Wednesday, June 11, 2008

Fruit and vegetables, WHEL study and McDougall

This was mentioned in the comments section of another thread. Needs its own post!

Because Stan (Heretic) visits some pretty weird places on the net, he led me astray to this bizarre commentary from some vegan low fat nut on the WHEL study. McDougall is a Dr no less. Here are some of the things he has to say:

"Breast cancer is a fatal disease and women will do almost anything to live. They will endure poisoning by toxic chemotherapy, burning with radiation, and mutilation from breast-amputating mastectomy; in the hopes of living a few more days. Obviously, if asked to do so, and given proper support from their doctors and dietitians, they would do something as simple, safe, costeffective, and enjoyable as eating oatmeal and bean burritos while avoiding beefsteaks and cheese omelets"

This initial quote from McDougall sums up what I imagine is the mental outlook of the WHEL study intervention group nicely. Women in the aftermath of breast cancer surgery DO want to live. As the dietary intervention tested in the WHEL study failed utterly to make an iota of difference to breast cancer recurrence, what is the explanation for its failure? This is how McDougall sees it:

"Data collected by asking the study participants about what they ate suggested they were eating more fruits and vegetables and less fat after being given instructions dictated by the study guidelines. But people don’t always tell the truth—they often want to please the investigators, so they tell them what they think they want to hear, which in this case was clearly inaccurate"

I'd summarise this as "the patients lied and the patients cheated". Now just try and reconcile statement one with statement two. Women will do anything to survive, statement one. Women will cheat and lie in a study which is trying to save their lives with vegetables, statement two. McDougall's answer as to what actually happened?

Statement one is correct, they cheated and lied. How can he tell?

Easy, next quote:

"Proof that the data collected from asking the women what they ate was inaccurate is shown in table 2. The women eating “a dietary pattern very high in vegetables, fruit, and fiber and low in fat” were reported to have decreased their daily calorie intake by an average of 181 calories (1719 initially, and 1538 six years later), yet they gained weight"

I hate to mention insulin, but ALL fruit and vegetables raise insulin levels. No one looses weight while insulin levels are high. Fruit and vegetables raise insulin. The only way that you can loose weight on a carbohydrate based diet is by caloric restriction to the extent that insulin levels fall between meals. The WHEL study was not a weight loss project, it was a "fruit and vegetables to save your life" project. Lack of weight loss can be taken as the removal of a variable extraneous to the study. It's a marked plus point about this particular study.

The increased weight in the intervention group, to my mind, is the clincher that the patients DID comply. They ate fruit and veggies, raised their insulin and kept any fat they stored post prandially.

I'd just like to point out that anyone on a vegan low fat diet who IS loosing weight is sourcing their calories from the ANIMAL fat on their own butt (this was a USA study, pardon the phraseology). Any health benefits claimed for veganism WITH weight loss has to accept this undeniable fact. Humans carry animal fat on their butt. Wasting muscles will provide animal protein.

I do have to thank Dr McDougall for one pointer.

Long term readers will know that I tend to believe people unless it's patently obvious that they're lying. The WHEL intervention group FAILED to maintain their fat intake reduction, and reported this truthfully. It was always below the non intervention group's fat intake, but it drifted up to 28.9% of 1538kcal, ie about 40g/d. The non intervention group ended up on 32.4% of 1159kcal (50g/d) of fat.

Why is this good? I was worried, at the back of my mind, that there had to be a reason why the death rate was identical in both groups. Given the background of the SAD, any increase of carbohydrate on top of the saturation levels of PUFA and sugar likely to be eaten routinely should have increased the death rate. The answer seems to be that the fat intake drop never really happened, so carbs never really increased and so luckily no one extra died in the intervention group.

This lack of compliance in dietary fat reduction occurred because the elevated insulin was locking energy in to adipose tissue and so energy had be sourced from the diet. That's called hunger. The effect on weight gain was small, in proportion to the small decrease in dietary fat.

The kindest thing I can say about McDougall is that he is a ranting extremist. He is stuck in his vegan rut and doesn't seem to understand how metabolism works.

The weird thing is that I believe he gets results! How come?

A real low fat diet will dump almost all PUFA. A real Food diet will eliminate all sugar. A hypocaloric weight reduction diet will both reduce insulin levels (a growth promoter for breast cancer) and switch metabolism to animal sourced saturated fat, the best source of calories available. Of course ketosis is out of the question, low fat veganism is a very limited approach.

Does McDougall know what he's doing, to get whatever results he does get?

No way.



Gyan said...

I am personally deeply invested in breast cancer questions so I apppreciate this post.

I read somewhere that a nutritional intervention experiment for BC patients removed every fat except 10% of total calorie intake in form of fish oil. Said to be well-tolerated but I wonder could it be for an extended period in absence of protective
saturated fats.

I suppose 1 g/d of DHA would be
helpful, though

Gyan said...

About fiber, since it came up, I recently browsed Fiber Menace website.
The author makes some sensible points, but I am not really qualified to judge it.
Some statements seem wrong ie
colestreum contains useful bacteria that help colonize baby's colon.

About fiber, I ended up in getting confused. In the end he says that people going low-carb
should consume sufficient soluble fiber to maintain proper stool.
As I am considering LC, perhaps people here could tell me the situation re: fiber. Is it required or not?

As I consume a lot of coconut flesh, I do get a lot of soluble fiber. My problem is that I may be getting an excess of it, actually.
Am I setting myself up for future trouble with constipation with eating raw coconut?
PS His book is recommended by Western Price.

Peter said...


I put another post up, not a dig at you, but WHEL is the best there is so far. Anything else is epidemiology which doesn't usually even ask about sugar consumption and regards PUFA intake as good (lowers cholesterol, don't you know). There's a similar intervention study on low fat high fiber for colorectal cancer. Useless too.


Peter said...


I avoid all fiber as far as practical. You can't avoid it it all. Yes, my bowel works and no, I'm not full of poop (to loosely quote Frank). I wouldn't personally worry about a dose of fiber from coconut.


Anna said...

I've been on LC for several years. I also have a pelvic prolapse condition, including some rectocele problems (from stretched or weak pelvic tendons that worsened after a lot of heavy lifting during a DIY kitchen remodeling project - PP seems to run in the family somewhat, too) that causes problems with very bulky stools that grain fiber forms.

After a period of adjustment to LC, I found less fiber to be better than a lot, especially if it is mostly from non-starchy vegetables instead of cereals (grain) or fiber supplements. On the rare occasions when I need a bit of "help", I take some magnesium or Vit C and that takes care of it.

I read the Fiber Menace book and agree that he does have some valid points. But I thought a lot of it was hard to swallow, too. Additionally, it is terribly repetitive, makes some patently false and unwarranted statements about Dr. Atkins (the FM author seems to have a hatred of Atkins for some reason). The author sounded more like someone who spends a lot of time in a medical library searching for tidbits that support his view.

My interpretation of the WAPF's review of his book was that it had some useful info, but their recommendation for the book had a lot of qualifiers. My view is the same - it's ok, but with a big BUT. Someone will probably see that as a pun, I guess.

Keep in mind that a good portion of stools is just dead bacteria, shed cell matter, etc., not food or fiber residue. Even comotose people make stools.

Anonymous said...
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Anonymous said...

McDougall is another PETA nut like Ornish, Pritikin, John Robbins (of Baskin-Robbins fame), Neal Barnard, etc. They confuse the Western Diet of refined sugar, flour, vegetable oils, and other junk with meat and eggs and butter, that are eaten as mere garnishes by comparison.

The best among the low-fat crowd is Joel Fuhrman IMO. He puts grain at the top of his food pyramid, to be limited (or avoided). He also bans oils, sugar, and flours (including whole grain). Flours are deficient, unless they're extremely fresh (as in ground the same day). They turn rancid and lose vitamins, as noted by Weston Price and others.

Fuhrman isn't really a low-fat guru like Ornish, McDougall, etc. He has no problem with eating whole foods, like avocados, raw nuts, and seeds, including coconut. He just doesn't like oils or processed food. Unlike Dr. Dean Ornish who looks pudgy and pasty-skinned, Fuhrman looks like a marathon runner. He was a champion Olympic figure skater. He allows a small amount of animal foods (like 1-2 servings of fish a week or one meal of eggs/poultry). His diet is based on vegetables, fruits, beans, raw nuts, raw seeds, and potatoes, in that order. Whole grains aren't emphasized. Flour products are all forbidden, because they are low in nutrients (even whole grain).

Stephan Guyenet said...


What a train wreck!! I agree with Taubes that the nutrition research field is full of very bad scientists.

I stumbled on some excellent, thorough old-school research on the CVD health of the Masai from the early 70s today. I'm going to post on it soon; I think you will be very interested. I'm so grateful for the library here, I was able to dig up the full texts for everything I wanted.

Stan Bleszynski said...

Re: I stumbled on some excellent, thorough old-school research on the CVD health of the Masai from the early 70s today.


We (on the other forum) tried to resolve a long standing discrepancy in Masai authopsy (aorthas) studies from the 70-ties published by G.Mann

One study (earlier) finds no atherosclerosis and no heart disease, the other one (later) finds some atheroma and no heart disease. Did you look into it? Have you seen some other studies on Masai that would resolve this?

I am curious,
Stan (Heretic)


I do visit some "seedy" places to stir up some dialogue. Also, they often post some interesting studies although they often interpret them in the most bizarre and illogical way, as you noticed! 8-:)

Anonymous said...

Stephan, very little research being done now even qualifies as science, IMO. Look at Colin Campbell. He has studies feeding rats casein powder, sucrose, corn starch, and corn oil, but he blames "animal protein", and ignores the fact that the sugar and corn starch and corn oil might have skewed the results. People fall for this nonsense, when they need to be laughing in Campbell's face.

Ditto for people like Neal Barnard, who blame meat for all the problems in the Western Diet, while giving a free pass to sugar, flour, and PUFA oils. In the alternate universe for people like Barnard and Ornish, the Western diet is the "beef diet" and not the "sugar, flour, omega-6, and trans fat diet." What a joke.

Anonymous said...

Stan: "One study (earlier) finds no atherosclerosis and no heart disease, the other one (later) finds some atheroma and no heart disease. Did you look into it? Have you seen some other studies on Masai that would resolve this?"

The Masai have increasingly adopted Western diet habits. Their diet was increasingly corrupted, by the time George Mann studied them. Masai now have crowded teeth and cavities, in contrast to when Weston Price first studied them. Their health has been steadily declining, along with most other cultures, that have adopted a Western Diet of sugar, flour, trans fat, and high-PUFA oils.

Stephan Guyenet said...

Stan and Bruce,

I got my hands on the Mann studies today (full text), as well as a few others from the same time period. They are excellent, really thorough. I discussed them on my blog. I posted two figures that say it all. They basically implicate processed food in atherosclerosis, but not total fat, saturated fat or cholesterol.

The Masai atherosclerosis study by Mann et al. severely undercuts the lipid hypothesis, to the contrary of how people cite the reference. Goes to show you what you can learn when you read more than the abstract...

Anonymous said...

While I agree with George Mann that the cholesterol hypothesis is dumb, the fact remains that the Masai are now eating Western Foods. They have strayed from their traditional diet some. They engage in trade/commerce and eat flour, sugar, and PUFA oils regularly. Their diet when Dr. Mann studied them was not the same as it was when Weston Price studied them.

I saw a photo recently of the Masai boys doing their jumping dance, and many of them had badly crowded, and decayed teeth, though they were all thin and tall. The picture has been taken down or I'd give a link. They are rapidly losing their health and disease resistance, though.

Gyan said...

On a LC diet what would your bacteria feed on?
Maybe they feed on colonic secreations (mucin?).
Fibre Power does recommend consuming some soluble fibre daily.
He is unfamilar that one can get soluble fibre on LC diet my just consuming coconut (probably uniquely low carb, high fibre).
Then is it good that they feed on your musin?
Or do they also feed upon our cellular wastes?

frank said...

The confusion over the Masai arises because atherosclerosis does not necessarily equal death from heart attack. Many animals, both laboratory and wild, develop fatty streaks or atherosclerosis but none ever has an acute myocardial infarction (AMI). There is no real animal model of AMI - they use noxious chemicals or physically tie off the arteries. More recent research has revealed the microcirculation and coronary reserve are more important predictors of cardiac death. The aortic calcium that they have recently found a strong association for cardiac death (much, much stronger than piffly cholesterol) may simply represent a total body issue with calcium derangements. Too much calcium entering a cell causes apoptosis. Look up myocardial stunning and hibernation and you'll see the current atherosclerosis + clot = AMI just isn't that simple.

Stephan Guyenet said...


You're correct about the '70s Masai not suffering MI. None of the 50 hearts they autopsied in the Mann study showed any sign of MI. Some had severe atherosclerosis yet they all still had wide lumens. He hypothesizes that exercise kept their vessels wide.

However, there is another element to the story. Only the hearts from Masai eating processed food had significant atherosclerosis. The men who were on a strict milk/meat/blood diet had very little, only occasional small fatty streaks or fibrosis. Mostly their arteries were as clean as a whistle.

Anonymous said...

Stephan: "Only the hearts from Masai eating processed food had significant atherosclerosis. The men who were on a strict milk/meat/blood diet had very little, only occasional small fatty streaks or fibrosis. Mostly their arteries were as clean as a whistle."

This is an important point, because people like Ravnskov and Colpo make it sound like all the Masai had the arterioscleros, when the reality is that only members who had abandoned their traditional diets had it. By eating sugar, flour, and other junk foods, they damaged their arteries. They likely ate enough natural food to reverse heart disease, but their health was still under-mined.

Uffe Ravnskov tries so hard to be a "skeptic", that he ends up ignoring critical facts like what foods will cause heart disease. Namely refined sugars, all flours, and most of the (high-PUFA) oils. I've read various places that wild animals don't have atherosclerosis and this seems very significant. Heart disease afflicts humans and animals who eat diets of processed food, esp carbs.

frank said...

The trouble is that atherosclerosis is seen as synonymous with heart disease. If you clutch your chest and drop down dead and your arteries are found to be clear you are classed as a "sudden cardiac death" (around 50% of cardiac deaths). If you do likewise and have 50% occlusion in 2-3 vessels you die of "AMI".
Pathology studies suggest the clot is not obligatory and that it is the result of, rather than the cause of AMI. Like so much in medicine, everyone wants a simple explanation.

Anonymous said...

If atherosclerosis advances with age on one diet and never occurs on some other diet, which do you prefer? The fact that those with atherosclerosis were eating processed food is highly relevant. Most indigenous tribes are at least partly civilized. They have abandoned their traditional foods or added Western Foods or both. This is true of the Masai at the time George Mann studied them. I'm not sure that atherosclerosis can be dismissed.

Kristin, BSN, RN said...

What about the mount of success stories with Gerson therapy? Does anyone have an opinion about that...? I would like to hear what people think. He cured hundreds of terminal cancer patients with all different types of cancer, not just breast cancer, and he empasized juicing with fruits and vegetables, no meat, very little fat at all, and coffee enemas. Anyone? Thoughts?

Peter said...

Hi Kristin,

Yes, Gerson therapy is interesting and I found his personal accounts of his dismay at finding an effective treatment for cancer, using a diet he developed for his own migraines, to be convincing. The need for certain types of juicers (crushing, not rotary) was a big no-no to me. He does three or four things that I think help. Liver juice, ie Q10 and a ton of other useful things. Hypocaloric eating, ie weight loss leading to hypoinsulinaemia, enemas to the point where they had to paint the walls (more weight loss, lower insulin????). Human weight loss = animal fat based nutrition! One comment I've heard about failures to replicate Gerson's findings is that many cancer patients won't accept the caloric restriction. Then the juice gives a big supply of the essentials to allow sugar burning with as little insulin as practical (Mg++ and K+ from all that juice, especially vegetable juice). Just a few random ideas...

The modern study

shows promise but has no control group and may simply reflect that these people refused conventional cancer treatment and were highly motivated. The experience during the various doctor's strikes should convince anyone that avoiding the medical profession as far as practical is a possible therapeutic breakthrough...


Unknown said...

Thank you, Peter. When I returned from a Weston Price conference [I went at the insistence of my homeopathic vet], it literally took all I had to cancel my next 'advanced' seminar w/ McDougall. I thought it was me that was so unsuccessful being a vegetarian, vegan and then raw vegan. I was about 273 pds.
For the first time in 20 years, I experienced satiety w/ half my dinner at the conference. OMG! I was surprised. Sally Fallon sat across from me and laughed when I told her I had just come from a McDougall seminar. She commented that "this week-end must be turning your mind 180 degrees! It was.
Bottom line: Gave up flour and sugar, focused on 25 mg of fruit/day [Thomas Cowan, MD advice], grass-fed beef, veggies and real butter. I've lost 90 pounds and my mind is healing [emotionally, memory-wise, clarity].
You've answered some of my questions too...and I thank you from the bottom of my heart for translating from 'science acronyms' to English, so I can share the information.
You're the best!
Joy, Karen in CA

Peter said...

Thank you Karen, it's nice to see you have found an approach which helps...