A working thesis

Published 9.15.2016
So back in March, I announced that I intended to write a series about cardiovascular disease (CVD). As I am not a medical professional of any kind, nor do I play on on the internet, the series was certainly never going to be an expert's view. Rather, it was going to be my own exploration into the topic. Well, I continue to explore, but haven't written any further pieces, because, well, the topic is both huge and complicated. The very last thing I wanted to do was present some completely ignorant essay on a topic I know little about— something that's way too easy to do on the internet.

However, recently there's been a spate of articles about the revelation that back in 1967, Harvard researchers writing a review of the evidence then known about the causes of CVD (including atherosclerosis) received payment from the Sugar industry. The payment wasn't disclosed at the time, but requirements for disclosure was different back in the 1960s. As everyone involved is dead, there isn't anyway to ask for clarification.

It is clear, however, that sugar producers were interested in influencing the outcome, and were pleased with the paper, which it saw before it was submitted for publication. If nothing else, there is the appearance of impropriety, and it is catnip to the "sugar is the devil, fat is the savior" crowd.

They go on to "conclude, on the basis of epidemiologic, experimental and clinical evidence, that a lowering of the proportion of dietary saturated fatty acids, increasing the proportion of polyunsaturated acids and reducing the level of dietary cholesterol are the dietary changes most likely to be of benefit." By contrast, they "conclude that the practical significance of differences in dietary carbohydrate is minimal in comparison to those related to dietary fat and cholesterol."

The lobbyist Nina Teicholz is quoted, though she says there's no smoking gun. In the New York Times coverage, Marion Nestle claims that there is a smoking gun. Nestle also notes that the Times only this year revealed Coca-Cola's efforts to fund (she says influence because she equates the two) research.

National Public Radio (NPR) covered the same ground. Bloomberg notes that the doctors were paid $6500 in 1967, which in 2016 dollars would be about $48,000. That is fine as a comparison, but I doubt the doctors would take $48,000 today. We will never know because now the disclosure rules are much stricter.

I found Kevin Klatt's discussion after I'd hit publish, which is too bad because it's one of the more detailed accounts of the history of the research. The debate between those who thought sugar as the baddie and those who bet on fat was long and vigorous. It is simply not true that the effects of sugar were ignored. The evidence for the action of fat was stronger. the piece is well worth a read for his comments about industry involvement as well.

My hypotheses

Bringing the topic back to my own CVD study, my working thesis can be summed in two words: TOO MUCH. The dose makes the poison. Just because saturated fat might not be a primary cause of CVD doesn’t mean downing sticks of butter is a good idea. Just because sugar isn’t poison doesn’t mean it’s a good idea to eat cups of it daily, and just because the body can adapt to both substances doesn’t mean that the tons of both might not overwhelm it. How much for each person? wHere is where individuality comes in, which would include genetics.

Entire societies live healthily on diets that are very low in fat— especially saturated fat. Levels lower than 10% of total calories in some traditional Asian societies, for example. There are also societies that eat relatively high amounts of fat and are healthy. There are even societies that eat diets fairly high in fat and carbohydrates (that in essence is what the traditional Mediterranean diet is) that are healthy. The critical factor isn't the macronutrient mix, it's the calorie count that matters.

You can eat anything, so long as you don't overeat and overwhelm your bodies ability to compensate for your diet. Humans are omnivores who can (and do) survive on vastly varied diets around the globe.

In the end, TOO MUCH of whatever (in this case sugar or fat) can overwhelm the body’s ability to compensate, and the "wheels come off." Too much stress can damage the body, as can the use of drugs (be those drugs legal or illegal).

That's my guess as to why naming a cause for CVD is so difficult, because there are many ways to overwhelm the body's ability to compensate and thereby damage the body. It's also why CALORIE CONTROL remain the most powerful way to think about obesity.

Calories can be controlled in many ways. If never eating a piece of bread again is a way you can live, then go for it. Likewise if you can be satisfied with lower fat intake. In my household, we are a mix. I am content eating relatively low fat, the other eaters are not. Mixed meals are therefore the norm here, and people choose what entices them most.

Adherence remains the most important factor. It doesn't matter if a low carb diet shrinks your waist if you can't maintain that diet at the lower calorie amount you will need to eat to keep your smaller waist.

The human body is complex and amazing, and it can tolerate and compensate for an amazing amount of abuse (used in the broadest meaning of the term). But when the body's systems become overwhelmed and its equilibrium in lost, re-establishing an equilibrium condition can be very difficult and very likely time consuming.


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