I assume you don't agree that the cholesterol hypothesis is "wrong," since you recommend reducing LDL to 60.

Fat Head has been in the back of my mind for awhile, but you've reminded to to go ahead and order it.  I think it will be great to pass on to friends curious about paleo/low-carb without having their eyes glaze over.  Very jealous of the cruise -- gotta get on it next year.

Most of the people in extreme high carb cultures are Asians before their food started getting westernized.  And they had very low rates of heart disease, diabetes, and obesity  It's a population of billions, not a study of small group.  

If carbs are bad for me(and I am more and more thinking they are bad for me) why weren't they bad for them?

I'm not arguing for any particular diet, I'm trying to figure out what to have for dinner.

Most folks who bash Ancel Keys haven't actually opened any of his books.  They would be surprised to discover he advocated eating organ meats, wild fish and game, and real food.  One of his books has a chapter on choosing the proper wines for dinner.  He was a fan of espresso coffee about 30 years before we all started going to Starbucks.  His dietary advice was not ultra "low-fat" a la Ornish.  In fact, he mainly recommended substituting unsaturated fats for saturated, which is advice you hear from many contemporary sources, including the first "Paleo" proponents like Lorne Cordain.  It's advice that has appeared from time to time on this very blog!

Keys undoubtedly got a few things wrong.  All scientists and researchers do.  Their mistakes are corrected by those who follow.  That's the way science works.  To blame him for the obesity crisis, or for the "low-fat" marketing strategy that Food Inc concocted in the 80s and 90s, is silly.  As for the lipid theory itself, the naysayers have their own sorting out to do. Some say it's all bunk, others want to keep bits and pieces of it.   When the science behind one of these camps becomes overwhelming, their view will prevail. This takes a while.  Nutrition is an extremely complex subject!

As for Keys, he lived to be 100 following the Mediterranean diet he advocated for others.  His wife and co-researcher Margaret died at 97. Call that anecdotal evidence if you want.  I call it having the last laugh your critics.

I like this trend of documentaries making it to the cinema, beats the butchered remakes of classic films, and the pomp of it attracts a wider audience.
Michael Moore seems to have started kick-started it all.

Hi, Steve--

Not knowing what to expect when Jimmy Moore invited me to join his cruise, I didn't tell everyone about it.

However, now having had the experience, I can recommend it wholeheartedly to anyone desiring a fun informative experience for the low-carbohydrate eating viewpoint. Jimmy seems to have a talent for appealing to speakers who come from a diverse panel of perspectives, all who contribute something unique to the low-carb conversation.

Too much hype for me, I'm afraid ...
and the "humor" wears thin pretty quickly. The message is obscurred by
this guy trying too hard to be folksy.

What ever happened to the "Keep It
Simple Stupid" approach to things.

"Most of the people in extreme high carb cultures are Asians before their food started getting westernized. And they had very low rates of heart disease, diabetes, and obesity It's a population of billions, not a study of small group.

If carbs are bad for me(and I am more and more thinking they are bad for me) why weren't they bad for them?"

I lived more than a decade in Korea and China and made several visits to Japan and Southeast Asia.  The only high-carb food on the table is a bowl of rice or noodles.  The other dishes contain non-starch veggies, legumes, and some animal protein.  The liquid on the table is water or unsweetened tea.  Traditionally Asians don't snack between meals and rarely eat sweets although young people are picking up these habits and it shows.  Fruit is expensive, consumed only in season.  The SAD probably contains more easily digested carbs than traditional Asian diets.  

True obesity is rare, but type II diabetes is not, and neither are cardiovascular diseases.  Americans are much more likely to get heart attacks while Asians are more likely to have strokes.

Peter,

You'd have to travel to Asian countries to fully understand what their diet is all about. It's not what you think. The BIGGEST problem is that we eat way too much of carbs.

I just saw documentaries of North Korea and pretty much every single person is skinny. Only the "president" of NK looked to be overweight.

What else... oh yeah, Asian people tend to eat rice, not wheat/corn starch/fructose. Probably not as much rice as you'd think. American people consume unbelievable amount of wheat/cornstarch/fructose. They are everywhere in USA. 95% of food at stores are from them...

Ancel Keys dazzled me as well when I actually took the time to review his work.  Reading his 1385 page The Biology of Human Starvation was quite an enlightening experience, and highlighted the integrity of Keys as a laboratory scientist.  Sure, he rushed to conclusions with the lipid hypothesis, but can you blame him?  I'm sure it seemed obvious and irrefutable at the time that he noticed cholesterol in the arteries of heart attack victims while noticing that fat tended to raise cholesterol levels.

But it wasn't any more flawed than blaming carbohydrates for all of mankind's problems either, as the biggest carb-eaters on earth remain the healthiest and longest-lived peoples, and high-carb/low-fat diets continue to drop fasting insulin and glucose levels in clinical study.    

And Keys lived the good life until the ripe age of 100. It's unlikely that any low-carb author/blogger will live more quality years than Keys.

There were several things I liked about the Fathead documentary. It pointed out the weaknesses of Supersize Me, it outlined many of the problems of the lipid hypothesis, it presented a clear explanation of why low-carb can be effective for both weight loss and cardiovascular health.

Things I didn't like? Fathead had a clear agenda - to promote Libertarian politics and ways of thinking. As such, Naughton was obligated to place primary blame for all problems on government. Sure, government has a role to play. But if the scientific community had it's act together, government would follow. If we talk about other public health issues (smallpox, tuberculosis, goiter), then we must acknowledge that government can do things right sometimes.  

Also, there was a disconnect between the 'common sense' of the people and the scientific explanation that was offered. Sure, people know that fast food meal has more calories than a carrot. So what?  If people have that common sense, why is obesity, diabetes, and heart disease so prevalent? I don't think he really answers that. Does common sense tell people that a large plate of pasta is equivalent to eating a cup or two of sugar? Does 'common sense' also tell them that saturated fat is bad, or that to lose weight, they simply need to eat less and exercise more?

@ Peter
The answer to the puzzle as to why Asians had very low rates of heart disease, diabetes, and obesity may lie partly in the fact that
Curcumin is a novel nutritionally derived ligand of the vitamin D receptor
So the vitamin D status of Asians may have been assisted to some extent by the use of TURMERIC in their diets.
As urban pollution blocks the penetration of UVB to ground level while hard surfaces reflect the Vitamin D degrading UVA spectrum the urbanization of Asian populations combined with the westernization of their diets has exacerbated the decline in 25(OH)D levels.

This may be a simplification for why Asians may have less heart disease, but it simply could be because of the use of red yeast rice in many of their foods?

Curcumin is a component of turmeric.  Koreans and Japanese don't consume it, except in fast-food type curry dishes.  Most of China's major cuisines do not use the spice either.  It is South and Southeast Asians who use it, and Indians have notoriously high rates of heart disease and diabetes.

As for North Korea, the semi-starving country dependent on foreign aid isn't exactly representative of Asia.  Prosperous neighbors Japan and South Korea have the lowest obesity rates in the OECD.

Very fascinating info on raising Vitamin D status and CAD below. People who had their 25(OH)D up to 30 ng/ml from 19 ng/ml got the benefits and in the other study 43 ng/ml level seemed optimal yet extra benefits were not seen in, say, 60 gn/ml:

http://www.webmd.com/heart-disease/news/20100315/vitamin-d-supplements-lower-heart-disease-risk?src=RSS_PUBLIC

There was, perhaps, a misunderstanding on Ted's part. We're from England where we term Asian as Indian, Pakistani or Bangladeshi and call the Japanese, Chinese and Koreans individually.

The core reason of increased heart disease in South Asians probably is partly vitamin D deficiency caused by a conservative dress sense in a sunny climate. India also has a lot of air pollution.

Many Asian foods (and I mean all of Asia now) use similar ingredients; in fact one Japanese dessert looks and tastes exactly like a Indian/Pakistani one (how that came to be - I don't know). South Asians though eat chapattis (wheat) quite commonly, and from what I gather there isn't a large wheat consumption in East Asians.

Yes, as Anonymous above mentions, Naughton's political ideology  
distorts his views. That actually seems more important to him than the issue of diet in Fat Head, which is why he expends so much effort defending Fast Food companies. Witness the part where he holds a huge bucket of French fries
(think about how many carbs are in that!) and rants something to the effect of:
"If they want to sell me a huge bucket of fries for 50 cents, and I want to buy it, it's no one's business to tell
us we shouldn't."
I'd imagine most readers of this blog are interested in diet and health, not political ideology, so overall Fat Head will probably not appeal to them.

"I'd imagine most readers of this blog are interested in diet and health, not political ideology" ~ Anonymous above

I used to be uninterested in anything political until I got interested in diet and health care.  The idea that a nanny government could dictate what I can and cannot eat is quite frightening, especially when you consider what the establishment thinks is healthy.  I personally do not want to eat french fries but if we don't object to the government making french fries illegal, who is going to stop the government from banning "artery clogging" coconut oil or outlawing meat?

>> who is going to stop the government from banning "artery clogging" coconut oil or outlawing meat?

Yeah, that is the paranoia talking. After 40+ years of research showing the dangers of smoking, tobacco is still legal. Government is not going to outlaw meat, and I question the good judgment of anyone who suggests that they might.

I lived more than a decade in Korea and China and made several visits to Japan and Southeast Asia. The only high-carb food on the table is a bowl of rice or noodles. The other dishes contain non-starch veggies, legumes, and some animal protein. The liquid on the table is water or unsweetened tea. Traditionally Asians don't snack between meals and rarely eat sweets although young people are picking up these habits and it shows. Fruit is expensive, consumed only in season. The SAD probably contains more easily digested carbs than traditional Asian diets.

I lean heavily toward low carb/paleo and think the "conventional wisdom" is full of holes, but I don't think "Fat Head" does a good job (at all) of advancing the argument to the uninitiated.

The attack on Morgan Spurlock is misguided, and Naughton's counter-experiment proves nothing.  Spurlock went on an extreme binge which everyone, including Spurlock, expected in advance to cause weight gain and other negative effects ("duh"), which he wanted to document on film.  It was more of an exercise in "performance art" than in science, and meant to simply to provoke the viewer into the thinking a bit about the possible consequences of regularly ingesting the same kind of food over a lifetime.

Naughton, on the other hand, takes in an actual caloric deficit, with restricted carbs, and regular exercise, and then experiences a weight loss.  How does Naughton's experiment in any way "rebut" Spurlock's?  And, given the fact that Naughton goes on to argue that restricting carbs is more important than lowering calorie intake, his own experiment is useless to prove either strategy, since he cut intake of both calories AND carbs.

The film is poorly organized and produced, and is undermined at every turn by the injection of sophomoric humor.  In a typically tedious sequence, the snarky Naughton asks people on the street if they have ever collapsed with a heart attack immediately after eating fettuccine alfredo.  Tres dumb.  Especially when you consider that a plate-full of pasta smothered in cream, butter, and cheese is a food that both low carb and low fat eaters would want to avoid eating often.  In one of his failed attempts at humor (in a scene showing his own wife in bed), she asks if he is a moron, and in that moment she seems to speak on behalf of the viewer.

Worst of all is the ongoing anti-government Libertarian ideology that underscores Naughton's narrative.  He argues that anyone "with a functioning brain" can make proper food choices, but at the same time argues that the public has been deluged with mountains of false information and bad advice for decades.  The film is littered with such logical inconsistencies.  Naughton's gratuitous political agenda shows up in some bizarre assertions, like when he argues that higher tendency toward obesity among the poor is merely the result of a predisposition among non-whites toward "thicker" bodies, and the assertion that court-mandated busing to achieve racial desegregation contributed to overweight school children.  These theories simply detract from the credibility of the diet and health science he eventually discusses.  Naughton is entitled to whatever political views he wishes, but injecting them into a documentary about nutrition and health does nothing to advance an essentially purely scientific subject.

At his blog and in interviews like the one above, Naughton comes off considerably better than in the amateurish film that he actually made.  If you know anyone "with a functioning brain" that is still clinging to the conventional wisdom that you'd like to convert, showing them "Fat Head" may not be the best way to get them to become more open-minded, thanks to the many mis-guided and unhelpful aspects of the film.

But they are trying to shut down raw milk, continue to protect Monsanto and not include GMO in nutrition labeling, and continue to put up barriers and regulations that effectively hurt small local and sustainable food producers.  The result is that soon all food will be GMO/CAFO!

Hmmn - reminds me of a book I read called "Coronary: A True Story of Medicine Gone Awry," recommended by you, Dr. Davis.  Unnecessary procedures for profits.

It's a scary world out there in medical land.

The local heart hospital has a "Heartsaver CT" http://www.heartsaverct.com/index.aspx?CORE_ElementID=HSCT_AHH_Home

Is this the same as the CT Heart Scan?

I saw another car Bill had worked on this month.  My father and I have an auto hobby shop were we'll bang away on making our own hot rod cars and from time to time a friend or friend of a friend in this case will ask to bring a car by for inspection.  The guy has been having many problems with his hot rod and for repairs had been taking it to Bill's place.  I had an idea of what to expect.  Sure enough Bill had done it again.  Bill's scam is that he will splice a weaker gage wire into a hidden unseen area.  The weak gage can not handle the power load for long and once the wire melts and the part stops working, he explains that the engine part broke, new parts need to be ordered and of course that intales hours of labor costs.  
    

After reading this blog it reminded me of scammer auto shops.  Hospitals have their scams too.    I wish I could walk into a doctor’s office and expect that only the best, least expensive, treatment will be offered me - but I now know that isn't the case.  I can't be lazy.  I need to educate myself in the basics of medical care to ensure I receive the best treatment for me.  Thanks for being a good teacher Dr. Davis.

Yes, it looks like it is the real thing, a simple heart scan, judging from their comment that "There are no needles, no dyes, no injections and no exercise." CT angiograms require needles, dye, and injections.

The CT angiogram makers are generating lots of reports on how great their machines are.

http://www.theheart.org/viewArticle.do?primaryKey=830205&nl_id=tho28nov07

They certainly are. Big bucks, big marketing.

I do believe, in all honesty, that the new devices really represent great advances in diagnostic imaging. It's their mis-use and over-use that I object to. Of course, the manufacturers keep their lips closed about it because overuse drives more sales.

Hi Dr. Davis,

I've learned from reading your blog that typically 20% of TOTAL PLAQUE is calcified or "hard". Is that a steadfast rule - or is that an average? What if someone has a calcium score of zero (or close to it)? Can it be assume that that person also has very little in the way of "soft" plaque?

Thanks!

Paul

Speaking generally, people with zero heart scan scores have heart attack rates of near zero (if asymptomatic).

The likelihood of detecting pure "soft" plaque in someone without symptoms and a zero heart scan score is <5%. It does happen, particularly when certain severe risks for heart disease are present (e.g., very high LDL/small LDL). It is exceptional, however.

Since I can't afford the current local price of a 64 slice CT scan ($1100), I've decided to get a lipoprotein breakdown to determine my risk.   I can use your "treatment" protocol of supplements to try and achieve the 60-60-60 values when I see the results.   Is this a good plan?

Hi, Noreen--

I'm afraid that you may regret not getting the scan a few years from now. After you've successfully corrected lipoproteins, you may want to know if you've also successfully controlled plaque growth, the MORE IMPORTANT parameter.

Have you thought about looking elsewhere for a scan? In Milwaukee, for instance, scans can be obtained for as little as $79. (Though the low-priced scans also come with a sales pitch for CT coronary angiography. Just say "no thanks.")

I am 72 and pretty healthy.
This year I have been seeing a cardio because of some nocturnal palpitations. He has subjected me to a series of tests-sleep-ultrasound-both negative, and a nuclear stress test which gave a hint of possible blockage. He recommended either an angiography or a CTA scan. I chose the latter, and was rated "normal".
I asked if this meant normal for my age. He said "no, normal for any age, I couldn' find any trace of hard or soft plaque". Yes he is part of a large group.

My father died of a second heart attack at 76.
I have taken vitamin D, fish oil, magnesium, pantethine, flaxseed, co-Q10, lutein, olive oil, for some years.
I am trying hard not to feel smug, but should I feel safe?
We are still working on the nocturnal palpitations which seem to be dependent on sleep position.
I have bradycardia, and no other obvious health 'problems'.

With regard to the 20% value for calcified plaque, if you look at figure 1 from Rumberger’s classic 1995 paper (Circulation. 1995;92:2157-2162.), it shows the plaque area and calcium areas for each of 13 hearts that were examined on autopsy. If you take the points in this graph and determine the areas for each heart, the data shows that the calcium area and calcium percentage increases with plaque area. Unfortunately the paper doesn’t say what the calcium scores were for each heart, only the calcium areas and total plaque areas. However, over the range of plaque areas of the 13 hearts, the percentage of calcium in plaque increased from 0% to 14% for the 9 hearts with with plaque areas less than 150 square mm to 14% to 28% for the hearts with the plaque areas greater than 230 square mm. So from that we can conclude that the 20% value is an average, and that the calcium percentage increases as more and more plaque accumulates.

Harry35

Sehr interessant!