Debunking Michael Greger

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Calrifying Health Claims on Nuts

Postby JeffN » Thu Aug 02, 2012 7:30 am

f1jim wrote:Maybe Jeff Novick can clear up much of this with a visit. His input is always valuable.
f1jim


f1jim wrote:I am told by our illustrious staff nutritionist that the only nut study getting a B rating is one on walnuts. All the others are C
f1jim


Thanks Jim, and correct.

To help set the record straight, and because of the intensity of this discussion, I also spoke with the FDA yesterday afternoon about the issue and their current position. After all, might as well go directly to the horse's mouth.

As many of you know, in my lectures, From Oil to Nuts, and, Nuts and Health, I cover all of this information in detail including how and why the rating system got started, how it has changed over time and what level is assigned to different foods.

The links being used above to document the claims for nuts are not links to the official FDA website or to their documents related to health claims or to any quotes of theirs, but are links to other various health websites and articles. As we all know, many well-meaning and good-intentioned enthusiastic writers, even those from health websites, often get their information wrong. And, in this case, it appears to be what has happened.

From the FDA

Ranking the Strength of the Evidence for a Health Claim

The first level, or highest rank of scientific evidence to support the substance/disease relationship meets the "Significant Scientific Agreement among qualified experts" standard. (For the purpose of this guidance, the first level rank is only used as a reference point. In all other respects it is outside the scope of this guidance.)

This level reflects a high level of comfort(10) among qualified scientists that the claimed substance/disease relationship is scientifically valid. In general, the first level ranked relationship would be considered to have a very low probability of significant new data overturning the conclusion that the relationship is valid or significantly changing the nature of the relationship. It would have high consistency with conclusions of authoritative bodies. The relationship would be based on relevant, high quality studies of mostly study design types one and two, and sufficient numbers of individuals would be tested to result in a high degree of confidence that results are relevant to the target population. Studies of different design would almost always result in similar findings, and the benefit would be physiologically meaningful and achievable under intake and use conditions that are appropriate for such conventional human food and human dietary supplements that would be the subject of the claim.

The second level rank of scientific evidence to support the substance/disease relationship is the highest level for a qualified health claim, and represents a moderate/good level of comfort among qualified scientists that the claimed relationship is scientifically valid. Qualified experts would rank the relationship as "promising," but not definitive. The claim would be based on relevant, high to moderate quality studies of study design type three and higher (i.e., design types one and two) and sufficient numbers of individuals would be tested to result in a moderate degree of confidence that results could be extrapolated to the target population. Studies of similar or different design would generally result in similar findings and the benefit would reasonably be considered to be physiologically meaningful and achievable under intake and use conditions that are appropriate for such conventional human food and dietary supplements that would be the subject of the claim. (Note: The term "moderate/good" for the second level rank may seem ungenerous. This terminology derives from historical data evaluated by the National Academy of Sciences(11) that indicated that over time many diet/disease relationships that met this level of evidence were not necessarily sustained.) (NOTE: This is the level walnuts received)

The third level rank of scientific evidence to support the substance/disease relationship is the middle level for a qualified health claim and represents a low level of comfort among qualified scientists that the claimed relationship is scientifically valid. It would have low consistency with statements from authoritative bodies or be ranked as "low" in terms of scientific support by qualified scientists. The relationship would be based mostly on moderate to low quality studies of study design type three, and insufficient numbers of individuals would be tested, resulting in a low degree of confidence that results could be extrapolated to the target population. Studies of different design would generally result in similar findings but uncertainties would exist. Uncertainties would also exist as to whether the benefit would be considered physiologically meaningful and achievable under intake and use conditions that are appropriate for such conventional human food and human dietary supplements that would be the subject of the claim. (NOTE: This is the level nuts received)

The fourth level, or the lowest rank of scientific evidence to support the claimed substance/disease relationship, is the lowest level for a qualified health claim and represents an extremely low level of comfort among qualified scientists that the claimed relationship is scientifically valid. It would have very low consistency with conclusions of authoritative bodies or be ranked very low by qualified scientists. The relationship would be based mostly on moderate to low quality studies of study design type three and insufficient numbers of individuals would be tested, resulting in a very low degree of confidence that results could be extrapolated to the target population. Studies of different design would generally result in similar findings but uncertainties would exist. There could be considerable uncertainty as to whether or not the benefit would be considered physiologically meaningful or achievable under intake and use conditions that are appropriate for such conventional human food and human dietary supplements that would be the subject of the claim. This level requires at least some credible evidence to support the relationship. There cannot be a strong body of evidence against the claim (e.g., a study or studies of high persuasiveness, quality and relevance that do not detect an effect). If that is the case, such evidence provides a sound basis for concluding that the claim is not valid.

If the scientific evidence to support the substance/disease relationship is below that described as the fourth level (see above) no claim will be appropriate.



As we can see, the FDA has determined there are four levels of health claims, the top one being an unqualified health claim where there is "Significant Scientific Agreement among qualified experts." Then, there are three lower levels of health claims were the health claim must have a qualifying statement with it to explain why it has not meant the level of "Significant Scientific Agreement among qualified experts."

The FDA has created a tiered chart based on the above, and assigned grade levels of B, C, and D to these qualified health claims rankings and established "Standardized Qualifying Language for Qualified Health Claims," which you can see here...


Scientific Ranking & Standardized Qualifying Language for Qualified Health Claims

Image


Now, lets look at the official health claims for nuts in general and for walnuts specifically

On Nuts in general.

Qualified Claims About Cardiovascular Disease Risk
Nuts & Heart Disease
Docket No. 02P-0505

Claim Statement

Scientific evidence suggests but does not prove that eating 1.5 ounces per day of most nuts [such as name of specific nut] as part of a diet low in saturated fat and cholesterol may reduce the risk of heart disease. [See nutrition information for fat content.}

Types of nuts eligible for this claim are restricted to almonds, hazelnuts, peanuts, pecans, some pine nuts, pistachio nuts, and walnuts.



On walnuts specifically.

Walnuts & Heart Disease
Docket No. 02P-0292
Claim Statement

Supportive but not conclusive research shows that eating 1.5 ounces per day of walnuts, as part of a low saturated fat and low cholesterol diet and not resulting in increased caloric intake, may reduce the risk of coronary heart disease. See nutrition information for fat [and calorie] content.



To make this easier for everyone, I have highlighted the key language in the claims that can be seen in the ranking system. And, as we can see, walnuts specifically, and nuts in general get completely different claims with differing wording, so we know they are not the same. And, the FDA allows a little lee-way in the language as long as certain key words are in there.

As we can see by the wording, nuts (as a general group of the named nuts) get a "C" level claim and walnuts specifically do get a "B" level claim with the key words for each being "suggests" (nuts) and "supporting" (walnuts).

So, as we can see, Laurie Budgar, who writes for the Natural Foods Merchandiser, got the variety of nuts eligible for the claim right, and she and Lauren Neergaard of the Associated Press are both correct about the FDA adding in the new levels for qualified health claims but Laurens comments that "nuts" got a b, is inaccurate.

The confusion by the above linked writers is most likely due to the fact that walnuts were originally part of the generic nut group that got a C rating but 8 months later the grade level for walnuts only was raised to a B. At the time, which is when the above linked articles were written, many people thought that the rankings for all nuts was raised to a B. An understandable error.

Now, IMH(P&P)O, anything less than an A is basically marketing and advertising as the secondary qualified levels did not even exist for many years till the FDA added them due to industry pressure. The only level that existed for many years and the only level that should be accepted is a A level claim and when you read the descriptions above about the four levels, you will see why.

Also, to help put the health claims for nuts in perspective, as a general group (except for walnuts) they have been awarded the same level claim as olive oil, canola oil, calcium supplements for hypertension and calcium supplements for colon cancer which, as most of us know, are fairly weak claims, at best.

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Re: Debunking Michael Greger

Postby rijman » Thu Aug 02, 2012 8:20 am

Mark Simon wrote:If he expects to come into Dr. McDougall's living room (these discussion boards) while he has leveled insults at Dr. McDougall, I don't believe he should be returned a level of respect, because in that case he is just a spammer here, to promoter his videos and website. The fact that he doesn't answer makes you wonder.

I understand Dr. McDougall commonly invites doctors with differing diet opinions to his public events so they can discuss and debate the optimal diet. He understands that he and his colleagues don't agree 100% and instead of shunning them and their opinions he invites them to share their opinions in a public forum. Dr. Greger is is a reputable doctor on the same side of the fence as Dr's McDougall, Esselstyn, Campbell and Ornish, so he is worthy of my attention and respect.

BTW- I really appreciate all the efforts here to bring us the facts on nuts, especially Mark Simon and Jeff.
I may be naive.
But I still believe the truth will be revealed if enough light is shined on the subject.
Right now we are dealing with massive ignorance.

John McDougall, MD
(McDougall Discussion Board, posted 7/2/13)
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Re: Debunking Michael Greger

Postby f1jim » Thu Aug 02, 2012 8:49 am

Make no mistake. Dr. Greger is on our side. We can argue this or that point with him or even question his perspective on issues but he is working hard to improve the lives of people everywhere. He does a creditable job on what I have seen and for that I commend him. He is also not beyond criticism here on anything diet related. Keep the criticism on topic and not personal and there will be no problem.
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Re: Debunking Michael Greger

Postby Mark Simon » Thu Aug 02, 2012 9:11 am

rijman wrote:

I understand Dr. McDougall commonly invites doctors with differing diet opinions to his public events so they can discuss and debate the optimal diet. He understands that he and his colleagues don't agree 100% and instead of shunning them and their opinions he invites them to share their opinions in a public forum. Dr. Greger is is a reputable doctor on the same side of the fence as Dr's McDougall, Esselstyn, Campbell and Ornish, so he is worthy of my attention and respect.


Thank you for this comment. I have been around for many years, have read the boards, watched videos and am familiar with Dr. McDougall and the many other luminaries in the plant-based world. But I think you miss my point, rijman. I believe Dr. Greger has insulted Dr. McDougall, as he is using words like "ego-based" when referring to McDougall and/or Esselstyn, and he mischaracterizes Dr. McDougall's diet in a way that Joel Fuhrman invented in order to smear McDougall.

Dr. Greger has been asked by multiple people here in these forums to clarify what he meant and his position toward Dr. McDougall and his diet, and he has so far refused. In the absence of that, I think it is appropriate that people who are loyal to Dr. McDougall not embrace him.

I mention watching videos because, to provide some context, over many years the many plant-based doctors interacted in a professional and courteous way toward one another. Then about 5 or so years ago, Dr. Fuhrman started making insulting public comments about other doctors and their work. Not mere professional disagreement, but disparagement and smearing, even intentionally misrepresenting the work of others. This is a serious problem by Dr. Fuhrman, one that I may write more about at some point.

The reason I mention this is that Dr. Greger has now become the second doctor to begin engaging in personal insults, smears and intentional misrepresentations, and I find it quite troubling. I don't know if this is a signal that Greger has allied himself with Dr. Fuhrman for some mercantile reason or other and needs to be rude in order to show loyalty to Fuhrman, but I abhor the behavior of Dr. Fuhrman in this respect, and am shocked to see Dr. Greger follow Fuhrman's lead. And so to be honest, Greger is far less talented and his work is far less valuable than the rest of the crowd you mention, so it is really disturbing that he feels it's okay for him to namecall other doctors and rudely disparage their work.

New people or even people who, like me, have been eating healthy plant-based for many years, are the intended targets of the kind of rude, smear strategy that Fuhrman represents. And he does it in hope of increasing his market share. If Greger is going along with that, then he should not receive your respect. I don't know if Dr. McDougall is aware that Greger is calling his work "ego-based," "outdated" and "not the best science." Perhaps he can ask Dr. Greger to comment on that during his next program, since Greger refuses so far to do so in response to requests on Dr. McDougall's discussion boards.
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Re: Debunking Michael Greger

Postby scooterpie » Thu Aug 02, 2012 9:30 am

Mark Simon, could you please re-link to this--it's broken into link and plain text in your above post.

Thanks!

Mark Simon wrote:http://www.diseaseproof.com/archives/in ... er-md.html
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Re: Debunking Michael Greger

Postby Mark Simon » Thu Aug 02, 2012 9:32 am

Certainly. Let's see if it works this time:

http://www.diseaseproof.com/archives/in ... er-md.html
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Re: Debunking Michael Greger

Postby scooterpie » Thu Aug 02, 2012 9:45 am

Thanks!

Interesting that Greger's grandmother was an early Pritikin-ite. I haven't watched/read anything of Greger's thus far, so I can't join the discussion. He's not a trained scientist, nor is Dr McDougall (that I know of). I see this as a very healthy discussion.
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Re: Debunking Michael Greger

Postby Mark Simon » Thu Aug 02, 2012 9:51 am

Yes it is. And Dr. Greger credits the low-fat Pritikin diet for reversing her heart disease and giving her another 31 years to age 96. Which is why his anti-low-fat comments ala Fuhrman are that much more odd.
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Re: Debunking Michael Greger

Postby Acura » Thu Aug 02, 2012 9:51 am

Jeff your entire post in regards to Levels rest on "Nuts and Heart disease". Another aspect is, fatty acid deficiency which can develop over many many years. I'm not sure if there is a evidence to support fatty acid deficiency after following Low fat diet, not in a short term but over long run.
Last edited by Acura on Thu Aug 02, 2012 10:28 am, edited 1 time in total.
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Re: Debunking Michael Greger

Postby patty » Thu Aug 02, 2012 10:07 am

Mark Simon wrote:Yes it is. And Dr. Greger credits the low-fat Pritikin diet for reversing her heart disease and giving her another 31 years to age 96. Which is why his anti-low-fat comments ala Fuhrman are that much more odd.


There is a difference coming from desire and desperation. Suffering and desire come from the same root. Dr. Greger is still caught in the illusion of scarcity (the biological metabolic dollar for a famine that never comes). He has to go deeper, letters behind your name does not give entitlement to the state of Nirvana. Our conscious lives on if we are in or out of a body. Dr. McDougall is the epitome of generosity.

Mahalo, Mark for putting emotional honesty before cash register honesty.

Aloha, patty
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Re: Debunking Michael Greger

Postby JeffN » Thu Aug 02, 2012 10:19 am

Chimichanga wrote:Jeff your entire post in regards to Levels rest on "Nuts and Heart disease". Another aspect is, fatty acid deficiency which can develop over many many years. I'm not sure if there is a evidence to support fatty acid deficiency after following Low fat diet.


As you know, I always recommend we evaluate any product, any diet any food, etc from a total perspective and not just from any one aspect. So, there are always many issues to be addressed but I was asked to specifically address the question at hand.

If you have seen the Nuts and Health DVD or Presentation, I analyse nuts from every perpective including protein, fiber, vitamins, minerals, nutrient density, calorie density, saturated fat, fatty acids (omega 6, omega 3, omega 6/3 ratio) and also go through and evaluate each and every health claim made about them including heart disease, diabetes, weight, and also review other issues like allergies, toxicity, consumption data, health claims and national recommendations.

Briefly, yes, getting in enough essential fatty acids is important, and, as you may know, well discussed in my forum in many threads over the years. However, in regard to nuts and essential fatty acids, most all nuts and most seeds are actually very poor sources of omega 3 fatty acids with only the walnut, flax seed and chia seed considered to be a rich source of them and only pecans are considered to be a good source (by standard defined and accepted definitions). In addition, most nuts and seeds have extremely high levels of omega 6's and as a result, they also have very high ratio's of omega 6 to 3's.

At the end of the presentation, I present an overview graph highlighting every nut/seed and every issue about them, scoring them in a color coded chart for each issue so everyone can easily see the overall picture.

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Re: Debunking Michael Greger

Postby f1jim » Thu Aug 02, 2012 1:01 pm

These arguments also came up when Dr. Dean Ornish's book The Spectrum came out. He was viewed by many as a sell out putting animal products and fish in as acceptable food items. Also working with large companies such as cola and fast food purpeyors. Yet, in his research on genetic pathways he used his standard reversal diet. Many saw him as abandoning the plant based movement and a turncoat. i admit I was sad to see a watering down of his recommendations and personally was a bit dismayed. But even with that I still look at him as being an important cog in the wheel turning us to better health. There are things that I can use to pick him apart over but he is still helping to pull us out of the nutritional quagmire we find ourselves in. I have heard him speak several times and I still get the message from him that this is the way out of our chronic illness epidemic. He isn't the first name out of my mouth when I speak about nutritional gurus but he is on my list of those trying to move us forward
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Re: Debunking Michael Greger

Postby Gramma Jackie » Thu Aug 02, 2012 1:22 pm

f1jim wrote:These arguments also came up when Dr. Dean Ornish's book The Spectrum came out. He was viewed by many as a sell out putting animal products and fish in as acceptable food items. Also working with large companies such as cola and fast food purpeyors. Yet, in his research on genetic pathways he used his standard reversal diet. Many saw him as abandoning the plant based movement and a turncoat. i admit I was sad to see a watering down of his recommendations and personally was a bit dismayed. But even with that I still look at him as being an important cog in the wheel turning us to better health. There are things that I can use to pick him apart over but he is still helping to pull us out of the nutritional quagmire we find ourselves in. I have heard him speak several times and I still get the message from him that this is the way out of our chronic illness epidemic. He isn't the first name out of my mouth when I speak about nutritional gurus but he is on my list of those trying to move us forward


I don't exactly see Ornish as "selling out" as almost giving up. He, like Dr. McDougall, worked for years to try to get the general public and most doctors to accept his ideas and yet here he is today like most plant-based doctors addressing a niche' audience---mainly those with diagnosed heart disease or other health problems. I have to admit, I can almost hear exasperation in Dr. McDougall's voice too, although I know he would never give in and allow low fat dairy and fish oil like Dr. Ornish. But sometimes I feel Dr. McDougall is also so frustrated that he says things like "go ahead, eat white bread and white rice" because it's better than eating meat anyway. And last night on the web-cast/ call hosted by Lanu Muelrath he said The Starch Solution would probably be his last book because he's done about all he can do to try to convince people to eat a low fat, plant-based, starch-centered diet. I know it must be frustrating to all the different doctors and it must be hard to continue to soldier on when few people are listening. Many of us get on these forums everyday and discuss this stuff while the rest of the world is "going to hell in a handbasket" metaphorically speaking when it comes to their health and there is not much more anyone can do about it. So apparently Ornish was just trying to make what some people think is an unappetizing diet more palatable when he wrote The Spectrum.
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Re: Debunking Michael Greger

Postby Acura » Thu Aug 02, 2012 1:34 pm

I agree with you Jim. Dr Ornish should not have diluted his research that has potential to reverse the heart disease. You will find lot more luminaries advise on taking middle approach which is spectrum approach. One more person telling the same thing doesn't make much difference but if you take someone like Dr Ornish and then have him say just do whatever you can do. It does make a difference. People sitting on the fence who would have otherwise traveled that arduous road may be happy with mediocre.
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Re: Debunking Michael Greger

Postby Vegan Hunter » Thu Aug 02, 2012 4:27 pm

I don't exactly see Ornish as "selling out" as almost giving up. He, like Dr. McDougall, worked for years to try to get the general public and most doctors to accept his ideas and yet here he is today like most plant-based doctors addressing a niche' audience---mainly those with diagnosed heart disease or other health problems. I have to admit, I can almost hear exasperation in Dr. McDougall's voice too, although I know he would never give in and allow low fat dairy and fish oil like Dr. Ornish.


I recently found the free Mcdougall podcasts on itunes and listened to every one. The one thing that kept occuring to me as I listened was that these interviews are in some cases 20 years old and virtually no progress has been made. Many times I heard McD say things like, "it's coming!" or, "It's right around the corner!" I completely understand the exasperation. What have we gained? More often than not he is preaching to the choir.

The ripple effects are faint but they are still there. After all, I'm vegan! If you had presented the me of 20 years ago with the idea of plant-based eating, I would have laughed in your face. Of course, I'd like to visit me back then and slap myself in the back of head, but I digress.

I am not going to dismiss everything Dr. Greger does just because he puts out conflicting information about nuts. I have watched many of his videos and consider him a valuable asset in the effort to sway understanding.

One last comment on the Podcasts. I actually heard Dr. McDougall sigh into the microphone and let just a little exasperation into his voice in one interview:) Guess which one? The Atkins interview. What a joke Dr. Atkins was.
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