So, of late I have become slightly addicted to Linked In… never thought I'd say that! Well, it is more the 'groups' that exist within Linked In, namely groups like 'Nutrition' and 'Nutrition Professionals' which I thought would be great as it would mean having intelligent discussion with like minded, similarly trained individuals so that we could talk 'on a level'. It is also a portal to professionals all over the world so it would be a great way to find out about others experiences and especially those in the US who have similar if not greater problems to us here in the UK; with high levels of overweight and obesity, diabetes etc as well as a meddling government that peddles misinformation on nutrition and health.Well, little did I know it but I was in for a rude awakening. Sometimes I do get a little bored of the same four words coming out of my mouth or being typed in blogs… "Fat. Is. Not. Bad." Sometimes with an "Inherently" thrown in there if I want to sound clever or with a disclaimer of "Unless it is a man made, trans fat." I get bored of these same words because in my tiny little world, everyone thinks the same, anyone with a shred of common sense knows that the lipid hypothesis is just that, a hypothesis that is unfortunately not holding up under non-observational research (you know, the kind that can show cause and effect to one degree or another). In my sheltered world, people know that excessive sugar is much more likely to do you harm and that eating low fat isn't the way forward for health OR performance. But MAN was I not ready for what I found on Linked In!
Cutting out entire food groups is healthy?
In the aforementioned groups I was coming across 'qualified' individuals still pushing the same old crap (excuse my french). I couldn't believe it! Not only that, but I've never come across so many individuals that truly believe the diet that most healthy for everyone is one that is vegetarian or vegan based!? Many people also tend towards this approach with a 'mostly plant based diet' but don't call themselves vegetarian or vegan.
I saw a post on Twitter recently that made me smile, it said something like "In a world without supplements, would there be any vegans?" This makes the point excellently… vegetarianism and veganism are not healthy ways to eat. If you do not like the taste of meat or want to make a stand against animal cruelty/improper and cruel farming methods then eating this way is possibly mandatory and therefore you make use of the array of supplements available to you to maintain your health. Specifically things like zinc, vitamin B12, vitamin B6, vitamin D, DHA and taurine are primarily found in animal products therefore supplementation could be wise. It is possible to exist as a vegetarian, some of the issues of not eating meat can be counteracted by a high egg intake. Earlier in my career I had success stories with vegetarians and eggs were generally the key to this. Veganism on the other hand just isn't a good way to thrive.
The primary issue that comes up in posts by these 'veggies' and friends is that they still believe fat is bad, saturated fat is inherently unhealthy and laughably still believe that dietary cholesterol is related to blood cholesterol levels. So, by eating plant proteins and not animal proteins they cleverly steer clear of these horrible substances! Oh, another thing to mention is that there is still a common belief in these individuals that somehow higher protein intakes will eventually kill you. When I talk of the level of protein intake we routinely recommend to athletes it is almost like blasphemy! If you saw my post "..there are no convincing arguments regarding the danger of excessive protein intakes..it is simply oxidised" (Broad & Cox, 2008) Discuss!?", you will understand this point even more.
Alkaline Diets
To make matters worse, I also came across what I have termed 'Alkaline Diet Hippies' (ADH). Not for the first time though… this group are also going strong in the UK and even in sporting circles. I believe I have a follower on Twitter who sells this stuff (well, until this blog post anyway). This group are all about overemphasising the consumption of alkaline foods i.e. fruits, vegetables and 'alkaline water' which is kinda like their holy water. They do not define themselves as vegan/vegetarian as they are also against many grains….because they are acidic… and acidic is 'the devil'… but in general a more plant based, vegetarian diet is consumed.
After challenging many of these proponents to back up their practice using scientific research… I got nothing. Another quote for you: "Fear not those who argue, but those who dodge." ~ Dale Carnegie. The question was genuine, I do want to know if there is any evidence for these extreme recommendations to drink alkaline water and to supplement with alkaline powders and capsules.There are nutritionists in the UK that hugely promote the use of these substances and even recommend the installation of alkaline water ionizer filters that are fitted into the plumbing of your house for the negligible fee of £1-2k. Awesome! Snake Oil on tap! I mean, Alkaline Water on tap! For £1-2k you'd want some pretty concrete evidence before investing no? Then we get the alkalising salts and 'green life' or 'goodness greens' products… necessary? No. Useful? Perhaps if you struggle to eat fruit and vegetables you might benefit from drinking them or popping a capsule but they are certainly not the wonder supplements that cure all ailments they are made out to be.
The Science
To give you a little science behind all this, when foods are digested they either have a net acidic or net alkaline effect on the body. Interestingly, things like lemons that we consider acidic in their whole form are actually alkalizing in the body once broken down. The body must regulate its internal environment (homeostasis) to maintain its 'acid-base' balance. The pH of the blood must be tightly maintained around 7.4, urine and saliva range from 6.0-7.4. If the environment becomes acidic, the body can use things like calcium, glutamine and bicarbonate to buffer the acidity bringing it back to the 7.4 level. This is why high protein diets were thought to be detrimental to bone health due to the acidic nature of meat. It makes sense right? Not quite. The problem with the Alkaline cult is they forget the concept of potential renal acid load (PRAL) which dictates the acid load that will
be eventually delt with by the kidneys. By simply consuming some fruit or vegetables with our meat we can easily balance the PRAL. Remembering, we are not trying to get our body to be unnaturally alkaline, we are simply giving it enough alkaline foods to leave our calcium and glutamine stores where we want them… in the bone and muscle. This is why I recommend the consumption of higher amounts of vegetables for individuals with higher protein intakes. Simples.
Lots of in vitro studies have been done where cancer cells are exposed to alkaline water. In this case, the alkaline water has a beneficial effect as cancer cells flourish in an acidic environment. This kind of research is used to by the ADHs as reason to drink it. Unfortunately, there is a big difference between immersing cancer cells in an alkaline solution (where they can't survive) and drinking it in vivo . If you want a really indepth analysis of the snake oil that is Alkaline water, feel free to read this: "Ionized" and alkaline water
Just a final point of clarification. I used inverted commas around 'qualified' earlier. One thing that I find completely irresponsible of people is that they feel they can prescribe all sorts of diets and weird and wonderful ways of eating with no formal, brick and mortar qualifications in nutrition. The norm on Linked In seems to be individuals who have done an online diploma in nutrition and feel this is enough. No wonder dietitians are so well respected as compared to 'nutritionists' with these quacks running wild! While I am all for continued professional development and working things out from ones own experience and that of clients… I think at least a founding in physiology, biochemistry and or nutrition would be helpful!
So, back to Linked In. One particular thread did not break down in name calling and actually generated the beginnings of interesting discussion. If you have had discussions with people following the reading of my blog but have become unstuck when they say 'but there is research to show saturated fat is bad' then you might benefit from reading the discussion. This is the post I put up to start the discussion:
Evidence/Research based practice – CHO, PRO & FAT
This has stemmed out of the 'thoughts on high protein diets for weightloss?' discussion thread here.
It turned into somewhat of a CHO vs PRO & Fat as well as a Vegan/Vegetarian vs Omnivorous diet thread so I thought I would start this thread so we could flesh this topic out a little further and share research on the topic.
I base my nutritional practice on the following facts:
1) Saturated fat is not inherently detrimental for health
2) There is no evidence to suggest that in otherwise healthy people, high protein intakes in the region of 1.5 – 4g/kg body weight over the long term will cause any detriment to health.
3) Dietary cholesterol does not have a huge impact on plasma cholesterol levels
4) A high intake of grains and starches has the greatest potential to damage health
5) Dietary carbohydrate is not essential for life
6) Vegan and Vegetarian diets have a high potential to cause deficiencies
7) Vegetables are great and with adequate fruit and vegetable intake it nullifies the need for starchy carbohydrate intake to contribute to micronutrient needs.Many observational studies have linked fat and protein to health issues but clinical trials are lacking. The best many proponents of high carbohydrate intake can come up with is that "there is no benefit of a high fat/protein diet over a high carbohydrate diet" which begs the question… why would you recommend one over the other?
Discuss
One particular answer caught my attention because it actually hinted at research that linked saturated fat to ill health and also carbohydrates to improved health… which is great… because it is very hard for me to motivate myself to trawl through research trying to disprove what I know… this is probably a good reason I am not a researcher. So, I have posted this comment below and then my response below that:
Some research does tie higher animal protein, esp. red meat intakes with mortality–The China Study–and a number of studies tie higher saturated fat intake with higher rates of heart disease, diabetes, obesity, and cancer. However, some studies have also shown no link between saturated fat and heart disease. But your "paleo claim" that grains are associated with disease is also not supported by evidence as a large number of studies tie whole grains with disease prevention.
Merchant et al. Interrelation of saturated fat, trans fat, alcohol intake, and subclinical atherosclerosis. Am J Clin Nutr 2008 87: 1 168-174.
Hu et al. Dietary saturated fats and their food sources in relation to the risk of coronary heart disease in women. Am J Clin Nutr 1999 70: 6 1001-1008
Lopez et al, Effects of meals rich in either monounsaturated or saturated fat on lipid concentrations and on insulin secretion and action in subjects with high fasting triglyceride concentrations. Am J Clin Nutr 2011 93: 3 494-499
Sieri et al. Dietary fat and breast cancer risk in the European Prospective Investigation into Cancer and Nutrition. Am J Clin Nutr 2008 88: 5 1304-1312
Majken et al Intakes of whole grains, bran, and germ and the risk of coronary heart disease in men Am J Clin Nutr 2004 80: 6 1492-1499
Martin you say that 'A high intake of grains and starches has the greatest potential to damage health'and despite a fair amount of agreement among the nutrition community that eating a lot of grains promotes chronic diseases, myself included, there is more research proving that whole grains are health promoting than that grains are health damaging.
…and my response:
Thank you for your interesting posts. I must say I am quite surprised by your comments of "despite a fair amount of agreement among the nutrition community that eating a lot of grains promotes chronic diseases, myself included."
Only then to go on to say that there is more research showing that these very grains are health promoting… genuine question – is it your view that what yourself and the nutrition community believe to be true simply isn't supported by the research?
Just to get one minor point cleared up. I said "A high intake of grains and starches has the greatest potential to damage health" which is vastly different from a 'paleo' claim. Happy to explain this further if people aren't sure what the difference between my statement and paleo beliefs are.
As Aliss has said, the China study was… terrible. If you are really interested in progressing your knowledge (and have the time) and if anyone else is interested because the China Study comes up so much, please read this: www.cholesterol-and-health.com/Campbell-Masterjohn.html it outlines just how much the information found in the China study does not hold up.
With regards to the studies you have posted (thank you for doing so), I had a read of a couple I had not see that I could get the full text of. They are unfortunately all, but one, purely observational studies showing no cause and effect. Interestingly we can find the exact opposite of what has been found in these studies in other 'observational' studies. So really, what we need is intervention trials and this is where things become a lot more clear and we start to see that high intakes of carbohydrates (whether they are refined or not) are indeed related to markers of disease. Not only are these studies interventional, randomised and controlled, they even cover time scales as long as 1-2 years on prescribed diets. In these studies we get the interesting findings that actually saturated fat can be protective and that substituting saturated fat for 'starch' improves health! Unfortunately, the government has thrown such a curve ball with its 'fat is bad' dogma that it is somehow affecting cross sectional, observational studies!
Just to talk about your references quickly/briefly.
Interrelation of saturated fat, trans fat, alcohol intake, and subclinical atherosclerosis – Observational cross sectional using highly inaccurate tools of measurement of nutrient intake. Interestingly, last year, Frank Hu (the lead author of this study) published a released an editorial basically saying that saturated fat wasn’t the bad guy and it was refined carbohydrates that were. He also closed the commentary thanking Dariush Mozaffarian, who publishes much research on saturated fat and recently published “The great fat debate: taking the focus off of saturated fat.” In J Am Diet Assoc.
Dietary saturated fats and their food sources in relation to the risk of coronary heart disease in women – Again, observational, based on the Nurses Heatlh Study which has been highly criticised for its use of inaccurate methods. Again I will highlight its use of a food frequency questionnaire completed in 1980 and then not again…. in the 14 years of follow up!
Effects of meals rich in either monounsaturated or saturated fat on lipid concentrations and on insulin secretion and action in subjects with high fasting triglyceride concentrations – Only intervention study but unfortunately an acute one. Showing no long term change in health parameters. Do you have the full text? I’m interested in what the meals actually contained.
Dietary fat and breast cancer risk in the European Prospective Investigation into Cancer and Nutrition – Observational. Weak correlations.
Intakes of whole grains, bran, and germ and the risk of coronary heart disease in men – Observational
Please do post if you find intervention studies showing high CHO is good. That's why I started this thread.
A last minute edit to the blog. In next response my fellow Linked In member posted that all he was doing was trying to point out that there is much conflicting evidence; and that even with our commonly held beliefs the research still wasn't supporting the fact that fat is OK and too many carbohydrates are not. He even said, the research can throw some curve ball sometimes and proceeded to cite the following study:
This (observational) study shows that there is a correlation between higher levels of omega 3 fatty acids (you know, those healthy ones we get from oily fish) and high-grade prostate cancer… and higher levels of Trans fats (you know, the bad ones that are illegal in many countries) decrease the risk of high-grade prostate cancer! Well… wasn't I chuffed when this was posted! Here was my reply:
You somewhat make my point perfectly. Yet another observational study showing crazy results!? Although, if Trans Fats every turn out to be healthy and in 40 years time I am recommending high Trans fat diets I will eat my hat and apologise to all the people here on Linked In I have argued with!
Anyway, again, without an intervention we can't show cause and effect and this is what I am trying to get across…
The 'equal amount' of evidence you say there is for carbohydrates being healthy is based on observational studies. The same kinds of studies that can show trans fats are good and omega 3s are linked to prostate cancer.
However, the studies that show fat is not bad for you and that it is actually a great substitution for carbohydrate are controlled clinical intervention trials.
Well, there you have it. I hope this blog has been helpful to you…it's been fun writing it.
Update: An interesting piece here. The Adversiting Standards Agency has got hold of an alkaline water manufacturer and told them to basically stop making unsustantiated claims on their website aka LIES!
