Review of the Year
We’re kicking off with a review of last year. As Veganuary has just been re-launched, last January’s note about the nutritional deficiencies of a vegan diet is topical. Maybe you’re about to try Time Restricted Eating? February opened with a review of the impact of this way of eating in people with metabolic syndrome. March saw the start of many articles on Covid-19, and a couple of articles that month got to the bottom of the debate about high protein diets and kidney disease. In June, I presented the definitive review of all the Cochrane reports into dietary fat – saturated fat and heart disease especially. The Scientific Report for the 2020-2025 Dietary Guidelines for Americans was summarised in one of the July articles. August has a ‘bookmark’ post on meat and TMAO, as this is something that keeps coming up in attacks on omnivore diets. September turned out to be a bumper type 2 diabetes month, including a comparison of the performance of very low carb (Virta) vs very low calorie (DiRECT) diets for putting type 2 diabetes into remission. The rest of the year covered obesity, SAGE conflicts of interest, Gary Taubes’ book (out 7th January 2021) and bone fractures in vegans. Here’s a quick summary of each post and a link to the full article for convenience.
Is veganuary healthy? Veganuary was launched in the UK in 2014. The number one reason given by people for trying Veganuary is health. I analysed the health content of the campaign website: Veganuary.com to evaluate whether Veganuary is a healthy thing to do.
Higher LDL-cholesterol & lower mortality. A study examined the relationship between high LDL-cholesterol and dying among the highest risk group of people with heart disease. Following heart attack, or acute heart failure, people were less likely to die and more likely to live longer if they had high LDL-cholesterol. This study undermines the belief that high LDL-cholesterol is harmful – especially in those with heart disease.
LDL-Cholesterol targets following ischemic stroke. A study reported on a clinical trial where 2,860 patients – who had had an ischemic stroke – were assigned to two different LDL-cholesterol targets. The paper reported that the patients assigned to the lower LDL-cholesterol target group had a lower event rate during the approximately 3.5 years of follow up. There were at least a dozen issues with the study.
Inclisiran – new ‘cholesterol-busting jab’. A collaboration between the drug company Novartis and the UK National Health Service announced that British people would start taking part in a trial for a new cholesterol-lowering drug called inclisiran. Inclisiran is not yet approved for use by any regulatory authority. I took a look at the efficacy and safety of the plan.
Time restricted eating in people with metabolic syndrome. A small study involved 24 people with metabolic syndrome, who were asked to eat within a self-chosen 10-hour window for 12 weeks. A number of interesting observations were made about the eating pattern, adherence, and food intake. There were some surprising non-findings as well as some interesting findings.
The healthy low carb vs low fat study. The Harvard school of public health published a study about the association between low-carb and low-fat diets and mortality. There were two main findings (summarised in the Executive Summary of the note). However, the extremes of low carb were 46-58% of total energy intake and the extremes of low fat were 27-36% of total energy intake. Hence the study examined neither low carb nor low fat.
Carb restriction ‘associated with T2D in Australian women.’ A study claimed that carbohydrate restriction in midlife is associated with a higher risk of type 2 diabetes among Australian women. The headline claim did not adjust for BMI. When the data were adjusted for BMI there were no findings. I spell out what the paper actually found, therefore.
Trust Me I’m a Doctor – Don’t! This was a copy of a complaint that I sent to the BBC following a clip during a well-known UK programme called Trust me I’m a Doctor. The segment was completely biased against meat and in favour of plant foods. Conflicts of interest were not declared, sweeping statements were made with no evidence, a shockingly bad uncontrolled experiment was undertaken and no warnings about the nutritional deficiencies of a plant food diet were issued. A reply from the BBC finally arrived, and I published it at the end of this post.
The British Heart Foundation and Familial Hypercholesterolemia (FH). This post was inspired by a presentation I saw Dr David Diamond deliver. David asks the right question in his presentations on FH: if high LDL-cholesterol is so dangerous, why doesn’t everyone with FH die prematurely from heart disease? His research has led to evidence that there are significant differences between people with FH who develop heart disease and those who don’t.
Dear British Heart Foundation. This post detailed an email exchange that I had with the British Heart Foundation back in February 2018. The BHF position statement on Familial Hypercholesterolemia is wrong and still hasn’t been corrected two years later.
Intermittent Fasting, Mediterranean & Paleo diets. A study was undertaken involving 250 overweight, but otherwise healthy, adults in New Zealand. They were given information about three diets – Intermittent Fasting, Mediterranean Diet, and the Paleo diet – and then asked which one they would like to follow for 12 months. What they chose and how they did was really interesting.
High protein diets & kidney disease. This note is about two different studies that were reported as showing that high protein diets could be/are bad for kidney health. Closer examination of both studies revealed the same flaw in both.
Do high protein diets cause kidney disease? Last week’s note reported on two epidemiological studies that claimed an association between protein intake and kidney function, but the food intake data were not credible. This week we ask the proper research question – do high protein diets cause kidney disease?
Coronavirus – COVID-19 – some facts & figures. This was an early look at coronaviruses in general and COVID-19 in particular from a fact and figure perspective. This was written just before the UK locked down.
Anxiety and The Power of Now. This note was written in unprecedented times of uncertainty. Little did we know then how long those uncertain times would continue. It asked: what is anxiety? When was it first captured in the literature? What is the early evidence on how COVID-19 is affecting people? Is there anything we can do to alleviate anxiety?
COVID-19 – do masks help? At the time this note was written the official advice was that masks for general public use do more harm than good. At the time this note was written the evidence – admittedly from healthcare settings – suggested otherwise.
COVID-19 tests. At the time this note was written, much was being said about testing, while less was being said about test reliability. There are two key attributes of a medical test – test sensitivity and test specificity. Test sensitivity is the ability of a test to correctly identify those with the disease. Test specificity is the ability of a test to correctly identify those without the disease. While testing for who has got COVID-19 and who has had it are ongoing, which side do these tests need to err on for caution?
SACN consultation on lowER carb diets & T2D. In March 2020, Public Health England announced a consultation on a SACN (Scientific Advisory Committee on Nutrition) draft report examining lowER carbohydrate diets for adults with type 2 diabetes. This note replicates my reply to the consultation. It covers conflicts, ignored data, and the absurdity of the lowER carbohydrate intake examined.
COVID-19 Risk factors. This was an examination, at that time, of the evidence from China, Italy, and the US on risk factors for having a bad outcome from COVID-19. There were some inconsistent findings and some surprising findings.
Coconut oil, olive oil, butter & LDL-cholesterol. This post looked at a classic paper from 2018 in an attempt to see if saturated fat can, let alone does, raise LDL-cholesterol. The study randomised 96 (healthy) adults to one of three interventions – consuming 50g daily of extra virgin coconut oil, extra virgin olive oil, or unsalted butter for 4 weeks. The main outcome was change in LDL-cholesterol. There were many flaws.
COVID-19 and Vitamin D. Papers on COVID-19 were being published in pre-print because of the urgency of the situation. I reviewed five on COVID-19 and vitamin D. Two, from southern Asian countries, reported striking odds ratios (between 7 and 10 fold differences) for poor outcomes from COVID-19 in patients with deficient vitamin D.
Fat shaming or life saving. Judging by responses, this was one of the most popular posts of the year. It explored ‘doughnut-gate’, as it became known on twitter and the issue of obesity and poor outcomes with COVID-19. Is it ‘fat shaming’ to draw attention to things that might worsen obesity at a time when obesity is associated so negatively with COVID-19 complications?
Dietary Fat & Mortality. This reviewed the latest attack on dietary fat – saturated fat especially. There were so many errors that I entered into communications with the authors and they asked if I might review their next paper to fact check before publication!
Animal Based Low Carb vs Plant Based Low Fat Diets. This was a review of the latest study from Dr Kevin Hall. It was intended to assess the relative merits of low-carb vs low-fat diet arguments. The study randomised 20 inpatients to an animal based low carb diet or a plant based low fat diet for 2 weeks and then they swapped over to the other diet. There were many interesting findings.
Cochrane saturated fat reviews. A revised Cochrane report on saturated fat, mortality and heart disease was published. The first one was published in 2000. I took the opportunity to do a definitive review of the four Cochrane reports that have been published on this topic and why they have found anything against saturated fat when other researchers haven’t.
Social distancing – the evidence. The WHO position on social distancing changed several times during the spring of 2020. This post reviewed the evidence that was available on viruses generally before COVID-19. It then reviewed a Lancet paper just published with the most current evidence – including some studies relevant to COVID-19. It turned out that none of these had even examined social distancing as global populations were being advised to undertake.
Making value judgements about life and death. I was invited to take part in a scientific survey making value judgements about life and death decisions related to COVID-19. It reminded me of a similar Massachusetts Institute of Technology (MIT) on-line survey about driver-less cars. What would you do?
The risk of CVD over the next 10 years. Population studies and randomised controlled trials have been undertaken since the post World War II period in an attempt to understand the risk factors for CVD. What turns out to be a risk factor and what doesn’t?
COVID-19 deaths and excess deaths. This post reported deaths during spring 2020 for Australia, the US, and the UK. It presented the most recent data for deaths with COVID-19, a few weeks on from the peak in deaths that occurred for all three countries in April 2020.
What is a healthy food? This week’s note was inspired by the second Swiss Re/BMJ “Food for thought” conference and by an email I received. The conference posed the question what is a healthy food? The email pointed me to an article that claimed to have the answer for the top 100 most nutritious foods. What were they? What were the assumptions that led to this ranking and what went wrong?
Animal vs plant protein. A tweet by WebMD inspired this post. It claimed that chickpeas “offer just as much, or more” protein than eggs. It was wrong and wrong in many ways.
Is saturated fat worse than sugar? This study – funded by sugar and anti-saturated fat organisations – concluded that it is. There were so many things wrong with the paper, it was tough to know where to start.
Dietary Guidelines for Americans 2020. The Scientific Report for the 2020 Dietary Guidelines for Americans (DGAs) was published in July. This is the comprehensive document (835 pages), which precedes the Dietary Guidelines for Americans due out at the end of 2020. This post reviewed the history of the DGAs, the major changes over the years and any changes that might happen in the final 2020 publication.
Statins in the over 75s. Headlines in July 2020 reported that “A study of over-75s found that those taking statins were 25 per cent less likely to die from any cause.” The raw data showed the opposite. The entire claim rested on the statistical technique used for adjustment.
The hierarchy of evidence. This is a post to refer back to. It’s all about evidence in academic studies. What’s the best evidence? What exactly is meta-analysis? How do population studies compare with randomised controlled trials? What is a case control study? It’s a glossary of evidence and types of studies.
The carnivore diet and micronutrients. What’s the history of micronutrients and Recommended Dietary Allowances (RDAs)? If we analyse a typical carnivore diet, as we have previously vegan diets, how do they fare for micronutrients? Can deficiencies be overcome? Which nutrients are most likely to be lacking and is that an issue?
Meat, plants & TMAO. This post looked at a recent study funded by plant-based meat. The main outcome of interest was TMAO, which is a substance known to increase following consumption of meat, eggs and especially fish. TMAO did increase (no surprise) but not consistently (surprise) and no evidence was provided for TMAO being harmful anyway.
Cholesterol & PCSK9s – the lower the better? This note was about a fabulous study reviewing all trial data on PCSK9 inhibitors (cholesterol lowering injections). The research found that PCSK9 inhibitors lower cholesterol (no surprise) but they have no effect on mortality. The research team thus asked: if PCSK9 inhibitors lower LDL-cholesterol and lowering LDL-cholesterol is claimed to reduce mortality, why is the evidence from PCSK9 interventions not showing reduced mortality?
Soups & Shakes for Type 2 Diabetes. The UK National Health Service (NHS) announced that, from 1st September, 2020, thousands of adults would be offered very low calorie liquid diets (soups and shakes) in an attempt to put type 2 diabetes (T2D) into remission. I took a look at the evidence upon which this initiative was based.
Liquid diets & regain. Following on from last week’s note, which was about very low calorie (liquid) diets for T2D remission, this note examined a classic systematic review from 2007, which examined the evidence for weight loss – and regain – following very low calorie liquid diets.
Low calorie vs low carbohydrate for T2D remission (DiRECT vs Virta). This was a natural follow-up to the previous two notes looking at very low calorie diets for T2D remission. Results are available from the DiRECT (very low calorie) and Virta (very low carbohydrate) trials at one year and at two years. This note compared the outcomes between the two dietary options for T2D remission.
The Eatwell Guide & Mortality. A paper was published, which claimed that adherence to the UK ‘Eatwell’ Guide (EWG) could reduce your risk of dying early and lower your environmental footprint. This note looks at the dying early claim. It provided virtually no evidence in support of the ‘Eatwell’ Guide for health arguments.
The Eatwell Guide & The Environment. This note was the follow-up to the previous week’s note and it looked at the environmental footprint claim. My research for this note was the most troubling I have ever undertaken. I came to the conclusion that there is a global food agenda, becoming increasingly sinister, which we need to wise up to. Health messages attacking meat, eggs and dairy have not achieved the desired plant-based global diet. Environmental messages are now being added in to achieve this goal and, I think, will soon replace health as the key rationale for the plant-based diet. Human and planet health requires ruminants building and protecting topsoil and eco systems, but this does not suit the agrichemical and big food agenda.
The 500th Monday note! This note was the 500th written – that’s one a week over ten years. It summarised the reviews of the year and the top 10 most popular posts over the past 10 years.
Calories, Thermodynamics & Weight. Last week was the 500th Monday note and it made me wonder what the first note was. It was called “Where do calories go?” It was inspired by a programme about morbidly obese people who were gaining a fraction in weight of what their excess food intake suggested that they would. This note went through seven errors/misapplications of the laws of thermodynamics to energy and weight loss.
UK Deaths in 2020. This was a note about a report and a number of datasets that were published in October by the UK Office for National Statistics. It looked at deaths and excess deaths in private homes, hospitals, and care homes. There were some significant differences vs patterns over the previous five year average. This was also the note with my personal p.s. as my father became one of these statistics 🙁
The Impact of Lockdowns. This was a review of a very comprehensive paper in the Lancet, which examined 790 phases of various lockdown measures from 131 countries. The study found that only 1 measure made a statistically significant difference at 28 days.
UK Deaths with Covid-19 & R. This note plotted on the same graph:
1) Deaths for the UK with Covid-19 from week 11 until week 42.
2) The R estimate when known during this period. The reader is then invited to review the strength of any relationship between the R estimate and UK deaths with Covid-19.
SAGE Conflicts of Interest. I was kicking myself for not having done this note sooner. I went through the SAGE meeting minutes for attendees to find the key influencers and then researched their conflicts of interest. Twelve out of 20 key influencers work for/have received funding from organisations involved in the Covid-19 vaccine. It is in their interests, therefore, to keep people in lockdown.
Essay on the Obesity Epidemic. This was an essay on the obesity epidemic, which was due to appear in a journal publication and then didn’t and so I was able to share it.
Eggs, Diabetes & Chinese Adults. An epidemiological study claimed that eggs were associated with diabetes (the type wasn’t specified), which didn’t make sense. Examination of the study revealed misleading passages and a falsehood and a genuine explanation, which should have made the headline, but it was about cake rather than eggs!
Vegans & Bone Fractures. A paper was published, which generated the headline that vegans might be at higher risk for bone fractures. The study was long and large, and the risk ratios were high, suggesting causation and not just association. There are plausible nutritional mechanisms too. There was an even more interesting finding, however.
The Case for Keto. This was a review of Gary Taubes’ latest book, which I very much enjoyed reading. It comes out on January 7th, 2021 for anyone keen to get hold of a copy.
The impact of a 10% limit on saturated fat. The 10% restriction on saturated fat has been in place since 1977 in the US and adopted by most other countries since. For reasons explained in this note, I reviewed which single foods contain no more than 10% saturated fat. The exercise revealed that this (non-evidence-based) goal achieves another goal, which I hadn’t previously realised.
ChAdOx1 nCoV-19 – The Lancet Papers. This was a review of the academic papers published in The Lancet by the Oxford/AstraZeneca trial team. It also covered the December Pfizer publication. This note reviewed the trial designs, objectives, participants and numbers. It showed what 90% efficacy means vs what people think it means.
Who knows what the topics will be this year? Thank you so much for your continued support as I await the next diet and health story to unpack.
Until the next time
All the best – Zoë