"NHS on its knees"

Do any of these authors cite legitimate examples where official diet advice was to actually consume too much sugar and simple carbs? I think you’ll find that this notion is an example of historical revisionism/False Memory Syndrome…or simply making spit up to serve a given narrative.

I also think you’ll find that what the majority of folk who want to blame dietary advice for the obesity epidemic are ignoring is the fact that what most folk did actually eat whilst supposedly following low fat diet recommendations bore little relationship to what those recommendations actually were.

A reminder …Ancel Keys never actually recommended SnackWell cookies or lashings of low fat dressing on a salad.

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To your points

  1. No it’s not. At least, not any longer. For sure, the US had a head start in this race but other nations have played catch up pretty effectively…UK and Australia to name but two.

  2. Correlates with certainly but, as noted upstream, what a good many folk were actually eating wasn’t a lower fat, higher carb diet as envisioned by, say, Ancel Keys etc but rather higher carbs (regardless of quality) and just about the same amount of fat. Familiarity with the food pyramid probably extended no further than the cartoons depicting it on the back of cereal boxes or, yes…boxes of SnackWell cookies.

  3. Totally agree…which is why I pointed out #1 was an incorrect statement.

  4. Well, given that the obesity epidemic hasn’t respected artificially created borders either, offering that as proof of statement isn’t very relevant. I don’t happen to think it plays a large part, but there’s a fair bit of sturdy evidence of an influence of the gut microbiome on this phenom

No. But if you cruise the grocery store aisles and look at most of the food that is sold (that is, down the aisles, not in the produce/dairy/meat counters) is loaded with sugars and simple carbs. And that is where most people buy their food.

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Of course…but that’s only relevant when there are no other options available and, if there are, people choose to buy and consume these food items for whatever reason (that they’re commonly accepted as healthy eating isn’t usually one of those reasons) That’s a long way from suggesting that such behaviour in any way comports with any nutritional guidelines in the past.

There comes a point when folk have to accept that, whatever the societal pressures or machinations of the food industry etc have on personal choices, those choices are, in fact, personal.

What are these supported claims, out of interest. I’m sort of familiar with the nuts and bolts of the JUPITER study but not your author’s claims…or rather, what your perception of his claims actually mean.

I’m pretty sure we’ve discussed this before. This is exactly me. I’ve experimented on myself since 1993, and the results have been the same EVERY time without fail.

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Sorry. Anyone who grew up in post-1960s USA was bombarded, literally, in school, in all media, in popular TV shows, by all arms of government, all sorts of endless public service campaigns, AND BY THEIR OWN DOCTORS including pediatricians, about it. I’m big on personal responsibility, but we aren’t talking about ordinary societal pressures here.

For 3+ decades it was USA only. Then the USA exported its bad habits, especially through the use of media, but also via multinationals. It’s no accident that the more English spoken in a country, the worse their nutritional habits trended over recent decades … as that English language media spread. I wouldn’t be at all surprised to see that 10+% of US sitcom episodes contain some sort of dietary fat fear mongering.

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I think you’re baiting the hook with a red herring, so to speak. It’s certainly possible that falsehoods get repeated. To answer your question, I admit I don’t know, but I suspect that no authority deliberately advocated “too much” empty calories. But when a diet recommends reducing fats, especially the supposedly unhealthy saturated fats, usually the calorie balance is made up by sugars and simple starches. Yes, there are “healthy” grains and such, but they make up a darned small percentage of the average diet.

I only have a passing familiarity with Keys. He’s most famous for “cherry picking” the seven countries that had both high fat consumption and high heart disease rates for his infamous “Seven countries study.” Granted, I’m informed by a biased source (Kendrick’s books). He makes a persuasive case that fat has been demonized, that cholesterol/LDL is NOT even a factor in cardiovascular disease, (CVD) Much of the strongest evidence for that is simply that there are populations that eat lots of saturated fat and have comparatively low levels of cardiovascular disease. “The French Paradox” remains one of the best known, much to the dismay of the “cholesterol is evil” crowd. But also lesser known cultures like the Masai. Bringing the conversation back to obesity, part of Kendrick’s hypothesis is that it’s stress that is a major (but certainly not the sole) factor in stressing the body’s hormones. He cites two post-WW II examples of “forced” relocations (Finland, Scotland) and how the relocated populations suffered much higher CVD for a few decades following, compared to their compatriots.

If Kendrick is right, then all else held equal, a person or a nation that is subjected to chronic stressors (war or other adversity) will suffer all sorts of health problems, perhaps to include abnormal obesity, even if diet didn’t change.

In reply to VanEen asking “What are these supported claims, out of interest. I’m sort of familiar with the nuts and bolts of the JUPITER study but not your author’s claims…or rather, what your perception of his claims actually mean.”

My perceptions (of statins) are that they are all but useless. Kendrick is far from the only one to say this, but he’s the one I’m most familiar with. Having an ebook version of “Doctoring Data,” here is an extended quote from Chapter 3 that’s relevant. You can easily find the JUPITER trial online. If you’re unfamiliar with studies, you may not be able to deciper what appears below. Many studies go out of their way to “hide” unfavorable data. From the section I quote below, apparently even Kendrick, a doctor of many decades practice, was baffled until his associate explained the figures.

"If there were potential problems with these data, where could they be? I thank Professor Michel de Lorgeril for pointing them out. Because, at first, I couldn’t see them at all, although they were staring me in the face. Typical of a man looking for anything, so I am told by someone living not a million miles away from me.

The main problem goes like this:

Statins were developed to stop people dying of cardiovascular disease. Heart attacks and strokes mainly. They have not been shown to reduce deaths from any other cause – ever. Therefore, one would expect that if there were a reduction in overall mortality, it would have to be due to a reduction in cardiovascular deaths. Would it not?

On this basis, the JUPITER trials started off pretty well. If you look at the total number of heart attacks, there were 31 in the statin arm, and 68 in the placebo arm. Relatively speaking, there were more than twice as many heart attacks in the placebo arm.

However, and please read this bit slowly. There were 22 non-fatal MIs in the statin arm, and 62 non-fatal MIs in the placebo arm.

I shall put this another way:

  • In those taking the statin there were thirty one heart attacks which resulted in nine deaths.
  • In those taking a placebo there were sixty eight heart attacks which resulted in six deaths.

If we look at stroke:

  • In those taking a statin there were thirty three strokes resulting in three deaths.
  • In those taking a placebo there were sixty four strokes resulting in six deaths.

If we add heart attacks to stroke, we find that:

  • In the statin arm there were twelve deaths from stroke and heart attacks.
  • In the placebo arm there were twelve deaths from stroke and heart attacks.

It does not take the use of a super-computer to work out that the difference between twelve, and twelve, is zero. Although it did take a bit of detective work to establish these figures.

To quote Michel de Lorgeril, in the rather damning article he wrote in the Archives of Internal Medicine:

“Although it is quite unusual that the burden of calculating cardiovascular mortality is placed on the readers, all methods used, however, lead to the same conclusion: there is no significant difference in cardiovascular mortality between the 2 groups in the JUPITER trial.”[[38]

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Well, the thing is with the average diet (whatever that is) is that it wasn’t healthy before dietary recommendations any more than it was after…for a whole variety of reasons. Too much fat, too many low quality carbs…including, but not limited to too much sugar (which, of course, I have to be thankful for as a dentist) …too much of everything, in fact. Reducing fat in the diet didn’t mean that there was a need to replace said fat with anything at all, let alone sugars and simple starches. In fact, if you seek out that old food pyramid that’s consistently cited as the cause of the obesity epidemic, you’ll see that at the very tip of the pyramid under “use sparingly”, along with added fat is…sugar.

The average diet demonstrates the facts that poor eating habits are rarely due to one macronutrient alone and that there are multiple ways of eating badly…and no shortage of people following them

Now the interesting thing about Ancel Keys is that most folk, like you, have little more than a passing familiarity with his work…relying for the most part on stuff that’s written about him by biased sources such as your man Kendrick, rather than anything by him. He’s most famous for being quoted as “cherry picking” his data for the Seven Countries Study…but again, by folk who themselves are quoting biased sources. See if you can find this book somewhere. Published in 1959, out of print now and a bear to read…but a lot of detail about the challenges and logistics of undertaking a massive epidemiologic study that was underfunded and at a time when much of the developed world was in turmoil after WWII. Also a precursor of the Mediterranean diet in principle.

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Indeed. Here it is…

https://www.nejm.org/doi/full/10.1056/nejmoa0807646

…and as anyone who takes the trouble to read through it will see, the published data do not correspond with your quote of Kendrick’s quotes.

The JUPITER trial was quite interesting at the time, I imagine, as it wasn’t a study designed to test the efficacy of rosuvastatin (that was already demonstrated prior to FDA approval) but rather a hypothesis testing to see if it was effective in a population…and a BIG one at that…that was deemed to be low risk by virtue of all the usual risk factors. Not overweight, a “low” LDL-C of 130 mg/dL or less (this was 2003, mind so not exactly low by current guidelines)…but with a hs-CRP >2. Testing to see if rosuvastatin (and by implication other statins, I guess) worked by means of lowering inflammation in addition to lowering LDL.

The effects on the clinical end points was, in fact, so pronounced in the treatment arm that the trial was ended prematurity (much like the pre approval studies on the Covid vaccine that we’ve discussed in a different thread) so I can’t think how Kendrick got himself so bamboozled.

Here’s the thing (and again, this isn’t tremendously different from the Covid vaccine pre approval studies) Kendrick’s assertions are an example of past tense thinking…as in this hypothesis testing study was started back in 2003 and published in 2008. The passage of time means that such criticisms that you find so plausible are quite out of date. Lipid testing is far more sophisticated and “granular” than it was nearly 20 years ago, along with understanding of the pathogenesis of ASCVD and the role of particles such as Lp(a) and Apo-b lipoprotein.

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Of course nobody ever seriously said “you really should eat too much sugar.”

However, the US’s Food and Drug Administration still recommends 225 to 325 grams of carbs daily in order to stay healthy… even though, if pressed, it will admit that the minimum level needed to avoid adverse health effects is ZERO.

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So I threw out a couple of abbreviations that you probably didn’t get too much exposure to in Malcolm Kendrick’s books (and hopefully in Real Life) so I’ll start you off with a bit of background from one of the writers I follow with actual expertise in the area. Not behind a paywall (unlike Peter Attia)and with a few hyperlinks and follow up articles that’ll put more puzzle pieces on the table…

…and a repeat of one more link I recently posted…

Just these 3 areas are worth time and attention if they’re new concepts, as they were to me a year or so back. I’ve had “mildly elevated” LDL-C and total cholesterol for as long as I’ve taken notice but have been reassured constantly that there’s more to managing ASCVD risk than micromanaging lipids. An LDL that routinely toggled around 120-130 mg/dL, a level that would put me in the low risk group per the guidelines in the JUPITER study. Especially since I’ve always had a concurrent low hs-CRP below 1 AND a very high Righteous Living Quotient…i.e. not fat/never fat, non smoker/never smoker, consistent level of worthwhile exercise (strength and endurance training). A good all round custodian.

Such reassurances were wrong. Spectacularly so. After a CAC scan and subsequent follow-up I have evidence (but no symptoms) of quite marked ASCVD and the culprits…marked elevation of Lp(a) and Apo-b. A dead giveaway for one of the multitude of variants for Familial Hypercholesterolemia.

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I have neither the time nor the inclination to read Keys or similar authors. Call me a skeptic, a cynic even. For now allow me to merely note the following, which I believe are generally the truth: In the broad topic of whether cholesterol (later: saturated fats) are a major cause of cardiovascular disease, it remains controversial*, despite having been a central part of Western medical study since (at least) the 1950s and probably earlier. Now, the fact that something is “controversial” among highly-educated professionals (doctors of medicine, researchers, etc.) to me means that the issues are far from settled. That fact alone should pique the interest of an outsider. When one looks into vested financial and professional interests, it lends additional weight to the apparently cynical beliefs that, as is true of a great many human enterprises, that money and power have taken precedence over what the science says. And in this case, the biggest toll is probably on the health or lives of billions of human beings.

In the meantime, all it takes is a population of animal-fat eating Europeans who have heart disease rates a fraction of neighboring nations (e.g. France), or a tribe in Africa that eats a similar diet and has virtually zero circulatory disease (the Maasai tribe), or at the other end of the scale, a population of vegans who eat little or no saturated fats and get atherosclerosis [I’ll admit I haven’t looked for that one, yet.] and at least in my opinion, it pretty well shows that the LDL/saturated fat hypthesis as a prime cause of said diseases is in all probability a load of BS.

*I wryly observe there is a web site, sevencountriesstudy.com, that apparently supports the Keys study. Don’t you find it curious that a study from 64 years ago is still funded by…well, that’d be interesting to know, but I don’t have the resources to look.

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I must respectfully disagree. I personally verified Kendrick’s claims against the published JUPITER study and his claims are validated.As such, I must admit I’m a bit confused when you claim that the “published data” doesn’t correspond with Kendrick’s claim.

I will concede, I don’t think Kendrick mentions it, that JUPITER did show a 20% RELATIVE reduction in all-cause deaths. It was one of the very few statin studies to show even that much of a reduction. Many studies leave much to be desired in terms of scientific rigor and such, and JUPITER is no exception. I direct your attention to Longeril who seems to pretty much shred the credibility of JUPITER:

“Out of date?” So, the passage of time will change the (lack of) effectiveness of a drug?

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Thank you. I will browse the links. I too am interested in learning more about CVD merely as one who is otherwise healthy but has reached thresholds of age/LDL/blood pressure where they try and treat one.

For anyone still reading, I already do many of the most important things to support my health. Many of these are non-controversial, like getting regular exercise and not smoking or in my case drinking at all. I watch my diet, but here the advice veers to the unconventional (e.g. I minimize sugars/carbs.) Obviously, I’ve grown distrustful of much standard medical advice, and in my own opinion, justifiably so. By all means feel free to label me a denier, a lunatic, whatever.

I will mellow my otherwise cheeky comments (although I do stand by them!) that I am still learning, and yes, what was wisdom ten or twenty years ago may be modified by later learning. I still take a cynic pill each day, nonetheless.

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How can they be when the data published in the actual study are very much at odds with the opinion Kendrick was parroting.

Here’s the thing to understand with clinical studies…especially those of this magnitude…and it’s this: primary endpoints are decided upon and announced ahead of the study being initiated. Independent review boards are appointed to independently determine whether and or when these primary endpoints are reached without consultation with the study investigators or the funding source. They wouldn’t be Independent if they did that.

Now, it’s a perfectly reasonable thing to challenge the conclusions of any published study (that’s the Scientific Method in progress) and it oftentimes results in a whole different take on a paper. However, it usually comes from new evidence not a constant harping on about conflicts of interest (which weren’t hidden in the primary document) or quoting another author who’s conjured up a slew of endpoints that I can’t quite fathom where they come from. Table 3 in the primary document quite clearly shows the difference between the study arm and placebo in numbers of participants in addition to the relative difference in rates per 100 person years.

Now here’s the things to remember WRT the passage of time…and in the context of this study in particular …

As I mentioned upstream, the passage of time can demonstrate quite a few things. First being that, although this study selected the subjects as being low risk (by parameters of the day) and that the theoretical “low” LDL noted back then is no longer considered low. Obviously, in a group of low risk individuals, no one could realistically expect a big difference between a study arm with a “cholesterol lowering” profile (among other effects) and a placebo group, right. No matter how effective a medication might be in a high risk group for secondary prevention, right? If the statins and other cholesterol lower meds were as ineffective as Kendrick and Lorgeril etc were claiming back then, there should’ve been no difference. And yet there was per the raw data (and I don’t believe even Lorgeril is trying to demonstrate outright fraud)

And this was a benefit demonstrated quite quickly. ASCVD is a disease that develops over the long haul (not unlike, say, the power of compound interest to use a financial analogy) These patients weren’t followed over the longhaul (because the study was terminated per the independent monitoring board’s guidelines)…but plenty of accrued evidence and new understanding leaves these statin denialists as just that. Denialists

One interesting thing is that the hs-CRP as a biomarker hasn’t proven to be such a useful tool for risk prediction as it was expected to be back in the aughts. I first read about this on the Foolish Collective and a series of Cholesterol Plays by a poster edmiller years ago…who had in fact had a low risk profile but high hs-CRP and suffered a heart attack. Hugely popular with a high rec count…anyone remember the Cholesterol Plays?

That’s usually called denialism, not skepticism. I think it’s a pretty safe bet that Kendrick et.al. know their audience.

As you can tell, I like “cheeky” myself, but tend to appreciate evidence and facts … however tentative… a little bit more (however much those two are subject to change in the face of new data)

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I find it useful to remember something I learned in, I think, junior-high science classes: What’s settled is the precipitate, not part of the solution.

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If we all were to end up on less expensive generic drugs this would be far less of a cost. It is not like people in the 1950s lived longer. They did not. The drug treatments were not fully available.

The choices of expensive often less effective drugs with worse side effects also were not on the market. We save people one year only having to double up on meds for secondary problems later on. Have to say it here, those meds choices where people end up with more problems all too often are bad medicine. Not always I am not trying to generalize. All too often though. The drug companies lapping up massive profits constantly in the process.

There is nothing wrong with spending more on healthcare. In the US as it stands we can spend less actually.

There is nothing great about getting obese. That is not the problem. In earlier days there were not the vaccines and antibiotics people died less expensive deaths but yeah were not as obese or long lived.

Cutting costs means getting rid of private insurers and negotiating with pharmaceutical companies. Only the reasonably run private supplemental policies bring down the total system costs while upping care for many people who can afford to chip in.

The UK is just very cheap with the medical care. All or almost all of the western powers spend more per capita. The UK really does need to spend more.

As far as Japanese better health? As a population ages the healthcare infrastructure needs building out at great expense. Japan spent those monies years before the rest of us. We are now facing particularly in the US building out nursing homes etc for the boomers. It is expensive now.

Yeah I said the US can spend less. Yes building out the nursing homes etc costs a lot now. Don’t start doing the boomer math that has never worked. We can cut costs considerably and do expensive things. Most boomers can not do math like that. I get that.

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