5 Steps to prevent Heart Disease

Sunday, June 3, 2012

National Lipid Association Meeting at Scottsdale, AZ

Great meeting!

 Gary Taube and Robert Lustig gave presentations.  This was a historic moment for the NLA. Not all calories are the same.  Sugar and CHO create more fat because of insulin.

HDL-C is more confusing than ever as devotees cling to it despite the new genetic evidence, the pharmaceutic dumping of it's HDL-C elevating drug and the old AIM HIGH information. 

The EPA vs. DHA was fascinating for this lipid geek.  I am not running out to buy EPA products. 

The June 2011 Journal of Clinical Lipidology had a comprehensive update on Fatty Acids in Cardiovascular Health and Disease.  Let me quote Walter C. Willett MD from Harvard on p. 218, "Fifteen years ago, this debate would have been considered impossible because it was believed that Saturated Fatty Acid intake was the primary determinant of high rates of Cardiovascular disease in Western countries.  However, in recent years, that question has been re-examined, or more accurately, seriously examined for the first time.  In truth, there was not very good epidemiological evidence for this relationship from the beginning."

WOW!  No real surprise because that is what he said in NYC in May 2011 NLA meeting and echos the talk Dr. Mafassarian gave at the NLA meeting in Washington D.C. in summer 2010.  Penny introduced Doctor Mafassian and made a comment similar to "Fifteen years ago, this debate would have been considered impossible"

On Sunday, on June 3, 2012, I went to listen to Penny Kris-Etherton talk at the NLA workshop. 

To my surprise she reported the AHA recommendations on diet without the above qualifications.

On page 5, in the booklet titled program materials she read from the two slides.  Saturated fat < 7% of total energy uptake.  Strong evidence.  The next slide stated that the "overall strength of the available supporting evidence (for SFA) is a Grade I which means it is good. 

My interest is shining a light on the conflicting information the NLA is presenting and request we examine these issues more closely.

I thought that Dr. Kris-Etherton's talk was one of the best nutrition talks I have ever heard. 

She presented several trials to back up the diet recommendations:
1- Portfolio Eating Plan to lower cholesterol
2- DASH trial
3- PREMIER
4- DIET COMPARISON TRIAL by Sachs et. al.
5-The Diabetes Prevention Program
6- Look Ahead trial
7- Comparative Effectiveness of Weight-Loss interventions in Clinical Medicine
8-The Weight Loss Maintenance Trial
9- A Two Year Randomized Trial of Obesity Treatment in Primary Care Practice.


I don't know why she left out the Lyon Diet Heart Trial as it is often cited as proof of a healthy Mediterranean diet?

My first question is whether there was weight loss in the Portfolio diet and the DASH diet.  If there was weight loss,  does that confound the results?  When, I point to the Diet Comparison trial as evidence that low carbohydrate diet was at least lipid neutral, Nutritionists will counter that is because there was weight loss.

In my book, The Tubby Traveler from Topeka, I went on a 60% fat (mostly animal fat) low carbohydrate diet and did not lose weight.  I decreased my exercise from the prior year and my advanced lipid panel at the end of the year was excellent.    I did this because I could not find this detailed lab documented results anyplace else.
  
The DASH trial may be re-examined after reading Gary Taubes NY TIMES article on SALT today.


The Look Ahead trial was presented at this meeting by Dr Echel.  He showed slides that by year 4,  much of the original weight loss was regained.  I remarked in the question period that this maintenance of weight loss is the issue and no diet has been able to document more than 5-10% weight maintenance after five years.  The reason is well known.  The Energy Gap (aka plateau, resettlement point).
I said that after a 40 pound weight loss their is an energy gap of 350 to 500 calorie energy gap.  This needs to be made up with less food or more exercise according to the NWCR, just to maintain the weight loss. At the Orlando Obesity Society Meeting, I was told that the 6,000 folks who maintained their weight loss more than five years ate about 7 calorie/lb/day and exercised the equivalent of 500 calories a day.    I said that five miles of walking a day does not burn off 500 calories a day because of the 42% reduction in exercise metabolism.   I said this is why low calorie diets fail.  The reduced obese develop the Sponge syndrome where calories get soaked up like a sponge due to several compensatory mechanisms to prevent starvation.  Dr. Echel said my energy statements were incorrect but did not go into detail. 


The Sunday morning NLA workshop on nutrition counseling is still trying to teach us how to change the eating behavior of our patients.  The Internet is the new tool for interactive support to help our patients stay on the diet. 

I'm sorry, until I am shown how to overcome the energy gap,  behavioral therapy will make no difference. 

It doesn't get much more intense in terms of support than the Look Ahead trial.  13 years from now, it will be inevitable that the participants will weight more than when they started their diet because their metabolism will have slowed by 2% just because of the aging process. 

If leaving three bites of food on the plate or replacing low glycemic fruit for SFA and salmon for beef solved the problem,  there would be no obesity crisis. 

I suggest we do what Dr. Willett says is beginning to be done with the SFA science:

"However, in recent years, that question(SFA causing CVD) has been re-examined, or more accurately, seriously examined for the first time.  In truth, there was not very good epidemiological evidence for this relationship from the beginning."

I believe his statement may be applied to diet and obesity.


No comments:

Post a Comment