Nutritionism’s Great Blunder

Dr. Ancel Keys has been accused of many great nutritional crimes, but his greatest blunder was the inadvertent triumph of nutritionism.  Dr. Keys was one of the great proponents of saturated fat as one of the main determinants of the epidemic of coronary disease in the 1950’s and 1960’s.  This led directly to the low fat mania of the 1980’s, which many believe set the stage for the obesity epidemic.  Recently, the Academy of Nutrition and Dietetics reversed their position on saturated fats. It now recommends that saturated fats as well as cholesterol no longer be considered ‘nutrients of concern’. In other words, they no longer believe that eating saturated fats and cholesterol are bad for you. As Dr. Sarah Hallberg writes – Yes, pigs are flying. Hell is freezing over. What happened?Ancel

The Seven Countries Study was Dr. Key’s crowning nutritional achievement.  By studying rates of heart disease and dietary saturated fats, he showed an association between these two variables.  Clearly overstepping the reach of the evidence, he insinuated that there was a causal relationship between them.  For this, he has often been vilified.

However, Dr. Keys was simply a man with a hypothesis.  Certainly, he should not have mixed correlation with causation, but he is not the first man to have done so, nor is he the last.  This critical, but juvenile mistake happens in medicine all the time.

For example, take the case of hormone replacement therapy (HRT) in post menopausal women.  There was a strong correlation between women who take HRT and reduction in heart disease.  Pretty soon, doctors convinced themselves that the HRT caused the reduction in heart disease.  Pretty stupid, right?  Well, it didn’t stop thousands of doctors earnestly prescribing HRT to millions of women, my mother included.  When the trial results came in, HRT wasn’t beneficial, it was harmful.  Horribly harmful. Breast cancer increased 26%. Stroke increased 41%. Heart attacks increased 29%. Blood clots increased 100%.  There was no benefit on heart disease.  The company that made HRT was sued into non-existence. Good riddance.

Or consider that high HDL correlates to less heart disease.  Pfizer spent billions of dollars developing torceptratib to raise HDL.  This is simply an association, not a causation.  When studies were done to see, the results were sensational.  But not in a good way.

The drug killed people left and right.  Correlation is not causation.  The fact that people who exercise have higher HDL, and people who exercise have less heart disease seems to have evaded them.  Luckily this error was caught before millions were exposed.  So, yes, this correlation = causation mistake happens. A lot. To some otherwise very good doctors. It is likely because doctors, more than most, want to believe that these things are helpful. This longing to help blinds them in their search for the truth. So Dr. Ancel Keys is not alone in making this mistake.

No, Dr. Key’s great nutritional crime was the inadvertent triumph of nutritionism.  This is the practice where all foods are categorized by their macro or micro nutrient content.  So, instead of discussing foods like beef and kale, we speak of protein and carbohydrates.  We pretend, without proof that all carbohydrates are equal.  That all proteins are equal. That all fats are equal.  That all saturated fats are equal.

If foods were humans, we would call this racism.  By painting an entire race with the same brush, we lose all sense of individualism.  So we might make the mistake that Tiger Woods (as half black and half asian) should be playing basketball, or doing math problems or singing karaoke instead of becoming the greatest golfer of his generation.  We realize this is ludicrous in humans, yet use the same logic for foods.

This brings us to this interesting recent article in The Lancet, Diabetes and Endocrinology, which considers the differing effects of even versus odd chain length in saturated fats.

Saturated fatty acids (SFA) may contain different fats that have entirely different effects on health. While most of the attention has been directed to effects on serum cholesterol, SFAs have other physiologic effects, in particular on the insulin response. Furthermore, blood SFA levels are not solely diet related. The liver can produce new fat in response to high insulin and carbohydrate intake in a process called hepatic de-novo lipogenesis (DNL). Those SFAs produced by DNL are typically even-chained, whereas odd chain SFAs are typically found in the diet. The health consequences are distinctly different.

The odd length SFA (15:0 and 17:0) are good markers of dietary SFA intake.  These are derived predominantly from dairy SFAs.  The body does not make these SFA all of the odd length SFA’s reflect dietary intake.

The even length SFAs, palmitic acid (16:0) and stearic acid (18:0), can be synthesized in the liver by DNL in response to excess carbohydrate intake.  In addition, these SFAs can be taken in through the diet.  So the even length SFAs can reflect excessive dietary SFA or excessive carbohydrates.

So what’s the implication of these different SFAs?

The European Prospective Investigation into Cancer and Nutrition Study (EPIC), a huge multi-national, long-term cohort study following 340,234 people in 8 European countries identified 12,403 new cases of type 2 diabetes.

Even chain length SFAs (14:0, 16:0, and 18:0) were positively associated with the incidence of type 2 diabetes.  This means that high levels of even chain saturated fat in the blood are associated with higher chances of diabetes.  This may be caused by dietary SFA intake, but equally likely by excessive carbohydrate intake. Excessive intake of carbs led to De Novo Lipogenesis in the liver (literally the making of new fat) which produces many even length saturated fats. So, it was the carbohydrates that were increasing even chain length SFAs.

What about the odd chain length?  These are typically the dietary saturated fats – like dairy fats for example. “odd-chain SFAs (15:0 and 17:0)… were inversely associated with type 2 diabetes.”  Full fat dairy contains large amounts of odd chain SFAs, and is consistently associated with protection against Type 2 Diabetes.  In other words, eating more dairy fat protects us against diabetes.

Dairy fat has also been consistently associated with protection against obesity as well, but that is another story for another day.  Looking at the chart of what correlated to even versus odd chain fatty acids, it is striking that dairy raises even chain SFA slightly, but odd chain SFA a lot.  Red meat also tends to raise even chain SFA slightly, but alcohol, potatoes, soft drinks and margarine are the biggest culprits here. They tend to raise Even-chain FA and lower Odd-chain FAs – the worst combination.

So, we’ve been drinking low fat milk and choking down low fat cheese, all with the delusion that this will improve our health.  We replaced butter with margarine – truly a heinous crime against good taste.  We reduced saturated fats, but the wrong kinds.  All those odd-chain length SFAs were not harmful at all.  All saturated fatty acids are not the same.  We should have been eating high-fat dairy, not low fat dairy.  We should have enjoyed our cream in our coffee instead of skim milk.  We should have eaten the triple cream brie cheese.  And man, oh man, we should have eaten the butter.

There are even trans fats that exist in nature and are not harmful to human health. These are the conjugated linoleic acids (CLA). In fact, many people take supplements of these CLAs. However, the artificial trans fats produced by partial hydrogenation are quite harmful. So, we cannot stereotype even trans fat.  We need to talk about foods, not nutrients.

Dr. Ancel Keys was vilified for the wrong nutritional crime.  The campaign against saturated fat was wrong, but the more insidious and ultimately more dangerous crime was nutritionism.  All fats are not equal.  All saturated fats are not equal.  All carbohydrates are not equal.  As we saw in a previous post “Wheat” you can eat the same carbohydrate, amylopectin, but with dramatically different metabolic consequences.  In wheat, you eat amylopectin A which is completely and easily converted to glucose.  With legumes, you eat amylopectin C which is mostly undigested and food for the colonic bacteria which turn it into … farts.

There is just a huge difference even between the same carbohydrate – amylopectin.  Forget about trying to compare celluloses and hemi-celluloses (vegetable) against the amylose and amylopectins (bread).  To label all carbs as ‘good’ or ‘bad’ is clearly a fool’s errand.

Classifying all fats as ‘good’ or ‘bad’ is wrong.  Classifying all carbs as ‘good’ or ‘bad’ is wrong.  We must stop this stereotyping.  We must talk about foods as individuals.  Yes, broccoli is a carbohydrate, but no, it is not bad for you.  Yes, margarine is a fat, but no, it is not good for you.  We must speak about foods, not nutrients. Racism is a crime against humanity. Nutritionism is a crime against human health.

Start here with Calories I

Start here with How to Lose Weight I

Watch Dr. Sarah Hallbergs TEDx talk “Reversing Type 2 Diabetes starts with ignoring the guidelines”

2017-10-19T14:01:32-04:0029 Comments

About the Author:

Dr. Fung is a Toronto based kidney specialist, having graduated from the University of Toronto and finishing his medical specialty at the University of California, Los Angeles in 2001. He is the author of the bestsellers ‘The Obesity Code’ and ‘The Complete Guide to Fasting’. He has pioneered the use of therapeutic fasting for weight loss and type 2 diabetes reversal in his IDM clinic.

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EB
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EB

Another wonderful post Dr. Fung, thank you! It raises a few questions for me.

Are sweet potatoes in the same bad category as regular potatoes, with regards to the even/odd fatty chains? And, it looks like red meats reduce the odd-chain SLA, in the graph above, but not too substantially. What’s your take on that?

Also I’m curious, has anyone studied Asian populations, who traditionally consume quite a lot of rice and rice products, to see if their SLA response (via the liver) is different from Westerners? I think that would be fascinating.

Ron Culbertson
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Ron Culbertson

It didn’t help that he fudged the data by excluding the countries that contradicted his hypothesis.

Dr. Jason Fung: True enough. But he is not the first researcher to do so and will not be the last.

BobM
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BobM

Very interesting article. Thank you for this. This type of information shows me how complex everything is and how little we know.

It looks to me as if alcohol is the worst offender. That’s a bummer.

Tom Welsh
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Tom Welsh

And yet many studies show that red wine (at least), taken moderately, helps to lose weight. Moderate alcohol drinkers seem to be slightly healthier in many ways, although it’s impossible to say whether that’s causation or just correlation.

Tom Welsh
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Tom Welsh

I totally agree with your remark about the complexity of human metabolism and biochemistry. Even a single human cell is indescribably complex, perhaps comparable to a large city. Students of nutrition have got it wrong time and again, as a result of adopting overly simplistic models. In the 18th century, when there was great interest in steam engines and thermodynamics, the term “calorie” was first applied to food. Scientists actually burned various foods to find out their “energy content”, having no idea of the complex chemical reactions that take place inside the body. At first they thought sugar was the… Read more »

GN
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GN

I checked with nutritiondata.com for butter and butter oil and the saturated fat content was almost all 14:0, 16:0 and 18:0. Very little of the odd chain 15:0 and 17:0. Did EPIC use a different butter or something?

Liz Lund
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Liz Lund

Odd chain FAs are a tiny minority of the detectable fatty acids and are often ignored when analyzing lipids. The odd chain fatty acids are formed by bacterial fermentation in the stomach of ruminants and what is formed will depend on the feed provided. I suspect the odd chain FA data is just a reflection of dairy and meat intake uless someone can provide me a tangible mechansism. The length of FAs is also important as those of 12 carbons or less are generally not metabolised in the same way.

BobM
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BobM

Is insulin level useful to measure insulin resistance? I just had a fasting insulin test and got an insulin level of 3.8 uIU/ml. That seems low, considering the range is 2-19.6. However, I believe I’m insulin resistant to some (possibly high) degree.

Dr. Jason Fung: Great question. Insulin levels are too variable to be of use. Fasting insulin levels are more useful. You can also compare fasting insulin to fasting glucose levels to calculate HOMA, an indirect measure of insulin resistance.

Leah Brooks
Guest

Very interesting article — I had to read it twice. God designed food to be eaten whole!

Dr. Jason Fung: That’s exactly my point. If we eat foods unprocessed, even carbs, our bodies have adapted to handle it without problems. If we change the chemical composition of food, then problems arise.

Leslyn
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Leslyn

I am wondering about the endogenously-created saturated fat in breast milk and the diet composition of the mother. Would a mother’s high carb diet influence the type of SFAs in her milk? And what implication does that have for neonate health and development?

Deb Griffith
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Deb Griffith

Excellent question! And to take it another step, how does that affect the future weight of the child? My super thin sister has a daughter who is obese. How is that possible??

Tom Welsh
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Tom Welsh

If Dr William Davis is to be believed… dwarf wheat!

TomS
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TomS

I’m having trouble understanding the last chart. The way I interpret it I should be chowing down on cake and cookies to increase odd-chain and reduce even-chain fatty acids. Surely that can’t be right!

Nate
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Nate

Yeah, TomS, I had the same confusion. I compared the cakes and cookies to the nuts and seeds and thought that I should start snacking on C&C’s and not nuts, pretty nutty uh.

But, then Dr. Fung explains, at the end of the post. that foods are complex. C&C’s have a lot of sugar that Dr. Lustig calls a poison and addictive. And, the combination of a lot of fat and sugar causes more problems. The whole foods called C&C’s have maybe a few good points but many more bad ones. (Darn.)

Nate
Guest
Nate

Another confusing item in the last chart is vegetable oils. The saturated fatty acids that correlated with vegetable oils are very positive. But, many say vegetable oils are terrible. They have too many omega 6 fatty acids and can go rancid far too easily. The sum of all of that is what? If you manufacture those oils, I’m sure you would add all that up to say, positive.

Frank
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Frank

Before you chow down those high fat cakes and cookies, or some of Dr Fung’s high fat suggestions. I recommend you read studies that focus on other ailments such as atherosclerosis.

There are a few long-living societies around the world. Despite having “different” diets and lifestyles the common theme is a diet high in raw fruit and veg. Note that fruit and veg also the healthiest listed food in this article.

Jerome Benthamite
Guest

This example of the use of HRT is terrible wrong. It is another example of profits before health. Using the worse formula (Prempro) to prove all other formulations are bad is junk science. Equine estrogen (from mare’s urine) is not the same as the human estradiol (E2, the best of 4 human estrogens); moreover, medroxyprogesterone blocks many of the benefits of E2. The 2003 Scientific American publication, Hormone Hysteria said about the WHI study. “I think that it borders on a tragedy that Premarin and Provera [the 2 compounds in Prempro] were chosen as the only HRT treatments [for the… Read more »

Tom Welsh
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Tom Welsh

“In wheat, you eat amylopectin A which is completely and easily converted to glucose. With legumes, you eat amylopectin C which is mostly undigested and food for the colonic bacteria which turn it into … farts”. Hmm. Isn’t that last sentence a little one-sided? After all, if you wanted to make eating and breathing look bad, you could say, “they are just fuel for the human body which turns them into… carbon dioxide”. Although gut bacteria may produce farts as a side-effect, don’t many of them play important roles in keeping the body running smoothly? Besides, that glucose that wheat… Read more »

Robin B-T
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Robin B-T

I wonder, is there a difference between grass fed red meat and grain fed?

BobM
Guest
BobM

Supposedly there is. There’s more CLA in grass fed beef and the fat profile is different. How much that matters is anyone’s guess, though I believe grass fed has to be healthier — cows weren’t meant to eat grains.

Nate
Guest
Nate

Another informative post, thanks. I cannot wait for your book to come out. Relatively recently, I’ve been noticing that a lot of nutritionists and others strongly promoting the need to eat whole foods. Maybe the first person who I remember saying it was Michael Pollen. Now, your article gives me some of the science behind it. Again thanks. I must confess that I thought a lot of the nutritionists and other promoters of the low fat diet were, in part, saying to eat whole foods in a way to cover up their mistake. It really bothered me that they were… Read more »

Nate
Guest
Nate

In the past, wise chefs have often been called mothers. Nourishing Traditions, anyone?

Kim
Guest
Kim

I have had good success with the fasting regimine and I owe Dr. Fung for saving my life by introducing me to this concept. It has been and continues to be a long journey to find proper nutrition. Diabetes and Alzeimers runs in my family and despite my efforts to keep good health I have insulin resistance and celiac disease. I listened to the “experts” along the way and started with low fat with low calorie, then to weight watchers, then went to low carb, then wheat free, then to grain free and Paleo, now I am mostly raw, unprocessed,… Read more »

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[…] answer is this. Macronutrients, just as with calories is the wrong measure of a diet. This is nutritionism’s greatest blunder. This refers to the fact that trying to reduce the complexity of foods and their effect on humans […]

lass lassiter
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lass lassiter

Great article!!!!!

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[…] little diabesity. It is also possible to eat carbohydrates and have little diabesity. The problem, (Nutritionism’s Greatest Blunder) is focusing obsessively on macronutrient content (how much fat, how much carbs). It’s the […]

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[…] Dr. Jason Fung, has provided a great summary of the events that occurred to make us so fat-phobic, here. You will see that Dr. Keys did not report the full extent of his study and simply reported the […]

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[…] Dr. Fung’s discussion of this is a particularly good one, someone who has actually studied this, and he points out that there are two types of saturated fat, even chain and odd chain.  The odd chain, which dietary saturated fat consists of, is the healthy kind, and the kind that has been shown to help not hurt diabetes. […]

B. A.
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B. A.

I have searched and have gotten a seesaw answer to if honey is good or bad for health. I would love to get some honest feed back on the pros and cons of the consumption of honey. Some information says honey raises blood sugar but doesn’t spike insulin. Others say honey is the same as table sugar and just as bad. I will say it is an effect sleep aid in my experience.