High carb intake associated with higher mortality, high fat intake w/lower mortality

[SoCal Guy]

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32252-3/fulltext

Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study
[FONT=&quot][h=3]Findings[/b]During follow-up, we documented 5796 deaths and 4784 major cardiovascular disease events. Higher carbohydrate intake was associated with an increased risk of total mortality (highest [quintile 5] vs lowest quintile [quintile 1] category, HR 1·28 [95% CI 1·12–1·46], ptrend=0·0001) but not with the risk of cardiovascular disease or cardiovascular disease mortality. Intake of total fat and each type of fat was associated with lower risk of total mortality (quintile 5 vs quintile 1, total fat: HR 0·77 [95% CI 0·67–0·87], ptrend<0·0001; saturated fat, HR 0·86 [0·76–0·99], ptrend=0·0088; monounsaturated fat: HR 0·81 [0·71–0·92], ptrend<0·0001; and polyunsaturated fat: HR 0·80 [0·71–0·89], ptrend<0·0001). Higher saturated fat intake was associated with lower risk of stroke (quintile 5 vs quintile 1, HR 0·79 [95% CI 0·64–0·98], ptrend=0·0498). Total fat and saturated and unsaturated fats were not significantly associated with risk of myocardial infarction or cardiovascular disease mortality.

[/FONT]
[FONT=&quot][h=3]Interpretation[/b]High carbohydrate intake was associated with higher risk of total mortality, whereas total fat and individual types of fat were related to lower total mortality. Total fat and types of fat were not associated with cardiovascular disease, myocardial infarction, or cardiovascular disease mortality, whereas saturated fat had an inverse association with stroke. Global dietary guidelines should be reconsidered in light of these findings.

[/FONT]

 

[madman]

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32252-3/fulltext

Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study


Findings

During follow-up, we documented 5796 deaths and 4784 major cardiovascular disease events. Higher carbohydrate intake was associated with an increased risk of total mortality (highest [quintile 5] vs lowest quintile [quintile 1] category, HR 1·28 [95% CI 1·12–1·46], ptrend=0·0001) but not with the risk of cardiovascular disease or cardiovascular disease mortality. Intake of total fat and each type of fat was associated with lower risk of total mortality (quintile 5 vs quintile 1, total fat: HR 0·77 [95% CI 0·67–0·87], ptrend<0·0001; saturated fat, HR 0·86 [0·76–0·99], ptrend=0·0088; monounsaturated fat: HR 0·81 [0·71–0·92], ptrend<0·0001; and polyunsaturated fat: HR 0·80 [0·71–0·89], ptrend<0·0001). Higher saturated fat intake was associated with lower risk of stroke (quintile 5 vs quintile 1, HR 0·79 [95% CI 0·64–0·98], ptrend=0·0498). Total fat and saturated and unsaturated fats were not significantly associated with risk of myocardial infarction or cardiovascular disease mortality.


Interpretation

High carbohydrate intake was associated with higher risk of total mortality, whereas total fat and individual types of fat were related to lower total mortality. Total fat and types of fat were not associated with cardiovascular disease, myocardial infarction, or cardiovascular disease mortality, whereas saturated fat had an inverse association with stroke. Global dietary guidelines should be reconsidered in light of these findings.

Vince posted this study in a past post and if you read the full article you will understand that regarding carbohydrate intake it is flawed as there was no differentiation between specific types of carbs complex (starchy low g.i.) and refined carbs (simple sugars/processed carbs high g.i.) as anyone that understands nutrition would know that all carbs do not spike insulin as not only is GI (glycemic index) responsible for how a carb effects insulin but GL (glycemic load) and of course when adding protein/fats to the meal (mixed). https://www.hsph.harvard.edu/nutrit...headlines-but-the-conclusions-are-misleading/

 

[SoCal Guy]

Sorry, missed the earlier thread.

Here is Salim Yusuf, Marion W. Burke Chair in Cardiovascular Disease at McMaster University, and the lead investigator in the PURE study. Below are timestamped comments by Michael Eades.

Eades' commentary:


1:15 Carbs are bad. Shows carbs probably aren’t protective against cardiovascular disease.


1:40 Increasing fat protects us. Contrary to the advice from the AHA and other advisory groups, I would say this shows fat doesn’t hurt us.


2:48 Saturated fat is not harmful and may be beneficial. Shows saturated fats are not harmful.


3:13 No benefits to polyunsaturated fats. Can’t make the case that PUFA are beneficial despite the AHA and all the other advisory groups touting them for at least 50 years. (Based not on the PURE study, but my own study of the medical literature, I believe PUFA are seriously harmful. Especially in the large industrial doses we’ve been force fed over the past 50 years.)


3:22 Changes in oil consumption over the past 30 years. (See above parenthetical comment for my view.)


4:02 No evidence 1 percent or 2 percent milk is any more healthful than whole milk. That says it all.


5:00 Why did we go wrong? This is an important part of the presentation. Dr. Yusuf asks how we went so wrong on saturated fats. He makes the case that we went wrong because we looked at surrogate endpoints. In other words, we looked at what saturated fats do to LDL-cholesterol, which was assumed to be a risk factor for heart disease, i.e., a surrogate endpoint. It’s a lot easier to look at surrogate endpoints than real endpoints, i.e., heart disease itself. When saturated fat intake was compared to heart disease (instead of the surrogate endpoint of LDL), the PURE study found an inverse relationship. The more saturated fat eaten, the lower the rate of heart disease.


6:08 Carbohydrate intake vs ApoB/ApoA ( a sort of surrogate for triglycerides/HDL) shows carbs worsen the ratio. Doesn’t really prove anything other than carbs probably aren’t protective.


6:43 Saturated fat intake vs ApoB/ApoA shows the opposite of carb intake. Means to me that saturated fats aren’t harmful in terms of what they do to lipids.


6:54 Monounsaturated fat (MUFA) vs ApoB/ApoA shows great improvement.


7:12 PUFA are neutral in terms of ApoB/ApoA change.


In his talk, Dr. Yusuf makes the case that red meat is okay in moderation, but he doesn’t really tell us what moderation is. And, if the truth be known, I doubt he knows. But what we can derive from his results with the various fats and ApoB/ApoA is that saturated fat tends to the protective, MUFA is protective and PUFA are neutral. (Again, this kind of study can’t show causality, so I’m talking in terms of what conclusions we can draw, which are that none of these fats is harmful, and if any is protective, it would be the MUFA.) If you look at the kinds of fats in red meat, you find that beef, for example, contains about 4 percent PUFA, 46 percent saturated fat, and 50 percent MUFA. So, based on Dr. Yusuf’s data from the PURE study, he should be recommending red meat out the wazoo.


The next third of his talk is on sodium intake and makes the point that we probably need to increase the amount of sodium we're consuming. And that we should change the AHA values as to what is a healthful intake. He does make a couple of interesting points in addition.


12:34 Stop and think for a minute. Sodium is an essential nutrient. So why would we want to restrict it to next to nothing as most cardiologists would have us do.


13:02 The first line of defense against infection in the skin is sodium. Which is why the largest part of sodium in the body is stored in the subcutaneous (under the skin) fat.


13:50 Why do epidemiologists think you should lower sodium “all the way down to your boots and people will live forever?” Good question.


13:59 People have used the data from the Yanomami Indians to show that lower sodium intake means lower blood pressure. Which is true. But the Yanomami have a life expectancy of 32 years. And die overwhelmingly from infection.


14:43 Conclusions about sodium. All the recommendations are way too low.


15:30 Dr. Yusuf starts on fruits and vegetables. His study shows that a couple of servings of fruit per day is protective against heart disease, which means that a couple of servings of fruit per day probably isn’t harmful. Vegetables of all kinds have no effect one way or another, which means they’re probably neutral.


17:15 Nice rant by Dr. Yusuf. He makes the point that although his studies show vegetables to be neutral in terms of cardiovascular health, neutral is good. “If you like it, eat it.”


17:40 He starts on legumes. The PURE study does show a fairly strong protective effect for legume consumption. Which, of course, means legumes probably aren’t harmful. But you’ve got to remember that the PURE study was done across a number of countries and a vast array of socioeconomic groups and the data were pooled. Legumes are doubtless the major protein source for many of the groups studied, and since protein is an essential nutrient, it stands to reason that getting enough of it – even if from legumes only – is a good thing. In terms of a low-carb diet, the problem with legumes is that they come with too much carbohydrate. I suspect that if you’re getting enough protein from meat, legumes won’t add much to your health. Of course, that’s my speculation based on my own reasoning and not on the PURE data.


17:50 Dr. Yusuf goes into the economics of fruit and vegetable consumption across the world. I was surprised to learn that people from most low-income countries don’t eat many fruits and vegetables, because they can’t afford them. Here in the US, fruits and veggies are dirt cheap as compared to meat, so I always figured people from low-income countries would eat more fruits and vegetables than those in high-income countries. But not according to Dr. Yusuf. He didn’t really get into what they did eat. I assume it isn’t meat because that’s got to be more expensive than fruits and vegetables. I guess it’s rice and other grains.


19:30 Shows that in low-income countries, the cost of 2 servings of fruits and 3 servings of vegetables per day represents from 30 percent to 60 percent of their income. And even when they grow these foods themselves, they don’t eat them – they sell them as a cash crop.


20:15 Dr. Yusuf’s conclusions. This is where he really goes on a rant and over-interprets his data. But at least he over-interprets in a good way. If you don’t watch anything else, watch this last couple of minutes.


He starts right off saying that recommendations to restrict saturated fat have no scientific basis. Then he turns for confirmation to Nina Teicholz’s book The Big Fat Surprise, (you really need to read this book if you haven’t already; here is my review) which he says has shaken up the nutrition world. He seems stunned to have learned that the foundation for the lipid hypothesis for fifty years, the data for The Seven Country Study by Ancel Keys, had been cherry picked. Funny because low-carbers have known that for years. Note: As Dr. Zoë Harcombe pointed out to me, there is a general misunderstanding between the actual Keys study Seven Countries and his six countries graph. It is the latter that Dr. Yusuf is actually referring to when he mistakenly calls it the former. Note #2: Dr. Yusuf subsequently apologized for the error.