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Dr. Peter Attia: Readdressing Dietary Guidelines
Peter Attia is a meat industry funded nut job. Apparently Peter and his buddy Gary Taubes just love themselves some crappy pseudoscience. Both of them are funded by the Arnold Foundation, with substantial ties to the National Restaurant Association and the National Cattlemen’s Beef Association.
So let’s go over the bogus arguments in this hour long lecture of idiocy.
He starts off by citing a Siri-Tarino et al. Am J Clin Nutr. 2010 study, saying no significant evidence could be found showing saturated fat intake is associated with an increased risk of coronary heart disease (CHD) or cardiovascular disease (CVD).
The Tarino meta-analysis only looked at prospective epidemiological studies. We’ve known since the 1970s that epidemiological studies don’t have the statistical power to show an association between saturated fat intake and heart disease. The only studies that have the power to show the relationship come from dietary change experiments. If you want more information on this topic, look here.
He goes on to cite Chowdhury et al. in support of his nonsense. This study looked at a mix of observational and randomized control trials. Same issues again with the observational data, but the RCTs in this case only looked at supplementation of omega 6 and 3 polyunsaturated fats. So this tells us absolutely nothing about the role saturated fats play in CVD, it only tells us that supplementing more polyunsaturated fats isn’t going to protect us.
Then Attia goes on a long rambling history lesson about Ancel Keys that makes no real point at all, other than to bad mouth Keys ground breaking epidemiological work. Keys work at the time was the best science that could be done on the subject. Keys findings are what led to the hundreds of dietary change experiments being done, which showed us conclusively that saturated fat is the main culprit behind cardiovascular disease.
Then Attia gives a lecture on the subject of “correlation does not equal causation”, while bad mouthing epidemiological data. I find this hilarious, given that the only studies he’s cited so far in favor of his position are epidemiological studies. 30 minutes in, he’s still rambling about Ancel Keys.
Then he starts attacking the Framingham Heart Study. He notes that the FHS found no association between men with a total cholesterol over 300 and those with a total cholesterol under 170 with the amount or type of fat consumed. Again, this study lacks the statistical power to making a significant finding. This is probably why the data he cites remained unpublished.
Then he starts going on about more epidemiological data that counters what Keys found. Again, arguing about epidemiological data as it pertains to CVD and CHD at this point is nothing more than a red herring argument. It’s pointless to argue about since we have randomized control trial dietary change experiments that show conclusively that dietary saturated fat and cholesterol are the primary risk factors for disease.
Then he cites the 1981 paper by Shekelle, saying that even though the paper concluded that eating a high fat diet was a contributing factor for heart disease, we should ignore the paper because they found saturated fat in the diet wasn’t significantly correlated to CHD. Again, another epidemiological study that suffers from statistical power problems, but the authors were smart enough to understand this, which is why they came to conclusion that was opposite to what their own data suggested.
Now he’s back to talking about 1970s and 60s data from unreferenced sources, claiming that in 1963 Hungarian researchers found a benefit for eating a maximum of 1.5 oz of fat per day, while in 1965, British researchers found no benefit to eating 1.5 oz max per day. It’s impossible to refute since the source isn’t cited. I suspect something funny was going on with the diet in the British study.
Then he cites the 1973 Minnesota Coronary Study. Here’s what that study actually looked at:
The Minnesota Coronary Survey was a 4.5-year, open enrollment, single end-time double-blind, randomized clinical trial that was conducted in six Minnesota state mental hospitals and one nursing home. It involved 4393 institutionalized men and 4664 institutionalized women. The trial compared the effects of a 39% fat control diet (18% saturated fat, 5% polyunsaturated fat, 16% monounsaturated fat, 446 mg dietary cholesterol per day) with a 38% fat treatment diet (9% saturated fat, 15% polyunsaturated fat, 14% monounsaturated fat, 166 mg dietary cholesterol per day) on serum cholesterol levels and the incidence of myocardial infarctions, sudden deaths, and all-cause mortality.
And we’re supposed to be surprised that the control group had more deaths? That’s the best he’s got to support his nonsense? The control group was still eating a 38% fat diet and 166 mg a day of cholesterol! We know from studies done by Ornish that when total fat is lowered to 10% and saturated fat and cholesterol are lowered to zero, cardiovascular disease is reversed.
Why is he still rambling on about studies done in the 1970s? Why is he ignoring the hundreds of other dietary change experiments that have been done in the meantime?
Now he’s back to the Framingham study. Still rambling on about the history of cholesterol computation. He’s claiming that based on the study’s findings, LDL is a marginal predictor of heart disease, so we should ignore it and instead focus on HDL, since the study concluded that raising HDL lowered disease risk. So by his logic (not the paper’s), since eating saturated fat raises HDL, we should eat saturated fat. I mean wow. Way to twist the findings.
It’s worth noting that subsequent studies have found that saturated fat raises LDL at a rate that is higher than it raises HDL when consumed with dietary cholesterol. To quote one study, “The ability of saturated fats to raise LDL cholesterol is enhanced by increased intake of dietary cholesterol as well as baseline LDL cholesterol concentrations.” (and that study was written by Ron Krauss, who is funded by the National Dairy Council, National Cattleman’s Beef Association, and the Robert C. and Veronica Atkins Foundation!)
He goes on and on about HDL and triglycerides. It’s worth noting that Ornish found that when he put people on a whole food plant based diet, their HDL dropped and their triglycerides increased, yet they still showed a reversal of their heart disease through angiography. So that basically blows his whole theory about HDL and triglycerides out of the water.
Then he covers the MRFIT and LRC trails, which were drug control trials. I don’t find it surprising that there were virtually no differences between them. Again, he ignores conclusions of the studies authors claiming that the data doesn’t support their assertions, while ignoring the reasoning behind the authors claims.
Bad mouths the NIH consensus conference. No evidence presented.
Then he talks about the Cochrane Collaboration’s 2001 study, claiming that they found modified fat intake had no significant effect on longevity or cardiovascular events out of 27 RCTs. Here’s what the study actually found:
Twenty seven studies were included (40 intervention arms, 30,901 person-years). There was no significant effect on total mortality (rate ratio 0.98, 95% CI 0.86 to 1.12), a trend towards protection form cardiovascular mortality (rate ratio 0.91, 95% CI 0.77 to 1.07), and significant protection from cardiovascular events (rate ratio 0.84, 95% CI 0.72 to 0.99). The latter became non-significant on sensitivity analysis. Trials where participants were involved for more than 2 years showed significant reductions in the rate of cardiovascular events and a suggestion of protection from total mortality. The degree of protection from cardiovascular events appeared similar in high and low risk groups, but was statistically significant only in the former.
Of course, he never mentions the bolded part of the findings. Further, who knows what constituted a “low fat” diet. Most trials consider 30% to be a low fat diet, which is still a ridiculously high amount of fat compared to what a plant based diet would provide. And of course, cholesterol intake was not controlled for either.
Then the 2006-11 study that found that risk factor intervention had no effect on mortality. Well this study only looked at using counseling and education aimed at behavior change. Is anyone surprised that Billy Bob didn’t quit smoking and stop eating his ribs when the doctor told him to? This study doesn’t tell us anything about risk factors, it only tells us that counselling has a limited ability to change people’s habits. This isn’t some shocking revelation.
Then he talks about the Women’s Health Initiative study. This study found no reduced risk of CHD or stroke between treatment and control groups. The treatment group lowered their fat consumption by 8.2% and saturated fat by 2.9%. Again, the women in the control group were still eating a high fat diet. They were still eating 29% of their diet from fat, and they were still eating loads of cholesterol, so it’s not surprising that there were no differences in disease risk between the two groups. For comparison, the control group averaged a 35% fat diet. The authors wanted the treatment group to hit 20%, so there was very poor compliance.
Then he talks about the A to Z trial in 2007 that compares various diets to each other. He notes that the Atkins diet outperformed the Ornish (plant based) diet on several metrics. It’s worth noting that he’s using erroneous statistics. JAMA actually published a retraction on the weight claims for that study, “Weight loss was not statistically different among the Zone, LEARN, and Ornish groups. At 12 months, secondary outcomes for the Atkins group were comparable with or more favorable than the other diet groups.” – So at best the Atkins diet is a wash, but it may actually be worse because the study didn’t run long enough to track mortality or cardiovascular events. Ornish mentions this retraction in his response to The Scientific American, where he refutes many of the arguments Attia is making here.
Ornish has proven his diet reverses heart disease, and every time a low carb diet has been tested for the treatment of heart disease, it has failed. Further, we know that a certain subset of the population is at a far greater genetic risk for the development of CVD if they consume a high saturated fat and cholesterol diet. So it is downright dangerous to suggest people eat that way. Some people will do fine, others will drop dead. Biomarkers don’t tell us about disease progression, and the trial didn’t run long enough to look for mortality or cardiac event risk.
Then he talks about the Diet Trial in 2008, which compared low fat, Mediterranean and low carb diets. The low carb had modestly better outcomes, but again, he’s not giving us all the information. Since I don’t have access to the study, I can’t tell what constituted a “low fat” diet. It may be that they were using a 30% fat, unlimited cholesterol intake, diet as a “low fat” diet for comparison, which we know will accomplish nothing. Then he talks about the 2014 diet trail, which again faces the same problems as the first diet trail. People were still eating 30% total fat and 9% saturated fat in the “low fat” group, with no limits on cholesterol intake.
And that’s the extent of “proof” in his total bullshit lecture. It takes a seriously sick individual to twist the results of the studies he cites and ignore the MOUNTAINS of studies that run contrary to his position.
Now if you want some real science, watch this:
Source: https://www.libertariannews.org/2016/03/07/dr-peter-attia-readdressing-dietary-guidelines/
