Evan Allen🌱 Profile picture
Jan 31, 2018 7 tweets 4 min read Twitter logo Read on Twitter
Chanced upon an interesting study from Sweden today. Sweden had some of the highest CVD mortality in the 1970s, so programs were put in place to decrease cholesterol. They were successful at getting reductions in serum cholesterol by decreasing SFA primarily in the 80s and 90s.
In 2004, the #LCHF movement got a lot of press and Swedes seemed to be convinced by social media campaigns to abandon their dietary guidelines and decrease carbohydrates and increase fats. You can see that they did exactly that from the graphs. What happened?
Cholesterol levels went up, in spite of a near doubling of the use of statin drugs. In addition, BMI continued an inexorable rise, no changes were seen in the trends for obesity and no reduction in cancer rates was seen. In fact, cancer continued a steady rise.
Now it is clear that Swedes continued to eat CHO, but the reductions were significant. It is also clear that this divergence from the dietary guidelines did not help with any significant health measure. nutritionj.biomedcentral.com/articles/10.11…
So the space to make an argument for #LCHF from this data is to argue that these modest reduction in CHO and increases in SFA are inadequate to reduce BMI or CVD risks, but that more extreme increases in SFA and decreases in CHO would be better. But is that reasonable?
Arguments are always put forward that #LCHF is easier to adhere to due to this satiety factor or that amount of increased protein. But this campaign in social media clearly worked to alter behavior. Swedes got the message. They ate less CHO and more fat. researchgate.net/publication/28…
Proponents need to show why disease and BMI trajectories didn't change at all during this period of national compliance with #LCHF guidelines.

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More from @EAllen0417

Dec 21, 2017
Some final thoughts on S-T & K's meta-analysis on SFA and CVD. When this was published back in 2010, headlines and news articles repeatedly called it "new research." The same canards were recycled when Chowdhury published a similar study 4 years later.
Of course, none of that is true. These were not new studies. Medicine is a human endeavor and people who are told there is "new research" that exonerates SFA should be getting actual new research.
A meta-analysis of tens of studies that shows no effect of SFA, when a detailed analysis of the individual studies shows a relatively robust effect of SFA on CHD is a form of lying. Remember, all the research is known to the researchers before they crunch numbers.
Read 7 tweets
Dec 20, 2017
Our final, non-duplicate study in S-T and K's meta-analysis is another study of strokes out of Japan. The Adult Health Study (apparently rated R), looked at a single category of cerebral infarction in Japanese from Hiroshima and Nagasaki.
The answer to the question you have in your mind right now is, "Yes, they were all exposed to the atomic bombs." So this is not your typical run-of-the-mill nutritional epidemiological study. What it's doing in this analysis is really hard to justify IMO. stroke.ahajournals.org/content/35/7/1…
The infarction is a single category, with no breakout between hemorrhagic stroke and ischemic stroke. Does radiation exposure materially effect the risk of hemorrhagic stroke? One study suggests the possibility but I have seen no high quality research. bmj.com/content/340/bm…
Read 8 tweets
Dec 19, 2017
I want to take a final census of the studies we've looked at before doing the stroke studies from the S-T & K meta-analysis. Adopting the most favorable reading of all studies (studies with no overall significant results) it's 10-6 harmful vs. no harm.
None of the studies of CHD and SFA showed benefit to SFA, and when we read it critically, including all studies that showed harm from a subgroup, we get 14-2 harmful vs. no harm. I want to point out that all the studies excluded people with existing CHD.
This only makes sense if the process that leads to additional cardiac events in a patient with CHD is different than that which leads to the initial event. But there isn't much data to support this. One wonders what a meta-analysis that didn't exclude heart patients would show.
Read 11 tweets
Dec 18, 2017
Our final paper from ST-K's series on heart disease is the Strong Heart Study published in 2006 by Xu. This was a study of 3k people in Arizona, Oklahoma and the Dakotas. Conducted through the IHS, it used 24 hour dietary recall.
The patients were followed for about a decade, those with angina or known MI in the past were excluded. In patients under 60, there was a strong association between SFA and heart disease, that disappeared in those over 60. Trans fats had no association in all groups.
The risk ratios for those under 60 were quite significant, with SFA leading to a 5-fold higher rate of coronary death in the highest vs. lowest quartile in that age group. Curiously, MUFA led to a 3-fold increase in risk ratio. ncbi.nlm.nih.gov/pubmed/17023718
Read 7 tweets
Dec 15, 2017
Next up we have the Baltimore Longitudinal Study of Aging. This looked exclusively at 501 men free of disease at the outset that were followed for 18 years. Seven day diet records were recorded at multiple (up to 7x) intervals in the study.
The BLSA took so long that the nutrition calculations method were changed over the course of the study, but the investigators were scrupulous and unified the methods before the final analysis. The most interesting choice they made was dividing dichotomous variables into binaries.
So someone who ate 4 servings of fruit and vegetables daily was grouped with someone who had none, but someone who had 5 was grouped with someone who had 10. SFA was cut at 12% because almost nobody ate <10% SFA. jn.nutrition.org/content/135/3/…
Read 6 tweets
Dec 14, 2017
Today we look at the Nurses Health Study. This is an observational trial with ~80k female nurses. FFQs were done biennially and patients with CVD, DM and hyperlipidemia patients were excluded. They were followed for eighteen years.
For women in this study, total fat dropped from about 40% of calories to about 30% of calories over the time of the study. PUFA was protective of CHD, MUFA, TFA and SFA all were associated with increased CHD.
Of note, when you look at the chart you see the risk of SFA was actually greater than the risk of TFA, but the text of the study mentions only the protections from PUFA and the risks of TFA, not sure why the authors ignored the SFA. academic.oup.com/aje/article/16…
Read 5 tweets

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