Diets and Populations Studies

My good friend Evo Terra  (@EvoTerra) is going on a special one month diet – it was going to be just beer but I convinced him to add some sausages (including my favorite, reindeer sausage).  If you have been influenced by popular press you are aghast at what Evo is doing, and probably wonder, how can a physician supervise such a diet?  The answer is- because we need to know.

What we think we know about how the body reacts and what we really know are two different things – here are some popular myths through the years as they relate to diets.  The most dangerous assumptions about diets come from population studies, you have heard them,  this population did that, and here is why this diet is great…

Seven-Country Study:

Warning against all fats- he became the cover boy for Time in 1961

From the 1960’s through the 1970’s the primary focus of the American Heart Association to the Congressional Paper by McGovern in 1976 was cholesterol.  It was wrong – but the ramifications of this public policy live on in many nutritional books today. Ancel Keys, a physiologist, promoted this based on the “seven country study” where he concluded serum cholesterol was strongly associated with heart disease, therefore a diet low in cholesterol would reduce heart disease. The statistical data did not back up his conclusion- he left out the “French” paradox – and ignored the Japanese increase in meats after he war with a reduction in strokes and heart disease. We now know the “epidemic” of heart disease was more related to the increase in cigarette smoking than diet changes.

Now we have science (and my previous post have discussed this particular diet) – and science has shown that it is not cholesterol, nor is it dietary cholesterol, nor is it even saturated fat that is the problem. We  have also discovered that margarine- which is trans-fat, is probably one of the worse things that a person could have.

Keys later in life said cholesterol wasn’t so important. He then discovered olive oil, and was one of the founders of the Mediterranean Diet. He lived to be 101.

The China Study

Colin Campbell pooled blood samples from 100 remote villages in China, and based on the data came to the conclusion (which he had come to before) that those who had vegetable proteins lived the longest, and animal proteins were the primary cause of heart disease, cancer, and halitosis (ok maybe not halitosis).

The data in his study did not support his conclusions (which were remarkably made into a best selling book).  In fact, most of the data in the study, when critically examined came to the opposite conclusion. For example – the one village with the highest consumption of meat (twice that of even US populations) had the lowest incidence of cancer and heart disease.

Another bit of data – the higher the processed wheat and sugar in the diets- the greater incidence of heart disease.

For those who live in China – including remote rural China- they eat everything- all proteins, from animals, to insects, to anything that moves, walks, and crawls. Ask them what they eat for protein – and well, another story.

This has become the calling card for vegans everywhere- stating that this shows that their diet will allow them to live the longest and healthiest life.  Sadly- the study is horribly flawed and bias. A great review of this work is done by rawfoodsos.com

The Norwegian Study

Norway was invaded by Germany in World War 2 – the Germans confiscated all animal proteins to feed their soldiers  and Norwegian mortality True,  true and unrelated. Animal protein went down, fish went up 200 per cent, and sugars, flours, and processed goods were highly rationed.  Other issues- in wartime, deaths from other causes – trauma (guns), pneumonia, and other infectious disease increase before a person has a chance to choke off the coronary artery. When you read from the conditions during that time –

“During the first year [starting in spring of 1940] the rationing included all imported foods, bread, fats, sugar, coffee, cocoa, syrup, and coffee substitute. In the second year [starting in late 1941] all kinds of meat and pork, eggs, milk and dairy products were rationed”

Thus the mortality drop in 1941 is hardly explained by the events of that year. Norwegians were drinking more whole milk in 1941 than even before the war. In addition, fish consumption dramatically increased. Fresh fruit and vegetables were mostly gone by 1941 but the Norwegians increased rates of root vegetables. Sugar consumption dramatically dropped during that time.

Paleo-Diet

Ok, there are a few of these people who gather and hunt left but what we cannot conclude is that they were disease free, that they had few dental carries (cavities) and they lived in the garden of Eden. This is made up- totally made up. Sells a lot of books though.

Strong Heart Studies – the Pima Indians

When I arrived as a vascular surgeon to Arizona, I was told that the Pima Indians had something about them because they didn’t suffer from heart disease. In fact, it was such a strong issue that a study was made up – the Strong Heart Study.  This was at odds with medicine since the Pima Indians have the highest rate of diabetes in the world. Turns out, as they examined them – most Pimas die of heart disease.  Simply put- their hearts were no different than anyone else’s and their rate of death from heart disease was higher than the population.

The lesson from the Pima Indians is this—even with NIH people, and fully staffed health service- the statistics kept were not that great. Imagine a third world country, or even a number of studies done years’ ago- the statistics about what causes mortality is quite suspect.

So here is what we know from modern science and diets:

Conclusions from population studies are often flawed by the people who study them – and they come to conclusions that are often not backed by the evidence. Filled with confirmation bias, these studies are all but useless for making any conclusions to how food will affect health. Some useful things – fish are good, lots of sugar not so good, meat is ok.

With Evo we will examine some simple variables—body fat, muscle mass – some lipids and some liver profiles. Based on that we will see how his body is reacting to this. If we see anything that worries us, we will stop.

Thankfully Evo will not drink bad beer – only great craft beers.  Besides sausages- I hope to have him over to my house for some Wiener Schnitzel (it is German – and Evo will bring the beer).

I don’t know much about beer – but I’ll bet Evo likes this one

Who knows- perhaps the world needs more of the “Evo diet.”

Physician disclaimer time: do not attempt this diet on your own. You need a physician supervision for something like this- unless of course Evo and I write the book- in which case we will happily autograph books of  “The Evo Diet” – please order ten at a time.

Dr. Terry Simpson About Dr. Terry Simpson
Dr. Terry Simpson received his undergraduate and graduate degrees from the University of Chicago where he spent several years in the Kovler Viral Oncology laboratories doing genetic engineering. He found he liked people more than petri dishes, and received his MD. Dr. Simpson, then became a renowned weight loss surgeon, and a leading advocate of culinary medicine. The first surgeon to become certified in Culinary Medicine, he advocates teaching people to improve their health through their food. On the other side of the world, he has been a leading advocate of changing health care to make it more "relationship based," and his efforts awarded his team the Malcom Baldrige award for healthcare in 2011 for the NUKA system of care in Alaska. A frequent contributor to media outlets discussing health related topics and advances in medicine, he is also a proud dad, husband, author, cook, and surgeon “in that order.” For media inquiries, please visit www.terrysimpson.com.

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