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.

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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