At the very least people need to read other points of view before accepting the author's conclusions. Even if you are persuaded that this is the best diet for you, there are millions of healthy people eating very different kinds of diets who are not overweight.
POINTS OF AGREEMENT
1) The diet recommended by the book is effective for short term weight loss (but there are no long term clinical trails showing it reduces heart disease, cancer or all-cause mortality.)
2) Filling up on high fiber foods helps to control the appetite (but high protein is not required, the Japanese have 1/10 our rate of obesity on a high grain, low fat, moderate protein diet.)
3) Diets high in certain carbohydrates, like sugar and white flour, are not healthy (but Harvard recommends fruits, vegetables, whole grains and beans which are healthy in long term trials.)
4) Interval training is an effective form of exercise (but modern hunter gatherers get a lot of low intensity exercise like walking.)
5) Hunter gatherers have a near absence of heart disease (but they also have 50 to 70 mg/dL LDL levels (1) which are not duplicated in clinical trails of high protein diets. Parasitic infections and fiber are responsible for their low LDL levels and near absence of heart disease. (2))
6) Hunter gatherers have a near absence of cancer (but this is in spite of their high protein diet not because of it.)
POINTS OF DISAGREEMENT
1) THERE ARE NO LONG TERM STUDIES OF THIS DIET AND THE ENDORSEMENTS DON'T REPRESENT WHAT ANY UNIVERSITY RECOMMENDS LONG TERM: The current Harvard School of Public Health website states (Copyright © 2012 The President and Fellows of Harvard College):
"The answer to the question "What should I eat?" is actually pretty simple. But you wouldn't know that from news reports on diet and nutrition studies, whose sole purpose seems to be to confuse people on a daily basis. When it comes down to it, though--when all the evidence is looked at together--the best nutrition advice on what to eat is relatively straightforward: Eat a plant-based diet rich in fruits, vegetables, and whole grains; choose healthy fats, like olive and canola oil; and eat red meat and unhealthy fats, like saturated and trans fats, sparingly. Drink water and other healthy beverages, and limit sugary drinks and salt. Most important of all is keeping calories in check, so you can avoid weight gain, which makes exercise a key partner to a healthy diet." This is basically a Mediterranean diet. See [[ASIN:0743266420 Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating]]. This diet is high in whole grains and relatively low in animal protein, very different from the grain-free, 33% protein diet recommended by Jonathan Bailor.
2) THE VIEWS OF UFFE RAVNSKOV ON LDL DO NOT REPRESENT THE MAJORITY OF DOCTORS AND SCIENTISTS: There is a lot of evidence contradicting Dr. Ravnskov. The following studies are just a few examples.
According to the third report of the National Cholesterol Education Program (NCEP), "Only in populations that maintain very low levels of serum cholesterol, e.g., total cholesterol <150 mg/dL (or LDL cholesterol <100 mg/dL) throughout life do we find a near-absence of clinical CHD." (3)
"Scientists studied nine single nucleotide polymorphisms which influence LDL levels. From homozygous familial hypercholesterolemia (FH) at the high extreme (over 600 mg/dL LDL cholesterol) to hypobeta-lipoproteinemia at the low extreme (less than 15mg/dL LDL cholesterol). Since these SNP's are present from birth, this allowed them to see the effect of low LDL levels maintained over a lifetime. The results show a three times greater benefit for these life long low LDL levels compared taking statins later in life."
The lead scientist stated, "the effect of each of the included SNPs on risk of CHD is mediated largely or entirely through effect on circulating levels of LDL, rather than through some other pleiotropic effect." "The researchers also conducted a meta-analysis of the "natural" randomized trials by combining non-overlapping data from multiple SNPs involving 326,443 participants. Results of this study indicated that lifetime exposure to lower LDL was associated with a 54% (95% CI, 48-59) relative reduction of CVD for each 38.7 mg/dL (1 mmol/L) lower LDL." (4) There is a clear dose response relationship.
Michael Brown and Joseph Goldstein discovered that the number of functional LDL receptors on the surface of cells, especially liver cells determines the level of LDL in the blood. If the receptors are defective or too few in number, LDL builds up in the blood instead of being taken into the cells. Familial hypercholesterolemia (FH) is caused by the mutation of a single gene that does one thing; make LDL receptors. People with two copies of the mutation for FH have LDL levels 6 to 10 fold above normal and can have a heart attack as early as 18 months of age. People with one copy of the mutation have LDL levels 2 to 4 times above normal and develop clinical symptoms between the ages of 30 and 60. (5) In the era before the statins, FH patients aged 20 to 39 years old were 100 times more likely die of heart disease and 10 times more likely to die from all causes than someone in the general population. (6)
It is claimed by Dr. Ravnskov that Ancel Keys misled us in his Six Countries Study. In 1957 Yerushalmy and Hilleboe took another look at the FAO data that Keys had used. Their primary criticism was that there were other variables more strongly associated with heart disease mortality than TOTAL FAT which had a correlation of .659. (BTW, even though a graph of all 22 countries didn't make a straight line the correlation was strong and significant even for total fat.) It's ironic that Jonathan Bailor chose to cite this study, since the two variables that Yerushalmy and Hilleboe found most strongly associated with heart disease mortality in the 22 countries were ANIMAL PROTEIN first (correlation of .756) and ANIMAL FAT second (.684). (7) It's Dr. Ravnskov, who is not even a scientist, who misled us.
3) THE BOOK CLAIMS WE ARE IN THE MIDST OF A HEART DISEASE EPIDEMIC CAUSED BY OBESITY: In reality the age-adjusted mortality rate for cardiovascular disease peaked in 1963 and has been falling ever since. This is a well established fact.
In the introduction, the book contains a graph showing that the TOTAL NUMBER OF NON FATAL HEART DISEASE INCIDENTS has gone up from 1.4 to 2.2 million (57%). However, the population has grown by 50% during that time period and the percentage of elderly has also increased so it's not surprising that the total number of incidents might also go up. And various factors other than an actual increase in heart disease could account for non fatal incident reports. This seems like a very misleading way to report the evidence.
However the age-adjusted RATE OF DEATH from cardiovascular disease has been falling and at present is less than half of what is was at the peak of the heart disease epidemic in the 1960`s. According to the CDC: "Age-adjusted death rates per 100,000 persons (standardized to the 1940 U.S. population) for diseases of the heart (i.e., coronary heart disease, hypertensive heart disease, and rheumatic heart disease) have decreased from a peak of 307.4 in 1950 to 134.6 in 1996, an overall decline of 56% (Figure 1). Age-adjusted death rates for coronary heart disease (the major form of CVD contributing to mortality) continued to increase into the 1960s, then declined. In 1996, 621,000 fewer deaths occurred from coronary heart disease than would have been expected had the rate remained at its 1963 peak."
A greater than 50% decline in cardiovascular disease is further confirmed by the Framingham Heart Study. (8)
And a study by Ergin et al. in 2004 shows that both the incidence and mortality of cardiovascular disease fell in the United states from 1971 through 1992. (9)
And according to the Atherosclerosis Risk in Communities (ARIC) Study: "Scientists now have information indicating that reductions in the risk factors for coronary heart disease are contributing to the decline in coronary heart disease rates, such as lowering blood cholesterol, blood pressure, and smoking rates (24%, 20%, and 12% reduction in coronary heart disease mortality from each)." The remaining 44% reduction is due to improved care during an acute heart attack.
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The book claims that between 1930 and 1970 heart attacks increased by 1000% in England while meat consumption remained stable. And that a similar increase in heart attacks occurred in the US while animal fat consumption actually fell. However because of vague classifications of heart disease the death rate from all diseases of the heart is a better measure and that only increased about 2.5 times in England.(10)
And in the US, from 1909 until the peak of the heart disease epidemic around 1965, while butter and lard consumption did fall, meat consumption rose from 141 to 148 pounds per capita and dairy products excluding butter rose from 177 to 237. Wheat flour fell from 291 to 147 and potatoes fell from 182 to 94. Percent fat increased from 32.1 to 41.1 percent and carbohydrates fell from 56.2 to 47.0 percent. During this time period meat transitioned from mostly grass-fed with less saturated fat to factory-farmed which contains several times as much saturated fat. This fact was not considered by the study and would make a large increase in animal fat. (11) So as fat climbed and carbohydrates fell the heart disease epidemic gained momentum.
4) THERE ARE SEVERAL REASONS AN EXTREMELY HIGH PROTEIN DIET (33% OF TOTAL CALORIES) MAY BE HARMFUL IN THE LONG RUN:
a) High meat diets increase IGF-1, which is a risk factor of cancer.
"Reducing protein intake from an average of 1.67 g kg '1 of body weight per day to 0.95 g kg '1 of body weight per day for 3 weeks in six volunteers practicing CR resulted in a reduction in serum IGF-1 from 194 ng mL '1 to 152 ng mL '1 ." (12)
"Men with relatively high intakes of total protein (top quintile) and minerals (top quintile of the five minerals combined) had a 25% higher mean plasma level of IGF-I compared with those in the low quintiles simultaneously." (13)
b) In three very large studies (one by AARP and two by Harvard) red meat intake was associated with mortality.
According to the AARP study of over half a million people "Conclusion: Red and processed meat intakes were associated with modest increases in total mortality, cancer mortality, and cardiovascular disease mortality." (14)
Concerning the Harvard studies of over 37,000 men and over 83,000 women, the Harvard School of Public Health says "Replacing one serving of total red meat with one serving of a healthy protein source was associated with a lower mortality risk: 7% for fish, 14% for poultry, 19% for nuts, 10% for legumes, 10% for low-fat dairy products, and 14% for whole grains." (15)
c) Restriction of the amino acid methionine extends life in rodents (and methionine restriction reduces free radical formation) (16)
5) THE BOOK MISLEADS US ABOUT LOW-FAT DIETS: The book uses the Women's Health Initiative to claim that low fat diets are ineffective for weight loss or the prevention of heart disease and cancer. But in that study people were free to replace fat with anything they chose and in this country that's usually sugar, white flour and fried potatoes swimming in trans fat. And there was no significant lowering of LDL. However there are other kinds of low fat diets that are very effective at lowering LDL and reducing heart attacks.
In the 1950s, Dr. Morrison put 50 heart attack survivors on a 15% fat, high protein diet and another 50 survivors were told to eat as usual. Total cholesterol fell from 312 mg/dl to 220 mg/dl in the experimental group. That's a reduction of 29%. And over a period of 8 years, 38 patients eating as usual died while only 22 in the experimental group died. (17)
In the 80's Dr. Esselstyn used a 10% fat, high fiber diet plus low dose statins to arrest or reverse heart disease in 18 severely ill heart patients. The average for total cholesterol and LDL was maintained at 145 mg/dl and 82 mg/dl respectively. We know it worked because of before and after coronary angiograms and cardiac PET scans. Some had been given less than a year to live by their referring cardiologist. After 12 years, "Adherent patients have experienced no extension of clinical disease, no coronary events, and no interventions. This finding is all the more compelling when we consider that the original compliant 18 participants experienced 49 coronary events in the 8 years before the study." There was no requirement to count calories or exercise to get these results. Although the sample was small, the results were statistically significant. The percent of reduction in mortality and cardiac events by far outperforms any other study that has ever been done on coronary artery disease patients. (18) Also see [[ASIN:1583333002 Prevent and Reverse Heart Disease: The Revolutionary, Scientifically Proven, Nutrition-Based Cure]].
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." Insurance companies wouldn't pay for something that made a lot of people worse. If any one got worse it had to be a small minority of patients. (19) Also see [[ASIN:0345496310 The Spectrum: A Scientifically Proven Program to Feel Better, Live Longer, Lose Weight, and Gain Health]].
6) THE CAUSE OF THE OBESITY EPIDEMIC IS NOT SETTLED SCIENCE: Dr. Lustig believes it's the fructose in sugar (especially in soft drinks and fruit juice) and not starch that is causing obesity and metabolic syndrome. Numerous studies in rodents have demonstrated that diets high in fructose induce insulin resistance. And fructose can induce metabolic syndrome in non-human primates as well. And fructose suppresses leptin, the hormone that controls appetite. And sugar is associated with the symptoms of metabolic syndrome in people. Starch does not produce the same effects even if the glycemic index is high. According to a study by Stanhope et al. in 2009 which compared fructose-sweetened to glucose-sweetened beverage consumption for 10 weeks: Only the fructose group had a significant increase in belly fat and markers of altered lipid metabolism including fasting apoB, LDL, small dense LDL, oxidized LDL, and postprandial concentrations of remnant-like particle-triglyceride and -cholesterol significantly increased during fructose but not glucose consumption. In addition, fasting plasma glucose and insulin levels increased and insulin sensitivity decreased in subjects consuming fructose but not in those consuming glucose. And American's consume more calories from sucrose and caloric sweeteners (like HFCS) than any other single food. In 2007 they consumed 629 calories per person per day of caloric sweeteners and this doesn't count the fructose in the fruit juice.
Wherever American fast food restaurants (large portions, high in sugar and salt and low in phytochemicals and fiber) spread around the world, obesity soon follows. And according to this study by the USDA, "The number of fast-food outlets increased from about 30,000 in 1970 to 140,000 in 1980, and fast-food sales increased by about 300%. More recent estimates show that in 2001, there were about 222,000 fast-food locations in the United States, generating sales of more than $125 billion." (20)
7) THE BOOK MISLEADS US ABOUT GRAINS: During the 50's and 60's Greece had the best longevity in the world and they ate more whole grains than Americans. Today Japan has the best longevity in the world and 1/10 as much obesity of Americans but they eat a lot more grain. However both these countries ate much less sugar than Americans. Millions of people including myself eat a diet containing a lot of whole grain and we're not overweight or unhealthy. The books high protein diet may be good for weight loss but there are no long term studies to show it will make people live longer. It is patterned after hunter gatherers, but hunter gatherers are not known for longevity. However cultures that consume more grains than Americans are known for less obesity and longer life.
The author actually claims on page 202 "... the amount of starch in the average Chinese or Indian diet is lower than the amount of starch in the average American diet." However according to the FAO the total calories/day/person from grains, starchy roots and beans consumed in 2007 by China was 1614, by India was 1570 and by the United States was only 964. What was he thinking? Did someone dare him to write this?
There is something called the "Rice Diet" developed by Dr. Kempner from Duke University that is free of added sugar or salt, is low in protein and most of the calories come from rice. According to this study "Treatment of massive obesity with rice/reduction diet program. An analysis of 106 patients with at least a 45-kg weight loss" it's extremely effective for weight loss. (21)
8) THE BOOKS CLAIMS TO REACH OBJECTIVE CONCLUSIONS BASED ON ALL THE EVIDENCE: Although the book says "Yet all too often a popular author selectively cites the scientific evidence, emphasizing only those aspects of the wide-ranging research that support the diet plan he or she is promoting." It seems that is exactly what the author did, perhaps without realizing it. Evidence was selected to make his high protein diet look as good as possible and make alternative diets look as bad as possible including the diet endorsed by Harvard Medical School. The result is a gross distortion of the facts. All the research that looks good for carbohydrate restricted diets is done along with weight loss so that the beneficial effects of calorie restriction are confused with the effects of the diet. But during weight maintenance, when calorie restriction is no longer around to help, it's another story. And when carbohydrate restricted diets are compared to low fat diets generally a 30% fat, low fiber diet with junky carbs is used instead of an optimal low fat diet with lots of fiber.
CONCLUSION: THERE ARE SEVERAL WAYS TO BE HEALTHIER THAN THE AVERAGE AMERICAN
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. About 10% of people need to avoid gluten. Bottom line, everyone should follow a diet that makes them feel good as well as having some evidence for long term health.
The vast majority of the American people are not eating a Mediterranean diet, an Asian diet or whole foods vegetarian diet so their problems don't prove anything about these healthy diets. The diet the vast majority eat is much higher in animal protein, animal fat and sugar and much lower in fiber and phytonutrients.
Seven choices healthier than the SAD.
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. According to the Seven Countries Study, they ate 37% 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). According to the FAO, in 1961 they ate 1327 calories/person/day from whole grains, mostly wheat and they ate almost no table sugar. Ancel Keys and his wife followed a similar diet and he lived to be 100 years old and she lived to be 97 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 10% low-fat diet with low glycemic index, high fiber carbs can save your life. Dr. Ornish' 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. Dr. Esselstyn's extremely successful study used a strict vegan diet.
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.
7. The real Paleo diet/lifestyle. Modern hunter gatherers have a near absence of modern diseases, but they also have very low levels of LDL which are not duplicated in clinical trails of high protein diets. The HGs eat wild game which contains on average about 1/8th as much saturated fat as factory-farmed meat, with few exceptions they eat over 100 grams of fiber/person/day, they have parasitic infections which lower their LDL and they get a lot of moderate intensity exercise not once a week interval training. And their average life span is 72 years and "Heart attacks and strokes appear rare and do not account for these old-age deaths (see Eaton, Konner, and Shostak 1988), which tend to occur when sleeping." (22) So in spite of escaping chronic disease and hunting accidents and not smoking or eating processed foods they tend to die of old age around 72.
Two bad choices
1) Eat low fat diet with lots of sugar, white flour and salty fried potatoes swimming in trans fat and order large portions when you eat out. That will increase your risk of the obesity, metabolic syndrome and diabetes.
2) Eat a Paleo diet without lots of allium (e.g. onions, leeks, garlic) and cruciferous (e.g. broccoli, Brussels sprouts, cabbage etc.) vegetables and lots of berries to offset the cancer promoting effects of meat.
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