Friday, February 10, 2006

Low-fat diets lose luster (low-salt too!)

The front pages have been crowded with this story, blogged earlier here, and now the editorial writers are beginning to grasp the breadth of impact -- it goes WAY beyond fat. As USA Today reminds us:
Not long ago, it was generally estimated that 400,000 Americans a year die from obesity. Oops. A new study last year by the Centers for Disease Control and Prevention (CDC) found that obesity accounts for only 26,000 deaths, and that a few extra pounds might add to longevity.

"Similarly, hormone replacement therapy was once thought to protect postmenopausal women against heart attack or stroke. Subsequent studies say it doesn't.

"Yesterday's conventional wisdom is today's myth. No wonder so many are skeptical about whether any study can be believed.

"The latest surprising finding is that low-fat diets don't reduce the rate of heart disease, stroke, breast cancer or colorectal cancer, or even result in greater weight loss. That's the conclusion of a government-sponsored study published Wednesday in the Journal of the American Medical Association. It followed nearly 50,000 overweight, postmenopausal women for an average of eight years.


"The low-fat study only means that there's no magic bullet, which leaves an obvious if unpleasant fact: Good health comes from a balanced diet, frequent exercise and avoiding obvious risks. Family history and genes count for a lot also, regardless of diet."

It's not that all of "yesterday's conventional wisdom is today's myth." Only when the conventional wisdom isn't based on sufficiently-rigorous thinking or evidence. Here, as in the salt case, we have a very plausible theory (hypothesis) and a bunch of obvservational studies, though far from consensus the fat studies seemed less controversial than those for salt. What we lacked was a randomized trial. Now we have it. NOW we're prepared to act on the evidence or, in the case of fat, perhaps not act. This study may have cost $415 million, but if we learn the harsh lesson about prejudging before we conduct a controlled trial of the health outcomes of the proposed intervention, it will be money very well spent.


At 8:21 PM, Blogger Medicare Sentinel said...

Rush to Judgment

The recent study showing correlation between low fat diets and breast cancer is indeed interesting as it disproves many of the related “myths” that have been circulating in the scientific/nutrition community for years.

There are many factors that influence our lives and outcomes. This study has gone a distance to show that there may indeed be other non-considered factors in relation to breast cancer and dietary intake; particular fat consumption. It shows more importantly that we have much to learn.

The more we study, the more we realize that heredity, obesity, exercise, genetic abnormalities, hormones, environmental factors, and other influences account for results that we may not have been previously observed or considered.

Many years ago, when I was in school, I attended a prominent lecture series. The lecturer told us that we all needed to do was decrease saturated fat consumption and decrease our intake of sodium in our daily diets to alleviate heart and cardiac related diseases. This was “the” major roadmap in the path to “wellness.” Not once were factors such as age/weight/race/genetic makeup ever addressed.

The “salt” and sodium consumption link in regard to health may exist but is exaggerated by incomplete testing, scientific validation, and inaccurate/prejudiced ideas which may have historical roots based on unsubstantiated facts.

At this point, the NIH has identified that 1 in 5 Americans suffers from Hypertensive Indicators. That being the case, we do know that untreated hypertension can lead to kidney damage, stroke and other medical conditions which cost the healthcare system hundreds of millions of dollars in health related treatment.

A major and long overdue study needs to be done to determine what direction(s) is/are best in the overall treatment of hypertension. Small and incomplete studies have been done to date. Evidence is sketchy at best and only points to the pieces of a larger puzzle. Focus seems to look at singular parameters and inevitably, salt is demonized to a he large degree.

To merely point to one indicator (such as salt usage) is not the relative answer. It is a major injustice to all those who suffer from hypertension and its effects to ignore the multifaceted causative agents available in its relief and cure.

A study to include the following parameters and considerations would go far to dispel myth and bring about practical solutions in treatment:

1. The effects of obesity on hypertension
2. The effects of salt intake in the daily diet
3. Hormonal effects on overall hypertension
4. The effects of age, race, gender on incidence of hypertension
5. External and environment effects on hypertension

Once we determine the causes and reasons for hypertension, we can better determine a proper and effective response to treatment.

Some novel solutions to responding to hypertensive individuals have been suggested:

1. Identification of genetic markers which would predispose individuals to hypertension
2. Testing which more clearly identifies the source of hypertension
3. Early identification of hypertensive individuals based on standardized assessment and screening

The most recent Low Fat Diet and Breast Cancer outcomes show us that we must open ourselves to new ideas and greater research. A study of similar magnitude would go far to reduce overall healthcare costs and hospitalizations. This study would be highly cost effect.

Let’s look at something more than simplicity and singularly identified historical prejudices such as salt intake in curing a far more complex problem.

Frank R. Wojtylak, RD/CDN
Consultant Nutritionist


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