Tag: obesity

Worried about diet soda? Strokes are not likely.

diet cokeLate last week, the popular press began touting a paper by Matthew Pase and coworkers in the journal Stroke on the newfound risks of diet sodas, (artificially sweetened beverages, ASBs) as compared to sugar sweetened beverages (SSBs). Most of the articles have been pretty accurate, NBC, CNN and Arstechnica got it pretty much right. Only Meredith Bland, writing as Scary Mommy went a bit off the deep end.

What the researchers did was examine data on 2888 participants from the Framingham Heart Study Offspring Cohort, looking at their reported consumption of ASBs and SSBs, and the results of their regular examinations, which ended in 2001. Surveillance continued for 10 years, ending in 2011.

They found that “higher recent and cumulative consumption of ASBs were associated with an increased risk of ischemic stroke, all-cause dementia, and Alzheimer’s disease dementia.” Specifically, they found that stroke was 2.96 times as likely and dementia about 2.89 times as likely.

This sounds really worrisome, but bear in mind that this is a single study, and that they found a correlation, not any actual cause. In fact, they didn’t propose any cause, because these results are very difficult to explain medically. They do, of course, note that “future research is needed to replicate our findings and investigate the mechanisms…”

What many writers did not specifically mention, is that there is an accompanying editorial in this same journal by Wersching, Gardener and Sacco, that is quite critical of Pase’s paper. In addition to pointing out that they show correlation and not causation, the editorial notes that while Pase reported that those consuming SSBs did not seem to have strokes or dementia, they suggested that this could be because of selection bias because those consuming sugary beverages may have died earlier. They note that previous studies have indeed found negative outcomes from those consuming SSBs.

As regards those consuming diet beverages (ASBs), the editorial suggests that “reverse causation” cannot be ruled out. What they mean is that those who know they are at risk may have chosen to switch to diet beverages and thus their strokes and dementia were incorrectly being correlated with the diet beverages instead of their already existing risk. They specifically point out that “disentangling these effects” is “challenging” in such studies.

Finally, they note that there is no obvious biological pathway to explain these cardiovascular events in those consuming diet beverages. They suggest that the current body of research, including this paper, is inconclusive and that carefully designed studies, following subjects from childhood would be necessary to establish these effects for certain.

So, for the moment, it would seem that nothing has really been established concerning diet beverages, and you can go ahead and sip yours without new worries.

 

 

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Is coconut oil healthy or just a fad? We check with Doctor Oz.

Is coconut oil healthy or just a fad? We check with Doctor Oz.

Recently we were discussing approaches to weight loss with a group of friends in Wilton, and one pointed out that Dr Oz had said that coconut oil was good for weight loss. This seemed surprising since it is an oil made of saturated fats, so we looked into it. You can buy coconut oil  almost everywhere now and from quacks like Dr Mercola.

Dr Oz did indeed endorse coconut oil on a recent show, claiming that unspecified “recent research” said it was good for weight loss, skin conditions and treating ulcers. He didn’t claim it would walk your dog or fold your laundry, but that might be in the next segment.

Dr Oz trained as a medical doctor, and some of his straightforward medical advice can be pretty helpful, but he increasingly has moved to endorse alternative medicine, pseudo-science and even faith healing. Many scientists and physicians feel he has gone completely “over to the dark side,” eschewing science-based medicine for a lot of hokum.

Coconut oil may very well make a good skin treatment, as you often find it in suntan lotions and the like. But there really isn’t much peer-reviewed research to support Oz’s assertions. It has been linked to impaired memory performance in rats. But there are no studies linking coconut oil to the stomach ulcer bacteria h pylori. There are, however, a number of sites hawking coconut oil that make these claims, though.

There is one preliminary study on 20 obese Malaysian males that showed some reduction in waist circumference and another study showing increasing obesity upon ingestion of coconut oil and other saturated fats. Finally there is a study among Filipino women showing that coconut oil improved the lipid profile by increasing HDL (good cholesterol).

However, these are small and preliminary, and no definitive conclusions have been reached. On the web site sharecare.com, the Mt Sinai Medical Center answers a query about coconut oil, suggesting it is unlikely to be useful.

The bottom line, according to the Mayo Clinic and others is this: People on coconut oil diets showed higher arterial fat after just one meal, it can increase cholesterol and, if it is not reducing your caloric intake, coconut oil can actually lead to weight gain.

And the Mayo Clinic web site points out

Although eating coconut oil in moderation for a short-term diet probably won’t harm your health, it may not help you lose weight. And keep in mind that coconut oil actually has more saturated fat than do butter and lard. For successful, long-term weight loss, stick to the basics — an overall healthy-eating plan and exercise.

There are some articles on Oz’s web site but mostly by blog contributors, many with only Naturopath training (which is not science based medicine) and even they come back to these same preliminary studies. There is also one by a board certified dermatologist touting essentially the same studies.

The only places strongly touting coconut oil are quack doctor Joe Mercola’s site and the even more suspect site at the Weston A Price Foundation. The paper Mercola appears to be referring to is also the 2009 Brazilian study where 2 groups of volunteers were fed either soybean oil or coconut oil over 12 weeks and instructed to walk 50 minutes a day and follow an otherwise balanced low calorie diet. Both groups lost weight, but HDL (good) cholesterol was higher in the coconut oil group.

In conclusion, there is a bit of preliminary evidence for some benefits,  but since it seems counter-intuitive that eating a high saturated fat diet can help you lose weight, it is probably better to follow the advice of the established experts such as WebMD and the American Heart Association who recommend against it.

 

‘Fed Up’ movie review: it gets a lot wrong

logoLast night, the Wilton Library presented a screening of the film “Fed Up” by Laurie David which takes the view that excess sugar added to just about everything is a main cause of the  world wide obesity epidemic. The screening was followed by a discussion featuring chef Michel Nischan of Wholesome Wave (and formerly of the now closed Dressing Room restaurant) and Ceci Maher of Person2Person, a local food bank and assistance organizaion, with local filmmaker Megan Smith-Harris as moderator.

The film was partly supported by the local Jesse and Betsy Fink foundation Moral Ground, and was introduced by Jesse Fink. It was directed by Stephanie Soechtig and narrated by Katie Couric.

The central thesis of the film’s scattered interviews and visuals is that of Dr Robert Lustig, who is interviewed throughout. Lustig, in his book Fat Chance presents the thesis that added sugar is the cause of all our dietary woes. The trouble is that Lustig’s views are considered outliers and have not really been scientifically tested. And the idea that sugar is “poison” is just not accurate.

The film follows three morbidly obese young teenagers who struggle with their weight quite unsuccessfully. All are clearly from fairly low income families and the film skirts the issue of class and obesity even though it is clearly part of these youngster’s problems. One of the three ends up having lap band surgery, although as the surgeon clearly notes, such surgery is really not advisable for 14 year olds, and that the potential side effects might be worse than the possible weight loss outcome.

The film shows kids eating fast food and greasy, starchy school lunches and suggests that far too many school lunch programs have contracts with fast food suppliers like McDonalds and Pizza Hut. It really doesn’t show them consuming much that is sugar laden. And in fact, it is these greasy, starchy foods which are most likely to be at the root of their obesity.

Most of the speakers interviewed in the film are writers, politicians and pseudo-scientists like Mark Hyman and Lustig. We also hear from Michael Pollan (of course), food writer Mark Bittman, and pediatrician Harvey Karp. Nutritionist Marion Nestle is one of the few credible speakers, but most of the rest are just opinionators.

The film also denigrates research in the area as having been “paid for by food companies,” which shows a pretty poor understanding of how peer-reviewed science actually is carried out and checked.

Well-intentioned and produced though this film is, it does not really talk to many actual scientists who support its thesis. And it does get a number of things wrong: notably that the current generation’s life expectancy will be lower than their parents. As noted in the review in Science-Based Medicine the CDC projects continuing increases in life expectancy.

The film also claims that more people die of obesity than starvation, but this isn’t true either as Food Insight’s review points out. The WHO claims that 2.8 million people die from overweight and obesity but Oxfam estimates that over 8 million a year die from starvation.

The film also tries to make us believe that obesity isn’t caused by just too many calories, but by the sugar itself. However, this is one of Lustig’s off-the-wall ideas that isn’t supported by science. A calorie is a calorie, and too many of them will lead to obesity: it is that simple, and that difficult.

In fact, the whole idea that sugar causes obesity is wrong. Calories cause obesity, and obesity can lead to diabetes. Sugar is not a cause, but it is definitely part of the problem.

The film also groups diet soft drinks with sugary soft drinks and fruit juices as leading to obesity because it claims that diet sodas initiate a craving for sugar. This has been discredited by any number of papers. It ain’t so and they should know it.

The depressing part of this film is that it presents no hope and no solutions. One child had lap band surgery. Another family changed their eating habits to emphasize fresh foods, which the film called “sugar detox,” and indeed all of them lost weight while they cooked that way. And they regained it when they stopped! They class/income issue is not touched on, but none of these families have a lot of money, and cooking with fresh ingredients is much more expensive, and unlikely to be supported by their budgets long term.

The film, which seems overly long when sitting on hard chairs finally concludes, offering little positive outcomes, and led to a lively panel discussion.

Chef Michel Nischan’s Wholesome Wave is now active in 30 states, helping provide nourishing fresh food to low income areas, and Ceci Maher’s Person2Person provides both food and assistant to families in the Fairfield County area. They noted that local farmers’ markets now double the value of food stamps, and that the most recent Farm Bill provides $100 million in funding to help support this program.

Overall, this is a well-meaning if disorganized film, but it offers little that is positive and gets a lot wrong.

Originally published on Examiner.com on 12/13/14