Low Fat / Low Cholesterol Study

In 1964, F.W. Lowenstein, a medical officer for the World Health Organization in Geneva, collected every study he could find on men who were virtually free of heart disease, and concluded that their fat consumption varied wildly, from about 7 percent of total calories among Benedictine monks and the Japanese to 65 percent among Somalis. And there was every number in between: Mayans checked in with 26 percent, Phillippines with 14 percent, the Gabonese with 18 percent, and black slaves on the island of St. Kitts with 17 percent. The type of fat also varied dramatically, from cottonseed and seasme oil (vegetable fats) eaten by Buddhist monks to the gallons of milk (all animal fat) drunk by the Masai. Most other groups ate some kind of mixture of vegetable and animal fats. One could only conclude from thees findings that any link between dietary fat and heart disease was, at best, weak and unreliable. 

- Nina Teicholz - The Big Fat Surprise - page 56

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SEATTLE, Oct. 2—The American Diabetes Association has recommended that physicians encourage their diabetic patients to eat the same amount of carbohydrate foods—sugars, starches and celluloses—as people who are unaffected by the disease.

If physicians and patients follow the association's recommendation, it will mean a major change in the rationale of treating the disease, which has afflicted man since ancient times.

The association said that the recommendation to alter diabetics' diets—raising carbohydrates and thereby lowering fats—was taken to minimize the risk of diabetic patients developing hardened arteries (called arteriosclerosis), heart attacks and strokes.

Though the private association's guidelines are not binding on physicians, the recommendations are likely to influence the dietary care of many of the 2.8 million known diabetics in this country. The association said that an additional 1.6 million Americans have undetected diabetes.

The recommendations, which were made in a “special report,” were intended as a general policy. Like all other general guidelines in medicine, they may have to be tailored by a private physician to an individual patient's needs.

A Cardinal Therapy

Diet is a cardinal therapy for diabetes because weight reduction alone can control the disease in many—but not all—adult diabetics.

In the past, the association has not set limits on the amount of carbohydrates that it has recommended diabetics to eat. However, many doctors have urged their diabetic patients to limit carbohydrates to about 30 per cent of the calories in their daily diet, and thereby, to eat a disproportionately larger amount of fats.

Now, the association said that diabetics, like other Americans, can eat diets that contain about 45 per cent carbohydrates. Carbohydrates include a wide variety of sugars. Table sugar is just one of many that nature provides.

The remainder of the diet should consist of fats and proteins in a ratio geared to the patient's taste and his doctor's advice. Because the association says that most diabetics must limit their calories each day, this means that these patients would eat less fat.

Fifty years after the discovery of insulin — the hormone that among other functions controls the blood sugar level — arteriosclerosis has become the major killer of diabetics. Americans rarely die now of diabetic coma because insulin, a hormone derived inexpensively from the pancreas glands of animals, is so widely available for human use.

However, not all diabetics require insulin. Physicians generally prescribe insulin injections just for patients whose diabetes cannot be managed by special diet or pills. Such pills do not contain insulin, but rather other drugs that, by different pharmacologic actions, affect the blood sugar level.

“There no longer appears to be any need to restrict disproportionately the intake of carbohydrates in the diet of most diabetic patients,” the association said in the current issue of Diabetes, a scientific journal that the American Diabetes Association publishes in New York.

“The average proportion of calories consumed as carbohydrate in the U. S. population as a whole approximates 45 per cent. This proportion or even higher appears to be acceptable for the usual diabetic patient as well,” the report said.

Dr. Edwin L. Bierman, who was chairman of the committee that wrote the report, stressed in an interview here:

“For those adult diabetics treated by diet alone, the cornerstone of our recommendation is restriction of total caloric intake, and it doesn't make any difference how you do it.”

Dr. Bierman, who is considered one of the nation's leading researchers on diabetes and arteriosclerosis, treats patients with such diseases at the Seattle Veterans Administration Hospital and teaches medical students at the University of Washington.

“Most adult diabetics are obese,” he said, citing statistics from the Metropolitan Life Insurance Company, which show that two‐thirds of the female diabetics and half of the male diabetics in this country are more than 20 per cent overweight. Obesity does not cause diabetes, but it does tend to bring out the disease in those patients who are genetically susceptable.

Advice for Obese and Lean

Accordingly, the Diabetes Association stressed in its report that doctors should advise their overweight diabetic patients to reduce and their leaner diabetics to avoid weight gains with advancing age.

A calorie is a unit measurement of the amount of heat energy that a specific food can yield for muscular and other bodily activity when it is chemically changed in the tissues lof man. Though the need varies with each individual, depending in such factors as age, activity, weight and height, American men generally use about 2,500 calories per day and women about 1,800 calories.

Diabetes, depending on its severity, can produce weakness, weight loss and fatigue among other symptoms. These symptoms result from the biochemical changes that scientists think result from production of an insufficient amount of insulin to meet the body's needs.

Lack of insulin impairs the body's metabolism, or biochemistry, of carbohydrates. As a result of the complex interlocking relationship of the body's biochemical reaction, diabetes also disturbs the metabolism of protein, chemicals, water and fats.

“Today many diabetologists believe that blood fat is as important to a diabetic as is blood sugar,” Dr. Bierman said, meaning that abnormal blood fat levels are now considered one of the several factors associated with a high risk for arterosclerosis.

The Diabetes Association's action comes at a time when experts are expressing a growing appreciation and concern about the role of nutrition in health.

“The basic nutritional requirement for patients with diabetes are in general the Isame as those for all individuals,” the association said. Such needs include adequate quantities of protein, vitamins, minerals and essential fatty acids.

However, the association stressed that physicians should write dietary prescriptions for diabetic patients whenever necessary as part of their broader general health care that includes:

¶Periodic medical examination.

¶Regular exercise.

¶Avoidance of cigarette smoking.

¶ Attention to personal hygiene.

¶Prevention of infection.

For many decades, physicians have noted that diabetic patients handle infections poorly. This is true despite the proper use of antibiotic drugs when infection occurs in a diabetic patient.

The reason for this phenomenon mystifies scientists who still do not know what causes the incurable, yet treatable disease, diabetes. Though most doctors say they believe diabetes is a heredetary disease, scientists do not know the precise pattern of such proposed inheritance.

Until insulin was discovered, starvation diets were doctors' best therapy for the disease.

A half‐century ago when Dr. Frederick G. Banting and Dr. Charles H. Best, working in Dr. John J. R. Macleod's laboratory at the University of Toronto, discovered insulin, physicians began prescribing regular diets for diabetes patients.

“Thereafter, somehow, carbohydrate restriction began to hold sway as the cornerstone of treatment of diabetes,” Dr. Bierman said.

Though evidence began mounting in the late nineteentwenties that diabetics could eat diets higher in carbohydrates without apparent untoward effects, results of such observations caused few physicians to change their dietary prescription habits for their diabetic patients.

Now, those earlier observations are being confirmed with more sophisticated laboratory techniques by investigators like Dr. Bierman.

Earlier this year, for example, Dr. Bierman and his colleagues, Dr. John D. Brunzell, Dr. Roger L. Lerner, Dr. William R. Hazzard and Dr. Daniel Porte Jr., reported in the New England Journal of Medicine scientific evidence that showed high carbohydrate diets lowered blood sugar in the mild diabetic and normal humans studied.

“Diets high in carbohydrates do not raise the blood sugar,” Dr. Bierman said, adding, “That's the misconception that most physicians have had during the last 30 years.”

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The Consensus Conference

If a large portion of middle-aged American adults are now cutting back on meat and taking statin pills, it is due almost entirely to the step that the NHLBI took next. Dispensing drugs and dietary advice to the entire US population is a huge responsibility, and the NHLBI decided it needed to create a scientific consensus, or at least the appearance of one, before moving forward. Also, the agency needed to define the exact cholesterol thresholds above which it could tell doctors to prescribe a low-fat diet or a statin. So once again, in 1984, NHLBI convened an expert group in Washington, DC, with a public meeting component attended by more than six hundred doctors and researchers. Their job—in an unrealistic two-and-a-half days—was to grapple with and debate the entire, massive stack of scientific literature on diet and disease, and then to come to a consensus about the recommended cholesterol targets for men and women of all ages.

The conference was described by various attendees as having preordained results from the start, and it’s hard not to conclude otherwise. The sheer number of people testifying in favor of cholesterol lowering was larger than the number of spaces allotted to challengers, and powerful diet-heart supporters controlled all the key posts: Basil Rifkind chaired the planning committee, Daniel Steinberg chaired the conference itself, and both men testified.

The conference “consensus” statement, which Steinberg read out on the last morning of the event, was not a measured assessment of the complicated role that diet might play in a little-understood disease. Instead, there was “no doubt,” he stated, that reducing cholesterol through a low-fat, low-saturated-fat diet would “afford significant protection against coronary heart disease” for every American over the age of two. Heart disease would now be the most important factor driving dietary choices for the entire nation.

After the conference, in March 1984, Time magazine ran an illustration on its cover of a face on a dinner plate, comprised of two fried-egg eyes over a bacon-strip frown. “Hold the Eggs and Butter!” stated the headline, and the story began: “Cholesterol is proved deadly, and our diet may never be the same.”

As we’ve seen, LRC had nothing to say about diet, and even its conclusions on cholesterol were only weakly supported by the data, but Rifkind had already demonstrated that he believed this extrapolation was fair. He told Time that the results “strongly indicate that the more you lower cholesterol and fat in your diet, the more you reduce the risk of heart disease.”