Dietary Fats, Overcooked: Lots of Heat, Little Light

David L. Katz, MD, MPH, FACPM, FACP

Director, Prevention Research Center

Yale University / Griffin Hospital

President, American College of Lifestyle Medicine

Editor-in-Chief, Childhood Obesity

Author, Disease Proof

Nutrition in Medicine

Washington, DC

7-31-15

Dorothy, we are not in the Cretaceous

anymore…

Konner M, Eaton SB. Paleolithic nutrition: twenty-

five years later. Nutr Clin Pract. 2010 Dec;25(6):594-

602

Some KEYS to good health -

Keys’ work is now ~70 years old; nutritional epidemiology did

not stop then

Keys never recommended Snackwells; they had not been

invented yet

If Keys’ work had never existed, we would likely know by now

exactly what we know by now

Katz DL. The Keys to Good Health. Huffington

Post.

Posted: 08/14/2014 5:19

http://www.huffingtonpost.com/david-katz-md/diet-and-

nutrition_b_5679928.html

Dean’s Data-

Ornish D, Brown SE, Scherwitz LW, Billings JH, Armstrong

WT, Ports TA, McLanahan SM, Kirkeeide RL, Brand RJ, Gould

KL. Can lifestyle changes reverse coronary heart disease? The

Lifestyle Heart Trial. Lancet. 1990 Jul 21;336(8708):129-33

Ornish D, Scherwitz LW, Billings JH, Brown SE, Gould KL,

Merritt TA, Sparler S, Armstrong WT, Ports TA, Kirkeeide RL,

Hogeboom C, Brand RJ. Intensive lifestyle changes for reversal

of coronary heart disease. JAMA. 1998 Dec 16;280(23):2001-7

Sense applied to science?

Well, he tried…

By MICHAEL POLLAN

Published: January 28, 2007

Eat food. Not too much. Mostly plants.

Not Really Low-carb versus Not At ALL Low-fat-

Bazzano LA et al. Effects of low-

carbohydrate and low-fat diets: a

randomized trial. Ann Intern Med.

2014;161:309-318

My take-

Diet Research, Stuck in the Stone Age

Posted: 09/02/2014

http://www.huffingtonpost.com/david-katz-

md/post_8304_b_5752160.html

While fat intake was "trimmed" 5

percent, carbohydrate intake in that

assignment was slashed 75 percent.

This might have been billed "a study

to compare a really big change from

baseline diet to a really small change

from baseline diet."

Less pepperoni, more…_____?

Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Meta-

analysis of prospective cohort studies evaluating

the association of saturated fat with cardiovascular

disease. Am J Clin Nutr. 2010 Mar;91(3):535-46

Sat Fat redux…

Chowdhury R et al. Association of Dietary,

Circulating, and Supplement Fatty Acids With

Coronary Risk: A Systematic Review and Meta-

analysis. Ann Intern Med. 2014;160:398-406

Is butter REALLY back?

http://www.nytimes.com/2014/03/26/opinion/bittman-butter-is-back.html?_r=0

The Opinion Pages | Contributing Op-Ed

Butter Is Back MARCH 25, 2014

My take-

The New Dietary Fat Study: What You Will Hear and What

It Really Means

Posted: 03/18/2014 4:20 pm EDT

http://www.huffingtonpost.com/david-katz-md/diet-and-

nutrition_b_4985323.html

Study: Saturated Fat as Bad as Sugar!

Posted: 06/18/2014

http://www.huffingtonpost.com/david-katz-md/study-saturated-fat-as-

ba_b_5507184.html

Basically, this study showed that if you

vary your intake of saturated fat or

omega-6 fat without altering the

overall quality of your diet, you are not

likely to alter your health much either.

Well, duh.

By the way…

I searched the full text of the Chowdhury meta-

analysis for the word sugar to see if the

replacement of saturated fat with sugar was

considered or addressed.

The word does not appear in the paper. Not once.

Dari’s own take-

Mozaffarian D. Diverging global trends in heart

disease and type 2 diabetes: the role of

carbohydrates and saturated fats. Lancet Diabetes

Endocrinol. 2015 Jun 26. pii: S2213-8587(15)00208-9

Lifestyle as Medicine…

McGinnis & Foege’s Top Ten…

McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA. 1993;270:2207-12

Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the

United States, 2000. JAMA. 2004;291:1238-45

The People in Potsdam-

Ford ES, Bergmann MM, Kröger J, Schienkiewitz A,

Weikert C, Boeing H. Healthy living is the best revenge:

findings from the European Prospective Investigation

Into Cancer and Nutrition-Potsdam study. Arch Intern

Med. 2009 Aug 10;169(15):1355-62

Or the UK:

Kvaavik E, Batty GD, Ursin G, Huxley R, Gale CR. Influence of individual and combined

health behaviors on total and cause-specific mortality in men and women: the United

Kingdom health and lifestyle survey. Arch Intern Med. 2010;170:711-8

Or the US McCullough ML, Patel AV, Kushi LH, Patel R, Willett WC, Doyle C, Thun MJ, Gapstur SM.

Following cancer prevention guidelines reduces risk of cancer, cardiovascular disease, and

all-cause mortality. Cancer Epidemiol Biomarkers Prev. 2011;20:1089-97

Fresher still? The beat goes on…

Akesson A, Larsson SC, Discacciati A, Wolk A. Low-Risk Diet and

Lifestyle Habits in the Primary Prevention of Myocardial Infarction in

Men: A Population-Based Prospective Cohort Study. J Am Coll Cardiol.

2014 Sep 30;64(13):1299-306

Aleksandrova K, et al. Combined impact of healthy lifestyle factors on

colorectal cancer: a large European cohort study. BMC Med. 2014 Oct

10;12(1):168. [Epub ahead of print]

Chomistek AK, Chiuve SE, Eliassen AH, Mukamal KJ, Willett WC, Rimm

EB. Healthy lifestyle in the primordial prevention of

cardiovascular disease among young women. J Am Coll Cardiol. 2015 Jan

6;65(1):43-51

rePercussions…

…to our pith and marrow; the case for nurturing nature:

Ornish D, Magbanua MJ, Weidner G, Weinberg V, Kemp C, Green C, Mattie MD,

Marlin R, Simko J, Shinohara K, Haqq CM, Carroll PR. Changes in prostate gene

expression in men undergoing an intensive nutrition and lifestyle intervention.

Proc Natl Acad Sci U S A. 2008 Jun 17;105(24):8369-74

Hietaniemi M, Jokela M, Rantala M, Ukkola O, Vuoristo JT, Ilves M, Rysä J, Kesäniemi Y. The effect

of a short-term hypocaloric diet on liver gene expression and metabolic risk factors in obese

women. Nutr Metab Cardiovasc Dis. 2009 Mar;19(3):177-83

Freedland SJ, Aronson WJ. Dietary intervention strategies to modulate prostate cancer risk and

prognosis. Curr Opin Urol. 2009 May;19(3):263-7

Ujvari U, Hulchiy M, Calaby A, Nybacka Å, Byström B, Hirschberg AL. Lifestyle intervention up-

regulates gene and protein levels of molecules involved in insulin signaling in the endometrium of

overweight/obese women with polycystic ovary syndrome. Hum Reprod. 2014 Jul;29(7):1526-35

Fingers… Feet… Forks...

Health Diet/Nutrition

Low-Carb Diet Beats Low-Fat for Weight Loss

•Mandy Oaklander @mandyoaklander

Sept. 1, 2014

Bird’s (Katz’?) eye view-

Katz DL et al. Can we say what diet is best for

health? Annu Rev Public Health. 2014 Mar 18; 35:83-

103

Science Compared Every Diet, and the Winner Is Real Food

Researchers asked if one diet could be crowned best in terms of health outcomes.

If diet is a set of rigid principles, the answer is a decisive no. In terms of broader

guidelines, it's a decisive yes.

James Hamblin Mar 24 2014, 1:14 PM ET

Katz DL et al. Nutrition in Clinical Practice, 3rd Edition. Wolters

Kluwer/Lippincott Williams & Wilkins. September, 2014

Other eyes, on the same prize -

Mann J et al. Low carbohydrate diets: going against the

grain. Lancet. 2014 Oct 25:384;1479-80

Ley SH, Hamdy O, Mohan V, Hu FB. Prevention and

management of type 2 diabetes: dietary components and

nutritional strategies. Lancet. 2014 Jun 7;383:1999-2007

Katz DL, Hu F. Knowing what to eat, refusing to swallow it. Huffington

Post. 7/2/14

Darwin’s dinner: Paleo diet, and variations on that theme

Eaton SB, et al. Evolutionary Health Promotion. Prev Med.

2002;34:109-118

Eaton SB, Eaton SB III, Konner MJ. Paleolithic nutrition revisited: A twelve-year retrospective on its nature and implications. Eur J Clin Nutr. 1997;51:207-216

Lev-Ran A. Human obesity: an evolutionary approach to understanding our bulging waistline. Diabetes Metab Res Rev. 2001;17:347-62

The low fat limbo stick- Ornish D, Magbanua MJ, Weidner G, Weinberg V, Kemp C, Green C, Mattie MD, Marlin

R, Simko J, Shinohara K, Haqq CM, Carroll PR. Changes in prostate gene expression in

men undergoing an intensive nutrition and lifestyle intervention. Proc Natl Acad Sci

U S A. 2008 Jun 17;105(24):8369-74

Ornish D, Scherwitz LW, Billings JH, Brown SE, Gould KL, Merritt TA, Sparler S,

Armstrong WT, Ports TA, Kirkeeide RL, Hogeboom C, Brand RJ. Intensive

lifestyle changes for reversal of coronary heart disease. JAMA. 1998 Dec

16;280(23):2001-7

Campbell TC, Junshi C. Diet and chronic degenerative diseases: perspectives from

China. Am J Clin Nutr. 1994 May;59(5 Suppl):1153S-1161S

Esselstyn CB Jr. Resolving the Coronary Artery Disease Epidemic Through Plant-

Based Nutrition. Prev Cardiol. 2001 Autumn;4(4):171-177

Sullivan S, Samuel S. Effect of short-term Pritikin diet therapy on the metabolic

syndrome. J Cardiometab Syndr. 2006 Fall;1(5):308-12

On beyond zebra (and anything else with

hooves, hair, scales, or feathers)-

Trapp CB, Barnard ND. Usefulness of vegetarian and vegan diets for treating type 2 diabetes.

Curr Diab Rep. 2010 Apr;10(2):152-8

Trapp C, Barnard N, Katcher H. A plant-based diet for type 2 diabetes: scientific support and

practical strategies. Diabetes Educ. 2010 Jan-Feb;36(1):33-48

Barnard ND, Katcher HI, Jenkins DJ, Cohen J, Turner-McGrievy G. Vegetarian and vegan

diets in type 2 diabetes management. Nutr Rev. 2009 May;67(5):255-63

Barnard ND, Cohen J, Jenkins DJ, Turner-McGrievy G, Gloede L, Green A, Ferdowsian H. A

low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a

randomized, controlled, 74-wk clinical trial. Am J Clin Nutr. 2009 May;89(5):1588S-1596S

Yokoyama Y et al. Vegetarian diets and blood pressure: a meta-analysis. JAMA Intern

Med. doi:10.1001/jamainternmed.2013.14547. Published online February 24, 2014

Just saying no (more or less)-

Smith DL Jr, Nagy TR, Allison DB. Calorie restriction: what recent results suggest

for the future of ageing research. Eur J Clin Invest. 2010 May;40(5):440-50

Redman LM, Ravussin E. Caloric Restriction in Humans: Impact on Physiological,

Psychological and Behavioral Outcomes. Antioxid Redox Signal. 2010 Jun 2.

[Epub ahead of print]

Minor RK, Allard JS, Younts CM, Ward TM, de Cabo R. Dietary interventions to

extend life span and health span based on calorie restriction. J Gerontol A Biol Sci

Med Sci. 2010 Jul;65(7):695-703

High protein-

Once…

A critique of low-carbohydrate ketogenic weight reduction regimens. A

review of Dr. Atkins' diet revolution. JAMA. 1973 Jun 4;224(10):1415-9

And future:

Jenkins DJ, Wong JM, Kendall CW, Esfahani A, Ng VW, Leong TC,

Faulkner DA, Vidgen E, Greaves KA, Paul G, Singer W. The effect of a

plant-based low-carbohydrate ("Eco-Atkins") diet on body weight and

blood lipid concentrations in hyperlipidemic subjects. Arch Intern Med.

2009 Jun 8;169(11):1046-54

Low GL-

Vrolix R, Mensink RP. Effects of glycemic load on metabolic risk markers in

subjects at increased risk of developing metabolic syndrome. Am J Clin Nutr. 2010

Aug;92(2):366-74

Sieri S, Krogh V, Berrino F, Evangelista A, Agnoli C, Brighenti F, Pellegrini N,

Palli D, Masala G, Sacerdote C, Veglia F, Tumino R, Frasca G, Grioni S, Pala V,

Mattiello A, Chiodini P, Panico S. Dietary glycemic load and index and risk of

coronary heart disease in a large italian cohort: the EPICOR study. Arch Intern

Med. 2010 Apr 12;170(7):640-7

Brand-Miller J, McMillan-Price J, Steinbeck K, Caterson I. Dietary glycemic index:

health implications. J Am Coll Nutr. 2009 Aug;28 Suppl:446S-449S

Willcox DC, Willcox BJ, Todoriki H, Suzuki M. The Okinawan diet: health

implications of a low-calorie, nutrient-dense, antioxidant-rich dietary pattern low in

glycemic load. J Am Coll Nutr. 2009 Aug;28 Suppl:500S-516S

Variations on the glycemic theme-

McMillan-Price J, Petocz P, Atkinson F, O'neill K, Samman S,

Steinbeck K, Caterson I, Brand-Miller J. Comparison of 4

diets of varying glycemic load on weight loss and

cardiovascular risk reduction in overweight and obese young

adults: a randomized controlled trial. Arch Intern Med. 2006

Jul 24;166(14):1466-75

DASH; its Premier, & Encore-

Blumenthal JA, Babyak MA, Hinderliter A, Watkins LL, Craighead L, Lin PH,

Caccia C, Johnson J, Waugh R, Sherwood A. Effects of the DASH diet alone and in

combination with exercise and weight loss on blood pressure and cardiovascular

biomarkers in men and women with high blood pressure: the ENCORE study.

Arch Intern Med. 2010 Jan 25;170(2):126-35

Harsha DW, Sacks FM, Obarzanek E, Svetkey LP, Lin PH, Bray GA, Aickin M,

Conlin PR, Miller ER 3rd, Appel LJ. Effect of dietary sodium intake on blood

lipids: results from the DASH-sodium trial. Hypertension. 2004 Feb;43(2):393-8

Svetkey LP, Harsha DW, Vollmer WM, Stevens VJ, Obarzanek E, Elmer PJ, Lin

PH, Champagne C, Simons-Morton DG, Aickin M, Proschan MA, Appel LJ.

Premier: a clinical trial of comprehensive lifestyle modification for blood pressure

control: rationale, design and baseline characteristics. Ann Epidemiol. 2003

Jul;13(6):462-71

DPP-

Diabetes Prevention Program Research Group, Knowler WC, Fowler SE,

Hamman RF, Christophi CA, Hoffman HJ, Brenneman AT, Brown-Friday

JO, Goldberg R, Venditti E, Nathan DM. 10-year follow-up of diabetes

incidence and weight loss in the Diabetes Prevention Program

Outcomes Study. Lancet. 2009 Nov 14;374(9702):1677-86

Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM,

Walker EA, Nathan DM; Diabetes Prevention Program Research Group.

Reduction in the incidence of type 2 diabetes with lifestyle intervention

or metformin. N Engl J Med. 2002 Feb 7;346(6):393-403

The right Portfolio-

Jenkins DJ, Kendall CW, Marchie A, Faulkner DA, Wong JM,

de Souza R, Emam A, Parker TL, Vidgen E, Lapsley KG,

Trautwein EA, Josse RG, Leiter LA, Connelly PW. Effects of

a dietary portfolio of cholesterol-lowering foods vs

lovastatin on serum lipids and C-reactive protein. JAMA.

2003 Jul 23;290(4):502-10

And the Mediterranean- Buckland G et al. Adherence to the Mediterranean diet and risk of coronary heart disease in

the Spanish EPIC Cohort Study. Am J Epidemiol. 2009 Dec 15;170(12):1518-29

Champagne CM. The usefulness of a Mediterranean-based diet in individuals with type 2

diabetes. Curr Diab Rep. 2009 Oct;9(5):389-95

Zazpe I et al. Predictors of adherence to a Mediterranean-type diet in the PREDIMED trial.

Eur J Nutr. 2010 Mar;49(2):91-9

Esposito K et al. Effects of a Mediterranean-style diet on the need for antihyperglycemic drug

therapy in patients with newly diagnosed type 2 diabetes: a randomized trial. Ann Intern Med.

2009 Sep 1;151(5):306-14

Pérez-López FR, Chedraui P, Haya J, Cuadros JL. Effects of the Mediterranean diet on

longevity and age-related morbid conditions. Maturitas. 2009 Oct 20;64(2):67-79

de Lorgeril M, Salen P. Dietary prevention of coronary heart disease: the Lyon diet heart

study and after. World Rev Nutr Diet. 2005;95:103-14

de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Mediterranean diet,

traditional risk factors, and the rate of cardiovascular complications after myocardial

infarction: final report of the Lyon Diet Heart Study. Circulation. 1999 Feb 16;99(6):779-85.

PubMed PMID: 9989963.

Active ingredients?

Trichopoulou A, Bamia C, Trichopoulos D.

Anatomy of health effects of Mediterranean diet:

Greek EPIC prospective cohort study. BMJ. 2009 Jun

23;338:b2337. doi: 10.1136/bmj.b2337

http://abcnews.go.com/Health/MensHealthNews/story?id=7911505

Mediterranean diet’s EPIC hits:

moderate consumption of ethanol

low consumption of meat and meat products

high consumption of vegetables, fruits and nuts,

olive oil, and legumes

Minimal contributions were found for cereals and dairy

products (heterogeneity)

Fish and seafood (low consumption)

Low fat vegan

Low GL

DASH

DPP Paleo

Low Carb Mediterranean

“Eat food, not too much, mostly plants.”

-Michael Pollan

Much the same, in 572 pages…

Scientific Report of the 2015 Dietary

Guidelines Advisory Committee

http://www.health.gov/dietaryguidelines/2015-

scientific-report/

Meat is a complex health issue but

a simple climate one: the world

needs to eat less of it July 5, 2015 4.18pm EDT

Academic rigor, journalistic flair

Mostly plants? Fuhggedaboudit!...

Blanck HM, Gillespie C, Kimmons JE, Seymour JD, Serdula MK. Trends in

fruit and vegetable consumption among U.S. men and women, 1994-2005.

Prev Chronic Dis. 2008 Apr;5(2):A35. Epub 2008 Mar 15

Kimmons J, Gillespie C, Seymour J, Serdula M, Blanck HM. Fruit and

vegetablei ntake among adolescents and adults in the United States:

percentage meeting individualized recommendations. Medscape J Med.

2009;11(1):26. Epub 2009 Jan 26

Katz DL. Plant foods in the American diet? As we

sow... Medscape J Med.2009;11(1):25. Epub 2009

Jan 26

We don’t know everything -

Stearic acid (18c)

Lauric acid (12c)

n-6 / n-3 ratio vs. total quantities

ALA vs. EPA / DHA

IF dairy: non-fat, low-fat, full-fat?

Etc.

LDL limbo -

From Medscape Education Cardiology

Radical New Concepts in Lipid Management:

Can LDL-C Levels Ever Be Too Low? CME

Kausik Ray, MD, MPhil, FRCP; Michel Farnier, MD,

PhD; Jennifer G. Robinson, MD, MPH

CME Released: 06/25/2015 ; Valid for credit through

06/25/2016

PCSK9 inhibitors: http://www.cnn.com/2015/07/24/health/fda-

cholesterol-drug-approved/

Just when you think you know what you

don’t know -

Oguntibeju OO, Esterhuyse AJ, Truter EJ. Red palm oil: nutritional, physiological and

therapeutic roles in improving human wellbeing and

quality of life. Br J Biomed Sci. 2009;66(4):216-22

The big spoon…

is culture.

Katz DL. Is obesity cultural? US News & World Report,

Eat + Run Blog; 10/4/12;

http://health.usnews.com/health-news/blogs/eat-

run/2012/10/04/is-obesity-cultural

Lifestyle Medicine

is

CULTURAL Medicine

GLiMMER

Global Lifestyle Medicine Movement to Effect Revolution

http://glimmerinitiative.org/

Lighting the World’s Way to Health

GLiMMER: Vision

The Earth is both a beautiful Blue Planet, and a

universal Blue Zone

LiM

Global coalition of lifestyle medicine organizations;

ACLM as convener

Development, Refinement, Dissemination of best

practice models

Contributions to medical education (all levels)

Engagement of payers and policy makers to

advance reimbursement models

Participant in the True Health Coalition (aid, out)

Able to leverage cultural supports (aid, in)

LaM

Radical idea: Time to use what we know?

Ending the Big, Fat Debate

Posted: 07/15/2015

http://www.huffingtonpost.com/david-katz-md/ending-

the-big-fat-debate_b_7804892.html

Ship & Sail, Wind & Wave

Project components are “ship & sail,” specific to a

given destination

The True Health Coalition generates a wind to fill

all sails by establishing consensus, repudiating

distractions and discord

Join us -

True Health Coalition

One Voice, United

A global voice devoted to disseminating and applying

what we know for sure about health promotion and

disease prevention.

Sign up today to become a member of the True Health

Coalition. Your voice matters!

sign me up!

http://glimmerinitiative.org/#coalition

Thank you!

David L. Katz, MD, MPH, FACPM, FACP Director, Yale Prevention Research Center

President, Turn the Tide Foundation, Inc.

130 Division St.

Derby, CT 06418

(203) 732-1265

David.katz@yale.edu

www.davidkatzmd.com