In article <[email hidden]>,
Alan said:I would like to be able to collect medical references (positive, negative or neutral) to allow me
to respond with some authority when the question is asked again.
Here's a mess of stuff on and around the topic which I was given as I was making my decision on how
to treat my diabetes last winter. Sorry I haven't culled it for you, but you can browse it.
Priscilla
"A recent study involving over 40,000 middle-aged and older American men over a period of six years
found that there was no link between saturated fat intake and heart disease in men. It also
supported the contention that linolenic acid (a form of fat) is preventive against heart disease.
(Ascherio A et. al. Dietary fat and risk of coronary heart disease in men: cohort follow up study in
the United States. British Medical Journal, 1996 Jul 13, 313:7049, 84-90.)"
"Several studies have shown that high-carbohydrate low-fat diets lead to high triglycerides,
elevated serum insulin levels, lower HDL cholesterol levels, and other factors known to raise the
risk of coronary artery disease. (See Liu GC; Coulston AM; Reaven GM. Effect of high-carbohydrate
low-fat diets on plasma glucose, insulin and lipid responses in hypertriglyceridemic humans.
Metabolism, 1983 Aug,
32:8, 750-3. See also Coulston AM; Liu GC; Reaven GM. Plasma glucose, insulin and lipid responses to
high-carbohydrate low-fat diets in normal humans. Metabolism, 1983 Jan, 32:1, 52-6. See also
Olefsky JM; Crapo P; Reaven GM. Postprandial plasma triglyceride and cholesterol responses to a
low-fat meal. American Journal of Clinical Nutrition, 1976 May, 29:5, 535-9. See also Ginsberg H
et. al. Induction of hypertriglyceridemia by a low-fat diet. Journal of Clin Endocrinol Metab,
1976 Apr, 42:4, 729-35) "
"The idea that saturated fats cause heart disease is completely wrong, but the statement has been
'published' so many times over the last three or more decades that it is very difficult to convince
people otherwise unless they are willing to take the time to read and learn what...produced the anti-
saturated fat agenda." (Dr. Mary Enig, Consulting Editor to the Journal of the American College of
Nutrition, President of the Maryland Nutritionists Association, and noted lipids researcher.)
"The diet-heart hypothesis [which suggests that high intake of saturated fat and cholesterol causes
heart disease] has been repeatedly shown to be wrong, and yet, for complicated reasons of pride,
profit and prejudice, the hypothesis continues to be exploited by scientists, fund-raising
enterprises, food companies and even governmental agencies. The public is being deceived by the
greatest health scam of the century." (Dr. George V. Mann, participating researcher in the
Framingham study and author of CORONARY HEART DISEASE: THE DIETARY SENSE AND NONSENSE, Janus
Publishing 1993.)
High intake of fats from the Omega-3 group increase HDL cholesterol, which is considered protective
against heart disease. Obviously it would be difficult to eat an Omega-3 rich diet while following a
traditional fat reduced diet, especially if one were following one of the popular American diets
that has one eating only 20-30 grams of fat per day. (Franceschini G. et. al. Omega-3 fatty acids
selectively raise high-density lipoprotein 2 levels in healthy volunteers. Metabolism, 1991 Dec,
40:12, 1283-6. See also Journal of the American College of Nutrition 1991:10(6);593-601)
A recent American study showed that low-fat, high-carbohydrate diets (15% protein, 60% carbohydrate,
25% fat) increase risk of heart disease in post-menopausal women over a higher fat, lower
carbohydrate diet (15% protein, 40% carbohydrate, 45% fat). (Jeppeson, J., et. al. Effects of low-
fat, high-carbohydrate diets on risk factors for ischemic heart disease in postmenopausal women.
American Journal of Clinical Nutrition, 1997;65:1027-33)
The largest and most comprehensive study on diet and breast cancer to date, studying over 5,000
women between 1991 and 1994, showed that women with the lowest intake of dietary fat had a
significantly higher incidence of breast cancer than the women with the highest intake of dietary
fat. It also found that women with the highest intake of starch had a significantly higher incidence
of breast cancer than the women with the lowest intake of starch. The study found no evidence that
saturated fat had any effect one way or the other on breast cancer, and that unsaturated fat had a
significantly protective effect against breast cancer. (Franceschi S et. al. Intake of
macronutrients and risk of breast cancer. Lancet; 347(9012):1351-6 1996)
"The commonly-held belief that the best diet for prevention of coronary heart disease is a low
saturated fat, low cholesterol diet is not supported by the available evidence from clinical trials.
In primary preventions, such diets do not reduce the risk of myocardial infarction or coronary or
all-cause mortality. Cost-benefit analyses of extensive primary prevention programmes, which are at
present vigorously supported by governments, health departments, and health educationalists, are
urgently required....Similarly, diets focused exclusively on reduction of saturated fats and
cholesterol are relatively ineffective for secondary prevention and should be abandoned. There may
be other effective diets for secondary prevention of coronary heart disease but these are not yet
sufficiently well defined or adequately tested." (European Heart Journal, Volume 18, January 1997.)
"We found no evidence of a positive association between total dietary fat intake and the risk of
breast cancer. There was no reduction in risk even among women whose energy intake from fat was less
than 20 percent of total energy intake. In the context of the Western lifestyle, lowering the total
intake of fat in midlife is unlikely to reduce the risk of breast cancer substantially." (Hunter, DJ
et. al. Cohort studies of fat intake and the risk of breast cancer - A pooled analysis. New England
Journal of Medicine, 334: (6) FEB 8 1996)
33) Title: DG-DISPATCH - ENDO 99: Diabetics Improve Health With Very High-Fat, Low Carb Diet
Doctor's Guide June 15, 1999
By Cameron Johnston Special to DG News
SAN DIEGO, CA -- June 15, 1999 -- A very high-fat, low-carbohydrate diet has been shown to have
astounding effects in helping type 2 diabetics lose weight and improve their blood lipid profiles.
The results of three studies involving such a diet, which is similar to, but has a few key
differences from the famous "Dr. Atkins Diet", were presented today at the annual meeting of the
Endocrine Society.
Dr. James Hays, an endocrinologist and director of the Limestone Medical Center in Wilmington, DE,
admitted that the concept of a high-fat diet in people who are already at higher risk of
cardiovascular disease might seem incongruous. Nonetheless, this study of 157 men and women with
type 2 diabetes showed an impressive benefit in body mass index (BMI) triglycerides, HDL, LDL
and HbA1c.
Most people are encouraged to reduce the amount of fat in their diets, particularly saturated fats,
and diabetics in particular are advised to reduce their overall caloric intake, Dr. Hays explained
in an interview in San Diego during the conference.
Whereas a normal diet would be in the order of 1800 to 2100 calories, with 60 percent of calories
coming from carbohydrates and 30 percent from fat, patients
in this diet were restricted to 1800 calories per day and were encouraged to get 50 percent of their
caloric intake from fat, and just 20 percent from carbohydrates. The balance of 30 percent would
come from proteins.
A whopping 90 percent of the fat content in their diets was saturated fat, compared with just 10
percent that was monounsaturated fat.
"I think this is at least worth considering for any diabetic," Dr. Hays said in an interview. "The
thing many diabetics coming into the office don't realize is that other forms of carbohydrates will
increase their sugars, too. Dietitians will point them toward complex carbohydrates ... oatmeal and
whole wheat bread, but we have to deliver the message that these are carbohydrates that increase
blood sugars, too."
Higher-fat diets, on the other hand, seem to make the person feel full faster so they eat less; higher-
fat diets also tend to reduce postprandial hypoglycemia so the patients feel better after eating.
"Every diabetic comes home from the doctor with instructions as to what their diet should consist
of, but they're not getting the information from dietitians about what complex carbohydrates they
should eat,"
Ds. Hays said: "The important thing here is no ketosis. We absolutely don't want people to become
ketotic, and so we said they had to have so many exchanges of fresh fruits and vegetables and we
specified the ones they could eat."
They were able to eat all the meat and cheese they wanted, but as for carbohydrates, they are
restricted to eating unprocessed foods, mainly fresh fruit and vegetables, he added.
Subjects recruited into the study (84 men, 73 women) were all type 2 diabetics and were required to
undergo a standard American Diabetes Association modified diet for one full year before entry into
the trial. Over the course of one year, the subjects achieved a mean decline in total cholesterol of
between 231 and 190 mg/dl. Triglycerides declined from 229 to 182 mg/dl.
Low-density lipoproteins (LDL cholesterol) fell from 133 to 105 mg/dl, while HDL increased from 44
to 47 mg/dl.
HbA1c, which at the start of the study averaged 3.34 percent above normal, declined to the point
that at one year, the mean was just 0.96 percent above normal.
The average weight loss among subjects in the study was in the order of 40 pounds, Dr. Hays said.
By the end of the one-year study, he added, 90 percent of the patients had achieved ADA (American
Diabetes Association) targets for HbA1c, HDL, LDL and triglycerides.
Even among juvenile diabetics, he said, they might not be overweight and they might have more or
less normal lipid levels, but when they are on this kind of diet it is possible to treat them with
lower doses of insulin and make their lives a little safer, he said.
As for the response from cardiologists who see a high-fat diet as anathema to what they have been
instructing their patients for years now, Dr. Hays said he has three cardiologist patients who are
now on the diet.
"If you have a diet that results in weight loss, lower cholesterol, and a better lipid profile,
eventually, everybody will be eating that way. It's going to come whether we like it or not."
The New England Journal of Medicine -- November 20, 1997 -- Vol. 337, No. 21
Dietary Fat Intake and the Risk of Coronary Heart Disease in Women Frank B. Hu, Meir J.
Stampfer, JoAnn E. Manson, Eric Rimm, Graham A. Colditz, Bernard A. Rosner, Charles H.
Hennekens, Walter C. Willett
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Abstract Background. The relation between dietary intake of specific types of fat, particularly
trans unsaturated fat, and the risk of coronary disease remains unclear. We therefore studied this
relation in women enrolled in the Nurses' Health Study.
Methods. We prospectively studied 80,082 women who were 34 to 59 years of age and had no known
coronary disease, stroke, cancer, hypercholesterolemia, or diabetes in 1980. Information on diet was
obtained at base line and updated during follow-up by means of validated questionnaires. During 14
years of follow-up, we documented 939 cases of nonfatal myocardial infarction or death from coronary
heart disease. Multivariate analyses included age, smoking status, total energy intake, dietary
cholesterol intake, percentages of energy obtained from protein and specific types of fat, and other
risk factors.
Results. Each increase of 5 percent of energy intake from saturated fat, as compared with equivalent
energy intake from carbohydrates, was associated with a 17 percent increase in the risk of coronary
disease (relative risk, 1.17; 95 percent confidence interval, 0.97 to 1.41; P = 0.10). As compared
with equivalent energy from carbohydrates, the relative risk for a 2 percent increment in energy
intake from trans unsaturated fat was 1.93 (95 percent confidence interval, 1.43 to 2.61; P<0.001);
that for a 5 percent increment in energy from monounsaturated fat was 0.81 (95 percent confidence
interval, 0.65 to 1.00; P = 0.05); and that for a 5 percent increment in energy from polyunsaturated
fat was 0.62 (95 percent confidence interval, 0.46 to 0.85; P = 0.003). Total fat intake was not
significantly related to the risk of coronary disease (for a 5 percent increase in energy from fat,
the relative risk was 1.02; 95 percent confidence interval, 0.97 to 1.07; P = 0.55). We estimated
that the replacement of 5 percent of energy from saturated fat with energy from unsaturated fats
would reduce risk by 42 percent (95 percent confidence interval, 23 to 56; P<0.001) and that the
replacement of 2 percent of energy from trans fat with energy from unhydrogenated, unsaturated fats
would reduce risk by 53 percent (95 percent confidence interval, 34 to 67; P<0.001).
Conclusions. Our findings suggest that replacing saturated and trans unsaturated fats with
unhydrogenated monounsaturated and polyunsaturated fats is more effective in preventing coronary
heart disease in women than reducing overall fat intake. (N Engl J Med 1997;337:1491-9.)
Source Information
Quoted message said:From the Departments of Nutrition (F.B.H., M.J.S., E.R., W.C.W.),
Epidemiology (M.J.S., J.E.M., E.R., B.A.R., W.C.W.), and Biostatistics
(D.s.A.), Harvard School of Public Health; and the Channing Laboratory (M.J.S.,
D.s.B., E.R., G.A.C., B.A.R., C.H.H., W.C.W.) and the Division of Preventive Medicine (J.E.M.,
C.H.H.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School --
all in Boston. Address reprint requests to Dr. Hu at the Department of Nutrition, Harvard
School of Public Health, 665 Huntington Ave., Boston, MA 02115.
Ann Intern Med 1998 Apr 1;128(7):524-33
Metabolic risk factors worsen continuously across the spectrum of nondiabetic glucose tolerance. The
Framingham Offspring Study.
Meigs JB, Nathan DM, Wilson PW, Cupples LA, Singer DE Massachusetts General Hospital, Harvard
Medical School, Boston University School of Public Health, 02114, USA. [email hidden]
BACKGROUND: Categorical definitions for glucose intolerance imply that risk thresholds exist, but
metabolic risk for type 2 diabetes mellitus or cardiovascular disease may increase continuously as
glucose intolerance increases. OBJECTIVE: To examine the distributions of the following metabolic
risk factors across the spectrum of glucose tolerance: overall and central obesity, hypertension,
low levels of high-density lipoprotein cholesterol, and increased triglyceride and insulin levels.
DESIGN: Cross-sectional analysis. SETTING: The community-based Framingham Offspring Study.
PARTICIPANTS: 2583 adults without previously diagnosed diabetes. MEASUREMENTS: Clinical data;
fasting glucose, insulin, and lipid levels; and glucose and insulin levels taken 2 hours after oral
challenge were collected from 1991 to 1993. Glucose tolerance was determined by 1980 World Health
Organization criteria. Patients with normal glucose tolerance were categorized into quintiles of
fasting glucose. The distributions of each metabolic risk factor and the metabolic sum of the six
risk factors were assessed across seven categories from the lowest quintile of normal fasting
glucose level through impaired glucose tolerance and previously undiagnosed diabetes. RESULTS: The
mean age of patients was 54 years (range, 26 to 82 years); 52.7% of patients were women. Glucose
tolerance testing found that 12.7% of patients had impaired glucose tolerance and 4.8% had
previously undiagnosed diabetes. Multivariable-adjusted mean measures of risk factors and odds
ratios for obesity, elevated waist-to-hip ratio, hypertension, low levels of high-density
lipoprotein cholesterol, elevated triglyceride levels, and hyperinsulinemia showed continuous
increases across the spectrum of nondiabetic glucose tolerance. Although a threshold effect near the
upper range of nondiabetic glucose tolerance could not be ruled out for triglyceride levels in men
and for insulin levels 2 hours after oral challenge in men and women, no other metabolic risk
factors showed clear evidence of thresholds for increased risk. CONCLUSIONS: Metabolic risk factors
for type 2 diabetes mellitus and for cardiovascular disease worsen continuously across the spectrum
of glucose tolerance categories, beginning in the lowest quintiles of normal fasting glucose level.
PMID: 9518396, UI: 98175274
