Cat Obesity On The Rise…Similar Pathway To Humans?

TheFatNurse just saw this video….WUT

Apparently pet obesity is on the rise with as many as 53% of dogs and 55% of cats being overweight/obese. This increase in weight increases their risk of arthritis, diabetes and cancer…just like HUMANS…

So what does the news report recommend for these overweight pets? Talk to your vet, start an exercise program and choose…A LOW FAT DIET PLAN…WUT…just like HUMANS…The focus of the news story was on an overweight cat being put on a michael phelps exercise regiment and low fat diet plan. The results? SUCCESS, according to the owner, because the cat lost 1 lb… in 6 months. The parallels to the frustration of human obesity are almost an exact match.

Now TheFatNurse is far from an expert on cat physiology…but some vets are suggesting that cats drop the carbohydrates

Diabetes is one of the most common feline endocrine diseases and, while we do  not know all of the causes of this complex disease, we do know that many diabetic cats cease needing insulin or have their insulin needs significantly decrease once their dietary carbohydrate level is lowered to a more species-appropriate level than that found in many commercial foods

WUT…

Feeding a high carbohydrate diet to a diabetic cat is analogous to pouring gasoline on a fire and wondering why you can’t put the fire out.

The so-called “light” diets that are on the market have targeted the fat content as the nutrient to be decreased but, in doing so, the pet food manufacturers have increased the grain fraction (because grains are always cheaper than meat), leading to a higher level of carbohydrates.

cats tend to overeat when free-fed high carb dry food.  The first reason is because the pet food manufacturers do not play fair when manufacturing dry food.  They coat the kibble with extremely enticing animal digests which makes this inferior source of food very palatable to the target animal.

…Carbohydrates do not seem to send the “I’m full and can now stop eating” signal to a cat’s brain like protein and fat do.

The third reason why some cats overeat is boredom.

Wow sounds like they go into the food palatability and hormonal obesity regulation theories of obesity there! This post is merely food for thought because using data from animals for human evidence (even tho early scientist did this by declaring dietary cholesterol leads to heart attacks by feeding cholesterol (an animal product) to rabbits (Herbivores) who then developed heart disease) is not always applicable. Especially so in this case since cats are oligate carnivores while humans are omnivores. Alright enough about cats, TheFatNurse just found it interesting that similar controversies about carbohydrates and chronic disease exists for humans as well as cats.

picture from pandawhale.com

 

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Is The Paradigm Shift Starting? Media Updates and Carpal Tunnel

TheFatNurse is Alive and Well despite the lack of updates. Had to take on finals and TheFatNurse is happy to report they never stood a chance! In the meantime, lots of changes occurred since the last update in regards to the media and some new things TheFatNurse learned on carpal tunnel and diabetics.

Doctor Oz…leading the way!? If you’ve followed this blog then you’ll know TheFatNurse is no fan of Dr. Oz who often regurgitates the existing paradigm and has condemned fat as a evil. So you can imagine TheFatNurse’s surprise when Dr. Oz had not ONE but TWO shows that challenged the existing paradigm on diet! Last week Dr. Oz had Dr. Stephen Sinatra & Dr. Jonny Bowden talking about how the current view on cholesterol is all wrong, that there is nothing generally wrong with eating saturated fat, and that cholesterol in general is good for us.

WHOOOA

TheFatNurse’s reaction to this Episode

None of this is new to TheFatNurse…but seeing it on the Dr. Oz show, a huge influential media source, was too surreal! Many days and nights TheFatNurse was laughed at for questioning the existing paradigm…well perhaps no more! The show was progressing nicely until Doctor Oz attempted to use an illustration on how LDL and HDL works…something about a suitcase? Simply put, this best explains how TheFatNurse felt about it:

Let your Guests Explain How it Works!

Kudos to Dr. Oz for bringing up the subject matter, but if you’re interested in how LDL and HDL relate to heart disease check out the For All Ages FatNurse comics on Cholesterol in General and HDL/Triglycerides. However, despite the kudos, TheFatNurse was deeply disturbed by one of Dr. Oz’s comments:

I’m blown away by these side effects you’re reporting. You’re saying there’s data that statin drugs cause diabetes…

For reals? This was big news earlier in the year (February 2012) when the FDA announced they were adding warnings to statins for this very thing. It’s right here on the FDA website if you’re curious. TheFatNurse is just a little shocked Dr. Oz didn’t know that.

People being treated with statins may have an increased risk of raised blood sugar levels and the development of Type 2 diabetes.

However, TheFatNurse was happy to hear Dr. Oz ending the online segment by informing people that sugar is a bigger problem than fats in the diet. What is a bit peculiar is how the online episodes cutoff 1/4 of the show about cholesterol. The part they cutoff is the segment exonerating dietary fats and dietary cholesterol. TheFatNurse was fortunate enough to come across the missing segment tho:

The second Oz show that got TheFatNurse all excited occurred two weeks ago and challenged the paradigm of healthy whole wheat grain. This episode featured Dr. William Davis, a cardiologist, and the author behind Wheat Belly. Again, nothing new if you’ve been following this blog but to see the idea that “healthy whole grain wheat” as unhealthy being discussed so openly on Dr. Oz is just amazing.

Another media boost challenging the dominant paradigm on fat came from CBN news which did a segment on how a ketogenic diet (super low carb & high fat) could help with cancer by “starving” the center cells of glucose.

Although it wasn’t easy, Hatfield stopped eating carbohydrates, which turn into glucose inside your body. Cancer cells love glucose and need it so badly, that if you stop giving it to them, they die.

TheFatNurse hasn’t looked into the medical literature on the subject for clinical trials and what not but this is certainly something worth following up on in the future.

Speaking of blood glucose, TheFatNurse never knew how much more at risk people with impaired blood glucose such as diabetics or people with metabolic syndrome were at developing carpal tunnel syndrome. In this study,

metabolic syndrome was found to be three times more common in patients with CTS and CTS was more severe in patients with metabolic syndrome when compared with those without metabolic syndrome.

To keep it short, what happens is when glucose is elevated and around proteins such as collagen, elastin and fascia in tendons, it goes through something called glycosylation. This basically means that the glucose and proteins combine together. This impairs the function of things such as collagen, elastin and fascia. In nerves, glucose is converted to sorbitol which attracts water. Nerves also have collagen and elastin components. So as you can see in the picture below, when you have all this glycosylation occurring on the median nerve and the surrounding tendons in an enclosed space like the carpal tunnel it’s bad news.

Picture by Wilfredor

TL;DR: Looks like the media may be more friendly and picking up on information that goes against the traditional paradigm than before. Who knows what direction their influence is going to direct things in the future? Also carpal tunnel and hyperglycemia may be closely related.

Diabetes in Asians and Asian Americans. Also New Meta!

Picture by Betoseha

Every now and then someone will inform TheFatNurse that over indulging on carbohydrates is “no big deal because Asians [and Asian Americans] eat carbs all the time and they are thin!” First, TheFatNurse thinks that is quite a general blanket statement to put on a whole race of peoples, but TheFatNurse is guessing this assumption is from the cultural importance of rice in those cultures. The following fact is usually a shocker to a lot of people:

Despite having lower body weight, Asian Americans are more likely than Caucasians to have diabetes

Sayyy whhhhat? That’s taken straight off the Joslin Diabetes Center of Asian American Diabetes Initiative which also says:

Because Asian descents develop diabetes at a body weight considered “normal” by mainstream western standard, some have concluded that obesity is not an important cause for diabetes in Asian descents.

This rise in diabetes occurs not only to Asian-Americans but extends to Asians as well. Last week in businessweek a story covered the dramatic rise of diabetes in China:

Prevalence of Type 2 diabetes, a disease linked to inactivity and excess calories, has more than tripled in China over the past decade, fueling 20 percent-a-year growth in drug sales and straining health services. It’s also stoking need for newer, costlier medications from Merck & Co. (MRK), Novo Nordisk A/S (NOVOB) and Sanofi that help avoid blood-sugar spikes and complications such as heart attack and stroke.

As few as two in five diabetics in China have their blood- sugar under control…That compares with the U.S., where blood-sugar is controlled in 70 percent…

…China’s health spending is forecast to almost triple to $1 trillion over the next eight years, surging rates of diabetes mean China is struggling to detect cases and provide basic care…

China has almost four times as many people with diabetes than the U.S., where there are 23.7 million sufferers, according to the IDF. By 2030, 40 million more will have the condition in China…

China has overtaken Japan to become Novo Nordisk’s biggest market after the U.S…

If you want to make some $$$ sounds like investments in pharmaceuticals for diseases related to high blood sugar will get you far in the future! The more important, but less financially rewarding message, is that these populations are becoming diabetic with lower weight gain compared to other populations. This can be troublesome since treatment and prevention is often focused on weight loss. For example, a new study that made the headlines a few weeks ago in the NIH newsletter showed:

An intensive diet and exercise program resulting in weight loss does not reduce cardiovascular events such as heart attack and stroke in people with longstanding type 2 diabetes, according to a study supported by the National Institutes of Health.

Few, if any, studies of this size and duration have had comparable success in achieving and maintaining weight loss. Participants in the intervention group lost an average of more than 8 percent of their initial body weight after one year of intervention. They maintained an average weight loss of nearly 5 percent at four years, an amount of weight loss that experts recommend to improve health. Participants in the diabetes support and education group lost about 1 percent of their initial weight after one and four years.

What kind of intensive diet was this? A low fat calorie restricted one. From their protocols page:

the calorie goals are 1200-1500 kcal/day for individuals weighing 250 lbs (114 kg) or less at baseline and 1500-1800 kcal/day for individuals who weigh more than 250 lbs. These goals can be reduced to 1000-1200 kcal/day and 1200-1500 kcal/day, respectively, if participants do not lose weight satisfactorily. These calorie levels should promote a weight loss of approximately one to two lbs/week.

The composition of the diet is structured to enhance glycemic control and to minimize cardiovascular risk factors. The recommended diet is based on guidelines of the ADA and National Cholesterol Education program and includes a maximum of 30% of total calories from total fat, a maximum of 10% of total calories from saturated fat, and a minimum of 15% of total calories from protein.

Interesting stuff…TheFatNurse will definitely have to wait until the final report is released to go over the details! TheFatNurse isn’t trying to say that exercise and weight loss isn’t important in diabetics because there are other benefits such as reducing sleep apnea, increased energy and etc. TheFatNurse is merely trying to suggest that weight loss is not everything! A new meta analysis form the American Journal of Epidemiology on clinical controlled trials recently showed something similar.

In comparing low fat to low carb diets, they found no statistical significance between the two on weight loss or abdominal obesity; subjects lost weight on either diet. However, there was statistical differences between the two on reducing Cholesterol, reducing LDL cholesterol, increasing HDL cholesterol and reducing triglycerides; this was the low carb. However, its important to note the low fat diet yielded good changes to these markers as well, the low carb diet just did it better.

Summary;TL;DR: TheFatNurse hopes this gives pause to the use of Asians and Asian Americans in the debate of high amounts of carbs being healthy. It’s an assumption that asians and asian americans have a high carbohydrate diet but even if we assume that is true, we can see that whatever diet they are eating is not exactly yielding good health due to the staggering amount of diabetes they are having in North America and Asia. This increase of diabetes is occurring even at lower levels of weight which also suggests there might be more to the story than the usual “obesity is a risk factor for diabetes.” Even when weight loss is the same between different diets, some studies have shown low carbohydrate diets yielding better results on metabolic markers vs low fat diets.

Ultimately, the problems of diabetes and diet in Asian/Asian American populations is a lot more complex than just the amounts of carbs eaten. With the introduction of western foods, marketing, and increased economic gain in China, there are ultimately other psychologic, social and financial factors that make the issue more complex…but well worth future study.

References:

Hu et al (2012). Effects of Low-Carbohydrate Diets Versus Low-Fat Diets on Metabolic Risk Factors: A Meta-Analysis of Randomized Controlled Clinical Trials. Am. J. Epidemiol. (2012) 176(suppl 7): S44-S54

Sugar Lobby vs Tobacco Lobby

Picture by Marlith

If you haven’t done so, Gary Taubes has a new article out on the history of the sugar industry that is worth a read. It is well written and the comparisons to the tobacco industry are eerily similar. Even more disturbing, according to the article, is how the sugar industry has been able to influence government policy and therefore public health policy during the past several decades. This influence extends to influential organizations such as the American Diabetes Association as well:

It is hard to overestimate Bierman’s role in shifting the diabetes conversation away from sugar. It was primarily Bierman who convinced the American Diabetes Association to liberalize the amount of carbohydrates (including sugar) it recommended in the diets of diabetics, and focus more on urging diabetics to lower their fat intake, since diabetics are particularly likely to die from heart disease. Bierman also presented industry-funded studies when he coauthored a section on potential causes for a National Commission on Diabetes report in 1976; the document influences the federal diabetes research agenda to this day. Some researchers, he acknowledged, had “argued eloquently” that consumption of refined carbohydrates (such as sugar) is a precipitating factor in diabetes.

If you go to the ADA’s website, they have a “Diabetes Myths” section to educate Americans on Diabetes “facts.” TheFatNurse finds this fact on the website about Type 2 Diabetes pretty interesting:

Pretty conventional stuff right? Being overweight is a risk factor and drinking sugared beverages is associated with Type 2 diabetes. Not too clear whether the ADA is trying to say the weight gain from consuming sugary drinks (which are high calories) is a risk factor for developing diabetes or if it’s the intake of high amounts of sugar in the drinks that leads to risk factors for diabetes. TheFatNurse is guessing it’s the former rather than the latter since the consumption of candies, ice cream, and other sugar added foods is not discussed. It seems the focus is only on sugared beverages. Does this mean a person can replace their sugar fix they get from coke with a bag of skittles instead to reduce their risk of diabetes!? Why all the focus on sugar added drinks and not the other sugar added junk foods!?

What you may find interesting is that the “Myth” fact on the ADA’s site was recently changed. In September 2012, TheFatNurse happened to take a screen shot of the previous statement on the myth that eating too much sugar causes diabetes:

This statement was as recent as September 2012 from the ADA!

So at least since September 2012, before the new changes mentioned earlier, the ADA was telling people that its ok to drink as much soda as you want provided you keep your weight under control? This was then changed to include warnings of sugar from sodas sometime between october and november 2012. This is strange considering a 2010 Meta-analysis from Diabetes Care, which is associated with the ADA, showed these links between sugared beverages and diabetes two years before the ADA decided to adjust their myths page. This meta-analysis also seems to hint that sugar’s damaging effects go beyond just causing obesity and a high amount of sugar by itself may lead to effects (SSB = sugar sweetened beverages):

Because of the high content of rapidly absorbable carbohydrates such as sucrose (50% glucose and 50% fructose) and high-fructose corn syrup (most often 45% glucose and 55% fructose), in conjunction with the large volumes consumed, SSBs may increase the risk of metabolic syndrome and type 2 diabetes not only through obesity but also by increasing dietary glycemic load, leading to insulin resistance, β-cell dysfunction, and inflammation

Although SSBs increase risk of metabolic syndrome and type 2 diabetes, in part because of their contribution to weight gain, an independent effect may also stem from the high levels of rapidly absorbable carbohydrates in the form of added sugars, which are used to flavor these beverages.

Exploring the links between sugar consumption and diabetes is nothing new. This debate started decades ago. From the Taubes article:

An international panel of experts—including Yudkin and Walter Mertz, head of the Human Nutrition Institute at the Department of Agriculture—testified that variations in sugar consumption were the best explanation for the differences in diabetes rates between populations, and that research by the USDA and others supported the notion that eating too much sugar promotes dramatic population-wide increases in the disease.

To be clear, one shouldn’t assume cause and effect with high sugar consumption and the development of diabetes. The statement from the ADA, “the answer is not so simple” is actually pretty accurate since the evidence isn’t quite conclusive yet, although there are some pretty strong associations. There are many factors and the significance of this subject deserves exploration of all its complexities. However, the “not so simple” response should have been the standard answer a long time ago rather than saying sugar has no role.

Additionally, Dr. Lustig (mentioned in the Taubes article) has been mentioning potential links between sugar consumption and metabolic syndrome (in which one of the criteria is impaired fasting glucose) for awhile. If you are not familiar with his name, I recommend watching his famous Sugar Lecture at UCSF which covers history, policy and biochemistry on sugar:

Things are changing tho and it seems TheFatNurse sees more and more public service campaigns advocating the reduction of sugars such as the “real bears” on youtube:

However, as mentioned previously, why such a focus on the sugar in sodas and not other sugar added foods like candy or kids breakfast cereals? Regardless, TheFatNurse is happy to see the conversation on the dangers of sugar progressing.

Type 3 Diabetes, Bacon shortage and Updates!

TheFatNurse is still alive and well! Yes It’s been awhile since TheFatNurse last posted but for good reason! TheFatNurse had a string of events involving midterms, classes, clinics and even a mini lecture TheFatNurse gave on cholesterol and heart disease at TheFatNurse’s uni! But now that is all over and done with so TheFatNurse is back and ready to step into the frying pan. Speaking of frying pans…a global bacon shortage was predicted during the two months TheFatNurse was out…truly the end of times.

In the last post TheFatNurse briefly covered glucose and brain atrophy, well another related news story occurred in USATODAY about carbohydrate consumption and alzheimers!

Older people who load up their plates with carbohydrates have nearly four times the risk of developing mild cognitive impairment, a study out Tuesday finds. Sugars also played a role in the development of MCI, often a precursor to Alzheimer’s disease, according to the report in the Journal of Alzheimer’s Disease. Eating more proteins and fats offer some protection from MCI.

Whoa…what! TheFatNurse isn’t shocked by the news of carbohydrates being linked to MCI (Mild cognitive impairment) and early alzheimers…its the fact that this story was published in a major news media (okay USATODAY isn’t necessarily quality….but it is popular) for people to see! Not only that…the story actually supports that eating fat and protein is good? Not only are they taking on that controversy….but they also take on the healthy complex carbs and fruits paradigm as well!

Among the foods regarded as complex carbohydrates: rice, pasta, bread and cereals. The digestive system turns them into sugars. Fruits, vegetables and milk products are simple carbs.

“A high-carbohydrate intake could be bad for you because carbohydrates impact your glucose and insulin metabolism,” says Roberts. “Sugar fuels the brain, so moderate intake is good. However, high levels of sugar may actually prevent the brain from using the sugar — similar to what we see with type 2 diabetes.”

WHAT THE HELL IS HAPPENING!!!

TheFatNurse’s Reaction To This Article

To be fair, the study seems to be a prospective descriptive study from how the article describes it, so this really doesn’t tell us anything solid but can be used for generating new hypotheses. This subject interested TheFatNurse enough to explore this new paradigm of glucose and the pathophysiology of Alzheimer’s – a change which is classifying it as Type 3 diabetes. A good recent review on the subject can be found in this 2012 Curr Alzheimer Research review

Growing evidence supports the concept that AD fundamentally represents a metabolic disease in which brain glucose utilization and energy production are impaired. Metabolic abnormalities have been linked to brain insulin and insulin-like growth factor (IGF) resistance with disruption of signaling pathways that regulate neuronal survival, energy production, gene expression, and plasticity.

This idea has been around for awhile but has recently been picking up more steam as new studies are showing more evidence of insulin resistance and alzheimer’s. Earlier this month, NewScientist had diet and alzheimer’s as it’s cover story.

The rigid employment of standardized criteria for diagnosing AD, in fact, restricts our ability to fully comprehend the underlying disease process.

Subsequently, AD was shown to be associated with brain insulin resistance and insulin deficiency, with significant abnormalities in the expression of genes and activation of kinases that are regulated by insulin and insulin-like growth factor (IGF) signaling.

In essence, AD can be regarded as a form of brain diabetes that has elements of both insulin resistance and insulin deficiency. To consolidate this concept, we proposed that AD be referred to as, “Type 3 diabetes

Very interesting stuff and honestly pretty frightening if the increased rates of diabetes in children and adults will turn into increased rates of Alzheimers in the next few decades.

References:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3349985/

http://www.ncbi.nlm.nih.gov/pubmed/22810099

The Start of Low Carb in China?

TheFatNurse was shopping for groceries in Chinatown here in the States when a Chinese magazine stood out in dramatic fashion:

Now…TheFatNurse has no idea what this article is saying since the only words TheFatNurse knows is the english “Low-Carb,” but doesn’t that look like a pro low carb article to you (For all TheFatNurse knows, this might be anti-low carb)? A blockade of letters on top of white rice – TheFatNurse is thinking this either means switch out to other lower carb options or…the Chinese have invented a low carb rice (is that even possible!?). Either way, if you follow dietdoctor.com, you’ll know that a large amount of Swedes are following a low carb high fat diet now…is a shift starting to begin in China as well?

The view on China is interesting since proponents against low carb diets often point to the Chinese as having a high carbohydrate diet based on rice while maintaining lower rates of obesity, heart disease, diabetes and etc. Is this really true tho?

“China was once considered to have one of the leanest populations,1 but it is fast catching up with the West in terms of the prevalence of overweight and obesity; disturbingly, this transition has occurred in a remarkably short time”

“…it is the rapid increase of the condition,4especially among children, that is particularly alarming.”

Source *TheFatNurse only read the abstract

“…results indicate that diabetes has become a major public health problem in China and that strategies aimed at the prevention and treatment of diabetes are needed.”

Source *TheFatNurse only read the abstract

“With 3 million deaths annually, cardiovascular disease is now the leading cause of death in China, according to the recently-released “2011 China’s Cardiovascular Disease Report.”

Source

“The more common type of diabetes, type 2 diabetes, is rising sharply in China, and has
increased by 
30 percent in just seven years…”

Source

I can only speculate to the cause, but with China continuing its rise in wealth their caloric consumption has increased to roughly 2970 calories, which is still lower than the average consumption here in the states of 3770 calories – however, with an increase in calories, it is important to ask where these calories are coming from. It is often argued and accepted as medical dogma that “a calorie is a calorie” but anyone who follows this blog or any of the blogs on TheFatNurse’s Dispatch link knows the research doesn’t show that to be the case. There are hormonal factors at play that are often unaccounted for in the “calories is a calorie” theory.

By believing in the “calorie is a calorie” theory, one could look at these increases in obesity, diabetes and heart disease as a problem of simply the Chinese eating more calories as a result of increasing prosperity and therefore they just need to eat less (sounds familiar don’t it?). For example, what if the the increase in calories is from carbohydrates? According to this study from the Harvard School of Public Health released last month *TheFatNurse only read the abstract:

“Higher consumption of white rice is associated with a significantly increased risk of type 2 diabetes, especially in Asian (Chinese and Japanese) populations.”

Of course a higher risk of type 2 diabetes would also be connected with higher rates of obesity and heart disease as well if you prescribe to the carbohydrate/insulin hypothesis.

Bottom Line: So does the consumption of rice in Asian populations show that low carbohydrate diets have no basis? Who knows, but the data is showing remarkable increases in heart disease, obesity and diabetes in China. By the way, TheFatNurse has no idea what the average Chinese person eats, the view that Chinese people eat rice rice and rice seems very…archaic…in its view. The rise of popularity in western foods (especially fast foods) does indeed bring increases in fat but more in carbohydrates such as sweets, sodas and refined starches.

The important thing is to be open to the possibility that carbohydrates may play a factor instead of jumping to the same old ideas of fat consumption, sedentary lifestyle and etc like this article seems to do about China. Notice how that article points out high fat intake and western fast food but doesn’t make the connection that there is a lot more carbs in a burger, fries and soda than fat? Has the advice centered on these ideas worked in the states? No (well except for the stop smoking part). Why would they work in China?

Red Meat and Saturated Fat: a Tasty but Cautious Combo?

So if carbohydrates are the suspects, what should we replace them with? Most people naturally gravitate towards a Low Carb High Fat diet (LCHF) but even that can be ambiguous due to what kinds of fats should be selected. While browsing through the American Journal of Clinical Nutrition TheFatNurse found an interesting study about low carbohydrates, saturated fats and beef.

This study, which involved Dr. Krauss (famous for differentiating LDL particles and risk), decided to look at how much of a role red meat and its association with saturated fat plays in CVD risk. Red meat is often thought of as a CVD risk from the questionable lipid hypothesis due to the amount of saturated fat it has.

Free Beef to be a research subject? LETS DO IT

Participants were given a baseline diet that consisted of 50% carbohydrates before being divided up into a Low Carb High Saturated Fat group (LCHSF) or Low Carb Low Saturated Fat (LCLSF) group for another 3 weeks. Both groups dropped to 31% of their energy from carbs but increased their protein consumption to 31% of energy and fat to 38% of energy. The differences between the groups occurred in the percentage of saturated fat (made up from dairy). The Low Carb High saturated fat group took in 15% of their energy from saturated fat whereas the low carb low saturated fat group only took in 8% (with an increase in monounsaturated fat to keep the total fat even). So what were the results?

***Atherogenic dyslipidemia is often associated with elevated triglycerides, low HDL cholesterol and more small LDL particles***

Triglycerides: Baseline diet (1.22+/-0.61), LCHSF (1.10+/-0.61), LCLSF (1.05 +/- 0.49)

HDL-C: Baseline diet (1.08+/-0.27), LCHSF (1.07+/-0.30), LCLSF (1.04 +/- 0.27)

So based off those results it seems that both Low Carb options here perform much better than the Baseline diet that was higher in carbohydrate right? Not so fast. While it’s true that the LCHSF yielded much lower triglycerides, it also yielded increases in LDL than the baseline group. This shouldn’t be surprising tho due to the saturated fats. However, what concerns TheFatNurse is the types of LDLs raised. The LCHSF group had increases in the large LDLs and medium LDLs (as expected) but also in the small LDLs!

This is a bit concerning since Krauss had shown through previous studies that it’s the small LDL particles that are associated to CVD risk and not so much the larger ones (Recent findings are also suggesting its the total particle count that matters most). Perhaps the saving grace for LCHSF is that it did yield a smaller result for “very small LDLs” but this was not statistically significant (p=0.23).

In his study, Krauss reports previous studies showing saturated fats raising LDLs and total cholesterol but not contributing towards levels of small LDL particles. Could the results of this study have been due to the type of protein eaten with the saturated fat? Additionally, could these results have been due to the substitution of monounsaturated fats for the LCLSF group? Krauss addresses these points and remarks that the difference in this study was the strict use of beef as the protein source. Does this mean it’s the beef protein itself with saturated fat that is causing these changes to LDLs? Krauss remarks that it can be due to other factors such as iron which has been shown to contribute with lipid metabolism as well.

The Bottom Line: So while some previous studies did not show any cardiovascular risk with saturated fat intake…does this study mean that people should be careful if they are eating lots of saturated fat with red meat (specifically beef)? Maybe, maybe not. As Krauss notes, more studies are definitely needed, and this experiment had people eating more beef than what is typically normal. TheFatNurse think the biggest thing to take away for now is more evidence that carbohydrates are a risk factor since both low carb diets in the study yielded lower triglycerides. As for the increase in small LDLs from the higher saturated fat diet? Just cut out a little saturated fat from red meat in your diet and replace with non red meat saturated fats if this one study makes you cautious. In the meantime, TheFatNurse is gonna go fry up a steak.

***Of note, some people would consider the 31% of calories from carbohydrates in the Low carb groups not low enough to be considered a “true low-carb” diet***

Steak

Changes in Atherogenic Dyslipidemia Induced by Carbohydrate Restriction in Men Are Dependent on Dietary Protein Source

Lara M MangraviteSally ChiuKathleen WojnoonskiRobin S Rawlings, et al. The Journal of Nutrition. Bethesda: Dec 2011. Vol. 141, Iss. 12; pg. 2180, 6 pgs