Adam, the moral of the story seems to be eat your Thanksgiving feast with gratitude and grace and feel no guilt. I did my 5-mile run before the feast and I took two walks afterwards. I ate well and I felt no guilt. I get so tired of all the guilting of people for enjoying a good meal with their family. Some folks need to get a life and mind their own damn business.
Generally a good article debunking much of the nonsense that journalists propagate regarding food and diet. Early on the author refers to a two part article on Nutritional Churnalism published on this site in August of this year and I would object strongly to a few of the statements contained therein.
The worst: "The cholesterol lowering statins are the most effective medications ever developed for treating cardiovascular disease. These drugs, marketed under names like Lipitor, Zocor, and Crestor have revolutionized the care of patients with cardiovascular disease. The most impressive results we have for these drugs shows that, in high risk patients, statins decrease the risk of death from heart attack and stroke by 34%." He links to the article and it is the Scandanavian Simvastatin Survival Study (4S). In this trial the incidence of Cardiovascular Mortality was 5.0% and 8.5% in the drug and control groups respectively. The Total Mortality was 8.2% and 11.5%. So the risk of death figure of 34% is obviously a relative risk as the actual risk reductions were 3.3% and 3.5%. To cite only the relative risk is a tactic that I was surprised to see on this web site. Even more so since the same author cited in Part 2 a hypothetical study with incidences of 5% and 8% and dismissed that as random variation and characterized as "just noise".
I reviewed this 4S study along with several others in my book The Cholesterol Delusion and will quote a paragraph from it in order to illustrate a further weakness in the study:
"The most interesting feature of this trial (4S) was not even mentioned in the published report. There was a total disconnection between the improved outcomes and both the initial cholesterol level and the degree of cholesterol lowering attained. In other words, protection against CHD was the same whether the initial cholesterol was relatively high or low, and the degree of protection did not correlate with the degree of cholesterol lowering. Subjects whose cholesterol went down a relatively small amount benefited to the same degree as those whose cholesterol went down a lot. This disconnection is called "lack of normal exposure-response" and generally means that the factor under investigation is not the true cause of the disorder. In plain English, the small benefit conferred by the drug was not due to its effect on cholesterol but rather to some other cause,"
I apologize for the length of this comment but I feel compelled to counter statements like this that we see all too often regarding statin drugs.
I would add Sin #8 to the list: Ignorance of the physiologic processes of digestion and absorption of the food we eat. I used to tell patients that I could give them a fairly complete course in nutrition in about ten minutes. Then I would explain how each of the three types of major macronutrients were digested down to molecules small enough to be absorbed through the cells lining the stomach and proximal small intestine and very little, if anything, was absorbed in the form that was ingested. Therefore anything remotely resembling a normal diet was sufficient and they need not worry that their food was going to adversely affect their health. Taking in more calories than one expends will cause one to gain weight, but otherwise, the negative things that many say about carbohydrates is pure nonsense. If your body burns more calories than you consume, you will lose weight. Some people have hormonal problems or other disorders that may affect their rate of metabolism and hence their expenditure of calories and they will have to further restrict their calories in order to lose weight. It is really that simple and doesn't require a medical or other advanced degree in order to understand it.
I first heard about resistant starches in relation to researchers looking at some African tribes that eat diets very high in starches (mainly cassava, I believe) and yet they have a low incidence rate of diabetes, CVD and cancers, etc. It was thought to be the resistant nature of the starch that was a contributing factor to their good health because the high starch content of the diet seemed like it would normally lead to all sorts of metabolic issues based on the common understanding of the role of starch in a diet. There are probably multiple contributing factors to their good health -- resistant starch is likely not the only thing (if it even contributes at all), but it does serve as some observational evidence that low carb diets are not a panacea and that possibly *gasp* one can still be healthy and eat starches.
Beware of studies citing disease incidence in African tribes or other cultures where poverty is the norm. The fact is that many die quite young from malnutrition and infectious diseases and, therefore, have very low incidence of diseases that develop in middle age and beyond in more economically advanced societies. Starch is a polysaccharide made up of long chains of glucose molecules. The common carbohydrates in most diets are sucrose, lactose, and starch. Sucrose and lactose are disaccharides and cannot be absorbed until they are broken down into their monosaccharide constituents: glucose, fructose, and galactose. Starch must be broken down into individual glucose molecules and I assume "resistant" starch is simply that part of the food that passes intact beyond the part of the small intestine where the digestion takes place. The undigested portion may then be acted upon by the bacteria in the colon which will generally produce only gas. Other indigestible food is largely plant based as mammals don't possess the enzymes necessary to break down cellulose which is the major component of the cell walls in plants. This is commonly known as fiber. All the initial literature claiming health benefits of high fiber diets were based on the supposed low incidence of cancer and other degenerative diseases in African tribes that, at the time of publication, had a life expectancy that was about half of that in more advanced countries.
I thought the book "How Not to Die" had a well thought out hypothesis with a few studies to back it up as to why the shape of whole grains as they go through the GI tract could influence digestion. Reheating leftovers in a NYT article might be stretching it, but I found the initial hypothesis credible.
This is the problem with "scientizing" everything for the public. You can provide great nutritional or health advice without doing a million crappy studies on it, people have done that since the dawn of time. It's called: having a culture.
The other main issue is that nutritional science is largely captured by large food and pharmaceutical companies (well, most of science really, since most of our government is captured by these companies and grants for this type of research mostly come from that same captured government). It generates tons of junk science that either (a) isn't good enough to make any decent arguments because the studies are neither well funded nor well done, or (b) is deeply spun to benefit profit interests.
There was a study recently that came out showing that taking one of the poorest quality multivitamins on the market (Centrum) was correlated with a reduction in dementia onset. This was an RCT, which in nutritional science, is incredibly rare and moreso to be powered enough to actually demonstrate anything. If a multivitamin could help dementia (and depending on the cause of the dementia, it could), we should have known this decades ago. There are thousands of high quality multivitamin products with almost identical vitamin/mineral combinations to Centrum. Oh wait, did I mention that Centrum is a Pfizer product?
There are things that are obvious and yet people still need to add a layer of scientism in order to justify it to themselves. Eating food that is grown without essentially plant TRT and tons of chemicals and poor soil (aka "organic") is demonstrably better for you. Period. People who want to hyperintellectualize this are more interested in proving how smart they are than the truth.
Love the ‘sin’ framework which I believe is just another word for ‘missing the mark’ (translation: bad aim).
Interestingly Aspirin first showed promise in preventing colon cancer in the exact same literature of Lynch Syndrome which is why USPSTF was previously excited to endorse it for ‘at least 10 years of use’ (first general population ‘study’ was retrospective cohort).
Then when finally tested in a RCT (ASPREE) the 5 year arm showed increased colorectal cancer rates (and a near significant trend towards death) in the treatment arm.
Our chains of evidence validity are so fragile that you are right to tug on them a bit. Amazing how quickly they become undone.
You mean I don't have to eat my potatoes cold any more?! YAY! Believe it or not, I actually added cold potatoes to my daily diet back in 2007 ('cuz I LOVE them), when I first read about this. I put nothing on the potatoes except a fat free spread with 5 calories per Tbs. I gained 10 pounds! I guess my intestinal microbiota forget to consume the starch! Now that NPR (and numerous other media) have reported that beta glucan increases GLP-1 just like Ozempic and other GLP-1 receptor agonists, that will probably replace resistant starch as the new weight loss fiber (link #1). But research shows beta glucan does not always increase GLP-1 (link #2), although it IS cheaper than any of the GLP-1 receptor agonists, and is probably healthier than the refined carbs that are so prevalent today. It seems like our gut microbiota might play a role in health and weight loss, but we are a long ways from understanding how to effectively intervene. Nevertheless, I hope the researchers keep studying it because SOMETHING needs to be done to address the tsunami of metabolic dysfunction induced by the Western diet, and eating carbs that are equally as satisfying as the processed junk that's so addicting would be helpful. But I think we're stuck with studying surrogate endpoints, because it's unlikely General Mills will fund a 3-year study of oatmeal!
Why would anyone have reason to question medical science these days? Surely no scientist worth his salt (see what I did there?) would ever publish or peer review something that was inaccurate, under powered, incomplete or, heaven forbid, outright false! Especially in the realm of nutritional science, which is beyond reproach! I’m old enough to recall the original USDA food pyramid with its “fats bad, tons of carbs good” set up. I’d bet some science went into setting up that bad boy.
Here's a cartoonist's take on the issue of trust in the medical-industrial complex. . For those not familiar, it bears mention that this is a major, syndicated cartoonist read by millions, not some obscure unknown artist.
Adam, the moral of the story seems to be eat your Thanksgiving feast with gratitude and grace and feel no guilt. I did my 5-mile run before the feast and I took two walks afterwards. I ate well and I felt no guilt. I get so tired of all the guilting of people for enjoying a good meal with their family. Some folks need to get a life and mind their own damn business.
Generally a good article debunking much of the nonsense that journalists propagate regarding food and diet. Early on the author refers to a two part article on Nutritional Churnalism published on this site in August of this year and I would object strongly to a few of the statements contained therein.
The worst: "The cholesterol lowering statins are the most effective medications ever developed for treating cardiovascular disease. These drugs, marketed under names like Lipitor, Zocor, and Crestor have revolutionized the care of patients with cardiovascular disease. The most impressive results we have for these drugs shows that, in high risk patients, statins decrease the risk of death from heart attack and stroke by 34%." He links to the article and it is the Scandanavian Simvastatin Survival Study (4S). In this trial the incidence of Cardiovascular Mortality was 5.0% and 8.5% in the drug and control groups respectively. The Total Mortality was 8.2% and 11.5%. So the risk of death figure of 34% is obviously a relative risk as the actual risk reductions were 3.3% and 3.5%. To cite only the relative risk is a tactic that I was surprised to see on this web site. Even more so since the same author cited in Part 2 a hypothetical study with incidences of 5% and 8% and dismissed that as random variation and characterized as "just noise".
I reviewed this 4S study along with several others in my book The Cholesterol Delusion and will quote a paragraph from it in order to illustrate a further weakness in the study:
"The most interesting feature of this trial (4S) was not even mentioned in the published report. There was a total disconnection between the improved outcomes and both the initial cholesterol level and the degree of cholesterol lowering attained. In other words, protection against CHD was the same whether the initial cholesterol was relatively high or low, and the degree of protection did not correlate with the degree of cholesterol lowering. Subjects whose cholesterol went down a relatively small amount benefited to the same degree as those whose cholesterol went down a lot. This disconnection is called "lack of normal exposure-response" and generally means that the factor under investigation is not the true cause of the disorder. In plain English, the small benefit conferred by the drug was not due to its effect on cholesterol but rather to some other cause,"
I apologize for the length of this comment but I feel compelled to counter statements like this that we see all too often regarding statin drugs.
I would add Sin #8 to the list: Ignorance of the physiologic processes of digestion and absorption of the food we eat. I used to tell patients that I could give them a fairly complete course in nutrition in about ten minutes. Then I would explain how each of the three types of major macronutrients were digested down to molecules small enough to be absorbed through the cells lining the stomach and proximal small intestine and very little, if anything, was absorbed in the form that was ingested. Therefore anything remotely resembling a normal diet was sufficient and they need not worry that their food was going to adversely affect their health. Taking in more calories than one expends will cause one to gain weight, but otherwise, the negative things that many say about carbohydrates is pure nonsense. If your body burns more calories than you consume, you will lose weight. Some people have hormonal problems or other disorders that may affect their rate of metabolism and hence their expenditure of calories and they will have to further restrict their calories in order to lose weight. It is really that simple and doesn't require a medical or other advanced degree in order to understand it.
I first heard about resistant starches in relation to researchers looking at some African tribes that eat diets very high in starches (mainly cassava, I believe) and yet they have a low incidence rate of diabetes, CVD and cancers, etc. It was thought to be the resistant nature of the starch that was a contributing factor to their good health because the high starch content of the diet seemed like it would normally lead to all sorts of metabolic issues based on the common understanding of the role of starch in a diet. There are probably multiple contributing factors to their good health -- resistant starch is likely not the only thing (if it even contributes at all), but it does serve as some observational evidence that low carb diets are not a panacea and that possibly *gasp* one can still be healthy and eat starches.
Beware of studies citing disease incidence in African tribes or other cultures where poverty is the norm. The fact is that many die quite young from malnutrition and infectious diseases and, therefore, have very low incidence of diseases that develop in middle age and beyond in more economically advanced societies. Starch is a polysaccharide made up of long chains of glucose molecules. The common carbohydrates in most diets are sucrose, lactose, and starch. Sucrose and lactose are disaccharides and cannot be absorbed until they are broken down into their monosaccharide constituents: glucose, fructose, and galactose. Starch must be broken down into individual glucose molecules and I assume "resistant" starch is simply that part of the food that passes intact beyond the part of the small intestine where the digestion takes place. The undigested portion may then be acted upon by the bacteria in the colon which will generally produce only gas. Other indigestible food is largely plant based as mammals don't possess the enzymes necessary to break down cellulose which is the major component of the cell walls in plants. This is commonly known as fiber. All the initial literature claiming health benefits of high fiber diets were based on the supposed low incidence of cancer and other degenerative diseases in African tribes that, at the time of publication, had a life expectancy that was about half of that in more advanced countries.
I thought the book "How Not to Die" had a well thought out hypothesis with a few studies to back it up as to why the shape of whole grains as they go through the GI tract could influence digestion. Reheating leftovers in a NYT article might be stretching it, but I found the initial hypothesis credible.
This is the problem with "scientizing" everything for the public. You can provide great nutritional or health advice without doing a million crappy studies on it, people have done that since the dawn of time. It's called: having a culture.
The other main issue is that nutritional science is largely captured by large food and pharmaceutical companies (well, most of science really, since most of our government is captured by these companies and grants for this type of research mostly come from that same captured government). It generates tons of junk science that either (a) isn't good enough to make any decent arguments because the studies are neither well funded nor well done, or (b) is deeply spun to benefit profit interests.
There was a study recently that came out showing that taking one of the poorest quality multivitamins on the market (Centrum) was correlated with a reduction in dementia onset. This was an RCT, which in nutritional science, is incredibly rare and moreso to be powered enough to actually demonstrate anything. If a multivitamin could help dementia (and depending on the cause of the dementia, it could), we should have known this decades ago. There are thousands of high quality multivitamin products with almost identical vitamin/mineral combinations to Centrum. Oh wait, did I mention that Centrum is a Pfizer product?
There are things that are obvious and yet people still need to add a layer of scientism in order to justify it to themselves. Eating food that is grown without essentially plant TRT and tons of chemicals and poor soil (aka "organic") is demonstrably better for you. Period. People who want to hyperintellectualize this are more interested in proving how smart they are than the truth.
Please do this study next! It claims that receiving a flu vaccine reduces the risk of dementia in people over the age of 65. https://content.iospress.com/articles/journal-of-alzheimers-disease/jad220361
Love the ‘sin’ framework which I believe is just another word for ‘missing the mark’ (translation: bad aim).
Interestingly Aspirin first showed promise in preventing colon cancer in the exact same literature of Lynch Syndrome which is why USPSTF was previously excited to endorse it for ‘at least 10 years of use’ (first general population ‘study’ was retrospective cohort).
Then when finally tested in a RCT (ASPREE) the 5 year arm showed increased colorectal cancer rates (and a near significant trend towards death) in the treatment arm.
Our chains of evidence validity are so fragile that you are right to tug on them a bit. Amazing how quickly they become undone.
What fun! Thank you for sharing your thought about resistant starches—-so few people give them their due.
You mean I don't have to eat my potatoes cold any more?! YAY! Believe it or not, I actually added cold potatoes to my daily diet back in 2007 ('cuz I LOVE them), when I first read about this. I put nothing on the potatoes except a fat free spread with 5 calories per Tbs. I gained 10 pounds! I guess my intestinal microbiota forget to consume the starch! Now that NPR (and numerous other media) have reported that beta glucan increases GLP-1 just like Ozempic and other GLP-1 receptor agonists, that will probably replace resistant starch as the new weight loss fiber (link #1). But research shows beta glucan does not always increase GLP-1 (link #2), although it IS cheaper than any of the GLP-1 receptor agonists, and is probably healthier than the refined carbs that are so prevalent today. It seems like our gut microbiota might play a role in health and weight loss, but we are a long ways from understanding how to effectively intervene. Nevertheless, I hope the researchers keep studying it because SOMETHING needs to be done to address the tsunami of metabolic dysfunction induced by the Western diet, and eating carbs that are equally as satisfying as the processed junk that's so addicting would be helpful. But I think we're stuck with studying surrogate endpoints, because it's unlikely General Mills will fund a 3-year study of oatmeal!
https://www.npr.org/sections/health-shots/2023/10/30/1208883691/diet-ozempic-wegovy-weight-loss-fiber-glp-1-diabetes-barley
https://www.sciencedirect.com/science/article/pii/S1756464620305351
Why would anyone have reason to question medical science these days? Surely no scientist worth his salt (see what I did there?) would ever publish or peer review something that was inaccurate, under powered, incomplete or, heaven forbid, outright false! Especially in the realm of nutritional science, which is beyond reproach! I’m old enough to recall the original USDA food pyramid with its “fats bad, tons of carbs good” set up. I’d bet some science went into setting up that bad boy.
Here's a cartoonist's take on the issue of trust in the medical-industrial complex. . For those not familiar, it bears mention that this is a major, syndicated cartoonist read by millions, not some obscure unknown artist.
https://www.gocomics.com/pearlsbeforeswine/2023/11/24
"in Italy, where chili is a common ingredient" - as opposed to, I don't know, Asia, where by this logic no one would ever have cardiac issues. 😂