was related to me is the vast majority of meals taken by these families were fast food, desserts, and what would generally be termed “highly processed snacks.”

Now, I do think far too much emphasis is placed on “diet.” For example, most people citing the upsides of Blue Zones focus almost exclusively on diet and pay little attention to the extended communities which are clearly a major factor in the health and well-being of these populations.

But the folks in the Blue Zones are NOT eating fast food. Ever. Not yet.

I asked these folks how they felt the program was working…as in, did they see decreasing rates of death and disease, were medical costs going down. These folks mentioned “evidence based medicine” quite frequently and I asked what one would consider to be a reasonable question about the efficacy (evidence of results) of this mindful-eating initiative. What I got was a pretty defensive back-pedaling as the unfortunate reality is the costs of dealing with all these diet and lifestyle related problems has continued its upward trend, which by the way is exponential in nature (understanding the implications of exponentials in this scenario might be worth unpacking in a future article.)

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So, despite good intentions, this mindful eating program is not producing results that really matter.

You may think I’m being a big meanie here, but I’ll share an example of how this thinking is failing the population these folks are entrusted to serve. I asked for an example of one of their most challenging and expensive situations. This turned out to be a middle-aged male who is type 2 diabetic, on dialysis and he is now effectively a trunk. ONLY a trunk. Both arms have been amputated at the shoulder, both legs amputated at the hips, all due to diabetic complications. This poor guy has suffered a slew of surgeries (those limbs come off in pieces, not at once…toes, then foot, then lower leg…you get the picture) and must be medically transported multiple times per week for dialysis…then you have his medication costs and the fact he is no longer able to work and needs a full-time care provider. I won’t even relate how much this one individual has cost this system (and continues to cost) as you’d think I’m making the number up.

Fifty years ago this scenario was UNHEARD of. It did not happen. It is now  commonplace…and the best “evidence based medicine” recommendations these healthcare providers can offer is “mindful eating” and an insistence that folks should not worry about their food quality. They do not want people to feel shame about what’s on their plate. Before you are Triggered and put words in my mouth, I am not advocating these people should be shamed in any way. But I do think this is an epic failure on the part of the folks tasked to educate and help these folks. Pushing for food quality is the only way this story is going to change and even doing that is going to be tough to implement when we consider the nature of our modern, hectic lives and hyper-palatable foods. Our best efforts are likely to produce lackluster results, but this is not remotely our “best efforts.”

Ok, now to point #1 from above: Drink more water.

These folks were absolutely starry eyed at this suggestion, and they did say they have seen improvements in this area. Often, “water” is interpreted as “soft-drinks” but to the point above, there is a nervousness around suggesting there may be better and worse options as it might make someone feel bad to suggest sodas, although tasty, may not be all that healthy. I asked these folks what they felt, from a medical and physiological perspective, drinking more water would do for folks.

The responses fell into two camps:

1-People are “chronically dehydrated” and this is a major health concern.

2-Drinking water “fills people up.”

To point #2 I will simply say “no, drinking more water does not cause people to spontaneously reduce caloric intake.” I’ll let you practice your Google-fu in digging up the citations on that. On point #1 I’ll refer you to this article and pull out a few highlights on heat related deaths/illness, particularly in athletic populations. Why am I using this information? People who are active tend to require more water. People in warm settings require more water. So, exercising in the heat….man, we should really see the dangerous effects of dehydration, right? Well, from the article:

The Myths of Dehydration and Heat Illnesses
  • -The primary cause of hyponatremia in athletes is drinking too much water.
  • -The incidence of hyponatremia appears to be between 13% and 15% among endurance athletes.
    -Sodium supplementation has no effect on the occurrence of hyponatremia.
  • There seems to not be a single case of death resulting from sports-related dehydration in the medical literature.
I bolded that last line and I should mention that hyponatremia is low blood salt…which is usually accomplished by consuming too much water, not too little salt.

Now, each year there are a not insignificant number of deaths/hospitalizations in the military, sporting events, hiking etc, and it is absolutely related to water…but it is generally due to TOO MUCH. I looked and looked, and what I consistently come back with is that last bolded line: One is hard pressed to find ANY examples of people dying from dehydration, even in remarkably challenging settings. People do not die and in fact do not become ill due to dehydration in the most extreme of physical activities, even in the heat…so how can one make “drink more water” the go-to recommendation for a sedentary population that spends an inordinate amount of time indoors, under near perfect temperature control?

About 700 people die each year in the US due to heat stroke. These tend to be infants, the elderly and the obese. These are populations with impaired ability to sweat and regulate body temperature. I’m not making light of that, nor am I saying that is not an important issue, but what I am saying is the focus on “drink more water” does not really address the challenges in these heat stroke examples, and appear to be not only be unhelpful, but injurious to the general athletic population.

How did this meeting wrap up? I cannot say it was a “high note.” We agreed to flesh out some common goals of educating folks about “eat whole foods” but even this seemingly benign angle on my part was met with near panic on the part of the dietetics staff.
There is a remarkable amount of energy being put into various healthcare debates, particularly in the US. These debates focus mainly on “who is going to pay” with some advocating for a system like auto insurance in which one largely pays as one goes and has a catastrophic plan for accidents, vs something folks familiar with the NHS, Canadian or Northern European models would be familiar with. I do think it’s important how we set up incentives in situations like this, but debating about who will pay for a system in which the costs of dealing with diabesity related problems are increasing exponentially and are on track to bankrupt the developed world is at best rearranging deck-chairs on the Titanic.

I will release an article on exponential costs in a  week or two to provide some context here.

We face an incredibly complex problem of having a set of genetics wired for a different time, and a modern industrial food system that is a master at producing what is effectively addictive, hyper-palatable food.

If I could wave a magic wand and have every healthcare provider on the planet fully bought-in on the ancestral health model, if all these folks recognized a low carb diet can work miracles for diabesity…we’d STILL have a monumental challenge ahead of us.

We have none of that.

We have gate-keepers that are afraid to tell people “food quality matters” and the best our healthcare providers have to offer (drink more water) appears to be at best a waste of time, at worst, it may be making the problem worse.

What to do?

When I think about this two terms keep coming up: Grassroots, Trench Warfare. Grassroots means we are unlikely to see effective solutions offered up from on-high. There is too much money, inertia, ego and confusion in the dominant paradigm to just do an about-face. Grassroots means starting locally and this is where we transition to Trench Warfare: We gain ground anywhere the opportunity arises.

Although information is not generally THE thing that makes people enact significant change, if we do not have at least decent information, it’s tough to get things oriented in a way that we have any hope of success. “Drink more water” is not going to cut it. Where Grassroots meets Trench Warfare is the growing number of  health practitioners who are steeped in this Ancestral Health/functional medicine model. If you’d like to learn more about this movement check out my podcast with Chris Kresser as we talk about his recently released book, Unconventional Medicine.
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Marshall Sutherland
  
@Cheese Forum+
Eating Cheese Every Day May Actually Be Good for You

In a new study, people who ate cheese every day were less likely to get heart disease or have a stroke compared to those who never did.
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Marshall Sutherland
  
Why I give a sh*t about sustainability

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Why does it matter to me that people buy better meat? Why should people care about making sure meat is not vilified in the media? Why give a shit about sustainability? Why should vegetarians and vegan join the fight? Does this even matter?

For the last eight years, I’ve helped people regain their health through eating foods that are biologically appropriate for humans. This means avoiding processed foods and sugars, and focusing on fresh produce, animal proteins and healthy fats. What I’ve noticed is that the majority of folks simply want to look good naked, want to solve their own health issues, or feed their family the best diet they can.

That’s all great but what do you do when you’ve pretty much solved that?  Why am I not satisfied just having a small nutrition practice and fixing individual people?

Because there’s some huge, systemic issues going on and I feel compelled to do something bigger.
Maria Karlsen
  
Thanks, that's a nuance that needs to be added to the debate.
Marshall Sutherland
  
Mark's Daily AppleMark's Daily Apple wrote the following post Wed, 29 Nov 2017 11:07:49 -0500
Why Aren’t We Talking About the Cognitive Health Crisis?
Why Aren’t We Talking About the Cognitive Health Crisis?

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If you look at the latest stats, you might assume there’s no cognitive health crisis. The overall number of dementia cases are going up, but that’s because the aging population is growing. Older folks are living longer than ever before, so there are more people around who can develop dementia. Dementia and Alzheimer’s rates are dropping in the Western world. Politicians, those archetypical paragons of cognitive aptitude, are hanging around in office longer than ever. Technology, science, and other fields that require large amounts of cognitive ability are progressing.

But broad trends and large numbers are just statistics. However reassuring they are to public policy analysts, they mean nothing to the individual suffering from cognitive decline. They’re too abstract. Your grandpa no longer knowing who you are? That’s real. You, personally, don’t want to lose your cognitive abilities as you age. You, personally, don’t want to see the people you love get Alzheimer’s. Individual cases matter to those individuals and their loved ones. And it’s still happening more than it should.

Maybe more than any other disease, severe cognitive impairments have the potential to unravel families. They’re not one and done. They drag on. They aren’t “lethal” in the normal sense. People with Alzheimer’s can lead long lives, the latter halves of which can get very difficult for everyone involved. There’s an entire body of literature devoted to studying the effects of Alzheimer’s on families and caregivers and discovering effective methods for mitigating the damage done. You don’t get that so much with other diseases.

Yet for whatever reason, Alzheimer’s doesn’t get enough attention. Sure, it’s mentioned. People are aware it exists. They can probably name the general symptoms. But it doesn’t seem as pressing a concern as something like cancer, diabetes, or heart disease.

One reason is that cognitive diseases are really scary to consider. Most other diseases affect what we consider to be the peripheral tissues. Heart disease is about the heart. Kidney disease affects the kidneys. Cancer can strike anywhere, but it’s usually in an organ or bone. Most diseases leave our personhood intact. We’re still us, even when we’re riddled with tumors or on dialysis. But with something like Alzheimer’s, we disappear. We forget who we are. We forget where we live, how old we are, and the name of that stranger hovering over us with a concerned look on her face. People define themselves by their intellect; our superior mind is what sets us apart from the rest of the animal kingdom. When that goes, what’s left? No one wants to think about that.

Another reason is that the conventional take on Alzheimer’s and other cognitive disorders is that we are helpless in the face of it. Most of the drugs have failed. Even the chief executive of Alzheimer’s Research UK accepts as “fact that there are no treatments to slow or stop the diseases behind dementia.” When the authorities are throwing up their hands and giving in, what is a lay person supposed to do but despair and stop thinking about it?

That has to change. There are legitimate treatments available. The problem is that the treatments aren’t “take this pill and call me in the morning.” They require lifelong commitments to healthy living, eating, and exercising.

In the most promising study I’ve seen, researchers had Alzheimer’s patients undertake a dramatic diet, exercise, and lifestyle shift. Bear in mind that this was a case study, or rather ten of them involving ten subjects, not a clinical trial involving hundreds. Still, the results were striking. Here’s what each subject did:
  • Eliminate all simple carbs and follow a low-glycemic, low-grain (especially refined grains) diet meant to reduce hyperinsulinemia.
  • Observe a 12-hour eating window and 12-hour fast each day, including at least three hours before bed.
  • Stress reduction (yoga, meditation, whatever works for the individual).
  • Get 8 hours of sleep a night (with melatonin if required).
  • Do 30-60 minutes of exercise 4-6 days per week.
  • Get regular brain stimulation (exercises, games, crosswords).
  • Supplement to optimize homocysteine, vitamin B12, CRP levels.
  • Take vitamin D and vitamin K2.
  • Improve gut health (prebiotics and probiotics).
  • Eat antioxidant-rich foods and spices (blueberries, turmeric).
  • Optimize hormone balance (thyroid panel, cortisol, pregnenolone, progesterone, estrogen, testosterone).
  • Obtain adequate DHA to support synaptic health (fish oil, fish).
  • Optimize mitochondrial function (CoQ10, zinc, selenium, other nutrients).
  • Use medium chain triglycerides (coconut oil, MCT oil).
Looks awfully familiar, doesn’t it? They weren’t messing around. They were even careful enough to include vitamin K2 with vitamin D. They had them fast. They were aware of the benefits of fats and ketones for the brain and didn’t even use a full-blown ketogenic diet to provide them.

How’d the subjects do?

First of all, they started with memory impairment from Alzheimer’s, amnesiac cognitive impairment, and/or subjective cognitive decline. They started from pretty serious deficits.

Nine of the ten patients showed subjective or objective improvements in cognitive function and performance within 3-6 months. The one failure was a person with late-stage Alzheimer’s disease.

Of the six patients who’d had to stop working due to their cognitive decline, all six were able to return to work.

In a 2.5 year followup, the patients had sustained and even improved on their results.

Note that they didn’t worry about “saturated fat” or “butter.” Only one subject stopped eating “meat.” Another switched to grass-fed beef over conventional beef. There were no mentions of sodium restriction or statin drugs.

This was published in 2014. The same researcher even confirmed that the protocol worked in ApoE4 subjects, the genetic variant that increases the risk of Alzheimer’s. Even the cynics over at Science Based Medicine were cautiously optimistic about it. Why aren’t Alzheimer’s researchers shouting from the rooftops and demanding more funding to run larger studies using this protocol?

I hate to assume the worst—that it doesn’t involve a patentable pharmaceutical—but what else can I do?

In the meantime, we have work to do. It’s going to take a lot to beat this. For one, we won’t beat it by reacting to the disease (although, as the case studies show, that can help and even reverse the disease before it’s progressed too far). We have to be proactive. We have to get sleep, sun, food, exercise, community, and every other lifestyle factor under control from day one. We have to stay abreast of the latest research into how diet and lifestyle affect brain function. What your kids do today may very well affect their cognitive health down the road. If that sounds heavy, it’s supposed to be. This is serious stuff, folks. You can’t play around with the most complex structure in the known universe: the human brain. Take no chances. Spare no expense.

And even then, it might not work. These were just case studies without placebo controls, after all. But at the very least, getting enough sleep and sunlight, learning to burn fat more effectively, eating micronutrient-rich diets, consuming polyphenol-rich spices and herbs, occasionally producing and burning ketones, optimizing our hormone panels, reducing or mitigating stress, avoiding hyperinsulinemia and insulin resistance, improving our gut health, and exercising on a regular basis is a good start that won’t hurt us.

That’s my plea for the day. Thanks for reading, folks.

Thoughts to share on how we talk about or treat cognitive health conditions? I’d like to read your feedback.

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The post Why Aren’t We Talking About the Cognitive Health Crisis? appeared first on Mark's Daily Apple.

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Marshall Sutherland
  
How Big Sugar Killed a 1968 Study That Pointed to a Heart Disease Link

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Industries have been trying to influence the scientific debate around products for decades, a tactic that can sometimes have unintended consequences.
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Manuel
  
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Marshall Sutherland
  
Mark's Daily AppleMark's Daily Apple wrote the following post Tue, 17 Oct 2017 11:32:29 -0400
Gender Bias in Medical Research: How It Operates and Why It Matters
Gender Bias in Medical Research: How It Operates and Why It Matters

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Some months ago the issue of gender bias in medical research came up on the comment board. It was certainly an issue I’d occasionally read about. But I’m also a proponent of lifestyle design and intervention. I don’t spend as much time as others on the nitty-gritty of medical treatment for good reason, but the conversation got me thinking. Maybe it was time for an article after all….

And, so, the questions started coming. How does gender figure into medicine, and what exactly is gender bias in this context? How does it operate? How has it been measured? What consequences are there? How much should it influence our trust in medical literature and subsequent recommendations—the validity of findings, the efficacy of treatment, the safety of drug prescriptions? And, finally, what if any progress are we making or can we count on in the near future?

That Was Then, This Is Now: The Beginnings of Gender Bias
Bias is a form of systematic error that influences scientific investigations and distorts the findings. Bias will always be present in some form during a study, but the goal is to minimize it to the point where the results can still be trusted. Gender bias, then, refers to errors that arise due to differences between male and female participants or target subjects.

Way back when, gender bias was rife in the medical community. Up until the late 19th century, women were commonly diagnosed with “hysteria,” a (very convenient) condition to imply emotional instability was at the core of any complaints, particularly when related to the female reproductive organs. Thus, where medical practitioners were faced with female patients they couldn’t (or couldn’t be bothered to) diagnose, it was accepted practice to chalk it up to her mental state. Surprisingly, this medical mindset remained entrenched up until at least the 1970s, where a 1972 textbook titled Gynecology and Obstetrics, Current Diagnosis and Treatment suggested that nausea during pregnancy was the result of resentment and ambivalence towards childbearing.

In response, legislation was passed in the same decade to prevent gender discrimination in research in an attempt to ensure studies included box sexes and thereby maintained “equality.” Despite this, the emotional and cultural misconceptions that had skewed female-related medical research and treatment for centuries remained very much entrenched, while women were still regularly left out of trials for fears of pregnancy-related complications…despite the fact that drugs were still being administered to pregnant and breastfeeding women.

Then in 1994, there came the big break that gender-aware researchers had been hoping for. The U.S. National Institutes of Health (NIH) issued a guideline for the study of gender differences in clinical trials to ensure those drugs were suitable for both sexes.

The guideline addressed the exclusion of women from trials based on unfounded safety reasons, forcing researchers to consider the fact that men and women can have very different responses to the same drug. As a result, an estimated 80% of prescription drugs were withdrawn from the US market due to newly uncovered women’s health issues.

These days, there’s more women than men enrolled in clinical trials. Nonetheless, to some extent gender bias continues to underpin many aspects of medical research.

An Issue of Equality and Inequality
So, what are the different forms of gender bias still prevalent in today’s medical research realm? Let’s dig in here….

A Swedish study conducted from 1997 to 1999 sought to uncover the reasons behind why researchers excluded women from clinical trials. Based on 26 different case studies, they determined that the reasons behind these exclusions were:
  • lack of knowledge regarding the physiology and metabolism of women of childbearing age
  • a continuing desire to base repeat studies on former (male) study populations, and
  • tight research budgets that enabled inclusion of men but not women
Today, the almost universal inclusion of women in clinical trials might give the impression that things have improved markedly, but there’s plenty of problems still operating under the radar. A 2017 meta-analysis of 2,742 case reports showed a “statistically significant gender bias against female case reports,” while the Society for Women’s Health notes that the richest charities aren’t pushing for the inclusion of more women in medical research and that only 3% of grant proposals measured sex differences.

Ultimately, these biases exist due to polarizing assumptions of equality and inequality. On the one hand, researchers have long entertained the assumption that men and women suffer from the same symptoms and similar disease risk factors. Many clinical trials on men carry the assumption that the findings can be equally applied to women.

Despite this, those trials that compare the effects of drugs and treatments between men and women continue to highlight marked differences in the way women metabolize drugs and respond to treatments. Thus, the assumption of equality puts women at risk, not only reducing disease treatment efficacy but also risking exposure to unforeseen adverse side effects.

There’s also the valid point that men and women (as a whole) differ in environmentally and culturally influenced risk behaviors and exposures, and perhaps in their varied perception of symptoms. These are all valid concerns when it comes to clinical trials, but the biomedical model that governs most medical and clinical research tends to brush over this consideration—men and women are simply biological entities separated by hormonal and muscular variations.

At the other end of the spectrum, assumed inequalities occur when physicians consider women’s complaints to be less severe than men’s, due to the cultural notions of male stoicism and the fact that men have a lower average life expectancy and higher rates of mortality. This is reinforced by more frequent research into male-centric chronic diseases, which solidifies the notion that men are more “at risk.” This assumption contradicts the fact that women have higher rates of non-fatal chronic conditions which seriously impact their quality of life, particularly during those “additional” years when they’ve statistically outlived their male counterparts.

Consequences of Systemic Assumptions
The repercussions of this long-standing sex bias in the research realm are sneaky but far-reaching. For starters, larger proportions of women are diagnosed as having “non-specific symptoms and signs,” perhaps reflecting a disease classification system more suited to men than women. These same women might actually be suffering from a fully identifiable illness, but practitioners fail to diagnose it, due at least in part to traditionally male-based diagnostic criteria or to female-centric complaints that aren’t highlighted or even understood by historically (predominantly) male-based research. As a result, many women may receive no or improper treatment of their unidentified disease, something that can be frustrating at best and downright dangerous at worst.

Next, despite the fact that primary healthcare is used more by women than men, research indicates that short-stay and emergency hospital services may be more accessible to men. In one study of patients with the same ultimate diagnosis, women waited longer in emergency rooms and were admitted less often.

Then there’s the issue of incorrect drug dosages arising from insufficient trials on women. Eight of the ten prescription drugs that were withdrawn since 1997 posed greater health risks for women than men. Half of those drugs were withdrawn not because more women took them than men, but because their effects on women weren’t well known prior to FDA approval. For example, antihistamines Seldane and Hismanal and gastroprokinetic Propulsid “can in some circumstances prolong the interval between the heart muscle’s contractions and induce…a potentially fatal cardiac arrhythmia. Women have a higher incremental risk of suffering an arrhythmia after taking these drugs than do men probably because (1) the interval between heart muscle contractions is naturally longer for women than for men and (2) male sex hormones moderate the heart muscle’s sensitivity to these drugs.”

At a less morbid level, the FDA recently reduced female doses of Ambien, a common sleeping aid by half. Ambien and similar products had been on market shelves for years, but it wasn’t until the FDA completed tests on a new sleeping aid, Intermezzo, that they realized women metabolized the active ingredient much more slowly than men. Up until that point, it was assumed that women had the same response to the drug as men, and therefore that the recommended dosages should also be the same.

Because of lingering research bias, I’d say women probably have ample (more) reason to be more skeptical of pharmaceutical recommendations.

Gender Bias In Literature and Practice
Coronary Heart Disease
Despite the fact that coronary heart disease is very much a disease of both genders, its role in female mortality rates is arguably under-appreciated. Women with coronary heart disease tend to have worse outcomes than their male counterparts, and they generally receive less evidence-based treatment than men with CHD.

A 2014 study that examined access to care for 1123 admitted patients exhibiting coronary symptoms found that men were more likely to receive faster care compared to women. Researchers also observed that, when women were anxious, doctors tended to underplay the severity of their condition, while anxious men were still admitted quickly. Even more interestingly, both men and women with “feminine character traits” were less likely to receive timely care than those with masculine traits.

Statins and NSAIDs
In a review of 27 trials of statin use for CHD and 25 trials of NSAIDs for osteoarthritic pain, the two drugs showed a huge difference in inclusion of women. While NSAID trials reflected the population in which they were used, only 16% of women were included in trials despite 45% of statin users being female.

These statistics become even more alarming when we consider the fact that women are often more at risk of adverse side effects from statin use than men. Elderly women, for example, face a higher risk of developing muscular disorders following statin use, while postmenopausal women are at an increased risk of developing diabetes mellitus from statin use.

Animal Studies
This is where things really get interesting. Many specialists now theorize that the high rate of adverse drug reactions in women may stem from biomedical research at its earliest stages—animal trials.

While over half of NIH-funded clinical research participants are women these days, the same progression in recognizing gender bias has not been reflected in animal research. Women have more strokes than men, but only 38% of animal studies on stroke used females. Many thyroid illnesses are up to ten times more prevalent in women, yet only 52% of animal trials used females. And studies that use mice and other rodents to test new drugs typically use only males, despite there being marked differences between the way men and women absorb and process drugs.

There’s plenty more where that came from. A 2011 review of gender bias in research on animals in 10 biological fields found that male bias was present in eight disciplines and most prominent in neuroscience, where male studies outnumber female by 5.5 to 1. According to researchers, in recent years male bias in human studies has declined while increasing in animal studies, and this doesn’t bode well for the safe development of drugs and disease treatments further down the line. This preponderance of males in animal research unfortunately runs the risk of obscuring key gender differences in clinical studies, preventing reproducibility in human studies, and is especially concerning given women experience higher rates of adverse drug reactions than do men.

Some Final Thoughts…
Clearly, there’s much that still needs to be addressed regarding gender inequalities in the medical research world, but we’ve thankfully come a long way from the days of “hysteria.” Women can now participate in phase one, two and three clinical trials, and the NIH continues to roll out legislation and training to ensure researchers don’t overlook or underplay the importance of including women in their trials. And in the animal research sector, the NIH has now enacted policies requiring a balance of genders in all future trial applications, unless sex-specific inclusion is unwarranted.

Unfortunately, however, I don’t think it’s as simple as merely dishing out pro-female policies left right and center. As this opinion piece points out, “modifying experiments to include both males and females costs money and requires a duplication of time and effort—time that researchers might not have to spare or that might be better spent conducting other research—that is rarely practical or scientifically warranted.” Being required to include females in a study where it’s unwarranted might simply increase variability and render the study findings useless. That said, I also understand how “unwarranted” might not always be as clear-cut as anyone would like to assume.

Still, a better approach may be to prioritize funding for research where analyzing differences between the sexes promises to provide substantiated benefit—and opening the conversation more for defining that “benefit.” Providing the necessary funding for female or mixed-gender studies should ensure that scientists no longer have reason to exclude women from trials. And mandating disclosure when a study uses only male or female animals in the title should improve transparency and assist drug and treatment approval processes.

Thanks for reading folks. What say you? Are there issues and/or solutions you’d add to the mix? I’d love to hear your thoughts.

The post Gender Bias in Medical Research: How It Operates and Why It Matters appeared first on Mark's Daily Apple.

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Marshall Sutherland
  
The tl;dr is that increased carbon dioxide may be causing plants to grow faster, but less nutrient dense. I guess an analogy would be a fast-growing tree having less physically dense wood than a slow-growing tree.

The great nutrient collapse

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The atmosphere is literally changing the food we eat, for the worse. And almost nobody is paying attention.
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Marshall Sutherland
  
An excellent conversation. For me a highlight was talking about how the "healthcare debate" in the US isn't about healthcare, it is about paying for healthcare, but unless we change how we deal with chronic health condition, it is all moot. It won't matter how we pay for it because we, as a nation, can't afford to pay for the exponential rise in cases and costs of chronic health care. In rough numbers, a type-2 diabetic can expect to rack up $1 million in healthcare expenses for diabetes and diabetes complications in their lifetime. There are an estimated 100 million diabetic and pre-diabetic people in the country. This has unsustainable written all over it. And that is just type-2 diabetes.

Episode 376 – Chris Kresser – Unconventional Medicine
Episode 376 – Chris Kresser – Unconventional Medicine

This week we have my good friend Chris Kresser on the show. Chris is a well known leader in the fields of ancestral health, Paleo nutrition, functional and integrative medicine, and one of the smartest guys I know.

Listen in as we chat about functional medicine, the state of health care, eliminating chronic disease, and Chris’s new book Unconventional Medicine.

Download Episode Here (MP3)

Websites:
https://chriskresser.com
https://kresserinstitute.com/
https://ccfmed.com/

Social Media:
Twitter: @ChrisKresser
Facebook: Chris Kresser L.Ac

Check out and pre-order the book Unconventional Medicine here (releases Nov 7th)

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Marshall Sutherland
  
Fat HeadFat Head wrote the following post Mon, 09 Oct 2017 21:00:06 -0400
The USDA Dietary Guidelines Committee Gets The Spanking It Deserves
The USDA Dietary Guidelines Committee Gets The Spanking It Deserves

As you’ve probably heard, the National Academies of Science, Engineering and Medicine (NASEM) recently gave the USDA Dietary Guidelines Committee the spanking it deserves. Here are some quotes from an editorial in The Hill written by Rep. Andy Harris, who also happens to be a doctor:
The nation’s senior scientific body recently released a new report raising serious questions about the “scientific rigor” of the Dietary Guidelines for Americans. This report confirms what many in government have suspected for years and is the reason why Congress mandated this report in the first place: our nation’s top nutrition policy is not based on sound science.

In order to “develop a trustworthy DGA [guidelines],” states the report by the National Academies of Science, Engineering and Medicine (NASEM), “the process needs to be redesigned.”

Among other things, the report finds that the guidelines process for reviewing the scientific evidence falls short of meeting the “best practices for conducting systematic reviews,” and advises that “methodological approaches and scientific rigor for evaluating the scientific evidence” need to “be strengthened.”

In other words, the Dietary Guidelines for Americans are far from the “gold standard” of science and dietary advice they need to be. In fact, they may be doing little to improve our health at all.

Heh-heh-heh … remember what happened when Nina Teicholz, author of The Big Fat Surprise, wrote a piece in the British Medical Journal criticizing the dietary guidelines as unscientific? Dr. David Katz (who reviewed his own novel under a false name and compared himself to Milton and Chaucer) dismissed her critique as “the opinion of one journalist.” The USDA’s report, he insisted, “is excellent, and represents both the weight of evidence, and global consensus among experts.”

Then for good measure, he and several other members of The Anointed tried to harass BMJ into retracting the article by Teicholz.

And now along comes the NASEM report, saying Teicholz was right. The “opinion of one journalist” (which of course was shared by countless doctors and researchers) is now the official opinion of the National Academies of Science, Engineering and Medicine. You gotta love it. Perhaps Dr. Katz can write a rebuttal to the NASEM report, then review his rebuttal under a false name and compare himself to Albert Einstein.

Anyway, back to the editorial by Rep. Harris:
It seems clear that the lack of sound science has led to a number of dietary tenets that are not just mistaken, but even harmful – as a number of recent studies suggest.

For instance, the guidelines’ recommendation to eat “healthy whole grains” turns out not to be supported by any strong science, according to a recent study by the Cochrane Collaboration, a group specializing in scientific literature reviews. Looking at all the data from clinical trials, which is the most rigorous data available, the study concluded that there is “insufficient evidence” to show that whole grains reduced blood pressure or had any cardiovascular benefit.

So far, so good. Now for the part where I disagree a bit:
It is imperative that the advice championed by our national nutrition policy be unimpeachable. With the process for the 2020 guidelines soon to be underway, now is the time for the Congress to take action to reform the Dietary Guidelines development process so that proposed guidelines work as intended – as a tool to restore and protect our nation’s health.

I periodically receive requests to sign a petition to put this-or-that expert in charge of the USDA Dietary Guidelines Committee. I always politely decline. Here’s who I think should be in charge of the nation’s dietary guidelines:

Nobody.

That’s right, nobody. We don’t need national dietary guidelines any more than we need national dog-grooming guidelines. People managed to figure out which foods were good for them long before the federal government got involved. In fact, it’s pretty obvious by now that the crowd wisdom handed down over the generations was vastly superior to the New & Improved! dietary advice concocted in Washington 40 years ago.

For reasons I can’t fathom, some people believe if you want a job done right, then by gosh, you need to put the feds in charge. Our history says otherwise. People don’t magically become smarter, wiser, or more ethical when they go to work for the federal government. They do, however, acquire the power to replace the diffused wisdom of crowds with the centralized decisions of the few. I don’t want a little group of experts in charge of dietary policy, even if they’re experts you and I respect.

As Nassim Nicholas Taleb points out in his terrific book Antifragile, centralized decision-making amplifies mistakes. If you empower one little group of experts to make decisions for everyone, their mistakes affect everyone.

That’s exactly what happened with our national dietary guidelines, which were imposed on schools, prisons, hospitals, the military, and pretty much every other institution run or funded by government. Worse yet, other countries adopted and imposed our dietary guidelines, apparently believing the people who wrote them had a flippin’ clue. Whoops.

Taleb points out that we rarely see big, disastrous governmental screw-ups in Switzerland. Why? Because there’s little centralized authority. Switzerland functions as a loose confederation of city-states that make most of their own decisions. If a city-state makes a bad decision, it doesn’t ripple through the entire country. The harm remains local. The other city-states see a plan that didn’t work and avoid it. On the other hand, if a city-state makes a very good decision, the other city-states see the happy result and adopt a similar plan.

That’s how the U.S. was originally intended to function as well. The states, not the federal government, were supposed to be the incubators of public policies. States and local governments can learn from each other’s successes and mistakes. When the feds make a mistake, what we usually learn is that while only death and taxes are forever, crappy federal departments and programs are so hard to kill, they may as well be immortal.

I’m glad the National Academies of Science, Engineering and Medicine gave the USDA Dietary Committee the spanking it deserves. If the 2020 national dietary guidelines are based on rigorous science, that would certainly be an improvement.

But the best outcome would be if Congress decided, once and for all, that the rest of us don’t need the U.S. government telling us how to eat. There’s no good reason to have bureaucrats in Washington deciding what grade schools in Franklin, Tennessee are allowed to serve for lunch.

Low-carb, paleo, gluten-free, locally raised … they’re all grass-roots movements that are making a huge difference. Nobody’s in charge of them.  They weren’t designed by government committees – if anything, they were resisted by government committees, but thrived anyway because of the Wisdom of Crowds effect.

So instead of rooting for 2020 to be the year we finally get some real scientists on the USDA Dietary Guidelines Committee, I’m hoping it’s the first year new dietary guidelines are scheduled to be released, but nobody bothers to write them.

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Marshall Sutherland
  last edited: Wed, 27 Sep 2017 07:17:51 -0400  
I haven't listened to this yet, but I recall some interest in an earlier direct primary healthcare repost I had made, so here you go...

Episode 373 – Dr. Brandon Alleman – Direct Primary Healthcare
Episode 373 – Dr. Brandon Alleman – Direct Primary Healthcare

On this episode of the podcast my guest is Dr. Brandon Alleman, MD, PhD. Dr. Alleman graduated from Hope College with a BS in Mathematics and a BA in Physics. He is a former Fulbright Scholar to Budapest, Hungary and graduated from the University of Iowa with his MD and PhD in Translational Biomedicine. He is a graduate of the Via Christi Family Medicine Residency and was the Chief Resident for obstetrics.

Listen in as we talk about the model of Direct Primary Healthcare, insurance, and problems and solutions that doctors and patients are facing today in the healthcare world.

Download Episode Here (MP3)

Website: www.antiochmed.com
Facebook: https://www.facebook.com/AntiochMedClinic/
Twitter: @AntiochMed

Direct Primary Care listings/map: http://www.dpcfrontier.com/mapper/
(We can’t vouch for the quality of all of these clinics but they are least people with similar models.)

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Marshall Sutherland
  
It looks like the link in the original message pointed to the previous episode (372). That has been corrected in the post above.
Marshall Sutherland
  
Fat HeadFat Head wrote the following post Mon, 18 Sep 2017 18:16:58 -0400
Signs Things Are Changing … And A Couple Signs They’re Not
Signs Things Are Changing … And A Couple Signs They’re Not

Back in December, I mentioned that our local Kroger started carrying chips like these:

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We’re seeing the wisdom of crowds at work. The U.S. government, the American Heart Association and other (ahem) “experts” still insist that coconut oil will kill us because of the saturated fat, and yet grocery stores are responding to demand from consumers who know better.

As more evidence that crowd wisdom is winning, I offer this picture:

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There are only three ingredients in these chips: sweet potatoes, coconut oil and sea salt.

So what? It’s just another bag of chips cooked in coconut oil, right? True, but I found these at …wait for it … a gas-station mini-mart, right there by the checkout. That means someone who buys snacks for the mini-mart chain has realized there’s a demand for products like this.  I remember driving from California to Tennessee in 2009 and not being able to find any gas-station snacks that weren’t vaguely horrifying.

Just for kicks, I also took a picture of the ingredients list for a bag of Lay’s cheddar-flavored baked chips:

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Look at those yummy ingredients.  But they’re baked! Lower in fat, ya see, so they must be good for you. Heh-heh-heh …

I’ll try not to strain my arm while patting myself on the back, but I’ve been predicting this trend for years. After Fat Head was released, I heard from plenty of food zealots who told me I’m an idiot, a shill for McDonald’s, etc., etc., for refusing to blame the evil corporations for making us all fat and sick by selling us bad foods.

I replied (over and over and over) that manufacturers only produce what people will buy, period. When more and more consumers demand grass-fed beef, or less-processed foods, or whatever, that’s what manufacturers will produce.

Here’s another example. I mentioned awhile back that I like a soup called True Primal. The latest incarnation is even better. It’s now made with all grass-fed beef, and the peas are gone. I’m sure that’s based on consumer feedback.

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One pouch of the soup provides 24 grams of protein and just 11 net carbs.  All the vegetables are organic.  My daughters like the flavor, which makes it an easy lunch for them.

The demand for grain-free and gluten-free products is continuing to change what’s available in stores as well. Our local Kroger now carries several types of wheat-free pastas. Sure, they had gluten-free pastas before, but most were made from rice. My glucose meter tells me that anything with rice as a primary ingredient will send my blood sugar into the stratosphere. But now we’re finding pastas made from lentils, peas, sweet potatoes, carrots and beets.

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Here’s the complicated ingredient list for the lentil pasta:

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If you’re on a strict ketogenic diet or a paleo purist, pasta made from lentils probably won’t appeal to you. I’m not a paleo purist (I think lentils are a fine food) and my daily carb intake is in the 75-100 gram range, so I’m happy to have the option of a pasta meal now and then. Unlike wheat pasta, which seems to just make me hungrier until I stuff myself, these pastas are quite satisfying.

The lentil pasta has 24 net carbs for two ounces. I use three ounces when I make a dinner-sized meal, so it’s 36 net carbs. I’ve checked my glucose an hour after eating and have yet to peak above 125 mg/dl. I’m fine with that.

I usually add four ounces of chicken breast to boost the protein, although the lentil pasta itself has a decent amount of protein at 20 grams per three ounces. For sauce, I make a quick-and-easy alfredo. Here are the ingredients for one serving – multiply as necessary.

3 tablespoons grass-fed butter
2 tablespoons Parmesan
2 tablespoons full-fat sour cream
Garlic and salt to taste
Warm the ingredients and whip with a fork.

Sometimes I also add a quarter-cup of marinara sauce made with no added sugars. According to my calculations, the meal comes out to:

900 calories
58 grams of protein
40 net carbs
11 grams of fiber

Nice to see more foods like these becoming available in grocery stores. Definitely a sign that things are changing for the better.

On the other hand, there’s this:

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Weight Watchers is still trying but failing to get it right. Yes, they’ve caught on that people want real ingredients you can pronounce, but they substituted bean puree for cream as a “smart swap.” I don’t have anything against bean puree, but it’s just not necessary to ditch the cream. And of course, they kept the wheat pasta. Wrong swap, folks.

Just to confirm that we have a ways to go despite all the positive changes, the checkout guy at Kroger furrowed his brow when he scanned a bag of the Boulder chips and said, “Coconut oil? Isn’t that bad for you?”

“What makes you say that?”

“I think I read it has too much of the bad kind of cholesterol or something like that.”

Ah, well. We’re getting there, but it will take time.

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Marshall Sutherland
  
Fat HeadFat Head wrote the following post Wed, 23 Aug 2017 20:51:39 -0400
Statins For Everyone! (again)
Statins For Everyone! (again)

I’ll turn 59 in November. That means in just 15 months, I should start taking a statin. That’s the conclusion of a new study reported in the U.K. Independent online:
Almost every older person should be taking statins, a new study has found. Almost all men over 60 and women over 75 should be taking the drugs, the research found. And more than a third of people between 30 and 84 should be allowed to do so.

Sure, let’s put all older people on statins. Society would really benefit by having more older folks with memory problems and damaged muscles.
The sweeping findings could suggest that GPs will be asked to prescribe the drugs to the majority of their patients, leading to huge strain on doctors.

That was, of course, my first concern as well. Oh my goodness! If we start giving statins to all older people, won’t that be a strain on doctors?!
The research looked to investigate the effects of guidance that was set by the National Institute of Health and Care Excellence (Nice) in 2014. That controversial ruling allowed many more people to receive statin therapy on the NHS, since it suggested that anyone with cardiovascular disease should be given the drug, and anyone with a more than 10 per cent chance of developing it in the next 10 years should take it too.

The latest study, published in the British Journal of General Practice, examined the algorithm endorsed by Nice for the assessment of CVD risk and compared it to data from the 2011 Health Survey for England to estimate the number of people who are eligible for statin therapy under the guidance.

Let me explain how that algorithm works: if you’re a male older than 60 or a woman older than 75 and still have a pulse, statistics say there’s a decent chance you may have a heart attack at some point in the future, so the algorithm says you should be on statins. The actual health of your heart doesn’t figure into it much.

Last month, I admitted that I’m a member of the anti-statin cult that Dr. Steve Nissen (America’s Statinator-In-Chief) blames for scaring people away from these wunnerful, wunnerful, life-saving drugs. So you won’t be surprised that I’m under orders from the cult leaders to explain why guidelines that would put nearly all older people on statins are complete nonsense. (I’m also under orders to smack myself in the head with my t-post hammer if the post doesn’t draw at least a thousand views, but I’m negotiating on that one.)

Advertisements for statins throw out impressive-sounding claims, such as reduces the risk of heart attack by 33 percent! If you didn’t know any better, you’d think a third of the people taking statins are saving themselves from a heart attack.

But of course, that’s not the case. That figure is derived from results like this: in a statin trial lasting some number of years, two of every 100 patients with known heart disease who took the statins had a heart attack, while three of every 100 patients with known heart disease who took a placebo had a heart attack. Two is one-third less than three, so the relative reduction is 33 percent.

But in absolute terms, it means for every 100 patients who took the drug, one was saved from a heart attack. So the number needed to treat (NNT) is 100. That’s the figure that matters.

There’s a site called The NNT that provides exactly those kinds of figures. Here’s what it says on the home page:
We are a group of physicians that have developed a framework and rating system to evaluate therapies based on their patient-important benefits and harms as well as a system to evaluate diagnostics by patient sign, symptom, lab test or study.

We only use the highest quality, evidence-based studies (frequently, but not always Cochrane Reviews), and we accept no outside funding or advertisements.

The b.s. guidelines suggested by the new study say almost everyone over a certain age should be on statins, whether they actually have heart disease or not. Here’s what The NNT tells us about statin trials conducted on people who don’t already have heart disease:

Benefits:
None were helped (life saved)
1 in 104 were helped (preventing heart attack)

Compare the statin groups to the placebo groups, and the combined results say not a single death was prevented by the statins. The statins prevented an average of one non-fatal heart attack for every 104 people who took them for five years.

Wowzers. Doesn’t that make you want to run out and fill that statin prescription as soon as you turn 60?

But wait, let’s not forget to look at the other side of the equation:

Harms:
1 in 50 were harmed (develop diabetes)
1 in 10 were harmed (muscle damage)

And keep in mind, these figures are mostly from studies published by the makers of statin drugs. In other words, they’re the most positive studies. We don’t know how many studies conducted by Big Pharma were simply dumped because the results were less-than-positive. Here’s what the gang at The NNT says on the subject:
Virtually all of the major statin studies were paid for and conducted by their respective pharmaceutical company. A long history of misrepresentation of data and occasionally fraudulent reporting of data suggests that these results are often much more optimistic than subsequent data produced by researchers and parties that do not have a financial stake in the results.

The combined results of these mostly-positive studies say 10% of the people on statins suffered muscle damage. I’ll bet you dollars to donuts (and you can keep the donuts) the figure in the real world is much higher. When Big Pharma conducts these studies, they screen out patients who report side effects from other drugs. So the population that goes into the study is less likely to experience side effects than the population at large.

But what the heck, let’s suppose the figure is actually the 10% reported in the studies instead of the 25% or greater I suspect we’d find in the real world. And let’s suppose you’re a man 60 or older, or a woman 75 or older, with no previous heart attacks or known heart disease. Let’s put you in a group of 100 of your peers and give you all statins. Here’s what would happen, according to the most positive data Big Pharma can produce:
  • One of you will be prevented from having a non-fatal heart attack, but none of you will be prevented from actually dying. (And preventing the one non-fatal heart attack will likely only apply to the men.)
  • Two or more of you will develop diabetes you wouldn’t otherwise have had (which increases the odds of heart disease or stroke down the line).
  • Ten or more of you will end up with damaged muscles, thus seriously reducing your quality of life.
I think we should ignore this latest edition of the Statins For Everyone! guidelines.

At least that’s what the cult leaders told me to say.

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Maria Karlsen
  
Oh wow...
Where's the common sense?