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Monday’s medical myth: cutting carbs is the best way to lose weight

There seems to be an endless number of fad diets and “golden rules” for weight loss. One of the most popular of these rules is that cutting carbohydrates (carbs) is the best way to lose weight. The most…

There’s no good evidence to show cutting carbs works better than just cutting calories. Skley

There seems to be an endless number of fad diets and “golden rules” for weight loss. One of the most popular of these rules is that cutting carbohydrates (carbs) is the best way to lose weight.

The most famous low-carb diet is the Atkins diet, first developed in the 1970s. The Atkins diet recommends limiting foods high in carbs, such as bread, pasta and rice. Carbs are replaced with foods containing a higher percentage of proteins and fats (meat, poultry, fish, eggs and cheese) and other low-carb foods (most vegetables).

But what does the evidence show us about whether low-carb diets really are best for weight loss?

Theoretically, a “calorie is a calorie” and it doesn’t matter what types of food the calories come from. Accordingly, all reduced-energy (calorie) diets should lead to equivalent weight loss.

However, some studies have reported that low-carb diets lead to greater weight loss than other types of diets, at least in the short-term. So, what are the possible explanations for these results, and can we rely on them?

1) Changes in body composition

Energy is stored in the body as protein, fat, and glycogen, which is a form of carbohydrate. If there is an imbalance between how many of these nutrients are ingested (through the food that is eaten) and how many are used by the body for every day functions, body composition will change.

In turn, this will affect body weight because of the different impact that the relative amounts of stored protein, fat and carbohydrates have on body weight.

A calorie is a calorie, no matter what type of food it comes from. Mrs Magic

However, the vast majority of studies in which they’ve measured calorie intake very accurately (that is, they’ve locked people in a room and measured exactly what they’ve eaten for several days), show absolutely no difference in weight loss based on the composition of the diet. High-protein diets and high-carb diets resulted in the same weight loss.

This indicates that, in the short-term at least, the human body is a superb regulator of the type of energy it uses, and whether the diet is low-carb or high-carb probably won’t make much of a difference to the amount of weight lost.

2) Changes in metabolic rate

The body’s metabolic rate (the amount of energy expended by the body in a given time) is dependent on the composition of the diet. Consumption of protein, for example, is known to result in a larger increase in energy expenditure for several hours after a meal compared with the consumption of fat or carbs.

But the overall effect of diet composition on total energy expenditure is relatively small. As a result, the assumption that a “calorie is a calorie” is probably a reasonable estimation as far as energy expenditure is concerned.

3) Changes in hunger levels and satiety

Some diets can lead to reduced hunger, improved satiety (feeling full), and can be easier to stick to than others. There is an enormous amount of research on this.

Long-term weight loss requires permanent change to your daily calorie consumption. Flickr/torisan

The problem is that it’s extremely difficult to accurately measure what people are eating over extended time periods. People rarely stick to their diets for more than just a few weeks, making it almost impossible to adequately compare the effects of different diets.

And so, is cutting carbs the best way to lose weight?

Maybe, but there’s not really good evidence supporting it. All diets with similar calorie content have a similar effect on weight loss in the short-term. This is because the body adapts rapidly to changes in relative protein, fat and carbohydrate intake levels.

The truth is that losing weight and keeping it off in the long-term is difficult. It requires permanent changes to the number of calories you eat each day.

Perhaps the best dietary advice comes from Michael Pollan when he says, “Eat food. Not too much. Mostly plants.”

Join the conversation

227 Comments sorted by

  1. John Wright

    Director

    Hi Gary
    I have just finished Volek and Phinney's Art and Science of Low Carbohydrate Living and now the Performance supplement. Two things from their work contrast immediately with your article. The first is that you do not define what you regard as low carb. The second and unfortunately this appears common with most discussions concerning weight loss, is the article presumes a generic template for all, best or otherwise.

    Is a low carb or even ketogenic approach the 'best' for some, most probably, particularly those who are insulin resistant or have some carbohydrate intolerance. Is it necessary for all probably not.

    Perhaps a better topic for your Monday Myth could be Are carbohydrates an essential part of the human diet?

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    1. Gary Campbell

      RN

      In reply to John Wright

      "Are carbohydrates an essential part of the human diet?"

      Fats take a while to be released into the bloodstream as glucose/energy for use by the Krebs cycle (cellular metabolism of glucose) due to the mechanism of being "condensed" for initial storage. (tens of minutes to hours for deployment).

      Protein when broken down does produce energy in a form the Krebs cycle can use almost immediately, but it also produces nitrogenous waste which can be difficult for the body to get rid of in a short…

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    2. John Wright

      Director

      In reply to Gary Campbell

      Gary I agree with everything you say, and you are perfectly describing the non keto-adapted individual.
      My question was rhetorical of course, hence the reason for posing it as a monday myth. It is entirely possible to live and thrive in a keto-adapted state, there is nothing 'essential' about dietary carbohydrate.
      I am not suggesting for one moment that it is a preferred way to live and I agree completely with Rosemary there is no one size fits all approach to weight loss.
      Similarly there appears…

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    3. Rosemary Stanton

      Nutritionist & Visiting Fellow at University of New South Wales

      In reply to John Wright

      John

      Carbohydrates come in foods. Many foods that contain carbohydrate are excellent source of essential nutrients. I fully support eating less of the junky drinks and foods that are high in sugar and refined starches, but why would one avoid otherhihgly nutritious (and delicious) foods just because they contain carbohydrate?

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    4. Rodger Kensen

      Systems Analyst

      In reply to John Wright

      Is it possible that the amazing benefits people claim about Atkins diets and such is more that they are replacing imbalanced sugar laden diets with the actual nutrients they need? In other words does the no-carb diet work because it's replacing the previous excessively carb laden diet, where those with a balanced healthy diet gain little advantage?

      As stated it is hard to gauge the effects due to the inability of most people to actually stick to any diet.

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  2. John Coochey

    Mr

    I find the article a little schitzophrenic (can't be bothered to spell check) because surely the lower the carbs the best weight loss for a given exercise level? I understand excess protein can be turned into carbs for storage but it is not very efficient so if people get filled up with low carb food that should help achieve the objective.

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    1. Dion Kerfont

      logged in via Facebook

      In reply to John Coochey

      You replace carbs with saturated fat. Unlike what the author of this article would tell you, saturated fat is actually very good for you. Once your body has adapted to using fat for fuel instead of carbs, you'll feel better, burn fat more efficiently and lose the visceral fat around your mid section.

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    2. Sue Ieraci

      Public hospital clinician

      In reply to Dion Kerfont

      Dion - the fat around your midsection is not "visceral" - it is subcutaneous. "Visceral" fat is that around the intenal organs (also known in Latin as "viscera").

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    3. Rosemary Stanton

      Nutritionist & Visiting Fellow at University of New South Wales

      In reply to Dion Kerfont

      Dion

      How about a reference to back your claims that "saturated fat is very good for you"? I am aware that some short chain saturated fatty acids, and also stearic acid, won't raise serum cholesterol like some of the saturated fatty acids, but that's hardly justification for a statement they are 'good for you'.

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    4. Steve Bruhn

      logged in via Facebook

      In reply to Dion Kerfont

      Yes, this is true. Cholesterol will clean up nicely too. I got HDL up, LDL down, and total to the min by eating more bacon, for real.

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    5. Steve Bruhn

      logged in via Facebook

      In reply to Rosemary Stanton

      How about a million years of natural selection? If saturated fat is unhealthy, carnivores would have a big problem. They don't, but humans do.

      I don't need a reference from a human that tries to explain away a fact humans don't want to understand!

      I can show you blood test results before and after, and I can attest that a big bacon breakfast goes a long way in cleaning up cholesterol, IF you drop the carbs too.

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    6. Sue Ieraci

      Public hospital clinician

      In reply to Steve Bruhn

      Steve Bruhn - I don't think you understand how "natural selection" works.

      Ancient people DID have a huge problem, as do all living things. They need enough excess reproduction to account for loss.

      "Millions of years of natural selection" have not, for example, eminimated the life-threatening risks of childbirth - moderns obstetrics has.

      "Millions of years of natual selection" have not made humans resistent to infection - antibiotics and immunisation have.

      I just don't get why the zealots feel they need to try and convert the learned and experienced people here like the author and various posters.

      Science, by its very nature, evolves over time (maybe THAT is natural selection). Science develops models with the best avaiolable evidence at the time, and these models are thrown out, supported or strengthened as new evidence accumulates. The science-based nutrition professionals keep up with science in their area. There is no place for rigidity and zealotry.

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    7. Paul Rogers

      logged in via Twitter

      In reply to Dion Kerfont

      Dion, you are way out of date, and cherry picking as well. Here is the latest collaborative review of the evidence for replacing saturated fat with unsaturated fat, especially polyunsaturated fat, for prevention of cardiovascular disease.

      Am J Clin Nutr. 2011 Apr;93(4):684-8. The role of reducing intakes of saturated fat in the prevention of cardiovascular disease: where does the evidence stand in 2010? Astrup A, Dyerberg J, Elwood P, Hermansen K, Hu FB, Jakobsen MU, Kok FJ, Krauss RM, Lecerf…

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    8. Paul Savage

      Theme Leader, Biotechnology at CSIRO

      In reply to Paul Rogers

      Thanks very much for that review link Paul, it's a nice summary. I think the evidence for PUFAs being beneficial over SFAs looks pretty solid, although the magnitude of the benefit is not huge. It's also interesting to note the comment that substituting total carbohydrate for SFAs is associated with no or a moderately higher risk of cardiovascular disease (although there remains an open question regarding the quality of the carbohydrates - refined versus low GI).

      So if the CHD risks are roughly…

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    9. Paul Rogers

      logged in via Twitter

      In reply to Paul Savage

      Paul Savage, I don't see that the evidence says that low-carb diets are easier to maintain. Can't lay my hands on a study right now, but from recollection the long-term maintenance of such is quite poor in cohorts examined outside of trials.

      The straw man attack on low-fat diets high in refined carb and sugars, is of course exactly that. That does not reflect standard healthy eating advice in this modern era. More unsaturated fat in the diet is fine, added sugars kept low, lots of fruit and veg, grains more or less whole, and fibre from plant foods, including beans and some nuts, high.

      Regarding replacing saturated fat with carbohydrates, the rule should be, of course, not to replace saturated fat with sugars and refined carbs. However, replacing saturated fat with high-fibre carbohydrates may produce similar benefits as the unsaturated oils as replacement, but the evidence for this is not yet mature. I would be surprised if it was not beneficial.

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    10. Sue Ieraci

      Public hospital clinician

      In reply to Paul Rogers

      Paul (Rogers) - I see a couple of "straw persons" here.

      Firstl;y, is there any evidence that people who reduce overall fat in their intake consistently replace the energy with refined sugars? I have seen the sweets that are promoted as "no fat" (ie full of sugar) - but are people eating more of them because they eat less fat?

      Then, the allegation that people are being given a simplistic message about reducing fat intake. My impression was that many people are much more aware of the nature of the various fats in their diet - including olive and canola. Is there evidence for a change to the more beneficial fats in our community.

      I know that olive oil has gone from something you bought from the chemist 50 years ago to a product that is in most homes - isn't this evidence that the newer messages about fats and oils are getting through?

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    11. Paul Savage

      Theme Leader, Biotechnology at CSIRO

      In reply to Paul Rogers

      I think we are perhaps in furious agreement Paul. I should be more careful when saying low-carb to indicate refined carbohydrates. I guess I really mean low-GI. Regarding maintaining the diets, I believe the long-term outcomes for either low-fat or low-carb, energy restricted diets is about the same with respect to weight loss. I have read (at the Mayo Clinic web site perhaps) that in the short term a low-carb diet is easier to stick with because fatty meals are more satiating (calorie for calorie…

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    12. Paul Rogers

      logged in via Twitter

      In reply to Sue Ieraci

      Sue, I've no doubt that in the past the labelled 'low-fat' foods in supermarkets have fooled a few people into eating confidently of these products without checking the added sugar content. The yogurts are an example. Bakery products and biscuits probably another. I checked a popular brand of biscuit with 'fruit' in the name recently: 48% sugar! Not unusual either.

      Soft drinks have been a big problem as well. I don't know the sales data, but when I see people filling their shopping carts with…

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    13. Sue Ieraci

      Public hospital clinician

      In reply to Paul Savage

      Paul Savage - your rant above notwithstanding, you have engaged me again with: " I believe the evidence that people who reduce overall fat in their intake consistently replace the energy with refined carbohydrates is generally right before our eyes with the obesity epidemic."

      But there you go again. I was asking Paul Rogers (who is more across this area than I will ever be) whether there is evidence for this assertion. You have answered with what you "believe", even though you later acknowledge that the obesity epidemic" is a complex social phenomenon.

      I'm not going out of my way to be argumentative - but can you not see how you apply scientific principles in your own discipline, but you make more simplistic assumptions in other people's areas? It's not MY area - I don't have beliefs here, and I am guided in this discussion by those who are across both the ltierature and the practice, as I am in my own area and you are in yours. Bye.

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    14. Paul Savage

      Theme Leader, Biotechnology at CSIRO

      In reply to Sue Ieraci

      Sue Ieraci: "your rant above notwithstanding" .... "I'm not going out of my way to be argumentative"

      Doesn't seem like you need to stray far out of your way Sue. :-)

      When I said "I believe" above, I didn't mean it in the sense of some quasi-religious, unshakable faith. It was shorthand for "my hypothesis is that...". Perhaps in your eagerness to jump all over me again you didn't appreciate the nuance of conversational writing. Contrary to your apparent assumptions about me, I don’t have a heavy…

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    15. Rosemary Stanton

      Nutritionist & Visiting Fellow at University of New South Wales

      In reply to Steve Bruhn

      Steve Bruhm

      There wasn't a lot of fat in anyone's diet millions of years ago. Wild animals are lean and the brain (which has more fat) is a small portion of the animal.

      Don't forget about physical activity, famine and short lifespan.

      Can you back your anecdote with evidence from large numbers of people whose cholesterol has been 'cleaned up' by a big bacon breakfast. Studies of high protein, high fat (Atkins style) diets don't necessarily report increased cholesterol in the short term, but long term they do (see
      Johansson I, Nilsson L, Stegmayr B, Boman K, Hallmans G, Winkvist A Associations among 25-year trends in diet, cholesterol and BMI from 140,000 observations in men and women in Northern Sweden. Nutrition Journal 2012, 11:40 doi:10.1186/1475-2891-11-40. Published: 11 June 2012

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  3. Gary Campbell

    RN

    The concept of "Low Carb" diets is simply marketing, taking advantage of peoples innate laziness and desire for a "quick fix" to their obesity (perceived or real).

    There is only one way to lose weight: energy expended must be greater than energy consumed, no ifs or buts. In the long term it does not matter what the source of the energy is, although it can give different rates of weight loss initially.

    It would be far better to recommend that people get off their backside and exercise (a couple of mile walk/day), than to pander to their laziness with questionable diets.

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    1. Clifford Chapman

      Retired English Teacher

      In reply to Gary Campbell

      Well said, Gary, and we've been there before on issues such as this one with the myth being sugar, if I remember the codswallop of some months ago.

      It's perfectly simple, really, and is, as you say it, nothing more than simply burning off what you consume.

      Oh for the day when one of these 'Medical Myths' is something like: 'People Are Not Personally Responsible For Being Over Weight.'

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    2. Dion Kerfont

      logged in via Facebook

      In reply to Gary Campbell

      Since when is eating whole food a marketing ploy? I don't follow a specific "diet" plan, but I do limit my carbohydrates. I eat very little in the way of processed garbage.

      I like how you refer to people eating this way as lazy. Biggest crock of BS I've ever read... and I've read a lot of BS on this topic lately. It takes time and effort to prepare meals with fresh, whole ingredients. It also takes a lot of effort to find a good source of pork or beef that hasn't been fed crap and loaded…

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    3. Gary Campbell

      RN

      In reply to Dion Kerfont

      Where did I mention anything about unprocessed versus processed foods? I simply stated the SCIENTIFIC facts about energy.

      As for the rest of your statement could you provide at least one scientifically based piece of evidence to support you statement about thermodynamics not applying to us, because there are some very esteemed exercise physiologists, Doctors of Medicine, and other scientifically credentialed individuals associated with many universities that would beg to differ?
      (See http://en.wikipedia.org/wiki/Laws_of_thermodynamics

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    4. Clifford Chapman

      Retired English Teacher

      In reply to Clifford Chapman

      Fancy that, I received a couple of negatives for basically saying people should take responsibility for themselves.

      That's what you get for bagging a parasitic industry.

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    5. Gary Cassidy

      In reply to Clifford Chapman

      'People Are Not Personally Responsible For Being Over Weight.'

      As much as it feels wrong for me to say this, I think there is some truth to that statement. The personal responsibility message is what government, dietitians, diet programs, etc have been pushing as THE strategy for loosing weight. But unfortunately it has not worked and the obesity problem has gotten worse.

      So somehow somewhere there is a range of factors that are causing society as a whole to get fatter. Personal responsibility is definitely important, but it cannot be relied upon as the main strategy against obesity. That hasn't worked and won't work.

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    6. Gary Campbell

      RN

      In reply to Gary Cassidy

      "...So somehow somewhere there is a range of factors that are causing society as a whole to get fatter...."

      Lack of exercise? SURELY this would be the most obvious.

      From spending 5 mins getting the car out of the garage to drive 1km to the local shops or 1 1/2 hr commute to work, to sitting at a desk all day while at "work", through to taking the elevator the for the two-three flights of stairs up to the office....the general public are lazy, for want of another description.

      Yes, bluntly LAZY. The very ugly truth.

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    7. Gary Cassidy

      In reply to Gary Campbell

      That would be an interesting study - Take 100 fat people, call 50 of them lazy, and remind them a few times a day, leave the other 50 alone and measure the difference in fat levels after a year. My bet would be on the result that measures no difference in fat levels at the end of the year.

      Calling people lazy might help you feel better when you're out there being not "lazy", but it is not a solution to the the obesity problem.

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    8. Gary Campbell

      RN

      In reply to Gary Cassidy

      Take 100 people, do nothing with 50, and get the other people exercising daily (walking to the shops, walking the stairs, walking to the bus stop/cycling to work, walking during their lunch break, etc) and tell me if they DON'T lose weight.

      I said they ARE lazy (observation), not that I TOLD THEM they were lazy (insult)....

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    9. Clifford Chapman

      Retired English Teacher

      In reply to Gary Cassidy

      Well, in all honesty, how can it really be, when push comes to shove, not a matter of personal and individual responsibility? If an adult has the freedom to act, doesn't that also mean that how they act and the choices they make, is their responsibility?

      Of course, it's not either/or so I'm not referring here to where crucial and important knowledge, for example, is denied us so that how we act, like working in the asbestos industry, was not known to be dangerous, when such serious knowledge was shamefully being suppressed.

      But as with the tobacco industry and smoking, drink driving, and now obesity, you'd have to be deaf, dumb and blind not to be aware of how dangerous to one's health such practices are.

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    10. Paul Savage

      Theme Leader, Biotechnology at CSIRO

      In reply to Clifford Chapman

      There are some parallels to those industries. In the 70s when we were all told by dieticians that fat was bad for you (with surprisingly little evidence as it turns out) the food companies invented all sorts of low fat food. Of course low fat food was also 'low taste' so to compensate and keep sales high they started increasing the sugar (and LFCS in the US) content. Many people were unaware that their low fat yoghurt had 20% sugar.

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    11. Clifford Chapman

      Retired English Teacher

      In reply to Paul Savage

      Yes, that is right.

      I read some time ago, and the detail may be corrected/confirmed and/or 'fleshed out' by someone here, that the first research on tobacco that clearly showed the detrimental effects of smoking, apparently occurred in 1950 and the professor involved, a smoker, immediately stopped smoking as a result.

      There is no way that I, as a seven year old then, became aware of how harmful cigarettes could be to one's health until the very late sixties/early seventies. The morally bankrupt tobacco companies have to have tried to suppress such studies.

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    12. Steve Brown

      logged in via email @yahoo.com.au

      In reply to Gary Campbell

      "Lack of exercise? SURELY this would be the most obvious."

      But is that the cause, or the effect of recent diet changes?

      Many western countries have had very radical changes in their eating habits in the last few decades- most notably the switch in seed oil from our traditional (more saturated) fats and an increase in grains plus a whole lot of other frankenstein ingredients you can see in our foods. These changes, and the evidence showing the raft of metabolic effects they induce, are being…

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    13. Dion Kerfont

      logged in via Facebook

      In reply to Gary Campbell

      It has been shown that people eating low-carb, high fat have a higher resting metabolism than those that follow a low-fat diet. Resting metabolism is more important because you quite obviously spend more time resting than being physically active.

      Insulin plays a key role in fat storage. It doesn't matter how many calories you've consumed; if your insulin is up, those calories will be stored as fat. Creating a "deficit" works short term, but soon you get tired of feeling hungry all the time…

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    14. Rosemary Stanton

      Nutritionist & Visiting Fellow at University of New South Wales

      In reply to Clifford Chapman

      Paul

      When people were advised to cut their kilojoules by reducing fatty foods, the dietitians of the time talked about trimming the fat from meat and skimming cream from milk as well as eating fewer cakes, biscuits, pies, pastries, desserts, chips, crisps and other high fat foods.

      It was the processed food industry that saw a marketing opportunity and started pushing low fat processed junk with sugar and refined starches in place of some of the fat. Those marketing products like jelly beans…

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    15. Dion Kerfont

      logged in via Facebook

      In reply to Steve Brown

      Spot on, Steve. Naturally thin people look down their noses at obese people simply dismissing them as lazy. I never take weight loss advice from people that were born at the finish line thinking they've won the race. If you're thin, your metabolism is obviously fine and you can get away with eating more carbs than someone who is insulin resistant (like myself).

      However, going crazy on the whole grains and processed seed oils will eventually take it's toll... it simply takes longer in some individuals than others... dependent again on how insulin resistant the person is or will be down the road.

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    16. Dion Kerfont

      logged in via Facebook

      In reply to Rosemary Stanton

      I never made any such claim about trans-fat, Rosemary... please do NOT put words in my mouth. Trans fats are as bad as excessive carbohydrates in the diet... even worse in some ways.

      You lose credibility when you make statements such as these. You either consciously threw trans fat in there (or perhaps even subconsciously) to strengthen your point because you are in fact right about trans fat... but oh so wrong about saturated fat.

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    17. Rosemary Stanton

      Nutritionist & Visiting Fellow at University of New South Wales

      In reply to Dion Kerfont

      Dion

      No - you are wrong. I did not say you mentioned trans fats. I did say that saturated and trans fats are not good for us. I wanted a reference that saturated fat is good for us. I did not ask for any reference that trans fat is good for us, because I didn't want to get into the conjugated linoleic acid story at this point..

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    18. Paul Savage

      Theme Leader, Biotechnology at CSIRO

      In reply to Rosemary Stanton

      Hi Rosemary. I agree of course with your advice to avoid "junk foods" and to increase vegetable (selected carefully - not potatoes) consumption. I'm a fan of your no-nonsense approach to diet and think you have contributed significantly in the debate in Australia. But I have to disagree with the issue on fat. While many of the current nutritional experts demand evidence for low carb diets they do not seem to apply that same standard to the 70's dogma of low fat recommendations. Where is the evidence…

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    19. Citizen SG

      Citizen

      In reply to Dion Kerfont

      the effect of insulin is to store blood glucose as fat, to store blood glucose as glycogen in the liver and muscles and to transport glucose into the cells as the substrate for metabolism (not the reverse 'because high levels are toxic' - you have the consequence mixed up with the cause).
      If there is a low blood glucose level hormone control (via feedback from glucagon/insulin - two antagonising hormones) will preferentially lead to the release of glucose from stored carbohydrates (glycogen…

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    20. Clifford Chapman

      Retired English Teacher

      In reply to Rosemary Stanton

      Rosemary, your reply begins 'Paul' but states it's a reply to my post so I will comment on some of what you have said, if you don't mind.

      I do maintain fundamentally that the view that you will not put on weight as long as you burn off what you consume, is basically true, and that is why I argue strongly that people have to be primarily seen as being responsible for their obesity.

      However, I'm not also, irrespective of receiving negative votes from members of the parasitic industries, therefore implying that eating junk food by the bucket load is okay so long as you burn it off.

      It's not an either/or thing.

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    21. John Wright

      Director

      In reply to Paul Savage

      Paul / Rosemary
      Leaving aside the excited commentary contained elsewhere, this is the nub of the issue. These hypotheses need to be appropriately tested.
      Gardner (2007) attempted to do this and his more recent sub-analyses suggest that both LF and LCHO diets were equally effective, but only in the tertiles with normal insulin sensitivity. The LCHO group was substantially more effective in achieving WL in the Insulin resistant group. Given 1 in 4 Australians are insulin resistant (AusDiab 2008…

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    22. Paul Savage

      Theme Leader, Biotechnology at CSIRO

      In reply to John Wright

      Well said John. What particularly resonates with me are your observations of how ideas can be dismissed or actively suppressed by the conventional mainstream. Not that I subscribe at all to the view that all ideas are equally valid, but certainly ideas backed up with evidence should at least be considered. I am a scientist in the physical sciences (organic chemistry) where hypotheses can be tested by repeatable experiments with very little latitude for interpretation based on statistical correlation…

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    23. Paul Rogers

      logged in via Twitter

      In reply to Paul Savage

      All diets can work, even low carb, if you find a way to decrease your food intake. Diets that restrict macronutrients -- low carb, very low fat, probably even very low protein like some vegan diets -- work because of restricted availability of macronutrients, and thus you eat less.

      If you lose weight, especially around the waist, it is possible your total cholesterol will decrease and your HDL might increase. What you need to find out is what happens when your weight is stable on a low-carb diet…

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    24. Paul Rogers

      logged in via Twitter

      In reply to Paul Savage

      I would also remind you of this study by Peter Clifton, at Baker.

      Curr Atheroscler Rep. 2011 Dec;13(6):493-8. Protein and coronary heart disease: the role of different protein sources. Clifton PM.

      CONCLUSIONS: "Meat protein is associated with an increase in risk of heart disease . . . Low-carbohydrate diets high in animal protein were associated with a 23% higher total mortality rate whereas low-carbohydrate diets high in vegetable protein were associated with a 20% lower total mortality rate."

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    25. Sue Ieraci

      Public hospital clinician

      In reply to Dion Kerfont

      Dion - you comments suggest you haven't studied or practised in either physiology or nutrition sciences.

      Why do you lecture people here rather than learn from them?

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    26. Michael James

      Research scientist

      In reply to Steve Brown

      Steve Brown.

      Ahem, re the French issue, I wrote about this recently:

      http://www.crikey.com.au/2011/12/16/butter-not-margarine-si-vous-plais/
      Butter not margarine, s’il vous plaît
      By Michael R. James Friday, 16 December, 2012.

      But I would object to any implication of sloth in the French especially as in the West "work" is mostly a very sedentary affair. Indeed there is evidence that just getting up from your desk and doing a short walk (not for the burned calories) has a beneficial effect…

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    27. Dion Kerfont

      logged in via Facebook

      In reply to Sue Ieraci

      Sue, you're not telling me anything I haven't already heard for the last 30 years or so... so you'll excuse me if I don't believe I'm learning anything. I have done a lot of reading on this subject lately; because quite frankly I got tired of hearing the same advice over and over again... despite all the evidence that it doesn't work, it still gets pushed like it is the "correct" advice.

      Medication? Why resort to medication when type 2 diabetes can be controlled exclusively through diet? Obesity doesn't cause type 2 diabetes, but what does cause type 2 diabetes also causes obesity: insulin resistance.

      The only thing I've consciously been controlling in my way of eating is my carbohydrate intake. I don't obsess over the amount of calories I consume, I simply eat when I am hungry and don't eat when I am not. I've been steadily losing weight simply by making that one change.

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    28. Sue Ieraci

      Public hospital clinician

      In reply to Dion Kerfont

      Dion - when you have studied the basic and clinical sciences, understood physiology and pathology, studied research methods and learned critical apprisal of the literature, AND then been responsible for advising a large group of clients and being responsible for their outcomes, come back and make pronouncements.

      Ever run a clinical for diabetics?

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    29. Sue Ieraci

      Public hospital clinician

      In reply to Paul Savage

      Paul Savage - you are likely to be competent in your own area, where you are across the underlying science as well as experimental practice.

      Why, then, don't you accord the same respect for the author of this article, or commentators liek Rosemary stanton or Paul Rogers?

      These people, who have been studying and practising in the area, tell us that it's not just that simple. We are all attracted to simple answers, but human health, unlike the chemical laboratory, doesnt; work that way.

      You…

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    30. Paul Savage

      Theme Leader, Biotechnology at CSIRO

      In reply to Sue Ieraci

      Huh? Where exactly was I being disrespectful to the author, Rosemary or Paul Rogers? On the contrary I greatly respect their input. In contrast, I have less time for someone who comes into the conversation and sprays accusations around like paintballs. Furthermore, I deplore the "you're not an expert, so don't question the conventional wisdom" advice. That's exactly how science fails. This is supposed to be a conversation, right?

      And by the way, perhaps in your haste to criticize you overlooked the fact that I explicitly noted that my personal experience was merely anecdotal.

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    31. Clifford Chapman

      Retired English Teacher

      In reply to Dion Kerfont

      I'd not be buying into your intepretation here, personally, as it seems to me you've got two points that need to be clearly separated, namely, people's health and fitness, and their weight.

      It's like your first paragraph is automatically suggesting that "Naturally thin people (who look) down their noses at obese people simply dismissing them as lazy.........thinking they've won the race. If you're thin, your metabolism is obviously fine' etc., means that such people are also fit.

      I wouldn't…

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    32. John Wright

      Director

      In reply to Paul Savage

      Hi Paul
      similar origins I think chemist - come pharmacologist and now after some period of retirement, trying to get my head around what passes for 'evidenced based' in nutrition.

      One of my former colleagues Malcolm Kendrick introduced me to the Andreas' presentation, after Andreas had sent him the Guldbrand 2012 paper, published in Diabetologica, looking at diabetics and the metabolic improvements from LCD as opposed to LFD.

      I think the issue of LCD will in the end come to the fore with Diabetics and there is already some early signs of this in the US. NIH have I understand started to open funding in this area and a new organisation NUSI will I believe seek to fund research aimed to challenge the status quo. All of this should of course be welcomed, but such are the entrenched views.

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    33. Dion Kerfont

      logged in via Facebook

      In reply to Citizen SG

      I said exercise alone isn't enough to fix a broken metabolism... and that is true. You won't fix metabolic issues completely by exercising more. It takes a significant dietary change combined with exercise to bring about a lasting change.

      My explanations may be simplistic, but I'm not a scientist. I do a lot of reading on the subject, however. Since I began limiting my carbs, my health has improved and I have steadily been losing weight. I think sugar plays a much larger role in obesity than any other nutrient... but fat is always demonized despite the fact that many people have lost weight and seen improved health eating a diet high in fat, moderate in protein and low in carbohydrates.

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    34. Dion Kerfont

      logged in via Facebook

      In reply to Sue Ieraci

      So you're telling me that a disease related to blood sugar issues cannot possibly be controlled by controlling blood sugar? I've spoken with type 2 diabetics that are controlling their condition exclusively through diet... should we simply dismiss their advice based on the fact that they are not scientists or doctors?

      Sorry Sue, appeals to authority don't work for me. Their advice has been shown to cause more harm than good.

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    35. Dion Kerfont

      logged in via Facebook

      In reply to Paul Savage

      I've experienced the same thing, Paul. Significant improvements in health markers, yet somehow despite the fact I'm healthier by every possible marker, I'm killing myself.

      I still want an explanation of this logical paradox.

      "Meat protein is associated with an increase in risk of heart disease . . ."

      Again, you are confusing correlation with causation. "Is associated with" does NOT equal "Is directly responsible for".

      "Low-carbohydrate diets high in animal protein were associated with a 23% higher total mortality rate whereas low-carbohydrate diets high in vegetable protein were associated with a 20% lower total mortality rate."

      Those percentages are likely relative risk rather than actual risk. I have never seen one of these "studies" state actual risk.

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    36. Sue Ieraci

      Public hospital clinician

      In reply to Dion Kerfont

      Dion - ever run a clinic for diabetics?

      Of course many people can control their diabetes with diet - the dietician is the first point of call at diabetic clinics.

      Sorry, Dion, but the assertions of amateur zealots don't appeal to me. It's not about "authority" - it's about knowledge and experience - both of which you don't seem to realise you are short on.

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    37. Sue Ieraci

      Public hospital clinician

      In reply to Paul Savage

      Paul Savage - I am not saying you have been disrespectful in style, but in the way you express opinions outside your area.

      What I was specifically referring to was your use of personal anecdote in the area of diet, which I doubt yuu would use in your own scientific practice.

      Hence, I asked why you couldn't afford the same respect for the learned commenters here, whose statements you contradict with your anecdote. I'm not talking about myself - I'm talking about the author and the other experts commenting here.

      The reason I am commenting is not about the science itself (ini which I an NOT an expert) but how the discourse here is dominated by a few zealots with strong opinions and n=1 or 2 experience.

      Yes, it's meant to be a conversation. My inpur into the conversation is to question why people make form assertions on the basis of personal opinion - even if they work in a scientific field.

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    38. Dion Kerfont

      logged in via Facebook

      In reply to Sue Ieraci

      Again, despite all the proof out there that the status quo is wrong, you deflect and dismiss simply because those that disagree aren't credentialed enough for your taste. You don't need to be a scientist to read and interpret data... and you certainly don't need to be a scientist to spot glaring logical fallacies in the conclusions of some of these "studies". I've seen a lot of studies where the conclusion simply does not have ANYTHING to do with the data. I've also seen data manipulated to reach the conclusion the scientist desires.

      I am very skeptical these days of those with "knowledge and experience"... they sit up on high and make all sort of pronouncements that we are simply supposed to sit and accept because they "know better". The last 40 years have shown me and a lot of others that these people don't know as much as they pretend to... or at the very least they manipulate data to fit pre-drawn conclusions.

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    39. Paul Savage

      Theme Leader, Biotechnology at CSIRO

      In reply to Sue Ieraci

      Quite right, I do not use anecdotes in my scientific publications, and actually if you read my publications -- synthetic organic chemistry -- you would realise just how funny that concept even was. But this isn't a scientific publication, it's a conversation, and the topic is carbohydrates in diet, not who is qualified enough to make a comment.

      Accusing me of making assertions based on anecdotes is drawing a very long bow indeed. It appears that you have misunderstand me and then got quite angry…

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    40. Gary Cassidy

      In reply to Sue Ieraci

      Sue, I don't think it's very helpful or respectful to start calling people zealots or any other derogatory term. If food science has been so successful where are the results? Sports performances perhaps. Certainly not in reducing lifestyle disease associated with diet. If the number of diet publications was correlated with general population health outcomes I think we'll find one of Rory's up is down scenario's.

      I really don't blame 99% of the population for being confused about diet (I certainly am), and having little trust in diet science.

      One clear outcome from a number of studies is that a typical western diet is associated with a number of adverse health outcomes. But, much of diet science still seems to be concerned with maintaining the western diet but just fixing it (i.e. low fat, low gi, no fuctose, low carb, etc). Meanwhile food has become so complicated that anybody would wonder how humans even survived up until now without such knowledge.

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    41. Citizen SG

      Citizen

      In reply to Dion Kerfont

      Personal anecdote is a poor predictor of risk, unfortunately.

      There's always some anecdotal excuse for remaining alive.

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    42. Steve Brown

      logged in via email @yahoo.com.au

      In reply to Rosemary Stanton

      "I wanted a reference that saturated fat is good for us"

      An observational study (I don't put any stock in it but I'll post it for anybody who does)

      However, compared with those with the lowest intake of full-fat dairy, participants with the highest intake (median intake 339 g/day) had reduced death due to CVD
      http://www.nature.com/ejcn/journal/v64/n6/abs/ejcn201045a.html

      There are protective effects of SAFA in anmial studies

      http://www.ncbi.nlm.nih.gov/pubmed/2915600
      http://www.ncbi.nlm.nih.gov/pubmed/7067902

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    43. Clifford Chapman

      Retired English Teacher

      In reply to Dion Kerfont

      You're making a good point here, Dion, and one with which I fully agree, despite the three childish negatives you've been given.

      I can't and won't mention names and details but where I live in W.A., medical incompetence of the highest order from 'health experts' resulted in the totally preventable and unnecessary death of two individuals I knew personally, and because of the experiences I have lately been going through with my own dear wife and the very serious medical problem she now has - a…

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    44. Rosemary Stanton

      Nutritionist & Visiting Fellow at University of New South Wales

      In reply to Steve Brown

      Steve

      Your first study http://www.ncbi.nlm.nih.gov/pubmed/2915600 is a 1989 study of alcoholic liver injury in rats - not quite relevant.
      The 2nd one
      http://www.ncbi.nlm.nih.gov/pubmed/7067902 is even older 1982 on rats given 2% cholesterol in their diet while levels of particular liver enzymes were measured - also not relevant and no mention made of protection from saturated fat.
      The 3rd rat study (1986) compared medium chain triglycerides with long chain triglycerides and found the MCT…

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    45. Steve Brown

      logged in via email @yahoo.com.au

      In reply to Rosemary Stanton

      Why is the first study not relevant Rosemary? It clearly demonstrated that the difference between rats getting alcholic liver injury was how much saturated fat was contained in their diet.

      The second study, I gave you the wrong link there sorry. Here is the correct one:
      http://www.ncbi.nlm.nih.gov/pubmed/663662
      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1805500/

      Your response to the 3rd study confuses me- the fact that the MCT rats didn't gain as much weight is a bad thing?

      This is getting…

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    46. Sue Ieraci

      Public hospital clinician

      In reply to Gary Cassidy

      Gary - you wonder how humans have survived up til now? By reproducing well over replacement value, and by reproducing before they die.

      Like the entire animal kingdom, nature wastes a significant number of the population.

      Unlike other species, though, humans have found a way of suriving by modifying a lot of "natural" factors. SO, we have agriculture, transport of food to poor growing areas, irrigation, health care, vaccination, obstetrics...and so much more. (I'm not getting into the discussion…

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    47. Paul Savage

      Theme Leader, Biotechnology at CSIRO

      In reply to Sue Ieraci

      Sue Ieraci: "We don't seem to have this hatred of authority in areas like engineering or nuclear physics - I guess the difference in diet/nutrition is that everyone is their own expert in their own experiment."

      "Hatred" is a bit emotive but you raise an interesting, if off-topic, point. The fact that with diet everyone is their own experiment may be part of the reason that "authority figures" are questioned but I suspect it goes beyond that. In sciences that deal with highly complex, multi-variate…

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    48. Sue Ieraci

      Public hospital clinician

      In reply to Paul Savage

      Paul - you present a thoughtful discourse - thank you. However, I see some different perspectives from working within clinical medicine.

      It's easy for people to allege arrogance and rigidity - but that's not what I experience daily. To keep up my knowldege of the literature in my own spcialty area, and to maintain my critical analysis skills in medical research, I go to journal clubs, conferences, workshops, M&M meetings - ongoing education is a legal requirement of my registration. I see approaches…

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    49. Gary Cassidy

      In reply to Sue Ieraci

      Hi Sue,

      "We don't seem to have this hatred of authority in areas like engineering or nuclear physics" -
      I think if peoples computers started getting slower and slower every year, while at the same time computer scientists and engineers were increasing their understanding of electronics and publishing evermore study results, then people would probably become more sceptical of the importance of computer scientists and engineers. Many computer users would probably start to offer advice on how to…

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    50. Gary Cassidy

      In reply to Sue Ieraci

      "the idea of "fructose is poison" came from a populist author who is an ex-lawyer"

      Not Really.

      "Pure, White and Deadly", John Yudkin, 1972. Physiologist and scientist.

      "Sugar: The Bitter Truth", Robert Lustig, 2009. Professor of Clinical Pediatrics, at the University of California.

      Personally (after reading/viewing the above) I think there is a reasonable chance that excess fructose is detrimental to good health. Just as excess salt, saturated fat, alcohol is detrimental.

      I've been (mostly) avoiding sugar added foods for a few months. Feeling better (in a number of ways) than before so I'll stick with it.

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    51. Sue Ieraci

      Public hospital clinician

      In reply to Gary Cassidy

      Thanks, Gary. You just illustrated my point beautifully.

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    52. Gary Cassidy

      In reply to Gary Cassidy

      lol. What point would that be Sue? An intolerance of anybody sharing a personal experience?

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  4. Sue Ieraci

    Public hospital clinician

    “Eat food. Not too much. Mostly plants.”

    ....and - ignore the fads.

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    1. Steve Brown

      logged in via email @yahoo.com.au

      In reply to Sue Ieraci

      “Eat food. Not too much. Mostly plants.”

      that sounds like a fad

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  5. Paul Rogers

    logged in via Twitter

    It's heartening to read some sensible and accurate views in the nutritional sciences realm these days.

    Unfortunately, judging by the comments and ratings (and rantings) here, the 'nonsense' crowd are well entrenched.

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    1. Sue Ieraci

      Public hospital clinician

      In reply to Paul Rogers

      Paul - it's fascinating how all the zealots come out on the dietary topics. It seems that, because everyone eats, everyone must be an expert.

      This is one of those topics, like parenting, where everyone feels that their personal opinion is valid, whether they have studies chemistry, physiology and nutrition or not.

      It must be frustrating for those who are actually trained and practising in this area, and who are across the evidence.

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    2. Paul Rogers

      logged in via Twitter

      In reply to Sue Ieraci

      Sue, yes, it drives me to distraction. I used to think the internet would be a great tool for teaching and informing people of evidence-based knowledge in the health and wellness sciences.

      Yet often I think it has actually worked in reverse. The ones who make the most noise tend to be faddists, zealots and opportunists, and in some sectors those opinions are being increasingly adopted by lay observers. Sad.

      Healthy eating is not too complicated or difficult, as you and Rosemary Stanton (and Pollan) have pointed out. Some exercise or physical activity is essential of course, for the able bodied, and the two should be combined into some sort of 'wellness' pyramid.

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    3. Sue Ieraci

      Public hospital clinician

      In reply to Paul Rogers

      Paul - I see two things at play here.

      First, the wide access to scientific papers on the net means that published research is not just read by an informed audience (who knows the underlying principles and practice - the CONTEXT if you like) - but by anyone who can read. I'm not saying this research should be hidden, but it is so easy to misinterpret if you don't understand both the context and critical analysis of research.

      Second, we have a post-modernist cultural view that everyone's view…

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    4. John Wright

      Director

      In reply to Sue Ieraci

      Sue, Paul
      Your earlier comments are spot on. Currently these is little opportunity for debate without it becoming polarised. This is one of the reasons why the earlier weight loss series on the Conversation was so popular.

      In May in Washington there was a Metabolism and Diet meeting that attempted to bring discordant views under one roof and I am aware a similar event will occur in Oxford in November, but these events are few.

      In September the ICD will be in Sydney, a quick look at the academic…

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  6. Leigh Miranda

    Gym Owner

    I'm afraid that this article is perpetuating assumptions with diet that are just not correct. A calorie is not a calorie.
    The crucial determinant is the impact that the food we consume has on our insulin levels. If insulin is present in our blood stream we cannot access our fat stores as an energy source. If an excess of insulin is present - such as when we consume high GI food and drink, we store the carbs (as glycogen) and when the reservoirs are full (about 500gms in an adult) we store the excess…

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    1. Paul Rogers

      logged in via Twitter

      In reply to Leigh Miranda

      No, Gary Sacks is correct, and you are incorrect. The body stores everything in excess of energy requirements as fat -- even fat of course. If you replace carbohydrate with more fat, as most low-carb diets suggest, any excess will be stored.

      Even so, in low-carb or high-carb diets, stored fat can be, and is mobilised for energy purposes. In energy-balanced diets, insulin does its storage work and subsides, leaving plenty of opportunity for fat mobilisation for energy purposes. It makes no sense at all to say that a diet in which you eat more fat promotes weight loss, unless the total energy of the diet is reduced.

      The other aspect you have missed is that protein is a potent inducer of insulin response (Holt et al), and some protein sources are equal to or superior to carbohydrate in this respect.

      Gary Taubes is an outlier in the nutrition community and his ideas are well outside the mainstream, proven science.

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    2. Gary Campbell

      RN

      In reply to Leigh Miranda

      For those wishing to view the original text of the quoted document try http://www.archive.org/stream/corpulen00bantletteronrich/corpulen00bantletteronrich_djvu.txt

      As is clearly evidenced (Section 10) by the consumption of bread, fruit (Glucose/Fructose), fortified wine (added sugar), and biscuits, this is clearly NOT a "Low carb" diet, simply a reduced calorie diet effecting the same result of weight loss.

      Section 11 gives some idea about the limits of total consumption amounts (quite limited) during the "diet", and further down you can compare with the excessive amounts of consumption before the "diet". From this alone you can simply see that it is a calorie controlled diet, that coincidentally has removed a lot of the "junk food" of the era. This gentleman's problem was not excess carbs, but excess calories in general, any reduction of calories by any means would have effeted the same weight loss.

      See my statement below about energy......

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    3. Sue Ieraci

      Public hospital clinician

      In reply to Leigh Miranda

      Leigh - a calorie (kilojoule in our system) is a standard measure of ENERGY. Of course a calorie is a calorie - the same as a kilometer is a kilometer and a minute is a minute

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  7. Geoff Russell

    Computer Programmer, Author

    Good article. There have been some studies showing surprising results but they are usually minor. And Leigh Miranda's mention of the CSIRO diet is misleading. Sure the CSIRO Total Wellbeing Diet books TOLD the million people who bought them that in their studies people on the high protein diet lost more weight than people on the control diet ... but it didn't actually happen.

    Quoting from the published peer reviewed study: "Weight loss was 7.3 +/- 0.3 kg with both diets." http://www.ncbi.nlm.nih.gov/pubmed/15941879

    That's the problem with diet books ... people can misrepresent results any way which suits their agenda. Who bothers checking when it tells them what they want to hear? The CSIRO board was told prior to the release of the second edition of the Total Wellbeing Diet that red meat diets raise bowel cancer risk, but the book told people the opposite.
    (Plug: http://perfidy.com.au)

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    1. Colin MacGillivray

      Architect, retired, Sarawak

      In reply to Geoff Russell

      "By the way, our bodies burn a mix of glucose and fatty acids as fuel - even when we are asleep. "
      I sleep with a fan but without aircon, where I live on the equator (150kms north actually) and lose nearly a kilo of weight each night. Almost 100% humidity 28C.
      Now that's a diet that could catch on!
      (Obviously it's mostly water, but don't tell the punters.)

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  8. Leigh Miranda

    Gym Owner

    Two comments Geoff Russell.
    Firstly, just every diet works because anyone that is going to give it a fair go will immediately eliminate the things that they know are "wrong"; sweets, chips, cakes, pies, pastries, chocolate, soft drink - all the high GI foods - the main culprits.
    Secondly, if you delve a bit further into the red meat criticisms you'll find that they included a lot of processed meat - sausages, hamburger, salami etc.
    (I should have made the point that the idea is to avoid REFINED AND PROCESSED carbohydrates and protein.) I would have thought that our own evolution was proof enough that unrefined red meat couldn't be bad for you.

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    1. Sue Ieraci

      Public hospital clinician

      In reply to Leigh Miranda

      Leigh - "refined" is a term applied to cereals - relating to removal of the husk (which is where a lot of vitamins are).

      What is "refined" meat?

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    2. Leigh Miranda

      Gym Owner

      In reply to Sue Ieraci

      The space available for comments doesn't really allow an opportunity to expand on many arguments, particularly when they may not be main stream ideas.
      There are elements of mainstream theory that have been corrupted by vested interests, particularly the powerful sugar lobby both here and in the U.S.
      It's only a few short years ago that we were being told that a healthy diet was high carbohydrate and low fat; that along with the diet foods industry proliferation of "low-fat" products coincided with the blossoming of the overweight and obesity epidemic in Australia.
      I'm well aware that I set myself up for criticism when I disagree with published articles but that's OK. I'm happy to put my name to it.
      This, however, is just pedantic and does you a disservice.
      I said "refined and processed carbohydrates and protein" and I referred to "processed meat - sausages, hamburgers, salami, etc."
      In your zeal to find fault with other people's opinion you haven't properly read the post.

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    3. Sue Ieraci

      Public hospital clinician

      In reply to Leigh Miranda

      No, Leigh - I did read your post.

      You wrote: "I would have thought that our own evolution was proof enough that unrefined red meat couldn't be bad for you."

      I can't make sense of this. It's nothing to do with my zeal. It reminds me of a type of "nostalgic naturalism" about ancient diets - which neglects ancient health outcomes.

      I guess that, reading the opinions here of the author and other people trained and experienced in this area, I have trouble accepting "I'm well aware that I set myself up for criticism when I disagree with published articles but that's OK. I'm happy to put my name to it."

      On what basis does "putting your name on it" give non-evidence-based personal opinions any validity?

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    4. Dion Kerfont

      logged in via Facebook

      In reply to Sue Ieraci

      "Refined" = processed, Sue... don't be obtuse.

      The fact is that processed meat is commonly consumed with a lot of processed (refined) carbohydrates: pizza on white flour crusts, burgers and hot dogs on white flour buns, etc. To single out the meat as the solitary cause is not very scientifically sound.

      Most nutrition studies are observational. The only thing an observational study can show you is correlation. Correlation does NOT equal causation... a mistake I see most people make... even scientists that are supposed to know better. Risk factors are also presented as a percentage of relative risk rather than actual risk because relative risk is a higher number and is great for sensationalism that the health media just gobbles up and regurgitates.

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    5. Citizen SG

      Citizen

      In reply to Dion Kerfont

      refined and processed are different concepts when applied to foodstuffs and may or not be unhealthy. For example, cutting and cooking raw foods is processing but confers enormous advantages for ancient and modern humans as it allows access to energy substrates and vitamins that are often inaccessible in the raw product. It is a myth to assume that raw foods are somehow more natural than cut and cooked foods.
      The nature of processing and refinement is obviously the issue, in that what doe highly processed modern foods leave in and what do they add in the process. It is not refinement and processing per se, it is the type of process and the end nature of the foodstuff.

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    6. Citizen SG

      Citizen

      In reply to Dion Kerfont

      refined and processed are different concepts when applied to foodstuffs and may or not be unhealthy. For example, cutting and cooking raw foods is processing but confers enormous advantages for ancient and modern humans as it allows access to energy substrates and vitamins that are often inaccessible in the raw product. It is a myth to assume that raw foods are somehow more natural than cut and cooked foods.
      The nature of processing and refinement is obviously the issue, in that what doe highly processed modern foods leave in and what do they add in the process. It is not refinement and processing per se, it is the type of process and the end nature of the foodstuff.

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    7. Sue Ieraci

      Public hospital clinician

      In reply to Dion Kerfont

      Dion says "Most nutrition studies are observational."

      Do you follow the nutrition/ metabolic/diabetic research, Dion?

      You must have missed a few of the RCT's:
      "A meta-analysis of randomised controlled trials (RCT) among healthy normotensive and essential hypertensive elderly patients to determine the effect of high salt (NaCl) diet of blood pressure"

      "A systematic review of the evidence regarding efficacy of obesity prevention interventions among adults"

      "Scientific Evidence of Interventions Using the Mediterranean Diet: A Systematic Review"

      "RCT of a High-protein Diet on Hunger Motivation and Weight-loss in Obese Children: An Extension and Replication"

      etc

      You might do well to resist making pronouncements without checking their validity first.

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    8. John Wright

      Director

      In reply to Sue Ieraci

      Sue I find your selection of nutrition RCT's interesting, here are some others you may have chosen not to read;

      Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial. Gardner 2007

      You can access the 2008 review of the data - particularly as it relates to IR here http://www.ncbi.nlm.nih.gov/pubmed/18268511

      There will also be a 2012 update I understand…

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    9. Dion Kerfont

      logged in via Facebook

      In reply to Sue Ieraci

      Sue, a few RCTs doesn't mean that the majority of nutritional information isn't gleaned from observational studies. All the sensationalistic headlines in newspapers telling us things like "Egg Yolks are as bad as Cigarettes!" are based on observational studies, not controlled clinical trials.

      However, after reading a statement from one of the former editors of the New England Journal of Medicine... I'm much less inclined to take a lot of these studies at face value.

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    10. Sue Ieraci

      Public hospital clinician

      In reply to Dion Kerfont

      Dion - those "few" RCTs were just what I found in the first few seconds - not a representative sample.

      Sensational headlines do not reflect the body of nutritional research.

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    11. Sue Ieraci

      Public hospital clinician

      In reply to John Wright

      John - don't read too much into my "selection" of papers - I was just trying to show Dion that these controlled studies are easy to find - I just posted the first few that ai found.

      Michael Faraday may have been a wise man, but the philosophers of old were essentially also the scientists of the day, because they had very limited technology with which to measure things.

      Many aspects of science are now directly measurable - so there is less need to creat unverified models. Scientific modesl are continuously developed and reviewed as new evidence or information emerges. If Faraday had the technology available today, I doubt that he would ignore it.

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  9. Rosemary Stanton

    Nutritionist & Visiting Fellow at University of New South Wales

    One of the problems inherent in all these discussions is that people quote diets by their macronutrient content but we don't buy macronutrients, we buy foods. A few foods contain a single macronutrient - for example, sugar is pure carbohydrate and oils are pure fat, but most foods contain a variety of macronutrients. Rolled oats, for example, contain almost as much protein as eggs, plus fat (including some essential fatty acids) and carbohydrate. They're also a good source of dietary fibre and many…

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    1. Steve Brown

      logged in via email @yahoo.com.au

      In reply to Rosemary Stanton

      "The World Cancer Research Fund reviews studies and rates the evidence for high consumption of red meat (fresh as well as processed, Leigh) as 'convincing' for colorectal cancer. (Note: 'convincing is its highest rating.) Since Australia has a high incidence of colorectal cancer, I wouldn't rate a high red meat diet as 'promoting health'."

      The red meat-colon cancer claims have only ever been half true:

      A counter study, however, by independent analysts, Exponent, drew completely different…

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    2. Geoff Russell

      Computer Programmer, Author

      In reply to Steve Brown

      Probably something is killing the Argentinians even faster than bowel cancer. The life expectancy is only 75, so you need data on the disease profile.

      You can get a handle on the back ground rates (rates without red meat) by looking at Japan prior to
      the addition of red meat. It's no good looking at African countries with a life expectancy of 60 ... there are too many competing diseases of poverty.

      But Japan has long had a high life expectancy. The population growth has
      been slow and the…

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    3. Rosemary Stanton

      Nutritionist & Visiting Fellow at University of New South Wales

      In reply to Steve Brown

      Steve

      I find it hard to believe that you are happy to take information from a website dedicated to marketing beef in preference to a wealth of data dn regularly updated reports from a team of scientists not funded by industry.

      The report you quote is dated May 2008 and it relies on claims made by Dr Alexander Dominik from Exponent, and funded by the Beef Checkoff through the National Cattlemen's Beef Association and The National Pork Board (see http://www.beefresearch.org/redmeatandprocessedmeatconsumptionandcancer.aspx

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    4. Steve Brown

      logged in via email @yahoo.com.au

      In reply to Geoff Russell

      "The WCRF didn't just make a decision using statistics, but considered the biochemistry ... the full causal chain."

      They failed to account for the variables and made a wholesale swipe against all red meat. It's really poor science. There are quite a few studies showing that unprocessed red meat simply doesn't have the same effects as the processed meats. For example

      http://www.ncbi.nlm.nih.gov/pubmed/20479151

      If red meat does indeed cause colorectal cancer then why aren't the Argentinians…

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    5. Sue Ieraci

      Public hospital clinician

      In reply to Steve Brown

      Steve - are you assuming that bowel cancer has only a single risk factor? Maybe Argentinians eat a lot of red meat - what else do they do or not do that affects their cancer risk (apart from longevity, as Geoff Russell says).

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    6. Rosemary Stanton

      Nutritionist & Visiting Fellow at University of New South Wales

      In reply to Steve Brown

      Steve

      The first study you quote refers to coronary heart disease and diabetes - not cancer.

      The second paper is interesting and is backed by a ncouple of other studies (all in Asian populations). The average red meat intake in these Japanese people (cases and controls) was 43g/day. Case control studies are less rigorous than cohort studies, but it does appear that at low levels of red meat intake, there is no increased risk of colorectal cancer apparent. Such studies have helped set an appropriate limit for red meat intake. WCRF sets this at 500g/week.

      Healthy eating is rarely a case of all or nothing. As we've noted before, small quantities of many foods are fine.

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    7. Geoff Russell

      Computer Programmer, Author

      In reply to Steve Brown

      Yes, there are plenty of changes in Japanese lifestyle, but red and processed meat is the only one for which there is solid evidence of a bowel cancer link. The other nice little feature of the Japanese data is the ratio of bowel cancer in men and women. Before the dietary change, the rate was the same in both sexes ... as it is around the world in low meat countries. But once you add red meat, the ratio changes. Now who eats the most red meat, men or women. I don't have any data, but I'd be predicting that in Japan its men. I'd also be predicting that the distribution is highly skewed ... ie., that not many people eat red meat but those that do eat far more than their share. ... because red meat is very expensive in Japan. So if anybody has some detailed nutrient intake data, I'd love to see it.

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    8. Paul Rogers

      logged in via Twitter

      In reply to Steve Brown

      Beyond the WCRF determinations on red meat and colon cancer, and the more recent systematic reviews and meta-analyses, what impresses is the apparent similar effect across countries and different ethnicities, for example study populations in the US, Europe and Asia.

      BTW, in the 2011 PLoS One meta-analysis by Chan, colorectal cancer risk for consumption of 'fresh red meat' and 'processed meat' was almost identical.

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    9. Geoff Russell

      Computer Programmer, Author

      In reply to Paul Rogers

      I haven't looked at this Paul, but in most studies the serving sizes of
      red and processed meat are different ... so risk associated with
      30g processed meat is similar to 100g fresh red meat.

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    10. Paul Rogers

      logged in via Twitter

      In reply to Geoff Russell

      Geoff, yes that could be so. I was pointing out that it is not correct to claim that the colorectal cancer risk only applies to processed meat.

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    11. Michael James

      Research scientist

      In reply to Paul Rogers

      Of course it could be both, ie. processed meat might make a contribution to CC that is higher per gram consumed, AND consumption of red meat above certain thresholds might make its contribution. Genetics will superimpose a powerful effect, and in CC especially needs to be factored in to make any sense of data.

      From my experience, admittedly more than a decade ago, the Argentinians and Brazilians eat a lot less processed meat than Americans. On the other hand they also eat a lot more charcoal-grilled…

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    12. Steve Brown

      logged in via email @yahoo.com.au

      In reply to Rosemary Stanton

      "The first study you quote refers to coronary heart disease and diabetes - not cancer."

      That was just to highlight the differences between red meat and processed red meat.

      "....but it does appear that at low levels of red meat intake, there is no increased risk of colorectal cancer apparent"

      The Argentines still look like the elephant in the room to me.

      If the supposedly bad effects of red meat are dose dependent then the biggest consumers should have the most colorectal cancer. When you consider the data I posted then clearly this isn't the case!

      http://www.indexmundi.com/agriculture/?commodity=beef-and-veal-meat&graph=per-capita-consumption
      http://globocan.iarc.fr/factsheets/cancers/colorectal.asp

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    13. Steve Brown

      logged in via email @yahoo.com.au

      In reply to Rosemary Stanton

      "I find it hard to believe that you are happy to take information from a website dedicated to marketing beef in preference to a wealth of data dn regularly updated reports from a team of scientists not funded by industry."

      Those criticisms about the quality of the red meat=poison studies have been leveled by a lot of people, not just those connected with the beef industry.

      I judge a claim on the quality of the evidence behind it, not for any other reason.

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    14. Steve Brown

      logged in via email @yahoo.com.au

      In reply to Paul Rogers

      "BTW, in the 2011 PLoS One meta-analysis by Chan, colorectal cancer risk for consumption of 'fresh red meat' and 'processed meat' was almost identical."

      After reading so many hopelessly confounded observational studies on the red meat scare I can say that I have no energy left to read a large review of them!

      Even the much vaunted Harvard study released earlier this year regarded hamburgers as 'unprocessed meats'. It becomes very boring after a certain point.

      Where are the clinical trials?

      I still don't understand why so many researchers insist on using epidemiological studies to prove the ills of certain foods. I can't accept that they have forgotten that correlations aren't causative effects so perhaps it's just way of keeping the research money rolling in.

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    15. Steve Brown

      logged in via email @yahoo.com.au

      In reply to Geoff Russell

      "but red and processed meat is the only one for which there is solid evidence of a bowel cancer link"

      Epidemiology is really a very pointless and utterly confusing way of trying to prove the ill effects of a food. There is always going to be some variable which is overlooked and you just end up chasing your tail.

      There have been countless groups of humans who have eaten large amounts of red meat and were free of the diseases attributed to it's consumption- Masai and other African herdsman, Native Americans etc. It's been part of the human diet since the get-go.

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    16. Geoff Russell

      Computer Programmer, Author

      In reply to Steve Brown

      That's because hamburgers ARE unprocessed meat. It's just minced beef.

      Fat levels vary depending on country ... McDonalds in Australia has MORE fat in its burgers than in the US. There are two things you can do with cattle, mince em or cut em. Cuts make for more waste, so the industry loves burgers because they don't have to throw out so much "valuable" fat. Meat Industry scientists tell me that its very unusual to use beef as processed meat ... some technical issues about the type of fat which…

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    17. Steve Brown

      logged in via email @yahoo.com.au

      In reply to Geoff Russell

      "That's because hamburgers ARE unprocessed meat. It's just minced beef."

      You may want to look at the ingredients next time you are the supermarket. You'll often find they contain preservatives, fillers and all sorts of other junk. It's not pure beef by any stretch.

      To dismiss the significant differences in processed meats to red meats (did you see the other study I posted?) and cooking methods as irrelevant nitpicking makes me think you are driven by ideology more than a quest for accurate…

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    18. Paul Rogers

      logged in via Twitter

      In reply to Steve Brown

      Truly, Steve Brown, you make Sisyphus look like a novice. The World Cancer Research Fund and its associated cancer organisations worldwide utilises the services of some of the best cancer epidemiologists available, including from Australia.

      If certain studies were excluded from their deliberations, you can be sure there was a good 'quality' reason for that. If you challenge the wide data base and supportive experimental and epidemiological evidence they have presented regarding red meat consumption and colon cancer (dose-related of course), then you challenge the very basis of our health and medical sciences.

      I understand that certain industries don't like this data, and that, like other industries challenged on their health impacts, they will fight relentlessly with obfuscation and misinformation. But I can assure you, that rock will get increasingly heavy.

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    19. Steve Brown

      logged in via email @yahoo.com.au

      In reply to Paul Rogers

      "dose-related of course"

      I've already shown you that this claim doesn't hold up yet you persist with it.

      "The World Cancer Research Fund and its associated cancer organisations worldwide utilises the services of some of the best cancer epidemiologists available,"

      It wouldn't matter if they were the best epidemiologists or worst. This research cannot prove a causal link.

      Unfortunately that is a rather important point which seems to be lost on the myriad of health gurus and researchers out there who quote this stuff.

      "If certain studies were excluded from their deliberations, you can be sure there was a good 'quality' reason for that"

      Why? Because of the prestige of the institution and the credentials of it's employees?

      Anybody who uses that as a basis to determine the quality of the science has basically dealt themselves out of the conversation.

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    20. Paul Rogers

      logged in via Twitter

      In reply to Steve Brown

      Well . . . the tobacco lobby also claim there is no causal link with lung cancer either, as did the asbestos companies for many years. It's pedantic and it does not protect public health when the evidence is "convincing", as it is in the case of excessive red meat consumption and colon cancer.

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    21. Rosemary Stanton

      Nutritionist & Visiting Fellow at University of New South Wales

      In reply to Steve Brown

      Steve

      The website you listed doesn't list colorectal cancer rates in Argentina, but http://www.worldlifeexpectancy.com/country-health-profile/argentina does. The rate for Argentina is 17.12/100,000 of population. Australia's rate is bad enough at 13.01/100,000 of population. It's not correct to claim Argentina doesn't have a major problem with colorectal cancer.

      You next post talks about Masai and other African herdsman, Native Americans. I can't find figures for rates of colorectal cancer in these groups, but I didn't really expect to because diagnosis would not have occurred and many other factors are also relevant, including their physical activity (decreases risk of colorectal cancer) and shorter life expectancy (rates of most cancers increase with age).

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    22. Rosemary Stanton

      Nutritionist & Visiting Fellow at University of New South Wales

      In reply to Steve Brown

      Steve

      If you don't like the huge number of well designed longitudinal studies, perhaps some of the studies looking at likely mechanisms to explain the correlation between meat intake and colorectal cancer might be more interesting for you.

      A few of the many studies investigating plausible mechanisms follow::
      Cross AJ et al. A large prospective study of meat consumption and colorectal cancer risk: an investigation of potential mechanisms underlying this association. Cancer Res. 2010 Mar 15;70(6):2406-1…

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    23. Steve Brown

      logged in via email @yahoo.com.au

      In reply to Rosemary Stanton

      Thanks for the links Rosemary.

      Looking at the Toden et al paper I see more than a difference between just red meat and white meat in the diets of the rats. The red meat group had significantly less beef tallow for the fat calories compared to the white meat group.

      That's important given what is known about the protective effects of the saturated fats (I don't know if you managed to read them but I posted a few rat studies down below which demonstrate this) so the worse outcomes in the red meat group could be because of it's great linoleic acid content rather than the red meat.

      There is a bit of evidence around showing that PUFA might be involved in gut disorders-

      http://www.ncbi.nlm.nih.gov/pubmed/19628674?dopt=AbstractPlus

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    24. Steve Brown

      logged in via email @yahoo.com.au

      In reply to Paul Rogers

      Was the case against tobacco build on a foundation of shaky data which proved nothing and was full of confounding variables or was it built on solid clinical evidence?

      The only people muddying the waters here are those who hold up as proof, research which is of the variety that can't ever be used to establish cause and effect and then fail to inform the public about this rather large hitch either because they don't understand it themselves or simply don't care.

      And if that wasn't bad enough…

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    25. Paul Rogers

      logged in via Twitter

      In reply to Steve Brown

      Sorry, but the Masai did have extensive atherosclerosis in this autopsy study of 50 Masai. Their lean weight and extensive physical activity probably protected them from overt heart disease.

      Am J Epidemiol. 1972 Jan;95(1):26-37. Atherosclerosis in the Masai. Mann GV, Spoerry A, Gray M, Jarashow D.

      More misinformation it seems.

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    26. Paul Rogers

      logged in via Twitter

      In reply to Steve Brown

      I found my copy of that Masai paper and here is what the authors say:

      "Measurements of the aorta showed extensive atherosclerosis with lipid infiltration and fibrous changes but very few complicated lesions. The coronary arteries showed intimal thickening by atherosclerosis which equaled that of old U.S. men. "

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    27. Paul Rogers

      logged in via Twitter

      In reply to Paul Rogers

      In contrast, this is what the autopsy on Nathan Pritikin (and his high-carb diet) revealed after his death:

      "The results of his autopsy were published in the New England Journal of Medicine and showed that Nathan Pritikin's arteries were free of any signs of heart disease, and were as "soft and pliable" as a teenager's. "In a man 69 years old," wrote pathologist Jeffrey Hubbard, "the near absence of atherosclerosis and the complete absence of its effects are remarkable."

      Unfortunately we did not get to see the results of Robert Atkins' autopsy.

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    28. Rodger Kensen

      Systems Analyst

      In reply to Rosemary Stanton

      Rosemary, my head agrees wholeheartedly with your evidence based approach to the red meat question. Certainly when going up against studies with vested interests.

      However the one issue is that while colorectal cancer may be a serious problem in the future, red meat is delicious now.

      You do touch on one area that I am curious about, is a radical change of diet more risky? The body is a pretty adaptable, so it tends to compensate (albeit with consequences) depending on the food consumed. If a body does adapt to a certain diet, is there a bigger risk of radical change?

      As for the polarised nature of the discussion it's like most things in life, there will be advantages and disadvantages of whatever choice is made. People seem to struggle with the idea of difference in people. Generally I find balance is the best way to go, I guess I learnt the lesson from Goldilocks that many seemed to have missed.

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  10. Guy Hibbins

    Clinical evaluator of therapeutic goods at Monash University

    I find the statement that a calorie is a calorie to be logically vague as it does not specify what equivalence actually means. While it may be true in terms of energy, (if all of the food is absorbed), it does not follow that it is true of satiety.
    Personally I have found that eating 400g of spinach (1 bowl or 100kCal or 420kJ) is more satisfying than eating half a Tim Tam which has equivalent calories.
    While everyone acknowledges the importance of feeding studies in determining the effects of various diets, they are rather artificial.
    In the real world people are not locked away, so it is necessary to design a diet which they will choose to eat.
    Part of the problem here is that nobody is spending vast sums of money advertising healthy foods.

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    1. Gary Campbell

      RN

      In reply to Guy Hibbins

      "I find the statement that a calorie is a calorie to be logically vague...."

      http://en.wikipedia.org/wiki/Calorie

      Nothing "vague" about a well defined, scientific measurement of energy.

      Calorie has NOTHING to do with satiety, nor was this article ever about satiety.

      "Part of the problem here is that nobody is spending vast sums of money advertising healthy foods." .....or exercise.

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    2. Paul Savage

      Theme Leader, Biotechnology at CSIRO

      In reply to Gary Campbell

      Gary, of course a calorie is a calorie in the strict chemistry sense. But the discussion here is about diet so people are using the term "calorie" in a broader context. I suspect you know that and are being deliberately obtuse. A calorie of glucose is energetically equivalent to a calorie of bran husks but the latter has its energy content tied up largely in a form that is not bio-available. Hence consuming these two "equivalent calories" will have quite different effects on human biochemistry, insulin…

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    3. Geoff Russell

      Computer Programmer, Author

      In reply to Paul Savage

      Why do CSIRO people keep saying this? Consider (for example) these
      three studies by CSIRO scientists:

      1. Long-term effects of a high-protein, low-carbohydrate diet on weight
      control and cardiovascular risk markers in obese hyperinsulinemic subjects

      2. Carbohydrate-restricted diets high in either monounsaturated fat or
      protein are equally effective at promoting fat loss and improving blood
      lipids

      3. Effect of an energy-restricted, high-protein, low-fat diet relative
      to a conventional…

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    4. Paul Savage

      Theme Leader, Biotechnology at CSIRO

      In reply to Geoff Russell

      Geoff, I'm not commenting on behalf of CSIRO and I'm not related to the group in CSIRO who did the diet research or produced the book. Unlike yourself (plugging an alternative book) I have no vested interest or financial motivation in this conversation -- just a personal interest.

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    5. Sue Ieraci

      Public hospital clinician

      In reply to Guy Hibbins

      "Part of the problem here is that nobody is spending vast sums of money advertising healthy foods. "

      Aren't they, Guy? I see ads on buses for bananas, oranges. Weetbix is one of the most popular breakfast cereals (best, of course, sans sucrose).

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    6. Sue Ieraci

      Public hospital clinician

      In reply to Paul Savage

      A calorie of glucose is energetically equivalent to a calorie of bran husks but the latter has its energy content tied up largely in a form that is not bio-available. "

      But, Paul Savage, isn't a food's caloric (kilojoule value) the amount of energy released when that substance is metabolised? How can that energy not be "bioavailable"? If no energy is released on consumption, the stuff releases no kilojoules, no?

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    7. Paul Savage

      Theme Leader, Biotechnology at CSIRO

      In reply to Sue Ieraci

      No. A material's calorific value (technically its "heat of combustion") is the amount of energy released when the material undergoes complete combustion with oxygen under standard conditions. In order to gain the entire calorific value of, say, glucose, it would need to be completely oxidised to carbon dioxide and water -- something that only typically happens under combustion. Anything that can combust has a heat of combustion and hence a calorific value in the technical, chemistry sense. But if…

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    8. Paul Rogers

      logged in via Twitter

      In reply to Paul Savage

      Paul Savage wrote: "The fundamental problem with a high GI diet is that it increases insulin production and that in turn triggers a hunger response, which some people are simply unable or unwilling to resist."

      Paul, seems to me the evidence for this is quite mixed, although I recognise that as the standard low-carb position. I could not find a conclusive systematic review of the complex science of satiety. Cochrane says some evidence for low-GI and weight loss, but this could be for reasons other than increased satiety.

      This is what Frank Hu and colleague (Harvard SPH) said recently (2011): "A number of studies have examined the role of dietary fiber, whole grains, and glycemic index or glycemic load on satiety and subsequent energy intake, but results remain inconclusive."

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    9. Paul Rogers

      logged in via Twitter

      In reply to Paul Savage

      "Glucose, fructose and sucrose are the easiest. Complex carbohydrates like bran are much more difficult."

      As a general rule, it's more like protein greater than carbohydrate, greater than fat -- thermic effect of food.

      Yes, TEF is a modifying factor, but in a dietary sense, it is pretty much inconsequential when you do the numbers. A calorie is still (mostly) a calorie!

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    10. Guy Hibbins

      Clinical evaluator of therapeutic goods at Monash University

      In reply to Sue Ieraci

      Well I do not have the exact relative figures, but I have not seen any ads for bananas or Weetbix on prime time television recently. They would likely be far too expensive. On the other hand we seel plenty of prime time advertising by the fast food chains. Former FDA Head David Kessler discusses unhealthy food promotions in his book The End of Overeating and points out that it runs to many billions annually.
      A 2009 study suggested that from one in seven up to one in three obese children in the USA might not have been obese in the absence of advertising for unhealthy food on TV. See Veerman JL et al., By how much would limiting TV food advertising reduce childhood obesity? Eur J Public Health. 2009 August; 19(4): 365–369.

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    11. Paul Savage

      Theme Leader, Biotechnology at CSIRO

      In reply to Paul Rogers

      Paul I agree with you that the issue of satiety (while eating) is very complex and the GI-related picture here is far from clear. What I was referring to was how after eating a high carb meal the blood sugar levels go very high, which prompts an insulin response, causing the blood sugar levels to drop below base-line some three hours later... hence triggering hunger. This is relatively easy to observe with a simple blood-sugar measuring device following a meal. Or easy to observe by experiment. Try a no-carb, high fat, breakfast like bacon and eggs and see how hungry you feel by mid morning. Then the next day have a high carb breakfast with about the same calories, say several slices of white toast with honey and compare. Just anecdotal I know, but the results are pretty convincing.

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    12. Rosemary Stanton

      Nutritionist & Visiting Fellow at University of New South Wales

      In reply to Paul Savage

      Paul

      The factors that prevent or alter full combustion are taken into account in the energy values given to proteins, fat, carbohydrate and dietary fibre. Some recent data suggests that some of the fat in nuts is not absorbed and is excreted in faeces. This is a factor that may need to be taken into account and would reduce the energy values assigned to nuts..

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    13. Steve Bruhn

      logged in via Facebook

      In reply to Sue Ieraci

      Weeibix are wheat, just about the worst food you can pick, so they are not advertising what is healthy, just what they have.

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    14. Rosemary Stanton

      Nutritionist & Visiting Fellow at University of New South Wales

      In reply to Steve Bruhn

      Steve - how about some evidence for your statement on wheat. Wholegrain wheat is a great source of dietary fibre, many vitamins and minerals and also provides protein (about 11% in wholewhat breakfast biscuits).

      I appreciate that you found a way to lose weight that suited you, but there is a wealth of evidence that wholegrains (including wheat) are associated with reduced risk of many health problems, including obesity.

      Many of us appreciate the fact that wholewheat products like Weetbix and Vita Brits have resisted the temptation to decrease the wheat content in favour of added sugar. I think they deserve support rather than condemnation.

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    15. Dion Kerfont

      logged in via Facebook

      In reply to Rosemary Stanton

      Wheat, especially modern wheat is NOT good for you... no matter how you spin it. Check out Dr. William Davis' blog "Wheat Belly":

      http://www.wheatbellyblog.com/

      Wheat certainly is NOT a good source of vitamins and minerals... ever notice how products based on it are always fortified with additional vitamins and minerals? If it was so good, why would it need to be fortified?

      Grains = carbohydrates. Consuming grains will raise your blood sugar, which in turn raises your insulin levels and…

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    16. Rosemary Stanton

      Nutritionist & Visiting Fellow at University of New South Wales

      In reply to Dion Kerfont

      Dion

      By references, I meant something other than a blog - how about some peer reviewed evidence?

      Grains contain substantial amounts of proteins (11-12% for wheat, for example). And wholegrains don't need fortification. I think you're referring to refined and processed grain products. Nothing needs (or is) added to rolled oats, cracked wheat, wholegrains of wheat ground or smashed for use in bread (along with water, yeast and salt - no additives ina decent loaf).

      Humans are omnivorous and…

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    17. Paul Rogers

      logged in via Twitter

      In reply to Paul Savage

      Paul, even if that was true regarding animal protein and satiety, I would be very surprised if a high-fibre diet of around 0.5 gm/kg/bw/day was not as equally or more satiating than animal protein, especially when a good mix of soluble and insoluble fibre from wholegrains is included. Reasonable evidence for this exists.

      In addition, I'd like to see TEF values recalculated to include wholegrain carbohydrates and not just refined starches. My estimate is that there would be no or very little thermic advantage of animal protein over high-fibre carbohydrates. (See Rosemary's comment elsewhere.)

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    18. Geoff Russell

      Computer Programmer, Author

      In reply to Dion Kerfont

      Anecdotes seem to rule here! .... so ... I cycle on Saturdays with a bunch of guys (and 1 woman!). All except one are thin and look like they've been that way for ever. But, one by one, as I've met them, the story is much the same. They are almost all ex-fatties, about 100 kg and now back at race weight. They lost the weight and kept it off doing exactly what Rosemary and every other competent nutritionist recommends. The woman is now 52kg, down from 85kg ... she's a walking calorie counter. They all eat wheat ... and some indulge in junk occasionally after a 4 hour 2500 Calorie hard ride in the hills.

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    19. Paul Savage

      Theme Leader, Biotechnology at CSIRO

      In reply to Paul Rogers

      Rosemary Stanton said: "The factors that prevent or alter full combustion are taken into account in the energy values given to proteins, fat, carbohydrate and dietary fibre."

      If that is true then I agree from a pure energy perspective all calories are equal. However I'm curious then as to how these numbers are calculated. Heats of combustion are easy to calculate -- one simply burns, completely, a weighed sample of the material in a bomb calorimeter and measures the energy output. How is the metabolic…

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    20. Guy Hibbins

      Clinical evaluator of therapeutic goods at Monash University

      In reply to Rosemary Stanton

      Well Rosemary I eat frozen spinach but it is not hard to eat when you season it correctly.

      I lost 6kg in April and 5kg in July. Joel Fuhrman who advises people to eat this much cooked vegetable every day has one of the best published weight loss case series at 2 years with 24kg. See Sarter B, Campbell TC, Fuhrman J. Effect of a high nutrient density diet on long-term weight loss: a retrospective chart review. Altern Ther Health Med. 2008 May-Jun;14(3):48-53.

      Of course this was a case series…

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    21. John Wright

      Director

      In reply to Gary Campbell

      Thanks Rosemary for your reply. To save time I have responded to you in the message reply stream between yourself and Paul Savage.

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    22. Paul Rogers

      logged in via Twitter

      In reply to Paul Savage

      I'm not an expert in the metabolic sciences, but I'd be surprised if the standard values we use for available energy from protein, carbohydrate and fat were not averaged or meaned over a range of foods when these values were initially derived.

      When we use these values (Atwater factors), I don't doubt that we take a few liberties with unders and overs for various foods, but essentially, except for some minor differences in thermic values, those calorific standards apply reliably when calculating…

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    23. John Wright

      Director

      In reply to Gary Campbell

      In reply to the general communication about thermodynamics and the energy equivalence of different nutrients.

      1. We need to consider both the first and second laws and not just the first.
      2. Read Jequier 2002 regarding utilisable energy conversion.
      3. Read Feinman and Fine 2007 regarding Non Equilibrium Thermodynamics.

      Now before anybody jumps and say Bray (2012) says it is about calories only - have a look at Richard Feiman's critique of this - and the letter to Jama. Unfortunately you have to read his blog because Jama refused to publish the letter. The letter is at the bottom of the blog.
      http://rdfeinman.wordpress.com/2012/03/19/bray-et-al-shows-that-a-calorie-is-not-a-calorie-and-that-dietary-carbohydrate-controls-fat-storage/

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    24. Sue Ieraci

      Public hospital clinician

      In reply to Paul Savage

      Paul Savage - I may have missed something in your logic, but I can't see how the intrinsic "calorific" value of a food varies if you don't absorb it. The energy value only exerts an effect if the food is absorbed and metabolised.

      So, to take another example, you might eat a chocolate cake, and then take a purgative, so you don't absorb teh cake. Does that change the calorific value of the cake? You seem to be trying to make some sort of a distinction here that may not actually exist.

      To take an even more obvious example, a tub of lard may hav a high calorific value but it doesnt affect you if you don't eat it. That doesn't make its calorific value zero, however.

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    25. Sue Ieraci

      Public hospital clinician

      In reply to Dion Kerfont

      In saying "It also makes us fat and sick because it is not our natural food", Dion repeats the common myth that there is any form of "natural" diet - or that people who subsisted on only local foods had any health outcome benefits.

      Is the "natural diet" of a Masai the same as the "natural diet" of an Aztec, or a Papuan, or an Innuit?

      Is it "natural" to eat highly salted or dried vegetables over winter because nothing grows under the snow?

      Isn't it "natural" eat wheat as your staple in the…

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    26. Paul Savage

      Theme Leader, Biotechnology at CSIRO

      In reply to Sue Ieraci

      Sue, probably I'm not being very clear. All matter, whether food or not, has some "calorific value" in the strictest sense of a calorie being a unit of energy. This is known as the matter's "heat of combustion" (http://en.wikipedia.org/wiki/Heat_of_combustion) and it essentially describes the total energy value per weight of material. This is a physical property that can be determined by burning a known mass of the material in oxygen and measuring the energy output. So as in my example, in the thermodynamic…

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    27. Dion Kerfont

      logged in via Facebook

      In reply to Rosemary Stanton

      A better natural obstacle to overeating is saturated fat. It will leave you feeling fuller longer, without damaging the gut the way grains can.

      While it is a blog, Dr. Davis is a preventative cardiologist... and his advice to stop consuming wheat has done wonders for his patients. I also suggest you have a look at the writing of Gary Taubes, Dr. Mary Enig and doctors Micheal and Mary Eades.

      You mention Asians and rice... however Asians don't eat as much rice as we've all been led to believe... they eat more meats and vegetables.

      I also suggest you watch a couple of videos on YouTube... and watch them with an open mind: "Big Fat Fiasco" and "Science for Smart People" (both by Tom Naughton). Also look for a lecture by Dr. Andreas Eenfeldt titled "The Food Revolution". You might also want to look up Denise Minger and her thorough debunking of The China Study.

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    28. Dion Kerfont

      logged in via Facebook

      In reply to Sue Ieraci

      We've only been consuming grains for about 10,000 years... a miniscule amount of time when you consider we've been around for 2 million plus.

      Dr. Davis isn't "running on a hunch". He's thoroughly researched his position ever since he started recommending to his patients to eliminate wheat. He's seen a great deal of improvements in his patients that have followed that advice.

      Sorry Sue, I don't buy what the "experts" have been telling us for the past 40 years... because it has clearly NOT worked. The low-fat craze has led to nothing but increased diabetes, obesity and cancer. We've been steadily decreasing our intake of saturated fat over those past 40 years and increasing carbohydrate intake to compensate. So somehow, saturated fat is implicated in the increasing health crises... despite the fact that North Americans have been eating less and less of it. You don't have to be a scientist, nutritionist or doctor to see the logical fallacy we're looking at.

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    29. Geoff Russell

      Computer Programmer, Author

      In reply to Dion Kerfont

      I'd suggest you do some fact checking of what you watch on youTube and what you read. Me? I check as much as possible ... and when I find too many errors, I just stop reading. You soon learn who is trustworthy.

      So, how much rice do Asians eat? It's easy to check, here's the data.

      http://faostat.fao.org/site/368/DesktopDefault.aspx?PageID=368#ancor

      Asians eat huge amounts of rice ... of the 2706 Calories/day in the Asian food supply (averaged over 4 billion people), 777 Calories are rice…

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    30. Geoff Russell

      Computer Programmer, Author

      In reply to Dion Kerfont

      You think 10,000 years isn't enough for genetic and epigenetic modifications?

      Just 3 weeks is enough for epigenetic modifications. You can easily turn some cancer protective genes on and cancer promoters off (or vice versa) in that time. The paleo eating advocates are about 2-3 decades out of date in their knowledge of genetics. They think that the general stability of genes means we should live like we did aeons ago. It's rubbish. Our genome has lots of tricks to adapt without needing to change genes. Thank bloody goodness, cause we'd be in deep trouble if it didn't.

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    31. Sue Ieraci

      Public hospital clinician

      In reply to Dion Kerfont

      Dion - you say " his advice to stop consuming wheat has done wonders for his patients."

      Where has he published the health outcomes of his interventions?

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    32. Sue Ieraci

      Public hospital clinician

      In reply to Dion Kerfont

      Sorry, Dion - I don't buy what the zealots say. If people who spend their lives studying and researching the issue find it complex, how likely is it that the simplistic answers of the untrained will do better?

      Science represents the best possible model, based on the information or evidence available at the time. We now have amore sophisticated understanding of the various lipids than we had several decades ago.

      The main reason for the increase in conditions like cancer is greater longevity.

      Can the food/nutritional professionals here tell us whether there is any evidence for Dion's contention that "We've been steadily decreasing our intake of saturated fat over those past 40 years and increasing carbohydrate intake to compensate." ?

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    33. Paul Rogers

      logged in via Twitter

      In reply to Geoff Russell

      And in the Neolithic it didn't take long for lactose tolerance to deveop, ie lactase enzyme. Perhaps 5000 years?

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    34. Paul Rogers

      logged in via Twitter

      In reply to Dion Kerfont

      Dion, I don't agree with anything you have said, but I must correct you on the earliest recorded date for human processed grain consumption.

      Unless there is a more recent discovery, the oldest evidence for grain consumption is at the Ohalo II archaeological site in Israel, which is dated at 19,400 BP.

      Other evidence suggests that early humans may have been consuming grains long before that.

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    35. Clifford Chapman

      Retired English Teacher

      In reply to Sue Ieraci

      I question your third paragraph assertion here. Is there specific evidence for it other than more people succumbing to it as they age?

      Longevity cannot really be a cause of it, can it?

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    36. Geoff Russell

      Computer Programmer, Author

      In reply to Sue Ieraci

      "We've been steadily decreasing our intake of saturated fat ... " and the mortality rates from cardiovascular disease have dropped by 80% since the 1960s ... gosh, could it be that the official advice is right about saturated fat?

      http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737418530

      Of course some of the decline in deaths is due to statins. But for many people I've known, it's simple. Doctors tell them to reduce the bacon and eggs and similar junk, they do so and their cholesterol drops and
      they don't die.

      But the rates of saturated fat intake are still way too high in children with about 80% getting 40% too much saturated fat. Do some searching and you'll find autopsy studies showing teenagers with athlerosclerotic plaques on autopsy ... (they died in accidents) setting themselves up for problems in the decades to come.

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    37. Dion Kerfont

      logged in via Facebook

      In reply to Geoff Russell

      Funny how I've done the exact opposite of what you're recommending, yet my health is better than it has been in a very long time. You're right, it's not just about weight loss, it's about better health. The way I eat has improved my health, the weight loss has been a nice side effect.

      If you think you're somehow saving the planet by limiting or eliminating meat, you're sorely mistaken. Mono-crop farming will destroy the environment much faster than animal agriculture. Topsoil is being lost along with the nutrients it contains. The resulting crops will in turn contain less and less nutrients as time goes on. Eventually you end up with dead soil unable to support growth. The Middle East was once a vast forest of cedar... until the trees were cut down to create farmland. Check out "The Vegetarian Myth" by Lierre Keith.

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    38. Dion Kerfont

      logged in via Facebook

      In reply to Geoff Russell

      Cholesterol isn't the cause of heart disease; it is a symptom. People with "normal" cholesterol also have heart attacks. The main cause of heart disease is inflammation; caused by excessive consumption of carbohydrates and omega 6 in chemically processed seed oils. Cholesterol is there to repair the damage caused by this way of eating.

      Statins have been shown to reduce inflammation; this is why they appear to work... it has NOTHING to do with lowering cholesterol. Statins have also been shown to cause muscle damage; considering the heart is comprised mainly of muscle, it stands to reason that statins can cause the heart issues they supposedly prevent.

      Bacon and eggs aren't in any way junk. Considering my health has improved eating a lot of both, I simply cannot believe the standard dietary advice given these days.

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    39. Dion Kerfont

      logged in via Facebook

      In reply to Sue Ieraci

      In his blog that you refuse to read... "because it's a blog".

      I thought open-mindedness was supposed to be the cornerstone of scientific understanding. If you refuse to even browse through the material that has led me to question the status quo, then you are as close-minded as you profess me to be.

      I'll continue to improve my health by following the advice that is clearly working for me... which is definitely not the same advice that our government and the vast majority of the nutritional community dispense.

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    40. Dion Kerfont

      logged in via Facebook

      In reply to Paul Rogers

      Consuming them in the recommended quantities that we (on average) consume today or consuming them simply because they would have starved otherwise?

      In any event, they most likely soaked / sprouted the grains which does neutralize a good deal of the toxins they contain. I don't know about you, but I certainly never considered soaking or sprouting grains before consuming them... and the vast majority of the people consuming them today don't either.

      Modern wheat, however, is a completely different story.

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    41. Geoff Russell

      Computer Programmer, Author

      In reply to Dion Kerfont

      I'm glad your health is improving but there are probably more compassionate ways of fixing your problems.

      As for Keith. I did try to read her book ... got as far as the free bit on the net and pretty much threw up. She has some kind of wierd allergy to both getting facts right and logical argument. Here's a review from somebody who actually managed to finish reading it: http://bit.ly/O5NCWX

      Globally, meat is about 8% of Calories and meat produced by pure grazing systems is about 8.4% of that ... so all up a bit over half of one percent. And to produce that miniscule amount of meat has involved deforestation of epic proportions and extinction of wildlife. Paleo-nutters simply don't give a damn about anybody or anything except themselves.

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    42. Sue Ieraci

      Public hospital clinician

      In reply to Clifford Chapman

      Clifford - it works both ways.

      Most cancers ARE more common with advancing age - there is clearly a cumulative effect with greater longevity (as there also is with heart disease).

      However, there is also a spefici effect of aging on cell replication.

      Ultimately, we have to die of something.

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    43. Sue Ieraci

      Public hospital clinician

      In reply to Dion Kerfont

      "The main cause of heart disease is inflammation;"

      Wrong again, Dion - why do you persist with these proclammations?

      Inflammation has been shown to be a factor in coronary heart disease, superimposed on a lipid based plaque that ruptures and clots, occluding the artery.

      What you believe or don't believe isn't really of consequence to public health.

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    44. Sue Ieraci

      Public hospital clinician

      In reply to Dion Kerfont

      No - I didn't refuse to read it. I just didn't see his data there. Can you direct me to it?

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    45. Dion Kerfont

      logged in via Facebook

      In reply to Sue Ieraci

      Like I said, cholesterol is there to repair the damage caused by prolonged inflammation... so by mistake it has been implicated as a direct cause of heart disease. You still haven't addressed the fact that people with "normal" or even below normal cholesterol still have heart attacks. People eating a vegan diet (Micheal Clarke Duncan, for instance) have heart attacks.

      I could quote a few studies to back me up, but since you won't read them anyway I won't bother wasting my time and effort. If you can't be bothered, neither can I. It seems you only read literature that directly correlates with your opinions.

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    46. Paul Rogers

      logged in via Twitter

      In reply to Dion Kerfont

      Dion, that's called the "smoker's defence". Like . . . "I knew a guy who never smoked his whole life and yet he got lung cancer". Heart disease is multifactorial, but you can do the pertinent lifestyle things. Good luck.

      Actually, I've read more low-carb, Paleo, Weston Price blogs than you can imagine, and I've done it for at least 15 years, and followed up their dodgy literature and claims. I had my own direct online sub to Medline in the mid 80s, using a 300 bps modem, then the internet since 1992. I have on the shelf next to me every low-carb, Paleo book from Atkins, Sears, the Eades, Cordain etc -- and, naturally, more informative texts.

      Have you bothered to actually read stuff on the validated, evidence-based side of the nutrition debate, or is that not your style?

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    47. Sue Ieraci

      Public hospital clinician

      In reply to Dion Kerfont

      Dion - I have read more studies about acute coronary occlusion, and treated more patients, than you will ever imagine.

      Do you know anything at all about the sturcture and anatomy of coronary arteries? Do you know what plaque is in a coronary artery, and what happens when plaque ruptures? Do you know about diffuse vs locaised coronary occlusion, and how to manage the two? Do you know about Takotsubo Cardiomyopathy?

      I don't read literature "that correlates with my opinions - I FORM my opinions from the high quality literature. My own practice is visible and I am held accountable for my outcomes - I hardly need to read up on what an amateur zealot suggests.

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    48. Steve Brown

      logged in via email @yahoo.com.au

      In reply to Sue Ieraci

      "Sorry, Dion - I don't buy what the zealots say. If people who spend their lives studying and researching the issue find it complex, how likely is it that the simplistic answers of the untrained will do better? "

      I have to say Sue, that particular comment is all to indicative of the arrogance and authoritarian nature which has come to characterize too many people in the medical establishment. Taking advice from people on the basis of their education as opposed to the quality of the data they present…

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    49. Steve Brown

      logged in via email @yahoo.com.au

      In reply to Steve Brown

      And the statins thing is a myth. The drug companies and researchers have diddled the stats to make it seem as if they are bringing deaths down when they aren't. It's been written about by a lot of people.

      The idea that low cholesterol is desirable and conducive to good health is something which benefits only drug companies:

      Low Cholesterol is Associated with Mortality from Cardiovascular Diseases: A Dynamic Cohort Study in Korean Adults
      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3247776/

      Low cholesterol is associated with mortality from stroke, heart disease, and cancer: the Jichi Medical School Cohort Study.
      http://www.ncbi.nlm.nih.gov/pubmed/21160131

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    50. Sue Ieraci

      Public hospital clinician

      In reply to Steve Brown

      Steve - there is strong evidence for statins and improve outcomes in coronary disease - it is not a myth, and the finding has been re-produced multiple times. It's easy to find both the original research and the meta-analyses.

      There is now speculation that the statins are working through an anti-inflammatory effect rather than by lowering lipids per se, but they have been clearly shown to be beneficial in coronary disease outcomes.

      Pharmaceutical companies may not be the paragon of ethical marketing, but they do produce products that improve health.

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    51. Sue Ieraci

      Public hospital clinician

      In reply to Steve Brown

      Thanks for your advice, Steve.

      I was responding to Dion, who said "Sorry Sue, I don't buy what the "experts" have been telling us ...."

      Hence my reciprocal response.

      I may have over-used the word "zealot" but my point stands. I know the complexity of both the research and practice in my own area (not nutrition) - so I guess I am respecting the fact that similar complexity exists in professions or specialty areas other than my own. Many commenters here don't seem to acknowledge the limits of their own understanding of the area.

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    52. Paul Rogers

      logged in via Twitter

      In reply to Steve Brown

      Steve, studies that show increased mortality or CVD at low cholesterol levels are almost always confounded by co-morbidity, that is, other illness that predispose to low cholesterol -- cachexia in cancer for example, alcoholics and smokers.

      I only looked at the Korean cohort, but sure enough, here is what the authors said in explanation:

      "Similar inverse, 'J' or 'U'-shaped relationships between lipid levels and all cause mortality have been reported in other populations and are thought to reflect a high prevalence of co-morbid disease in patients with low cholesterol levels." AND:

      "Although the increase in mortality at low levels of TC was explained by chance, regression dilution bias, competing risks, cause-effect, effect-cause, and residual confounding such as smoking . . ."

      Did you actually read that study?

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    53. John Wright

      Director

      In reply to Sue Ieraci

      Hi Sue
      Well you have got me interested again now, I was getting rather fed up with the playground.
      Maybe you would like to qualify your first statement. Are you including primary prevention, women, the under 50's, diabetics in your 'strong evidence' group? If so could you please provide links to the original research and not the meta-analyses which would be great.

      This is an area of longstanding interest to me having been involved in the development of some of the earlier landmark studies - so if you can update me I would be very grateful.

      The anti-inflammatory benefits of statins (of which I think there is a reasonable amount of consensus) opens some really interesting ideas WRT athlerosclerosis and perhaps refocusses research on endothelial damage rather than plaque formation as the bit that is interesting.

      In my experience Pharma Companies large and small, are about as honorable as the researchers they work with and you can read into that what you will.

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    54. Rosemary Stanton

      Nutritionist & Visiting Fellow at University of New South Wales

      In reply to Paul Savage

      Paul (and others who have raised this topic)

      Energy value of foods is calculated from the protein, fat, carbohydrate, dietary fibre and alcohol content. The combustion of these elements is modified by removing energy lost in faeces and urine.

      There's actually quite a reasonable explanation of the process in wikipedia (it can have some useful stuff!) at http://en.wikipedia.org/wiki/Atwater_system

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    55. Rosemary Stanton

      Nutritionist & Visiting Fellow at University of New South Wales

      In reply to Guy Hibbins

      Guy

      I agree that people can't be randomised to a particular diet. I dislike diets because the majority of people can't stick to them for long. That includes high protein/low carb diets. people need to change their eating patterns (and add more movement and exercise) to something they can do forever. I didn't mean to imply that eating a lot of vegetables was problematic. Personally, I eat loads of vegies - most of them freshly picked from my garden.

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    56. Steve Brown

      logged in via email @yahoo.com.au

      In reply to Paul Rogers

      "Although the increase in mortality at low levels of TC was explained by chance, regression dilution bias, competing risks, cause-effect, effect-cause, and residual confounding such as smoking . . ."

      Those are proposed explanations. I don't rule them out but I think the findings of the study are no real surprise when you consider the mounting evidence showing how low cholesterol compromises people's immune systems and makes them susceptible to infection

      http://www.ncbi.nlm.nih.gov/pubmed/9245545
      http://www.ncbi.nlm.nih.gov/pubmed/10920496
      http://www.ncbi.nlm.nih.gov/pubmed/15706008

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    57. Sue Ieraci

      Public hospital clinician

      In reply to John Wright

      Hi, John
      I went to an evidence review workshop on this topic recently, so I'll dig out the studies.

      As you are alluding to, it has been established that the major effect effect is not in primary prevention but in outcomes in established coronary disease -after the first espidoe of acute coronary syndrome.

      One of the earlier large studies was this one in NEJM:
      "The Long-term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group. Prevention of cardiovascular events and death…

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    58. Paul Rogers

      logged in via Twitter

      In reply to Steve Brown

      First, any such studies should be controlled for existing illness in low-cholesterol populations. Second, those papers say absolutely nothing about immune system integrity in the low-cholesterol cohorts.

      Variations in t-cell counts within norms tell us nothing, and in addition, t-cell responses to chronic inflammation, which may exist at high cholesterol levels, are quite complex and do not deserve trivial reference and interpretation. (Look it up.)

      Third, you would have to explain why human…

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  11. Murray Webster

    Forestry-Ecology Consultant/Contractor

    I can only speak for myself. I had been doing low fat for quite a while but it wasn't working. I had trouble losing body fat, even though doing weights and aerobic exercise several times a week. I was very drowsy at times during the day. I would be craving food two hours after breakfast and if I did not eat I would find myself angry - throwing kids out of the way to get at the food - and even a bit jittery.
    I followed a diet proposed by Rob Fagan and coined: Macro Nurtient Cycling. There was…

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  12. Steve Bruhn

    logged in via Facebook

    This article is a good example of how people who only look at metabolic studies cannot figure out human weight regulation. They keep trying to prove that only calories matter and it's all they know how to study.

    What they miss is the fact that humans like any other mammals have a weight set point that is driven by what you eat, the macros like fat, carbs, and protein.

    People who do low-carb dieting successfully are changing their weight set point by lowering the amount of insulin in their body…

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  13. Edward John Fearn
    Edward John Fearn is a Friend of The Conversation.

    Hypnotherapist and Naturopath

    Hi Gary

    This is certainly a fascinating topic for discussion.

    You may find the following abstract of some interest.

    It covers the effects of low-carbohydrate versus conventional (calorie restricted) weight loss diets in severely obese adults: as part of a one-year follow-up of a randomized trial.

    It included 132 obese adults with a body mass index of 35 kg/m2 or greater; 83% had diabetes or the metabolic syndrome.

    http://www.ncbi.nlm.nih.gov/pubmed/15148064

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    1. Rosemary Stanton

      Nutritionist & Visiting Fellow at University of New South Wales

      In reply to Edward John Fearn

      Edward

      It is often possible to find small studies showing a particular result - hence the tendency to give more weight to larger studies or to meta-analyses.

      Check out Nordmann AJ, Nordmann A, Briel M, Keller U, Yancy WS Jr, Brehm BJ, Bucher HCEffects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Arch Intern Med. 2006 Feb 13;166(3):285-93. This study was done after Judith Stern;s group reported their findings. More recent studies also support the fact that weight loss is similar with these diets but unfavourable effects occur with blood lipids after a longer time following diet that fits the high protein/low carb/high fat diet description.

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    2. Gary Cassidy

      In reply to Edward John Fearn

      One of the more important (and unsurprising) outcomes of this study is highlighted by in the Limitations:

      "These findings are limited by a high dropout rate (34%) and by suboptimal dietary adherence of the enrolled persons."

      It is well established that diets don't work long term due to high dropout rate and suboptimal adherence. Rather than focusing on small differences in weight loss between "Diet A" and "Diet B", I think diet science should start focussing on how to achieve long term food balance (including of coarse Energy balance).

      Personally, I think a strategy of having a set of simple rules that can be applied at each meal (and can be occasionally broken without the sky falling in) would be a good start. Also I don't think it is necessary for each rule to be justified by science, although science would need to show that the rules, when applied as a whole, lead to measurable positive outcomes.

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    3. Edward John Fearn
      Edward John Fearn is a Friend of The Conversation.

      Hypnotherapist and Naturopath

      In reply to Rosemary Stanton

      Thanks Rosemary

      I had read the meta analysis before, and it is certainly quite a valid point you make.

      I find the studies on low carb plant based diets quite intriguing especially in relation to blood lipids and heart disease risk factors in general.

      http://www.ncbi.nlm.nih.gov/pubmed/19506174

      In any case, many of the advantages found in the low carb diets are also found in the low glycemic load approach.

      http://news.harvard.edu/gazette/story/2012/06/when-a-calorie-is-not-just-a-calorie

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    4. Paul Savage

      Theme Leader, Biotechnology at CSIRO

      In reply to Edward John Fearn

      Edward, the popular literature, including that article in the Harvard Gazette, can be confusing when they talk about low-carb and low-GI as though they are as different as low-carb and low-fat, for example. In fact, low-carb and low-GI are very similar if you consider the chemistry. A carbohydrate like starch and other polysaccharides are just strings of sugar molecules (mostly glucose and fructose). When a person eats these carbohydrates, enzymes like amalyse break up the bonds between the individual…

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    5. Edward John Fearn
      Edward John Fearn is a Friend of The Conversation.

      Hypnotherapist and Naturopath

      In reply to Paul Savage

      Thanks for the comment Paul.

      While the GI value of a food is important it does have some limitations. The glycemic load (GL) of food is perhaps of greater importance. It is a number that estimates how much the food will raise a person's blood glucose level after eating it. A GL of over 20 is high, 11 to 19 is medium and 10 or under is low.

      While 120grams of watermelon can be considered high (GI 72) its Glycemic load is actually (4) which is low. At 6 carbs per serve it is even considered an allowable fruit on some low carbohydrate programmes such as “shake it” or “keto slim”.

      http://www.glycemicindex.com/foodSearch.php

      So please don’t neglect the humble watermelon, it bad reputation isn’t really deserved.

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    6. Gary Cassidy

      In reply to Edward John Fearn

      Yep, in the world of low-GI you would eat ice-cream, snickers, milo, etc. over watermelon and boiled potato? Been there, made that mistake! Even Coca Cola (GI = 55) is fine.

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    7. Edward John Fearn
      Edward John Fearn is a Friend of The Conversation.

      Hypnotherapist and Naturopath

      In reply to Gary Cassidy

      Thanks Gary

      Yes a simple set of rules to apply to each meal would be helpful; sometimes the simplest interventions are the most successful.

      I think if we were to just start by making smaller dinner plates it would make quite a difference.

      The Australian Governments “Swap it programme” is also a step in the right direction.

      http://swapit.gov.au/ways-to-swap

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    8. Sue Ieraci

      Public hospital clinician

      In reply to Paul Savage

      Paul Savage - your discussion about the breakdown of starches into more simple sugars is correct, but the clinical correlation is quite different.

      The significance of "GI" value is that it related to the SPEED in which insulin is required to be delivered. There is nothing at all wrong with a healthy person (normal pancreas) eating watermelon or potatoes - the pancreas responds by secreting the appropriate amount of insulin.

      It is in diabetics who either secrete no insulin or are relatively…

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    9. Paul Savage

      Theme Leader, Biotechnology at CSIRO

      In reply to Sue Ieraci

      I was being a touch tongue-in-cheek about "white foods" of course. And I agree with what you say Sue regarding the speed at which insulin needs to be produced and delivered to process blood sugar. That being the case, if people eat a diet high in sugar (and by implication, also one high in easily processed carbohydrates) they will put their pancreas under stress and the boom/bust cycle of blood sugar and insulin is what can lead to diabetes, correct?

      On the subject of potatoes - your implication…

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    10. Gary Cassidy

      In reply to Paul Savage

      "In fact, low-carb and low-GI are very similar if you consider the chemistry."

      Hi Paul, it seems you are only focusing on insulin response here. There many be many other weird and wonderful responses that our bodies have to various foods that are yet to be explained or discovered.

      Take that example of a potato, it has a high GI (insulin response), however it is very very high on the satiety index (i.e. less hunger and eat less 2 hours later) - this goes contrary to one of the premises of the The Glycemic Index Foundation. However, if you present that potato as french fries it's satiety index is much lower.

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    11. Sue Ieraci

      Public hospital clinician

      In reply to Paul Savage

      Paul - perhaps read up on the pathophysiology of the pancreas and diabetes.

      Type 1 diabetes reflects a non-functioning pancreas - generally as an auto-immune or post-viral phenomenon (nothing to do with the ordinary daily cyles of insulin secretion).

      Type 2 diabetes is caused by relative insulin resistence - not "pancreas under stress". The pancreas is not "burnt out" by "boom-bust" cycles of insulin secretion. Insulin resistence is mostly linked to obesity, with some familial pre-disposition…

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    12. Rosemary Stanton

      Nutritionist & Visiting Fellow at University of New South Wales

      In reply to Gary Cassidy

      Gary

      I've had to abandon this conversation due to demands of work, but I would just quickly make the point that the GI of potatoes varies dramatically.

      As I've written elsewhere recently, the Glycaemic Index list has 116 GI values for potatoes with wide (and incomprehensible) variations. How is the public expected to understand why ‘potato, type not specified’ has a very low GI value of 24 whereas ‘potatoes boiled’ rates 49 (low GI), ‘white potato, cooked’ has one value of 41 (low GI) and…

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    13. Gary Cassidy

      In reply to Rosemary Stanton

      Hi Rosemary,

      Thanks for that confusing clarity. I'll remember to look out for those ‘potato, type not specified’ next time I go shopping.

      An interesting thing about the foods tested on the satiety index is that unprocessed foods tend to fall on the high side, whereas highly processed foods tend to fall on the low side.

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    14. Rosemary Stanton

      Nutritionist & Visiting Fellow at University of New South Wales

      In reply to Gary Cassidy

      The satiety study was done by using portions of foods with equal kilojoules. You get a lot of potatoes and more apples than bananas whereas the portions of fatty foods (croissants for example) was very small.

      It was an interesting study but you could also make out a good case that it would be more interesting to compare usual portion sizes. Foods that have a lot of water or dietary fibre or little or no fat have much lower energy density, especially compared with high fat/low water foods like crisps or croissants.

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    15. Paul Rogers

      logged in via Twitter

      In reply to Edward John Fearn

      "I find the studies on low carb plant based diets quite intriguing especially in relation to blood lipids and heart disease risk factors in general. http://www.ncbi.nlm.nih.gov/pubmed/19506174";

      Edward, in my view, those blood lipid results in the so-called Eco-Atkins trial most likely result from the high quantities of plant foods, especially viscous fibre and plant sterols in the allocated diet and not from the low-carbohydrate content per se, as demonstrated by David Jenkins in his Portfolio diet approach.

      http://www.ncbi.nlm.nih.gov/pubmed/21862744

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    16. Paul Rogers

      logged in via Twitter

      In reply to Sue Ieraci

      I agree with Sue Ieraci's position on this. Overeating and obesity along with some genetic predisposition is likely to be the main cause of type 2 diabetes.

      While I support the high-fibre, low-GI approach in principle, I don't know of any useful evidence that carbohydrates put the "pancreas under stress" and destroy the insulin-producing beta cells of the pancreas as a primary cause of type 2 diabetes. This is somewhat typical low-carb diet book propaganda. There is some evidence that high-GI…

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    17. Edward John Fearn
      Edward John Fearn is a Friend of The Conversation.

      Hypnotherapist and Naturopath

      In reply to Paul Rogers

      Thanks Paul, yes I suspected that it might be a factor in the reduced lipid levels found in the trial subjects. I would also suspect that such a restrictive diet would be difficult to follow for any extended period and the calorie percentage of vegetable oil consumed seems excessive. I would still be interested in seeing the results of any future trials with a simular diet protocol that included a modest serving of fish and perhaps even the occasional small amount of lean animal protein.

      “Sadly a quick Google of “low carb diets” would also leave many with the impression that bacon fried in butter with black coffee is a healthy low carb food option”

      What are your thoughts on the findings of Ebblings “JAMA” paper in relation to weight loss maintenance?

      .jama.jamanetwork.com/article.aspx?articleid=1199154

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  14. Tony Brideson

    logged in via Facebook

    can we see a 'medical myth' post on 'fat makes us fat'?

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    1. Tony Brideson

      logged in via Facebook

      In reply to Tony Brideson

      and as usual the comments are far more entertaining than the post itself!

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  15. Clifford Chapman

    Retired English Teacher

    Well, it sure baffles me why comments quoting irrelevant studies and data keep coming into my mailbox about this topic.

    There surely really are only two issues that count:

    1. Personal responsibility, and
    2. Government actions and legislation.

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  16. Tj Dhavale

    Cell & Molecular Biologist at La Trobe University

    It's more the type of carb that matters. Anything overly processed (refined sugar, high fructose corn syrup etc) gets converted to lard pretty quickly (your body has issues with breaking down fructose so it stores it for desperate times' which never arrive and so the lard accrues). There are a whole lot of other interactions (genetics, insulin processing systems etc) but over all the carbs packed into high fibre foodstuff (vegetables and fruit) move through your body faster due to the peristaltic effect of the fibre and are less likely to be converted to (and stored as) lard.

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  17. Ken Leebow

    logged in via Facebook

    While I am a big fan of Michael Pollan, that was a lazy way to end this article. And, I would agree with Dr. Joel Fuhrman:

    It's the road to failure trying to eat less exercise more.

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  18. Garry Spee

    logged in via Facebook

    low carb helps curb appetite

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  19. Dean Ashby

    Company Owner at Ezestore Storage Sydney

    This just flies in the face of conventional wisdom does it? I was actually talking to a doctor who told me carbohydrates converts to simple sugars which becomes part of the body’s fat storage until it’s burnt away, so if you activity level is low, your body becomes heavier. I’m not sure how much he knew about diet but I think it makes sense. However, whether or not carbohydrates increases a person’s weight or not is not important. What, I feel, is most important is exercise. Of course this comes from the person with his exercise bike in storage haha.

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