Trending Cardiovascular Nutrition Controversies- Nuts, Oil..

[JeffN]

Just published in the Journal of the American College of Cardiology.

The authors include Dr Barnard, Dr Esselstyn, Dr Ornish & Dr Williams

Trending Cardiovascular Nutrition Controversies
(J Am Coll Cardiol 2017;69:1172–87)

Andrew M. Freeman, MD,a Pamela B. Morris, MD,b Neal Barnard, MD,c Caldwell B. Esselstyn, MD,d, Emilio Ros, MD, PHD,e Arthur Agatston, MD,f Stephen Devries, MD,g,h James O’Keefe, MD,i Michael Miller, MD,j Dean Ornish, MD,k Kim Williams, MD,l Penny Kris-Etherton, PHDm

Full text

http://www.onlinejacc.org/content/69/9/1172

Abstract

The potential cardiovascular benefits of several trending foods and dietary patterns are still incompletely understood, and nutritional science continues to evolve. However, in the meantime, a number of controversial dietary patterns, foods, and nutrients have received significant media exposure and are mired by hype. This review addresses some of the more popular foods and dietary patterns that are promoted for cardiovascular health to provide clinicians with accurate information for patient discussions in the clinical setting.

A Look to the Future

In summary, the future health of the global population largely depends on a shift to healthier dietary patterns (Central Illustration). However, in the search for the perfect dietary pattern and foods that provide miraculous benefits, consumers are vulnerable to unsubstantiated health benefit claims. As clinicians, it is important to stay abreast of the current scientific evidence to provide meaningful and effective nutrition guidance to patients for ASCVD risk reduction. In this brief review, just a few of the current trends in nutrition have been highlighted to serve as a starting point for the patient-clinician discussion. Available evidence supports CV benefits of nuts, olive oil and other liquid vegetable oils, plant-based diets and plant-based proteins, green leafy vegetables, and antioxidant-rich foods (Central Illustration). Although juicing may be of benefit for individuals who would otherwise not consume adequate amounts of fresh fruits and vegetables, caution must be exercised to avoid excessive calorie intake. There is currently no evidence to supplement regular intake of antioxidant dietary supplements. Gluten is an issue for those with GRDs, and it is important to be mindful of this in routine clinical practice; however, there is no evidence for CV or weight loss benefits, apart from the potential caloric restriction associated with a gluten-free diet.

Summary Chart



Looks like Dr Esselstyn just put his name on a published paper endorsing nuts & oils

In Health
Jeff

[JeffN]

I will post my specific response in a few days however, anyone familiar with me and this forum, already knows my response to each point (coconut oil, saturated fat, eggs, high fat diets, supplements, juicing, fruits and veggies, protein and oil).

In the meantime, considering this paper published in one of the leading CVD journals and is a consensus of some of the top names in the industry, I think this is a great paper. To get all these names to agree on the above is monumental.

I would encourage everyone to read it in its entirety, especially the summary for each section.

In Health
Jeff

[JeffN]

I was asked by one of the official McDougall FB pages to respond so I did.

Here are my "off the cuff" comments. I will have more details later.

I think to see such names on one paper, perfect or not, is monumental.

I agree 100% with most all of it including...

no to
- - juicing
- - (most) supplements
- - coconut oil
- - eggs
- - hi fat diets

and

yes to..
- -veggies,
- - protein from plant foods
- - (fruits)/berries.

The question is on nuts, which we do allow in moderation but they are not recommended for weight loss, which is exactly what the paper recommends, limiting intake to one ounce a day (30 gm) and that "Moderate quantities are required to prevent caloric excess." No argument there.

The real question is liquid vegetable oils like corn, olive & canola oils which I have addressed in this forum in detail and in my talk. I would recommend reading the paper on this issue. It says they found that when substituting these vegetable oils for saturated fat, there was a decrease in the numbers but no evidence on better CVD outcomes.That is exactly what I say in the fats talk and in this forum.

It says olive has some more evidence from some MED studies and PREDIMED Trial, which I discuss in this forum and in my talk. They also say there are no studies comparing the MED to the Okinawan which uses virtually no nuts or oils and has great outcomes too.

Most of what they are discussing is the impact of these oils on those on the SAD moving in our direction or on a current unhealthy MED diet. They are not discussing what happens when someone is on our diet and lifestyle and then adds the oil to them. These are all the same points I make in my writing/talks. Olive oil may be shown to decrease LDL or LDL oxidation when someone is not on a very healthy diet, but it is not going to decrease LDL or LDL oxidation even more when someone is strictly adhering to our recommendations.

It's like the example I use on the nuts studies that show that adding nuts to a typical diet may lower TC 4.5% and LDL 6.5%. Yet, changing ones whole diet to the one we recommend without the use of nuts, lowered TC and LDL 25-30%, Will adding nuts now to that diet lower TC and LDL even more?

Also, remember, only very, very low oil/oil free diets have documented reversal of CVD.

So, I think it is the weakest of all the points they made.

For the record, Pritikin allowed the use of canola or olive oil in moderation for flavoring only, something the McDougalls do on a rare occasion in some of their recipes. The limit at Pritikin was 4% of calories which is about 1-2 tsp a day.

The problem you & I know, is if most people are given an inch, an ounce of nuts and/or a tsp (or 2) of oil, they will take a mile and really overdo both. That's how we all got here. So if the paper recommended a glass of wine a day, it would not be good for those of use who can't have just one glass. It would be best for us to avoid it.

Those of us who do skip oil & nuts are not missing anything as long as we are getting all our minimally processed fruits, veggies, starchy vegetables, intact whole grains & beans.

So when you think about this, and the controversies out there in nutrition, I think it's a real winner with just one minor concern that has to be put in perspective.

In Health
Jeff

PS This is why I don't understand how and why moderation is promoted as a public health and nutrition recommendation. Around 70-75% of Americans (who are overweight and obese) have clearly shown that beyond the shadow of any doubt, that in this ad-libitum, toxic food environment, they can't do moderation. Add in the percentage of those who manage their weight by disordered exercise and/or disordered eating and we may be close to 80% (or more). So, we are promoting and recommending a public health/nutrition policy (moderation) that can't ever work for 80% of us in this environment.

And to think, they call me crazy