BMJ support criticism of Industry backed Statin Research

Sir Rory Collins is an advocate for statins claiming it is safe and effective in healthy patients. His research has shown that they benefit practically everyone and have virtually no side-effects. His opinion is based on “secret data” has not been made available for inspection. And, yes, his research is funded by the companies supplying those drugs including Pfizer and Merck Sharp & Dohme.

Lipitor“The research centre that Sir Rory heads – the Cholesterol Treatment Trialists (CTT) in Oxford – holds the biggest collection of statin data in the world, but no one outside the organisation has been able to study it for 20 years.”

Two authors have written papers attacking his work (Abramson Oct 2013 | Malhotra October 2013). These were published in the British Medical Journal. Sir Collins took offense and has been demanding that the BMJ retract the papers.

The BMJ suggested Sir Collins write a rebuttal which is the normal way these things get duked out in peer reviewed journals. But instead, he sent replies by letter marked “Not For Publication” – a move which doesn’t exactly encourage open dialogue.

A committee was then set up by the BMJ to consider Sir Collin’s request to have the opposing papers withdrawn. Not only did this body reject his demands but has instead issued a report which criticizes how he has been dealing with data (Statin Papers Stand, Aug 1).

Although statin use is widely prescribed, the jury is still out on whether they are effective and worth the cost of side effects.

“Yet here we are 20 years on and there is widespread agreement that we still don’t really know how effective they are at preventing heart attacks in healthy people – the group who get by far the most statin prescriptions – or what the true side-effect rate is. Part of the problem is the drug companies’ well-known habit of fiddling of statistics, hiding of unfavourable results, selecting trial subjects most likely to produce favourable results and so on.”



Obesity and Food Palatability

Great talk by Steven Guyenet on the hypothesis that increased food palatability is an important factor in growing rates of obesity.

There is no doubt that increased calorie consumption is a proximate cause of increased levels of obesity. But that is not very useful information. The question is WHY are we eating so much more?

Guyenet provides details from a number of studies which suggest that food palatability is driving our consumption of calorie dense processed foods.

  • Study found that rats ignored their rat show in favor of human “cafeteria” junk food diet and gained weight rapidly. Such tasty human food far exceeded any other rat chow diets in producing weight gains – Sclafani & Springer, 1976
  • Overweight patients who were free to consume as many calories as they wanted from a bland diet consistently lost weight without reporting hunger despite, at times, consuming less than 300 calories per day. Lean patients on the same diet maintained their body weight. “This machine-feeding regimen was nearly as close as one can get to a diet with no rewarding properties whatsoever.” – New York Academy of Sciences, 1965
  • These findings were replicated in a similar study in which “subjects reduced their calorie intake voluntarily and were always in good spirits” while consuming a bland diet. – Michel Cabanac, 1976

Guyenet has more detailed write-ups on these studies here.

Factors involved in the reward value of a diet:

  • calorie density
  • fat
  • starch
  • sugar
  • absense of bitterness
  • free glutamate (MSG)
  • textures (crunchy, soft, liquid(
  • variety
  • certain aromas
  • consistency of flavour

The last point is worth noting: the more we can depend on a food tasting the same, the more we are likely to crave it for the certainty of the food reward. Think McDonalds.

He went on to compare two weight-loss diet studies, one low carb and another low fat, and showed that loss was comparable regardless of the preponderance of these two macronutrients. It suggests that, perhaps, whether you remove fat or carbohydrates, the common factor is a reduction in food palatability.

He also gave examples of a two native peoples who, despite having diets with widely different macronutrient contents, were both extremely lean:

  • Kung San of Botswana: consumed mostly nuts, starchy tubers, fruit, assorted leaves, insects and, less often, large and small game. At times up to 58% of their diet came from a single food (Mongongo nuts). “Somewhat monotonous”. Overall their diet was 60% fat, 25% carbs, 15% protein.
  • The people of Tukisenta, Papua New Guinea: Sweet potato accounted for 90% of food consumed. The rest included taro, sugarcane, pandanus, insects and, rarely during festivals, pork. Overall their diet was 95% carbs, 2% fat, 3% protein.

It seems that the low fat versus low carb wars may be a red herring.

So what has happened to our own tribe? Americans have changed where they eat, and therefor what they eat, quite significantly over the past 100 years with the presence of fast food really taking off since the late 60’s.

Guyenet points out that this graph understates the magnitude of the change in diet as much of the food now being consumed at home is also processed.

His next graph illustrated the massive increase in sugar consumption, another marker of this processed food intake:

A similar trend is seen in the consumption of fresh versus processed potatoes:

So what’s the bottom line? Return to simple food.

“Food that is professionally engineered to maximize palatability and reward value is uniquely fattening. The solution is to avoid it.”

The first step is to eliminate comfort aka “maximum reward” foods:

  • Candy
  • Chocolate
  • Ice cream
  • Potato/corn chips
  • Cookies/cakes
  • Fast food
  • Pizza

If that thought is painful, he proposes a strategy for easing into a healthier diet. Each step requires increased effort so get comfortable with a stage before moving on to the next one:

  1. Eat three of fewer meals per day, but no snacks
  2. Cook food at home from simple ingredients
  3. Restrict palatability/reward factors that were absent in the ancestral environment
  4. Eat a few staple foods consistently, with no flavorings added

This sounds quite daunting but he claims that simple food becomes more satisfying after a 1-2 week period of withdrawal. He doesn’t actually say withdrawal but as you look at this list, you can feel the monkey on your back and he does NOT want off.

It’s a sensible plan. Should definitely work. Requires effort.
Isn’t there a pill I can take instead???

My thoughts:

What I find interesting about his theory is how it somewhat overlaps but clashes with Seth Robert’s theory behind the Shangri-La diet. The diet involves taking a small serving of flavorless calories 1-2 times per day and that this on its own seems to cause the body to change its body fat set point. Food palatability IS a factor but you don’t have to completely eliminate modern foods from your diet. Roberts does not know how this works or what the mechanism is but many people claim to have successfully lost weight this way without any other changes to their diet or activity levels.

Is it possible that Guyenet is describing a much more arduous route to reach the same Shangri-La brain hack so to speak? The question is to what extent those people who claimed to have lost weight on the Shangri-La diet have continued to eat junk food. Maybe they spontaneously lost interest in junk food due to this protocol. Perhaps the actual hack of Shangri-La is to change one’s preference for highly palatable foods.

Certainly the Shangri-La route seems much easier. But try downing 100 calories of light olive oil and you will certainly question whether it is healthier, regardless of how easy it goes down.

Guyenet’s advice is undoubtedly no-nonsense and will work. But it may require massive changes to how you meet and socialise over food. It is likely that most people could adjust to the dietary changes required here. But in the long run, how many can maintain the social changes eating an ancestral diet may require? I doubt there are many.

So yes there are still no shortcuts. And maybe that’s the point. We have all the answers, just not ones we like.

Anti-Inflammatory Diet

So who needs a so-called “Anti-inflammatory diet”? Well just about anyone who is not genetically adapted to a modern diet… meaning everyone. Inflammation is your body’s response to you giving it stuff it is not adapted to.

A wide range of modern health problems start as elevated levels of inflammation.

In a nutshell, an anti-inflammatory diet is this:

  • Take Vitamin D
  • Eat Low carb – avoid grains
  • Avoid vegetable oils — only olive oil is safe (trans fats are dangerous), butter is better
  • Consume Fish oil
  • Eliminate High fructose corn syrup
  • Eat Saturated Fats — safer than polyunsaturated fats, major source of calories
  • Eat Fermented foods — boost your good bacteria


It all sounds vaguely familiar…
Bottom line: no more bread… but you are welcome to enjoy a steak with butter!


Alzheimer’s treated with Ketones

I saw a touching documentary on Alzheimers recently but it freaked me out a bit because my dad is in the advanced stages of Alzheimers and I wondered, is this my fate?

I’ve long heard that Alzheimer’s is referred to as Type-III diabetes. So the obvious question was, had anyone done research on the impact of a ketogenic diet for arresting or delaying the disease? The answer sadly, is no, not really.

But if you are happy to be swayed by anecdotal evidence (I often am) then this story from 2008 is full of hope:

In this account, Dr. Mary Newport supplemented her husbands diet with coconut oil (a medium chain triglyceride) to increase ketones in circulation.

There was no carbohydrate restriction. In fact many of you will cringe to see pictures of coconut oil added to every grain imaginable (she usually stirs it into his oatmeal). The dose given was 2 tablespoons of pure coconut oil daily (non-hydrogenated).

In just 24 hours his severe Alzheimer’s showed improvement and this continued for several months. He literally “rolled back the clock” as shown by the amazing improvement in his ability to draw a clock face (a standard test for Alzheimer’s).

She has written a book on her experience but to save time and money, just check out this 4 page case study she wrote.

Here is a similar story of using coconut oil to treat Alzheimers. In this case, intervention was a lot sooner and appears to have been completely effective in stopping progression of the disease (although they do not appear to have independently verified his condition):


Peter at Hyperlipid looked at Dr. Newport’s story when it first came out and made this interesting comment:

One of the first posts I ever put up on Hyperlipid was the use of the full blown ketogenic diet for the partial reversal of Parkinsons Disease. As far as I can see Alzheimers Disease, Parkinsons Disease and ALS are all essentially the same disease, but the genetics of your glutamate receptor subtypes or quirks of your glutamate processing enzymes determine which you get. They’re excitotoxin diseases, and Russell Blaylock has the most self consistent hypothesis of their generation that I’ve come across.

For me all this means that I need to hunt down a good source of coconut oil pronto. If Alzheimer’s is in the cards I may notice nothing for another 20 years, but likely the seeds of it are taking hold now.

I have had a hard time sticking to a low carb diet over the long terms and have indulged in regular carb-filled relapses. So it seems that, as a minimum, I should start taking coconut oil as a potential prophylactic against brain rot…


Alternative to NMR Scan? ApoB

I am blatantly recopying this without permission because this information was burried in the comments thread to this post on cholesterol by Perer Attia. The info is very useful to everyone living outside of the US interested in getting a measurement of their LDL-P.


The NMR scans you are so keen on do not seem to be available in the UK (so I suspect also not in many other places outside the USA): this being the case can you give advice as to how we can make the best use we can of the standard lipid panel, e.g. say a bit more about the usefulness of ratios like that of triglycerides to HDL (giving – with all necessary caveats – broad information about good, bad and middling ratios). – Roger Butler, May 17, 2012


You’re right. Outside of the US the best thing to is have apoB directly measured, as it’s done by a number of labs. This is the best proxy for LDL-P and is more available. – Peter Attia

Note that you will see the test referred to as both “Apo B” and “ApoB” in different places.

So what is ApoB?

From John Hopkins Health Alerts:

The problem with using LDL cholesterol levels to determine heart attack risk is that the test measures only the amount of cholesterol in the LDL cholesterol particles, not the number or size of these particles. Apo B measurements, on the other hand, provide information on the number of LDL cholesterol particles.

Apo B is a protein found on the surface of LDL cholesterol particles. Because each LDL particle contains only one molecule of apo B, the total amount of apo B in the blood is equivalent to the number of LDL cholesterol particles. The size of these particles can sometimes be inferred from the total amount of apo B and the LDL cholesterol level.

For example, people with a higher apo B value than LDL cholesterol value tend to have smaller, denser LDL cholesterol particles. Studies have shown that small, dense LDL cholesterol particles are more strongly associated with heart attack risk than large, “fluffy” LDL cholesterol particles.

Research published in The Lancet reviewed five studies of LDL cholesterol and apo B in nearly 200,000 people. The researchers concluded that high levels of apo B were more strongly linked with future heart attack risk than LDL cholesterol levels.

Apo B is measured with a simple blood test. Proponents of apo B argue that the test is accurate, inexpensive, and does not require fasting, as LDL cholesterol testing usually does. However, the American Heart Association has determined that the evidence to date is not strong enough to recommend that apo B testing become standard procedure.

Even apo B researchers recognize that LDL cholesterol is an important predictor of heart attack risk and suggest that apo B is most helpful for predicting risk in people with normal or low LDL levels but high triglyceride levels. Overall, if one’s LDL cholesterol value is high, an apo B measurement is not necessary.

Dr. Davis Primer

Whenever I implicate carbs instead of fat as a major risk factor for obesity and heart disease, I am met with rolling eyes and eventually that look that says “you’re insane.”

In an ongoing effort to convince my audience that I am NOT nuts, I encourage them to read the advice of someone with better qualifications on the subject: a cardiologist.

Not just any cardiologist mind you, but a rare breed actually concerned with prevention:
Dr. William Davis

Dr. Davis’ Heart Scan Blog is full of great info but there is a LOT to wade through.

To make your first encounter with Dr. D easier, let me start you off with a few recommendations:

1. Know your risk factors for heart disease

2. Understanding cholesterol Values
The LDL/HDL/Total cholesterol numbers are NOT a good indication of your risk of heart disease. These number can mislead by underestimating or overestimating risk. Learn what Lipoprotein analysis (NMR) is and understand what small LDL particles are.

3. Reducing your risks and reversing heart disease
There is no one post that pulls this all together* but his advice is consistent:

  • Eliminate sugars, wheat and cornstarch
    Eliminate–not reduce, but eliminate wheat products from your diet, whether or not the fancy label on the package says it’s healthy, high in fiber, a "healthy low-fat snack", etc. This means no bread, pasta, crackers, cookies, breads, chips, pancakes, waffles, breading on chicken, rolls, bagels, cakes, breakfast cereal. This includes
  • Eliminate junk foods
    such as candies, cookies, pretzels, rice cakes, potato chips, etc.
  • Take Omega 3
    It must be from fish oil There is no need for expensive brands like Lovaza (aka Omacor). Dosing frequently (eg 2-3 times per day) seems to enhance the effect. Take a minimum EPA + DHA of 1200 mg per day (ie 4000mg standard fish oil) or more.
  • Take Vitamin D3
    This should be oil based (ie gel not tablet). Dr. D has on occasion recommended Carlson’s and Vitamin Shoppe brands.
    "Though needs vary widely, the majority of men require 6000 units per day, women 5000 units per day. Only then do most men and women achieve what I’d define as desirable: 60-70 ng/ml 25-hydroxy vitamin D blood level." ref
  • Dr. D has also mentioned that exercise may enhance the benefits of these changes but he does not discuss exercise much.

    Likewise he has stated that one should not allow saturated fats to dominate but again his blog does spend a lot of time on this recommendation. In this respect he is more conservative than much of the low-carb community particularly given that he remains anti-egg yolk: "One yolk per day is clearly too much."

    More info:

* Note that this list is my own compilation from various posts and may not accurately reflect Dr. Davis’ protocol due to errors of omission or emphasis.

In the end, Only Calories Count: Wrong

I’ve been seeing this headline a lot lately:

Diets That Reduce Calories Lead to Weight Loss, Regardless of Carbohydrate, Protein or Fat Content

Well yes that’s true. But quite frankly, it misses the point.

A person who is overweight does not have a weight problem. She has a weight symptom. Her problem is hunger.

There is no point trying to manage weight if you do not manage hunger. There is only so long you can fight your body’s desire to reach and maintain its target weight. And by target I don’t mean the one you have for yourself that makes you look good in a bathing suit. It’s the one your body feels is necessary given your diet composition, your level of activity and your genetic propensity for fat and sugar regulation.

Most people don’t know why they are overweight.

They think they know why but they don’t.

The standard answer from patient and doctor alike is “over-eating” which tells you absolutely nothing. I’m here to tell you that there is no such thing as over-eating short of the kind that leaves you feeling unwell because you’ve surpassed the volume comfortable for your stomach.

Over-eating, in the most common sense, refers to any food consumption that precedes weight gain. It’s a tautology. All things being equal, if two people follow the exact same diet and one gains weight, he is said to have “over-eaten” while the other “ate in moderation.” It’s like saying the tree was green because it was green.

The goal of any weight-loss diet should not simply be to create a caloric deficit, but to adopt sustainable lifelong eating habits which make it easy to reach and maintain an ideal weight. That is not to suggest it will ever be easy to drop detrimental eating habits which have been acquired over a lifetime and are probably central to one’s eating culture. But the changes must be sustainable physiologically.

Skinny people may admonish fat ones for failing to show self control, but the fact is that a modern diet makes some people constantly hungry. Fighting that kind of psychological torture day-in day-out is not possible. Gross caloric deficits can be sustained for short periods of time but falling off the wagon is inevitable unless hunger is addressed.

So it is true that the macro-nutrient composition of a diet is irrelevant if you are simply trying to achieve a caloric deficit.

However it is completely relevant if you are trying to control hunger in order to achieve a sustained depletion of fat stores.

Fat Fine

Well intentioned but seriously misguided…

Alabama To Charge Obese Workers $25 Monthly
The state has given its 37,527 employees a year to start getting fit or they’ll pay $25 a month for insurance that otherwise is free. The board will apply the obesity charge to anyone with a body mass index of 35 or higher who is not making progress.

If the screenings turn up serious problems with blood pressure, cholesterol, glucose or obesity, employees will have a year to see a doctor at no cost, enroll in a wellness program or take steps on their own to improve their health. If they show progress in a follow-up screening, they won’t be charged. But if they don’t, they must pay starting in January 2011.

Via Neatorama

GMO Contamination

U.S. rice farmers want class action against Bayer

Germany’s Bayer AG is battling to keep thousands of U.S. rice farmers from becoming part of a massive class-action lawsuit over the contamination of commercial rice supplies by a Bayer biotech rice not approved for human consumption.

Farmers suffered extensive losses, both from a plunge in rice prices, and in a drop in export business as Japan and the European Union moved to restrict U.S. rice from crossing their borders.

About 700 rice farmers have filed lawsuits against Bayer following the August 2006 disclosure that the company’s genetically altered experimental rice had somehow contaminated food supplies.

This is an interesting case because, regardless of your view on the benefit or ills of GMO, it illustrates how difficult it is to ensure that such crops are isolated.

In this particular case, farmers lost out because many of their export markets ban GM products.

The U.S. Department of Agriculture and Food and Drug Administration said there was no public health or environmental risks associated with the genetically engineered rice and the two agencies elected not to punish Bayer for the contamination.

This has to be an excellent example of lobby power because, regardless of the impact of the contamination, the company has demonstrated that it has weak biosecurity measures in place.

Likewise, by not acting on the offence, the FDA has signalled that it does not take biosecurity seriously. Perhaps they want a tragedy on their hands first.

Bayer is, at least, on the defensive.

This is a marginal improvement over the typical farmer’s experience with Monsanto which has a record for suing farmers who fall victims to such contamination.

Obesity and Oil Prices

Reducing Global Demand For Food And Fuel By Reducing Obesity

If fat people would eat less and walk more instead of driving, the world problems of high food and oil prices could be alleviated.

Sadly this naive conclusion is not the product of some troll on a random internet forum but is in fact the summary of correspondence published in The Lancet.

It is also argued that since the mass of the obese population is greater than a normal population, more transportation fuel energy is required to transport the obese. This is only likely to worsen since obese people will choose to walk less and drive more in response to their increased body mass.

There is little point in addressing such a proposal which is essentially the application bad medicine to a misunderstood matter of economics. The authors betray both a lack of insight into the nature of obesity as well as global market forces.

The greatest gains, they say, would not be through a general decline in car use, but through a reduction in the excess food and car use demands that come from the obese portion of the population.

Without really wanting to “go there” it might be worth pointing these people to studies which suggest that it takes far more food calories than petro-carbon calories to move a body… so the economies they are expecting might just not work out.

But that’s not really in the spirit of what they are saying… which is effecitvely “these people are getting more than their fair share of food and oil to haul their fat asses about. If only we could trim them down then the world is saved.”

The obese population, therefore, requires more than 18% more food energy than a normal population.

The sad part is that this kind of thinking is mainstream and it’s what many people face when they go to their doctor for advice on weight management.

Start walking and don’t eat so damn much. And by the way, your fat is making it rather expensive to run the Benz.



Psst. Perhaps fat people are responsible for global warming too… it’s those thighs… and all that friction.