Dispelling nutrition myths, ranting, and occasionally, raving


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Revisiting Dr Esselstyn

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A reader recently commented on a blog post from over a year ago: <a Something's Greasy About Dr Esselstyn's Diet. He suggested that I take a look at some recently published research supporting the diet (and, I think, revise my previously stated opinion).

One of the links was to a series of case studies presented by Dr Esselstyn. As we know, case studies can be interesting, especially in cases of rare conditions, but are not readily generalized. As coronary artery disease (CAD) is a fairly common condition, I feel that it’s more prudent to focus on larger research studies when developing recommendations for the public.

The other link was to a study conducted by, you guessed it, Dr Esselstyn. The study followed 198 CAD patients who were counselled in plant-based nutrition for approximately 44 months. Upon follow-up it was found that 21 were non-compliant (what ever that means… more on this to follow). The remaining participants all showed significant improvement, and only one experienced a related medical incident (i.e. stroke) during those 44 months.

The biggest issue with this study is that there was no control group. There is nothing to compare the participants with. It’s entirely possible that a group, provided with all the same medical treatments and advice, minus the nutritional counselling would have fared just as well. It does seem unlikely, but without the inclusion of such a group, there is no way to be certain that the nutrition counselling (and subsequent adherence) was the reason the participants fared so well. In addition, there was no control for any potential confounding factors. The authors didn’t control for anything. That means that the success could have been due to physical activity/exercise, sleep, stress reduction, socioeconomic status, etc.

There are a few other issues I have with this research. The article states that:

Initially the intervention avoided all added oils and processed
foods that contain oils, fish, meat, fowl, dairy
products, avocado, nuts, and excess salt. Patients were also asked to avoid sugary foods
(sucrose, fructose, and drinks containing
them, refined carbohydrates, fruit juices, syrups, and molasses). Subsequently, we also
excluded caffeine and fructose

However, “We considered participants adherent if they eliminated dairy, fish,
and meat, and added oil.”

My issue with the diet prescribed by Dr Esselstyn was the lack of healthy fats. I have no issue with a vegetarian diet (yes, I’m still not convinced that oil, fish, and dairy products are unhealthy, especially for those who do not suffer from CAD) which is what the adherent participants followed. This means that they could have added nuts, seeds, nut butters, sugar, coffee, avocado, and so on, to their diets and still been adherent. A far cry from the original Esselstyn diet. In turn, I also wonder what the non-adherent participants consumed. Did they eat some fish or meat? Drink some milk? Or were they chowing down on fast food and Hungry Man dinners on the regular? Without knowing these things we shouldn’t be too quick to jump to the conclusion that the Esselstyn diet is superior to all other diets when it comes to treating CAD.

Naturally, there’s also the issue that (despite stating that the authors had no known conflicts of interest) Dr Esselstyn is the author of a number of heart health and lifestyle books that would surely take a hit in sales were research contrary to his hypothesis to be published.

Sure, this study warrants further research into the benefits of plant-based diets (and Dr Esselstyn’s very low-fat plant-based diet) for CAD patients. I’d like to see some larger studies with control groups conducted. Until then, I’ll still be cooking with oils and enjoying my guacamole.

 

 


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Too much of a good thing: 5 fats that will make you fat

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Oh those Hungry for Change people. I signed-up for their email notifications so that I could stay abreast of the latest stuff they’re peddling. One of the more recent messages came with this headline: 5 Fats That Don’t Make You Fat.

I visited their website so see what these magical fats are. They are: coconut oil, nuts, avocados, seeds, and olive oil. I’m not even going to bother quibbling with the fact that the items included in this list are not all fats because they do contain fat and I think that’s what they were getting at. Yes, these are all healthy foods and we know that eating fat is not going to automatically make you fat. However, eating too many calories (i.e. more than you expend) most certainly will “make you fat” and eating too much of any of these five “fats” is no exception to this rule.


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The cure for heart disease

My mum recently sent me a link to this article  about the perils of a low-fat diet. While I am in complete agreement that a low-fat diet is not a healthy diet (we need all of the macronutrients: fats, carbohydrates, and proteins) I disagree with the argument that we need more fat and that low-fat, high-grain diets are the cause of heart disease.

The article is based on the work of a Dr Dwight Lundell. He argues that our “mainstream” diet that is low in saturated fat, and high in grains is the cause of obesity, heart disease, and type two diabetes. I would argue that demonizing any one food, or food group, is no the solution. Grains are not causing obesity and related diseases. Excess consumption of calories (regardless of their source) and insufficient levels of exercise excess levels of sedentary activities are the controllable causes of these diseases.

He also discusses the role of inflammation as the cause of accumulation of cholesterol in our bodies. As far as I can tell, the idea that certain foods promote inflammation in the body is just another made-up diet to convince us to buy a certain series of diet books. Dr Lundell also argues that our use of polyunsaturated fats (such as olive oil) is unhealthy and we should all consume more saturated fats. I don’t think that eschewing plant oils for butter is the solution. I think that both can be incorporated in a healthy diet.

I decided to do a quick google search on our Dr Lundell. Fortunately for me, it was very quick. Right at the top of the list of results was what I was looking for: an article on Quack Watch. This article informed me that Dr Lundell actually lost his medical licence in 2008 for a number of reasons including inadequate patient care. This article warns against heeding Dr Lundell’s advice. Now, that’s advice I would be inclined to heed.