@ProfTimNoakes         Slides available on www.health.uct.ac.zaProfessor TD Noakes OMS, MBChB, MD, DSc, PhD (hc), FACSM, (...
Economic             Within 5 years of     The presence of      A high fat dietconsiderations       the widespread        ...
TODAY         2.5 - 3.5 MILLION                             YEARS AGOOmnivore                                             ...
This change       For 3.5 million yearsoccurred as humans     we have done very  became the best      well without beingmi...
TRIBE / COUNTRY            HEIGHT (cm)                   Cheyenne                   176.7                   Arapaho       ...
MODERN PLAINS INDIANS HUNTING    THE WHITE MAN’S DIET
THE COUNTRIES WITH THE HIGHEST PERCENTAGE             OF OBESE ADULTS         Rank   Country                          Adul...
ANCEL KEYS (1904-2004)                        8                        7                                                  ...
CHANGES IN CIGARETTE CONSUMPTION MATCHES                             THE CHANGING INCIDENCE OF HEART DISEASE              ...
COUNTRIES WHERE DATA WERE AVAILABLE                                      WHEN KEYS PUBLISHED                          8   ...
“….the evidence from 22 countries for which data are availableindicates that the association between the percentage of fat...
RICHARD NIXONAPPOINTS EARL   “Food Bill” insures that US   BUTZ AS      farmers receive $5 billion per SECRETARY OF   year...
“Food Bill” insures that USfarmers receive $5 billion peryear to grow corn and soy.An additional $5 billion forother farme...
• Reduce consumption of fat• Switch from saturated fat to vegetable fats• Reduce cholesterol to 1 egg per day• Eat more ca...
UNITED STATES SENATE SELECT COMMITTEE ON NUTRITION AND HUMAN NEEDS (1968-1977)               “What right has the federal  ...
UNITED STATES SENATE SELECT COMMITTEE ON NUTRITION AND HUMAN NEEDS (1968-1977)               “Resolution of this dilemma t...
UNITED STATES SENATE SELECT COMMITTEE ON   NUTRITION AND HUMAN NEEDS (1968-1977)“…a trial of the low fat diet recommended ...
2010: …no significant evidence for                                             During 5-23 y of follow-up of concluding th...
2011:There were no cleareffects of dietary fatchanges on total mortalityor cardiovascular mortality.
CONSUMPTION OF ANIMAL FAT IN USA FALLS AS                                     INCIDENCE OF HEART DISEASE RISES            ...
Economic             Within 5 years of     The presence of       A high fat dietconsiderations       the widespread       ...
Economic             Within 5 years of     The presence of       A high fat dietconsiderations       the widespread       ...
MILLIONS OF YEARS
28YEARS
INFLUENCE OF 1977 DIETARY GUIDELINES ON                                            % OBESITY IN USA                       ...
DIABETES AND OBESITY RATES IN THE US HAVE SORED      SINCE THE ADOPTION OF THE 1977 DIETARY GUIDELINES% of Americans with ...
CHANGES IN US MACRONUTRIENT INTAKES – 1971 - 2000                                             NHANES MEN                  ...
Economic             Within 5 years of     The presence of       A high fat diet      The Woman’s                         ...
Economic             Within 5 years of     The presence of       A high fat dietconsiderations       the widespread       ...
WHY DOES OBESITY OCCUR ONLY IN SOME WHEN ALL EAT           HIGH CARBOHYDRATE DIETS?      Largest man in the    American po...
Obesity cannot be due simply to doing too littleexercise.In a homeostatically-regulated system, anyreduction in energy exp...
THE CONDITON OF CARBOHYDRATE RESISTANCE                                              KF Petersen, S Dufour, DB Savage. PNA...
The metabolism of every human is          not the same.    Those with carbohydrate    resistance are unable to metabolize ...
METABOLIC PROFILE OF PERSONS WITH CR INGESTING A HIGH CARBOHYDRATE DIET           Elevated blood glucose concentrations   ...
BLOOD RISK FACTORS FOR CORONARY HEART DISEASE                       Total Cholesterol                      Ultrasensitive ...
THE DIETARY FAT HYPOTHESIS FOR HEART DISEASE             Atherogenic Dyslipidaemia (AD)                  Increased LDL  Hi...
RELATIVE IMPORTANCE (BASED ON HAZARD RATIO) OFDIFFERENT RISK FACTORS FOR CORONARY HEART DISEASE                    RISK FA...
PREDICTIVE VALUE OF HbA1c FOR CORONARY HEART                                           DISEASE EVENTS AND ALL-CAUSE MORTAL...
CUMULATIVE INCIDENCE OF IHD FOR DIFFERENT                                      RANDOM BLOOD GLUCOSE CONCENTRATIONS        ...
BLOOD GLUCOSE (mmol/L) IN THE NORMAL RANGE PREDICTS              CARDIOVASCULAR OUTCOME               2.0               1....
Economicconsiderations                     Within 5 years of                     the widespread                           ...
Economic             Within 5 years of     The presence of       A high fat dietconsiderations       the widespread       ...
A HIGH FAT DIET REVERSES ALL CORONARY RISK         FACTORS MORE EFFECTIVELY THAN A LOW FAT DIET      ApoB/ApoA-1          ...
“Meta-analysis … on data obtained in 1,141 obesepatients, showed the low carbohydrate diet to beassociated with significan...
THE DIETARY CARBOHYDRATE HYPOTHESIS FOR HEART DISEASEHyperglycaemic HyperinsulinaemicAtherogenic Dyslipidaemia (HHAD)     ...
Economic             Within 5 years of     The presence of the    A high fat diet     CONCLUSION:considerations       the ...
The 48 836-personEconomic             Within 5 years of     The presence of       A high fat diet                         ...
WOMEN’S HEALTH DIETARY MODIFICATION TRIAL                                 48 836 post-menopausal women               40% a...
Conclusion: The study “did notsignificantly reduce the risk of coronaryheart disease, stroke, or cardiovasculardisease in ...
“...THE HR FOR THE 3.4%                            OF WOMEN WITH CVD AT                            BASELINE WAS 1.26 (95% ...
“The results of this study do not changeestablished recommendations on diseaseprevention. Women should continue to …work w...
“This study shows that just reducing total fatintake does not go far enough to have animpact on heart disease risk. While ...
THE UPTON SINCLAIR THEOREM“It is difficult to geta man to understandsomething, when hissalary dependsupon his notunderstan...
Shikany JM, Margolis KL, Pettinger M, et al. Effects of a low-fat dietary intervention on glucose, insulin, and insulinres...
“….women with diabetes at baseline didexperience adverse glycemic effects of the low-fat diet, which indicated thatunless ...
The Look AHEAD Trial was terminatedprematurely in October 2012 after 11.5years as it was found that even whencombined with...
CONCLUSION:Economic             Within 5 years of     The presence of       A high fat diet      The 48 836-personconsider...
Economic             Within 5 years of     The presence of       A high fat diet      The 48 836-personconsiderations     ...
Cholesterol is not an important risk factor for heart disease and current dietary recommendations do more harm than good, ...
Cholesterol is not an important risk factor for heart disease and current dietary recommendations do more harm than good, ...
Cholesterol is not an important risk factor for heart disease and current dietary recommendations do more harm than good, ...
Cholesterol is not an important risk factor for heart disease and current dietary recommendations do more harm than good, ...
Cholesterol is not an important risk factor for heart disease and current dietary recommendations do more harm than good, ...
Cholesterol is not an important risk factor for heart disease and current dietary recommendations do more harm than good, ...
Cholesterol is not an important risk factor for heart disease and current dietary recommendations do more harm than good, ...
Cholesterol is not an important risk factor for heart disease and current dietary recommendations do more harm than good, ...
Cholesterol is not an important risk factor for heart disease and current dietary recommendations do more harm than good, ...
Cholesterol is not an important risk factor for heart disease and current dietary recommendations do more harm than good, ...
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Cholesterol is not an important risk factor for heart disease and current dietary recommendations do more harm than good, by Tim Noakes

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A talk by Tim Noakes.
Original slides available here: http://www.health.uct.ac.za/centenary/past_events/centenary_debate/

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  • In the interests of trying to keep to my time allocation I will be reading from a prepared text which is not my preferred method of lecturing but I have a very short time to convince you that everything you believe on this topic is wrong. Given enough time that would be an easy task. But to get through enough evidence to make you even consider it – I have to stick to my text. Even then I am going to go too fast and I apologise for that. However the slides are available on this website.So to begin: For 59 years we have been brainwashed by governments, industry, some NGO’s and the “experts” to believe that a diet that is killing us is actually good for us. And the evidence that this diet is killing us is all around us but for some reason we apparently can’t see it. Many of our parents have died from chronic diseases that our medicines have been powerless to prevent; our children’s generation is the most obese in the history of mankind. And our own health is not always ideal. I am a perfect example. Despite eating the so-called healthy low fat diet for 33 years I have developed adult-onset diabetes even though I ran more than 70 marathons or ultramarathons in my life and continue to run 30-60 minutes most days. Why is this?
  • I began to question what I should eat when I was first exposed to these books. Gary Taubes’s book traces the changes in our understanding of nutrition over the past 200 years; Russell Smith describes what he calls the cholesterol conspiracy - the greatest scam in the history of medicine and Ben Goldacre looks at the pharmaceutical companies’ influence on what we teach our students. I decided that what I had written in my book Lore of Running was wrong and 2 years ago I said: Sorry I am wrong. And that then led to this debate.
  • Tonight I am going to present 5 irrefutable facts that to my knowledge are not taught at any medical schools in the world. The reason they are not taught is because they are inconvenient – they require that we think differently. And that takes effort. Yet if these facts are true then by ignoring them we cannot arrive at a complete truth and help our patients. So my challenge tonight to this faculty is to ask this question: Do we teach all the facts and therefore have a chance at arriving at the truth? Or do we delete that which is inconvenient? In which case what we are teaching is a blind faith, a religious dogma, not a science. The choice Ladies and Gentlemen is simple but the effects will be profound. My story begin 2.5 million years ago….
  • The acme of human physical perfection was reached in the 1800s by the American Plains Indians who at the time were the tallest in the world – taller even as you can see from this table than even the Australians.
  • But all that changed when the white man shot out the bison and forced these Plains Indians to eat the White Man’s diet with lots of cereals and grains and sugar and other healthy processed foods. And every year millions of dollars are spent trying to understand what causes obesity.
  • And this sequence is repeated all around the world. The 7 fattest nations in the world are small Pacific Islands where people where profoundly healthy eating the foods that existed in their environment. Until they adopted the low fat American health diet full of grains, sugar laden boxed cereals, bread and soft drinks like Coca-Cola and fruit juices. In all these countries, as happened with the Plains Indians, obesity follows immediately and diabetes within 10-20 years. Surely It does not require great intellect to work out what is going on? So where does the problem start?
  • It begins with one man Ancel Keys who was a biochemist with ambition who strayed into epidemiology. In 1953 he collected some data from the World Health Organization and drew this very pretty graph apparently showing a straight line relationshiop between deaths from coronary heart disease in 6 countries and the amount of dietary fat that they ate. What he failed to mention was that an association like this does not prove causation. It was something he never understood at any point in his life. For this this type of study can never PROVE anything. Because it cannot ever exclude that some difference other than the one you measured causes the difference you have found. Do we really believe that the the only important difference between the Japanese and the Americans is that the Americans eat more fat in the diet. But Keys managed to convince the world that that was the case.
  • Problem for Keys was that he was trying to fix a problem that did not need fixing. The rise in heart disease mortality had already reached its peak in 1953 when Keys began his crusade. He should have been around in 1920 to make a difference. In fact the dramatic rise in heart disease rates can be explained quite simply by the rise in cigarette smoking which begin to increase in 1905 nicely 15 years before the rise in heart disease as would be expected as cigarettes take time to cause health damage.
  • Two American epidemiologists showed that Keys had reported only 6 countries not the 22 for which the data were available. They added in the 16 missing points and the graph no longer looked quite so spectacular. However they then looked at all possible factors that might explain this association and concluded - But their effort was wasted as no one took any notice and this classic paper is never read by modern scientists. Instead Key’s acquired political support and his idea became the accepted “truth”. The theory was helped by the next man in our story – President Richard Nixon
  • who appointed Earl Butz as Secretary of Agriculture in 1971 with the twin goals of making the farmers wealthy and bringing down the price of food. Butz decided that the solution was to industrialize the production of corn with the use of massive subsidies to farmers. This drove down the price of corn and irreversibly changed what we have eaten since 1972.
  • But there had to be a market into which the corn could be sold. This was conveniently provided by a Senate Select Committee which under the chairmanship of Senator George McGovern in 1977 produced the first dietary guidelines which fundamentally changed our attitude to what we should eat. Until 1960 everyone knew that carbohydrates are fattening and that is what would then have been taught at this Medical School. But these guidelines written by a vegan with no training in the nutritional science now made carbohydrates the health food and demonized fat producing what we call dietary lipophobia – the fear of fat.
  • But not everyone agreed. Philip Handler President of the US National Academy of Science asked:
  • He added that it could not be a scientific question since there were no data. Rather the decision was made on ethical, moral and political grounds.
  • Dr Ahrens, a highly regarded scientist, who spent his life studying cholesterol metabolism was of the same opinion:
  • But three decades later we know that Handler and Ehrens were correct: This meta-analysis of published studies involving 347 747 subjects studied for between 5 and 23 years concluded that there is (read):
  • And the highest independent authority in science the Cochrane Collaboration has also concluded in 2011 that there is no evidence that reducing the fat in our diet will reduce our risk of dying from heart disease. So the Keys diet-heart theory is wrong– just as the real scientists of the 1950s and 60s warned. The challenge for this medical school is that we either embrace this or we ignore it and continue to teach blind faith. The choice is ours and I am only the messenger!
  • Now we could also have saved ourselves 50 wasted years by simply checking what happened to animal fat consumption in the US as the incidence of heart disease was rising. It was completely stable but has fallen dramatically since 1950 as a direct result of lipohobia.
  • So the first irrefutable truth is that: .
  • The second irrefutable truth is that:..
  • Clearly obesity rates at all ages start to rise immediately after the introduction of the 1977 guidelines.
  • The change in the size of these circles gives an idea of how rapidly this change has occurred in diabetes (point), in childhood obesity and in adult obesity. The growth Is frightening.
  • This slide shows the changes in energy and macronutrient consumption that has happened in these 30 years. ( Point to intake, carbohydrates, fat and saturated fat in men and women over time).
  • So the conclusion of the second irrefutable fact is that:
  • The third irrefutable fact is that we are not all the same – in particular we are not all equally able to metabolize carbohydrate. Instead some are like me and we are carbohydrate-resistant so that (read the slide)
  • Why is that some become as large as these gentlemen? The answer is that the homeostat that regulates our weight has been busted in all who are overweight even those who are much less obese than the American policeman. We are told for example that one cause of obesity is simply because we exercise too little. Well (read overlay)
  • The answer of why the homestat gets broken is best shown by this study from the US. The authors began by screening 400 healthy lean sedentary subjects with a glucose tolerance test and then selected those 12 who had the best carbohydrate metabolism and the 12 with the worst whom they called insulin resistant which is the same as carbohydrate resistant. They then studied the metabolic response of both groups when they ate 2 high carbohydrate meals (55% carbohydrate) plus a large sugar load. This is what was found:
  • We have known since the 1960s that high carbohydrate diets cause the following changes in person with carbohydrate resistance. In the interests of time I am not going to read all of them. The point is that there is a unifying explanation for why these changes occur – they occur in genetically-predisposed individuals exposed to a high carbohydrate diet. All are features of the condition doctors recognize as the metabolic syndrome. The question is how important are all these changes?
  • Now there are a number of chemicals in our blood that tell us something about our health status – again I do not have the time to discuss them all. But the point is that because of our blind faith in Keys’ diet-heart hypothesis, we generally only measure the following blood variables to predict our health and risk: Total cholesterol; HDL-cholesterol; LDL-cholesterol and triglycerides.We do this according to this model of heart disease:
  • That a high fat diet causesatherogenicdyslipidaemia by raising blood cholesterol and triglyceride concentrations and lowering the good HDL cholesterol which then leads magically to arterial clogging. According to this disease a high fat diet causes heart disease but obesity, diabetes, hypertension, gout and the metabolic syndrome are different diseases requiring different treatments. But this model is false because as I will show a high fat diet does not always raise the LDL cholesterol but it always causes triglycerides to go up and HDL cholesterol to go down. In fact it is a high carbohydrate diet which causes the triglycerides to go up and the HDL cholesterol to go down.
  • The next question we need to answer is which of these blood factors is the more important in predicting our future health. To answer this here is the most recent study I could find. In a study of 165 000 subjects of whom 15 000 developed heart attacks and 5000 had strokes it was found that these were the risk factors in order of predictive ability. It shows that the traditional measures of atherogenicdyslipidemia are the least good predictors and are in fact pretty useless. Which is very surprising if cholesterol is meant to be the unique cause of heart disease. The best predictor by far is the disease I have, diabetes. What is it about diabetes that raises the risk of heart disease?
  • Answer comes from European Prospective Investigation in Cancer in 10 000 residents of Norfolk. It was found that the blood glycosylatedhaemoglobin concentration (HBA1c) was the best predictor of risk of heart disease. The HBA1c is a measure of the average blood glucose concentration over the previous 3 months. These data show that at any increasing level of HbA1c there was an increasing risk of heart disease and that at the end of the range the risk is increased more than 7 fold. This compares with an increase of only 1.2-fold for an elevated blood cholesterol concentration (press for arrow). This shows that HBA1c is a far superior predictor of risk than is a raised blood cholesterol concentration.
  • Now HBA!C does not cause heart disease – it just tells us something about the historical blood glucose concentration. This study of 81 000 people in Denmark measured their random blood glucose concentrations many years earlier and then followed them for many years until a sufficient number had developed heart disease. What they found was that for those with a blood glucose of 11 which is found only in diabetes, the cumulative incidence of ischemic heart disease events rose very steeply whereas ….. The consequence was…. These data show that if you want to stay healthy for a long time, you need to keep your blood glucose concentration as close to 5 as possible. And this was confirmed in another recent study
  • reported in the American Heart Journal In which cardiovascular outcome was measured in persons with what we call normal blood glucose concentrations. It was found that even within this range, heart attack risk rose to above that predicted by the total cholesterol concentration (arrow). So this seems to suggest that if you want to really know your heart attack risk you need to measure your blood glucose level regularly as do I with a simple and very cheap piece of equipment.
  • So my conclusion is that …..
  • The fourth irrefutable truth is that
  • I knew nothing of this until I came across the work of Dr Jeff Volek who for the past 30 years has been the world’s leading researcher of the biological effects of low carbohydrate diets. His work is extensive and published in some of the best journals of the world but he has also collated the work in these books.
  • A recent publication of his reviewed the findings in a study of subjects who ate either the heart healthy high carbohydrate diet or the heart unhealthy high fat diet. Both were calorie restricted. They found the following:Of course this is one study: But fortunately a recent meta-analysis of all these studies shows that Volek is right since a …
  • So we come to the dietary carbohydrate hypothesis for heart disease which is that a …Note in this model there is a single cause.Interestingly this is so easy to test. Either the hypothesis is right or it is wrong. Would be very easy to prove me wrong. But who in the medical school is performing this trial and if no one is, why not? The only reason people don’t test theories is because they are scared of what they might find.
  • So the 4th irrefutable truth is that a …………….
  • The fifth irrefutable truth is that
  • Here is the front page of the first publication dealing with the dietary findings of the Womans Health Inititative showing that Professor Rossouw is indeed an author of the paper. The study design was the following: …This was the conclusion. Of course this is predictable since we know that a low fat diet makes coronary risk factors worse compared to a high fat diet. But was that all that was found?
  • So in a press release at the time Dr E Nable Director of the National Heart Lung and Blood Institute said this:…. She failed to mention that the diet low in fat had increased the risk that the health of women with heart disease would worsen if they ate the low fat diet.
  • Professor Rossouw had his own spin on the study for he said But reducing fat intake in women with heart disease made their outcome worse! So how possibly could reducing it further do anything else than make their condition even worse.
  • And then the final WHI Study relates to diabetes and again the finding is clear: Women with diabetes do worse if they eat the low fat diet. This is entirely predictable because a high carbohydrate diet worsens the metabolic profile in person with carbohydrate resistance as I showed earlier. So they found that (read text)Of course the authors of the WHI did not have the courage to say – actually women with diabetes should have been told to increase their fat intakes!
  • Thus the final irrefutable truth is that:
  • So my final conclusion based on the 5 irrefutable truths that I have presented is that: Thank you for your patience and attention.
  • Cholesterol is not an important risk factor for heart disease and current dietary recommendations do more harm than good, by Tim Noakes

    1. 1. @ProfTimNoakes Slides available on www.health.uct.ac.zaProfessor TD Noakes OMS, MBChB, MD, DSc, PhD (hc), FACSM, (hon) FFSEM (UK) Discovery Health Professor of Exercise and Sports Science MRC/UCT Research Unit for Exercise Science and Sports Medicine, University of Cape Town and Sports Science Institute of South Africa
    2. 2. Economic Within 5 years of The presence of A high fat dietconsiderations the widespread the genetic reversesdrove the adoption adoption of these predisposing allknownof the current guidelines rates of condition, coronary riskdietary guidelines diabetes and carbohydrate- factors in personswithout proper obesity increased resistance, with carbohydrate-scientific explosively. explains why large resistanceevaluation or numbers of whereas a highproof. persons in carbohydrate diet predisposed worsens those populations factors. become obese and diabetic when exposed to a high carbohydrate diet.
    3. 3. TODAY 2.5 - 3.5 MILLION YEARS AGOOmnivore Vegetarian Homo sapiens Australopithecus Africanus
    4. 4. This change For 3.5 million yearsoccurred as humans we have done very became the best well without beingmid-day persistence told what we should hunters in the eat animal kingdom
    5. 5. TRIBE / COUNTRY HEIGHT (cm) Cheyenne 176.7 Arapaho 174.3 Crow 173.6 Sioux 172.8 Blackfeet 172.0 Australia 172.0 Canada 171.0 United States 171.0 Norway 169.0 United Kingdom 166.0 Russia 165.0 Italy 161.0 PLAINS INDIANS HUNTING BUFFALO BEFORE THE ARRIVAL OF THE WHITE MANSteckel RH, Prince JM. Tallest in the world: Native Americans of theGreat Plains in the nineteenth century. Am Econ Rev 2001; 91: 287-294.
    6. 6. MODERN PLAINS INDIANS HUNTING THE WHITE MAN’S DIET
    7. 7. THE COUNTRIES WITH THE HIGHEST PERCENTAGE OF OBESE ADULTS Rank Country Adult obesity (%) 1 Nauru 78.7 2 Samoa 74.8 3 Tokelau 63.2 4 Kiribati 50.3 5 Marshall Islands 46.0 6 Federated States of Micronesia 44.0 7 French Polynesia 40.4 8 Saudi Arabia 36.1 9 Panama 33.9 10 United States 33.7 11 United Arab Emirates 32.8 12 Iraq 32.2 13 Mexico 29.4 14 Kuwait 29.0 15 Egypt 28.9 16 Bahrain 28.5 17 New Zealand 25.4 18 Macedonia 25.3 19 Seychelles 25.1 20 Australia 24.8 21 United Kingdom 24.0
    8. 8. ANCEL KEYS (1904-2004) 8 7 US Canada 6CHD (deaths per 1000) Australia 5 4 England & Wales 3 2 Italy 1 Japan 0 0 10 20 30 40 50 Percent calories from fat
    9. 9. CHANGES IN CIGARETTE CONSUMPTION MATCHES THE CHANGING INCIDENCE OF HEART DISEASE 40 All heart disease 5000 Cigarette consumption 35 4000 Cigarettes per capita per yearAnnual deaths per 100,000 30 25 3000 20 15 2000 10 1000 5 0 0 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 Year
    10. 10. COUNTRIES WHERE DATA WERE AVAILABLE WHEN KEYS PUBLISHED 8 US “….the evidence from 22 countries for which data are available 7 Finland Canada US Canada indicates that the association between the percentage of fat 6 AustraliaCHD (deaths per 1000) Australia calories available for consumption in the national diets and 5 NZ Ireland mortality from arteriosclerotic and degenerativeGreat Britain 4 Israel heart disease is England & Wales not valid; the association is specific neither for dietary fat nor Switzerland W. Germany Sweden 3 Chile for heart disease mortality. Clearly this tenuous association Italy Italy Norway 2 Portugal Holland cannot Japan as much support serve Italy for the hypothesis which 1 etiologic factor France implicates fat as anCeylon Denmark in arteriosclerotic and Japan Mexico degenerative heart disease.” 0 0 10 20 30 40 50 Percent calories from fat Yerushalmy J, Hilleboe HE. Fat in the diet and mortality from heart disease; a methodologic note. N Y State J Med 1957; 57: 2343-2354.
    11. 11. “….the evidence from 22 countries for which data are availableindicates that the association between the percentage of fatcalories available for consumption in the national diets andmortality from arteriosclerotic and degenerative heart disease isnot valid; the association is specific neither for dietary fat norfor heart disease mortality. Clearly this tenuous associationcannot serve as much support for the hypothesis whichimplicates fat as an etiologic factor in arteriosclerotic anddegenerative heart disease.”
    12. 12. RICHARD NIXONAPPOINTS EARL “Food Bill” insures that US BUTZ AS farmers receive $5 billion per SECRETARY OF year to grow corn and soy. AGRICULTURE An additional $5 billion for other farmers.
    13. 13. “Food Bill” insures that USfarmers receive $5 billion peryear to grow corn and soy.An additional $5 billion forother farmers.
    14. 14. • Reduce consumption of fat• Switch from saturated fat to vegetable fats• Reduce cholesterol to 1 egg per day• Eat more carbohydrate, especially grainsThe McGovern Report was written by a junior staffer, avegan, who had no training in the nutritional sciences.
    15. 15. UNITED STATES SENATE SELECT COMMITTEE ON NUTRITION AND HUMAN NEEDS (1968-1977) “What right has the federal government to propose that the American people conduct a vast nutritional experiment, with themselves as subjects, on the strength of so very little evidence?” Philip Handler, National Academy of Science
    16. 16. UNITED STATES SENATE SELECT COMMITTEE ON NUTRITION AND HUMAN NEEDS (1968-1977) “Resolution of this dilemma turns on a value judgment. The dilemma so posed is not a scientific question; it is a question of ethics, morals, politics. Those who argue either position strongly are expressing their values; they are not making scientific judgments”. Philip Handler, National Academy of Science
    17. 17. UNITED STATES SENATE SELECT COMMITTEE ON NUTRITION AND HUMAN NEEDS (1968-1977)“…a trial of the low fat diet recommended by the McGovernCommittee and the American Heart Association has neverbeen carried out. It seems that the proponents of this dietarychange are willing to advocate an untested diet to the nationon the basis of suggestive evidence obtained in tests of adifferent diet. This illogic is presumably justified by the beliefthan benefits will be obtained, vis-à-vis CHDprevention, by any diet that causes areduction in plasma lipid levels”.Ahrens EH. Dietary fats and coronary heartdisease: unfinished business. Lancet 1979; 2: 1345-1348.
    18. 18. 2010: …no significant evidence for During 5-23 y of follow-up of concluding that dietary 347,747 subjects, 11,006 developed CVD or stroke. saturated fat is Intake of saturated fat was not associated with an associated with an increased increased risk of risk of CHD, stroke or CVD. Consideration of age, sex and coronary heart disease study quality did not change or cardiovascular the results. disease.Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Meta-analysis of prospective cohort studies evaluating theassociation of saturated fat with cardiovascular disease. Am J ClinNutr 2010; 91: 535-546.
    19. 19. 2011:There were no cleareffects of dietary fatchanges on total mortalityor cardiovascular mortality.
    20. 20. CONSUMPTION OF ANIMAL FAT IN USA FALLS AS INCIDENCE OF HEART DISEASE RISES 40 All heart disease 15 Animal fat 35 Pounds animal fat per year per personAnnual deaths per 100,000 30 10 25 20 15 5 10 5 0 0 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 Year
    21. 21. Economic Within 5 years of The presence of A high fat dietconsiderations the widespread the genetic reversesdrove the adoption adoption of these predisposing allknownof the current guidelines rates of condition, carbohy coronary risk CONCLUSION:dietary guidelines diabetes and drate- factors in personswithout proper obesity increased resistance, explain with carbohydrate-scientific explosively. s why large resistanceevaluation or numbers of whereas a highproof. Keys was wrong. persons in predisposed carbohydrate diet worsens those Fat in the diet does not cause populations factors. become obese and diabetic when heart disease. exposed to a high carbohydrate diet. Diet-heart hypothesis is wrong.
    22. 22. Economic Within 5 years of The presence of A high fat dietconsiderations the widespread the genetic reversesdrove the adoption adoption of these predisposing allknownof the current guidelines rates of condition, carbohy coronary riskdietary guidelines diabetes and drate- factors in personswithout proper obesity increased resistance, explain with carbohydrate-scientific explosively. s why large resistanceevaluation or numbers of whereas a highproof. persons in carbohydrate diet predisposed worsens those populations factors. become obese and diabetic when exposed to a high carbohydrate diet.
    23. 23. MILLIONS OF YEARS
    24. 24. 28YEARS
    25. 25. INFLUENCE OF 1977 DIETARY GUIDELINES ON % OBESITY IN USA 50 40 Dietary goals forPercent with BMI> 30kg.m2 Americans released 30 20 45-64 years 10 30-44 years 65 years & over 18-29 years 0 1971-74 1976-80 1988-94 1999-00 2005-06 2001-02 Year
    26. 26. DIABETES AND OBESITY RATES IN THE US HAVE SORED SINCE THE ADOPTION OF THE 1977 DIETARY GUIDELINES% of Americans with diabetes % of US children who are obese 1980 2010 1980 2010 % of US adults who are obese 1980 2010
    27. 27. CHANGES IN US MACRONUTRIENT INTAKES – 1971 - 2000 NHANES MEN NHANES WOMEN 3000 CHO:FAT:PROT 3000 CHO:FAT:PROT 42:37:17 49:33:16 45:36:17 52:33:15 +6.8% 2500 2500 Carbohydrate-induced Hyperphagia 2000 2000Energy intake (kcal) +21.7% 1500 1500 +23.4% 1000 1000 +38.4% -5% +11% 500 500 -14% +3% 0 0 71-74 76-80 88-94 99-2000 71-74 76-80 88-94 99-2000 Intake Carbohydrates Fat Saturated fat Hite AH, Feinman RD, Guzman GE, et al. In the face of contradictory evidence: report of the
    28. 28. Economic Within 5 years of The presence of A high fat diet The Woman’s CONCLUSION:considerations the widespread the genetic reverses Health Initiativedrove the adoption adoption of these predisposing allknown Randomizedof the current guidelines rates of condition, carbohy coronary risk Controlled Dietarydietary guidelines diabetes and drate- factors in persons Modification Trialwithout properscientific obesity increased explosively. Explosive increase in rates resistance, explain s why large with carbohydrate- resistance (WHIRCDMT) of which myevaluation orproof. of obesity and Type II numbers of persons in whereas a high carbohydrate diet opponent was Project Leader diabetes in the US has predisposed populations worsens those factors. proves that the prescription of a been caused by an become obese and diabetic when high carbohydrate diet to persons increased carbohydrate exposed to a high carbohydrate diet. with either known heart disease or intake resulting from the diabetes constitutes 1977 Dietary Guidelines medical malpractice.
    29. 29. Economic Within 5 years of The presence of A high fat dietconsiderations the widespread the genetic reversesdrove the adoption adoption of these predisposing allknownof the current guidelines rates of condition, carbohy coronary riskdietary guidelines diabetes and drate- factors in personswithout proper obesity increased resistance, explain with carbohydrate-scientific explosively. s why large resistanceevaluation or numbers of whereas a highproof. persons in carbohydrate diet predisposed worsens those populations factors. become obese and diabetic when exposed to a high carbohydrate diet.
    30. 30. WHY DOES OBESITY OCCUR ONLY IN SOME WHEN ALL EAT HIGH CARBOHYDRATE DIETS? Largest man in the American police world in 1903 officer in 2012
    31. 31. Obesity cannot be due simply to doing too littleexercise.In a homeostatically-regulated system, anyreduction in energy expenditure will be matchedby an exactly equal reduction in energy intake.Conversely any sustained increase in energyconsumption should be matched by an increasein energy expenditure.Hence the problem must be that the homeostathas been broken by the 1977 Dietary Guidelines.
    32. 32. THE CONDITON OF CARBOHYDRATE RESISTANCE KF Petersen, S Dufour, DB Savage. PNAS. 104; 12587–12594, 2007. 180 Meal Meal 250 Meal Meal 10am 2:30pm Insulin-resistant 10am 2:30pmPlasma glucose concentrations Plasma insulin concentrations 160 Insulin-sensitive 200 140 150 (µU/mL) (mg/dL) 120 100 100 80 50 60 0 10am 12pm 2pm 4pm 6pm 10pm 12am 2am 4am 6am 10am 12pm 2pm 4pm 6pm 10pm 12am 2am 4am 6am 180 28 P = 0.00005Plasma triglyceride concentrations 160 24 140 De novo lipogenesis 20 120 (mg/dL) 16 (mg/dL) 100 80 12 60 8 40 20 4 0 0 10am 12pm 2pm 4pm 6pm 10pm 12am 2am 4am 6am Insulin sensitive Insulin resistantPetersen KF, Dufour S, Savage DB, et al. The role of skeletal muscle insulin resistance in the
    33. 33. The metabolism of every human is not the same. Those with carbohydrate resistance are unable to metabolize carbohydrate safely.
    34. 34. METABOLIC PROFILE OF PERSONS WITH CR INGESTING A HIGH CARBOHYDRATE DIET Elevated blood glucose concentrations Elevated blood insulin concentrations Elevated HbA1c concentrations Elevated blood triglyceride concentrations Reduced blood HDL-cholesterol concentrations (HDL-C) Increased small LDL-cholesterol particles (LDL-C P) Increased blood uric acid concentrations Increased blood ultrasensitive CRP concentrations Additional features: Fatty liver Obesity Hypertension
    35. 35. BLOOD RISK FACTORS FOR CORONARY HEART DISEASE Total Cholesterol Ultrasensitive CRP Fibrinogen Glucose HbA1c Homocysteine HDL-cholesterol LDL-Cholesterol LDL- Cholesterol particle size or number Lp (a) Insulin Omega 6 to Omega 3 ratios Triglycerides Uric Acid
    36. 36. THE DIETARY FAT HYPOTHESIS FOR HEART DISEASE Atherogenic Dyslipidaemia (AD) Increased LDL High fat cholesterol Arterial diet Increased “clogging” triglycerides Reduced HDL cholesterolOBESITY, DIABETES, HYPERTENSION, GOUT, METABOLIC SYNDROME ARE SEPARATE/DISTINCT DISEASES
    37. 37. RELATIVE IMPORTANCE (BASED ON HAZARD RATIO) OFDIFFERENT RISK FACTORS FOR CORONARY HEART DISEASE RISK FACTOR HAZARD RATIO (RANGE) Diabetes 2.04 (1.76 – 2.35) Age 1.87 (1.73 – 2.02) Current smoking 1.79 (1.66 – 1.94) Systolic blood pressure 1.31 (1.26 – 1.37) Total [Cholesterol] 1.22 (1.17 – 1.27) [Triglyceride] 1.19 (1.15 – 1.23) [HDL-Cholesterol] 0.83 (0.78 – 0.87) Di AE, Gao P, Pennells L, et al. Lipid-related markers and cardiovascular disease
    38. 38. PREDICTIVE VALUE OF HbA1c FOR CORONARY HEART DISEASE EVENTS AND ALL-CAUSE MORTALITY 8 Coronary heart disease events 7 All-cause mortality Age-adjusted relative risk (95% CI) 6 5 Carbohydrate resistance 4 “Pre-diabetes” 3 2 1 Total Cholesterol Hazard Ratio 0 <5.0 5-5.4 5.5-5.9 6.0-6.4 6.5-6.9 >7.0 Known diabetes Hemoglobin A1C concentrations (%)Khaw KT, Wareham N, Bingham S, et al. Association of hemoglobin A1c with cardiovascular disease and mortality in adults:
    39. 39. CUMULATIVE INCIDENCE OF IHD FOR DIFFERENT RANDOM BLOOD GLUCOSE CONCENTRATIONS Ischemic heart disease Myocardial infarction 100 >11mmol/L (>198 mg/dL) 90 9-10.9 mmol/L (162-197 mg/dL) 7-8.9 mmol/L (126-161 mg/dL) 80 5-6.9 mmol/L (90-125 mg/dL) <5 mmol/L (<90 mg/dL) Cumulative incidence (%) 70 Overall log rank p<0.001 60 50 40 30 20 10 0 20 30 40 50 60 70 80 90 100 20 30 40 50 60 70 80 90 100 Age (Years) Age (Years)Benn M et al. Non-fasting glucose, ischemic heart disease and myocardial infarction. Journal of the American College of Cardiology 59; 2012.
    40. 40. BLOOD GLUCOSE (mmol/L) IN THE NORMAL RANGE PREDICTS CARDIOVASCULAR OUTCOME 2.0 1.5Hazard Ratio Total Cholesterol 1.0 Hazard Ratio 0.5 Group 1 Group 2 Group 3 Group 4 Group 5 IFG 2.8-4.4 4.5-4.6 4.7-4.9 5.0-5.2 5.3-5.5 5.6-7.0 Shaye K, Amir T, Shlomo S, Yechezkel S. Fasting glucose levels within the high normal range .
    41. 41. Economicconsiderations Within 5 years of the widespread The presence of the genetic CONCLUSION: A high fat diet reverses allknown The Woman’s Health Initiativedrove the adoption adoption of these predisposing Randomizedof the currentdietary guidelines guidelines rates of diabetes and condition, carbohydrate- Their abnormal coronary risk factors in persons Controlled Dietary Modification Trialwithout proper obesity increased resistance, carbohydrate with carbohydrate- (WHIRCDMT) ofscientificevaluation or explosively. explains why large numbers of metabolism explains resistance whereas a high which my opponent wasproof. persons in predisposed why those with carbohydrate diet worsens those Project Leader proves that the populations carbohydrate factors. prescription of a become obese and diabetic when resistance develop high carbohydrate diet to persons exposed to a high carbohydrate diet. obesity, diabetes and with either known heart disease or coronary heart disease diabetes when eating a high constitutes medical carbohydrate diet. malpractice.
    42. 42. Economic Within 5 years of The presence of A high fat dietconsiderations the widespread the genetic reversesdrove the adoption adoption of these predisposing allknownof the current guidelines rates of condition, carbohy coronary riskdietary guidelines diabetes and drate- factors in personswithout proper obesity increased resistance, explain with carbohydrate-scientific explosively. s why large resistanceevaluation or numbers of whereas a highproof. persons in carbohydrate diet predisposed worsens those populations factors. become obese and diabetic when exposed to a high carbohydrate diet.
    43. 43. A HIGH FAT DIET REVERSES ALL CORONARY RISK FACTORS MORE EFFECTIVELY THAN A LOW FAT DIET ApoB/ApoA-1 High Carbohydrate Low Fat ApoB Low Carbohydrate High Fat Total Saturated Fatty Acids 12% CHO 60% Fat KetogenicDIet Small LDL-C particles Triglyceride/HDL-C HDL-C Triglyceride AUC Triglyceride Leptin HOMA Insulin Glucose Abdominal fat Body mass 10 0 -10 -20 -30 -40 -50 -60 Percent changeVolek JS, Fernandez ML, Feinman RD, Phinney SD. Dietary carbohydrate restriction induces a unique metabolic state positively
    44. 44. “Meta-analysis … on data obtained in 1,141 obesepatients, showed the low carbohydrate diet to beassociated with significant decreases in body weight,body mass index, abdominal circumference, systolicblood pressure, diastolic blood pressure, plasmatriglycerides, fasting plasma glucose,glycatedhaemoglobin, plasma insulin and plasma C-reactive protein, as well as an increase in high-densitylipoprotein cholesterol. Low-density lipoproteincholesterol and creatininedid not changesignificantly,whereas limited data exist concerningplasma uric acid”.Santos FL et al.
    45. 45. THE DIETARY CARBOHYDRATE HYPOTHESIS FOR HEART DISEASEHyperglycaemic HyperinsulinaemicAtherogenic Dyslipidaemia (HHAD) Low  Glucose Omega  Insulin 3, high Omega 6 High  Triglycerides carbohydrate  HDL-C • Arterial inflammation * (fructose) diet  Small LDL-C • Metabolic syndrome particles • Coronary heart disease/stroke  Uric acid* • Obesity  CRP • Diabetes Fatty liver • Hypertension ONE CAUSE, ONE TREATMENT FOR ALL CONDITIONS
    46. 46. Economic Within 5 years of The presence of the A high fat diet CONCLUSION:considerations the widespread genetic reversesdrove the adoption adoption of these predisposing allknownof the current guidelines rates of condition, carbohyd coronary riskdietary guidelines diabetes and rate- factors in personswithout proper obesity increased resistance, explains with carbohydrate-scientific explosively. why large numbers resistanceevaluation or of persons in whereas a highproof. predisposed carbohydrate diet populations become worsens those obese and diabetic factors. when exposed to a high carbohydrate diet.
    47. 47. The 48 836-personEconomic Within 5 years of The presence of A high fat diet Woman’s Healthconsiderations the widespread the genetic reverses Initiative of whichdrove the adoption adoption of these predisposing allknown my opponent wasof the current guidelines rates of condition, carbohy coronary risk the Projectdietary guidelines diabetes and drate- factors in persons Director proveswithout proper obesity increased resistance, explain with carbohydrate- that the 1977 USscientific explosively. s why large resistance Dietary Guidelinesevaluation or numbers of whereas a high accelerate diseaseproof. persons in carbohydrate diet progression in predisposed worsens those persons with populations factors. either known heart become obese and disease or diabetic when diabetes. Thus his exposed to a high landmark study carbohydrate diet. provides the definitive evidence disproving Keys’ false diet-heart hypothesis.
    48. 48. WOMEN’S HEALTH DIETARY MODIFICATION TRIAL 48 836 post-menopausal women 40% assigned to low fat 60% to self-selected eating pattern dietary behaviour Subjects reduced energy from Control subjects received a copy fat to 20% and from saturated fat of Dietary Guidelines for to 7% and increased fruit and Americans “as well as other vegetable intake to at least five health-related material but had servings per day and grains to at no contact with nutritional least six servings per day. interventionists”. Subjects were followed for 8.1 years.Howard BV, Van HL, Hsia J, et al. Low-fat dietary pattern and risk of cardiovascular disease: the Womens
    49. 49. Conclusion: The study “did notsignificantly reduce the risk of coronaryheart disease, stroke, or cardiovasculardisease in postmenopausal women andachieved only modest effects oncardiovascular risk factors”. But was that all they found?
    50. 50. “...THE HR FOR THE 3.4% OF WOMEN WITH CVD AT BASELINE WAS 1.26 (95% CI 1.03-1.54)....”This is entirely predictable as a high carbohydrate diet producesHHAD(hyperglycaemichyperinsulinaemicatherogenicdyslipidaemia) inthose who are metabolically vulnerable.
    51. 51. “The results of this study do not changeestablished recommendations on diseaseprevention. Women should continue to …work with their doctors to reduce theirrisks for heart disease including followinga diet low in saturated fat, trans fat andcholesterol”.E Nabel, Director, NHLBI.
    52. 52. “This study shows that just reducing total fatintake does not go far enough to have animpact on heart disease risk. While theparticipants’ overall change in LDL “bad”cholesterol was small, we saw trends towardsgreater reductions in cholesterol and heartdisease risk in women eating less saturatedand trans fat”.J Rossouw, Project Director, WHIRCDMT
    53. 53. THE UPTON SINCLAIR THEOREM“It is difficult to geta man to understandsomething, when hissalary dependsupon his notunderstanding it”.
    54. 54. Shikany JM, Margolis KL, Pettinger M, et al. Effects of a low-fat dietary intervention on glucose, insulin, and insulinresistance
    55. 55. “….women with diabetes at baseline didexperience adverse glycemic effects of the low-fat diet, which indicated thatunless accompanied by additionalrecommendations to guide carbohydrateintake”.Shikany JM et al.
    56. 56. The Look AHEAD Trial was terminatedprematurely in October 2012 after 11.5years as it was found that even whencombined with exercise, the Prudent diethad no measureble effect on developmentof arterial disease and its complications inpersons with Type 2 Diabetes. Continuingthe trial was considered “pointless”.
    57. 57. CONCLUSION:Economic Within 5 years of The presence of A high fat diet The 48 836-personconsiderations the widespread the genetic reverses Woman’s Healthdrove the adoption adoption of these predisposing allknown Initiative provesof the current guidelines rates of condition, carbohy coronary risk that the 1977 US The WHI provides the definitivedietary guidelineswithout proper diabetes and obesity increased drate- resistance, explain factors in persons with carbohydrate- Dietary Guidelines accelerate disease evidence from a randomizedscientificevaluation or explosively. s why large numbers of resistance whereas a high progression in persons withproof.controlled clinical trial that persons in predisposed carbohydrate diet worsens those either known heart disease or disproves the diet-heart hypothesis. populations become obese and factors. diabetes. Thus the research of my Following the 1977 US “Prudent” Diet diabetic when exposed to a high opponent provides the definitive Guidelines worsens the outcome of carbohydrate diet. evidence that disproves Keys’ those who are the most vulnerable false diet-heart hypothesis. because they have either heart disease or diabetes.
    58. 58. Economic Within 5 years of The presence of A high fat diet The 48 836-personconsiderations the widespread the genetic reverses Woman’s Healthdrove the adoption adoption of these predisposing allknown Initiative of whichof the current guidelines rates of condition, carbohy coronary risk my opponent was CONCLUSION:dietary guidelines diabetes and drate- factors in persons the Project Leaderwithout proper obesity increased resistance, explain with carbohydrate- proves that thescientific explosively. s why large resistance 1977 US Dietaryevaluation or numbers of Guidelinesproof. The Diet Heart Hypothesis of Ancel Keys is WRONG. persons in whereas a high carbohydrate diet accelerate disease predisposed worsens those progression in Its widespread promotion in the name of good science populations factors. persons with represents the single greatest error in medicine in the become obese and diabetic when either known heart disease or past 60 years. exposed to a high carbohydrate diet. diabetes. Thus that landmark study provides the definitive evidence disproving Keys’ false diet-heart hypothesis.

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