Tuesday, May 22, 2012

Lowers Cholesterol. So What.

There's a new diet in town, it's referred to as "The Portfolio Diet."  Here's the introduction:
Low-fat diets, move over. When it comes to lowering cholesterol, a “portfolio” diet that includes cholesterol-lowering foods such as oatmeal, nuts, and soy products is better.

What are the specific foods to lower cholesterol?
Margarine enriched with plant sterols; oats, barley, psyllium, okra, and eggplant, all rich in soluble fiber; soy protein; and whole almonds.

Here's why it is such “good news”:
In a head-to-head test against the low-fat diet traditionally recommended by the American Heart Association, the portfolio approach was the clear winner. (You can see the makeup of the test diet here.) After 24 weeks, it lowered harmful LDL cholesterol by 13%, while the low-fat diet lowered LDL by only 3%. As an added benefit, the portfolio approach also lowered triglycerides and blood pressure, and did not depress the level of beneficial HDL cholesterol. The results were published in the Journal of the American Medical Association.

Well, that's the good news for the author.  What he points out next may actually make it good news for some of the un-knowing; now a doctor could do something instead of recommending a low fat diet, which was always a poor choice for a person with a "cholesterol problem", after which no result would likely be obtained and for which the patient would then be prescribed a statin.  IOW, this beats the heck out of the low-fat-high-carb-statin crazy train. 

Here’s what they say about the virtue of this diet and its mechanisms:
None of these foods is a magic bullet against high LDL. In fact, the combination is probably important, since they lower cholesterol in different ways.
Here are some suggestions for adding these foods to your diet:
Plant sterols. The best sources of these are margarines enriched with plant sterols and stanols, such as Benecol and Take Control, and other foods to which they have been added, including orange juice, granola bars, and cooking oil. You don’t need more than 2 grams a day.

Of course, one of these articles would be complete unless it mentioned the darling of the non-meat crowd, fiber.  I'm still waiting for any evidence that fiber is good for you, but since everyone in these circles is convinced that it is good for you, no one ever is embarrassed not provide proof of fiber's virtue.  Hey, I'll grant it may be good for silly things like lowering cholesterol.
Soluble fiber. Two servings per day should be sufficient. Good sources of soluble fiber include oats and oat bran, barley, almost any kind of bean, eggplant, and okra. Aim for 10 grams of soluble fiber per day.

I will not comment on soy too much, but if you want to know why you don’t want to eat soy, I recommend Lierre Keith's “The vegetarian Myth.”
Not long ago, the only ways to get soy protein was by eating soybeans or tofu (also called bean curd). Today you can buy soy milk, soy bars, soy burgers, dried soy protein, and more. Soy protein and fish are two of the healthiest ways to get your daily protein. Twenty-five grams of soy protein a day is a good target.

Nor would any one of these articles be complete unless they cited the mythical “heart healthy” diet “rich” in some random feel good food item like beans, fiber, whole grains, or perhaps statins dissolved in the drinking water.
All participants in the study followed a heart-healthy diet that was low in saturated fat (minimal butter and other dairy fats, beef fat) and rich in fruits and vegetables, beans and whole grains.

So, why is this article a complete joke?

Mainly because the entire premise – lower cholesterol is good – is junk science.  There is, quite simply, no proof that lower cholesterol predicts a better mortality rate.  The government spent big piles of money over several years trying to prove the “cholesterol conjecture” and failed.  Totally.

Above and beyond that, efforts to manipulate cholesterol numbers do not have a great track record.  Vytorin was a statin with another agent which also lowered LDL cholesterol, and it worked like a champ for lowering cholesterol – however, the product test was halted when it became clear that those with the Vytorin lowered cholesterol numbers were dying off faster than the control group.  The same thing happened when they paired a statin with a powerful form of niacin (to raise the HDL cholesterol) – lower LDL, higher HDL and a higher mortality rate.  I’m thinking all that might be quantified as “not good” for the idea of treating cholesterol numbers.  How about just eating good food instead? 
Note:  I’m in year five of “eating good food” and will have my fifth round of blood work results soon, and I’ll post.  Generally, my numbers show triglycerides under 75, LDL over 115, HDL over 60, glucose around 85, and something like a 200 total cholesterol.  The doctor says things like “I don’t know what you are doing but keep doing it.”

The plus side of the article is how it lays waste to the concept that low fat intake helps to improve cholesterol.  It does not, and the fact that so many believed that it did was a pure shame.  If you want health, start by avoiding foods that skyrocket your blood sugars - for most of us, that means skipping the heart healthy grains and taking it easy on the fruit.

As Dr. Mary C. Vernon is reported to ask at medical conferences:  "I'll give you this $100 bill if you produce an intervention study that shows a better outcome from a low fat diet than from a carb restriction diet."

If someone can lose weight and feel good eating beans and whole grains and soy products, great.  It probably works for some, but hopefully, only if they like that kind of food.  For me, low fat was misery and poor sleep and many allergies and a big belly and moderate physical performance and worst of all – it necessitated that I keep food handy all the time to stave of the reactive hypoglycemia (which is not to say that I did low fat “right” – I could have done better with less sugar; but why?  I like meat!).   The list of meds and maladies I’ve eliminated from my life by eating good food is long. 

Eating low meat or low fat based on one’s belief in the junk science that is propagated by articles like this one from this Harvard-disaster-factory-of-nutritional-hoohah is another pure shame.

Eat meat and vegetables, nuts and seeds, little fruit or starch, no sugar no wheat, and live well.

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