Dispelling nutrition myths, ranting, and occasionally, raving


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What came first: the fried chicken or the heart disease?

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Last month a study was published about fried food consumption and the risk of coronary artery disease. The study was conducted with US military veterans and concluded that: “In a large national cohort of U.S. Veterans, fried food consumption has a positive, dose-dependent association with CAD.” Meaning that the more fried food a veteran consumed, the more likely they were to have heart disease. But what does this mean for the average person?

It’s important to note that the vast majority of study participants were men (90%) and the average age was 64. It’s well known that heart disease in women is poorly researched and important to acknowledge that the results of this study don’t necessarily apply to women. There are also many factors that contribute to the risk of developing heart disease and the researchers took the following into account: race (insofar as to categorize participants as black, white, or other), BMI, alcohol use, education status, exercise, smoking status, pre-existing type 2 diabetes, consumption of fish, fruit, and vegetables. After controlling for these factors, the researchers still found a relationship between fried food consumption and CAD.

However, the authors neglected to control for one important factor: poverty. Poverty is a significant risk factor for many so-called “lifestyle-related diseases”, including CAD. Other lifestyle factors are often also enmeshed with poverty making it nearly impossible to determine true contributing factors. People who live in poverty often have poorer diet quality than those with higher incomes and may rely on fast food, including fried foods. If poverty is indeed a greater risk factor than fried food consumption, or if fried food consumption is a result of poverty, this means that simply telling people to consume less fried food may not be the most helpful advice. It takes a certain level of privilege to be able to “choose” to consume the recommended diet. It means having the financial means, time, access, and facilities necessary to prepare nutritious meals.

While the findings of this study support the common belief that fried food is not a healthy choice they also serve to entrench the belief that diet is all about choice when for many people it is not. We need to look further than fried food to determine the root causes of illnesses such as coronary artery disease if we truly want to work to reduce incidence of these diseases.


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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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Throwing the fish out with the oil

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For the most part I love Fooducate; however, I was a little surprised by this recent blog post on their site. The post referenced a recently published study that suggested our touting fish oil supplements (or even the recommendation to consume fatty fish twice a week) is faulty. They did not offer any thoughts or critique on the new “study”.

The study was actually an analysis of previously published research. They claimed that our recommendation to consume fish (or fish oil) was based solely on a research study of Icelandic Eskimos conducted in the 1970s. They assert that the findings of this study were misinterpreted and that the researchers did not even look at the prevalence of cardiovascular disease in the population they studied. They then looked at the other research on diet and CVD in Eskimo and Inuit populations. They only found one study that performed direct measurements on the Greenland Eskimo
population for assessing the presence of CAD or CAD risk factors”
. They state that this study, conducted before the Eskimo population had adopted a Western diet, found no difference between incidence of CAD in the Inuit population in comparison to American and European populations. Interestingly, I took a look at the original research study and the researchers actually found a lower risk of CVD in the Inuit population as compared to the Western population. Essentially the opposite of what the current researchers are claiming.

So… “What the heck does this all mean??” you may be wondering. Should you be eating fish twice a week? Should you be taking fish oil supplements? Well, unless you are a Greenlandic Inuit then this research may not apply to you at all. We can’t say that what’s healthy for the Inuit population is healthy for other populations. We also can’t be certain that it’s the consumption of fatty fish that reduced their risk of heart disease. It may be any of  number of other lifestyle factors that placed them at lower risk for CVD. Recent research into the benefits of fish oil has yielded mixed results. Some studies show benefits of fish oil consumption, others show negative effects of its consumption. As always, the best advice is that variety is the spice of life and it’s best to obtain your nutrients from whole foods. Yes, eat fish (limit the larger saltwater fish you consume though as it can be high in mercury), choose a variety. If you don’t eat fish, you might want to consider consuming a fish oil supplement. There may be benefits other than lower CVD risk associated with consuming omega-3s from fish/fish oil (such as mental and cognitive well-being, bone and joint health). Research is ongoing and you might want to wait before you turf your fish oil supplement or grilled salmon.


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Can a glass of water really prevent a heart attack?

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I’m so glad that I got a facebook page. If only because it’s quickly becoming a better source for blog fodder than Dr Oz. Okay, okay, that’s a slight exaggeration. Regardless, there’s a wealth of health misinformation floating around around on there.

Take this post, for example. It purports to be information coming from the Mayo Clinic and tells people that they can reduce the risk of heart attack by drinking a glass of water just before going to bed for the night. Too good to be true? You bet! Now, most of us could probably stand to consume more water on a regular basis so I really don’t want to discourage you (no not you, I know that you get plenty!) from drinking water. However, I don’t like people thinking that a glass of water before bed is the ultimate in heart attack prevention.

There is no information on the Mayo Clinic website advising people to drink water before bedtime to prevent a heart attack. Moreover, there is no scientific research to support this claim.

The article also makes three additional claims about the optimal times to consume water in order to help certain health conditions:

 2 glasses of water after waking up – helps activate internal organs
1 glass of water 30 minutes before a meal – helps digestion
1 glass of water before taking a bath – helps lower blood pressure
1 glass of water before going to bed – avoids stroke or heart attack

This is all a lot of hooey. Want to know the optimal times to drink water: when you’re thirsty, when you’ve been sweating a considerable amount, and when you’re sleepy and want to be alert.

Want to “activate internal organs”? Avoid death or becoming a zombie. You’re good to go! Want to help digestion? Avoid consuming extremely large meals. Want to lower blood pressure? Avoid stroke or heart attack? Get plenty of exercise, avoid sitting for prolonged periods, consume a healthy, primarily plant-based diet.

The post goes on to mention additional advice about aspirin use for heart attacks. It references a Dr. Virend Somers at the Mayo Clinic. Google his name and the first thing that comes up is this post on the Mayo Clinic website:

We have been informed of a recently circulated email regarding the use of aspirin, which included mention of Dr. Virend Somers and of Mayo Clinic. Neither Dr. Somers nor Mayo Clinic contributed to this email, which contains some information that is inaccurate and potentially harmful. We recommend that you speak with your physician if you have specific questions.

This was posted back in 2010! Clearly this misinformation has been making the rounds for some time. I would like to echo the Mayo Clinic’s advice: if you are concerned about heart disease risk, or any other medical condition, go see your doctor. Definitely don’t accept unsolicited advice from facebook.


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Bad news for science: naturopaths get positive press

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The twitterverse was all abuzz the other day with the release of a journal article that found that patients who received counselling from naturopaths reduced their risk of heart disease significantly more than patients who only went to see a doctor.

Of course, a number of the authors of the paper reported potential conflicts of interest such as receiving funding from alternative medicine groups and naturopathic organizations. Naturally, they would have a vested interest in showing that there is a benefit to seeing a naturopath.

Doctors, unfortunately, are more often than not, ill-equipped to provide lifestyle and nutrition counselling. It seems pretty obvious that patients provided with an additional level of care would experience better outcomes than the patients who only met with their family doctors. This does not mean that all patients with elevated risk for cardiovascular disease should seek the help of a naturopath. It means that they should be receiving specialized nutrition and lifestyle counselling from a trained health care professional. Ideally, a dietitian as our advice is science-based and we do not promote homeopathic remedies.

The two things I get out of this study are: 1. patients with elevated risk for diseases which can be mitigated by lifestyle changes should receive counselling in the appropriate area(s), 2. doctors should be referring their patients to their appropriate counterparts in healthcare to supply that counselling. The fact that naturopaths were the providers of the counselling in this study is unimportant and gives the false impression to the public that naturopaths are a suitable alternative to doctors and dietitians.