Ancestral Health Symposium                             The nutrition mess.                               Can we fix it?    ...
The first question we ask medical students:   “Do you think there has ever been a moment in the history of   medicine, whe...
The nutrition mess:   Mixed messages and ambiguous writing from health   organizations and their media.   ...and the news ...
Monday, August 29, 2011
Wait a minute...    Robert Lustig’s lecture on YouTube, with 1.5 million hits, asked,    as Gary Taubes put it: “Is fructo...
We ask incoming medical students...           1. The most energy-dense nutrient (most calories/gram) is                A. ...
This is actually not good for such an educated group. But             they’re young, healthy and generally thin.          ...
2. For a slice of buttered bread,             which is more fattening?                 A. the bread                 B. the...
2. For a slice of buttered bread,            which is more fattening?                 A. the bread                 B. the ...
3. During the epidemic of obesity and diabetes, the macronutrient that           increased most was:                 A. ca...
3. During the epidemic of obesity and diabetes, the macronutrient that           increased most was:                 A. ca...
The increase in calories during the obesity and diabetes epidemic was due largely          to carbohydrate intake. For men...
The problem:           “You are what you eat.”           Bad idea.           Dietary fat does not           necessarily tu...
March. 1984                                                              February. 2011   Cholesterol is proved deadly, an...
The nutrition mess.                           A basic premise of the Dietary Guidelines is                           that ...
PUFA for SFA                        PUFA:                              reduces risk                        risk ↑         ...
A basic premise of the Dietary Guidelines is                          that nutrient needs should be met primarily         ...
A basic premise of the Dietary Guidelines is                          that nutrient needs should be met primarily         ...
A basic premise of the Dietary Guidelines is                          that nutrient needs should be met primarily         ...
The nutrition mess.     Mixed message and ambiguous writing from health     organizations and their media.Monday, August 2...
The nutrition mess.   The news services play   along.                          dumb, but...Monday, August 29, 2011
does anybody get hurt?Monday, August 29, 2011
CHAPEL HILL, N.C. – A diet high in saturated fat is a key                          contributor to type 2 diabetes, a major...
Monday, August 29, 2011
Monday, August 29, 2011
In fact...         Figure 1 Palmitate activates NLRP3-ASC inflammasome.         (a–d) ELISA for IL-1β (a–c), IL-18 (d) and ...
The nutrition mess and the health agencies. First...           5. The dietary requirement for carbohydrate is:            ...
The nutrition mess and the health agencies. First...           5. The dietary requirement for carbohydrate is:            ...
could this be a place for government intervention?                                     ● Sucrose-containing foods can be  ...
Goals of MNT that apply to individuals with diabetes    4) To maintain the pleasure of eating by only limiting food choice...
Monday, August 29, 2011
“For weight loss, either low-carbohydrate or low-fat calorie-                    restricted diets may be effective in the ...
Monday, August 29, 2011
Statistical Analysis                                      We used The previously mentioned longitudinal models preclude   ...
Suppose we plot drop-outs vs.                          difference between groups.Monday, August 29, 2011
Samuel Klein, MD    DISCUSSION    Our study has 2 main findings. First, neither dietary fat nor carbohydrate intake influenc...
Monday, August 29, 2011
Bethesda, we have a problem.Monday, August 29, 2011
8. Several large clinical or population studies have been carried out to           determine if there is an association be...
8. Several large clinical or population studies have been carried out to           determine if there is an association be...
At the end of our clinic day, we go home thinking, "The clinical improvements are so large   and obvious, why dont other d...
Returning to the first question a moment in the history of                    medicine. Ignaz Semmelweis was a physician i...
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Feinman - The Nutrition Mess. Can We Fix It?

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Presentation at the Ancestral Health Symposium. Government can provide education and oversight of scientific publications and the press which accounts for the current nutrition mess.

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  • Great piece Richard; the producers of many studies are either fundamentally incompetent or significantly biased - a mixture of both I guess.
    Either way, the conclusions are infuriating to read for anyone who has specialized in engineering problem solving; handing ownership of such critical questions to these groups is like giving barbed wire to the baby.....keep up the great work!
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Feinman - The Nutrition Mess. Can We Fix It?

  1. 1. Ancestral Health Symposium The nutrition mess. Can we fix it? Richard David Feinman Department of Cell Biology SUNY Downstate Medical Center Brooklyn, New York feinman@mac.comMonday, August 29, 2011
  2. 2. The first question we ask medical students: “Do you think there has ever been a moment in the history of medicine, when a majority of physicians and scientists held to a theory that was wrong and dangerous and resisted change despite contradictory evidence? Do you think that there has ever been such a period?” If you think it has happened before, you at least have to consider the possibility that this is another such period. My answer will be that current nutrition is a mess with scandals equal to any in the history of medicine. I will suggest a government solution.Monday, August 29, 2011
  3. 3. The nutrition mess: Mixed messages and ambiguous writing from health organizations and their media. ...and the news services play along. Sins of omission in the scientific literature: Failure to cite relevant literature. Experiments with no null hypothesis. Two worlds. Establishment nutrition does not cite or even recognize carbohydrate restriction. Peer review is so biased as to be meaningless. Progression of scapegoats: cholesterol, saturated fat, trans-fat, fructose.Monday, August 29, 2011
  4. 4. Monday, August 29, 2011
  5. 5. Wait a minute... Robert Lustig’s lecture on YouTube, with 1.5 million hits, asked, as Gary Taubes put it: “Is fructose a toxin?.” Case against fructose not established but, more important... ...suggestion for government intervention in terms of taxes on sugar and pressure on private industry. Government intervention has other mechanisms than punitive measures. Government can evaluate the science -- even the science of government agencies. Beyond private industry, how about private health agencies? ADA, AHA: are they accountable?. Look at a couple of examples. But first, whaddaya’ know?Monday, August 29, 2011
  6. 6. We ask incoming medical students... 1. The most energy-dense nutrient (most calories/gram) is A. carbohydrate B. fat C. protein D. ethanol -Monday, August 29, 2011
  7. 7. This is actually not good for such an educated group. But they’re young, healthy and generally thin. 1. The most energy-dense nutrient (most calories/gram) is A. carbohydrate B. fat C. protein D. ethanol carbohydrate = 4 kcal/g fat = 9 kcal/g protein= 4 kcal/g ethanol= 7 kcal/g • Everybody, including the National Boards, expects you to know these numbers.Monday, August 29, 2011
  8. 8. 2. For a slice of buttered bread, which is more fattening? A. the bread B. the butter C. both are equally fattening D. cannot tell from information given -Monday, August 29, 2011
  9. 9. 2. For a slice of buttered bread, which is more fattening? A. the bread B. the butter C. both are equally fattening D. cannot tell from information given You cannot tell without knowing how much butter and how much bread. • Energy-density, like any density, is an intensive property: two pieces of bread have the same energy-density as one. • Total calories is an extensive property = energy-density x grams.Monday, August 29, 2011
  10. 10. 3. During the epidemic of obesity and diabetes, the macronutrient that increased most was: A. carbohydrate B. fat C. protein D. all about the same, calories increased across the board.Monday, August 29, 2011
  11. 11. 3. During the epidemic of obesity and diabetes, the macronutrient that increased most was: A. carbohydrate B. fat C. protein D. all about the same, calories increased across the board.Monday, August 29, 2011
  12. 12. The increase in calories during the obesity and diabetes epidemic was due largely to carbohydrate intake. For men, the absolute amount of total fat and saturated fat went down.Monday, August 29, 2011
  13. 13. The problem: “You are what you eat.” Bad idea. Dietary fat does not necessarily turn to body fat. Better: “You are what your body does with what you eat.” Metabolism describes how foods are processed. Hormones affect rates of metabolic processes. Did we get the message?Monday, August 29, 2011
  14. 14. March. 1984 February. 2011 Cholesterol is proved deadly, and our diet may never be the same Other doctors are not so sure, and urge a stricter This year began with the announcement by the Federal Government interpretation of the study. Says Dr. Edward Ahrens, a of the results of the broadest and most expensive research project in veteran cholesterol researcher at Rockefeller University: medical history. Its subject was cholesterol... Among the "Since this was basically a drug study, we can conclude conclusions: nothing about diet; such extrapolation is unwarranted, • Heart disease is directly linked to the level of cholesterol in the unscientific and wishful thinking." blood. • Lowering cholesterol levels markedly reduces the incidence of fatal heart attacks.Monday, August 29, 2011
  15. 15. The nutrition mess. A basic premise of the Dietary Guidelines is that nutrient needs should be met primarily through consuming foods. Foods provide an array of nutrients and other components that are thought to have beneficial effects on health. Nutrient-dense foods and beverages are lean or low in solid fats low in solid fats, and minimize or exclude added solid fats, sugars, starches, and sodium. Ideally, they also are in forms that retain naturally fats exclude added solid occurring components, such as dietary fiber. All vegetables, fruits, whole grains, seafood, eggs, fat-free unsalted nuts and seeds,milk beans and peas, fat-free fat- free and fat-free milk and milk products, and lean lean meats meats and poultry—when prepared without adding solid fats or sugars—are nutrient-dense without adding solid fats foods.Monday, August 29, 2011
  16. 16. PUFA for SFA PUFA: reduces risk risk ↑ CHO for SFA CHO: reduces risk risk ↑ NO EFFECT Jakobsen MU, et al: Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies. Am J Clin Nutr 2009, 89(5):1425-1432. Statistical rule: If 95% CI crosses 1.0, no difference. Almost none of the individual studies show an effect of saturated fat. And....Monday, August 29, 2011
  17. 17. A basic premise of the Dietary Guidelines is that nutrient needs should be met primarily through consuming foods. Foods provide an array of nutrients and other components that are thought to have beneficial effects on health. Nutrient-dense foods and beverages are lean or low in solid fats, and minimize or exclude added solid fats, sugars, starches, and sodium. Ideally, they also are in forms that retain naturally occurring components, such as dietary fiber. All vegetables, fruits, whole grains, seafood, eggs, beans and peas, unsalted nuts and seeds, fat-free and low-fat milk and milk products, and lean meats and poultry—when prepared without adding solid fats or sugars—are nutrient-dense foods. A deceptive message and criticism ignored.Monday, August 29, 2011
  18. 18. A basic premise of the Dietary Guidelines is that nutrient needs should be met primarily through consuming foods. Foods provide an array of nutrients and other components that are thought to have beneficial effects on health. Nutrient-dense foods and beverages are lean or low in solid fats, and minimize or exclude added solid fats, sugars, starches, and sodium. Ideally, they also are in forms that retain naturally occurring components, such as dietary fiber. All vegetables, fruits, whole grains, seafood, eggs, beans and peas, unsalted nuts and seeds, fat-free and low-fat milk and milk products, and lean meats and poultry—when prepared without adding solid fats or sugars—are nutrient-dense foods.Monday, August 29, 2011
  19. 19. A basic premise of the Dietary Guidelines is that nutrient needs should be met primarily through consuming fog Foods provide an Feds food foods. array of nutrients and wrong Guidelines get it other components that are thought to have August 5, 2010effects on Last Updated: 3:26 AM, beneficial Posted: 12:39 AM, August 5, 2010 health. 8 Comments: Nutrient-dense foods and beverages are lean orSteven Malanga minimize or exclude low in solid fats, and As government agencies in places like New York seek a added solidin shaping diets, the next set of federal greater hand fats, sugars, starches, and sodium. guidelines, theypublished this year, could nutrition Ideally, to be also are in forms that retain controversialoccurring components, such prove naturally -- for growing scientific evidence suggests that some federal recommendations have as dietary fiber. All vegetables, fruits, whole simply been wrong. grains, seafood, eggs,isbeansitand peas, The crux of the controversy the quantity of fat and carbohydrates we consume and how influences unsalted nuts and seeds, fat-free and low-fat cardiac health. As Scientific American recentlypointed milk and since the first set of guidelines in 1980, and out, ever milk products, and lean meats Americans heard that they had to reduce their intake of poultry—when prepared without dairy products saturated fat by cutting back on meat and adding solid fats or sugars—are carbohydrates. They foods. and replacing them with nutrient-dense dutifully complied. Since then, obesity has increased sharply, and the progress that the country has made against heart disease has largely come from statin drugs. Read more: http://www.nypost.com/p/news/opinion/ opedcolumnists/ feds_food_fog_1Sn8sLmkw7dv8wl47bqQKL#ixzz1GcdEMonday, August 29, 2011
  20. 20. The nutrition mess. Mixed message and ambiguous writing from health organizations and their media.Monday, August 29, 2011
  21. 21. The nutrition mess. The news services play along. dumb, but...Monday, August 29, 2011
  22. 22. does anybody get hurt?Monday, August 29, 2011
  23. 23. CHAPEL HILL, N.C. – A diet high in saturated fat is a key contributor to type 2 diabetes, a major health threat worldwide. Several decades ago scientists noticed that people with type 2 diabetes have overly active immune responses, leaving their bodies rife with inflammatory chemicals. In addition, people who acquire the disease are typically obese and are resistant to insulin, the hormone that removes sugar from the blood and stores it as energy.Monday, August 29, 2011
  24. 24. Monday, August 29, 2011
  25. 25. Monday, August 29, 2011
  26. 26. In fact... Figure 1 Palmitate activates NLRP3-ASC inflammasome. (a–d) ELISA for IL-1β (a–c), IL-18 (d) and IL-6 (e) in supernatants of resting or LPS-primed bone marrow- derived macrophages (BMMs) stimulated with palmitate conjugated to BSA (PA-BSA) or BSA control. cell study...no mice. CHAPEL HILL, N.C. – A diet high in saturated fat is a key contributor to type 2 diabetes, a major health threat worldwide. Several decades ago scientists noticed that people with type 2 diabetes have overly active immuneMonday, August 29, 2011
  27. 27. The nutrition mess and the health agencies. First... 5. The dietary requirement for carbohydrate is: A. approximately 130 g/day B. approximately 50 % of calories C. as much as possible D. there is no dietary requirement for carbohydrate 6. The carbohydrate intake recommended by the USDA, the American Diabetes Association and other agencies is: A. approximately 130 g/day B. approximately 50 % of calories C. as much as possible D. as little as possibleMonday, August 29, 2011
  28. 28. The nutrition mess and the health agencies. First... 5. The dietary requirement for carbohydrate is: A. approximately 130 g/day B. approximately 50 % of calories C. as much as possible D. there is no dietary requirement for carbohydrate 6. The carbohydrate intake recommended by the USDA, the American Diabetes Association and other agencies is: A. approximately 130 g/day B. approximately 50 % of calories C. as much as possible D. as little as possibleMonday, August 29, 2011
  29. 29. could this be a place for government intervention? ● Sucrose-containing foods can be substituted for other carbohydrates in the meal plan or, if added to the meal plan, covered with insulin or other glucose lowering medications.Monday, August 29, 2011
  30. 30. Goals of MNT that apply to individuals with diabetes 4) To maintain the pleasure of eating by only limiting food choices when indicated by scientific evidence from the hedonists at ADA Recommendations ● Nutrition counseling should be sensitive to the personal needs, willingness to change, and ability to make changes of the individual with pre-diabetes or diabetes. ● For weight loss, either low-carbohydrate or low-fat calorie-restricted diets may be effective in the short term (up to 1 year). ● For patients on low-carbohydrate diets, monitor lipid profiles, renal function, and protein intake (in those with nephropathy), and adjust hypoglycemic therapy as needed. sure, we don’t have a problem with low-carb diets, if you don’t mind CVD ... dietary carbohydrate is the major determinant of postprandial glucose levels. Low-carbohydrate diets might seem to be a logical approach to lowering postprandial glucose. However, foods that contain carbohydrate are important sources of energy, fiber, vitamins, and minerals and are important in dietary palatability. I thought we wanted to reduce energy. is there room for an alternative opinion?Monday, August 29, 2011
  31. 31. Monday, August 29, 2011
  32. 32. “For weight loss, either low-carbohydrate or low-fat calorie- restricted diets may be effective in the short term (up to 1 year).” fat in the “good blood the same ? cholesterol” data from Foster GD, et al.: A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med 2003, 348(21):2082-2090.Monday, August 29, 2011
  33. 33. Monday, August 29, 2011
  34. 34. Statistical Analysis We used The previously mentioned longitudinal models preclude a random-effects linear model that was fitted to all observed data for each variable such as fixed imputation the use of fixed imputation on each of the 307 ...such as less robust approaches,methods (for example, last participants (forthe primary analysis. Each carried methods for example, last observationthe analysis of random-effects observation carried forward or slope to adjust model consisted of a random participants with complete data forward or the analysis of intercept and for [that is, complete case variability due to [that is, complete case participants with complete data within participant individual participant analyses]). These alternative approaches correlations among the observedunrelatedmodels implemented for analyses]).... The data are longitudinalpreviously assume that missing longitudinal to data. These models also contained covariates, including observed outcomes or baseline the following fixed effects: this study relax follow-up visit, group assignment, this missing-completely-at-random main effects for each missing completely at random). The treatment (that is, interactions between each follow-up visitthis study relax this to assumptionmodels implemented for and group related longitudinal in different ways.... can be indicator variables,because it valuecovariate inWe ways. the treatment and baseline is a as a covariate. the model. missing-completely-at-random assumption in different estimated with maximum likelihood by using the PROC The generalized estimating equation– based longitudinal MIXED procedureassume that missing dataInstitute, Cary, logistic models in SAS, version 9 (SAS are unrelated Northpreviously observed outcomes but model structure to Carolina). A parallel longitudinal can be related to based on main effects forit is a covariate in the model. (that the treatment because visit, treatment group, and baseline value covariate-dependent missing completely at random) is, and visit-treatment interactions was implemented with logistic likelihood-based mixed-effects models further relax (18). The regression for binary outcomes. We didthe covariate-dependent missing-completely-at-random estimates by using generalized estimating equations under theassumption by allowing missing data to be dependent on logistic regression model for correlated longitudinal binary outcomes implemented in the GENMOD (that is, missing previously observed outcomes and treatment procedure in SAS, version 9.assess departures for each treatment at random). To Predicted values from the missing-atrandom and visit combinationinformative withdrawal—that assumption under at the mean level of the baseline outcome, missing weights are lower and upperwhich patients is, the with corresponding informative for confidence bounds, were produced under each model for the fi chose to withdraw or continue to participate in the . Oh, hell...intention to treat study—we present sensitivity analyses. As such, we assume that all participants who withdraw would follow first the maximum and then minimum patient trajectory of weight under the random intercept model.Monday, August 29, 2011
  35. 35. Suppose we plot drop-outs vs. difference between groups.Monday, August 29, 2011
  36. 36. Samuel Klein, MD DISCUSSION Our study has 2 main findings. First, neither dietary fat nor carbohydrate intake influenced weight loss when combined with a comprehensive lifestyle intervention. The data? No dietary records were reported. Klein S, Wolfe RR: Carbohydrate restriction regulates the adaptive response to fasting. Am J Physiol 1992, 262:E631-636. “carbohydrate restriction, not the presence of a negative energy balance, is responsible for initiating the metabolic response to fasting.”Monday, August 29, 2011
  37. 37. Monday, August 29, 2011
  38. 38. Bethesda, we have a problem.Monday, August 29, 2011
  39. 39. 8. Several large clinical or population studies have been carried out to determine if there is an association between dietary saturated fat (SF) and cardiovascular disease (CVD). The trial(s) that have successful shown such an association: A. The Framingham Study. B. The Multiple Risk Factor Investigation Trial (MR FIT). C. The Women’s Health Initiative. D. All have demonstrated a relation between SF and CVD E. A and B F. Only A G. None have demonstrated a relation.Monday, August 29, 2011
  40. 40. 8. Several large clinical or population studies have been carried out to determine if there is an association between dietary saturated fat (SF) and cardiovascular disease (CVD). The trial(s) that have successful shown such an association: A. The Framingham Study. B. The Multiple Risk Factor Investigation Trial (MR FIT). C. The Women’s Health Initiative. D. All have demonstrated a relation between SF and CVD E. A and B F. Only A G. None have demonstrated a relation.Monday, August 29, 2011
  41. 41. At the end of our clinic day, we go home thinking, "The clinical improvements are so large and obvious, why dont other doctors understand?" Carbohydrate-restriction is easily grasped by patients: because carbohydrates in the diet raise the blood glucose, and as diabetes is defined by high blood glucose, it makes sense to lower the carbohydrate in the diet.Monday, August 29, 2011
  42. 42. Returning to the first question a moment in the history of medicine. Ignaz Semmelweis was a physician in Vienna in early nineteenth century. One ward in the General Hospital had much greater incidence of puerperal fever (infection following childbirth) than the other. In the latter, babies were delivered by midwives; in the first, by doctors, some of who had just performed autopsies. Semmelweis suggested that physicians should wash their hands between procedures but many refused, some because it was in conflict with established medical practice. Some, because it was too much trouble. In my opinion much harm is being done because physicians refuse to wash their hands of low-fat and other bad ideas.Monday, August 29, 2011
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