Posts Tagged ‘Diet & Exercise’

Three Weight-Loss Diets Compared

Posted by medconsumers on June 1, 2008

It’s Hard to Lose Weight, but the Mediterranean and the Atkins Diets are Best

Three weight loss diets were compared over the course of two years in a newly published clinical trial conducted in Israel. The “winners” are the Mediterranean and the Atkins diet. People on one of these two diets lost more weight than the people on the low-fat diet long recommended by the American Heart Association and many physicians.

The differences and the amounts of weight lost were not great, ranging from 6 1/2 to 11 pounds. The results, however, call into question the dire health warnings about going on the Atkins diet, which is high in fat and protein and represented in this study as the low-carbohydrate diet. Published last month in The New England Journal of Medicine, the study was partially funded by the Dr. Robert C. and Veronica Atkins Research Foundation. It was so well designed that one could reasonably come to the conclusion the trial provides yet-another example of just how hard it is to lose weight.

The Dietary Intervention Randomized Controlled Trial (DIRECT) Group was led by Iris Shai, RD, PhD, Ben-Gurion University of the Negev. The Israeli researchers have designed their trial to overcome the usual problems associated with diet studies that rely solely on the participants filling out extensive food-frequency questionnaires. (Who among us can accurately remember how many cups of broccoli were eaten in the last 12 months, much less the amount and type of fat used in the cooking?)

The best type of diet-study design would required the participants to be institutionalized for a year or two, so that the only foods available to them would be consistent with the diets under scrutiny. Such trials are too expensive, and not likely to get many willing participants.

The Israeli DIRECT study was conducted at a workplace in a country where lunch is the main meal. The 322 moderately obese, mostly male participants worked at a nuclear research center in Dimona, Israel, with a self-service cafeteria and an on-site medical clinic. The foods they were instructed to eat had been marked with stickers color-coded according to each participant’s assigned diet.

Each food item also had a label showing the number of calories and the number of grams of carbohydrates, fat, and saturated fat. Each food item was also labeled with a full circle (indicating “feel free to consume”) or a half circle (indicating “consume in moderation”). Here’s how the three diets were described in the study: “low-fat, restricted-calorie American Heart Association diet]; Mediterranean, restricted-calorie; or low-carbohydrate, non–restricted-calorie [i.e., Atkins diet].”

Food-frequency questionnaires were used in this study to validate the participants’ adherence to their assigned diets. The questionnaires had to be filled out three times during the two-year duration of the study. And lastly, the participants received telephone pep talks from dieticians six times. Even their spouses received educational support.

After all that effort, here’s what was accomplished after two years: The people on the Mediterranean diet and the people on the Atkins diet lost 9 and 11 pounds, respectively. And the people on the low-fat, restricted calories diet lost 6 1/2 pounds. The small number of women who participated in this study tended to lose more weight on the Mediterranean diet (14 pounds) than on the other diets.

Dr. Shai and colleagues concluded that the Mediterranean diet may be better for people with type 2 diabetes because it showed a more favorable effect on glucose and insulin levels, which the researchers attributed high consumption of monounsaturated fats like olive oil. The high-fat, high-protein Atkins diet had the best effect on cholesterol levels. Both diets were described as effective alternatives to the American Heart Association low-fat diet.

This study was supported by the Nuclear Research Center Negev, the Dr. Robert C. and Veronica Atkins Research Foundation, and the S. Daniel Abraham International Center for Health and Nutrition, Ben-Gurion University, Israel.

For More Information:

The DIRECT study is freely accessible at The New England Journal of Medicine’s Web site (www.nejm.org) Go to the July 17, 2008 issue to read, “Weight Loss with a Low-Carbohydrate, Mediterranean or, Low-Fat Diet.egy.

Maryann Napoli, Center for Medical Consumers ©
June 2008

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You Can Be Fat and Fit

Posted by medconsumers on April 1, 2008

Walk More—That’s all you have to do

For cardiovascular and other health benefits like increased longevity, you need only exercise moderately for 30 minutes at least five days a week. That has been the recommendation for nearly 15 years, and it has decades of high-quality research to back it up. In an attempt to refine things further, a team of researchers asked the questions: Can this exercise recommendation be cut back further and still produce health benefits? Will 45 minutes five days of the week provide even more?

The study designed to answer these questions drew participants from the most sedentary segment of the U.S. population—postmenopausal women. Published last year in the Journal of the American Medical Association, this study continues to produce surprise findings as researchers are still analyzing the mountains of data it has generated.

A co-author of this and many other landmark studies is exercise scientist Steven N. Blair, PED, professor in the Department of Exercise Science at the University of South Carolina. One of the world’s leading researchers on the health benefits of exercise, Dr. Blair is interviewed by Maryann Napoli.

MN: Is it fair to summarize your research as providing proof that people can be fat and fit and that they can achieve cardiovascular fitness with only a moderate degree and amount of activity?

SNB: Scientists try to stay away from using the word “proof”, but we have provided pretty compelling evidence that you can be fat and fit—just as you can be thin and unfit. And that fitness provides important protection from many chronic diseases and premature mortality even in people who are obese.

MN: And it need not be vigorous exercise.

SNB: To attain what we’ve labeled “moderate fitness”—that is, if one follows the recommendation of 30 minutes of moderate intensity activity, such as walking on five or more days a week, you will develop a level of fitness that is protective.

MN: Must it be done in 30 consecutive minutes?

SNB: You can do it in separate segments—in bouts of at least ten minutes or more. The evidence for that has accumulated since we first made that recommendation back in the mid-1990s. It’s clear that whether you do 30 minutes of walking in three ten-minute bouts or two 15-minute bouts or all at once, the physiologic benefits are identical.

MN: That would also cut down on injuries.

SNB: It’s clear from our studies—and those of others—that as the amount and the intensity of the exercise goes up, the risk of injury does as well. The injury rate associated with moderate-intensity activity is incredibly low.

MN: How fast should people walk?

SNB: Walk purposefully as if you were going to a meeting—about 3 miles per hour, or 20 minutes a mile—but that will vary a bit depending on a person’s age, fitness, and health status. Some will need to walk a bit slower, especially when starting a program, and more fit individuals may walk at a faster rate.

MN: Why is it that those cardiac risk calculators that doctors use to determine an individual’s chance of having a heart attack in the next ten years do not include a question about physical activity? I’m referring to “risk assessment tools” like the one from the National Heart, Lung and Blood Institute that ask questions about blood pressure, cholesterol, etc. to identify who should be on drug therapy.

SNB: That calculator is largely based on the Framingham Heart Study [initiated 60 years ago], and they have never incorporated fitness. I tell physicians if you use the Framingham risk score to characterize your patients’ risk, you’re not finished with the job, unless you also have a measure of fitness or at very least, take a careful physical activity history.

MN: Why do you think the public continues to be told that excess weight will cause premature death and heart attacks? Three years ago, researchers at the Centers for Disease Control and Prevention (CDC) published a study that showed people who are overweight or even obese do not have shortened life spans. Decreased mortality was shown only at either end of the spectrum—the morbidly obese and the very thin.

SNB: Some people are dedicated to a concept that being overweight is hazardous to your health and they have an unwillingness to look at the actual data. When you look at the work of Katherine Flegal who headed that CDC study, you will see that she found that overweight is not the hazard for mortality as it has been made out to be, and it may even be protective. She used the best available data, such as that from the National Health and Nutrition Examination Surveys, which are broadly representative of the U.S. population. Yet there are people who have been vehement in their unrelenting criticism of Katherine and her work.

MN: Your work is focused on cardiovascular benefits, but weight loss motivates most people to exercise. I want to talk about a weight-related finding from your latest study that included 464 postmenopausal women who were sedentary, overweight or obese but basically healthy when they were randomly assigned to one of three exercise groups or the control group. This finding surprised me: After six months, “There were no differences in weight or body fat percent across the groups at follow-up but waist circumference was significantly smaller in all three exercise groups compared with the control [no exercise] group.”

SNB: That finding was not a surprise to anyone who works in this area. My colleague Bob Ross from Queen’s University in Kingston, Ontario has done more work on exercise and visceral adiposity than just about anyone. Bob said, “If you get people exercising, the visceral fat is going to go.” What we saw [in our study] was no difference in weight change across those four groups, yet all three exercising groups lost waist circumference, presumably visceral fat, compared with the control group.

MN: It should be pointed out here that one important aspect of your study is the fact that the women in the exercise groups performed their exercise routines under observation in the laboratory, thus bypassing the unreliable self-reporting that so often characterizes physical-activity studies. Your study measured what researchers call “dose response,” i.e., whether any health benefits were gained or lost by going lower or higher then the standard recommendation of 30 minutes five days a week of moderate exercise. Any other surprises?

SNB: I was a little surprised that the high-dose exercise group [225 minutes of exercise a week] did not lose more weight because they were doing three times the amount of exercise per week as the low-dose exercise group [72 minutes a week].

MN: What are you working on now?

SNB: We continue to analyze data from our study. When we looked at weights that were measured weekly in all the women, there are some fascinating findings there that I cannot talk about because we have not yet published our findings. It’s based on the notion promoted by the U.S. dietary guidelines 2005, which state, in order to prevent weight gain or promote weight loss, 60 minutes of activity a day is needed. Others have been trumpeting similar ideas. Well, if that’s the case, then the women in our high-dose exercise group should have lost a good bit more weight than the women in the lowest exercise group. We didn’t see that.

MN: Any idea why?

SNB: I’m not sure we’re ever going to know, but it is an area of research that cries out for more study—to try to understand where exercise fits in relation to weight management.

MN: The exercising study participants may not have lost weight, but regular testing of their cardiovascular/respiratory fitness during the study showed that they improved according to the amount of exercise they were assigned to perform.

SNB: Yes. As you see from our study there was a strong positive dose-response relationship for VO2 peak across the control and the three doses of exercise. Even the women in the lowest exercise group significantly improved their cardiovascular/respiratory symptoms and they only did 72 minutes of moderate intensive exercise a week. I’m coming to the conclusion that doing anything is better than nothing. I should be standing up right now while I’m talking with you.

MN: The blood pressure reductions in all three exercise groups were pitifully small.

SNB: Yes, I had expected exercise to show a dose-response gradient for blood pressure.

MN: You mean that you had expected the women doing the highest amount of exercise to have larger reductions in blood pressure.

SNB: Yes, the women were mildly hypertensive at the start of the study but all the exercise groups lowered their blood pressure only a few millimeters of mercury.

MN: There are still many proponents of vigorous-intensity exercise out there. I read that you used to be one of them until your own studies showed the health benefits of moderate-intensity exercise. I also read that you continue to enjoy running. Do you think that one day researchers will find that there are more health benefits to be gained with an intensive exercise routine?

SNB: Perhaps there might be some additional health benefits shown for vigorous exercise, but I frankly think the jury is still out on that one. I’m willing to go out on a limb here and say that doing something is better than doing nothing.

Maryann Napoli, Center for Medical Consumers ©
April 2008

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Vitamin D Deficiency: Cause Of Many Ailments

Posted by medconsumers on January 1, 2005

The Institute of Medicine brought experts together recently to explore the question of whether the RDA or recommended daily allowance, of vitamin D has been set too low. The impetus for the occasion was the mounting evidence for this vitamin’s role in preventing common cancers, autoimmune diseases, type 1 diabetes, heart disease, and osteoporosis. Furthermore, studies have shown that vitamin D deficiency is common in the U.S. Because the typical symptoms are aching bones and muscle discomfort, vitamin D deficiency is often misdiagnosed as fibromyalgia or chronic fatigue syndrome, according to Michael F. Holick, MD, PhD, of the Boston University School of Medicine.

Dr. Holick has conducted a review of all vitamin D studies, which was published in the December 2004 issue of the American Journal of Clinical Nutrition. Vitamin D has become the vitamin of the moment, possibly because researchers in this field want to raise the RDA again. And Dr. Holick’s review, which was funded by the U.S. National Institutes of Health, certainly supports the move.

For most Americans, sunlight provides the lion’s share of our vitamin D requirements because we eat few foods that naturally contain vitamin D, such as cod liver oil and oily fish (salmon, sardines, and mackerel). But many Americans do not meet the minimum requirement of sun exposure. What’s more, vitamin D deficiency is more pronounced among people living at higher latitudes, such as the New England States, especially in winter.

Dr. Holick and colleagues conducted a 2002 study at the Boston Medical Center , which found that, by the end of the winter, 32% of students and doctors, aged 18 to 29 years, were vitamin D deficient. Winter isn’t the only problem because, year-round, many people spend a lot of time indoors or slather themselves with sunscreen when they do go outside. So it was not too surprising that another study conducted in Boston found a high degree of D deficiency in white (30%), Hispanic (42%) and black (84%) elderly people at the end of August. Another study found that 38% of nursing home residents were vitamin D deficient.

Much of the sun avoidance and excessive sunscreen use is attributed to public education campaigns by dermatologists warning about skin cancers. It should be noted, however, that the most deadly form of skin cancer, melanoma, is not entirely related to sun exposure. In fact, Dr. Holick describes the sunlight-melanoma link as baffling because the disease rarely occurs on the face and hands. Instead, melanoma is more likely to appear on areas of the body that are not as exposed to the sun.

Obesity is yet another cause of vitamin D deficiency, according to Dr. Holick, who found that even when dietary vitamin D intake and sun exposure are adequate, the vitamin becomes unavailable because it becomes stored in the large amount of body fat. Aging skin requires more sun exposure. A 70-year-old exposed to the same amount of sunlight as a 20-year-old will only make 25% of the vitamin D that the young person can make. Breastfed infants are deficient in vitamin D because human milk is deficient in vitamin D. Dr. Holick offered this explanation for why deficiencies are widely overlooked: During the standard blood work-up, doctors tend to focus on the blood calcium levels, and if they are normal, doctors incorrectly assume their patients are getting enough D.

Why the seemingly sudden interest in vitamin D when intriguing research goes back over a half century? In 1949, a researcher published his observation that people who live at higher latitudes, such as New Hampshire , Vermont , and Massachusetts , had a higher incidence of cancer deaths, compared with people living in southern states, such as Texas , Georgia , and Alabama.

In a telephone interview, Dr. Holick was asked why other researchers didn’t pick up on this study and look further. “It was an interesting observation, but people didn’t take epidemiology seriously,” he answered. “Little attention was paid to it until the 1980s when other researchers reported that colon and breast cancer rates were higher for those living at higher latitudes in the U.S. ” Even then, the finding was not taken seriously until researchers understood the mechanism for how the breast, colon, and prostate activate vitamin D and use it to regulate cell growth, which Dr. Holick explained as a process that is, “keeping cell growth in check and possibly preventing the cell from becoming autonomous and developing into an unregulated cancer cell.”

After the paper explaining the mechanism was published in the British journal The Lancet, much more research attention began to be paid to vitamin D. And after 1999, many more observational studies were published showing a link between vitamin D deficiency and several chronic diseases. For example, there are higher rates of multiple sclerosis in people who live at higher latitudes; and another study showed vitamin D intake is inversely associated with rheumatoid arthritis.

In a 2001 study published in The Lancet, children treated with 2,000 IU daily of vitamin D from their first birthday onward had an 80% decreased risk of developing type 1 diabetes throughout the next 20 years. And in the last few years, several studies have been published indicating a link between schizophrenia and decreased exposure to sunlight. Dr. Holick’s review states that animal studies have successfully shown that type 1 diabetes, rheumatoid arthritis, and multiple sclerosis can be prevented using mice prone to these diseases.

To Dr. Holick, who is an endocrinologist, it is clear from studies like these (and many more that go unmentioned in this article for lack of space) that vitamin D should no longer be thought of only as the nutrient necessary for the prevention of rickets in young children. He said that his work has been instrumental in the vitamin D fortification of several common foods, including milk products, bread, and orange juice.

In the telephone interview, Dr. Holick was asked whether an increase in the RDA for vitamin D was imminent, given the fact that the Institute of Medicine , a division of the National Academy of Science, recently held a meeting on the topic. “No, it usually takes 10 to 15 years to change an RDA,” he answered. “A huge bureaucratic system is involved.” In the meantime, he and other vitamin D researchers recommend a minimum of 1,000 IU vitamin D daily. This increase, he explained, will maximize the absorption of calcium.

As for the risk of overdose, Dr Holick said, “You’d have to take 10,000 to 20,000 IU daily to approach toxicity.” Is the type of vitamin D important? “Multivitamins usually have D 2 which comes from yeast, but it’s probably only 20-40% as effective as D 3 ,” which, he believes is better and longer lasting.

Then there’s the question of what constitutes an adequate amount of sunlight: “Five to ten minutes of exposure of the arms and legs or the hands, arms and face two or three times a week,” stated Dr. Holick, adding a way of determining the right timing, “25% of the time that it would take to cause a light pinkness to the skin.”

For More Information:
Read Dr. Holick’s book, co-authored with Mark Jenkins and written for the general public, The UV Advantage ( New York : Simon & Schuster/ibooks , 2003).

Maryann Napoli, Center for Medical Consumers ©
January 2005

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The Obesity Myth

Posted by medconsumers on December 1, 2004

The Obesity Myth: Why America’s Obsession with Weight is Hazardous to Your Health (Penguin Group New York: 2004) by Paul Campos

The obesity myth, according to author Paul Campos, is based on three claims: that excess weight causes illness and early death; that losing weight improves health and extends life; and that we know how to make fat people thin. The book is well armed with footnotes to support his argument that the public has gotten a skewed view of the research from the media and from obesity specialists, who are largely funded by the $50 billion a year weight loss industry.

The author is not saying that weight is entirely irrelevant to good health. (It is, he says, unhealthy to be at each extreme, morbidly obese and extremely thin.) Instead, he lays out a convincing case for how the adverse health effects of excess weight have been grossly exaggerated. Take heart disease, for example. Most cardiologists will tell you that excess weight is right up there after smoking as a major risk factor for heart attack.

Yet the nation’s heart disease death rate has been steadily declining since the 1960s and continues to decline even after the upsurge in the number of overweight and obese Americans that began in the 1980s. Contrary to conventional medical wisdom, many fat people have none of the risk factors–high blood sugar levels, high blood pressure and high cholesterol–associated with illness and early death. Excess weight increases the risk of heart disease, at most, by 1-5%, says Campos, and some studies even suggest obesity is a protection against vascular disease.

By now, the extremely high failure rate of all diets is well known, and Campos, a professor of law at the University of Colorado and a syndicated columnist, reminds us of the well publicized deaths and injuries associated with diet drugs. One popular over-the-counter weight loss drug, for example, had a now withdrawn ingredient proven to cause strokes in young women.

Still, the “get thin, live longer” message drives many people to diet and drugs with the idea that the benefits of losing weight clearly outweigh the risks. Unfortunately, numerous studies suggest otherwise. For example, The New York Times reported this in 2002: “Dr. Jules Hirsch, an obesity researcher at Rockefeller University [in New York City] provided evidence from studies conducted by others that followed thousands of people for years, keeping track of who lost weight, who kept it off, who become ill and who died. Repeatedly, investigators reported that fat people who lost weight and kept it off had more heart disease and a higher death rate than people whose weight never changed.”

Campos’s book is filled with references to this type of research that is largely overlooked because of its inconvenient findings. And why don’t we hear about the health risks of yo-yo dieting (weight cycling)? Could it be that there are industries from–women’s magazines to weight loss clinics–that would go down the tubes if word gets out? One reason why the public gets a distorted view of the adverse health effects of obesity, says Campos, is the focus on weight by most researchers who ignore other factors that create ill health in fat people, such as sedentary lifestyle, poor diet, dieting-induced weight fluctuations, diet drug use, poverty, lack of access to and discrimination in health care, and social discrimination.

That a fat person can be healthy and physically fit has been demonstrated in the work of Steven Blair and colleagues at the Cooper Institute in Dallas, who have conducted a study of over 70,000 people and followed them for more than 20 years. Unlike other researchers who either ignore the role of physical activity or allow study participants to self-report activity levels, the Cooper Institute conducted regular treadmill testing throughout their study. Campos says that this study showed that obese, not merely overweight, people who engage in at least moderate levels of physical activity show half the death rate of sedentary people of ideal weight.

America is on the verge of an obesity-induced Type 2 diabetes epidemic, we are told, but Campos pokes holes in this contention. Here, he relies on the work of Paul Ernsberger, professor at the Case Western Reserve University School of Medicine, who is well versed in the obesity research and a critic of how the findings are portrayed to the public. “Actually, there is no hard data that says blood sugar levels are rising,” according to Dr. Ernsberger, who points to telephone surveys as the source for this purported rising incidence of Type 2 diabetes. Aggressive educational programs aimed at testing are one reason why many people report themselves as diabetics in telephone surveys, according to Dr. Ernsberger, who explained that doctors often tell people they are “borderline diabetics” or to “watch out for diabetes,” and this has led some people to think they already have the condition. Not incidentally, the definition of Type 2 diabetes was changed from a fasting blood sugar of 140 to a blood sugar of 126. Overnight, millions of Americans became diabetics.

The book’s parting words of advice–stop obsessing about weight. “The prosecutors in the case against fat aren’t completely wrong: They’ve just indicted the wrong parties. Americans are too sedentary. We do eat too much junk that isn’t good for us, because it’s quick and cheap and easier than the alternative of spending the time and money to prepare food that is both good for us and satisfies our cravings. A rational public health policy would focus on those issues, not on weight, which isn’t the problem, any more than diets and diet drugs would be the solution, even if they actually made people thin (thin people with bad health habits are no healthier than fat people with the same habits).”

Reviewed by Maryann Napoli, Center for Medical Consumers © 2004

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How We Came to Believe that the Low-Fat Diet is Good and Cholesterol is Bad

Posted by medconsumers on December 30, 2003

Despite decades of effort and many thousands of people randomized [into clinical trials], there is still only limited and inconclusive evidence of the effects of modification of total, saturated, monounsaturated, or polyunsaturated fats on cardiovascular morbidity and mortality.

Lee Hooper et al, British Medical Journal, March 31, 2001

Yes, the low-fat message is yet-another overrated bit of medical advice. Haven’t we been hearing for years that a low-fat diet will reduce your odds of dying of a heart attack? Yet those who assessed all the relevant studies (like the reviewers quoted above) have concluded that the evidence supporting the advice boils down to this: Eating a low-fat diet will not help you live longer, but it may slightly reduce the odds of having a non-fatal heart attack–if you are a man. 

You may wonder why we have been led to believe otherwise. It’s a long story that begins with the Korean War. Autopsies done on the young casualties, whose average age was 22 years, surprised physicians who saw early evidence of heart disease in 77% of them. Next came the Framingham Heart Study, which began in the early 1950s and followed over 5,000 healthy men and women. High blood levels of cholesterol emerged as a major risk factor for heart attack for young and middle-aged men, but not for women or the elderly. It was, however, only one of 240 risk factors identified by the Framingham Heart Study.

Though dietary cholesterol was the assumed culprit in the development of heart disease, this possibility was disproved early on, according to an historical account by Thomas J. Moore for his 1989 book, Heart Failure. Moore notes that the Framingham researchers singled out over 900 men and women to compare their blood levels of cholesterol with the amount of cholesterol in their diets. To their surprise, there was no relationship. As so often happens in other areas of medicine, opinions became fixed before definitive studies proved or disproved the hypothesis. And in this case, a medical consensus had already developed: Everyone should be concerned about the amount of cholesterol in their diets. In time, the public was told to increase intake of polyunsaturated fats (e.g., vegetable oils), reduce intake of saturated fats (e.g., meat and dairy products), and severely restrict dietary cholesterol (e.g., egg yolks, beef, pork). Total fat intake was to be kept under 30% of calories.

Many more studies confirmed the Framingham finding of an association between high blood levels of cholesterol and heart disease. It is, however, one thing to identify a factor that puts people at higher risk for heart attack–proving that a change in the risk factor will lower a person’s death rate is an entirely different matter. This was demonstrated by the failure of the Multiple Risk Factor Intervention Trial, sponsored by the National Heart, Lung, and Blood Institute. 

This ten-year, $115 million research project followed over 12,866 middle-aged healthy but high-risk men who were randomly assigned to one of two groups. The Special Intervention Group received intensive instruction on smoking cessation, reducing consumption of dietary cholesterol and saturated fats, the need for regular physical activity, and blood pressure reduction. The other half of the participants formed the Usual Care Group who received no encouragement to change their risk factors. At ten years, there was no difference between the two groups in overall death rate or in the heart disease death rate.

In three other major trials where diet was used to reduce cholesterol, the best that could be found was a barely significant reduction in non-fatal cardiovascular “events.” In cholesterol-lowering drug trials, the heart disease death rates went down among the drug-treated men, but the reduction was always offset by a higher rate of death from other causes. “All we are doing is changing what it says on the death certificate,” said researcher Dr. William C. Taylor. With several colleagues, Dr. Taylor had calculated that a lifelong program of cholesterol reduction adds about three days to three months to the life expectancy of a low-risk symptom-free adult (Annals of Internal Medicine, 4/87). 

Despite the lack of proof that lowering cholesterol in people without heart disease has a lifesaving benefit, the National Cholesterol Education Program began a nationwide “Know Your Numbers” campaign in 1987 to get all Americans to have their blood cholesterol measured regularly. In 1995, a landmark clinical trial proved for the first time that a cholesterol-lowering drug could prevent heart disease deaths in healthy but high-risk men without increasing their odds of dying of something else. The drug used in this study was from a new class of cholesterol-lowering medications called statins. Half the 6,000 middle-aged Scottish men in this trial were given pravastatin and half were given a placebo. Results showed a modest lifesaving benefit for the group taking pravastatin. At five years, there was a 3.2% heart disease death rate among the men on pravastatin (brand name: Pravachol) and a 4.1% heart disease death rate among the men on the placebo.

Several years later, another statin, lovastatin (Mevacor), became the first drug to benefit healthy men and women with normal or borderline levels of cholesterol. The heart attack rate in the placebo group was 5.4%, compared with 3.5% in the lovastatin-treated group. The overall death rate was the same for both groups. While these two trials appear to verify the benefits of lowering blood levels of cholesterol, a growing number of researchers see another explanation for the statins’ benefit. These drugs appear to have anti-coagulation, anti-inflammatory, and some other biological effects that protect the arteries. Many researchers believe that inflammation plays a role in heart attacks and some forms of stroke, but the exact mechanism is uncertain. The inflammatory theory could explain why half the heart attacks occur in people with normal cholesterol levels. 

As statin drugs move front and center in the heart attack prevention picture, the low-fat diet is now under attack because the lack of supporting evidence was brought to the public’s attention by Gary Taubes, first in a 2001 article for Science (“The Soft Science of Dietary Fat”) and later in a much-discussed 2002 article for The New York Times (“What If It’s All Been a Big Fat Lie?”).  

While researchers continue to work out the ways that heart attacks and stroke can be prevented, it should be noted that the death rates for both have been declining steadily since the late 1940s–well before Americans ever heard the low-fat, lower your cholesterol messages. The nation is experiencing an epidemic of obesity that some attribute to the low-fat message which drove people to consume more refined carbohydrates and to increase their total caloric intake. Still, the heart disease death rate has dropped dramatically in the last two decades, a period in which the nation’s fat intake dropped only a pitiful 6%. Better treatments are thought to be the reason. It could also be due to the increasing percentage of Americans entering the middle class, a trend that began after World War II. (High socioeconomic status is associated with a lower rate of premature heart disease death, especially for women.) Whatever the reason, it isn’t the low-fat diet, and it isn’t reduced intake of dietary cholesterol.

 Maryann Napoli, Center for Medical Consumers© 2003

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The Good Fat Cookbook by Fran McCullough

Posted by medconsumers on December 30, 2003

(Paperback — Scribner: New York, 2004)

This book is organized around a simple premise: “Foods that are really good for you taste really good.” And believe or not, science has begun to back up this appealing idea. In the last few years, foods once thought to be unhealthy were judged to be good for us. Among those that have made a comeback are: eggs (rich in two essential nutrients–choline and lutein), butter (healthier than margarine which usually contains trans-fatty acids), avocados (contain protein, fiber, antioxidants, monounsaturated fat), nuts (protect against heart disease and cancer), beef (see below), and alcohol (moderate daily drinking is good for the heart). If this trend sounds good to you, this book will make you even happier. Part I deals with the scientific evidence; part II provides the recipes.

The low-fat diet has been promoted to the public for over 30 years by government officials and the American Heart Association. It is considered the ideal way to prevent heart disease and obesity. Yet despite the proliferation of reduced-fat products (over 15,000) and a small drop in the nation’s fat intake (34% down from 40%), Americans have become the fattest people on earth. 

Now the low-fat diet is undergoing a major rethink, and the tide of scientific evidence is changing in favor of those who have challenged the conventional medical wisdom. Two population groups are frequently cited to support the contention that certain fats are so healthy that they should be consumed in high quantities: The Greenland Eskimos with their high consumption of fatty fish (rich in heart-healthy omega-3 oil) and people living in Mediterranean regions where the diet is high in olive oil, a healthy monounsaturated fat. Both groups have a total fat intake that is just as high or higher than that of the average American, but the Eskimos have virtually no heart disease and the Mediterranean people have low rates of heart disease and some cancers. Citing studies of such populations, a 1998 international conference convened by the Harvard School of Public Health, reached a consensus that a healthy diet need not be restricted in total fat. 

In The Good Fat Cookbook, Fran McCullough gathers the latest scientific evidence to show there are healthy and unhealthy fats. Her findings are likely to surprise. “The best fat of all is coconut and the worst fat of all is soy,” she writes. Canola and soy oils are so highly processed that the good nutrients are lost and trans-fatty acids develop (80% of cooking oil used in the U.S. is soy oil). The biggest surprise comes in the section on the health benefits of coconut. As anyone who has tried to keep up with the latest nutrition information knows, tropical fats (coconut and palm oil) are extremely unhealthy and should be banished from the diet. Not so, says McCullough. Coconut has numerous health virtues: It protects against heart disease and cancer; stimulates metabolic activity and gives you a burst of energy; provides high levels of antioxidants; contains lauric acid, the protective substances in mother’s milk; and has strong antiviral, antimicrobial, antibacterial, antifungal, and anti-inflammatory activity. 

Coconut oil used to be the predominant fat used in cookies, crackers, and most baked goods. In 1986, writes McCullough, the soy industry mounted a campaign to discredit coconut oil and warn the public of its dangers. The campaign was successful, according to McCullough, because “there is no Coconut Council to fund research and send out press kits, take journalists on junkets, and lobby Washington for favorable treatment in the way other elements in the agribusiness food industry cooked up the Dietary Guidelines.”

Some foods are innately healthy but become much less so due to human interference. When cattle and sheep are allowed to slowly fatten on grasses, as they are meant to, their meat has a healthy ratio of omega-3 to omega-6 fats. But that has changed with the mass production feedlots that supply most of America’s meat. The animals are fed corn that disrupts their digestive systems because they weren’t meant to eat grain, which, in turn, creates major health problems that necessitates antibiotics. Furthermore, their meat often undergoes irradiation to be sure that infections are not passed on to us. 

The book has a resource section with web sites and 800 #s for finding high quality products, such as meat from grass-fed animals, high quality oils, and omega-3 supplements. 

Maryann Napoli, Center for Medical Consumers©2003

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Links: Alternative Medicine & Nutrition

Posted by medconsumers on January 1, 2000

Center for Science in the Public Interest (CSPI)
CSPI is a nonprofit education and advocacy organization that focuses on improving the safety and nutritional quality of food. Their Web site offers information on food additives, substitutes and advice on improving you and your children’s diet. CSPI is the publisher of Nutrition Action Healthletter.

The National Center for Complementary and Alternative Medicine
The National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH) is dedicated to exploring complementary and alternative healing practices in the context of rigorous science; training CAM researchers; and disseminating authoritative information.

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Links: Children’s Health

Posted by medconsumers on January 1, 2000

Mt. Sinai School of Medicine’s Center for Children’s Health and the Environment
Nation’s first academic research and policy center to examine the links between exposure to toxic polllutants and children’s illness.

National Vaccine Information Center
National Vaccine Information Center is an independent source of childhood vaccine safety information.

www.safeminds.org
Organization led by parents of autistic children provides research information about how mercury in vaccines, the environment, and food may be causing health problems.

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Links: Women’s Health

Posted by medconsumers on January 1, 2000

Boston Women’s Health Collective
The organization that publishes the classic women’s health book called “Our Bodies, Ourselves.” Free information about women’s physical and sexual health.

Canadian Women’s Health Network
A range of advocacy issues explained and free information about women’s health.

Childbirth Connection
Everything you want to know about evidence-based pregnancy care and childbirth interventions.

National Center for Policy Research for Women and Families
Extensive critiques of studies involving women’s health and of the FDA’s process for approving medical devices.

National Women’s Health Network
Free health information and position statements about the Network’s advocacy issues. Newsletter by subscription.

Osteoporosis
Aimed at physicians and the general public, this educational Web site is maintained by researcher Susan Ott, MD, Associate Professor Department of Medicine, University of Washington.

Planned Parenthood of New York CityThe New York City branch of the Planned Parenthood have set up a Web site offering information on different methods of birth control, insurance coverage for reproductive services, and much more.

Pre-Term Labor Drugs Web site
This Web site includes research about the various risks associated with pre-term labor drugs. The researcher, is a woman who had previously experienced serious side effects after using these drugs. Now she is using the Web to inform other woman of the risks associated with pre-term labor drugs, so that they may make an educated decision about their treatments.

Women and Health Protection
A coalition of community groups, researchers, journalists and activists concerned about the safety of pharmaceutical drugs. The group keeps a close watch over ongoing changes in Canadian federal health protection legislation and examines the impact of those changes on women’s health.

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