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Nutrition Past and Future

The Drivers of the Herd, Part 6

Catalyst Corrected 6, Lyon: A Successful, Horrific Diet Trial


Slide 3                   We’ve been taking a closer look at what I consider to have been the seven key messages of Catalyst’s show disputing diet-heart and the lipid hypothesis. In this video I’ll examine the last idea, that animal fats are good for our health and vegetable oils are bad. Let’s listen to what we heard on the show that relates to this idea.



Slide 4                   Demasi: “There is one diet that stands out from the rest – the Lyon Diet Heart Study, which touted the benefits of a Mediterranean diet. Remarkably, after several years, those on the Mediterranean diet had a whopping 76% less deaths from heart attacks.”



Slide 5                   Let’s keep track of what we’re being told on this subject. For starters, we learned that the Lyon Diet Heart Trial was a big success. What else did they say?



Slide 6                   Bowden: “Here's the part that nobody talks about. See, you think that in the group that had the double-digit reduction in heart disease, their cholesterol levels must have plummeted, right? Their cholesterol levels didn't budge. Both groups had the same cholesterol levels, except one group just stopped dying. So, so much for the relationship between cholesterol and the risk for heart disease.”


Bowden seems pretty convinced that this blows up the lipid hypothesis. He must have really studied this.



Slide 7                   Let’s call that point number two. The Lyon study tells us there is no relationship between cholesterol and heart disease. And Jonny Bowden means it. This list will get longer but let’s deal with this second idea now.



Slide 8                   Fell, James S. "Holistic nutrition is weak on science, strong on selling supplements." The Los Angeles Times [Los Angeles] 20 Dec. 2010: n. pag. Web. 15 Dec. 2013. <>.


As the Media Watch program pointed out, Jonny Bowden’s education is a bit questionable. Here’s a slide to remind you of that. I bring this up because Bowden’s comments suggest he doesn’t know much about trials like this. A trial is designed to test a specific hypothesis. You don’t design an experiment to test one thing and then go back when it’s over and say it was actually supposed to test something else. It would be improper for researchers to figure out what their trial was about only after seeing the data they created from it. Bowden apparently doesn’t understand that Lyon wasn’t a study designed to test of the effects of cholesterol lowering. It was not meant to address only one variable. Moreover, no one says that the only risk factor in heart disease is high cholesterol. Other risk factors include obesity, hypertension, smoking, and diabetes. All of those risk factors matter independently of cholesterol in the statistical sense.




Slide 9         


I’ve made a video for people like Bowden who don’t understand this concept. He really needs to watch it and think hard about it.



Slide 10                 Vermeulen, A., K. I. Lie, and D. Durrer. "Effects of cardiac rehabilitation after myocardial infarction: changes in coronary risk factors and long-term prognosis." American heart journal 105.5 (1983): 798-801.


Here’s an example to show you how dumb this argument of his is. This was a study that looked at heart disease outcomes in men. The men were divided into two groups, one group that took part in an exercise program and one that didn’t. As you’d expect, the men who did the exercise fared better than the men who didn’t. Nothing special about that.



Slide 11                 It turns out that it didn’t make a difference for their survival whether or not the men had high blood pressure. Now if your critical thinking is as bad as Jonny Bowden’s, then you’ll jump to the conclusion that hypertension doesn’t have a relationship to heart disease. But that would be an ignorant statement. This wasn’t a trial that was designed to assess the effects of controlling blood pressure. It was a trial that looked at exercise. If you used this study to argue that hypertension doesn’t matter while you ignore all the other science that says it does, you’d come off as a simple-minded and biased quack. Bowden had other deep thoughts that apply to our discussion of Lyon and fats.



Slide 12                 Bowden: “Margarine is a perfect example of the stupidest nutritional swap-out in history. We had this trans-fat-laden crappy manufactured product that we were eating because we were so phobic about cutting saturated fat and cholesterol.”


Sinatra: “To switch to polyunsaturated fats with the vegetable oils, that's horrific advice.”




Slide 13                 Let’s take note of these points as well. Margarine is “horrific.” Vegetable oils are bad. Now do you remember our point one. Lyon was amazingly successful. So what happened in the Lyon study?



Slide 14                 De Lorgeril, Michel, et al. "Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease." The Lancet 343.8911 (1994): 1454-1459.


The experimental group, the group that had [fewer] heart attacks, was asked to eat less meat and replace butter and cream with margarine.



Slide 15                 This was an “oil-based margarine” that was supplied free to all the experimental subjects. How ridiculous are these guys? Did they even read this?



Slide 16                 de Lorgeril, Michel, and Patricia Salen. "Modified Cretan Mediterranean diet in the prevention of coronary heart disease and cancer: an update." (2006): 1-32. From Simopoulos AP, Visioli F (eds): More on Mediterranean Diets. World Rev Nutr Diet. Basel, Karger, 2007, vol 97, pp 1-32.


Look at the differences between the groups. The men who had fewer heart attacks ate less meat, drank less whole milk, ate less cheese, butter, and cream. They also consumed more margarine and more vegetable oils. Of course, the margarine wasn’t full of trans fats, but who is in favor of trans fats?


Given all that, you may be wondering why cholesterol wasn’t different between the two groups.



Slide 17                 De Lorgeril, M., et al. "Control of bias in dietary trial to prevent coronary recurrences: The Lyon Diet Heart Study." European journal of clinical nutrition51.2 (1997): 116.

De Lorgeril, Michel, et al. "Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease." The Lancet 343.8911 (1994): 1454-1459.


Well again, it’s important to remember that the trial wasn’t designed to look at cholesterol in isolation. If it were, they wouldn’t have allowed so many more people in the control group to be on cholesterol-lowering medications. Also, the difference in saturated fat consumption wasn’t all that different, either, because the trial wasn’t meant to look at that alone. This was a trial based on a complete diet pattern. That means there were a lot of variables being tweaked at once here. Let’s pretend this was a trial meant to look only at the effects of alpha-linolenic acid, which was the fatty acid that made their margarine special.



Slide 18                 Campos, Hannia, Ana Baylin, and Walter C. Willett. "α-Linolenic acid and risk of nonfatal acute myocardial infarction." Circulation 118.4 (2008): 339-345.


Alpha-linolenic acid has its own particular effects on cardiovascular health and these effects go beyond an effect on cholesterol.



Slide 19                 p.158. Abeywardena, Mahinda Y., et al. "Dietary fatty acids and cardiovascular disease: modulation of non-lipid risk factors." Dietary fats and risk of chronic disease (2006): 157-167.


Moreover, trading out some saturated fat for oils will have benefits that go beyond cholesterol, too. Lyon is sometimes cited as evidence of that.



Slide 20                 van Dijk, Susan J., et al. "A saturated fatty acid–rich diet induces an obesity-linked proinflammatory gene expression profile in adipose tissue of subjects at risk of metabolic syndrome." The American journal of clinical nutrition 90.6 (2009): 1656-1664.


One of the effects of saturated fat besides its effects on cholesterol is the way it promotes inflammation. Here is just a token reference for that idea. This brings us to other claims about fats made on Catalyst.



Slide 21                 Sinatra: “You call it, the LDL, bad cholesterol? Well, you know, I don't really call it bad unless it's oxidized. Remember, if it's oxidized, then it's inflammatory.”


Demasi: “So cholesterol's not bad, only if it's oxidized.”


Sinatra: “Exactly. If the cholesterol is oxidized, if there's free radical stress involved and it's oxidized, that's inflammatory and that starts the cascade for inflammation.”




Slide 22                 van Dijk, Susan J., et al. "A saturated fatty acid–rich diet induces an obesity-linked proinflammatory gene expression profile in adipose tissue of subjects at risk of metabolic syndrome." The American journal of clinical nutrition 90.6 (2009): 1656-1664.


And as you saw, saturated fats tend to be inflammatory. But Sinatra gives us a new addition to our list.



Slide 23                 According to Dr. Sinatra, we should be concerned if cholesterol is oxidized and we should be concerned about inflammation.



Slide 24                 Staprans, Ilona, et al. "The role of dietary oxidized cholesterol and oxidized fatty acids in the development of atherosclerosis." Molecular nutrition & food research 49.11 (2005): 1075-1082.


If he were sincere about this concern he would be aware of the research that says lower cholesterol and less saturated fat means less inflammation and oxidation of LDL. The oxidation angle works the opposite way when it comes to LDL. In this study, researchers wanted to see what happens to different oxidized fats once they are eaten. They fed subjects a meal full of oxidized linoleic acid. That’s an omega-6 fatty acid, an oil, the sort of thing Sinatra says we should avoid. Once eaten these were cleared from the circulation after eight hours and they never found their way into LDLs. But oxidized dietary cholesterol remained in the circulation for 72 hours and it did take up residence in LDLs. If he believes what he’s saying about oxidation then he’ll advise patients to avoid cholesterol-filled animal foods.



Slide 25                 Staprans, Ilona, et al. "The role of dietary oxidized cholesterol and oxidized fatty acids in the development of atherosclerosis." Molecular nutrition & food research 49.11 (2005): 1075-1082.


And yes, you do find oxidized cholesterol in food, including eggs, dairy, meat, and fish.



Slide 26                 César, Thais B., et al. "High cholesterol intake modifies chylomicron metabolism in normolipidemic young men." The Journal of nutrition 136.4 (2006): 971-976.


Here’s another study which found that another atherogenic lipoprotein remained in circulation longer when dietary cholesterol is consumed. Here they used three whole eggs. Why would you want any of your lipid-carrying particles hanging out too long in circulation where they can be exposed to oxidative insult?



Slide 27                 Ari, Palomäki, et al. "Effects of dietary cold-pressed turnip rapeseed oil and butter on serum lipids, oxidized LDL and arterial elasticity in men with metabolic syndrome.” Lipids in Health and Disease 2010, 9:137


Here’s another study that compared oils and fats. 37 men consumed either oil from turnip seeds or butter. Once again, the consumption of oil instead of animal fats reduced the amount of oxidized LDL in circulation. Their cholesterol was lower too. Will Sinatra admit that his advice is completely wrong by his own standard?



Slide 28                 Aikawa, Masanori, et al. "Lipid lowering reduces oxidative stress and endothelial cell activation in rabbit atheroma." Circulation 106.11 (2002): 1390-1396.


Here’s another way of looking at this issue. In this experiment, rabbits were given a vascular injury. Then they were fed high-fat diets that gave them atherosclerosis similar to human atherosclerosis. Of course, their arteries became inflamed and diseased. Then some of them were switched to normal diets without all the excess fat. Their inflammation subsided.



Slide 29                 These scientists wrote, “… The present study provides unambiguous evidence of the importance of lipid lowering itself in vascular inflammation.”


That experiment showed that the inflammation in heart disease won’t last when cholesterol levels are appropriately low. Sinatra has this all backwards.



Slide 30                 Steinberg, Daniel, Christopher K. Glass, and Joseph L. Witztum. "Evidence mandating earlier and more aggressive treatment of hypercholesterolemia."Circulation 118.6 (2008): 672-677.


The evidence is clear. High cholesterol is inflammatory.



Slide 31                 Hall, Stephen S. "Genetics: a gene of rare effect." Nature 496.7444 (2013): 152.


Sinatra is apparently just trying to rationalize high cholesterol numbers. The fact is we know people can be healthy with LDL below 50, sometimes far below 50.



Slide 32                 von Birgelen, Clemens, et al. "Relation between progression and regression of atherosclerotic left main coronary artery disease and serum cholesterol levels as assessed with serial long-term (≥ 12 months) follow-up intravascular ultrasound." Circulation 108.22 (2003): 2757-2762.


And we know that we need LDL at 75 or lower if we don’t want the hardening of our arteries to get any worse. Why not just adopt a diet that lowers your cholesterol, enjoy it, and stop lying to yourself about what the science really says?



Slide 33                 We’ve got one more wacky claim to think about to finish off Catalyst’s terrible show.



Slide 34                 Eades: “It becomes a rancid fat, and it becomes really bad for you. Saturated fats, on the other hand, have no double bonds. That's why they're incredibly stable. That's why they're great for cooking. That's why they're great for frying. And that's why they don't really perpetuate free radical cascades in the body, because they're inert fats.”


I must say, that’s the first time I’ve heard explicit dietary advice to eat things that are inert.



Slide 35       


Unless you’re in charge of stocking up Stephen Colbert’s Doom Bunker, I’m not sure why you’d make a virtue of inertness. Most of us value freshness over shelf life.



Slide 36                 I can’t relate to his preference but to each his own. Let’s write it down. Eades has completed our list of Catalyst’s big ideas about fats. Saturated fats are better because they’re inert. What evidence is out there on this topic?



Slide 37                 Jones, P. J., P. B. Pencharz, and M. T. Clandinin. "Whole body oxidation of dietary fatty acids: implications for energy utilization." The American journal of clinical nutrition 42.5 (1985): 769-777.


If you are someone who is interested in getting or staying lean, saturated fats, due to their inertness, are not a good choice. Several studies have shown that saturated fat’s resistance to oxidation makes it a likely contributor to weight gain for reasons beyond its caloric density. This 1985 study is the earliest one I could find that gave us an insight into this. Saturated fat’s energy is not readily utilized, implying it would be preferentially stored as adipose tissue.



Slide 38                 DeLany, James P., et al. "Differential oxidation of individual dietary fatty acids in humans." The American journal of clinical nutrition 72.4 (2000): 905-911.


Here’s a study from 2000 that also found saturated fats to be relatively inert and again the authors indicated that this property would make these fats likely candidates to make us fatter. They alluded to some animal studies upon which their expectations were based. We’ll see some of those studies later in video 13.



Slide 39                 Kien, C. Lawrence, Janice Y. Bunn, and Figen Ugrasbul. "Increasing dietary palmitic acid decreases fat oxidation and daily energy expenditure." The American journal of clinical nutrition 82.2 (2005): 320-326.


Here is one more study addressing this question, and once again the implications are that those inert saturated fats would promote obesity and insulin resistance.



Slide 40                 And those were the big themes of the Catalyst broadcast about saturated fat.



Slide 41       


Do you remember how Dr. Demasi said she conducted an extensive review of the literature for this show? Do you think that was true?




Slide 42       


And do you really think she was encouraging critical thinking by misrepresenting the history of diet-heart?



Slide 43       


More importantly, do you think the ABC upheld its editorial policies with this program? Do you think anyone there actually read the primary source criticizing Ancel Keys, the one that found a higher correlation with coronary death for animal protein? Do you think Demasi read all the relevant papers that came out of the Bogalusa study?



Slide 44       


Do you think her program gave a factual and balanced account of the history of diet-heart? I think it’s clear that Catalyst didn’t even attempt to meet its responsibilities to its audience. The ABC should do a serious review of how this debacle was allowed to happen.


Maryanne Demasi was not the only doctor who recently gave the nonsense generated by the low-carb blogs a respectable forum. The British Medical Journal let a very misguided cardiologist sound off on saturated fat in its pages. I’ll show you how wrong he was in the next two videos.




The Drivers of the Herd, Part 6

Catalyst Corrected 6, Lyon: A Successful, Horrific Diet Trial