The following review of the year captures the 52 articles/topics that I have researched and written about during 2019:
Slimming World’s view of low carb diets. To kick off 2019, Slimming World issued a press release entitled “How low-carbohydrate diets are ‘damaging the nation’s health.’” The press release listed 13 ways in which carbs can help weight loss. I went through each of them and found them to tumble under even basic scrutiny.
HRT & blood clots. A case control study, involving over 80,000 women matched with almost 400,000 control women, claimed that HRT doubles the risk of developing dangerous blood clots. There were some interesting facts in the paper that made the headlines less concerning, but still worth taking note of.
The EAT Lancet diet is nutritionally deficient. Within an hour or so of the EAT Lancet report being published, I had analysed the nutritional content of the recommended diet and found it to be dangerously lacking in vital nutrients.
Why do studies conclude that fiber is associated with better health? This was inspired by the Dr Andrew Reynolds paper in The Lancet, which claimed that high fiber diets cut the risk of heart disease. I went back to basics on fiber and showed why researchers can’t claim such things.
Does low carb mean low fiber? Building on last week’s note, this note showed how a very low carbohydrate diet (43g carb in the example) could deliver 31g of fiber. There is no evidence for the recommendation to consume 30g of fiber a day, but if someone wants to do this, they can do so on a well formulated low carb diet.
Statins in the over 75s. A publication in The Lancet by the Cholesterol Treatment Trialists’ (CTT) Collaboration claimed that “8000 deaths per year could be prevented if all [people over 75] took them [statins]”. The trouble was that the data in the paper did not support this claim. The data were not statistically significant for primary prevention in the over 75s and hence this claim could not be made. This article links to a rapid response I had published in the BMJ on this falsehood.
Why cholesterol can’t cause heart disease. This post connected three things from the previous week – the first was the Appendix to last week’s statin paper in the Lancet (statins in the over 75s). The second was an article “How to beat Heart Disease” in the UK Mail on Sunday newspaper and the third was Dr Malcolm Kendrick’s latest book “A Statin Nation”. The connections led to the logic argued in the title of this post.
Does skipping breakfast increase the risk of type 2 diabetes? The short and obvious answer is clearly no. A systematic review and meta-analysis from November 2018 suggested that it does. I went through the study to show where it went wrong.
Is a vegan diet safe for infants and children? This post was written to support a dietitian friend working in the real food world. She had posted a comment on Facebook about vegan diets not being safe for children and was threatened with being reported to her dietetic body. Incredibly I discovered that the American Academy for Nutrition and Dietetics does support vegan diets for infants and children. I examined advice from other professional bodies and highlighted the nutrients most at risk. I also documented numerous cases of infants being breastfed by vegans and/or on a vegan diet being seriously harmed or even killed by malnutrition.
Cholesterol, statins, the CTSU & the Mail on Sunday. On the first Sunday in March, the Mail on Sunday featured an extraordinary attack on Dr Aseem Malhotra, Dr Malcolm Kendrick and me for our position that information on statins should be provided more fully to patients so that they might make an informed choice. We argue that the benefits are oversold and the harms are routinely dismissed and yet honest sharing of the Numbers Needed to Treat would show patients how few people might be helped if they take statins for 5 years vs. how many might be harmed. This note shares the exchange with the journalist before publication.
Letter to The Lancet re. EAT. I wrote to The Lancet about the deficiencies in the EAT Lancet diet. They refused to publish my letter and so I published it here.
The All-Party Parliamentary Group for Type 2 Diabetes. Thanks to Dr Aseem Malhotra and MP Tom Watson I had the amazing opportunity to present in parliament at an All-Party parliamentary group for type 2 diabetes. This post shares my slides and what I said.
Low carb Denver. There were many wonderful speakers at Low carb Denver and I asked them for the key take-home message from their presentations. This post is a collection of those summary messages.
Eggs, Cholesterol & Cardiovascular disease. This was a review of an article published in the Journal of the American Medical Association claiming that “Eating 300 milligrams of dietary cholesterol a day – or less than that of two egg yolks – was associated with a 17% higher risk of cardiovascular disease.” Just read the Eggs-ecutive summary to see just how many things were wrong with the paper. I tweeted the headines here.
Expecting better. A pregnant friend recommended that I read a book called “Expecting Better.” It was written by an economics professor at the University of Chicago, Dr Emily Oster, who decided to examine the advice given to pregnant women vs the evidence for that advice. She found a huge dearth of information to support the advice that women are given on diet and more.
Keys, cholesterol & rabbits. The following quotation, attributed to Ancel Keys, has been repeated quite often, but with the source for it not always clear: “There’s no connection whatsoever between cholesterol in food and cholesterol in the blood. None. And we’ve known that all along. Cholesterol in the diet doesn’t matter at all unless you happen to be a chicken or a rabbit.” Bob Kaplan helped me to find the source, so I’ve documented it here to help others.
Diet & Deaths. A paper published in the Lancet reported that “In 2017, 11 million deaths were attributable to dietary risk factors.” There were other claims – including that diet was responsible for more deaths than smoking (always guaranteed to get media headlines). These claims cannot be asserted as fact. They were the findings from a computer modelling exercise, the outputs of which are determined by the inputs. I went through the inputs to see where the outputs were not robust.
A global diet in an obese and starving world. This note looks at the global hunger index and world obesity tables in parallel. Most of the world’s most starving and the world’s most obese countries were among the 195 countries reviewed by the ‘diet and deaths’ paper. This note questions whether the global diet being pushed, by some of the most privileged people in the world, is a good idea for the underweight and overweight alike.
Statins don’t work well for half those who take them. The headlines emanating from the paper behind this note seemed extraordinary until you looked at what the researchers hadn’t adjusted for. This study should have been reported as, “Smokers and alcohol misusers have more CVD events – oh and they tend to be less compliant with health advice generally.”
Red meat and bowel cancer. The headlines claimed “Eating just one slice of bacon a day linked to higher risk of colorectal cancer.” The reality was a study that could only show association, not causation. A study where the relative risk claimed was 19%, but the absolute risk was 8 bowel cancer cases per 10,000 people. And that’s over almost 6 years, making the difference in any 1 year, just over 1 person per 10,000. And the healthy person confounder applied…
The relationships between heart disease, cholesterol & dietary fat in Europe. This note is mostly pictures – graphs showing energy from fat across Europe and deaths from heart disease across Europe. They are visibly inverse (higher fat/lower deaths; lower fat/higher deaths.)
Low carb diets & mortality. This is a review of a classic study, so it’s one to bookmark. The Noto 2013 article on low carb diets and mortality is often used against supporters of a low carb diet. The stunt pulled in the paper to get the results that were claimed was one of the most extraordinary I have seen. And I have seen many!
The Public Health Collaboration Conference. If it’s May, it must be the PHC conference. As with Low carb Denver, this note presents the key messages from many of the presentations.
Low fat diet & breast cancer. Headlines in the US and UK claimed “Low-fat diet with more fruits and vegetables may decrease risk of dying from breast cancer.” Two numbers were quoted: that the risk of death from any cause was 15% lower and that the chance of death from breast cancer fell by 21%. The first claim was untrue and the second was not worth calculating, as this note explains…
Prebiotics, probiotics & anxiety. I went through an interesting systematic review with great care and found that the claims made by the researchers simply could not be made. It’s astonishing how often this happens – even following peer review.
White meat as bad as red meat for cholesterol. That was the headline. The headline should have been: “Study shows that almost doubling protein intake and having red or white meat twice a day makes no difference to cholesterol.” I take you through where this study went wrong.
The definition of red meat. I used an epidemiological study just published to show the games that are played with definitions of red and processed meat. There really have been no findings against red meat – let alone pasture fed quality red meat. However, researchers intent on damning meat will lump red and processed meat together at any opportunity. Processed meat also varies greatly from hot dogs and burgers – with the confounders of ketchup, buns, fizzy drinks etc – to the dried and cured natural meats found in delicatessens in the Mediterranean.
Intermittent fasting – time restricted eating. This was a review of an interesting intervention trial. The intervention group consumed three meals at 08.00, 11.00 and 14.00. The control group consumed the same meals at 08.00, 14.00 and 20.00. The intervention was called early Time-Restricted Feeding (eTRF). Glucose and insulin findings confirmed intuitive expectations.
The EAT Lancet diet & the EPIC study. A paper was published on June 21st, which claimed to show that following the EAT Lancet diet was associated with lower risks of ischaemic heart disease and diabetes. The researchers had taken data from a UK population study, called EPIC, and then they had tried to match intakes from the EPIC food frequency questionnaires with the recommended EAT Lancet diet to make their claims. The trouble is, they didn’t match the EAT Lancet diet and therefore all claims are invalid.
Time to re-think saturated fat? A review paper was published in the BMJ on 4th July 2019. The paper questioned whether the World Health Organisation (WHO) guidelines on saturated fat were based on evidence and whether they might be having an adverse impact on disease and deaths. Hallelujah!
Processed food, CVD & NOVA. NutriNet-Santé is an ongoing web-based population study, which was launched in France in 2009 to examine the associations between nutrition and health. It is a classic epidemiological study, but the key difference with this study is that it has defined and is focused on examining ultra-processed food and disease.
How alcohol affects weight. Calories, carbs, glucagon – all the different ways in which alcohol might impair weight loss.
Plant-based diets & type 2 diabetes. Yet another paper was published from the Harvard epidemiology production line. This one claimed that eating plant-based diets was associated with a 23% reduction in the risk of getting type 2 diabetes. This intuitively just doesn’t make sense. Analysis of the paper revealed a fundamental flaw, which undermined all conclusions. The fundamental flaw was that the lowest plant intake people claimed to have eaten an average of 1,400 calories a day (women) and 1,600 calories a day (men). This was two thirds of the calorie intake of those in the highest plant intake group. Clearly the food intake of the ‘bad-diet’ people – used for the entire comparison – was not robust.
US dietitians & their monopoly on dietary advice. 10 years ago, I researched the relationships between the American Dietetic Association (ADA) and big food companies. The combined revenue from organisations in some kind of partnership with the ADA amounted to $467 billion. I updated this research for a presentation I did at CrossFit health in the first week of August. The backing now ‘only’ amounts to $105 billion, but the fake food relationships prevail. As for the monopoly…
SACN (UK) final report on saturated fat. In June 2014, the UK Scientific Advisory Committee on Nutrition (SACN) was tasked with reviewing the role of fats in health in the general UK population. The final report has just been published. The SACN did not examine total fat. The total fat guidelines were issued decades ago completely without evidence base and are now conspicuous in their non-mention. The SACN has re-issued the recommendation from the 1980s/90s that saturated fat should comprise no more than 10% of total calorie intake. There was no evidence for this recommendation at the time. (There is no more now.)
Saturated fat: friends, foes & some fun. One of the most interesting aspects of the Scientific Advisory Committee on Nutrition (SACN) review was seeing the submissions made in response to the draft SACN report. These tell us who are the friends and foes of saturated fat. This note covers the main points made by the friends and foes. It ends with an experiment I did to find individual foods that would meet the 10% saturated fat restriction (as a percentage of total calories) – the results of which surprised me.
Plant based diet propaganda. This is the first of a two part review of a leaflet supporting plant based diets and attacking any animal foods (even eggs and fish). It provides a useful reference for the main claims made by plant based diet proponents, the main papers they rely on and the main issues with their claims.
Plant based diet propaganda Part 2. See above.
Teen goes blind on junk food diet. This was a shocking case report published in the Annals of Internal Medicine about a boy whose diet was so bad he developed multiple nutritional deficiencies and even went medically blind before doctors thought to question what he was eating.
Is lack of sleep making us fat? This is a comprehensive review of the hormones involved in sleep, light, eating and weight.
Is being vegetarian protected in employment law? A really interesting employment tribunal tested this question and it combined my previous life as an HR Director with my current life interested in diet. The vegan issue also came up in the tribunal.
Dairy & disease: revisiting the evidence. This note looks at a paper written by Dariush Mozaffarian. It reviewed the evidence related to the consumption of dairy foods for obesity, heart disease and type 2 diabetes. Current dietary guidelines limit dairy intake and advise that low-fat dairy is consumed, rather than whole/high-fat dairy products. The evidence simply does not support this.
Meat guidelines – the evidence. Six papers about red and processed meat were published in the Annals of Internal Medicine on 30th September 2019. The first was a summary paper about dietary guidelines. The second was a systematic review of randomised controlled trials. There were three systematic reviews and meta-analyses of cohort (observational) studies and one final paper on attitudes towards eating meat. The summary recommendations were that adults should continue current unprocessed and processed red meat consumption, although the recommendations were reported as weak and based on low-certainty evidence.
Can vitamin C help type 2 diabetes? An Australian study claimed that vitamin C could help people with type 2 diabetes. The study claimed that significant differences were observed following vitamin C supplementation, relative to the placebo. Closer examination of the results revealed that the improvements were found because the placebo turned out to have a significant impact. This should not have happened – the placebo should be chosen to have no effect. Hence any claimed results could not be attributed to a positive impact of vitamin C, but rather to the negative impact of the placebo.
How to assess evidence in nutrition. This turned out to be one of the most popular posts of the year (judging by replies and comments). It provides a flow chart for you to work through to examine the value of any study in the field of nutrition. Virtually every publication can be ignored!
National Food Strategy – Call for evidence. This was a submission to a call for evidence for a new food strategy for England. It ended up being a 1,000 word article on what we should eat and why. It might be a good one to tag.
Progress since the last World Diabetes Day. World Diabetes Day is on November 14th each year. I took a look at progress in Australia, the US and the UK since the last World Diabetes Day.
The power of continuous glucose monitors. Andy (hubby) and I wore continuous glucose monitors each for 2 weeks and made some interesting observations.
Eating late & cardiac risk. A story made global headlines along the lines of “eating late could raise cardiac risk.” This article looked at the AHA Life’s Simple 7® as a measure of cardiac health. It also looked at the study behind the headlines and found that, as a population study, this suffered from the usual flaws of epidemiology (association not causation, relative not absolute risk and the healthy person confounder.) There was an even bigger confounder not mentioned. Junk is far more likely to be consumed after 6pm than before. This study may have found nothing more than – the more junk you eat, the worse your heart health score.
Sarcopenia & Diet. This was a review of a study about sarcopenia and diet in very elderly people (over the age of 85). It claimed that people in what it called “the high red meat and butter” group had more sarcopenia than people in what it called “the low butter” group. However, the supplemental material revealed that the so-called ‘high red meat’ group actually consumed 15% less red meat than the so-called ‘low butter’ group.
Carb loading before surgery. ‘Debbie’ emailed to ask if I could look at some advice that she had been given to carb load (food and drink) before surgery. The advice is given world wide and it dates back to a belief (from 1994+) that a glucose drink before surgery reduced insulin resistance. There are many reasons why this claim simply doesn’t stack up today. This note went through the reasons, with the help of an anaesthetist (Shaun) who just happens to have studied this to poster presentation level.
Non-HDL cholesterol & cardiovascular disease. This was a review of a paper published in The Lancet on 3rd December 2019. The paper was a risk-evaluation and risk-modelling study. Models are only as robust as their assumptions and this paper made many assumptions. This post went through the assumptions and what impact they had on the claims made. Essentially, it was claimed that risk could be reduced by up to 90% simply because they assumed it could be so.