Awwwwwwww YEEEESSSSSSSH

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Whoo hoo the TheFatNurse appears to be a board certified FNP now! With this out of the way I can return back to obsessing over obesity related topics…although it would probably be better career wise to obsess over primary care in general…or obsess over learning spanish…or obsess using my energy to look for a full time primary care position…

In anycase, thank you so much for keeping up with this blog and my progress. A special thank you to the people who have e-mailed me their own personal stories with their struggle against obesity and metabolic disease; it is you guys who drive me to always be open minded and always do my best!

Saturated Fat, Cholesterol & Carbohydrates all over the World & Updates

Hello again! It’s been a long 5 months since TheFatNurse’s last post! I’ve been finishing up the last semester of my Family Nurse Practitioner Program and getting ready for the Boards. This means I’ve been spending less time focusing on fat related issues and more time diving into other areas of health. As result, I’ve had less time to focus on the blog. I do plan to get back into updating more regularly once the year is over.

However, the past couple of weeks has had several developments that are too note worthy to not mention! Starting in Australia:

ABC has an investigative show called Catalyst in Australia. Last week they aired a controversial report on saturated fat and cholesterol’s weak association with heart disease. This generated the obvious controversy…but the show followed it up with an episode about statins that generated even more controversy!

The basic premise of this episode was the overprescription of statins based off faulty guidelines and research on primary prevention groups (this is important to keep in mind). In addition to the literature on statins and heart disease, the show also covers some of the research process/designs when drug trials are conducted that can lead to flawed conclusions.

The expected controversy even lead the Australian Advisory Committee to urge ABC to pull the episode from airing since they believed it could have lead people to stop taking their medications – leading to death. Today Dr. Kerryn Phelps, a former Australian Medical Association president, added to the controversy by writing:

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Both episodes are worth a look to understand what the discussion is all about as many people are probably going to be confused with all this conflicting advice.

Moving onto Italy:

Apparently Pasta consumption has dropped 23% in the past decade. Why is this?

Worried about its fattening effects, she and her husband eat it no more than a few times a week, favoring couscous, meat and vegetables instead. “Metabolism changes when you approach 40,” she says, “and pasta is out of the question.”

The share of women between 26 and 30 years old who believe pasta is fattening increased 26% from 2008 to 2012, according to a Nielsen survey. And among 26- to 30-year-old men, the number who think pasta makes people fat increased 16%.

Reminds me of this episode of Portlandia:

Now to Britain:

Looks like the amount of saturated fat that will be in Britain will be decreased and taken out of the food supply:

Almost half of the food manufacturing and retail industry has signed up to the Responsibility Deal Saturated Fat Reduction Pledge by agreeing to reduce the amount of saturated fat in our food and change their products to make them healthier.

Cutting the amount of saturated fat we eat by just fifteen per cent could prevent around 2,600 premature deaths every year from conditions such as cardiovascular disease, heart diseaseand stroke.

Check out the link to the story which details what companies are planning to do. Such as:

Nestlé – which will remove 3,800 tonnes of saturated fat from over a billion Kit Kat bars per year by reformulating the recipe

And whatever they end up replacing the saturated fat will make kit kats “healthier?” Sigh…

And in Sweden:

Apparently, “Sweden has become the first Western nation to develop national dietary guidelines that reject the popular low-fat diet dogma in favor of  low-carb high-fat nutrition advice.”

I’ve heard in the past that a huge portion of the population in Sweden follows a Low Carb High Fat diet so this is not too surprising.

We’ll end with China

I’ve covered in the past how asians are often used in popular press to demonstrate how carbohydrates cannot be fattening since Asians are so skinny…despite being healthy and skinny not being the same thing.

Apparently a new study was released last month showing increased carbohydrate consumption being tied to coronary heart disease in the Chinese.

I won’t get into too much about this particular study since it’s observational and relies on questionnaires – which have faults in generating conclusive evidence. However, these study designs were used in the past to demonize dietary fat. So even if this study is not conclusive, it’s worth noting since it produced different results using similar methods in the past. Some notable observations:

These associations were robust and independent of several known CHD risk factors, including socio economic status, centralobesity, smokingstatus, hypertension, and saturated fat intake.

In a Japanese cohort, the average intakes of raw white rice were 170 g/day in women and 180 g/day in men. In that study, white rice intake was found to be inversely associated with death from cardiovascular disease in men but not in women (49). The reasons for the apparent conflicting results between that study and ours are not clear.

Can More Fat and Less Carbohydrate Help with Migraines?

Picture by Shanghai killer whale; No this isn’t TheFatNurse

TheFatNurse was in the clinic today when the topic of migraines came up. This is a pretty common condition that is seen in the outpatient clinic and can be treated with abortive and preventive drug regimes…but is there a dietary approach to this? Well TheFatNurse came upon this study released last month that may be of interest. Now keep in mind, that it’s a prospective observational study so nothing truly conclusive can be drawn from it, but if enough interest gets generated we might be able to see some Randomized controlled clinical trials perhaps.

So what the researchers did was compare the effects of a ketogenic diet (KD; high fat low carb) to a standard calorie restricted one (SD) for 1 month with people who have migraines. So what happened?

Headache frequency and drug consumption was reduced during the observation period, but only in KD group.

The author’s conclusions:

KD ameliorates headache and reduces drug consumption in migraineurs, while the SD is fully ineffective on migraine in a short term observation. Our findings support the role of KDs in migraine treatment, maybe modulated by KBs inhibitory effects on neural inflammation and cortical spreading depression, and enhancing brain mitochondrial metabolism.

Again, it’s hard to draw conclusions from this design method but it certainly is interesting.

C Di Lorenzo – G Coppola (2013) Short term improvement of migraine headaches during ketogenic diet: a prospective observational study in a dietician clinical setting. The Journal of Headache and Pain. Suppl 1):P219

Interesting New Meta Analyses Out on BP and Low Carb. Response from Egg Study

In case you haven’t heard, last week the Cochrane Hypertension Group released some compelling updates on Blood pressure medications (1). But before we get to that, you may be wondering what the heck the Cochrane Collaborative is. While TheFatNurse can’t comment on all nursing schools, during TheFatNurse’s time as a wee little nursing student, one of the buzzwords was Evidence Based Practice in school. As a result, one of the organizations to help increase the use of evidence based practice is the Cochrane collaboration.

The Cochran Collaboration consists of over 28,000 volunteers in more than 100 countries that saw a need to organize the medical literature in a way that was easy to understand and evaluate. The goal is to allow evidence based practice to make its way into the healthcare setting. They go about doing this through systematic reviews of randomized control trials. So what did they findout about hypertension and blood pressure?

The Cochrane group set out to see what the literature showed about individuals with anti hypertension medications and mild hypertension (systolic of 140-159 or diastolic of 90-99) but no prior related issues involving cardiovascular diseases/events. They wanted to examine Randomized Control Trial studies that had at least 1 year duration. Specifically, the outcomes from the literature they were examining were all hypertension related such as coronary heat disease, stroke, mortality, total cardiovascular events and adverse effects from medications causing withdrawals. So what did they conclude? In the author’s own words:

In this review, existing evidence comparing the health outcomes between treated and untreated individuals are summarized. Available data from the limited number of available trials and participants showed no difference between treated and untreated individuals in heart attack, stroke, and death. About 9% of patients treated with drugs discontinued treatment due to adverse effects. Therefore, the benefits and harms of antihypertensive drug therapy in this population need to be investigated by further research.

Pretty interesting. Another new study out last week was a meta analysis on low carb diets (2). Here were the results:

A total of 23 reports, corresponding to 17 clinical investigations, were identified as meeting the pre-specified criteria. Meta-analysis carried out on data obtained in 1,141 obese patients, showed the LCD to be associated with significant decreases in body weight (−7.04 kg [95% CI −7.20/−6.88]), body mass index (−2.09 kg m−2[95% CI −2.15/−2.04]), abdominal circumference (−5.74 cm [95% CI −6.07/−5.41]), systolic blood pressure (−4.81 mm Hg [95% CI −5.33/−4.29]), diastolic blood pressure (−3.10 mm Hg [95% CI −3.45/−2.74]), plasma triglycerides (−29.71 mg dL−1[95% CI −31.99/−27.44]), fasting plasma glucose (−1.05 mg dL−1[95% CI −1.67/−0.44]), glycated haemoglobin (−0.21% [95% CI −0.24/−0.18]), plasma insulin (−2.24 micro IU mL−1[95% CI −2.65/−1.82]) and plasma C-reactive protein, as well as an increase in high-density lipoprotein cholesterol (1.73 mg dL−1[95%CI 1.44/2.01]). Low-density lipoprotein cholesterol and creatinine did not change significantly

Again, very interesting stuff. Also David Spence, the author behind the egg yolk as deadly as cigarette smoking study (as some in the media dubbed it), responded to Nutritionist Zoe Harcombe’s critique of his study in her blog’s comments. Just scroll down until you find it.  It’s a good debate between Dr. Spence and Zoe Harcombe.

Picture by Coldbourne from ClipArt. Creative Commons Attribution-Share Alike 3.0

TheFatNurse hopes this is where the future of research is heading towards where debate can occur openly and freely for people to observe and put in their analysis. What would make this better is if all studies were open to the public and not just the abstracts. For example, the two studies TheFatNurse mentioned are not accessible with TheFatNurse’s university account which means TheFatNurse and others can only rely on the abstract to see what the study is about. This is a start, but the abstract tells us nothing about the details on how the experiment was setup, potential confounding factors and other information to allow an honest critique. By having open debate, it’ll be much more productive in moving towards the truth and confirming the validity of studies whether they are for or against the existing paradigm of fat.

References:

(1) Pharmacotherapy for mild hypertension

  1. Diana Diao1,*,
  2. James M Wright2,
  3. David K Cundiff3,
  4. Francois Gueyffier4

Editorial Group: Cochrane Hypertension Group

Published Online: 15 AUG 2012

Assessed as up-to-date: 1 OCT 2011

DOI: 10.1002/14651858.CD006742.pub2

(2) Systematic review and meta-analysis of clinical trials of the effects of low carbohydrate diets on cardiovascular risk factors

  1. F. L. Santos1,
  2. S. S. Esteves2,
  3. A. da Costa Pereira3,
  4. W. S. Yancy Jr4,5,
  5. J. P. L. Nunes3,*

Article first published online: 20 AUG 2012

DOI: 10.1111/j.1467-789X.2012.01021.x