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We Lost a Few Hundred Million
Dollars -- But no Fat
According to the headlines, a low-fat diet fails to decrease cancer and
heart risks in older women. With such an important announcement, it
behooves us to take a closer look at this 415 million dollar study funded
with your tax dollars. Perhaps we can find flaws that may get it nominated
for the "Worthless Research of the Year," award. This is an award that I
created this week, motivated by this study. I know it's still early in the
year 2006 and another study could still trump this one.
Here are the basic facts about the study published in the February 8,
2006 issue of the Journal of the American Medical Association. It involved
48,000 postmenopausal women with an average age of 62. These women were
advised to cut overall fat consumption and increase vegetables, fruits and
grains. The women in the study had 18 sessions in small groups with a
trained nutritionist in the first year and four sessions a year after
that. Women in the intervention group were instructed to reduce their
intake of total fat to 20 percent of their energy intake and to increase
their consumption of vegetables and fruits to at least five servings
daily, and to increase their grain consumption. All fats were supposed to
be reduced without distinction between various types of fat. The results
were compared to women (the control group) who continued their usual
eating habits. Supposedly, and according to the headlines, the eight-year
study showed no difference in the rate of breast cancer, colon cancer and
heart disease among those who ate lower-fat diets and those who didn’t.
SuperSized Study Flaws
1. It is naive and simplistic to categorize all fats as having the
same health benefit or risk. There are good fats, neutral fats, and bad
fats, and the ratios can make a huge difference. The scientific thinking
on the role fats play in disease prevention has evolved since this study
was designed back in the early 1990s. We now know that not all fats are
bad. Some fats, like the kind in fish, olive oil and nuts, are healthier
than the saturated fats and trans fats found in processed and fried foods,
cookies, cakes, and junk foods. Study participants probably reduced intake
of all kinds of fats, assuming that all fats carried the same risk.
2. The women started this diet too late, an average age of 62. Most
cancers take years or decades to form and be detected. For breast cancer
in particular, earlier eating habits may have the most influence on risk.
Hardening of the arteries takes years and decades to form.
3. The researchers mentioned that in the study women did not reduce
the fat content of their diet to the extent that the study required. They
admit the low fat diet was difficult to follow. The diet they were told to
follow meant, for example, no butter on bread, no cream cheese on bagels,
no oil in salad dressings. The researchers did not differentiate between
trans fats (for instance in baked goods), saturated fats, monounsaturated
fats (found in olive oil), and polyunsaturated fats. They told the women
to reduce all fats.
4. Both groups started out
with about 37 percent of daily calories from fat. The goal was to cut that
to 20 percent for the low-fat group; the women managed about 24 percent on
average in the first year, but it climbed to about 29 percent later on. We
all know how difficult it is to follow a particular diet for prolonged
periods without cheating. And, by the way, not overtly mentioned by the
media, the subgroup of women who reduced their fat intake the most, did
have a lower rate of breast cancer and heart disease.
5. Most of the women in the study remained overweight. Excess
pounds increase the risk for heart disease and cancer, whether the pounds
come from fats or carbohydrates. Both groups had on average a similar
weight at the end of the study and they consumed about the same number of
calories.
6. When a person is asked to lower their fat intake, guess what
they often substitute: carbohydrates. Carbohydrates, particularly simple
carbohydrates from sugar, fructose, and pasta, get converted into
saturated fats, one of the worst kinds of fats. If you are not getting
enough fat in the diet, your body may crave simple carbs, and simple carbs
are probably worse than saturated fats.
7. Some of the women in the control group who ate their regular
diet may possibly have changed their eating habits with time by just
following recommendations mentioned in the media and women's magazines
over the past few years on how to eat healthier. Therefore, their diet may
not have been significantly different than those in the study group as the
researchers would have hoped. It appears that both groups had relatively
low rates of heart disease, about 2.5 percent compared with just over 4
percent among postmenopausal women nationally.
Who and What to Believe
Certain comments by so called researchers and pundits regarding the
results of this study were clearly.... how shall I say... eh... stupid.
Yes, that's the word I'm looking for, Stupid.
Dr. Timothy Johnson, the medical
commentator on ABC nightly news, said, "This is a wake up call. This study
shows we can't rely on lifestyle changes, like weight loss, exercise, diet
changes, to reliably reduce the risk of disease. I say to people to take
advantage of testing, colonoscopy, blood tests, and mammograms. We can get
these diseases even living a good lifestyle."
Yes, Dr. Johnson, it is very true that we can get these diseases even
by living a good lifestyle, but I am shocked that you would minimize the
role of food choices on health and disease based on this flawed study.
Barbara V. Howard, an epidemiologist
at MedStar Research Institute, a nonprofit hospital group, and a principle
investigator in the study, is quoted in a newspaper article saying "People
should realize that diet alone is not enough to stay healthy. We are not
going to reverse any of the chronic diseases in this country by changing
the composition of the diet."
I wonder if she said this while wolfing down a double cheeseburger
sandwiched with two large empty calorie white buns along with a 64 ounce
sugared soda refill cup and a side order of deep fried onion rings.
No one denies that genetics, smoking and exercise play a crucial role
in health and disease, but to minimize and dismiss the role of diet is
just plain.... what's the word... (you fill in the blank).
Summary
We did learn a few things from this 415 million dollar study: a) Most
people find it difficult to stick to a low fat diet for prolonged periods,
b) Scientists, even with the best intentions, may design a study with a
poor understanding of nutritional knowledge, ie, not recognizing that
different fats have different health effects, and c) After several decades
of nutritional research the consumer, and researchers, are as confused as
ever about the role of diet in health and disease.
My suggestion is that you try your best at eating a variety of foods,
increase your intake of fresh vegetables, fruits, whole grains and beans,
spices, and fish, and reduce your intake of simple sugars and trans fats,
along with reducing intake of pastry and junk food. It's not that
complicated.
A friend of mine commented recently that she learned more about the
influence of diet on health from seeing the movie Supersize Me than
learning the results of this study.
For suggestions on a
reasonable diet you can follow for long term health maintenance, see
http://www.raysahelian.com/diet.html
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Feel free to forward this supplement
research update to a friend who might be interested in these topics.
For prior issues, visit
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