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About this week’s eSkeptic

In this week’s eSkeptic, Dr. Harriet Hall, M.D., the SkepDoc, reviews The Gluten Lie: and other myths about what you eat, by Alan Levinovitz.

Harriet Hall is a retired family physician and Air Force Colonel living in Puyallup, WA. She writes about alternative medicine, pseudoscience, quackery, and critical thinking. She is a contributing editor to both Skeptic and Skeptical Inquirer, an advisor to the Quackwatch website, and an editor of Sciencebasedmedicine.org, where she writes an article every Tuesday. She is author of Women Aren’t Supposed to Fly: The Memoirs of a Female Flight Surgeon. Her website is www.skepdoc.info.

Food Faiths & Diet Religions

a review by Harriet Hall, M.D., the SkepDoc

The parade of diet fads is unending; they will continue to proliferate as long as humans have to eat. They have created a hellish world in which every food component is a potential demon: fat, gluten, carbs, sugar, wheat, salt, etc. Diet gurus, both professional and amateur, are always ready to tell us what to eat or not to eat. Their advice is supported by great enthusiasm and plentiful testimonials but little scientific evidence.

In his new book The Gluten Lie: and other myths about what you eat Alan Levinovitz examines the diet myth phenomenon from a refreshingly different viewpoint. He might seem like a strange candidate to author a book on diet. He’s not a nutrition expert, a doctor, or even a scientist; he is a scholar of religion. But that gives him a unique perspective. His expertise is in studying religious stories that function as metaphors. He says the key to understanding fad diets is not science, but history. “Once you see enough of the same archetypal myths and the same superstitions, new dietary claims start to look a lot like flood myths.”

They do indeed. The same memes keep repeating. Good vs. evil. Natural vs. manmade. Magical thinking: you are what you eat. The scary technology of the modern world vs. the idealistic Eden our ancestors supposedly enjoyed (they didn’t!). Evolutionary “Just So Stories” that convert what we think our ancestors ate into what we should eat or argue that since evolution didn’t equip us with sharp fangs, we shouldn’t eat meat. People presume to know Nature’s intentions. Clean, pure, virtuous foods vs. “unclean” forbidden foods, toxins, and sinful indulgence. We are being manipulated for profit by evil big corporations to the detriment of our health. Subconscious Puritan values kick in: if it’s pleasurable, it must be bad. Religious-like mantras divide the world into simplistic binary categories. Following the strict guidelines of the in-group proves you are a good person. Moral and religious vocabulary is inappropriately applied to scientific questions.

Levinovitz suggests that it would be helpful for scholars of folk and fairy tales to examine nutrition myths. Folklore studies would be able to classify diet stories into repeated story types like “miracle food from Tibet,” “dietary cures for chronic disease,” and “everyday food is poisonous.”

To many people science is suspect because of the steady stream of scientific reversals on butter, wine, or whatever food appears in the headlines. But he points out that these are not reversals at all, because nothing was ever established in the first place. The headlines report single preliminary studies that are questionable, not scientific consensus based on an accumulated body of reliable data. True science is humble, cautious, and embraces complexity and uncertainty.

“The unpleasant reality is that we don’t know what constitutes an ‘ideal’ diet, and there may be no such thing.” Eating in moderation has always been the common sense mainstay of diet advice, and science has added nothing that stands up to rigorous scrutiny. Levinovitz advocates removing the fear and restoring the pleasure in eating. “Fiction, not food, is the real demon.” With healthy helpings of history and skepticism, we can learn to laugh at fads and eat our dinner in peace.

As Levinovitz relates the history of MSG, gluten, fat, sugar, and salt, the repeated memes produce a strong sensation of déjà vu: someone makes a chance observation, gets an Idea that might explain the observation, extrapolates to apply the Idea to everyone, does a poor-quality uncontrolled study that seems to support the Idea, and persuades people to try his diet. They respond because the Idea strikes a chord, fits in with their worldview, is emotionally satisfying, and seems scientifically plausible. When they change their diet, they tend to eat healthier because they cook at home and eat less junk food. They feel better for psychological reasons and placebo effects, confirmation bias kicks in, and they spread the word with testimonials. Eventually more rigorous scientific studies debunk the Idea, but it is too late. MSG is exonerated, but people continue to believe MSG is the reason for their symptoms. Emerging evidence suggests that non-celiac gluten sensitivity may not be sensitivity to gluten but to FODMAPS (Fermentable Oligo-, Di-, Mono-saccharides And Polyols); if that is confirmed, we can predict that people will continue to believe gluten is the culprit. Once people’s minds are made up, they resist new evidence. Anecdotes and big Ideas reinforce powerful myths and promise simple solutions to a variety of health problems. Asking someone to question their food beliefs is tantamount to asking them to change their religion.

Levinovitz has done his research, and he understands science better than many scientists. He says,

If we are serious about the quest for good health, physical and mental, we cannot be slaves to fear and to our desire for easy answers. We must honestly admit our ignorance. We must recognize our capacity for self-deception. And when others—including medical and scientific professionals—refuse to do the same, we must learn to recognize their lies.

Most fad diets have been definitively debunked by scientific evidence. He doesn’t mince words: he says Grain Brain is a lie. Unfortunately, professional organizations don’t always follow the evidence. They promote their own lies, recommending low salt and low fat diets long after they should have been discarded for lack of evidence. They see themselves as experts and saviors and their egos won’t let them admit they have been giving their patients bad advice and making false dogmatic pronouncements about things that are far from settled. There is no good evidence that low fat diets are healthier. The low salt recommendations are practically impossible to follow; they may be advisable for a small sub-section of the population that is salt-sensitive, but for the rest of us, low salt diets are unnecessary and may create problems like potassium deficiency.

The book ends with two appendixes: (1) The Unpacked Diet and (2) UNPACKED: The Unpacked Diet. The first is a persuasive argument that the problem is not what you eat but what it is packaged in. It cites numerous scientific studies showing that plastics (like BPA), Styrofoam, and even aluminum have deadly health effects. By switching to Unpacked-approved packaging materials, you will experience health benefits: weight loss, sound sleep, lower blood pressure, no risk of cancer or Alzheimer’s, no more acne, dry skin or brain fog. It recommends a 9-day “detox” trial to see for yourself how much better you will feel when you avoid those toxic packaging materials.

The second appendix is an annotated version of the first revealing that it is a satire and showing how it copies the methods of diet faddists, reproduces their testimonials word for word, cherry-picks scientific studies that appear to support the thesis, uses faulty logic, plays on emotions, and is designed to thoroughly mislead readers. I would encourage you to read the first version and try critiquing it yourself before you read the second. It’s a good exercise to see how much you have learned from the book.

The Gluten Lie is well written, entertaining, solidly referenced, and perhaps the best debunking of popular diet myths ever. Reading it will equip you to quickly spot the flaws and the recurrent myths in the next fad that you will inevitably encounter. END

38 Comments »

38 Comments

  1. Dr. Sidethink says:

    a Jesuit Prayer

    “Give us food for the hungry , and a hunger for justice for those who have food”

    ****************

    Food Macick is a luxury and part of the “magickal” worldview that
    is diverting the attention to just distribution of resources.

    We are in danger from neo-dominionist movements
    and resource distribution but choose to practice Food Magick in addition to Anti-Science

    rjp

  2. Jayne calderwood says:

    I was called a freak the other day when I said I could not eat gluten, whilst I agree with de bunking health myths, let’s not forget that there are a lot of people who do suffer from debilitating conditions which mean they cannot eat certain foods. I feel as if I have to go around with a big label around my neck stating my medical condition and saying I am not on a fad diet. Myth busters please be aware of people like myself. I have started to dread refusing foods.

    • Cara says:

      Bless you, Jayne. Sounds to me like this book contains a pretty high level of demagoguery. I find the approach taken to be unhelpful as well as lacking genuine scientific merit. Ironic that science deniers come in all forms — even among those who purport to be skeptical for the purpose of seeking “truth”.

      • stewart klein says:

        In reading the book the author goes to great lengths to separate those with coeliacs disease from fadists.

    • Grace Belsky says:

      Thank you Jayne. I’ve been eating gluten free for almost 30 years because I have Celiac disease. This guy and his ilk are dangerous.

      • Terry Waites says:

        As was stated earlier “In reading the book the author goes to great lengths to separate those with coeliacs disease from fadists”.

  3. Evan Allen says:

    Dr. Hall states: “There is no good evidence that low fat diets are healthier.”

    Yet the World Heart Federation states:

    “Research makes it clear that abnormal blood lipid (fat) levels have a strong correlation with the risk of coronary artery disease, heart attack and coronary death. In turn, abnormal blood lipids are related to what you eat. A diet high in saturated fats (e.g. cheese) and trans fats (often used in cakes, cookies and fast food) leads to high levels of cholesterol.

    Saturated fats are found in animal products. Trans fats are oils that have been hydrogenated to turn them into semi-hard fats. Hydrogenated fat is found in processed food like shop-bought cakes, biscuits, stock cubes and a range of other products you buy every day. Saturated and trans fats raise cholesterol levels in the blood, which in turn can lead to atherosclerosis.”

    The consensus position among all physicians and health groups is that diets high in saturated fat, which tend to be diets high in total fat are dangerous. Did this book offer evidence to overturn that consensus?

    • Harriet Hall says:

      Did this book offer evidence to overturn that consensus?
      Yes.
      So did Gary Taubes.
      The professional organizations that still recommend low fat diets are behind the times. There is evidence for avoiding trans fats but not saturated fats or fats in general. There is usually a grain of truth behind every myth, and in this case the grain is that fats have more calories per gram, diets high in fat tend to be high in calories, high calorie diets result in weight gain, and obesity is a risk factor for heart disease.
      Read the book.

      • Evan Allen says:

        Dr. Hall, I have read the book and found it lacked any evidence to support the claim that diets low in fat were not generally more healthy.

        If you, as a doctor, support Gary Taubes — a nonmedical journalist with a degree in physics whose books are riddled with errors of fact and misquotations over the pioneering, nobel-prize winners of the last century like Brown and Goldstein, it is hard to consider you a proper skeptic.

        On saturated fat, Levinovitz’s book simply regurgitates Taubes. Taubes is not a serious scientist and neither is Levinovitz, neither has ever treated a patient for a heart attack like you and I have. As a skeptic, you should think twice before hitching your wagon to his instead of the World Heart Federation, American Heart Association, European Society of Cardiology and many others that have analyzed the data in total, including the recently concluded Dietary Guidelines for Americans Committee.

        It is possible that all those organizations are incorrect, but it is much more likely that Taubes, whose arguments are the core of all anti-saturated fat studies, is wrong.

        This is from Steinberg’s 2004 review article on the history of cholesterol:

        “1) Cholesterol derived from plasma lipoproteins is a consistent and striking feature of atherosclerotic lesions,

        2) People with dramatically high blood cholesterol levels, as in familial hypercholesterolemia, have dramatically premature CHD (28–32),

        3) People with even relatively modest elevations of blood cholesterol levels are at significantly higher risk. This is true across a wide spectrum of blood cholesterol levels and holds on
        comparison of populations from different countries (37) and also within populations (40, 41),

        4) Blood cholesterol level is increased when dietary saturated fat intake is increased, as shown by carefully controlled metabolic ward studies (49, 50). Moreover, populations with dietary habits
        that include a high saturated fat intake have higher blood cholesterol levels and a higher CHD incidence than populations
        with lower saturated fat intake (37),

        5) The wide differences in blood cholesterol levels and CHD risk between populations of different countries are due largely to
        environmental factors (probably diet) rather than genetic
        factors, as shown, for example, by the Japanese migration
        studies (39),

        6) Dietary intervention to lower blood cholesterol by decreasing saturated fat intake in favor of polyunsaturated fat intake reduces blood cholesterol levels and decreases risk of CHD and other atherosclerotic complications”

        Link here: http://www.jlr.org/content/46/2/179.full.pdf+html

        What new facts have come up (please from reputable peer-reviewed science, not Taubes) that discredit any of those propositions?

        A few error-ridden meta-analyses of questionable value cannot overturn established science. Extraordinary claims and all …

        • Harriet Hall says:

          I have written about this on Science-Based Medicine. Google my name and cholesterol to find the articles.
          I do not support Gary Taubes. Again, I have written about him on SBM and you can find my articles by searching for his name and mine.

        • Alan Levinovitz says:

          Thanks for the comment, Evan, and thank you also for reading the book! Let me try to address some of your complaints.

          First: I am no admirer of Taubes’ bizarre take on calories. I am of the CICO school, as is the scientific consensus (with slight variations, of course).

          That said, there is ample disagreement within the medical community about fat. First of all, it’s worth distinguishing between saturated fat and “fat”. Willett (no Taubesian, and, unlike me, a scientist and a doctor) and Harvard set no limit on fat consumption in their dietary guidelines. So much for low-fat diets:

          http://www.hsph.harvard.edu/nutritionsource/fats-and-cholesterol-1/

          Other organizations, however, do set limits on total fat, saturated or otherwise:

          http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyEating/-/HEARTORG/GettingHealthy/NutritionCenter/HealthyEating/Suggested-Servings-from-Each-Food-Group_UCM_318186_Article.jsp

          Who to trust? You mention the AHA, an organization you claim is more reputable than a non-scientist like myself. Yet the AHA continues to recommend a wildly low salt guideline of 1500 mg/day for most people. That runs counter to excellent studies by the IOM and others that suggest such a limit is not only not optimal, but may actually be dangerous. To point at the AHA as some kind of reputable barometer of nutrition claims strikes me as strange.

          As for saturated fat? There is more data (which I cite in my book) that casts doubt on the “all saturated fat is bad” hypothesis. Two examples:

          http://informahealthcare.com/doi/abs/10.3109/02813432.2012.757070

          http://ajcn.nutrition.org/content/96/2/397.short

          Are these studies conclusive? Not by a long shot. But that’s exactly my point in the book. We are, for the most part, on shaky ground when making dietary recommendations. No studies are conclusive, and we ought to proceed with great caution and humility. Saturated fat is not tobacco. We shouldn’t treat it that way.

          We do culture and science a great disservice by being more certain than we should be about dietary guidelines. I do not believe that our myriad health problems (heart attacks included) are due to people eating moderate diets that are too high in saturated fat. If you do, I’d like to see some seriously good evidence to back up your claims. Otherwise, perhaps we can agree to fight massive overconsumption of calories and nit-pick the details later. That way we won’t be in the position of rolling back overzealous claims about saturated fat, just as we are currently doing with dietary cholesterol and salt.

          • Evan Allen says:

            Alan, first thank you for responding to my comment. It is an unexpected pleasure to get an authorial response and I appreciate it greatly. I was interested in your book as I also have found serious problems with Wheat Belly and Grain Brain and was interested to see if we intersected on that issue.

            What I find excellent about the book is its attempt to rely on sound science against food fads and charlatans. I completely agree with that. But the evidence against dietary fat is sound science, well established for over five decades, just about as long as Wegener’s theory of continental drift has been established.

            The links in the chain of causation implicating dietary fat are long and varied but the basics are listed in Steinberg’s article above that I quoted. The fact is that when westerners eat a high fat diet or are told that fat doesn’t matter, the bulk of the fat they eat will be saturated fat.

            When the country of Finland wanted to reduce its worst in the world heart disease death rate, they focused on getting people to reduce total and saturated fats to reduce cholesterol levels, and succeeded in getting an 80% reduction in heart disease deaths. They did this in the 1980s. This is settled science.

            I think that articles and books like yours and Taubes’ that exculpate fat as a class will generally result in high levels of consumption of saturated fat. Accepting that there may be some controversy over total levels of fat, there is really none about saturated fat. Brown and Goldstein won a Nobel Prize, there are no contrary studies showing anyone giving people extra saturated fat in the diet and improving their health, Grain Brain notwithstanding.

            The science that implicates saturated fat as a primary cause of heart disease is just as strong and just as good as that which implicates smoking as a cause of lung cancer. There has never even been a single randomized trial showing that a prospective group of people given cigarettes vs. another matched control that didn’t have cigarettes have higher lung cancer rates. We have those studies for saturated fat.

            On the other hand, whatever you think of their verbiage, behavior and belief systems, Kempner, Pritikin, Ornish, McDougall and Esselstyn (among others) use low fat diets to get dramatic reversals of longstanding chronic diseases that are unique to the western world. They then have been published in the scientific literature. Low carbohydrate diets (which all high fat diets tend to be) have been show to increase mortality and increase rates of diabetes and cancer. Again, I agree that a focus on whole foods is better than one based on micro or macronutrients, but the evidence supports a whole food approach that emphasizes foods that are low in fat.

            The western world is staggering under a heavy burden of disease. This is what has created the market for books like Wheat Belly and Grain Brain. This disease level is an evolutionary and historical novelty. Our recent ancestors did not have this problem. So it is likely that it is environmental and our biggest encounter with the environment is our air and our diet.

            Ornish has not only reversed heart disease, but prostate cancer with a low fat diet. To criticize his findings and those of other low fat doctors you have to show how they are flawed. He and others who recommend low fat diets are certainly evangelistic for their way of eating, but wouldn’t you be too if you thought you could reverse the number one killer of Americans?

      • Earle Loxton says:

        @SkepDoc, you agree with Gary Taubes that fat is not the enemy and my assumption is that you agree with his basic hypotheses. Yet it appears you postulate that diets high in fat lead to obesity because of their calorie density. I would agree that 1kg of fat may contain more calories than 1kg of carbs, but comparing the satiating properties of fat vs carbs, I imagine that most people would eat a lot less on LCHF, hence less calories. Your comment would be highly appreciated.

        • Harriet Hall says:

          I agree with Taubes that fat is not the enemy, but I disagree with many of the other things he says, and even he himself admits that his low carb hypotheses have not been properly tested. And I don’t think high fat diets cause obesity; I think high calorie diets do. LCHF is a useful trick that helps many people control their calorie intake, but the evidence for its superiority to other diets is far from convincing.

    • Adeline says:

      Water can also kill you. Have you ever thought that maybe… just maybe you shouldn’t eat an entire pig at once? If it’s not “low fat” does not mean it’s “high fat”.

    • Harriet Hall says:

      Sure there is “science” – you can find studies to support almost any belief. But there is no evidence from controlled clinical studies that eating wheat causes worse health outcomes in the general population.
      Remember that half of all clinical study results are false, that animal studies and test tube studies don’t prove that there will be meaningful effects in humans, and that it is risky to extrapolate from basic science to diet recommendations. Wheat Belly and Grain Brain are wrong.

  4. Liberté says:

    FODMAPS diet still keeps you on a gluten free diet. It’s not so much that it was a “gluten lie” as it was that gluten was only part of the puzzle.

  5. Harriet Hall says:

    @Evan Allen
    Levinovitz and I and Gary Taubes and a lot of others who have reviewed the research came to very different conclusions than you did. The science that implicates saturated fat as a primary cause of heart disease is NOT “just as strong and just as good as that which implicates smoking as a cause of lung cancer.” Dietary studies are inherently problematic and unreliable. They are mostly epidemiologic, and they assume accurate reporting of actual intake, which is fiendishly difficult to achieve. The evidence that smoking causes cancer is massive; the evidence that dietary fat causes heart disease is not. If it were, don’t you think the Surgeon General would have spoken out as strongly against saturated fat as against smoking?

    You are ignoring all the possible confounders in the data you cite. When study subjects go on a low fat diet, the amount of fat in the diet is not the only thing that changes. They are likely to be eating more fruits and vegetables, losing weight, exercising, and doing other things that may improve their health. The evolutionary arguments are flawed, too. Our ancestors did have heart disease if they lived long enough. And there are no chronic diseases that are “unique to the western world.” Those who say they used low fat diets to get dramatic reversals didn’t just decrease fat in the diet, they also used other interventions, and patients lost weight.

    Definitive studies on diet are never going to happen, because we can’t randomize people and enforce strict measured intake. We have to rely on imperfect information that so far is not sufficient to justify population-wide recommendations. Levinovitz shows how our thinking is influenced by factors other than hard data, and how even good scientists can succumb to myths.

  6. Evan Allen says:

    Dr. Hall, I appreciate your engagement on this issue, I also agree that data is critical to avoiding succumbing to myths.

    Angina pectoris wasn’t described as a disease known to medicine until the late 18th century. Do you really think physicians of antiquity saw this all the time but never sorted it out? Coronary disease as a cause of death in the US in 1850 was not even on the list of the top ten causes. By 1900 it was number four and by 2000 it was number one. That’s an epidemic.

    It tracks with elevated cholesterol levels.

    Metabolic ward studies clearly show that any individual given saturated fat will see a stepwise increase in their cholesterol level. There is an equation called the Hegsted equation that reliably predicts the increase. Has it been discredited experimentally?

    I want to believe hard data just like you. Metabolic ward studies (395 of them) consistently show saturated fat elevates cholesterol. It also does this reliably in all animal models. What possible evidence could overturn such an overwhelming scientific consensus?

    As for smoking, which randomized trials of cigarettes do you use to determine that they are dangerous?

    Finally, did you know that the surgeon general does in fact warn against saturated fats? You should check that out:

    http://www.surgeongeneral.gov/priorities/prevention/strategy/healthy-eating.html

    • Harriet Hall says:

      Heart disease is not new. It’s been found in Egyptian mummies.
      Heart disease has become more prevalent, but there is no reason to think one simple change like reducing saturated fat intake would eliminate it or even make a significant difference.
      Cholesterol is a risk factor for heart disease, not “the cause.” If saturated fat in the diet raises cholesterol levels, the next step is to ask if saturated fat causes any actual increase in heart attacks. Statins lower cholesterol levels far more effectively than dietary interventions, and they have been shown to reduce the number of heart attacks and deaths (possibly from anti-inflammatory effects in addition to or instead of their effect on cholesterol levels). We need to know actual POEMS: Patient Oriented Evidence that Matters.

      We don’t need randomized prospective trials to show that cigarettes are dangerous. We know cigarettes are dangerous based on a huge, consistent, and coherent body of evidence from basic science, epidemiological studies, studies of smoking cessation, the effects of smoking legislation, temporal relationship, evidence of dose-response relationship, etc. etc. If we had that amount and quality of evidence for saturated fats, everyone would agree; we don’t.

      In the link you provided, the surgeon general mentions saturated fat only in passing, as one of a large number of interventions to improve health. That’s a far cry from the voluminous Surgeon General’s Report on Smoking. We are not likely to see warnings on saturated fat products comparable to the warnings on cigarette packages.

  7. Evan Allen says:

    A coherent body of evidence from basic science:

    1. All atherosclerotic plaques are composed primarily of lipid, most of which is cholesterol. This is the case in all mammals studied. All mammals studied who develop hypercholesterolemia develop these plaques. An easy way to get all mammals studied to have high serum cholesterol is to feed them saturated fat under laboratory conditions and this has been done multiple times.

    2. Epidemiological studies show dramatic variations in the incidence of cardiovascular diseases between countries, and saturated fat consumption per capita is one of the best predictors of this variation. People who move from one country to another usually assume the risk of the country they move to. When a country industrializes and decreases starch consumption for more meat and processed foods, cardiovascular disease rates increase predictably. Mummified Egyptians were wealthy by definition and therefore were able to eat a diet higher in saturated fat … which at that time gave 25% of them atherosclerosis. Nearly all Americans have some degree atherosclerosis at autopsy.

    3. When nations and individuals dramatically drop saturated fat consumption, heart disease rates drop rapidly (Finland, Norway in WWII, Denmark in WWI), and this is also documented in Kempner, Pritikin, McDougall, Ornish and Esselstyn’s published scientific research.

    4. Legislation to help nations reduce saturated fat consumption worked to reduce heart disease death rates in Finland by 80%.

    5. Nations that adopt a western diet have predictable increases in heart disease, the epidemiologists refer to this as the nutritional transition.

    6. There is a dose response relationship between cholesterol and saturated fat, defined by the Hegsted relationship. There is a dose response relationship between serum cholesterol and heart disease as quantified by the NCEP.

    How is this evidence any different in quality than the evidence against smoking?

    • Alan Levinovitz says:

      Evan, I hate to say this, but the scientific consensus just isn’t with you. It seems dietary guidelines may de-emphasize saturated fat as a culprit. It’s hard to sort out what happened in Finland, say, since the intervention also included smoking reductions. I’ve visited your website: http://allenwellness.com/meet-dr-allen/, since as someone who studies rhetoric, and specifically rhetoric around diet, it is important for me to exercise my own area of expertise when evaluating commentary. It concerns me to see you blame “modern conventional medicine” for health problems, a category typically employed by alternative medicine practitioners. It also concerns me to see that you run a concierge care practice that makes extraordinary promises about the efficacy of diet in regards to preventing disease. These are not decisive factors (of course!) but they make me think twice about how you are coming to the evidence.

      There’s no denying that eating a healthful, balanced diet, getting exercise, and relaxing is a recipe for success when it comes to living long and well. “Conventional” doctors have been recommending that for a very long time. But to take things a step further, and argue that “healthful, balanced diets with little to no saturated fat” are to “healthful, balanced diets with fair amounts of saturated fat” as “non-smoker” is to “smoker” goes beyond any reasonable assessment of the science, at least as I see it.

  8. Harriet Hall says:

    Seriously? The evidence against smoking is massive. You provide 6 arguments against saturated fat that are mostly based on unreliable epidemiological evidence and subject to confounders that have not been ruled out. I think you are a victim of confirmation bias. You cite data that confirms your beliefs, but you fail to mention contradictory data like this: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2824152/? _escaped_fragment_=po=31.2500 – a meta-analysis of 21 studies with 5-23 year followup of 347,747 subjects that concluded there was no significant evidence that dietary saturated fat is associated with increased risk of coronary heart disease or cardiovascular disease. I don’t know of any comparable large meta-analysis concluding that there is no evidence that smoking is associated with lung cancer or other health hazards; do you?

    If you can’t see the difference in quality and quantity between the evidence against smoking and against saturated fat, nothing I can say is likely to persuade you. I have looked at both sides of the fat/heart issue, and IMHO the evidence against saturated fat is less than compelling. You disagree, and of course you are entitled to your own opinion. I’m going to sign off now and not waste any more time on a fruitless debate.

  9. Evan Allen says:

    Alan, the best way to find out what the scientific consensus is is to read scientific consensus papers. The AHA scientific consensus from 2006 states that we should limit saturated fat. The NHLBI consensus from 2005 states that diet high in saturated fat and cholesterol raise the risk of metabolic syndrome. The American Diabetes Association consensus statement on cardiovascular disease states that restriction of saturated fats is recommended. The American College of Cardiology consensus statement from 2001 recommends limiting saturated fat to reduce heart disease risk.

    So the scientific consensus is overwhelmingly against large amounts of saturated fat in the diet.

    The Victoria Heart Health Declaration from 1992 remains valid today:

    “Cardiovascular disease is largely preventable. We have the scientific knowledge to create a world in which most heart disease
    and stroke could be eliminated.”

    “Science has shown that the major risk factors for cardiovascular
    disease are either preventable or controllable. Studies of hundreds
    of thousands of individuals over the past 30 years have consistently shown that smoking, high blood pressure, elevated
    serum cholesterol and diabetes increase the risk of cardiovascular
    disease. In turn, these risk factors are strongly linked to abdominal obesity, diets high in saturated fat, and inadequate physical activity. In any prevention effort, lifestyle and environmental factors are clearly of paramount importance.”

    http://www.med.mun.ca/chhdbc/pdf/victr_e.pdf

    Dr. David Katz, who you quote favorably states unequivocally:

    “Despite compelling statistics that show we could eliminate: 80% of all heart disease and strokes, 90% of all diabetes, and 60% of all cancers with basic lifestyle changes, we have failed to motivate the public to make these changes and failed to motivate policy makers to make healthy choices the easiest choice.”

    The claims made on my website are the same as the claims made by mainstream scientists over the past century and a half.

  10. Evan Allen says:

    Dr.Hall, thanks for your time. The Siri-Tarino meta-analysis is flawed, in my opinion as it corrected for serum lipid concentrations, which are a dependent variable.

    Interested readers can check out a more compelling deconstruction of this study here:

    http://plantpositive.com/siri-tarinos-meta-analysis-par/

    Epidemiological evidence is not unreliable, it’s as statistically valid as polling or other social science investigations and it’s not a pseudoscientific discipline. Are you, as a skeptic, not accepting of a peer-reviewed, scientific discipline?

    Moreso, I did not rely exclusively on epidemiology. The saturated fat studies on animals and those done on humans in metabolic wards do NOT rely on epidemiology at all and you chose to ignore them.

    A debate is fruitless when one side can’t be convinced, for sure, so I will sign off as well.

  11. james kenney says:

    Alan Levinovitz says: “Evan, I hate to say this, but the scientific consensus just isn’t with you. It seems dietary guidelines may de-emphasize saturated fat as a culprit.” AL

    Actually Alan you are wrong about dietary guidelines de-emphasizing saturated fat as a major causal factor in promoting atherosclerosis and CAD. The scientific consensus on this is with Evan Allen and not with you, Harriet, or Gary Taubes [who is a crackpot pseudoscientist IMO]. He has misrepresented the scientific evidence on both the harm caused by added dietary salt, saturated fat, and cholesterol. Any claim that increasing saturated fat and/or cholesterol in the diet won’t raise TC, LDL-C, and nonHDL-C is simply naïve. As Evan has correctly pointed out the consensus from carefully controlled clinical trials proves beyond any reasonable doubt that more saturated fat (and more cholesterol although here the latest dietary guidelines are incorrectly de-emphasizing it) raises the levels of atherogenic apoB-containing lipoproteins in the blood. And only someone naive or perhaps a pseudoscientific ideologue would argue that higher levels of TC, LDL-C, nonHDL-C, and apoB-containing liporpteins in the blood are not a major causal factor promoting atherosclerosis and CAD.

    So from my perspective Harriet and Alan have a lot to learn about diet, blood lipids and CAD.

  12. Evan Allen says:

    Baloney Detection for Gary Taubes and the idea that saturated fat has been exonerated:

    1. Reliability, are all the errors slanted in one direction?

    I am just going to list the errors in the first chapter of Good Calorie Bad Calories, so that interested readers can see if they all slant one direction:

    a. Over 50% of people with familial hypercholesterolemia do get coronary artery disease, this is even noted in the study Taubes cites (pg. 15)

    b. The study he cites from Dr. Debakey included 1700 cases, of which 1416 had cholesterol levels over 200 mg/dL, which is high cholesterol by modern definitions, Taubes simply accepts the old definition without telling anyone (pg. 15)

    c. Throughout the chapter Taubes discredits all animal studies on atherosclerosis, this suggests that evolutionary biology is invalid (not a very skeptical position)

    d. Taubes quotes Yerushalmy and Hilleboe’s criticism of Keys’ fat data from the original 1953 paper on six countries, but neglects to mention that their study implicated animal protein as the cause of coronary disease (pg. 18)

    e. Dwight Eisenhower’s diet was never particularly low in fat. He ate bacon and sausages for breakfast and cooked using coconut oil that had been hydrogenated, all knowable, all left out of GCBC

    Gary Taubes is very unreliable. Read Plant Positive’s posts on him or the reviews of his book at Seth’s The Science of Nutrition site for more.

    2. Does the source make similar claims?

    Taubes believes that calories don’t make someone heavier, in violation of the laws of physics.

    3. Has anyone verified the claim?

    Taube’s claim from GCBC that “Dietary fat, whether saturated or not, is not a cause of obesity, heart disease, or any other chronic disease of civilization,” is completely unverified, no reputable medical professional could utter it and he is on his own on this. There is no medical society that makes this claim and no dietitic group or other qualified organizations that have agreed with him.

    Numerous tests have been done in the scientific literature that show just the opposite. Taubes claim is a crank claim unless he can discredit the reams of research that show the opposite.

    4. Does this really fit with the way the world works?

    Of course not. Your friend who eats egg and cheese omelets for breakfast, barbecue for lunch and steak and eggs for dinner has very different health results than your friend who eats rice and vegetables. You know which one is sicker. Epidemiological studies back this up of course. They are not pseudoscience, they are peer-reviewed science.

    5. Has anyone tried to falsify this?

    Yes, low carb diets have been studied. When we look at them we see increased rates of death in the population that eats them:

    a. Fung, 2010, Annals of Internal Medicine — 23% increased all cause mortality for animal-based low carbohydrate diets (the ones Taubes recommends)
    b. Lagiou, 2012, BMJ — increased risk for ischemic and hemorrhagic stroke, ischemic heart disease, peripheral arterial disease and subarachnoid hemorrhage
    c. Noto, 2013, PLOS — Low carbohydrate diets showed increased all cause mortality but no increased risk of heart disease

    No ringing endorsement for pseudoscience there.

    6. What does the preponderance of the evidence suggest?

    Dietary saturated fat raises LDL cholesterol. Plaque in arteries is deposited there by LDL cholesterol in animal models. The Nobel committee awarded a prize in medicine to the scientists who discovered how this worked. Societies that eat very little saturated fat have very low rates of heart disease and low LDL cholesterol levels. I could go on and on …

    7. Are the people making the claim playing by the rules of science?

    I’d argue no.

    8. Is the claimant providing positive evidence for his theory or just denying evidence for the other theory?

    Taubes spends almost all his time criticizing nutrition science. Supposedly his NuSI group will do studies. They’ve had 14 million dollars since July of 2013 and three reported trials under way. So far not a peep. The Energy Balance Consortium Study was supposed to be completed last year.

    9. Does the new theory account for as many phenomena as the old theory?

    No, unless you think that Irish people in 1833 having a diet of 85% carbohydrate with diabetes death rates under 2 per million is well explained by the carbohydrate toxicity theory of diabetes that Taubes promotes.

    10. Are personal beliefs driving the claim?

    Of course, but I really don’t see how you can make a claim without it being your belief. Taubes has certainly gone all in with his statement from GCBC about fat never causing any disease.

  13. Terry M says:

    Is ketosis not an argument for the validity of “grain brain”? Or is a ketogenic diet merely a prescription for specific brain disorders rather than an indication for overall brain health?

  14. Sleepy says:

    No one seems to dispute that eating lots of saturated fat raises LDL. The question is whether that matters. In my case, I went to LCHF diet 14 months ago and within three weeks my LDL rose from 108 to 118. But my HDL went from 42 to 66, and triglycerides plummeted from 180-something down to (I forget exactly) about 90. Also, my fasting glucose dropped from 100-102 down to 88-90. I do not count carbs and still eat plenty (40-100 g per day).

    As I approached middle age, I was creeping toward metabolic syndrome, but now my numbers are fantastic. Expecting pushback from my physician, I was surprised when he agreed with my take on fat-not-being-the-enemy. A little blip in LDL seems dramatically overshadowed by the other health benefits. I am not a nutritionist but a lawyer who evaluates evidence for a living.

    Since fat has always been vilified (until recently), people who ate lots of fat also probably ate lots of other bad things, and tended to obesity given fat’s high calorie content.

  15. Terry Simpson says:

    A few things: while I am not a fan of Taubes – he is a good writer. Hegsted equation was for short term addition of saturated fat in diets- and does not appear to have any long-term validation with it.

    Relative risk of saturated fat in diets has never approached 2 or 3 with heart disease, so it is something to be skeptical of (I am a skeptic).

    While blood lipoprotein levels are highly correlated with heart disease, that does not correlate to the diet- what is absorbed and what is not. When we block absorption with some drugs- more effective than diet- we don’t have the resultant loss of plaques as others.

    Just a start

  16. skeptic says:

    Big surprise: a boutique doctor who has “success stories” about curing or preventing “reversible diseases” (like MS of course) on his website argues against data that may impact his business.

  17. theone says:

    it’s so easy to talk about this. why, in the first place, people try these miraculous remedies from my old granny from tybbet? why people turn themselves from the science based medicine? its the attitude dude. getting academical pills in the neck can get you more ill than tybett ones.

  18. murray Jones says:

    Got news for you I’ve felt like shit sinse Nov 2000 last year I started cutting things out of my diet with my doctors help flour seemed a culprit had all tests down throat even n no celiac diagnosis. Except all fine hairs in my stomach burnt off. Yes u wanka I was hit by lightning im staying GF I feel 1000% netter but then again must be in my mind

  19. Amy says:

    I have found that when I have a problem with gluten I am most likely low in my B vitamins. So, I just load up on my B vitamins and then I have no more problems after my levels go back up. I wonder if there my be some correlation?

  20. Jeff says:

    I loved this book but I have an important comment/caveat which should be addressed. I listed to the Audible audiobook version and it ends with the initial description of the Unpacked Diet with no mention (outside of the ever increasing silliness of the claims) that it is satire. The second appendix referred to in this review is not part of the audiobook and my possibly mislead some readers. I was afraid the satire might be lost on some but, after reading this review I see that the issue exists only in the audiobook.

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