Sunday, 28 September 2014

More about "The Big Fat Surprise." by Nina Teicholz.

           On reflection,  I feel a few further comments are necessary.  As I  have mentioned before,  I have had considerable experience over  a several years  of  running a weight control group at University  Hospital in  Saskatoon and of  treating overweight  patients in  both  Sask  and Ontario.
The hundreds of books written on this topic and  the thousands of articles in both  the Scientific journals and in the lay press, were and are a sure indicator that we have many more questions than answers.
           Much of this work challenged the efficiency of what has been known as the Heart Healthy Diet, directed primarily at reducing saturated fats and reducing the low density lipoprotein component of total  cholesterol in the blood.  Ms Teicholz preoccupies herself  excessively with the polemics of the  situation.and with her assessment of  the motives of investigators and promoters of the various theories relating to the many diets that have been advocated over the years.  Some of the rationale she uses for supporting the point of view she supports are quite a stretch.  For instance, the diet of the Inuit, a very  high animal fat diet, is extrapolated into being an ideal cardiovascular diet and preventing heart disease.  It may be, if one lives in a arctic zone, with sub freezing temperatures for a good part of the year,where, even if one wished it would be difficult to eat a fresh  vegetarian diet.  Similarly, the high saturated diet of the Masai warriors that she quotes as being responsible for a  low incidence of heart disease may in fact, have little  to do with a low rate of cardiac disease, if indeed, there is a low incidence.  I think much of Ms T's presented data is questionable and she makes some assumptions that are unverifiable.
           Now, while we must  not fall into the 'post hoc ergo propter hoc' fallacy and despite Ms T's assertions to the contrary, it appears we are doing some things correctly.    The bottom line is that the incidence of mortality and morbidity from cardiovascular disease has fallen markedly in recent years.   Since there are multiple factors involved here, such as  smoking cessation, obesity control and exercise  it is difficult to assign specific values for the precise amount of credit each one plays.however it is likely that our dietary modifications are a factor.
              The bottom  line is that based on the evidence that is available at present AND experience in patient care, I don't recommend abandoning our present dietary recommendations in favour of Ms T's recommendation.  

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