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
www.davidkatzmd.com