Tuesday, June 01, 2010

FSA in Glasgow

I thought I might just take a little time for a brief post , just some lightweight stuff from up here in Glasgow.

Glasgow is generally considered to be one of the less healthy cities in the UK, in terms of chronic disease. That makes it an excellent test-bed for ideas which might improve the health status of the population here and for the rest of the UK. You would have thought that we Glaswegians had nothing to lose from a dose of healthy eating. Siobhan Higgins and her group decided to test whether the current healthy eating advice from the Food Standard Agency (as of 2007) and the advice from the Department of Health, not updated since 1991, was good for Glasgow's post menopausal women. Or not.

The results of the Higgins study were published in 2009, so "nae rush" about checking the 1991 advice from the Department of Health.

The FSA-DoH advice is to reduce fat, especially saturated fat, to reduce sugar only if it is >10% of calories, plus to eat lots of stuff which is going to go down the loo 12 hours later (fibre).

The conclusion is that following UK Government advice, as epitomised by the FSA, damages every measured parameter reported in the study and probably damages a number more which were measured but didn't get reported. There is one exception, more on that later.

The change in HDL (downwards, of course) was not only statistically significant but biologically and probably clinically significant too (to a lipid hypothesis believer like Higgins). Of course this is rationalised by claiming that a subnormal HDL level is GOOD thing if you have a low HDL due to eating to FSA advice. The same low HDL is lethal if you self-select your diet. Hmmmmmmmmmm. What's the science behind this strange variation in the significance of a low HDL level?

Garbage trucks. My son loves garbage trucks. The blokes doing the wheelie bins always give him a wave and a grin. Back in Berkshire it was one of the highlights of his week! Aparently HDL is a garbage truck. Eat to FSA advice and your need for garbage trucks goes down. Woooooow! FSA + low HDL = Good Thing.

How true is this? Well Higgins has a reference! This is what she says:

"Lower fat intake is known to reduce the requirement for HDL-mediated cholesterol removal [27]"

Reference [27] says that a high carbohydrate diet lowers your HDL by decreasing production of ApoAs. The implication is that this is Good. I think that's bollocks. If you believe low HDL is bad, it's bad. Otherwise why measure the stuff, why try and raise it with torcetrapib?

FSA-DoH advice dropped these women's HDL to an unacceptable level. This is unacceptable. The women were injured. Full stop.

So what else happened? Despite weight loss triglycerides increased, fasting glucose rose, fasting insulin rose, HOMA rose, LDL dropped (probably smaller and denser LDL, obviously this was not checked but it will have been the case) and CRP rose.

NOTHING improved.

Luckily very few changes reached statistical significance within 4 weeks, but then it is hard to take a normal post menopausal woman in Glasgow and make her frankly diabetic in 4 weeks. But you can sure as hell get her started! Just employ a mainstream dietitian spouting FSA advice. I wonder if they did power calculations to make sure the p value for changes in glucose and insulin would fail to reach statistical significance by limiting the study size to just 12 victims? Bit of a cock-up on the HDL calculation then...

I was also wondering about the weight loss. It would have been interesting to measure waist:hip ratio and absolute change in waist circumference on a disaster diet. I was disappointed they didn't report these. Until I read the methods carefully and found that they actually did measure them. They just didn't report the changes in those measurements. I read the results very carefully, not reported. So I think we can safely assume the waist expanded, the hip measurement didn't change and the victims lost muscle. Non of these changes need to have been statistically significant but because fasting insulin rose it seems reasonable the assume the changes were toward that pot bellied, sarcopaenic physique so beloved of a modern dietician.

Final words of Higgins et al:

"In conclusion, the results of this study showed that whilst following the UK dietary guidelines to increase carbohydrate and reduce fat intake did appear to have adverse effects on HDL cholesterol concentration, these same dietary changes were also associated with some positive health effects on the antioxidant potential of the plasma and a reduction in BMI."

No no no no no. The HDL didn't "appear" to drop. It dropped. It dropped right out of the clinically acceptable range. These women were injured in the study, directly by the dietitians and indirectly by the FSA. I wonder if they were told to go back to their previous self selected diet to get their HDL back in to the clinically acceptable range and their triglycerides down? Ha ha ha.

Last two comments are about those positive effects, those on FRAP and BMI.

The group never mentioned uric acid. That's the mammalian antioxidant which normally goes up in response to fructose intake and gives the superficial impression that the sucrose in fruit is somehow healthy. I can't see the extra sucrose in any of the diet tables (obviously it went up as a % of calories, I was looking for an absolute increase) but I'm suspicious it's there somewhere. What was the uric acid level? Not measured. Duh.

The BMI dropped. Whoopee. Talk about treating a number! BMI decrease, especially in older people, is bad news anyway (for all cause mortality). Imagining that weight loss which is accompanied by a deterioration of every measured parameter is "a positive health benefit" just insults the intelligence. If it were "weight" per se which mattered then carrying a backpack or gaining muscle would be risk factors for heart disease.

So, can you make a resident of the least healthy city in the UK less healthy by altering their diet? Absolutely. Just follow FSA advice.



John said...

Sometimes bad science/interpretation is irritating, but this is pretty funny--unfortunate for the women though...

Peter said...

Aye, too right....

Peter (learning the lingo)

Anna said...

This would be funny if it wasn't so truly so sad.

The official advice affects real people and their families (who often follow the same advice, or have to put up and shut up to keep the family peace ;-). So few question anything "official", when the evidence of how bad the advice is is literally all around us, right in plain sight.

I watched this with my own mother (located in a former manufacturing town in often cloudy "rust-belt" of upstate NY, a place not so very different than Glasgow in some ways). She long followed the somewhat vague anti-saturated fat advice that took hold with Ancel Keyes, but in the early 80s she really took to the AHA recommendations in earnest, in the hope of escaping the CVD disease which took her father's life at age 50 (when she was still a teenager).

Now, at age 67+, it's true she's lived far longer than her father (she shares his temperament, body shape, and other traits). But starting with her "high total cholesterol" in her 40s, then high LDL cholesterol when that was fingered as a factor, she has participated in the Emperor's New Clothes plan by taking synthetic HRT, statins, and adopting a low fat-high carb diet/now a Low GI diet (plus her 25 + yr career as a night-shift nurse in upstate NY didn't help her health - talk about Vit D and sleep deprivation!). Nonetheless, still she developed hypertension, T2 diabetes, sleep apnea, and two blocked coronary arteries (undergoing double bypass op last June). She apparently doesn't see the dissonance or the irony in her results despite following all the official recommendations. She's thankful for modern medicine because it has given her more years than her father had.

I'll pass on the Koolaid, thanks. I'm so grateful it dawned on me some years back that I needed to pursue a healthier future in a different way. Thanks for this post. I hope a lot of people read it and pay attention to their cognitive dissonance.

Peter said...

Anna, with the recent meta analysis by Krauss and the rival meta analysis of replacing saturated fat with PUFA (utterly shred-able), the donkey work for having a go at the FSA has been done. But the task is so daunting and the likelihood of any impact so slim that spending a week or two drafting a watertight case against the current advice is a big investment of precious time per probable unit return. I'm not sure I could face it.

Ultimately the cognoscenti always do better than the canon fodder. But I agree, it's so sad to watch relatives and relatives of friends dying slowly at the hands of the FSA.


John said...

It is sad. It's an awkward position (for me at least) to have spent years nudging family members towards healthy diets, see the recommendations ignored, then see health problems arise--what then to say?...I told you so?...

blogblog said...

Unfortunately the cholseterol myths will take another 40-50 years to disappear. Until dozens of skeptics hold leading postions in academia and medicine nothing will change. These future skeptics are only babies at the moment.

O Primitivo said...

"Statins, Cholesterol, Women and Primary Prevention: Evidence-Based Medicine or Wishful Thinking?" -

Quelle said...

Link for the article pls?

Peter said...

Hi Quelle,


Sorry I forgot to link in the text, I'll edit it in.


Peter said...

BTW email if you would like the full text


Quelle said...

Well, this was so small study that i doubt i need to read the full article straight away.

I was wondering, if in the full text you can find how well the participants sticked to the FSA diet?

According to that table u posted, it seems that they had an awful lot of energy from sugars alone which kinda suggested that they didnt follow the FSA guide lines that well.

Peter said...

Hi Quelle,

Well in Glasgow we do eat an awful lot of sugar. The FSA guidelines via the paper suggest reducing sucrose intake if it comprises more than 10% of calories. Sucrose intake dropped from 69.4g/d to 53.2g/d, p=0.015. I doubt the FSA would push for less than 10% of 1502kcal as non-milk extrinsic sugar intake because the average Glaswegian would go cold turkey at this level of deprivation of a vital nutrient.

So compliabnce was good. Obviously the fat reduction was also excellent as shown by the free-fall in HDL.


Neonomide said...

Nice stuff. Yet I wonder this you Peter said:

"FSA-DoH advice dropped these women's HDL to an unacceptable level. This is unacceptable. The women were injured. Full stop."

Lindeberg (2010) states that:

"The average serum cholesterol is 2,8-3,5 mmol/l among hunter-gatherers and other traditional populations living off shore (12 references)"
- -
"Traditional populations do not have 'better' HDl cholesterol and triglyseride levels than Westerners (8 references)"

So is there a HDL levels which is dangerously in light of this ?

Neonomide said...

Sry I'm in hurry, bad engrish and all. ^^

I'll try to check those refs for some reference levels in the meantime.

Peter said...

Hi Neonomide,

Sorry, I'm not always as clear as I should be. I couldn't give a monkey's about HDL or LDL. To me they are markers of doing what, in a western, liver damaged, insulin resistant population, will raise glycaemic damamge, ie thet ate less fat. You can be Kitavan and have an HDL through the floor, or even Italian and have HDL genetically through the floor. If your glycaemic parameters are good, you are good.

Or even more depressing, take torcetrapib and die of a heart attack with HDL through the roof.

But in FSA/Higgins-speak, these people were injured. I just looked at the HOMA score and scowled.


Heidi said...

I have been enjoying this blog with great interest. One subject I have missed (and maybe I have not read enough) is the use of wine in the high fat, medium protein and low carbohydrate diet. Does it initiate insulin response? Any comments? Hopefully, in favor since I do enjoy a nice wine in the evening...