In studies, the average person who tries the Cordain Paleo diet sees their HDL go up, and both their triglycerides and LDL go down. The average person who tries a high saturated fat Atkins diet sees both their HDL and LDL go up and only their triglycerides go down. And in EVERY long term study of high saturated fat diets in this country, there is more heart disease in the group eating a high amount than the group eating a moderate amount.
Throughout the book, Taubes focuses on reducing carbs, but there is a long list of differences between modern humans and hunter gatherers besides refined carbs and increased insulin: Grain fattened meat with more saturated fat and less CLA and omega-3, vitamin D insufficiency, a sedentary lifestyle, a shortage of phytochemicals from fruit and vegetables, a shortage of omega-3, eating too much salt, smoking and alcohol. And according to Weston Price, organically grown food, minimally processed food, calcium, fat soluble nutrients and whole grains were important reasons for the health of the people he studied. All these things effect Western diseases including heart disease and cancer.
EVIDENCE THAT HUNTER GATHERERS ATE MEAT THAT WAS VERY DIFFERENT FROM WHAT MODERN AMERICANS EAT
On page 163 Taubes says, "The idea is that the longer a particular type of food has been part of the human diet, the more beneficial and less harmful it probably is---the better adapted we become to that food. And if some food is new to the human diets, or new in large quantities, it's likely that we haven't yet had time to adapt, and so it's doing us harm."
Yet he lets the reader assume that grain fattened meat is no problem even though it has been a staple in the American diet for less than 100 years (it increased during the same era that sugar and white flour increased.) It contains about 10.2 times as much palmitic, myristic and lauric acid as wild elk and about 5.4 times as much as lean grass fed meat. Stearic acid lowers LDL so it wasn't used in the calculation. And I adjusted for the fact that the t-bone had 22% refuse (leaving only 78 grams meat), the grass fed beef had 34% refuse (leaving only 66 grams of meat) and the elk was all meat. You can check T-bone, grass-fed beef and game meat elk in the USDA food composition database for yourself. Not only does grain fed meat contain more palmitic (16:O), myristic (14:O) and lauric acid (12:O), but it contains a lower percentage of LDL lowering stearic acid (18:O) and very little omega-3 or CLA and don't forget, added hormones and antibiotics. And the blubber of sea mammals that live in the arctic contains a much lower percentage of saturated fat than the fat of land animals.
On page 164 - 65 Taubes says, "The best we can do is what nutritional anthropologists began doing in the mid-1980s---use modern day hunter-gatherer societies as surrogates for our Stone Age ancestors. In 2000, researchers from the United States and Australia published an analysis of 229 hunter gatherer populations that survived deep into the twentieth century to have their diets assessed by anthropologists."
Taubes says this is "the best we can do", then he decides to ignore their findings on saturated fat, because they don't fit his preconceived ideas.
In his latest book, The Paleo Diet: Lose Weight and Get Healthy by Eating the Foods You Were Designed to Eat, published in December 2010, Professor Loren Cordain says that hunter gatherers ate about half the palmitic acid eaten in the modern American diet (this is the main saturated fatty acid that elevates LDL in the American diet.) This is in spite of the fact that they consumed the entire carcass of the animal. This is because they ate wild game (average of .89 grams saturated fat per serving) instead of grain fattened domestic animals (average of 7.04 grams saturated fat per serving). Cordain et al actually gathered the data and did the calculations. Modern HG diets ranged from very low to very high in saturated fat consumption. They were not uniformly high. Because one group can eat a high saturated fat diet proves nothing about people whose ancestors didn't do this. No one with basic knowledge of natural selection and genetics would assume we are all equally adapted to eat a high saturated fat diet. And according to Eaton et al (1988) the average cholesterol of the hunter gatherers they studied was about 124. This can't be achieved on a high diet high in grain fed meat and dairy, unless you have genetic hypocholesterolemia like the Masai.
In metabolic ward trials where all variables are controlled and people live in the ward and eat meals prepared by the research staff, LDL is routinely increased by increasing dietary saturated fat when carbs are at a moderate level as well as when carbs are virtually eliminated. For example, Dr. Stephen Phinney conducted a normal caloric intake metabolic ward trial with nine healthy lean men, "The human metabolic response to chronic ketosis without caloric restriction: physical and biochemical adaptation." These men consumed nothing but meat, fish, eggs, cheese and cream for 35 days. Their carbohydrate intake was less than 20 grams a day. Their blood cholesterol went up from 159 to 208 on average in 35 days. That is a 31% increase. The average adult in this country has a cholesterol level of 199. A 31% increase would give 261. The high risk category is anything over 240.
Humans have always eaten saturated fat, but the average human has never eaten as much as they do now. Then along comes Dr. Atkins and Mr. Taubes who tell us to eat even more. If you are going to recommend a diet for life long consumption by the general public, the burden of proof is on you to show that it's safe. However, every long term study shows that high saturated fat diets are associated with more heart disease than the control. Therefore recommending this kind of diet to the general public seems reckless. Especially since there's no need to eat a lot of saturated fat in order to eat low carb.
HOW SOME BUT NOT ALL SATURATED FAT CONTRIBUTES TO ATHEROSCLEROSIS
Chemicals in the body have a healthy range. When they're too high or too low it makes us sick, whether it's glucose or LDL or something else. As long as you keep them in the healthy range, I guess it doesn't matter how you do it. Your body needs LDL, but if it's too low there is an increased risk of infection and stroke. If it's too high, there's an increased risk of atherosclerosis and heart attack. You could keep meat consumption moderate like the ECo-ATkins. Or you could eat a lot of meat as long as you avoid fatty cuts grain fattened meat like the Cordain Paleo.
Certain dietary saturated fatty acids (16:O, 14:O and 12:O) down regulate LDL receptors on the surface of your cells. This interferes with the cells ability to take in the LDL they need and causes the level of LDL in the blood to go up. In the blood, macrophages absorb oxidized LDL and become foam cells. They continue to grow and eventually rupture depositing plaque inside the artery walls.
People are different. Some have more LDL receptors than others which means that eating the same amount of saturated fat does not elevate their LDL as much. And people with too few LDL receptors have hypercholesterolemia and premature heart disease. Saturated fat is not the only risk factor for heart disease but the fewer LDL receptors a person has the more important it is for them.
According to a study by Nicholls et al in 2006, consumption of saturated fat impairs the anti-inflammatory properties of high-density lipoproteins as well as endothelial function. And according to a meta-analysis of 24 studies by Ip et al in 2009, higher LDL particle number was consistently associated with increased risk for cardiovascular disease, independent of size or density.
There are different kinds of saturated fat. Stearic acid lowers LDL. And the diets of HGs had a higher percentage of stearic acid and a lower percentage of palmitic acid than modern diets. Coconuts are rich in saturated fat, but Pacific Islanders consume the coconut water and coconut fiber which contain chemicals that lower LDL.
WHY UNCONTROLLED STUDIES CAN GIVE INCONSISTENT RESULTS
Heart disease has multiple risk factors. In uncontrolled studies we see a lot of inconsistent results. But associations or lack of associations in an uncontrolled study can only suggest, not prove cause and effect or lack of it. The results depends on:
1) CONFOUNDING VARIABLES. These include genetics of the population, smoking, sedentary lifestyle, hypertension, diabetes, trans fat, high glycemic index carbohydrates etc. For example, in an uncontrolled study lower saturated fat can be associated with either less heart disease or more heart disease depending on whether people replaced the saturated fat with olive oil or stick margarine with trans fat.
2) THE RANGE OF THE VARIABLE. Studies where the difference between the lowest level of saturated fat and highest level is very great have better resolution than studies with a smaller difference. When the difference is large, the effect of confounding variables is less pronounced. For example, in studies of very high saturated fat diets, even if they are not controlled, the harmful effects of saturated fat override the confounding variables and give consistent positive associations between saturated fat and heart disease. This is why the Seven Countries Study with large differences in saturated fat consumption showed a strong association and other studies where everyone was more or less similar didn't.
EVIDENCE THAT EATING LESS SATURATED FAT CAN BE HELPFUL
Since there's more than one risk factor for heart disease, it makes since that interventions to treat heart disease that reduce the most risk factors would be the most effective. And the most effective interventions usually involve eating less saturated fat and lowering LDL. For example:
In China and Japan where they eat less saturated fat and over 50% carbs, they have a low rate of heart disease and they don't have an obesity epidemic. They eat less sugar and white flour. That seems to be all the vast majority of us need to give up.
Dr. Esselstyn used a 10% fat, low glycemic index, high fiber diet plus low dose Statins to reverse heart disease. (See [[ASIN:1583333002 Prevent and Reverse Heart Disease: The Revolutionary, Scientifically Proven, Nutrition-Based Cure]].) We know it worked because of before and after coronary angiograms and cardiac PET scans. People given less than a year to live are alive and healthier 20 years later. There was no requirement to count calories or exercise to get these results.
Dr. Ornish also reversed heart disease using a similar diet plus exercise and meditation but no Statins. Since then Dr. Ornish has enrolled at least 3800 patients in demonstration projects (to demonstrate savings on surgery) which resulted in over 40 insurance companies including Medicare covering a program in diet and lifestyle for heart disease patients. According to Dr. Ornish, "In brief, we found that almost 80 percent of patients who were eligible for bypass surgery or angioplasty were able to safely avoid it for at least three years."
The Mediterranean diet which is low in saturated fat is also associated with low rates of heart disease. Statins, exercise or meditation are not necessary to produce this result. (See Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating.) Statins alone or exercise alone or meditation alone can't achieve these results. So it appears that diet is partly, perhaps mostly responsible for the favorable results.
The book makes no mention of Dr. Esselstyn or that heart disease can be reversed consistently on a diet that restricts saturated fat and cholesterol or that taking fish oil with a high complex carbohydrate diet reduces triglycerides better than eating a high fat diet according to a study by Jiménez-Gómez et al in 2010.
All that the book shows conclusively about saturated fat is that it can't be the only cause of heart disease and everybody knows that already. And while high glycemic index carbs are associated with heart disease, low glycemic index, high fiber carbs are associated with reversal of heart disease.
The book uses the false dilemma logical fallacy to make it seem like you only have two choices if you're overweight; follow the USDA recommendations and continue to be part of the obesity epidemic or follow Atkins and lose weight and reduce your risk of heart disease. There are many things wrong with this characterization. First, there are at least two ways of eating low carb that don't require you to eat a lot of saturated fat (Eco-Atkins and the Cordain Paleo). Second, people who are not insulin resistant can effectively reduce blood glucose and insulin, lose weight and reduce the risk of heart disease by reducing high GI carbs and saturated fat, even if they eat 70% carbs. Third, while a few risk factors look good on a high saturated fat diet, many other risk factors are not even measured, and tests show that atherosclerosis is accelerated in the short run and there's more heart disease mortality in the long run. Also, the book uses the straw man logical fallacy to make it seem like the obesity edipemic is the result of eating less saturated fat. However, Americans have not been following the USDA guidelines about the kind of carbs to eat and they have been eating out (with large portions) more than ever, and they are not even close to following the Ornish diet or the Mediterrnaean diet.
EVIDENCE THAT EATING TOO MUCH SATURATED FAT CAN BE HARMFUL
Six long term studies show that high saturated fat diets are associated with more heart disease, cancer and/or all-cause mortality than the control. This may not seem like very many, but there are no long term studies that show otherwise. All the studies that some people think show otherwise are either short term and only look at risk factors or only compare one moderate level of saturated fat with another moderate level. (It's the high saturated fat that's important, not the high protein.)
First study: "Low-carbohydrate diets and all-cause and cause-specific mortality" by Fung et al published in 2010. A high-meat diet with about 20% saturated fat had 43% greater all-cause mortality and than an Eco-Atkins diet with 12% saturated fat. This was not an uncontrolled epidemiological study; it's the kind of study that can be used to establish cause and effect because confounding variables have been controlled. The high-meat group ate the same or less trans fat, omega-6 and refined carbs so there's no reason to think something other than the meat caused them to do poorly. This study is as good as it gets, in spite of what Denise Minger says. She is nihilistic about any evidence against animal fat. To her, every study has a flaw and nothing is ever certain. But when it comes to uncontrolled observational studies of other cultures (evidence that's much weaker than the evidence she finds fault with), she accepts it without critical thinking. The reason she devotes so much effort trying to tear it down, is because the evidence against a high animal fat diet is so compelling.
Second study: "Low carbohydrate-high protein diet and mortality in a cohort of Swedish women" by Lagiou et al published in 2007. "CONCLUSIONS: A diet characterized by low carbohydrate and high protein intake was associated with increased total and particularly cardiovascular mortality amongst women."
Third study: "Mediterranean and carbohydrate-restricted diets and mortality among elderly men" by Sjogren et al published in 2010. The low carb, high meat group had 48% greater all-cause mortality and 81% greater heart disease mortality than the group eating a Mediterranean Diet.
Fourth study: "Low-carbohydrate-high-protein diet and long-term survival in a general population cohort" by Trichopoulou et al in 2007. "CONCLUSION: Prolonged consumption of diets low in carbohydrates and high in protein is associated with an increase in total mortality."
Fifth study: A study of patients on a high-meat diet by Fleming in 2000 showed a worsening of blood flow after one year with an overall 39.7% progression of coronary artery disease.
Sixth study: People are different. A high-meat Atkins is especially bad for people with the APOE4 allele. In a study by Corella et al in 2010, when saturated fat intake was greater than 10% of total calories in individuals carrying the APOE4 allele, the risk of heart disease was over 300% higher. About 25 to 30 percent of Americans carry this allele. And people with the metabolic syndrome are more likely to carry APOE4 than other people.
Taken together these six studies show that measuring the few risk factors that improve during the weight loss phase does not accurately predict what will actually happen after decades on the maintenance phase. They are giving people a false sense of security.
CONCLUSION : THERE ARE SEVERAL WAYS TO BE HEALTHY
People are different. People who are insulin resistant have a greater problem with carbs. People with fewer LDL receptors have a greater problem with saturated fat. People with the APOE4 allele are more likely to have problems with both. The Cordain Paleo diet, the Ornish diet and the Mediterranean diet all have less high GI carbs and less saturated fat than most Americans eat and they are all good for heart disease. The list of foods in the Appendix of WWGE only reduces carbs, while increasing saturated fat. It makes sense that the more risk factors you reduce the better results you will get.
1. Vegetarian Adventist men and women live an average of 87 and 89 years, respectively and have a typical cholesterol level in the 180s. They abstain from alcohol and tobacco, exercise regularly and eat nuts, eggs and dairy products.
2. In the 50's and 60's Crete had the best longevity in the world. They ate 40% fat mostly from olive oil, but only 8% saturated fat. The total red meat, poultry and fish consumed per-person, per-week in Crete was only about 371 grams (13 ounces). Ancel Keys followed the Mediterranean diet and lived to be 100 years old.
3. Japan has the best life expectancy of any country. The average man lives 79.4 years and the average women 86.1 years. They eat more carbs (about 59% versus 49%) and less fat (about 28% versus 38%) than the U.S. They eat more seafood than they do meat.
4. Iceland has the best longevity in Europe. The average man lives 80.1 years and the average women 83.5 years. They eat less carbs and more fat than the U.S. They eat more seafood than they do meat and their meat is grass fed. (In France they also eat grass fed meat.)
5. If you have heart disease, a low-fat diet with low glycemic index, high fiber carbs can save your life. This diet is associated with higher levels of telomerase, an enzyme that maintains telomere length which is associated with health and longevity. Skim milk and egg whites are allowed. People without heart disease can eat more fat including wild salmon.
6. If you have metabolic syndrome or can't eat grains, an Eco-Atkins diet with regular meat, that includes 12% or less animal protein and 12% or less saturated fat has been shown to be healthier than the standard American Diet. Lower values give even better lipid profiles.
7. The Cordain Paleo diet is good if you have metabolic syndrome or can't eat grains. But unless you eat wild game or lean cuts of grain fed meat you are not likely to get good results for heart disease and cancer (even if you lose weight and lower your blood sugar.)
Two bad choices
1) Reduce saturated at a little bit but eat lots of sugar, white flour, white rice and potatoes and order large portions when you eat out. It will increase your risk of the obesity, metabolic syndrome and diabetes.
2) Eat low carb with fatty cuts of grain fed meat. It won't increase everyone's LDL or give everyone heart disease and cancer, but it will increase the risk for the average American.
