DASHing to the “best diet” a critique

The DASH diet is currently hailed as the best diet by U.S News. So what is it? In a nutshell it advocates low-salt, low saturated fat, low cholesterol, more fiber, more fruits, more vegetables, and limited sweets while increasing physical activity. Its designed to hopefully decrease your blood pressure and weight. Oh and check it out, its got the U.S Department of Health and Human Services stamp of approval:

So how dramatic are these changes? Saturated fat drops to less than 7% of our daily calories and cholesterol to 150 mg in their studies…that’s less than a large egg! Carbohydrates, as usual, compose the majority of the diet and salt drops to 2.3 grams.

But how different is this diet really? Let’s compare its recommended servings to something a lot of us grew up familiar with:

VS

Grains are both 6-11 servings between the old food pyramid and the 1600-2600 calorie DASH diets
Vegetables are increased by one serving in the DASH if you are in the 2600 calorie group
Fruits take an increase with a minimum of 4 and up to 6 servings in the 2600 calories group for DASH
Milk products are the same except they must be fat free or low fat in the DASH diet
Meat takes a huge upswing with 3 more servings in the DASH diet
Nuts gets their own segment but in both cases, they recommend very little nut consumption
Fats get separated from Sweets in the DASH diet with 2 servings

So in summary the DASH diet still holds grains as their foundation, with a little more vegetables, a lot more fruit, fat free or low fat milk, and more lean meat. The basic foundation is still carbohydrates, and one can argue you’d consume more carbohydrates on the DASH diet with the increase in fruits and vegetables.

Now its being touted as being able to control cholesterol, triglycerides, weight, and insulin resistance along with blood pressure! But is it really the DASH diet by itself or something else? One study examined this through separating participants into 3 different groups: DASH diet alone, DASH with weight management strategies (psychological motivation, weight reduction and exercise training), or a usual diet control group through a 4 month session:

Effects of the dietary approaches to stop hypertension diet alone and in combination with exercise and caloric restriction on insulin sensitivity and lipids.
From: http://ukpmc.ac.uk/articles/PMC2874827

The two different DASH diets did show decreases in blood pressure compared to the control group but that’s about it. When the DASH alone is compared with the control diet there is no difference in glucose metabolism, insulin sensitivity, cholesterol, triglycerides, LDL levels and HDL levels. The control group did gain an average of 1.2 kg compared to the DASH diet alone…but when you look into the data you’ll find that the Dash diet alone group ate 1962 calories vs the control’s 2095. Is it really that surprising that the control group gained 1.2 kg with 133 more calories ingested everyday spread across 4 months?

It’s only when you add weight management strategies with the DASH diet that you see changes across all measures. Couldn’t it just be the exercise and weigh reduction making the difference? Yes the DASH did lower BP, but couldn’t that just be the lowered salt consumption? Why the need to target fat and cholesterol consumption (especially saturated fat) so much? Btw…even the salt restriction is debatable more on that in future posts…

So is the DASH diet bull? Not necessarily. It may work for some and fail for others in lowering blood pressure and perhaps even the other previously discussed measures. The important point is to not view it as a universal diet panacea that will work for everybody just because a publication hails it as the “best” diet.

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Looking at refined carbohydrates and not fat is so……..1986?

While I’m anxiously waiting for Dr. Lustig’s UCSF series on obesity to come out, I came upon a video that echoes exactly what he’s talking about…more than 25 years ago. While the video is more focused on refined sugar instead of carbohydrates as a whole, the basic arguments are all there. Additionally, Nobel laureate Dr. Linus Pauling is found in the video stating he has never seen any correlation with saturated fat intake and heart disease in the studies he has seen, but has seen some correlation of sugar consumption and heart disease.

“Artery Clogging-Saturated Fatty foods” like Chocolate are associated with…thinness?

Dr. Beatrice from the previous post and her team have found an association between lower BMI and increased chocolate consumption.

The results actually shouldn’t be that surprising since a lot of studies on chocolate have been coming out showing associations with decreased heart disease, better lipid profiles and decreased blood pressure.

Anyways lets take a look at the actual study itself. http://archinte.ama-assn.org/cgi/content/extract/172/6/519

Looks like they found 1018 men and women between 20-85 from San Diego without any cardiac or diabetes. However, to get their results they used food frequency questionnaires. Hmm….how reliable are these? However, food questionnaires are constantly used to support studies showing the usual low-fat advice so its fair game in that regard. Their results showed a 99% chance greater chocolate consumption frequency was linked to lower BMI. In addition, Chocolate consumption was also 99.9%  likely linked to greater calorie and saturated fat intake as well (duh!). By the way, being linked or associated with something doesn’t imply causation! These results are intriguing since we would probably assume the higher amount of calories and saturated fat intake would mean higher BMI.

So what happens when a study raises the ideas of a food people love and crave being associated with a lower BMI? OMG CHOCOLATE MAKES YOU THIN! LEMME AT IT! OUT OF THE WAY! BUY STOCK IN HERSHEY NOW! 

Relax, the people in the study ate chocolate on average 2 times a week (SD=2.5) and exercised 3.6 times a week (SD=3.0) don’t over do it! Again, the more intriguing aspect is the higher amount of calories and saturated fat ingested while being associated with lower BMI which runs contrary to what we would think based on traditional low fat advice.

Its in a study…in a respected academic journal…of course I can trust it!

In the previous post, the fat nurse took a look at a critique showing the inconsistencies and biased research in a study involving statins. How often does biased research occur? According to UCSD Medical School professor Dr. Beatrice Golomb…a heck of a lot:

The entire video is worth a look and is meant to address data manipulation as a whole and she uses Statins quite a bit as examples. The main points:

1) Funding: Pretty much all of the large randomized trials for drugs such as statins are funded by the drug companies. NIH is the second largest but has ties to industry.

2) Publishing: There is evidence showing that studies funded by the drug companies are vastly more likely to be published while studies that are negative are not published, or they are publish in a manner that conveys the drug as having potential outcomes. There is also a part where positive studies are duplicated and resubmitted using different authors (this sounds too unbelievable to be true)!?

3) Comparison study results are determined by the sponsor: 5:55 in the video had me laughing. When comparison of one drug vs another are done, the drug on top is usually the sponsor. Which is how you can find logic in statin studies that show: A beats B. B beats C. C beats D. And D beats A.

4) Results can be interpreted as positive in the conclusion even when results are a negative outcome.

5) Biased Authors: Not surprisingly, authors that have ties to certain drugs will portray them in positive light versus authors without ties.

6) Ghost writing: Drug companies pay for positive articles and then pay other doctors and pharmacists to sign their name to the articles as if they wrote them originally and independently.

7) Medical Journals are biased: Journals can be used for laundering and promoting products in which Dr. Golomb reports can be up to $100,000 per positive article.

8) Medical Education: The Drug companies spend $18.5 billion a year which is roughly $30,000 annually for every doctor in America. In addition, the Accrediting Commission for Continuing Medical Education has almost half of its members linked in some form to the pharmaceutical industry.

Statins lowering your cholesterol…and brain function?

Whoa, missed this piece of big news last month about Statins.

Apparently the FDA has recognized the risk of cognitive impairment with Statin use. Statins, known more by their trade names of Zocor, Crestol and Lipitor, are cholesterol reducing medications given in hopes to reduce serum cholesterol and therefore potentially reduce the risk of heart disease. How does this work? In a nutshell statins inhibit a liver enzyme that is responsible for cholesterol production. However, there are many side effects of Statin use including the risk of developing diabetes.

The interesting part of this article was a statement from the FDA Deputy Director of Safety Dr. Amy G. Egan:

But federal officials and some medical experts said the new alerts should not scare people away from statins. “The value of statins in preventing heart disease has been clearly established,” said Dr. Amy G. Egan, deputy director for safety in the F.D.A.’s division of metabolism and endocrinology products. “Their benefit is indisputable, but they need to be taken with care and knowledge of their side effects.”

When phrases such as “clearly established” and “benefit is indisputable” it conveys a sense of established reality to the public along the lines of “the earth is round.” However, Statin use has been controversial and perhaps more alarming – the studies used to support statin themselves. An example of these controversies can be found in the review Cholesterol Lowering, Cardiovascular Diseases, and the Rosuvastatin-JUPITER Controversy by Lorgeril et al from the Archives of Internal Medicine. http://archinte.ama-assn.org/cgi/content/abstract/170/12/1032

This review points out many flaws in the JUPITER (Justification for the Use of Statins in Primary Prevention) trial which showed rosuvastatin (Crestor) being effective in reducing heart disease complications in primary prevention. Some of the interesting comments by Lorgeril et al are:

“…the results have undoubtedly propelled many healthy persons without elevated cholesterol levels onto long-term statin treatment, the clinical relevance of the JUPITER trial remains in question.”

While this shouldn’t make you reject the use of statins, it should at least make one more interested in looking at additional literature on their efficacy opposite to the FDA’s statements.

Lorgeril et al also point out the study ending prematurely without specifying what the established criteria for a stoppage were. Studies often have stoppage rules that are strictly defined in order to protect subjects or to maintain validity. There might also be potential manipulation of variables that are unexplained:

“Although it is quite unusual that the burden of calculating cardiovascular mortality is placed on the readers, all methods used, however, lead to the same conclusion: there is no significant difference in cardiovascular mortality between the 2 groups in the JUPITER trial.”

Another important point Lorgeril et al point out is the population used is not reflective of populations outside Japanese and Mediterranean populations. Looking at previous studies on rosuvastatin, it also appears the study cherry picked statistics and results that favored them in the literature:

“…the JUPITER data set appears biased. Three other trials135 involving rosuvastatin therapy in high-risk patients did not show any protection. The authors of the JUPITER study fail to comment on these negative trials but go on to report…analyses that appear to support the efficacy (and safety) of rosuvastatin therapy.3538

Conflict of interests also plagued the study with 9 out of 14 authors being financed by the sponsor. Additionally, the sponsor was the one who collected and monitored all the RAW data. However, despite these controversies, this does not stop panels from advising the FDA to make changes to clinical practice such as what occurred in December 2009:

By the way, after checking out that piece on Crestor, take a look at this photo still from one of their ads. Notice something?

While inconsistencies in the literature should not cause people to drop their Statins overnight, it certainly warrants more research than being accepted as “indisputable” evidence.

Things that resemble Cocaine = Bad!

Dr. Lustig, the pediatric endocrinologist featured heavily from the last post, was featured on 60 minutes earlier this month talking about sugars and their effect on health. We all know that excess sugar is bad, but Dr. Lustig’s research in this 60 minutes segment shows excess sugar creating lifelong problems such as diabetes, heart disease, hypertension and even…cancer!

The most interesting part starts at 6:20 in the video. Dr. Gupta narrates:

“…so imagine, for these healthy young people drinking a sweetened drink might be just as bad for their hearts as the fatty cheeseburger we’ve all been warned about since the 1970s.”

What happened in the 1970s? That’s when the government recommended fat consumption to decrease and be replaced by higher carbohydrate consumption according to Dr. Gupta and 60 minutes.

What Dr. Gupta is referring to is the McGovern report. Here is a quick synopsis of it taken from the documentary Fathead.

Dr. Lustig remarks that Americans listened and replaced it with carbohydrates instead:

“…and we did. And guess what? Heart disease, metabolic syndrome, diabetes and death are skyrocketing.”

Could the shift to a low fat diet in hopes to prevent these pathologies form occurring could be the culprit in the first place? Maybe. Maybe not. What is clear tho, the assumption of increased fat consumption being unhealthy needs to constantly be challenged.