Milk and Calcium - Too Much Not Good for You

Drink milk because it contains calcium was the mantra.  Now more evidence is accumulating that the message should perhaps be the opposite: avoid milk because it contains calcium.

A recent Swedish cohort study published in the British Medical Journal showed people who drink three glasses of milk daily have a significantly higher chance of dying from all causes than those who drink just one glass of milk a day.

The theory that drinking milk leads to strong bones also suffers yet another setback. There was no evidence drinking more milk reduced the rate of hip fractures. Indeed the apparent paradox that the nations that consume the most calcium have the highest fracture rates remains. Other non-milk dairy products like cheese and yogurt, however, do seem to provide some of the advertised benefits.

This negative finding for milk is consistent with previous findings questioning the value of calcium supplementation that also found correlation between increased calcium supplementation and increased mortality.

Magnesium and Calcium?

It is unmentioned anywhere but could it be that the antagonistic properties of magnesium towards calcium and vice versa is part of what makes magnesium beneficial?  This is one of those relationships that are unaddressed but should be.

References

• Bischoff-Ferrari HA, Dawson-Hughes B, Baron JA, et al. (December 2007). Calcium intake and hip fracture risk in men and women: a meta-analysis of prospective cohort studies and randomized controlled trials. American Journal of Clinical Nutrition 86(6):1780-1790.
• Bischoff-Ferrari HA, Dawson-Hughes B, Baron JA, et al. (March 23, 2011). Milk intake and risk of hip fracture in men and women: A meta-analysis of prospective cohort studies. Journal of Bone and Mineral Research 26(4):833–839.
• Bolland MJ, Avenell A, Baron JA, et al. (July 29, 2010). Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ 341:c3691.
• Bolland MJ, Grey A, Avenell A, Gamble GD, Reid IR. (April 19, 2011). Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women's Health Initiative limited access dataset and meta-analysis. BMJ 342:d2040. 
• Feskanich D, Bischoff-Ferrari HA, Frazier AL, Willett WC. (January 2014). Milk Consumption During Teenage Years and Risk of Hip Fractures in Older Adults. JAMA Pediatrics 168(1):54-60.
• Kuanrong L, Kaaks R, Linseisen J, Rohrmann S. (May 21, 2012). Associations of dietary calcium intake and calcium supplementation with myocardial infarcation and stroke risk and overall cardiovascular mortality in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition study (EPIC-Heidelberg). Heart 98:920-925.
• Michaelsson K, Wolk A, Langenskiold S, et al. (October 28, 2014). Milk intake and risk of mortality and fractures in women and men: cohort studies. BMJ 349:g6015
• Xiao Q, Murphy R, Houston DK, et al. (2013). Dietary and Supplemental Calcium Intake and Cardiovascular Disease Mortality The National Institutes of Health–AARP Diet and Health Study. JAMA Internal Medicine 173(8):639-646.

Chocolate - Health Benefits

Jeanne Calment who holds the record for being the oldest woman was a notable chocoholic who regularly ate up to two pounds of dark chocolate a week despite the negative reputation of chocolate at the time.  As it turns out perhaps she was on to something.

The Central American Kuna Indians who regularly eat from the cacao plant from which cocoa and chocolate are derived have also been shown to have increased longevity.

Flavanols found in dark chocolate and also in tea and some vegetables have been found to possibly have a number of health benefits.

These include

• lowering blood pressure
• lowering mental stress
• improving or maintaining age-related memory functions
• correlating with reduced all-cause mortality

Epicatechin in particular is the flavanol that is thought to impart these health benefits but its effects seem to be significantly reduced or blunted in the presence of milk which is why milk chocolate doesn't seem to provide the same effects as dark chocolate. The common process of dutching or alkalinizing cocoa to modify its color and make it taste milder also reduces the flavanol content making chocolate that has undergone such a process less likely to give beneficial results.

While epicatechin has garnered all the attention it is probably also worthwhile to note that cocoa and dark chocolate are also chock-full of minerals and nutrients such as magnesium, phosphorous and potassium which are also linked to improved health.


Cocoa Powder Nutrients

Nutrient	Unit	Value per 100 g	1 cup 86g	1 tbsp 5.4g
Proximates
Water	g	3.00	2.58	0.16
Energy	kcal	228	196	12
Protein	g	19.60	16.86	1.06
Total lipid (fat)	g	13.70	11.78	0.74
Carbohydrate, by difference	g	57.90	49.79	3.13
Fiber, total dietary	g	37.0	31.8	2.0
Sugars, total	g	1.75	1.50	0.09
Minerals
Calcium, Ca	mg	128	110	7
Iron, Fe	mg	13.86	11.92	0.75
Magnesium, Mg	mg	499	429	27
Phosphorus, P	mg	734	631	40
Potassium, K	mg	1524	1311	82
Sodium, Na	mg	21	18	1
Zinc, Zn	mg	6.81	5.86	0.37
Vitamins
Vitamin C, total ascorbic acid	mg	0.0	0.0	0.0
Thiamin	mg	0.078	0.067	0.004
Riboflavin	mg	0.241	0.207	0.013
Niacin	mg	2.185	1.879	0.118
Vitamin B-6	mg	0.118	0.101	0.006
Folate, DFE	µg	32	28	2
Vitamin B-12	µg	0.00	0.00	0.00
Vitamin A, RAE	µg	0	0	0
Vitamin A, IU	IU	0	0	0
Vitamin E (alpha-tocopherol)	mg	0.10	0.09	0.01
Vitamin D (D2 + D3)	µg	0.0	0.0	0.0
Vitamin D	IU	0	0	0
Vitamin K (phylloquinone)	µg	2.5	2.2	0.1
Lipids
Fatty acids, total saturated	g	8.070	6.940	0.436
Fatty acids, total monounsaturated	g	4.570	3.930	0.247
Fatty acids, total polyunsaturated	g	0.440	0.378	0.024
Cholesterol	mg	0	0	0
Other
Caffeine	mg	230	198	12

National Nutrient Database for Standard Reference
Release 27   Software v.2.0b
The National Agricultural Library

References

• Brickman AM, Khan UA, Provenzano FA, et al. (October 26, 2014). Enhancing dentate gyrus function with dietary flavanols improves cognition in older adults. Nature Neuroscience.
• Corti R, Flammer AJ, Hollenberg NK, et al. (2009). Cocoa and Cardiovascular Health. Circulation 119: 1433-1441.

Olive Oil vs. Canola - Healthy, Healthiest, or Not?

Olive oil or canola? There is some disagreement as to which is the best cooking oil to use.  Some sources say olive oil is the healthiest oil for cooking, others recommend canola.  Setting aside other possible contenders like the resurgent coconut oil, between olive oil and canola which is better?

What is Canola? (Canadian Oil Low Acid) - Canola Facts

Canola is a vegetable oil derived from rapeseed that has been been bred using traditional breeding techniques. Canadian researchers pioneered this process to reduce the higher erucic acid levels and its associated toxicity found in natural rapeseed. It explains canola's name which is a contraction of Canadian oil low acid. Canola advocates say that its greater polyunsaturated fat content and lower saturated fat content than olive oil's argue for its superiority. They point to observational studies that show reductions in cardiovascular disease from substituting polyunsaturated fats for saturated fats, a finding that cannot be said of carbohydrates and is unclear for monounsaturated fats.

Possible Canola Dangers

Canola's detractors think the evidence for the benefits of polyunsaturates and the evils of saturates weak with the reality possibly being the reverse.  They argue that the studies showing benefits from polyunsaturated fats didn't segregate the effects of polyunsaturated omega 3 fatty acids from those of omega 6s. Therefore the perceived benefits may be due solely to omega 3s while omega 6s may have negative effects.  This is part of the thinking behind the theory that suggests that people should balance the ratio of omega 3 to omega 6 oils consumed in their diets. Saturated fats on the other hand are not as bad as they were once thought; especially as the negative effects of sugar and refined carbohydrates are increasingly recognized and their role as possible confounders in earlier studies on saturated fats sinks in.  Saturated fats are more stable at temperatures below their smoke point.  Polyunsaturated fats are less chemically stable and theoretically more prone to oxidation.  While canola is usually described as having a neutral taste, critics report instances of canola developing a rancid taste and smell.

Others skeptical of canola meanwhile note that canola can be described as man-made and unnatural. Even if accepting of traditional breeding techniques, the majority of seeds used in canola production today are not just the result of traditional breeding but have also been genetically modified. Consequently some see its safety as suspect whether for not enough time having passed for potential problems to come out or a general distrust and aversion of GMO foods. Canola also requires significant processing to extract the oil which exposes it to high heat and chemical treatment during the refining and deodorizing process. The refining does have the benefit of making canola more suitable for higher heat cooking.  

Olive Oil

Proponents of olive oil say that it is the time-tested traditional oil that forms the basis of the healthy patterns of eating described as Mediterranean-style diets.

Extra virgin olive oil is minimally processed and has much higher levels of antioxidant tocopherols and polyphenols. It also imparts a taste which depending on the situation can be a plus or minus.  On the other hand it has a relatively low smoke point. Refined olive oil though lower in polyphenols is better suited to higher heat cooking.

A new study also shows another possible advantage for olive oil.  It turns out that the different kinds of vitamin E in the two oils, alpha tocopherol in olive oil and gamma tocopherol in canola, may have different effects.  In the study the alpha tocopherol in olive oil was shown to improve lung health while the gamma tocopherol in canola worsened lung health.

Articles

O'Connor, Anahad. (May 29, 2014). Vitamin E May Harm, or Help, Your Lungs. The New York Times.

Diet Research Studies List

A list of diet studies typically a diet study comparing a low fat diet to a low carbohydrate diet or control diet and possibly other diets such as a Mediterranean-style diet, high glycemic diet or low glycemic diet.  [To be expanded over time].

Bouché C, Rizkalla SW, Luo J et al. (May 22, 2002). Five-week, low-glycemic index diet decreases total fat mass and improves plasma lipid profile in moderately overweight nondiabetic men. Diabetes Care 25(5):822-828.

Sondike SB, Copperman N, Jacobson MS. (March 2003). Effects of a low-carbohydrate diet on weight loss and cardiovascular risk factors in overweight adolescents. Journal of Pediatrics  142(3):253-258.

Brehm BJ, Seeley RJ, Daniels SR, D’Alessio D. (April 2003). A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women. The Journal of Clinical Endocrinology & Metabolism 88(4):1617-1623.

Samaha, Frederick F. et al. (May 22, 2003). A Low-Carbohydrate as Compared with a Low-Fat Diet in Severe Obesity. New England Journal of Medicine 348(21): 2074–2081.

Foster, Gary D. et al. (May 22, 2003). A Randomized Trial of a Low-Carbohydrate Diet for Obesity. New England Journal of Medicine 348(21): 2082–2090.

Greene P, Willett W, Devecis J, Skaf A. (2003). Pilot 12-week feeding weight loss comparison: low-fat vs. low-carbohydrate (ketogenic) diets. Obesity Research 11:A23.

Yancy, William S. Jr., Olsen, Maren K., Guyton, John R., et al. (May 18, 2004). A Low-Carbohydrate, Ketogenic Diet versus a Low-Fat Diet To Treat Obesity and Hyperlipidemia. Annals of Internal Medicine 140(10):769–777.

Stern, Linda, Iqbal N., Seshadri P., et al. (May 18, 2004). The Effects of Low-Carbohydrate versus Conventional Weight Loss Diets in Severely Obese Adults: One-Year Follow-up of a Randomized Trial.Annals of Internal Medicine 140(10):778-785.

Romieu, Isabelle,  Lazcano-Ponce E., Sanchez-Zamorano L.M., et al. (August 2004). Carbohydrates and the Risk of Breast Cancer among Mexican Women. Cancer Epidemiology Biomarkers & Prevention 13:1283-1289.

Aude, Yamil W., Agatston, A.S., Lopez-Jimenez F., et al. (October 25, 2004). The National Cholesterol Education Program Diet vs a Diet Lower in Carbohydrates and Higher in Protein and Monounsaturated Fat. Archives of Internal Medicine 164(19):2141-2146.

Mozaffarian D, Rimm EB and Herrington DM. (November 2004). Dietary fats, carbohydrate, and progression of coronary atherosclerosis in postmenopausal women. American Journal of Clinical Nutrition  80(5):1175–1184.

Volek JS, Sharman MJ, Gómez AL, et al. (November 8, 2004). Comparison of energy-restricted very low-carbohydrate and low-fat diets on weight loss and body composition in overweight men and women. Nutrition & Metabolism 1:13.

Pereira MA, Swain J, Goldfine AB, Rifai N, and Ludwig DS. (November 24, 2004). Effect of low-glycemic diet on resting energy expenditure and heart disease risk factors during weight loss. Journal of the American Medical Association 292(20):2482-2490. 

Ma, Yunsheng, Olendzki B., Chiriboga D., et al. (2005). Association between Dietary Carbohydrates and Body Weight. American Journal of Epidemiology 161(4):359–367.

Nickols-Richardson, SM, Coleman MD, Volpe JJ, and Hosig KW.  (September 2005). Perceived Hunger Is Lower and Weight Loss Is Greater in Overweight Premenopausal Women Consuming a Low-Carbohydrate/High-Protein vs High-Carbohydrate/Low-Fat Diet. Journal of the American Dietetic Association 105(9):1433-1437.

Yancy, William S. Jr., Foy M., Chalecki A.M., et al. (December 1, 2005). A low-carbohydrate, ketogenic diet to treat type 2 diabetes. Nutrition and Metabolism 2(1):34.

Daly, ME, Paisey R, Paisey R, et al. (January 2006). Short-term effects of severe dietary carbohydrate-restriction advice in Type 2 diabetes—a randomized controlled trial. Diabetic Medicine 23(1):15-20.

Johnston, C.S., Tjonn, S., Swan, P.D., White A., Hutchins H., and Sears B. (May 2006). Ketogenic low-carbohydrate diets have no metabolic advantage over nonketogenic low-carbohydrate diets. American Journal of  Clinical Nutrition 83(5):1055-1061.

Nielsen, Jørgen Vesti and Eva Joensson. (June 14, 2006). Low-carbohydrate diet in type 2 diabetes. Stable improvement of bodyweight and glycemic control during 22 months follow-up. Nutrition and Metabolism 3(1):22.

Bravi, Francesca,  Bosetti C, Scotti L, et al. (October 20, 2006). Food Groups and Renal Cell Carcinoma: A Case-Control Study from Italy. International Journal of Cancer 120(3):681–685.

McClernon FJ, Yancy WS Jr, Eberstein JA, Atkins RC, and Westman EC. (January 2007). The effects of a low-carbohydrate ketogenic diet and a low-fat diet on mood, hunger, and other self-reported symptoms. Obesity (Silver Spring) 15(1):182–187.

Ebbeling CB, Leidig MM, Feldman HA, Lovesky MM, and Ludwig DS. (May 16, 2007). Effects of a low–glycemic load vs. low-fat diet in obese young adults. Journal of the American Medical Association 297(19):2092-2102.

Halyburton AK, Brinkworth GD, Wilson CJ, et al. (September 2007). Low- and high-carbohydrate weight-loss diets have similar effects on mood but not cognitive performance. American Journal of Clinical Nutrition 86(3):580-587.

White AM, Johnston CS, Swan PD, Tjonn SL, and Sears B. (October 2007). Blood ketones are directly related to fatigue and perceived effort during exercise in overweight adults adhering to low-carbohydrate diets for weight loss: A pilot study. Journal of the American Dietetic Association 107(10):1792-1796.

Dyson PA, Beatty S and Matthews DR. (December 2007). A low-carbohydrate diet is more effective in reducing body weight than healthy eating in both diabetic and non-diabetic subjects. Diabetic Medicine 24(12):1430–1435.

Tay J, Brinkworth GD, Noakes M, et al. (January 2008). Metabolic Effects of Weight Loss on a Very-Low-Carbohydrate Diet Compared With an Isocaloric High-Carbohydrate Diet in Abdominally Obese Subjects . Journal of the American College of Cardiology  51(1):59–67.

Keogh JB, Brinkworth GD, Noakes M, et al. (March 2008). Effects of weight loss from a very-low-carbohydrate diet on endothelial function and markers of cardiovascular disease risk in subjects with abdominal obesity. American Journal of Clinical Nutrition 87(3):567-576.

Westman EC, Yancy WS, Mavropoulos JC, Marquart M and McDuffie JR. (December 19, 2008).
The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutrition and Metabolism 5:36.

Volek JS, Phinney SD, Forsythe CE, et al. (April 2009). Carbohydrate Restriction has a More Favorable Impact on the Metabolic Syndrome than a Low Fat Diet. Lipids 44(4):297-309.

Brinkworth GD, Noakes M, Buckley JD, et al. (July 2009). Long-term effects of a very-low-carbohydrate weight loss diet compared with an isocaloric low-fat diet after 12 mo. American Journal of Clinical Nutrition 90(1):23-32.

Hernandez TL, Sutherland JP,  Wolfe P, et al. (March 2010). Lack of suppression of circulating free fatty acids and hypercholesterolemia during weight loss on a high-fat, low-carbohydrate diet. American Journal of Clinical Nutrition 91(3):578-585.

Krebs NF, Gao D, Gralla J, et al. (August 2010). Efficacy and Safety of a High Protein, Low Carbohydrate Diet for Weight Loss in Severely Obese Adolescents. Journal of Pediatrics 157(2):252-258.

Ebbeling CB, Swain JF, Feldman HA, Wong WA, Hachey DL, Garcia-Logo E, and Ludwig DD. (June 27, 2012). Effects of dietary composition on energy expenditure during weight loss maintenance. Journal of the American Medical Association 307(24):2627-2634.

Guldbrand H, Dizdar B, Bunjaku B et al. (August 2012). In type 2 diabetes, randomization to advice to follow a low-carbohydrate diet transiently improves glycaemic control compared with advice to follow a low-fat diet producing a similar weight loss. Diabetologia 55(8):2118-2127.

Saslow LR,  Kim S, Daubenmier JJ, et al. (April 9, 2014). A Randomized Pilot Trial of a Moderate Carbohydrate Diet Compared to a Very Low Carbohydrate Diet in Overweight or Obese Individuals with Type 2 Diabetes Mellitus or Prediabetes. PLoS ONE 9(4): e91027

Bazzano LA, Hu T, Reynolds K, et al. (September 2, 2014). Effects of Low-Carbohydrate and Low-Fat Diets: A Randomized Trial. Annals of Internal Medicine 161(5):309-318.



Optimal Macronutrient Intake Trial for Heart Health - OmniHeart Randomized Trial

Appel LJ, Sacks FM, Carey VJ, et al. (November 16, 2005). Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial. Journal of the American Medical Association 294:2455-2464.

Women's Health Initiative Randomized Controlled Dietary Modification Trial

Howard BV, Manson JE, Stefanick ML, et al. (January 4, 2006). Low-Fat Dietary Pattern and Weight Change Over 7 Years. Journal of the American Medical Association 295(1):39-49.

Howard BV, Van Horn L, Hsia J, et al. (February 8, 2006). Low-Fat Dietary Pattern and Risk of Cardiovascular Disease. Journal of the American Medical Association 295(6):655-666.

A to Z Study

Gardner, Christopher et al. (March 7, 2007). Comparison of the Atkins, Zone, Ornish, and LEARN Diets for Change in Weight and Related Risk Factors Among Overweight Premenopausal Women – The A TO Z Weight Loss Study: A Randomized Trial. Journal of the American Medical Association 297(9):969-977.

Stanford. (January 17, 2008). The Battle of the Diets: Is Anyone Winning (At Losing?). Presentation by Christopher Gardner for the Stanford School of Medicine Medcast Lecture Series. [Video].

Dietary Intervention Randomized Controlled Trial  - DIRECT Study

Shai, Iris et al. (July 17, 2008). Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet. New England Journal of Medicine  359:229-241.

Schwartzfuchs, Dan et al. (October 4, 2012). Four-Year Follow-up after Two-Year Dietary Interventions. New England Journal of Medicine 367:1373-1374.

Preventing Overweight Using Novel Dietary Strategies - POUNDS LOST Study

Sacks FM, Bray GA, Carey VJ, et al. (February 26, 2009). Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. New England Journal of Medicine 360:859-873.

Eco-Atkins Weight Loss Trial

Jenkins DJ, Wong JM, Kendall CW, et al. (June 8, 2009). The effect of a plant-based low-carbohydrate (“Eco-Atkins”) diet on body weight and blood lipid concentrations in hyperlipidemic subjects. Archives of Internal Medicine 169:1046-1054.

National Institutes of Health Funded Temple University, University of Pennsylvania, University of Colorado, Washington University Study

Foster, Gary D. et al. (August 3, 2010). Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: a randomized trial. Annals of Internal Medicine 153(3):147-157.

Diet, Obesity, and Genes Project - Diogenes Studies

Larsen TM, Dalskov SM, van Baak M, Jebb SA, Papadaki A, Pfeiffer AF, Martinez JA, Handjieva-Darlenska T, Kunešová M, Pihlsgård M, Stender S, Holst C, Saris WH, Astrup A. (November 25, 2010). Diets with high or low protein content and glycemic index for weight-loss maintenance. New England Journal of Medicine 363(22):2102-2113.

Papadaki A, Linardakis M, Larsen TM, van Baak MA, Lindroos AK, Pfeiffer AF, Martinez JA, Handjieva-Darlenska T, Kunesová M, Holst C, Astrup A, Saris WH, Kafatos A. (November 1, 2010). The effect of protein and glycemic index on children’s body composition: the DiOGenes randomized study. Pediatrics 126(5):e1143-52.

Paleo Diet / Ancestral Diet Studies

Frassetto LA, Schloetter M, Mietus-Synder M, Morris RC, Jr., Sebastian A. (2009). Metabolic and physiologic improvements from consuming a paleolithic, hunter-gatherer type diet.  European Journal of Clinical Nutrition. 63:947–955.

Jönsson T, Granfeldt Y, Ahrén B, Branell UC, Pålsson G, Hansson A, Söderström M, Lindeberg S. (2009). Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes: a randomized cross-over pilot study. Cardiovascular Diabetology. 8:35.

Jönsson T, Granfeldt Y, Erlanson-Albertsson C, Ahrén B, Lindeberg S. (November 30, 2010). A Paleolithic diet is more satiating per calorie than a Mediterranean-like diet in individuals with ischemic heart disease. Nutrition and Metabolism 7(1):85.

Lindeberg S, Jönsson T, Granfeldt Y, Borgstrand E, Soffman J, Sjostrom K, Ahrén B. (2007). A Palaeolithic diet improves glucose tolerance more than a Mediterranean-like diet in individuals with ischaemic heart disease. Diabetologia 50(9):1795-1807.

O’Dea, K. (1984). Marked improvement in carbohydrate and lipid metabolism in diabetic Australian aborigines after temporary reversion to traditional lifestyle. Diabetes 33(6):596-603.

Osterdahl M, Kocturk T, Koochek A, Wandell PE. (2008). Effects of a short-term intervention with a paleolithic diet in healthy volunteers. European Journal of Clinical Nutrition 62(5):682-685.


Observational Studies

Halton TL, Willett WC, Liu S, et al. (November 9, 2006). Low-carbohydrate-diet score and the risk of coronary heart disease in women. New England Journal of Medicine 355:1991-2002.

Trichopoulou A, Psaltopoulou T, Orfanos P, et al. (November 29, 2006). Low-carbohydrate–high-protein diet and long-term survival in a general population cohort. European Journal of Clinical Nutrition 61:575–581.

Meta-Analyses and Systematic Reviews

Nordmann AJ, Suter-Zimmermann K, Bucher HC, Shai I, Tuttle KR, Estruch R, Briel M. (2011). Meta-analysis comparing Mediterranean to low-fat diets for modification of cardiovascular risk factors. American Journal of Medicine 124(9):841-851.

Santos, F. L., Esteves, S. S., da Costa Pereira, A., Yancy Jr, W. S. and Nunes, J. P. L. (2012). Systematic review and meta-analysis of clinical trials of the effects of low carbohydrate diets on cardiovascular risk factors. Obesity Reviews 13:1048–1066.

Hu T, Mills KT, Yao L, Demanelis K, Eloustaz M, Yancy WS Jr, Kelly TN, He J, Bazzano LA. (October 1, 2012). Effects of low-carbohydrate diets versus low-fat diets on metabolic risk factors: a meta-analysis of randomized controlled clinical trials. American Journal of Epidemiology 176(Suppl 7):S44-S54.

Ajala O, English P, Pinkney J. (2013). Systematic review and meta-analysis of different dietary approaches to the management of type 2 diabetes. American Journal of Clinical Nutrition 97(3): 505-516.

Bradley JC, Kanters S, Bandayrel K, et al. (September 3, 2014). Comparison of Weight Loss Among Named Diet Programs in Overweight and Obese Adults: A Meta-analysis. Journal of the American Medical Association 312(9):923-933.

Articles

Cordain, Loren, Maelán Fontes Villalba and Pedro Carrera Bastos. (2011). Rebuttal to U.S. News and World Top 20 Diets. www.robbwolf.com.

Dr. George Mann

Dr. George V. Mann was one of the leading figures against the diet-heart hypothesis. He was professor of biochemistry and medicine at Vanderbilt University, a recipient of a career investigatorship from the National Heart, Lung, and Blood Institute and an assistant professor of nutrition at the Harvard School of Public Health.  As an associate director of the Framingham Heart Study he had a close vantage point in one of the landmark studies on heart disease. He also studied the Masai a pastoral African people who consumed a high fat diet.  His strong views are found in a number of articles and in the book Coronary Heart Disease: The Dietary Sense and Nonsense which he edited. 

His views on diet-heart and cholesterol are as follows: saturated fat and cholesterol in the diet are not the cause of coronary heart disease. That myth is the greatest ‘scientific’ deception of the century, and perhaps any century.

Articles

Demaret, Kent and Judith Weinraub. (January 22, 1979).  Dr. George Mann Says Low Cholesterol Diets Are Useless, but the 'Heart Mafia' Disagrees. People.

Selected Works

Mann, George V. et al. (September 1, 1955). Exercise in the Disposition of Dietary Calories — Regulation of Serum Lipoprotein and Cholesterol Levels in Human Subjects. The New England Journal of Medicine 253:349-355.

Mann, G.V., Shaffer, R.D., Anderson, R.S., and Sandstead, H.H. (July-August 1964). Cardiovascular Disease in the Masai. Journal of Atherosclerosis Research 4:289-312.

Mann, George V. (December 1971). Obesity, the Nutritional Spook.  The American Journal of Public Health 61(8):1491-1498.

Mann, George V. et al. (1972). Atherosclerosis and the Masai. American Journal of Epidemiology 95 (1):26-37.

Mann, George V. (July 24, 1974). The Influence of Obesity on Health. The New England Journal of Medicine 291:178-185.

Mann, George V. (August 1, 1974). The Influence of Obesity on Health. The New England Journal of Medicine 291:226-232.

Mann, George V. (April 7, 1977). Diet and Obesity. The New England Journal of Medicine 296:812.

Mann, George V. (September 22, 1977). Diet-Heart: End of an Era. The New England Journal of Medicine 297:644-650.

Mann, George V. (July-August, 1985). Coronary Heart Disease—"Doing the Wrong Things". Nutrition Today.

Mann, George V. (May 21, 1994). Metabolic Consequences of Dietary Trans Fatty Acids. The Lancet 343(8908):1268-1271.

Mann, George V. (Ed.). (June 1, 1993). Coronary Heart Disease: The Dietary Sense and Nonsense – An evaluation by scientists. Harry Ransom Humanities Research Center.

Saturated Fats Controversy

Saturated fats are to be avoided. For many years that has been the recommendation from many governments, medical associations and professional health groups.  That advice has always had its detractors but with recent findings, that advice has come under renewed attack.

The realization that refined carbohydrates may be the driving cause behind the rise of obesity and diabetes cases has caused researchers to go back and take another look at saturated fats. The scrutiny has failed to show a significant link to adverse effects from saturated fats.

Meta-Analyses and Studies

Chowdhury R et al. (March 18, 2014). "Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk: A Systematic Review and Meta-analysis". Annals of Internal Medicine 160 (6): 398-406.

Danaei G et al. (April 2009). "The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors". In Hales, Simon. PLoS Medicine 6 (4): e1000058.

Hooper L, Summerbell CD, Thompson R, Sills D, Roberts FG, Moore H, Smith GD. (July 2011). "Reduced or modified dietary fat for preventing cardiovascular disease". The Cochrane Library. Earlier version.

Jakobsen MU, O'Reilly EJ, Heitmann, BL, Pereira MA, Bälter K, Fraser GE, Goldbourt U, Hallmans G et al. (2009). "Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies". The American Journal of Clinical Nutrition 89 (5): 1425–32.

Mente A, de Koning L, Shannon HS, Anand SS. (April 2009). "A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease". Archives of Internal Medicine 169 (7): 659–69.

Mozaffarian D, Micha R, Wallace S. (March 2010). "Effects on Coronary Heart Disease of Increasing Polyunsaturated Fat in Place of Saturated Fat: A Systematic Review and Meta-Analysis of Randomized Controlled Trials". In Katan, Martijn B. PLoS Medicine 7 (3): e1000252.

Skeaff M and Miller J. (September 15, 2009). "Dietary fat and coronary heart disease: Summary of evidence from prospective cohort and randomised controlled trials". Annals of Nutrition & Metabolism 55 (1–3): 173–201.

USDA Nutrition Evidence Library. (2010). "What is the effect of saturated fat intake on increased risk of cardiovascular disease or type 2 diabetes?"

Dairy

Kratz M, Baars T, Guyenet S. (February 2013). "The relationship between high-fat dairy consumption and obesity, cardiovascular, and metabolic disease".  European Journal of Nutrition 52 (1):1-24
 

Reviews, Editorials and Comments

DiNicolantonio JJ. (March 5, 2014). "The cardiometabolic consequences of replacing saturated fats with carbohydrates or Ω-6 polyunsaturated fats: Do the dietary guidelines have it wrong?". Open Heart 1 (1). The British Medical Journal.

Hite et al. (October 2010). "In the face of contradictory evidence: Report of the Dietary Guidelines for Americans Committee". Nutrition 26 (10): 915-924.

Hoenselaar R. (February 2012). "Saturated fat and cardiovascular disease: the discrepancy between the scientific literature and dietary advice". Nutrition 28 (2): 118-123.

Knopp RH and Retzlaff BM. (November 2004). "Saturated fat prevents coronary artery disease? An American paradox". American Journal of Clinical Nutrition 80 (5):  1102-1103.

Kuipers RS et al. (September 2011) "Saturated fat, carbohydrates and cardiovascular disease". The Journal of Medicine (Netherlands) 69 (9): 372-378.

Lawrence GD. (May 2013). "Dietary Fats and Health: Dietary Recommendations in the Context of Scientific Evidence". Advances in Nutrition 4: 294-302.

Malhotra A. (October 22, 2013). "Saturated fat is not the major issue". British Medical Journal 347: f6340.

Mann GV. (September 22, 1977). "Diet-heart: End of an era". New England Journal of Medicine 297: 644-49.

Weinberg SL. (March 2004). "The diet–heart hypothesis: a critique". Journal of the American College of Cardiology 43 (5): 731-733.

Articles

Teicholtz, Nina. (May 6, 2014). The Questionable Link Between Saturated Fat and Heart Disease. The Wall Street Journal.

Walsh, Bryan. (June 12, 2014). Ending the War on Fat. Time.

Dr. Peter Attia

Peter Attia is a co-founder along with Gary Taubes of the Nutritional Science Initiative (NuSI) that seeks to improve the quality of science in nutritional and obesity research. He was previously with McKinsey & Company where he worked on corporate risk and healthcare issues. Prior to that he was a general surgery resident at Johns Hopkins Hospital and a surgical oncology fellow at the National Cancer Institute of National Institutes of Health.  He attained his medical degree from Stanford University after having earlier graduated from Queens University with a degree in mechanical engineering and applied mathematics.  

Attia's shift to medical research from medical surgery is a result of  growing disenchantment with what he saw as the poor state of preventative medicine and the observation that doctors seemed mainly effective as a last line of defense against death.  As an avid swimming enthusiast who has crossed the San Pedro Channel off Santa Catalina Island,  Peter Attia was also dissatisfied with his weight gain despite following all the standard medical advice related to diet and exercise.  Through self-experimentation he found he was able to lose weight by dramatically lowering carbohydrate intake while increasing fat intake despite an overall increase in calories which goes against the standard medical advice.

More Information

• Peter Attia: Is the obesity crisis hiding a bigger problem? (2013). TED.
• Rainey, James. (October 18 2005). 30,000 strokes to go. Los Angeles Times.
• Speakers – Peter Attia: Surgeon. (2013). TED.

Links

• The Eating Academy
• Nutrition Science Initiative (NuSI) website