August 2017 News Round-Up

 

Pharmaceutical side effects kill thousands each year

In the US as many as 40,000 patients per year are killed by side effects of their drugs, but the recording system is inadequate. NewScientist (Aug 10th). 

‘Low fat diet could kill you’

Brilliant headline in The Telegraph (Aug 29th). A study published in the Lancet, tracked 135,000 adults and found that people who ate more carbohydrates had greater early death than those who ate more fats, including saturated fats.

“Loosening the restriction on total fat and saturated fat and imposing limits on carbohydrates when high to reduce intake to moderate levels would be optimal.”

Another finding from this study, covered by CBS News (Aug 31st) was that the benefits of fruit and vegetables levelled out at 3 servings per day. So much for the 5-a-day mantra. Oh, and the Guardian (Aug 29th): ‘Life-saving fruit and vegetable diet need only be three portions – study’

High Fat / Low Carb diets

As part of the sudden interest in all things keto,The Independent (Sep 2nd) asks ‘is a high fat diet the key to burning fat?’ and gives some anecdotal evidence.

Glucose and the brain

For at least a decade I have considered Alzheimers and Parkinson’s to be, in some cases, fundamentally due to ‘diabetes of the brain’ and have treated patients with these clinical pictures with an anti-diabetic diet. It can make a huge difference so it is nice to see this month’s news indicating that others in the medical research world are catching up with this idea:

Medical Express (Aug 30th) explains how raised glucose levels (from high carb diets) – even among non-diabetics – can have negative impact on the ageing brain. Meanwhile, a separate study demonstrated that a diabetes drug could slow the progress of Parkinson’s disease. Interestingly, it seemed to target the underlying cause of the condition, not just its symptoms. (NewScientist, Aug 3rd)

The fact that a diabetes drug seems to help Parkinson’s adds to a growing body of research suggesting that neurodegenerative diseases like Alzheimer’s and Parkinson’s may work in a similar way to diabetes, and that neurons can become unresponsive to insulin in the same way that cells in the pancreas do in type 2 diabetes.

Schematic representation of the factors associated with the development of cognitive impairment in patients with type 2 diabetes. (Belfort-DeAguiar et al. Diabetes, 2014) 

Paleo diet

Health Minute (Aug 21st) “Eating a Paleolithic-type diet without calorie restriction significantly improved the fatty acid profile associated with insulin sensitivity, and it reduced abdominal adiposity and body weight in obese postmenopausal women,” said lead author of a recent study.

Another reason to avoid breakfast cereals

The Daily Mail (Aug 10th) has an interesting article about endocrine disrupting additives (the antioxidants E321 & E320) often found in breakfast cereals, biscuits and sweets. Researchers found these substances interfere with gut-brain signalling, whilst E321 also damaged mitochondria.

Cutting out soy

The Independent (Sep 1st) asks whether we would be better off cutting out foods containing soya. Yep.

Coffee

Further evidence that higher coffee consumption is linked to lower mortality (Medical Express, Aug 28th).

Reduced meat intake associated with vitamin deficiencies

The Express (Aug 30th) reports on a study that found women in the UK eating less than 40g of red meat per day suffered deficiencies in zinc, iron, vitamin B12 and D.

Netflix’ recent vegan promoting film ‘What the Health’ is taken to task by New Scientist (Aug 16th). Whilst in a linked article from July, they explore some of the arguments around the environmental impacts of meat production, demonstrating that it isn’t as simple as vegetarians make it sound.

Silly Season

This month the papers were scraping the bottom of the barrel for food news. Here are some examples that will give you a giggle:

  • NHS no longer uses POST-IT NOTES to arrange life-saving heart transplants after adopting ‘groundbreaking’ new technology that is 300 times quicker” (Daily Mail, Aug 31st)
  • I tried ingesting rat tapeworm parasites and my poo turned green (NewScientist, Aug 8th)
  • How much of these everyday foods can you consume before they kill you? (Telegraph, Aug 9th)
  • The avocado divide: only 16 per cent of over-40s have tried the millennial favourite (Telegraph, Aug 9th)
  • National Trust flapjack gets a makeover – and it’s not everyone’s cup of tea (Telegraph, Aug 7th)

Harm from antiseptic cleaning and skincare ingredients

A class of common antiseptic cleaning ingredients known as quats—”quaterny ammonium compounds” has been found to interfere with the functioning of mitochondria and oestrogen signalling at typical concentrations. Of 1600 compounds screened all quats caused these effects. (Medical Express, Aug 22nd) This builds on earlier research that found just using these cleaners in the same room as caged lab mice led to birth defects (Medical Express, Jun 17th).

What to do? Thanks to AnnMarie organic skin care for the following:

These chemicals aren’t necessary—we have a lot of natural alternatives, including tea tree oil, lemon, honey, propolis, rosemary, vitamin E, and grapefruit seed extract.

 

To avoid quats, read labels, and stay away from the following:

 

  • Benzalkonium chloride
  • Cetalkonium chloride
  • Cetrimonium chloride
  • Lauryl dimonium hydrolysed collagen
  • Stearalkonium chloride
  • Diethyl ester dimethyl ammonium chloride
  • Dialkyl dimethl ammonium methyl sulfate
  • Hydroxethyl methyl ammonium methyl sulfate
  • Chemical DTDMAC (ditallow dimethyl ammonium chloride); also called quaternium-18
  • Quaternium-18
  • Quaternium-26 and other numbers

Intravenous Vitamin C

I’ve been hearing a lot of good things about intravenous vitamin C recently, including its life saving use in sepsis.

So I was pleased to see New Scientist (Aug 17th) report that it helps kill off cells that would cause certain blood cancers too.

Looks like we may all (or most) need to increase our vitamin C intake, just generally. So off I go to drink a glass of fizzy water with a quarter of a teaspoon of pure ascorbic acid powder dissolved in it. Wow! Zingy!

 

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Low fat (but not full fat) dairy associated with increased risk of Parkinson’s disease

Read time: 4.5 minutes (850 words)

Intro

MedPage Today [full article here] drew my attention to a recent Harvard study published in the journal Neurology [abstract herewhich took a closer look at previously identified associations between dairy products and Parkinsons Disease. Their analyses were based on data from two large prospective cohort studies, the Nurses’ Health Study (n = 80,736) and the Health Professionals Follow-up Study (n = 48,610), with a total of 26 and 24 years of follow-up, respectively. An previous study (see below) found an increased risk of Parkinson’s with higher levels of dairy protein consumption.

The latest study looked more carefully at the different types of dairy product. They found that among those who ate 3 or more portions of low fat dairy per day (skimmed milk, low fat cheese and yogurt etc) 4 in 1000 went on to develop Parkinson’s disease, whereas among those who ate no portions of low fat dairy only 3 in 1000 developed the disease.

Comparing the two groups that equates to a roughly 33% increased relative risk. Of course that is only a rather piffling 0.1% absolute risk increase – hardly anything to worry about in the grand scheme of things. What makes this study interesting, however, is that the association did not exist for full fat dairy products only low fat ones.

Uric acid and Parkinson’s disease

The study’s authors speculate that the increased risk seen in the low fat milk group may be due to the ability of milk protein (casein and lactalbumin) to reduce uric acid levels. Parkinson’s disease and uric acid? I wasn’t aware of this link, so started digging into the research…

A particularly helpful review in Practical Neurology [Uric Acid’s Relationship with Stroke and Parkinson’s Disease: A Review] filled me in on the background.

It turns out that there is a growing body of evidence demonstrating an association between low uric acid levels and incidence of Parkinson’s disease. Not only do Parkinson’s sufferers tend to have have low levels of uric acid, but those with higher levels have slower and less aggressive progression of the disease. Importantly, some studies have identified that low uric acid levels four years prior to the onset of Parkinson’s symptoms has a stronger association than levels at onset of symptoms, suggesting that uric acid is linked to the  pathogenesis of Parkinson’s.

Uric acid BTW is an intriguing endogenous antioxidant which although primarily synthesised by the body is also influenced by diet. Excess levels can lead to the formation of crystals which is the basis of the painful condition gout, but can also contribute to kidney stones and kidney damage. Foods containing purines, such as shellfish, offal, meat and beer, can raise uric acid levels, as can alcohol and fructose, so should be avoided if you suffer from gout or kidney stones. The idea that such foods may be protective against Parkinson’s is interesting (although clearly one would not want to go as far as to cause gout!) On the other hand, dairy, cherries and vitamin C are associated with lower risk of gout and are classed as hypouricemic foods as they reduce uric acid levels.

It is believed that uric acid may exert a neuro-protective effect through it’s antioxidant action:

It has been hypothesized that uric acid reduces oxidative stress on neurons. This may have a significant bearing on therapeutic management of disease, as many neurological disorders are believed to result from oxidative stress. As a potentially modifiable risk factor, the prospect for uric acid and its derivatives to play a role in disease modification or prevention has great potential. – Pello et al, 2009

Studies looking at dietary associations with Parkinson’s disease have identified that uric acid lowering foods (e.g. dairy) are always associated with an increased risk of Parkinson’s, except for one. Vitamin C is the only uric acid lowering nutrient associated with reduced Parkinson’s risk: possibly because it is a powerful anti-oxidant itself.

Results from an earlier analysis of the Health Professionals Follow-up Study found clear trends indicating reduced incidence of Parkinson’s disease with increasing consumption of fructose and alcohol (uric acid raising foods) and an increased risk with higher levels of dairy protein consumption (a uric acid lowering food) Adapted from Xiang Gao et al, 2008

Full fat dairy

In the new study the increased risk for Parkinson’s disease was only associated with low fat dairy, not full fat. Why wasn’t full fat dairy associated with an increased risk of Parkinson’s?

For now there is no clear answer, but according to MedPage Today the authors of the study say “The lack of association with full-fat dairy products could be due to a countervailing effect of saturated fats. I think more research is needed to better understand the mechanisms involved in this association,”

The benefits of dairy fats have come up time and again, yet I still know many people who avoid full fat milk, cream, cheese and butter. See our posts:

Bottom Line

The size of the increased absolute risk of Parkinson’s disease associated with consuming low fat dairy products (0.1%) is too small to make it a reason in and of itself to avoid low fat dairy – unless of course, you have a family history of the disease in which case every bit of risk reduction helps.

For all of us, however, this study adds to the evidence of the benefits of full fat over low-fat dairy.

References

  • Intake of dairy foods and risk of Parkinson diseaseKatherine C. Hughes et al, Neurology, June 2017 [Abstract]
  • Low-Fat Dairy Linked to Small Increased Risk for PDKate Kneisel, Contributing Writer, MedPage Today, June 2017 [Full article]
  • Uric Acid’s Relationship with Stroke and Parkinson’s Disease: A Review Scott Pello et al, Practical neurology, Jul/Aug 2009 [Full article]
  • Diet, Urate, and Parkinson’s Disease Risk in Men, Xiang Gao et al, American journal of epidemiology, 2008 [PMC full text]

In the News

  • Why you’re better off eating FULL fat dairy: Consuming three or more portions of the low fat variety of yoghurt, milk or cheese raises the risk of Parkinson’s disease, Daily Mail [Online Article]
  • Low-fat milk linked to Parkinson’s risk, The Times [Online Article]

April News Round-up

This month: Great British Beef Week Ketogenic diet in diabetes Low fat foods cause weight gain MUFA’s may extend life Olive oil helps reverse insulin resistance Fewer arterial plaques with Med diet BMJ article triggers saturates fat spat The perfect cuppa Conventional thinking on salt challenged again Health benefits of cheese


St George’s Day and Great British Beef Week

I held a St George’s Day party on Sunday 23rd (which is also, rather appropriately, Shakespeare’s birthday), and I served a traditional roast beef joint with parsnips and carrots. Turns out, without knowing it at the time, I was right on the money as April 23rd was the start of the Great British Beef week!

According to the Grimsby Telegraph (April 30th) this year was the seventh annual Great British Beef Week, run by The Ladies in Beef, an organisation of female beef farmers who care passionately about British beef. It’s purpose is to support the hard working British beef farmers, which is exactly what I did by purchasing a 3.5 kg organic beef joint from Goodwood – our local producer.

My St Goerge’s day roast beef looked like the one above (but without the Yorkie puds (wheat) and taties (American originally). Interestingly, the Goodwood butcher suggested that I do not season the joint – “Let the flavour of the meat speak for itself” he said, and it certainly did! The unseasoned joint was placed on a bed of thickly sliced onions rings and popped in an oven that had been pre-heated to its highest temperature. Once in, it was turned down to 140°C for 1hr 25 minutes. My guests were full of praise … very gratifying.

If you missed out during this year’s Great British Beef Week, don’t worry, you can cook it all year round!  The Telegraph (April 26th) has a range of British Beef recipes to inspire you (just avoid the ones that use gluten)

Ketogenic diet valuable in diabetes

Diabetes.co.uk (Mar 28th) reports on a trial, conducted by Stephen Phinney and Jeff Volek who placed 262 overweight participants with type 2 diabetes on a ketogenic diet for 10 weeks (carb intake < 30g per day, increase fat, and modest protein). Key findings:

  • HbA1C levels dropped an average of 20%, with half returning to normal (non-diabetic) levels by the end of the study
  • 7.2% weight loss; 20% reduction in triglycerides
  • 60% had one or more medications reduced in number and dosage or, in some cases, discontinued altogether

A two year trial is in the pipeline.

Volek and Phinney have been working in this field for a couple of decades and have an excellent track record in low carb high fat science. They have at least two books on the subject, so please look at their work online.

Low fat foods can cause weight gain and lead to fatty liver disease

Low fat yogurt packaged as heart healthy, but it contains nearly 5 teaspoons of sugar per serving (see chart of sugar in other low fat foods)

In 2014 The Telegraph undertook a study which found that many low fat diet foods contained high levels of sugars. In one case a “low fat” meal contained almost six times the sugar levels of its “full fat” equivalent dish. Many people have suggested that the sugar may be less healthy than the fat it replaces, and now a new study reported in Medical Daily (April 26th) confirms this.

In the study mice that were fed a high-sugar, low-fat diet had an increase in liver fat, body weight, and body fat, despite consuming the same amount of calories as the control mice. Compared to mice fed a high fat diet, sugar calories were found to cause twice as much fat accumulation as the fat calories they replaced.

“Most so-called diet products containing low or no fat have an increased amount of sugar and are camouflaged under fancy names, giving the impression that they are healthy, but the reality is that those foods may damage the liver and lead to obesity as well,” said the study’s lead investigator, Krzysztof Czaja

Monounsaturated fats extend life in animal study

Eureka Alert (April 5th) reports on an intriguing study from Stanford University published in Nature, of longevity in roundworms which found that feeding them monounsaturated fat increased lifespan in a similar way to calorie restriction, despite the fact that they put on weight.

Monounsaturated fats are found in high levels in olive oil, rape seed and avocado oils, and also in beef fat and lard. Whilst mentioning olive oil a recent study has also shown that…

Olive oil helps reverse insulin resistance

The Express (April 11th) reports on a mouse study that showed a compound found in olive oil (hydroxytyrosol) can reverse insulin resistance and fatty liver induced by an obesogenic diet. This adds to research published in December 2016 that showed this compound also reduced oxidative damage in cells and may contribute to explaining some of the benefits of a Mediterranean diet…

Fewer arterial plaques with real-world adherence to Mediterranean Diet

Adherence to a Mediterranean-style diet showed a dose-dependent protective association with the presence, number, and thickness of atherosclerotic plaques independent of other risk factors, in a new study (Medscape, April 26th).

BMJ article triggers saturated fat spat

The Guardian (April 25th) gives a good account of the controversy taking place amongst scientists over recent claims and counterclaims over the health credentials surrounding saturated fat. Worth a read: Good for a laugh.

The Perfect Cuppa

The Mail Online (April 18th) reports on a study that found the beneficial compounds in tea are most available when the tea has been brewed for longer. The study author also found that adding milk does not reduce the availability of these compounds. He recommends drinking three cups per day.

Conventional thinking on salt challenged again… and again.

We have written several posts challenging conventional thinking on the supposed harms of salt (see here and here). So we were interested to read in The Independent (April 17th) that a study investigating a simulated mission to mars which kept 10 men sealed in living quarters and given a strictly controlled diet for a period of 205 days. Unexpectedly, when given a high salt diet the participants drank less but were also hungrier. The results were confirmed in mice too. It appears that although salty food leads to an initial thirst (hence salted peanuts in the pub) over the long term the total intake of water is less.

More news on salt front came in on April 26th, in The Express, with an article on a recent study looking at blood pressure and sodium intake. The researchers found the participants who consumed less than 2,500 milligrams of sodium a day – about the equivalent of 6g of salt, had higher blood pressure than participants who consumed higher amounts of sodium.

“We saw no evidence that a diet lower in sodium had any long-term beneficial effects on blood pressure. Our findings add to growing evidence that current recommendations for sodium intake may be misguided.”

Salt – good or bad?
Seems that worrying about it is more likely to raise your blood pressure than eating it!

Health Benefits of Cheese

Wow. April 2017 was quite the month for cheese news. Goggle (April 28th) celebrated the 256th birthday of Marie Harel, the creator of Camembert in 1791, with a Google Doodle which provided a slideshow showing the steps involved in making this famous cheese (take a look here). As an aside, I think Brie and Camembert are the same thing, just in different shapes. Any comments anyone…?

Meanwhile, yet another study showing the benefits of cheese made the headlines with The Mail (April 24th) claiming “Eating cheese could prevent you from getting liver cancer – and it may even help you to reach 100!” – weirdly due to it containing spermidine (?!?)

Spurred on by the spermidine The Telegraph (April 25th) went further, pushing out the cheese boat with ‘5 surprising health benefits of cheese’. Here are their headings to tempt you to read more…

  1. Boosts your immune system
  2. The secret to longer life?
  3. Prevents tooth decay
  4. Helps with weight loss
  5. Makes you smarter

Finally, The Huff Post UK (April 25th) went just a bit too far with “7 Perfectly Valid Reasons To Eat More Cheese”. But really, that’s just showing off. Lets just gaze at a picture of lots of lovely cheeses…

An important and often overlooked benefit of cheeses, is that many – especially aged varieties – contain the precious vitamin K2, also known as menaquinone 7. This is not the same as vitamin K which is found in green vegetables, but is bacterially produced in cheeses during fermentation, and is particularly high in Brie and Gouda.

In the body K2 functions to guide calcium to the skeletal tissue, and prevent it being deposited, or rather, dumped, in soft tissues such as the aorta and other blood vessels where it contributes to atherosclerosis (sclerosis means hardening)Calcium in the wrong place leads to ‘calcification’ and having enough K2 to prevent this is one of the reasons for cheeses being a ‘top food’ in my reckoning.

Although some people are allergic to cows milk, many find they can tolerate goat and sheep milk cheeses which are increasingly available. The true unfortunates are those that cannot even tolerate these dairy products and they will need a regular K2 supplementation. Without sufficient K2 osteoporosis and calcification will occur. Clearly not a good state of affairs, so bring on the cheese trolley!

Vegetable oils losing their halo

 

high-omega-6-oils

Researchers from the University of North Carolina and the National Institutes of Health have revisited data from c.1970 that casts doubt on the traditional “heart healthy” advice to replace butter and other saturated fats with vegetable oils high in omega-6 fats. A re-analysis of the data suggests that high omega-6 vegetable oils may actually increase heart disease and all-cause mortality.

Their findings have just been published in the British Medical Journal in a paper titled: “Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73)” (Full Text)

Lead researchers Daisy Zamora of the University of North Carolina and Christopher Ramsden of the National Institutes of Health performed a similar analysis in 2013 on another set of unpublished data from the Sydney Diet Heart Study (1966-73), which lead them to similar conclusions, adding pressure to change dietary advice on the use of these oils.

The original Minnesota Coronary Experiment which the recent BMJ paper is based on, was by far the largest experiment ever undertaken to test whether replacing traditional fats (like butter, lard and dripping i.e. beef fat) with vegetable oils (such as corn oil and sunflower oil) high in the omega-6 linoleic acid, would lead to improved heart health and reductions in mortality. The study was designed to test the ‘diet-heart hypothesis’, which states that saturated fat raises cholesterol, and raised cholesterol increases the risk of fatal heart disease.

Whilst it had been shown that replacing saturated fats with vegetable oils lead to a reduction in blood cholesterol levels, it had not been shown that this in turn lead to better health outcomes. The Minnesota Coronary Experiment was designed to test this key step in the die-heart hypothesis.

diet-heart-hypothesis

Fig 1 Traditional diet-heart hypothesis. Solid line indicates that causal relation has been established by randomized controlled trials (A); dashed lines indicate that no causal relation has been established (B and C). A=randomized controlled trials show that replacement of saturated fat with vegetable oils rich in linoleic acid lowers serum total cholesterol and LDL; B=intermediate endpoints related to serum cholesterol are robustly associated with risk of coronary heart disease events and deaths in observational studies; C= randomized controlled trials have tested whether replacement of saturated fat with linoleic acid reduces coronary heart disease events or deaths; none have shown significant benefit – BMJ 2016

The experiment was conducted on institutionalised patients who’s meals were highly controlled. It involved 9423 women and men aged 20-97 who were residents at either nursing homes or state mental hospitals in Minnesota, USA. Patients were randomised to either the normal (high saturated fat, low omega-6) diet, or a low saturated fat, high omega-6 diet – primarily by substituting butter for corn oil in the meals the institutions provided.

The study was a double blinded, parallel group, randomized controlled dietary intervention trial, “designed to evaluate the effects of increasing n-6 linoleic acid from corn oil in place of saturated fat for primary and secondary prevention of cardiovascular events and deaths, and for reducing the degree of coronary, aortic, and cerebrovascular atherosclerosis, and the number of myocardial infarcts and strokes detected at autopsy.”

The results, which for some reason were not published until 1989, more than 15 years after the experiment finished, clearly showed that substituting saturated fats for vegetable oils decreased serum cholesterol. However, the data showed “no differences between the treatment and control groups… for cardiovascular events, cardiovascular deaths, or total mortality.” [ref] This was unexpected and went completely against the prevailing theories and public policy of the day. The awkwardness of such a finding may go some way to explaining the delay in publication and the fact that much of the raw data was omitted from the paper.

Part of the new study published this month, has involved tracking down and re-analysing that raw data. Fortunately, some of it was published in a rather obscure 1981 masters thesis by statistician, Steven K Broste, but it languished unacknowledged and unreferenced until the recent re-analysis. Helpfully, Broste was able to participate in the recent re-analysis and is one of the named authors of the new BMJ paper.

IBM-magnetic-tapesAnother large chunk of data has been recovered from the original magnetic computer tapes and more may be recoverable in future.

[Computer storage in the 1970’s consisted of state-of-the-art magnetic tapes like these IBM machines, right]

As well as recovering a large percentage of the  original data, Zamora and Ramsden’s team have been able to apply modern statistical tests and computer number crunching which were not available in the 1970’s and 80’s. Here is what they found…

Results of the reanalysis

Below are graphs from Broste’s thesis, showing the the cumulative mortality among patients aged less than 65, and those aged over 65.

Graphical depiction of cumulative mortality in full MCE cohort (n=9423) and prespecified subgroups in 1981 Broste thesis showed no indication of benefit and suggested possibility of unfavorable effects among participants aged ≥65.

What we can see is not simply that the high omega-6 vegetable oil diet (blue) failed to improve mortality compared to the high saturated fat diet (red), but that among subjects over 65 vegetable oils appeared to significantly increase mortality.

The authors of the BMJ paper point out some important points relevant to interpreting these graphs. The original study design was careful to use only liquid corn oil and soft vegetable margarine, deliberately avoiding hydrogenated fats. By comparison, the control diet was high in industrial tras-fats (found in artificially hardened margarines) – which are now recognised as particularly unhealthy. We can hypothesise that if the control diet had been equally low in unhealthy trans fats that the difference between these groups would have been even more marked.

The final part of their re-analysis looked at whether those who had the greatest cholesterol reduction also had the greatest reduction in heart disease and mortality, which is what the cholesterol hypothesis would predict. The analysis, however, revealed the opposite:

The number, proportion, and probability of death increased as serum cholesterol decreased [which] does not provide support for the traditional diet-heart hypothesis.

C Ramsden et al, BMJ 2016

The authors go on to consider why this might be, and argue that whilst vegetable oils clearly reduce LDL cholesterol, they may simultaneously make those LDL particles more susceptible to oxidation. Oxidised LDL is now considered a major factor in heart disease. Furthermore, they argue that linoleic acid leads to increased susceptibility to oxidative damage throughout the body and that this may be especially damaging for smokers, heavy drinkers and the elderly.

This graphic from the BMJ article neatly sums up the shifting perspectives on high-linoleic vegetable oils:

Unanticipated-consequences(Note: down arrow means reduced, up arrow means increased)

We have, for years, been recommending that our readers and Afifah’s patients ditch the vegetable oils and use butter, ghee, lard, dripping, coconut oil, avocado oil and extra-virgin olive oil instead. Looks like others are working it out too.

For more on vegetable oils and health check out our previous posts:

“The sugar conspiracy” – recommended read

TheSugarConspiracy

The Guardian’s ‘The Long Read’ this week has an excellent, in-depth article about how the dangers of sugar were ignored for decades due to the misplaced focus on saturated fat. The author digs deep into the workings of the nutrition orthodoxy and shows how it could get it so wrong for so long. HIGHLY RECOMMENDED.

The long read

The sugar conspiracy

In 1972, a British scientist sounded the alarm that sugar – and not fat – was the greatest danger to our health. But his findings were ridiculed and his reputation ruined. How did the world’s top nutrition scientists get it so wrong for so long?

by Ian Leslie

Robert Lustig is a paediatric endocrinologist at the University of California who specialises in the treatment of childhood obesity. A 90-minute talk he gave in 2009, titled Sugar: The Bitter Truth, has now been viewed more than six million times on YouTube. In it, Lustig argues forcefully that fructose, a form of sugar ubiquitous in modern diets, is a “poison” culpable for America’s obesity epidemic.

A year or so before the video was posted, Lustig gave a similar talk to a conference of biochemists in Adelaide, Australia. Afterwards, a scientist in the audience approached him. Surely, the man said, you’ve read Yudkin. Lustig shook his head. John Yudkin, said the scientist, was a British professor of nutrition who had sounded the alarm on sugar back in 1972, in a book called Pure, White, and Deadly.

“If only a small fraction of what we know about the effects of sugar were to be revealed in relation to any other material used as a food additive,” wrote Yudkin, “that material would promptly be banned.” The book did well, but Yudkin paid a high price for it. Prominent nutritionists combined with the food industry to destroy his reputation, and his career never recovered. He died, in 1995, a disappointed, largely forgotten man.

Continue reading on TheGuardian website…

January News Round-Up

Which is worse for the heart, sugar or saturated fat?

It’s amazing isn’t it? For anyone who checks literature the answer to this question has been clear for years, but for much of the public and medical community they can’t quite believe it. Medical Daily (January 14th) explains that a review of a half century of data shows that “sugar consumption, particularly in the form of refined added sugars, are (sic) a greater contributor to (coronary heart disease) than saturated fats.” Uh ha. A good one to email to any doubting Thomas you know. The funniest bit of this ‘no sh*t sherlock’ review is that it is came from the Albert Einstein College of Medicine! Who’d ‘ve thunk it?

High Carb v High Fat diet for endurance athletes

As it happens, I’m meeting a young endurance athlete this weekend who is excited about the possibilities of a high fat diet to improve his performance. The work of Jeff Volek (The Art and Science of Low Carb Performance) has demonstrated that high fat diets can offer considerable performance advantages compared to the high-carb approach recommended by traditional sports scientists.

The debate amongst performance athletes has been heated. The Guardian (January 19th) has a nice blog piece on this topic should you want to learn more.

Low fat v high fat weight loss diets

On the general theme of high fat v low fat, BBC Health (January 5th) had a good article considering both. They referred to recent researchers from Harvard School of Public Health in the United States who reviewed 53 weight loss trials involving 68,128 people.

The results, published in the Lancet medical journal, showed that both low-carb and low-fat approaches led to decent weight-loss. But those eating relatively more fat actually lost marginally more weight. Dr Deirdre Tobias, who led that study, said “Fat has been villainised because there’s a mentality that ‘fat makes you fat’. I think our evidence pretty much puts a nail in that coffin.”

Baby develops scurvy from ‘vegan milk’

A highly cited article in The Telegraph (January 21st) reported on a Spanish baby that developed scurvy (vitamin C deficiency), after being raised on almond milk instead of breast milk or formula milk. Breast milk contains vitamin C, and it is added to formula milk but not to almond milk. Glad we know that now.

Modern diets may be destroying our gut microbes ‘over generations’

mouse_neurons_gut_bacteria_595

National Geographic: An introduction to the microbiome provides a good primer on this revolutionary field

The discovery of a new human organ – the microbiome –  is profoundly changing our view of medicine. As one medic recently said: “Who would want to go to mars when we have the microbiome to explore?”

Science Daily (Januray 13th) reports on a recent paper that found a low plant fibre diet in mice led to depletion in gut bacterial diversity similar to the differences seen between industrialised peoples and hunter-gatherers. Interestingly, the low-fibre mice microbiomes did not recover fully when returned to a normal diet, and their offspring had less diversity too. All this suggests that simply eating a better diet may not be enough to restore a fully functioning microbiome.

“The extremely low-fibre intake in industrialized countries has occurred relatively recently,” noted Justin Sonnenburg. “Is it possible that over the next few generations we’ll lose even more species in our gut? And what will the ramifications be for our health?” Simple tweaks in our cultural practices — for example, not washing our hands after gardening or petting our dogs — could be a step in the right direction, and steering away from overuse of antibiotics certainly is, he said.

Human trials of one solution, faecal transplants, are soon to start with the aim of reversing obesity, according to MD Magazine (January 20th) . In another article Infants’ Long-Term Health Affected by Delivery Method and Diet they report on a study that found C-section delivery changed the infant microbiome even more than diet!

Gluten introduction raises babies risk of Coeliac disease

The physicians news journal MD Magazine (January 28th) reports on a Swedish study that looked at the quantity of gluten in the diets of 400 babies, followed for two years. They found that the greater the exposure to gluten the greater the risk of coeliac disease.

Results from other studies have been mixed, but a position paper, published this month by The European Society For Paediatric Gastroenterology, Hepatology & Nutrition recommend gradual introduction:

…consumption of large quantities of gluten should be avoided during the first weeks after gluten introduction and during infancy.

Optimum diet for weight loss and muscle gain?

Recently, I have been researching the importance of dietary protein for muscle health and intend to write a post about it soon. So a piece in The Independent (January 28th) caught my attention. The study they report on claims to have found  the perfect way for men to gain muscle and lose fat quickly: 40% reduction in calories, six day workout routine and increased protein, for a month. In the trial, split between normal and high protein intake, both groups lost fat mass, but only the high protein group increased muscle mass.

The authors point out that the diet is probably too extreme to be maintained in a non-supervised setting. Like most crash diets it is also not suitable for long term weight loss with many studies finding that almost all weight lost is regained in the long run, with no overall benefit. However, raised protein diets are now seen as important from middle age onwards, and have been shown to prevent age related muscle loss. Keep a look out for the article that we are working on re protein and muscle retention.

Paleo or Mediterranean diets to reverse diabetes?

Would you Adam and Eve it? You wait all year for a diabetes diet book to come along, then two arrive at once!

biabetes_diet_books

The Mirror (January 20th) tells the story of Eddy Marshall, director of BBC’s Holby City and Channel 4’s Hollyoaks, who’s diabetes was reversed using a version of the paleo diet, advocated by David Hack, author of a new book ‘The Back to Basics Diet’. I haven’t read it as it is only out this month, but from the Mirror article, it seems to be advocating a proper paleo diet: “organic meat, poultry, eggs, fish, and “plentiful volumes” of vegetables, salads and nuts” to reverse diabetes. Sounds about right to me.

Meanwhile in the DailyMail (January 18th) TV presenter Michael Mosley promotes his new diabetes-busting book. His diet is based around a version of the Mediterranean diet. So what do these two books have in common? Both avoid processed foods, sugar and sweeteners. Both are lowish-carbs. Both encourage real foods such as meat, fish, eggs and vegetables.

BTW: I’m not recommending either of these books – I haven’t read them.

More on diabetes, potatoes and mum’s to be

This month several papers carried the story that mothers that ate more potatoes in the lead up to pregnancy had a higher risk of gestational diabetes. NHS choices (January 13th) critiques the articles. Potatoes or course, are high glycaemic foods, ramping up blood sugar rapidly after consumption. The more portions of potatoes the women ate per week the higher their risk of diabetes. This shouldn’t surprise anyone, as it is basic physiology.

Should you avoid nightshade foods?

Some of my patients need to be on a Solanaceous (nightshade-family) – free diet. This means no tomatoes, peppers, aubergines, chillies, potatoes or paprika. It’s rare to see any articles about this subject, but Health Magazine’s website (January 28th) has a pretty good one on the subject this month. Take a look.

Nitrates and eye health

The Daily Mail (January 15th) reported on a study indicating that dietary nitrates reduce the risk of glaucoma, cutting the ‘risk of a leading cause of blindness by 30%’. Whilst this is interesting in its own right, I thought it was telling that the article only referred to ‘nitrates from green leafy veg’. Nitrates are also found in bacon and cured ham. Why didn’t they mention that? (see our post on pork for more about nitrates in bacon)

Guardian recipes Jan 2016

Recipes

To finish off, here are a few interesting grain-free vegetable dishes to inspire you, courtesy of the Guardian:

August News Round-Up

SHOCK REVELATION: NHS hands out Gluten-free Junk Food on prescription

The biggest laugh of the month has to be the widely circulated story that the NHS is providing gluten-free junk food (cakes, donuts, pizza) on prescription. According to the Telegraph (August 17th),  “One GP called the measures “irresponsible”, claiming some patients were providing a “shopping list” to feed their whole familes.”

Inevitably, backlash from irate coeliac sufferers followed almost instantly. “Patient groups defend NHS spending on gluten-free food for sufferers”, The Independent declared (August 17th).

As I’ve always argued, so called gluten-free products are part of the problem, not part of the solution. Although it is essential that coeliacs have access to gluten-free food they would be far better off adopting a truly grain-free diet, based around real foods such as meat, fish, nuts, vegetables and fruit, rather than the highly processed gluten-free simulacra. The NHS deserves ridicule simply for its failure to promote real food.

Call to switch focus from calories to nutrition to cut CVD

On the theme of real food, the Nursing TImes (August 27th) report on a paper by doctors Aseem Malhotra & Simon Capewell who say evidence shows that poor diet is consistently responsible for more disease and death than physical inactivity, smoking and alcohol put together. I like that!

In an editorial piece in BMJ’s Open Heart they argue that a move away from sugary drinks and towards regular consumption of fish, nuts and olive oil produces cardiovascular benefit in months. In fact they receive the accolade of…

Quote of the month

“Shifting the focus away from calories and emphasising a dietary pattern that focuses on food quality rather than quantity will help to rapidly reduce obesity, related diseases, and cardiovascular risk,”
Malhotra & Capewell, BMJ Open Heart

Sugar

Giving the real-food movement a shot of celebrity TV drama, Jamie Oliver is on the war path as he attempts to argue the case for a sugar tax. According to The Independent (August 27th) in his upcoming TV series Jamie will meet surgeons removing children’s sugar-rotted teeth and performing amputations on diabetes sufferers. The surgeons warn that the NHS will “crumble” due to the accumulating cost of treating sugar-related outcomes.

Sugar as a public health concern is a cause who’s time has come. It’s easy to understand, sufficient scientists have rallied against it, the public are largely on board, and it’s got the ear of politicians. Whilst, of course, I applaud the general direction of this debate I am always wary when an issue becomes a mass media movement. The media wants a simple story, without the subtleties inherent in the science.

An example of this is a study reported in Diabetes in Control (August 20th) that found vegetable oils (corn and soya oil), caused greater obesity and diabetic symptoms in mice than fructose (sugar), whilst highly saturated fats (coconut oil) caused the fewest symptoms. This didn’t make the main news outlets as it’s off-message. You can see the problem can’t you? Who’s going to break the news to Jamie?

Saturated Fat

The Telegraph (August 11th), in a highly cited article, headlines:

Butter unlikely to harm health, but margarine could be deadly

Although traditionally dieticians have advised people to cut down on animal fats, the biggest ever study has shown that it does not increase the risk of stroke, heart disease or diabetes.

Yes, we know that. But good to see the message is gradually getting out. The ‘margarine could be deadly’ bit refers to trans-fats which were indeed in the original margarines of the 1960’s and 70’s. What people casually refer to as margarines now are ‘vegetable spreads’ which don’t contain trans-fats, but instead those vegetable oils we just heard may cause mor obesity than sugar does. But hey ho! – ‘deadly margarine’ makes a good headline!

A more scientific review of this study can be found on Medpage Today and includes some interesting comments from researchers.

Best butter recipes

These recipes also c/o the Telegraph make good use of butter, and are grain-free:

Fish oils and mental health

The Guardian (August 11th) reported on a recent small study which showed that Omega 3 fish oils could prevent schizophrenia among at-risk young people. There was a marked reduction in incidence after 7 years among the group that was supplemented for only 3 months. Larger trials are called for to confirm the results.

The authors speculate that the timing of the intervention may be critical ― during adolescence and before conversion to psychosis, when the neurodevelopment in brain regions relevant to schizophrenia occurs.
MedScape Today (August 20th)

Meanwhile, The Telegraph (August 25th) reports on a large study that found that fish oils failed to slow cognitive decline in the elderly.

These results make some sense considering – as explained in our fish talks – that omega-3 oils are critical during brain development. Schizophrenia tends to emerge during late teen years as the brain matures, so more omega-3s at this critical point makes sense. For the elderly, the supplementation started 70 years too late!

Iodine in pregnancy

Linked to fish, is the issue of iodine. Based on earlier studies that identified the UK population as mildly to moderately iodine deficient, a new study has modelled the benefits of iodine supplementation during preganancy suggesting it could be cost effective simply through the national increase in child IQ. BBC News (August 10th) covered it well, whilst NHS Choices gave an in-depth analysis, and, to their credit, recommend good dietary sources of iodine (fish, milk, seaweed) rather than pill popping. So maybe I should be lenient on the NHS after all, as they certainly have this advice correct.

Vitamin D and Multiple Sclerosis

The relationship between low vitamin D status and incidence of multiple sclerosis (MS) is long standing and has been seen time and again in population studies. Observational associations do not, however, prove causality: it is quite possible that a third factor could be driving both low vitamin D and MS for instance.

A new study, reported in The Science Times (August 28th), however, takes us one step closer to an answer. Researchers looked at genes that limit vitamin D synthesis in people and found they were more common among MS patients. As these genes are inherited randomly and are not influenced by environmental factors, the results suggest that low vitamin D is a causative risk factor. Medpage Today (August 31st) goes into the methodology in a bit more detail.

Paleo News

Click to view The Guardian article

This beautiful image comes from The Guardian (August 18th) showing a wonderful range of paleo diet foods. So where’s the story in this?

A paper published this month has argued that the evolution of the human brain depended on access to tubers (like the sweet potato above) as well as meat. Apparently this is news, with The Guardian running the headline: “What Paleo diet experts think – and why they’re wrong“.

The problem with the media is that they always want a bite-size story. There has never been any doubt that the original paleolithic diet included tubers, along with nuts, fruit, leaves, molluscs, shellfish, elephants*, insects… i.e. real foods that can be hunted or gathered. Indeed studies of modern hunter-gatherers have provided evidence for the paleo-diet. Here is some of what these studies say:

  1. The consumption of carbohydrates varies enormously with geographic location
  2. On average carbohydrate consumption is lower than standard western diets whilst protein consumption is higher
  3. Carbohydrate consumption typically comes from tubers, fruit and nuts – but virtually never from grains
  4. Hunter gatherers almost always prize hunted game above gathered tubers which are very much seen as a second rate, fallback food.

Another thing the news papers have failed to point out clearly is that this paper includes no new data – it is simply presenting a hypothesis making an argument for tubers as a source of glucose for brain fuel. It’s a useful, if not entirely original, contribution to the discussion, but didn’t warrant the excitable headlines that most news outlets employed.

The paper that provoked these headlines (The Importance of Dietary Carbohydrate in Human Evolution) deserves a detailed analysis, but that will have to wait for another time.

Humans had a taste for elephants

In the previous section you may have noticed I cheekily slipped in elephants among the list of paleo foods? Even though we all associate cave men with eating woolly mammoths, we often forget that for much of human evolution African elephant was on the menu.

2A26519400000578-0-Early_human_ate_elephants

The Mail Online (July 2nd) had a great article covering recent research about modern tribes who hunted elephants.The researchers studied the taste preferences and hunting behaviour of several ethnographic hunter gatherer groups. They found:

  • Historically, tribes living in East Kenya, such as the Liangula, hunted elephants for meat and particularly preyed upon juveniles because their meat was said to taste better.
  • The Mbuti Pygmy people of Zaire particularly cherish the bone marrow of elephants.
  • The Nuer people of Southern Sudan hunt elephants illegally as they consider the meat to be a delicacy. They describe the flesh as tasting sweet and fat.
  • Historical texts by Western scientists described the taste of elephant meat as being ‘delicate’, ‘tender’ and ‘sweet’.

Take a look at the rest of the article which covers the archaeological evidence of similar consumption patterns going back 400,000 years!

I bet elephant burgers tasted good with roast yam chips. Wait… there’s a T-shirt for that…

Mammoth_Burger

P.S. Before I get complaints from people that don’t recognise a joke… I’m not actually advocating eating elephants! Or yam chips!

VIDEO: Harvard Scientist Supports U-Turn on Dietary Fats

Video

Original full-free text & audio here
http://jama.jamanetwork.com/article.aspx?articleid=2338262

Dariush Mozaffarian, MD, DrPH
http://www.hsph.harvard.edu/dariush-mozaffarian/brief-bio/

Write up on Medpage Today
Experts Applaud Dietary Guidelines That Lift Dietary Fat Cap – The new guidelines wisely reverse 4 decades of dietary advice, say two researchers.