Think again.

A story appeared in the online version of Time Magazine last year that I read when it came out, put aside to blog about later, then got sidetracked.  A reader sent me a link to it a few days ago, which brought it back to the front of my mind.

The article discusses a study being done in Germany using a carb-restricted diet to fight cancer.  In pre-WWII days, a German scientist, Otto Warburg, received a Nobel Prize for his work in sussing out the fact that cancer cells don’t generate energy the same way that normal cells do.  Cancer cells get their energy, not like normal cells, from the mitochondrial oxidation of fat, but from glycolysis, the breakdown of glucose withing the cytoplasm (the liquid part of the cell).  This different metabolism of cancer cells that sets them apart from normal cells is called the Warburg effect.  Warburg thought until his dying day that this difference is what causes cancer, and although it is true that people with elevated levels of insulin and glucose do develop more cancers, most scientists in the field don’t believe that the Warburg effect is the driving force behind the development of cancer.

But it stands to reason that it can be used to treat cancer that is already growing.  Since cancers can’t really get nourishment from anything but glucose, it stands to reason that cutting off this supply would, at the very least, slow down tumor growth, especially in aggressive, fast-growing cancers requiring a lot of glucose to fuel their rapid growth.

Thomas Seyfried (the same Thomas Seyfried mentioned in the article) has shown that ketogenic diets in animals and humans can stop malignant brain tumors.  There is no reason to believe they wouldn’t work in humans as well.

A group in Germany is looking at such diets in a small pilot study.  Patients are only admitted to the study when all standard therapies – chemotherapy, radiation, surgery, etc. – have failed and they have basically been sent home to die.  In fact, a few were so far gone that they died within the first week of starting the study. You couldn’t ask for a study group more destined for failure, but, according to the Times article

The good news is that for five patients who were able to endure three months of carb-free eating, the results were positive: the patients stayed alive, their physical condition stabilized or improved and their tumors slowed or stopped growing, or shrunk.

If you understand the Warburg effect and the metabolism of cancer cells, it’s easy to see why this therapy works, even in patients who at at death’s door.  Since the cancers can use only glucose, and since glucose is made in the cancer cells slowly and inefficiently, the cancer cells have to rely on outside glucose to provide nourishment for their rapid growth and replication.  People on very-low-carb diets produce ketones, which take the place of glucose in other cells that can use these ketones for fuel.  But cancer cells can’t use the ketones since ketones have to be burned in the mitochondria, which are dysfunctional in cancer cells.  If you can keep blood sugar low, then growth of the cancer cells may be held in check long enough for the body’s own previously overwhelmed immune system to rally and beat the vulnerable cancer back.

Now, given all this, if you had a big cancer eating you alive and you were offered a chance for salvation by doing nothing more than following a low-carb diet, would you take it?  I certainly would.  But, not everyone does. I was stunned to read the comments of Dr. Melanie Schmidt, one of the researchers, about people dropping out of the study.

[Some] dropped out because they found it hard to stick to the no-sweets diet: “We didn’t expect this to be such a big problem, but a considerable number of patients left the study because they were unable or unwilling to renounce soft drinks, chocolate and so on.”

Let me see if I’ve got this right.  A lifesaving therapy is offered to patients who have undergone the misery of radiation therapy, chemotherapy, and surgery, and who are beyond hope, and this therapy requires nothing more than eating a lot of butter, meat, cream, cheese, etc. while avoiding most carbohydrates.  And a considerable number” drop out because they can’t give up carbs?

I say it again.  And you don’t think carbs are addictive?

As a coda to this post, I’ve got to tell you that MD at this very moment is rolling out a fondant that she made a couple of days ago.  She was dragooned into making the birthday cake for our granddaughter whose party is tomorrow.  The kid doesn’t want a store-bought birthday cake, she wants a custom-made cake by her Nanny, which has become a tradition.  She wants a Razor (a Swat Kat) cake, so MD is having to free-hand it.  Although she’s never made a fondant before, she figured that would be the easiest way to frost and decorate the cake she has in mind.  I wandered over to get a cup of coffee and pulled off a tiny piece of the stuff and popped in my mouth just to see what it tasted like.  Her fondant is made with powdered sugar, corn syrup, and lard (not the vegetable shortening called for in the recipe), and it is good beyond belief.  I’m sitting here writing this post, and after a tiny, tiny piece (maybe 3/4 inch by 1/2 inch by 1/8 inch) of fondant, I am obsessing over how easy it would be to walk the 10 feet to where it is and start throwing it down by the handfuls.  So, yes, carbs are addictive.  Especially the carb-fat combo.

Lest you get the wrong idea, our granddaughter’s parents keep her on a kid’s version of the low-carb diet most of the time.  The cake is a once a year deal.  Thank God.

The study was pretty simple. Researchers looked at the diets of over 1000 subjects who had stage III colon cancer and who were enrolled in a chemotherapy trial. These subjects filled out food frequency questionnaires (FFQ) during their chemotherapy then again six months after. Researchers then stratified the data from the FFQs into what they called a Western dietary pattern and a prudent dietary pattern. After a little over 5 years of follow up about a quarter of these subjects had died from their colon cancer. Significantly more of the patients following the Western dietary pattern died than did those who followed the prudent dietary pattern. Therefore, say these researchers, those who have advanced colon cancer should avoid a Western dietary pattern in favor of a prudent dietary pattern in order to reduce their chances of dying from their disease. And the implication is that all of us should follow the prudent diet rather than a Western diet to maybe avoid getting colon cancer at all. And, as you shall see, what these researchers really want us to avoid is red meat.

Nice and tidy. Problem is that it’s all BS. And it’s the kind of BS that infuriates me because of the dishonesty involved. Let me show you what I mean.

The statistics involved in this paper are convoluted beyond belief. Very few people are going to go through the charts and tables and analyze these statistics as presented. I’m a pretty fair hand at statistics, and I didn’t want to spend the time to laboriously go through these to see if they were correct. I didn’t spend the time because it doesn’t matter if they are correct or not, so why bother. And that’s not to even mention that the nutritional data making up these statistics was derived from FFQs, which are the most notoriously inaccurate way to get nutritional data imaginable. The entire study is an observational study, and as such is absolutely worthless in determining whether the Western diet or the prudent diet or any other kind of diet causes colon cancer or anything else. But before we get into what an observational study really is and why it’s worthless, let’s look at a couple of other factors.

First, the researchers themselves cleverly defined the Western dietary pattern and the prudent dietary pattern so they could determine what made up each one. The prudent dietary pattern was filled with fruits, leafy vegetables, cruciferous vegetables, tomatoes, fish, poultry, wine, tea, and legumes. The Western dietary pattern was dairy, refined carbohydrates, red meat, sweets, desserts, margarine, processed meat, potatoes, French fries, snacks, beer, liquor, eggs, and sugar beverages among others.

Now this divvying up of all these foods into Western and prudent dietary patterns would be okay with me if that’s the way they reported it. I mean all the crap they put in the Western dietary pattern category is pretty much what makes up the typical American diet, and I, of all people, certainly wouldn’t be surprised to find that people following such a diet had their cancers worsen, but that’s not what the researchers reported. They focused on the red meat part of the Western diet in all their reports. It was made to sound like the red meat in the Western dietary pattern was the cause of all the woes, not the sugar, potatoes, sweets, high-fructose corn syrup sweetened beverages, margarine, and all the rest of the crap. Just the red meat. But before we get into examples of that, let’s look at what an observational study is and why these studies are worthless for determining the cause of anything.

Let’s say I come up with the idea that eating ice cream causes multiple sclerosis (MS). To study this I recruit 10,000 subjects and follow them for 5 years. Over this 5 year period I take nutritional surveys by having these subjects fill out detailed food diaries for 3 days every three months, and I have trained interviewers go over these food diaries with the subjects to make sure they included everything. I gather all this data for 5 years, then I look at the amounts of ice cream eaten by all the subjects, and I divide the subjects into quintiles (fifths) depending upon how much ice cream they ate. The top quintile would be the 2000 subjects who ate the most ice cream; the bottom quintile would be the 2ooo who ate the least; and the other three quintiles of 2000 subjects each would fall in the middle.

Now that I’ve got this data, I look to see how many of the subjects in each quintile developed MS during the course of the study. Let’s assume that 100 subjects in the top quintile of ice cream consumption developed MS and only 30 people in the bottom quintile developed MS. The number of cases of MS from the middle quintiles were between 90 and 4o with the higher quintiles developing MS at greater rates than the lower ones.

I could then put out a press release proclaiming that ice cream causes MS, which would be picked up by the press, and, before you know it, I’m on CNN and all the networks talking about my study. Life is great. I’m on TV. But hold on. Whoa, there, Bozo. Let’s take a few steps back and look a this study just a little closer.

The study I did was what is called an observational study. I didn’t give these subjects ice cream, placebo, medications, anything, I simply observed and tabulated their diets over a 5 year period. Those that ate the most ice cream had higher rates of development of MS, but the MS can’t be laid at the doorstep of ice cream consumption because there are too many other factors involved.

Maybe those who are prone to MS are, for whatever reason, driven to eat more ice cream. Maybe those who ate the most ice cream also ate the most cake, and we didn’t even look at cake. Maybe cake is the cause. Maybe those who ate the most ice cream also smoked the most. Maybe those who ate the most ice cream were the least active, and maybe lack of activity predisposes to MS. Maybe those who ate the most ice cream ate the fewest tomatoes, and maybe tomatoes are protective against MS. I could go on and on with the maybes coming up with countless scenarios showing that it isn’t really the ice cream that causes MS even though those who ate the most developed the most MS. The point is that in an observational study like this fictitious one I just came up with – which is no different than the JAMA study on the Western dietary pattern/prudent dietary pattern and death from colon cancer observational study – is meaningless in terms of what causes anything.

What observational studies are good for is creating hypotheses. For example, let’s say I did the above study and I was just looking to see which subjects developed what after 5 years. At the end of the study I discovered that a bunch of people had developed MS. I looked at all the different foods all the subjects ate and I noticed that the ones who ate the most ice cream seemed to develop MS at the greatest rate. So, I come up with a hypothesis that ice cream causes MS, then I get together the funds to test this hypothesis.

To determine if this hypothesis is valid I recruit 10,000 more subjects. This time I randomize them into two groups so that the ages, sexes, heights, weights, and any other thing I can think of are the same in both groups. Then I create a placebo that looks like ice cream, tastes like ice cream, but has no calories and isn’t really ice cream. (Actually, if I could come up with this placebo I would abandon the study, get filthy rich, and move to my own island.) I would then box the placebo and the real ice cream in identical cartons. I would have a staff of people who gave the ice cream or placebo to the subjects at regular intervals. The subjects would be instructed to never eat ice cream on their own, but to only eat the ice cream they were provided during the study.

I would then have a double-blind, placebo-controlled study. It’s double blind because the people administering the ‘ice cream’ don’t know whether its ice cream or placebo and the subjects receiving the ‘ice cream’ don’t know if it’s real ice cream or placebo.

After 5 years I could again determine how many subjects had developed MS and could compare it to the amount of real ice cream eaten by those subjects. If this time the results were the same, then I would have some reason to say that ice cream may indeed cause MS. But this would be a real, double-blind, placebo-controlled study, not an observational study.

Typically when hypotheses arise from data provided by observational studies, these hypotheses are destroyed when they are evaluated using a real study.

For the JAMA study to be able to say that the Western dietary pattern causes recurrence and death to a greater degree than does the prudent dietary pattern, the researchers would have had to randomize the patients into two groups, then give one group the Western diet and the other the prudent diet. And keep both groups on their respective diets for the 5 years, then see what happens.

And the authors of this study indeed know and understand that these observational studies don’t mean squat in terms of causality and admit as much. They write these words buried in the back of this study:

Because this was a observational study, causality cannot and should not be drawn from these data. [my italics]

So, the authors know and admit that no conclusions in terms of causality can or should be drawn from this study. But they go ahead and do just that with this statement that is the very next sentence after the one above:

Nonetheless, the data suggest that a diet characterized by higher intakes of red and processed meats, sweets and desserts, french fries, and refined grains increases the risk of cancer recurrence.

So, you fess up that the study doesn’t legitimately say squat, then you say in the very next sentence that, well, we don’t care about the truth, we think it really does matter. Because, after all, no one cares about a meaningless study. You can’t issue a press release about a meaningless, observational study. Can you? The authors and the folks at JAMA apparently think so.

Here is the press release from JAMA.

DIET HIGH IN MEAT, FAT AND REFINED GRAINS ASSOCIATED WITH INCREASED RISK FOR COLON CANCER RECURRENCE AND DEATH

Patients treated for colon cancer who had a diet high in meat, refined grains, fat and desserts had an increased risk of cancer recurrence and death compared with patients who had a diet high in fruits and vegetables, poultry and fish, according to a study in the August 15 issue of JAMA.

Previous research has indicated that diet and other lifestyle factors have a significant influence on the risk of developing colon cancer. However, few studies have assessed the influence of diet on colon cancer recurrence and survival, according to background information in the article.

Jeffrey A. Meyerhardt, M.D., M.P.H., of the Dana-Farber Cancer Institute, Boston, and colleagues examined the influence of two distinct dietary patterns on cancer recurrence and survival in a group of 1,009 stage III colon cancer patients (cancer present in the colon and lymph nodes) enrolled in a clinical trial of postoperative chemotherapy in addition to other treatment. Patients reported dietary intake using a food frequency questionnaire during and six months after supplemental chemotherapy. Two major dietary patterns were identified, prudent and Western. The prudent pattern was characterized by high intakes of fruits and vegetables, poultry, and fish; the Western pattern was characterized by high intakes of meat, fat, refined grains, and dessert.

Patients were followed up for cancer recurrence or death. During a median (midpoint) follow-up of 5.3 years, 324 patients had cancer recurrence, 223 patients died with cancer recurrence, and 28 died without documented cancer recurrence.

The researchers found that a higher intake of a Western dietary pattern after cancer diagnosis was associated with a significant increase in the risk of cancer recurrence or death. Compared with patients in the lowest Western dietary pattern quintile (bottom 20 percent), those in the highest quintile (top 20 percent) experienced a 3.3 times higher risk for cancer recurrence or death. Patients in the highest quintile of Western dietary pattern were 2.9 times more likely to have cancer recur than those in the lowest quintile. Similarly, a significantly higher overall risk of death with increasing Western dietary pattern was observed. In contrast, the prudent dietary pattern was not significantly associated with cancer recurrence or death.

“Studies have shown an improved disease-free survival among patients who receive adjuvant chemotherapy following the surgical resection of stage III colon cancer. This is the first study, to our knowledge, in a potentially cured population of colon cancer survivors to address the effect of diet. Because this was an observational study, causality cannot and should not be drawn from these data. Nonetheless, the data suggest that a diet characterized by higher intakes of red and processed meats, sweets and desserts, french fries, and refined grains increases the risk of cancer recurrence and decreases survival. Further analyses are under way to better delineate specific nutrients or food groupings that may have the strongest association,” the authors write.

Do you see anything in this press release that says no conclusions can or should be drawn from this study since it is an observational study? I didn’t see anything like that. And did you notice how it is no longer a Western dietary pattern, but is now a meat, fat and refined grains diet. And note what is listed first: meat. Most analyses of the Western diet show that the single largest contributor of calories is sugar, which I’m sure is the case in this Western dietary pattern, but the authors and the press release writers for JAMA single out and lead the press release with meat. Not sugar. Not high-fructose corn syrup. Meat.

What’s even worse than the press release is the video that goes along with it. In this video a survivor (so far) of stage III colon cancer, John, is shown cycling and going about his life. A voice over announcer talks about the diagnosis and treatment of John’s colon cancer. Then the announcer says

As you’d imagine, after that, John would do a lot to stay healthy. Turns out what he eats, or doesn’t eat, could really help.

This while John is shown putting fish on the grill. Then cut to Dr. Jeffrey Meyerhardt, the lead author of the study, who says:

It’s not really increasing the amount of fruits and vegetables but really trying to reduce the amount of red meat intake and fatty foods and sugary, ‘desserty’ foods, that seems to be protective for colon cancer recurrences and survival.

Note the emphasis on red meat and fatty foods. As Dr. Meyerhardt finishes his line the video cuts to a steak on a grill, then to someone cutting a steak. The announcer then says:

That higher fat diet Dr. Jefery Meyerhardt describes is called a Western pattern diet. He and colleagues at Dana-Farber Cancer Institute studied that pattern in colon cancer patients. Their findings appear in JAMA, Journal of the American Medical Association.

While the announcer is talking there is more footage of red meat on a grill.

There is some more blather, then the announcer says:

Stage III colon cancer patients who ate high amounts of a Western pattern diet were about three times more likely to have recurrent cancer, or to die, compared to patients who ate less of those types of foods.

More footage of John and his wife eating fish and vegetables. Then the announcer again:

The study says improved outcomes are more likely if stage III cancer patients eat the way John does…lots of fish, chicken, brown rice, and less Western pattern foods, like red meat.

Actually the study says no such thing. The study says that “causality cannot and should not be drawn from these data.”

John finally speaks. He is eating his ‘healthful’ non-Western pattern diet along with his wife, and he says:

To cut down from one steak a week to one steak a month is not a big deal.

As you watch the video you notice that right at first the overall Western pattern diet is described as being filled with red meat, fatty foods, sweets, and desserts. Then as the video rolls on the Western pattern diet transmogrifies into the red meat diet. Anyone watching this video would come away thinking that eating red meat will cause colon cancer to worsen. And that if anyone who has colon cancer eats meat, they’re going to die.

And all this from a study whose authors tell us that the data cannot and should not be used to determine causality. This entire episode is an education in how this nonsense spreads. And another reason to never, ever believe anything you see on television or read in the papers about medical studies. Most of it is pure hogwash.

Why, you may ask yourself, do these highly trained scientists buy into all this when it’s so patently false? Because they want to. Remember the post about the book Stumbling on Happiness? It takes very little evidence to persuade someone of something he/she already believes is true. All of these people believe red meat is bad for us despite there being absolutely no evidence showing such. So it doesn’t take much to prove to them that it really is bad. In this case, it takes no data at all. Merely the suggestion of data. Pitiful.

Here is a link to the JAMA video from which I quoted above. Warning. It takes forever to download this thing, which is why I quoted from it instead of merely linking to it. It took me about 5-6 minutes, so don’t give up if you really want to see it. It is a masterpiece of anti red meat propaganda.

Here’s the headline, right up top.

Low Fat Diet Does Not Cut Health Risks, Report Says

The first paragraph of the accompanying article sums it up pretty nicely:

The largest study ever to ask whether a low-fat diet reduces the risk of getting cancer or heart disease has found that the diet has no effect.

USA Today weighed in with an article entitled

Cutting Fat Alone Isn’t Enough, Women Advised

The Knight-Ridder news service, the providers of copy to many local papers including ours headlined their article

Low-Fat Diet Fails to Cut Risk

The reports referenced in these articles were three studies appearing in this week’s The Journal of the American Medical Association detailing the results of a massive, government-funded ($415 million) study, The Woman’s Health Initiative, showing that postmenopausal women who followed a low-fat diet for 8 years suffered the same rates of heart disease, colon cancer and breast cancer as those who ate what they wanted.

Almost 50,000 overweight women aged 50 to 79 were divided into a study group (the low-fat group) and a control group. The study group was given intensive dietary counseling and much hand holding. Subjects in this group were instructed to reduce their fat intake to 20 percent of their total caloric consumption and to increase the amount of fruits and vegetables to at least five servings daily and grains to six servings daily. This group

received an intensive behavioral modification program that consisted of 18 group sessions in the first year and quarterly maintenance sessions thereafter. Each group had 8 to 15 women and was led by a specially trained and certified nutritionist. Each participant was given her own total fat gram goal based on her height. The intervention emphasized self-monitoring techniques and introduced other individually tailored and targeted strategies, such as motivational interviewing.

The members of the control group were given a copy of Nutrition and Your Health: Dietary Guidelines for Americans and sent on their way.

All the heavy duty counseling paid off in that the women in the study group did manage to reduce their fat intake from about 38 percent to 24 percent of calories by the end of the first year and to 29 percent by the end of the study. The women in the control group, who also started at 38 percent, reduced their fat intake to 35 percent by the end of the first year and had drifted back up to 37 percent.

When the study ended and the incidence of cardiovascular disease, breast cancer and colon cancer in the two groups was tallied, there was virtually no difference between the two groups.

I felt that the New York Times had the most even-handed coverage of these reports, although, as we will see, they didn’t do their homework very well. The paper quoted extensively from Dr. David A. Freedman, a statistician at the University of California, Berkeley, who isn’t connected with the study but has published extensively on the design and analysis of clinical trials. Dr. Freeman, who basically opined that the results should be taken seriously, opined:

The studies were well designed and the investigators tried to confirm popular hypotheses about the protective effect of diet against three major diseases in women.

But, the diet studied here turned out not to be protective after all.

We, in the scientific community, often give strong advice based on flimsy evidence. That’s why we have to do experiments.

Needless to say, these findings were a huge shocker to the reduce-your-fat-intake-and-you’ll-decrease-your-risk-for-everything crowd. And, as you might imagine, excuses were thick on the ground.

Dean Ornish, who is fast aboard the low-fat freight train hurtling pell-mell toward irrelevance and oblivion, complains that the women didn’t lower their fat intake enough, and that they didn’t eat enough fruits and vegetables, and that the study wasn’t long enough. If it had gone on for a few years more, says the author of a number of low-fat books, a difference between the two groups might have immerged.

Yeah, well, ‘might’ won’t feed the whippet.

I was struck by the realization of exactly how difficult it must be to reduce fat in the diet to the 20 percent range. These women who all had loads of hands-on counseling and care during the first year could reduce their fat intake to 24 percent and no lower.

After a careful review of these papers a couple of other things caught my attention.

The first thing was that although the women in the study group reduced their fat intake, not only were they not protected against disease, they didn’t really lose any weight to speak of. Most of the cut-your-fatters such as the above mentioned Ornish believe and propound that reducing fat will bring about weight loss. Ornish’s best-selling book Eat More, Weigh Less actually instructed readers not to worry about anything but cutting fat. As long as fat intake goes down, so will weight.

Sorry, Deano, but these studies prove you wrong even there. But, who knows, maybe if the studies had lasted a little longer, the weight loss would have become apparent.

The other thing I noticed was that not only did the women in the study group cut the fat, they cut the calories. At the start of the study the women were consuming 1790 kcal per day. After one year their intake was down to about 1500 kcal daily and continued to drift down a tiny bit more to 1431 kcal by the end of the study. So, these women consumed roughly 300 fewer kcal per day over the course of the study, which calculates out (300kcal/day times 365 days/year times 8 years) to a reduction of about 876,000 kcal in all. If we divide that 876,000 kcal reduction by 3500 (the number of kcal in a pound of fat), we find that these women should have each lost about 250 pounds, which would have been difficult since they started with an average weight of about 170 pounds. Well, not only did they not lose 250 pounds, they didn’t lose any weight at all. So what happened?

Obviously something is amiss.

In going through the paper on cardiovascular disease I came upon the following paragraph about how the caloric intake as well as the macronutrient intake was determined in the Methods section:

All participants completed an FFQ (food frequency questionnaire) designed specifically for the study at baseline and 1 year. Thereafter, one third of the participants completed the FFQ each year in a rotating sample: completion rates were 100% at baseline and 81% thereafter. Data on follow-op dietary intake were computed from FFQs administered from years 5 through 7 (designated as year 6 follow-up), thus including all the participants.

Here is an interesting note:

Four-day food records were provide by all women prior to randomization.

As we saw in a post not too long ago, FFQ are next to worthless. Four-day food diaries are much more accurate, but much more costly. The directors of these studies spent $415 million to do this part of it. I’m sure they spent a bunch getting and evaluating the baseline intake, which at about 1800kcal/day sounds right for 50-79 year old women. Then they went the cheap route to get the follow up data. The fact that according to their data these women were consuming roughly 17% fewer calories per day over the course of the study and not losing weight didn’t tip the researchers off that something was amiss.

Not only didn’t it tip them off, they thought it was a helluva study. Dr. Michael Thun, a director of research for the American Cancer Society, was quoted in the New York Times as describing these studies as being so large and so expensive that they were

the Rolls-Royce of studies.

Someone needs to tell Dr. Thun that it’s not the amount of money spent, but the quality of the data that makes a good study.

The only thing that keeps me from writing these studies off as a waste of time and money is the fact that the control group also consumed way, way fewer calories as determined by their FFQs and didn’t lose any weight over the 8 years. I guess we can make the assumption that the subjects in both groups fudged their FFQs proportionately and so at least the differences in macronutrient composition are relatively valid.

So with all due respect to Dr. Freedman, the statistician at the University of California, Berkeley, I don’t believe the studies were particularly well designed. I would feel a whole lot better about them if they had used a different methodology to obtain their dietary data.

It’s a real shame to spend $415 million of our dollars—yours and mine—and not get anything better than this.

Data from the giant Women’s Health Initiative Dietary Modification Trial show that after 8 ½ years post menopausal women consuming a diet meant to contain about 20 percent of calories as fat, but in fact containing about 28 percent of calories as fat, showed no decrease risk for breast cancer, heart disease or colon cancer compared to a control group of women consuming their regular diet.

To read the full text of the paper on breast cancer click here.

To see the abstracts of the other two papers click here and here.

This same issue contains two editorials that show the bias of the editorialists in the direction of the low-fat diet. In one in the very last paragraph the authors just can’t help themselves. Despite these studies showing no benefit to the low-at diet, these guys just can’t leave it at that.

Despite null findings from the WHI Dietary Modification Trial, dietary changes can have powerful, beneficial effects on CVD risk factors and outcomes. To reduce the risk of CVD, individuals should maintain a desirable body weight, be physically active, avoid tobacco exposure, and eat a diet consistent with national guidelines [the low-fat diet]. Additional results from the WHI Dietary Modification Trial, likely forthcoming, should provide valuable evidence that will refine these recommendations and further enhance CVD prevention efforts in women.

So, what they’re saying is that despite these studies showing no benefit to low-fat diets it is advisable to follow a low-fat diet. Hmmm.

Many thanks to Regina Wilshire (her excellent blog is Weight of the Evidence) for giving me the heads up that these studies were coming out.

I’ll have much more to say later after an exhaustive evaluation of all these papers.

MD and I are flying back home tonight, so I’ll be back at it at full speed in short order.

The British journal Colorectal Disease published a paper a few months ago with the promising title “Diet and colorectal cancer: implications for the obese and devotees of the Atkins diet.” Hey, now were getting somewhere thinks I when this little baby fell into my hands through the agency of the university inter-library loan department. Then I began to read it.

I don’t know if medical journals have the equivalent of slow news days or if this particular journal, which I hadn’t previously seen, is a lower tier journal, but I can’t figure how this paper got published. I’m glad it did because most people will only get to read the abstract (my university didn’t have a subscription to the journal, thus my reliance on inter-library loan), and the abstract implies much that isn’t developed in the paper. I’m sure many people writing articles on low-carb diets will in the future reference this paper as one that shows low-carb diets to reduce the risk of colorectal cancer. The paper, however, doesn’t really do that. In fact, it doesn’t do much of anything.

When we take a look at the abstract, we – as low-carb devotees – see some exciting stuff:

Colorectal cancer (CRC) is the second most common cause of cancer-related death in the Western world and its prevalence is increasing. Potential causes of this increase are changes in diet and the increases in obesity seen. This paper looks at the literature surrounding diet and obesity and the links to this increase in CRC. Heralded as a weight loss miracle we investigate whether the literature suggests the Atkins diet may actually do more harm than good by acting to increase an individual’s risk of CRC. Obesity has been demonstrated to be a major factor in the increase in CRC although links to changes in diet are more tenuous. Published studies on diet suggest the Atkins diet may help reduce rather than increase the risk of CRC.

As we go through the paper, however, excitement wanes.

Basically, the paper can be summarized pretty quickly. Here is the Cliff Notes version.

Obesity is a huge problem worldwide. Many people looking for a solution have tried the Atkins and other low-carbohydrate diets. These low-carbohydrate diets recommend meat accompanied by non-starchy vegetables. Studies have shown a correlation between meat consumption and colorectal cancer (CRC). Other studies have shown no correlation between meat consumption and CRC. Studies have shown that consumption of non-starchy vegetables and fruits are protective against CRC. Some studies have shown a correlation between fat consumption and CRC; others have shown no such correlation. some studies show that carbohydrate intake, especially of sugars and refined starches, increase the risk for CRC; these findings have not been confirmed in other studies. The paper then makes a strange comment:

The reduction in carbohydrate on this diet (Atkins) may result in less fruit and vegetables ingested and for this reason the Atkins diet may actually increase the risk of CRC. This should not be the case for the phases where more carbohydrate is permitted; the problem is that as with many diets, there tends to be high rates of noncompliance and the initial induction phase may deter people from eating fresh fruit and vegetable, despite some public health measures of encouragement to do otherwise. Of additional concern is that dieters may solely utilize the ‘induction’ phase of the Atkins diet plan as an effective weight loss strategy before reverting back to an unhealthy regime of sugary foods.

More Cliff Notes:

Once again studies have shown dietary fat to cause increased risk for CRC; others don’t. Most studies have shown that obesity is a risk factor for CRC. In fact, obesity is probably the most significant risk factor. Low-carbohydrate diets are lower in calories than non-diets. Consuming fewer calories brings about weight-loss. Weight-loss reduces risk for CRC. And, therefore, the Atkins and other low-carb diets are a go. As the authors conclude:

Until there is more conclusive evidence, it does not appear that the Atkins diet plan should be rejected. Indeed, from the current evidence it may actually be beneficial by reducing the risk of developing CRC; total energy intake may be a more significant risk factor and any diet conferring a decreased calorie intake would presumably decrease this risk.

There is so much data out there showing that low-carb diets reduce the risk of CRC in so many ways that it’s really a shame that this kind of wishy washy crapola uses up valuable ink.

Reading this paper makes me recall the one and only time I ever listened to Howard Stern when I heard him say the following to a Star Trek fanatic who had spent God only knows how much time trying to derive the language of Klingons:

It’s lame, Dude. It’s really lame.