The Drivers of the Herd, Part 16
The NuSI Guys, Part 6 , A Very Serious Low Carber
Slide 3 p.43. Wolf, Robb. The Paleo Solution: The Original Human Diet. Las Vegas: Victory Belt, 2010. Print.
Some of my viewers will remember a video of mine that showed this nutty section in Robb Wolf’s The Paleo Solution. In it, he relates his personal fantasy of confronting feeble-minded and biased nutrition scientists with his devastatingly brilliant Paleo-logic. Since it’s his fantasy he can spice it up in any way he likes, so he decided to have one of these inferior Neolithic-types wear a tofu t-shirt. The idea was that a tofu t-shirt flags them as so in the thrall of Big Soy that they can’t possibly produce respectable scientific research. Only an expert who is hopelessly biased would wear a t-shirt personally identifying him with a food.
Slide 4 http://eatingacademy.com/dr-peter-attia
Meet Peter Attia. His t-shirt says “Praise the Lard”. He has come to us asking for money so he can do totally objective nutrition research.
Slide 5 Nutrition Science Initiative: Introduction and Overview. September 2012. Accessed Dec. 17, 2013 at http://www.givewell.org/files/conversations/NuSI%20overview.pdf
He’s teamed up with the journalist Gary Taubes in this endeavor. Taubes is totally objective, too, as you know by now. Don’t think for a moment that these two characters would add confusion to the mess that is the popular discussion of diet. No, these are exactly the two guys you’ve been waiting for to clear everything up for us. We’ve had plenty of opportunities already to see displays of Taubes’ high level of integrity and we’ll see more. But now it’s time to assess Peter Attia’s ideas. You should read his bio. His education is very impressive. No doubt, this is a remarkably bright guy. How many M.D.’s also have degrees in engineering or applied math? Read his blog and you’ll know he’s smart and serious.
Slide 6 http://eatingacademy.com/nutrition/ketosis-advantaged-or-misunderstood-state-part-I
For example, he says that “if you want to actually understand” ketosis, you’re going to have to invest yourself in studying his blogs.
Slide 7 http://eatingacademy.com/nutrition/the-straight-dope-on-cholesterol-part-I
If you have any intention of discussing cholesterol properly, you’ll need to apply “great care and attention”.
Slide 8 http://rationalwiki.org/wiki/Very_Serious_People
Attia seems like the nutrition version of what Paul Krugman calls a “Very Serious Person”.
Slide 9 http://eatingacademy.com/nutrition/the-straight-dope-on-cholesterol-part-I
The best thing about reading the blog of someone who is so smart is that he’ll make you smart, too. If you read his series about cholesterol you’ll know much more about this topic than 95% of doctors. What could be a better outcome for a blog than to have a bunch of uneducated low carbers out there thinking they know more than their doctors about the one aspect of low carb most likely to kill them?
Slide 10 http://eatingacademy.com/books-and-articles/good-science-bad-interpretation
In this post he laments utterly incompetent journalists who disseminate falsehoods about nutrition. He would never do that. He says most people don’t have the time or discipline to understand research findings, unlike him. He sarcastically refers to “reputable” journalists. Gary Taubes calls himself a journalist. I wonder if Attia thinks he’s reputable. Going by all this, you would think it would be next to impossible for little old me to find examples of this intellectual heavyweight getting his facts wrong or missing the forest for the trees. Well, I’ve got a few videos to give it a try here. Let’s see if he can back up all his posturing.
Slide 11 Omitted
Slide 12 http://vimeo.com/45485034
Dr. Attia has a video out there in which he defends saturated fat. Clearly, he wants us to know that he is an individual motivated by ethics. You’ll see his ethics on display in this video. It looks like he outsourced his research and his ethics to Gary Taubes – not a good decision.
Slide 13 For example, he wants us to think that in Framingham there was no association between cholesterol and saturated fat consumption. Attia must believe in recycling. I addressed this one in my first Anomaly Hunter video about Gary Taubes. Is he seriously arguing that saturated fat doesn’t raise cholesterol? Is he going to try to make this argument using unpublished epidemiological findings when we have seen what saturated fat does to cholesterol in hundreds of controlled trials? Watch videos 4 and 5 of this playlist if you aren’t convinced that saturated fat raises one’s cholesterol.
Slide 14 Corti, Maria-Chiara, et al. "Clarifying the direct relation between total cholesterol levels and death from coronary heart disease in older persons." Annals of Internal Medicine 126.10 (1997): 753-760.
If those findings were published we’d probably see that no accounting had been made for comorbidities that would have affected the cholesterol of older people.
Slide 15 Law, Malcolm R., and Nicholas J. Wald. "An ecological study of serum cholesterol and ischaemic heart disease between 1950 and 1990." European journal of clinical nutrition 48.5 (1994): 305.
What was not appreciated years ago and apparently is still not appreciated by Attia today is that in countries with high cholesterol, like the US and Finland of the 1970s, cholesterol tends to drop in old age. It’s a sign of worsening health in these populations.
Slide 16 Then he adopts the same deceptive spin as Taubes on the subject of MRFIT. By the way, notice that you’re looking at a screen capture from Attia’s video.
Slide 17 This is not. But it’s pretty much the same information. Where did I get this?
Slide 18 http://www.dairyaustralia.com.au/Health-and-nutrition/Health-professionals/Latest-research-and-reviews.aspx
At the end of video 13 I showed you that a Gary Taubes presentation is hosted by Dairy Australia. The dairy industry must like what Taubes has to say. I would have hoped someone of Peter Attia’s caliber might have bothered to do his own research before repeating Taubes’ deceptions.
Slide 19 By cutting corners on his research Attia is now left parroting the naysaying of the tobacco industry about MRFIT. We saw that in video 3. This is disappointing.
Slide 20 Attia also tells his audience that in the Western Electric study, more people died in a low-fat group than in a high-fat group. Notice he says that the researchers in that one compared the top 15% of men in terms of fat consumption with the bottom 15%. Two more men died in the low-fat group. I’m glad he included that line because it helped me catch a mistake I made in my Anomaly Hunter 2 video. Look at my Errata page for that correction. So what happened in Western Electric? You know already if you watched my fifth video of this playlist.
Slide 21 Paul, Oglesby, et al. "A longitudinal study of coronary heart disease."Circulation 28.1 (1963): 20-31.
There you see the line he’s talking about. First, this was only a difference of two new coronary cases after four and a half years, which could easily be the result of chance. Second, we don’t know much about their diets beyond fat intake.
Slide 22 But most importantly, their cholesterol levels were practically the same. If the low-fat group had actually achieved substantially lower cholesterol, then this might be more interesting.
Slide 23 All the information we are given about the two groups is from this table and you can see it lacks entries for average age and smoking status. Attia knows you can’t properly interpret this result without that information. Dr. Attia presents himself as a very careful person. We can see here that he can actually be quite careless. He knows better than this.
Slide 24 Remember, in this one we couldn’t even trust the information that was gathered about diet.
Attia then quotes the later paper that came from Western Electric. He wants his audience to be offended that a study with data that made saturated fat look innocent was ultimately spun to make saturated fat seem guilty.
Slide 25 Attia (quoting): “‘Within the context of the total literature, however, the present observations support the conclusion that (the) [fat] composition of the diet affects the serum cholesterol and the long term risk of death from CHD in middle-aged American men.’ [long pause.] Well, the media like that.”
Attia wants you to believe that’s all wrong and not supported by their data. But notice that in this quote he substituted the word “fat” for some other word.
Slide 26 Shekelle, Richard B., et al. "Diet, serum cholesterol, and death from coronary heart disease: the Western Electric Study." New England Journal of Medicine304.2 (1981): 65-70.
That word was “lipid”. You know, Dr. Attia, saturated fat isn’t the only lipid.
Slide 27 In fact, if you look at the context of the quote, they had just been writing about dietary cholesterol and how it was significantly associated with death from heart disease. Cholesterol is a lipid. Dr. Peter Attia is clearly trying to mislead us here. He keeps disappointing me.
Slide 28 If you look at the findings from this paper, you can see what really happened. I draw your attention to the top two lines because these are based on formulas that capture the expected effects of the total lipid composition on serum cholesterol and therefore heart disease risk. Both lines are based on saturated fat as well as polyunsaturated fat and dietary cholesterol because all those things are lipids. You can see that by both formulas the association with coronary death was exactly as would be predicted by the lipid hypothesis. Don’t ignore polyunsaturated fats, Dr. Attia. They matter because for the most part they lower cholesterol. You can see they went down across the table, showing an inverse association with heart disease death.
Slide 29 Read these few sentences. It’s true, saturated fat didn’t pop out as associated with heart disease by itself, but dietary cholesterol and polyunsaturated fats did show their expected associations. They are talking about the lipid composition of the diet. Now that you’ve seen this you can see that Peter Attia was getting this very wrong and giving us an impression opposite to the truth. His partnership with Taubes is making much more sense now.
Slide 30 Here’s another problem with this talk of his. He tells us how the FAO declared that “the available evidence from cohort and randomized controlled trials is unsatisfactory and unreliable to make judgment about and substantiate the effects of dietary fat on risk of CHD.”
Slide 31 p.185. Taubes, Gary. Why We Get Fat and What to Do About It. New York: Alfred A. Knopf, 2011. Print.
You can see that his pal Gary Taubes used this quote in his book as well.
Slide 32 Skeaff, C. Murray, and Jody Miller. "Dietary fat and coronary heart disease: summary of evidence from prospective cohort and randomised controlled trials."Annals of nutrition and metabolism 55.1-3 (2009): 173-201.
Here you can see its source. You can also read what it said right after that. Pause the video if you like. I don’t need to read this to you.
Slide 33 The people who wrote that explained how these particular sources of evidence – cohort studies and randomized trials – are weak for a variety of reasons. Despite the impression Attia gave, they were not saying that the lipid hypothesis is wrong. They wrote, “the null results are very likely to result from regression dilution bias and confounding.” I’ve made a video called The Measurement Problem about these very issues. Please read and understand this slide.
Slide 34 p.129. Fats and Fatty Acids in Human Nutrition: Report of an Expert Consultation : 10-14 November 2008, Geneva. Rome: Food and Agriculture Organization of the United Nations, 2010. Online at http://www.who.int/nutrition/publications/nutrientrequirements/fatsandfattyacids_humannutrition/en/
There was another FAO document that used similar verbiage. The context was also much the same.
Slide 35 p.131. p.129. Fats and Fatty Acids in Human Nutrition: Report of an Expert Consultation : 10-14 November 2008, Geneva. Rome: Food and Agriculture Organization of the United Nations, 2010. Online at http://www.who.int/nutrition/publications/nutrientrequirements/fatsandfattyacids_humannutrition/en/
Except in this one they were clearer. They concluded that there is “convincing evidence of lower CHD risk when PUFA replace SFA.” Again, Attia didn’t pass along this part of the FAO’s message. You see they thought there was enough evidence from other sources to make a judgment about the effects of dietary fat on the risk of CHD. Attia gave the opposite impression by taking that sentence out of context. I wish he were above these nasty little tricks.
Slide 36 Of course, Attia had to make reference to that Patty Siri-Tarino meta-analysis about saturated fat. Now you have two videos explaining why this not a paper that should be taken at face value. Do you think Attia was so careful and disciplined that he read the papers that went into this meta-analysis? Or do you think he took the bad journalist approach to this one?
Attia then says he’ll give us a history lesson about diet-heart. He tells us how Dwight Eisenhower tried to clean up his diet after his heart attack.
Slide 37 Attia: “The remainder of Eisenhower’s life was a consistent removal of fat from his diet. The poor man at the time of his death was eating only melba toast.”
And you can hear the audience react in amusement at the idea that Eisenhower was only eating melba toast. That seems unbelievable, right? It’s unbelievable for a good reason. Attia is not telling the truth.
Slide 38 My viewers know the Eisenhower story already. They’ve seen how Gary Taubes gave a completely false impression of Eisenhower’s medical history and diet. I won’t go over all that again now.
Slide 39 Just take note how Eisenhower ate the day of his heart attack. That stuff is part of a great diet if you’d like a heart attack, too.
Slide 40 p.258. Lasby, Clarence G. Eisenhower's Heart Attack: How Ike Beat Heart Disease and Held on to the Presidency. Lawrence: University Press of Kansas, 1997. Print.
And you can see here that he ate other things beside melba toast (after his heart attack), unless you’re going to tell me that melba toast is a “high-grade protein.” There’s a lot more to this story. Please watch my video about it.
Slide 41 http://vimeo.com/45485034
Earlier in his talk Dr. Attia tried to relate population dietary trends to increasing rates of obesity. I’ll discuss that topic with you in the next video.