Dr. Greger's latest video on nuts - is nuts!

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Dr. Greger's latest video on nuts - is nuts!

Postby Mark Simon » Fri Aug 10, 2012 10:25 am

Today Dr. Greger brings a new video

http://nutritionfacts.org/video/nuts-an ... -lowering/

which he touts as:

Nuts and Bolts of Cholesterol Lowering: A pooled analysis of studies on nut consumption, cholesterol levels, and risk of death from heart disease show extraordinary benefits, suggesting we should eat nuts every day.

First I have to give a little credit to Dr. Greger as he, for the first time, admits and reveals that many nut studies are funded by the nut industry, and that they use tricks to try to make the benefits of nuts appear much stronger than they are.

That said, Greger misses the point entirely on the studies he is touting today -- because they are perfect examples of the nut industry using sleight of hand to try to make nuts look like magic foods.

First, the Pooled Analysis which Greger discusses today has this as the first thing, under "Author Affiliations":

Financial Disclosure: Drs Sabaté and Ros have received research funding from the California Walnut Commission, the Almond Board of California, the National Peanut Board, and the International Tree Nut Council; they are also unpaid members of the Scientific Advisory Council of the California Walnut Commission. Dr Sabaté has received an honorarium as a member of the Pistachio Scientific Advisory Board.

see this at: http://archinte.jamanetwork.comarticle. ... eid=415912


So the authors of the analysis Greger touts have gotten a nutty amount of money from the nut industry. I would venture to say their livelihood depends on the nut industry.

And yes, this Pooled Analysis was paid for by the International Tree Nut Council Research and Education Foundation, in addition to being conducted by two researchers who get a lot of money from the nut industry. These are the same nut researchers, by the way, who claim that nuts cause weight loss in other studies, but when you look at the data in these studies, it shows the reverse. Not too honest...

Greger seems to be catching on that just because a food is vegan doesn't mean that the vegan food industry behind it isn't above pushing bad studies to make small benefits look huge, just like the dairy or any other industry does.

Here is a copy of the full study that Greger is talking about, as a pdf file:

http://archinte.jamanetwork.com/data/Jo ... 21_827.pdf

The Analysis Greger spotlights today shows that nuts can lower total cholesterol about 5.1% compared to control groups.

Greger mentions that the Analysis shows that LDL (or "bad" cholesterol") can be lowered up to around 10% by eating nuts -- if your LDL is over 160 to start, which is extremely high. If you have a low cholesterol to start, eating nuts won't have much impact.

As many in the veg world already know, a 5% decrease in cholesterol or a 10% decrease in LDL cholesterol (but only when it is above 160 to start, which is extremely high) is not a very significant amount of cholesterol lowering.

The following I've lifted and summarized from this article on nuts which talks about the same Pooled Analysis:

http://www.vegsource.com/news/2012/07/c ... -nuts.html

To get the very modest cholesterol lowering effect shown in the Pooled Analysis, you would have to eat 20% of your calories from nuts, such as 3 ounces of cashews a day. Less nuts means less improvement.

That's a lot of nuts to add to get very little benefit. And here is the kicker from the authors:

"Greater cholesterol lowering effect is found when nuts replace saturated fat than when olive oil or carbohydrates are replaced."


So if you replace 450 calories of bacon cheeseburgers with 450 calories of nuts, you'll get a very modest reduction of your awful 190 LDL.

But if you eat 450 calories of nuts in place of 450 calories of sweet potatoes and brown rice, forget about it. You won't see any meaningful benefit.

So basically this research on nuts is meaningless to people eating McDougall, Fuhrman, Esselstyn, Pritikin or Ornish diets. There's no meaningful cholesterol lowering impact, according to the Analysis Greger touts today.

In the video Greger goes into other studies and presents a table showing THEORETICAL ESTIMATES for a reduction in death rates, correlated with nut intake. This isn't from any controlled trials, like Pooled Analysis he talks about.

The estimates of reduction in death rates are drawn from studies like the Nurses Health Study or the Iowa Women's Health Study. These were not "nut studies" but studies where people filled out a questionnaire about their diet at one point. Many years later, food-industry researchers go through data to make all manner of speculation on the impact of one particular food and one disease, from these pools of women.

Greger calls them "some of the best studies" but in fact they are some of the weakest.

What makes these studies so weak is that the same group eating more nuts also eats less meat, exercises more, doesn't smoke, and eats more fruits and veggies. But the nut industry-paid researchers want to say it all comes down to the nuts and they make fancy diagrams of estimates, like the ones Greger shows today, to try to make nuts look like manna from heaven -- based PURELY on theoretical speculation and estimates.

As previously mentioned on this forum, using an "evidence-based rating system," the FDA scientists gave these health claims about nuts and cholesterol-lowering, which Greger is touting, only a C grade, which “represents a low level of comfort among qualified scientists that the claimed relationship is scientifically valid.” In other words, qualified scientists think this is mostly hype and not much good evidence.

This is the claim the FDA allowed for nuts: “scientific evidence suggests but does not prove that eating 1.5 ounces of nuts per day, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease.” (The exception is walnuts, which got a B.) The FDA also insisted the label also contain a caution: “See nutrition information for fat content.”

Anything below an "A" grade from the FDA rating system is advertising hype, and not really reliable or widely-accepted science, and that includes the Pooled Analysis Greger hypes today as "extraordinary."

Not really.
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Re: Dr. Greger's latest video on nuts - is nuts!

Postby Adrienne » Fri Aug 10, 2012 11:42 am

Thanks for that. Just to add I think Jeff talked about this study in his nuts lecture.
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Re: Dr. Greger's latest video on nuts - is nuts!

Postby f1jim » Fri Aug 10, 2012 12:14 pm

Mark Simon is correct with his statistics and also with his information about influence in the research business. I call it the research business because it's the relatively new playground for those in the marketing business. Whether it's a pharmaceutical company, the dairy industry, you name it, they have all realized the benefits of touting research to promote their product. We just have to be smart enough to sniff out conflict of interest and balance that with common sense. That will keep the "magic pill" thinking at bay and get us looking more at our overall diets and the roles single food items play in it.
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Re: Dr. Greger's latest video on nuts - is nuts!

Postby healthyvegan » Fri Aug 10, 2012 12:25 pm

So if you replace 450 calories of bacon cheeseburgers with 450 calories of nuts, you'll get a very modest reduction of your awful 190 LDL.

But if you eat 450 calories of nuts in place of 450 calories of sweet potatoes and brown rice, forget about it. You won't see any meaningful benefit.


there lies the invalidity of nearly every study touting miracle foods
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Re: Dr. Greger's latest video on nuts - is nuts!

Postby JeffN » Fri Aug 10, 2012 1:45 pm

Putting the Real Power of Plants in Proper Perspective

Mark makes some great points and I want to help put this in further perspective inspired by a recent patient.

But, first, while I may not agree with everything he says, Dr. Greger is a wonderful guy and I have known him personally and professionally for almost 2 decades and appreciate his work. As many of you know, we just worked together to get Eden Foods to straighten out a longstanding issue.

Also remember, none of us agree 100% with everyone else, not even Dr McDougall and I, and I've said much of what Mark is saying myself about nut studies in my talk, "Nuts and Health" and in my forum over the years. Anyone who really looks into the details on nuts and applies them properly, will also come to the same conclusion, which is...

Basically, they're not all they're cracked up to be :)

In fact, I think that will be the new name of my nut talk :)

Some perspective...

If we think that getting a reduction in Total Cholesterol and/or LDL of 5% or 6% or even 10% is impressive, let me share an example of something that is really impressive.

Here are some results from a person who came to me on 6/29 because of recent blood work that they were very unhappy about and here is what happened, as of this morning...

Here are their numbers from when they first came to me (which they have agreed to let me share)...

6/29/2012
Wt: BMI 24 (Normal)
Chol 217 (High)
LDL 137 (High)
TG 137 (Normal)
Blood Sugar 93 (Normal)

They said they had been following a McDougall style plant based diet for some time and were surprised their numbers were not better. So we looked over their diet and made some changes. I recommended they follow the MWL (Calorie Density) program to the tee for 12 weeks and keep it simple.

So, they ate mostly oatmeal and fruit for breakfast and used the meals from my Fast Food DVD's for most of their lunches and dinners. Fruit was a snack if and when hungry. Because of their concern for omega 3's, they included a TB or 2 of ground flax in their oatmeal on occasion. That is the equivalent of 1/2 oz on occasion and when included about 3-4% of their calories.

Here are their results from yesterdays test.

8/9/2012
Wt: BMI 23 (Normal)
Chol: 163 (25% drop)
LDL: 92 (33% drop)
TG: 137 (Normal)
Blood Sugar: 92 (Normal)

They did not lose much weight, so we can't say it is from the weight loss, but they got a 25-33% drop in total cholesterol and LDL.

So, let's put this in perspective.

In the controlled nut studies, someone with a starting LDL of 130 could expect a drop of about 5-7% at best for about 2 oz of nuts, and, mostly if and when the nuts replaced saturated fat.

So, with a starting LDL of 137, a 5-7% drop would put their LDL at 127-130. This is still way to high.

With a starting Total Cholesterol of 217, a 5-7% drop would lower it to 202-206. Better, but still to high.

Yet, with nothing other than a few Tbsp of ground flax here and there, they were able to drop their LDL by 33% and their total cholesterol by 25% just be adhering 100% to a low fat, whole plant food diet, low in calorie density.

Even if we give 5% of the drop to the flax (which is being more than fair as it was only a small amount of flax used on occasion), they still got a 20-28% drop as a result of their other changes.

And, this is not surprising as this is 100% in line with the other studies published on what happens when people apply a real low fat whole food plant base diet. Many studies over the last few years by the Pritikin center have shown average drops of 23% to 33% in Cholesterol, LDL and Triglycerides and most of these have happened in as little as 12 days.

- Low fat, whole food, plant based, low calorie dense diet - 23%-33% drop in cholesterol and LDL in 12 days.

- Substituting nuts for saturated fat - 5-10% drop in cholesterol and LDL at best in 12-16 weeks.

In Health
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Re: Dr. Greger's latest video on nuts - is nuts!

Postby pborst » Fri Aug 10, 2012 2:43 pm

On the other hand, except for triglycerides reduction, the Loma Linda authors said the type of funding had no different result on health endpoints. Moreover, although the difference was greater relative to Western Diets and Low Fat, the nuts did improve total cholesterol relative to low fat diets. http://archinte.jamanetwork.com/article.aspx?articleid=415912

To be specific, nuts were associated with a 7.4 percent reduction in total cholesterol and 9.6 percent reduction in LDL when added to Western diets vs. 4 & 6 percent reduction for a low fat diet. So, it wasn't that added the nuts didn't help in lowfat diets, just not as much. And to repeat, for total and LDL cholesterol, the type of funding of the study didn't make any difference. 9 of the 25 studies were non-industry sponsored.
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Re: Dr. Greger's latest video on nuts - is nuts!

Postby Mark Simon » Fri Aug 10, 2012 3:16 pm

pborst wrote:

To be specific, nuts were associated with a 7.4 percent reduction in total cholesterol and 9.6 percent reduction in LDL when added to Western diets vs. 4 & 6 percent reduction for a low fat diet.


That is correct, and of course everyone who is reading the boards here on Dr. McDougall's site realizes that the "low fat diet" that pborst refers to in the study is nothing like the low fat diet of McDougall, Esselstyn or Pritikin.  It's the very unhealthy "low fat Western diet" which can be anywhere from 25-34% fat, and low in fiber, nutrients and high in refined carbs

If you're eating a healthy low fat diet, like McDougall's, your cholesterol is already near 150, and your LDL is already near 80.  So in terms of a healthy McDougall or Esselstyn low fat diet, there is zero evidence that adding nuts would have any impact whatsoever on LDL or Cholesterol.

Try putting someone who eats the Western "low fat" diet onto a program like McDougall, and they will probably get a drop of 20-30% on their cholesterol numbers.  That is a hell of a lot more impressive than a 4% drop from nuts.
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Re: Dr. Greger's latest video on nuts - is nuts!

Postby f1jim » Fri Aug 10, 2012 3:23 pm

And working the other way would be just as telling. Putting someone who is already following a McDougall type diet and then adding in more nuts to their diet would be very interesting. Perhaps little or no change in the cholesterol? Perhaps a slight gain? A lot would depend if you substituted the calories from something already in the diet or whether you just added the nut calories. That study will probably never be done so it's only speculation.
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Re: Dr. Greger's latest video on nuts - is nuts!

Postby pborst » Fri Aug 17, 2012 12:04 pm

Actually by going to Table 1 in the link in my original post and looking under the column "control diet", the reader can see not just one but a variety of low fat diets, some more similar to Mc Dougall, some less similar. What one doesn't see is support for Mark's proposition that there is no improvement from changing from a Mc Dougall lowfat diet to one with a few more nuts and seeds displacing starches. As far as this review can establish, there is value added in making the change. Agreed, no Mc Dougall baseline in the report. At the same, no support for the proposition that blood parameters wouldn't improve with more nuts and seeds for starches. Also, Greger has published a new video showing that in over 90 percent of studies, nuts did not promote weight gain. http://nutritionfacts.org/video/nuts-and-obesity-the-weight-of-evidence/

Finally, I accept through tacit agreement that the source of funding in the original nut study didn't appear to prejudice the outcome for cholesterol. Cholesterol went down uniformly, total and LDL whether the study was funded by the nut industry or was independent.


Mark Simon wrote:pborst wrote:

To be specific, nuts were associated with a 7.4 percent reduction in total cholesterol and 9.6 percent reduction in LDL when added to Western diets vs. 4 & 6 percent reduction for a low fat diet.


That is correct, and of course everyone who is reading the boards here on Dr. McDougall's site realizes that the "low fat diet" that pborst refers to in the study is nothing like the low fat diet of McDougall, Esselstyn or Pritikin.  It's the very unhealthy "low fat Western diet" which can be anywhere from 25-34% fat, and low in fiber, nutrients and high in refined carbs

If you're eating a healthy low fat diet, like McDougall's, your cholesterol is already near 150, and your LDL is already near 80.  So in terms of a healthy McDougall or Esselstyn low fat diet, there is zero evidence that adding nuts would have any impact whatsoever on LDL or Cholesterol.

Try putting someone who eats the Western "low fat" diet onto a program like McDougall, and they will probably get a drop of 20-30% on their cholesterol numbers.  That is a hell of a lot more impressive than a 4% drop from nuts.
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Re: Dr. Greger's latest video on nuts - is nuts!

Postby Theodore » Fri Aug 17, 2012 12:19 pm

Results: With a mean daily consumption of 67 g of nuts, the following estimated mean reductions were achieved: total cholesterol concentration (10.9 mg/dL [5.1% change]), low-density lipoprotein cholesterol concentration (LDL-C) (10.2 mg/dL [7.4% change]), ratio of LDL-C to high-density lipoprotein cholesterol concentration (HDL-C) (0.22 [8.3% change]), and ratio of total cholesterol concentration to HDL-C (0.24 [5.6% change]) (P < .001 for all) (to convert all cholesterol concentrations to millimoles per liter, multiply by 0.0259). Triglyceride levels were reduced by 20.6 mg/dL (10.2%) in subjects with blood triglyceride levels of at least 150 mg/dL (P < .05) but not in those with lower levels (to convert triglyceride level to millimoles per liter, multiply by 0.0113). The effects of nut consumption were dose related, and different types of nuts had similar effects on blood lipid levels. The effects of nut consumption were significantly modified by LDL-C, body mass index, and diet type: the lipid-lowering effects of nut consumption were greatest among subjects with high baseline LDL-C and with low body mass index and among those consuming Western diets.

I don't understand the word "estimated" in this context.
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Re: Dr. Greger's latest video on nuts - is nuts!

Postby Adrienne » Fri Aug 17, 2012 2:48 pm

Dr McD on nuts and weight gain:

Of Course, Nuts Are Fattening

A casual review of the scientific literature might lead the reader to conclude that eating nuts does not cause weight gain. How could eating so many concentrated fat calories be OK for any weight loss plan? A careful review of the methods used reveals that the trick is to restrict the subjects’ calorie intake and/or limit the amount of nuts they are allowed to eat to about an ounce a day.12

Still, the addition of an ounce of nuts a day should cause some weight gain when the daily calories are otherwise unrestricted. An ounce of nuts means an additional 150 calories daily—that’s 4500 calories a month, which could represent a monthly gain of a pound and a half of body fat. Many reasons are given for this unexplainable effect of little or no weight gain with added nuts: the high satiety of nuts causes people to eat less, added nuts displace more fattening foods (cakes and pies), their monounsaturated and polyunsaturated fatty acids are more readily burned off (diet-induced thermogenesis), and an increase in fecal losses of fat due to incomplete mastication of whole nuts (nut butters would be much more readily digested and more fattening).

Even though an ounce of nuts a day may not cause appreciable weight gain, nuts do not violate the laws of thermodynamics and the evidence shows adding more than an ounce daily without other calorie restrictions does cause weight gain.12

http://www.drmcdougall.com/misc/2009nl/nov/nuts.htm

And I wanted to comment on another video Dr Greger posted a few days ago on phytosterols:
http://nutritionfacts.org/video/optimal ... erol-dose/

In it he says, "In terms of whole food sources...seeds provide the most especially sesame then nuts especially pistachio then legumes like peanuts."

However what he fails to mention is that the study he is referencing only examines the phytosterol content of nuts and seeds and very few other plant food sources. Fruits and vegetables are not listed.

http://www.ncbi.nlm.nih.gov/pubmed/16302759

And on top of that the amounts are listed in mg/100g therefore to get all those phytosterols from nuts and seeds you need to eat A LOT of them and with that comes a lot of calories and fat. It would have been much more informative to list the phytosterol amounts per calorie rather than per weight and then compare the amounts in nuts and seeds to the phytosterol content of other plant foods.
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Re: Dr. Greger's latest video on nuts - is nuts!

Postby secdroid » Fri Aug 17, 2012 4:37 pm

Great thread. Thanks, all.

Dr. Greger will be banging away on nuts/seeds again next week.
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Re: Dr. Greger's latest video on nuts - is nuts!

Postby Sistina » Fri Aug 17, 2012 4:42 pm

My body is my science experiment: I don't feel my best eating many nuts at all.
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Re: Dr. Greger's latest video on nuts - is nuts!

Postby secdroid » Sat Aug 18, 2012 2:22 pm

FWIW, I listened to Dr. Fuhrman's new "Immunity Solution" program on PBS. WTR to nuts/seeds, he recommends 1 TB flax or Chia per day for lignans, walnuts for Omega 3 (I think just a few) and a total of one ounce raw nuts/seeds per day for phytochemicals and to add fats to improve bio-availability of other nutrients.

One thing new (for me) is that it is better to cut onions before cooking in order to crush cells and release sulfur containing compounds. The released compounds aren't destroyed by the heat of cooking, but if you cook the uncut onion, the chemicals aren't released upon cutting. Didn't know that.

And I nuked a whole sweet onion as part of my lunch -- apparently a non-optimal way to enjoy them.
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Re: Dr. Greger's latest video on nuts - is nuts!

Postby MichaelGregerMD » Sat Aug 25, 2012 8:56 pm

Just wanted to let everyone know I corrected and updated my video in response to Jeff's article: http://nutritionfacts.org/video/nuts-an ... -evidence/

Please never hesitate any of you to email me at [email protected] or call my cell (240-252-8078) anytime for anything--especially if you think I got something wrong so I can correct it!

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