lundi 30 novembre 2015

Food guidelines are useless

When we are speaking about drugs we need data and look at evidence. Why is it not the case for public policies? Because we suspected drug companies to make money first and states to make guidelines for the common good.
And we are wrong on both sides.

jeudi 26 novembre 2015

In a country where electricity is mainly used to heat they invent a free electricity fridge

Dysnutrition: Fats and mortality: beginning of the end of a myth...

Dysnutrition: Fats and mortality: beginning of the end of a myth...: De Souza et al in the BMJ ( ) wrote a piece which is another stone in the backyard of government g...

Fats and mortality: beginning of the end of a myth

De Souza et al in the BMJ ( wrote a piece which is another stone in the backyard of government guidelines and conventional nutritionists who are still advising patients to eat a low fat diet to reduce their risk of CVD. In this comment we will challenge the link between saturated fats and CVD but not the issues of saturated fat replacement or trans fat.

Saturated fat consumption, scientific interest and political issues

Fat consumption  in populations is subjected to a continuous scrutiny from researchers and government agencies since the aftermath of World War 2. This is mainly the consequence of the lipid heart hypothesis formulated by Ancel Keys and never confirmed since.This scrutiny suffered all the bias of retrospective or prospective non-interventional epidemiological studies about diet and CVD:  
-Very poor quality of diet analysis and questionnaires
-No control group and a lot of confounding parameters
-Weak correlations and very low absolute risk differences
-Wide range of metabolic responses among individuals to intake of carbs / lipids / proteins
-Ignorance of  the type of fat and especially the amount of industrially produced trans fats
-Selection of countries and/ or avoidance of those with high intake of saturated fats and low CVD rates like France or Spain.
To illustrate the precedent bias let me review the selection process of the studies as shown in Figure N°1 of the paper ( From 20413 studies in the database only 41 were selected because of lack of information, low quality, and other insufficiencies. For instance from the 445 studies resulting of a process of eligibility based on the full text, 372 were excluded because
-They did not assess saturated fat exposure
-They did not measure outcomes of interest
-They duplicate data from previous publications
-They did not present a measure of associations
-They have an inappropriate study design.
There is more, the GRADE ( evidence profile of quality is very low for all the comparisons done in the selected studies (

What are the findings?

Another time I have to insist on a critical point in human observational studies about diet: mortality is crucial. As there is no experimental design but only a retrospective or prospective follow up of a cohort crude mortality is the more evident and unfalsifiable event that can be reported. Without any effect on mortality observational studies should be taken with extreme precautions for further conclusions. Figure number 2 which is displayed below illustrates very precisely how saturated fat are neutral on different risks ans d the great heterogeneity of studies on CHD and saturated fats..
De Souza RR with sat fats.jpg
What is obvious on this figure is that observational studies about saturated fats are not to be replicated. In order to assess eventually the discrete evidence of saturated fats only interventional studies of real foods in humans should be undertaken. Those future studies should also integrate a new model of diet assessment based on wireless technology and collection of data.
In this supplementary Figure one can look at an usual specific trend in observational studies on saturated fats and CVD. One can observe a  small trend in increased CHD mortality and a small beneficial trend on stroke mortality which lead to a summed neutral effect. How is it possible in such a class of disease where atheroma plays a great causal role? No clear answer could be formulated to this fact and another time only interventional high quality controlled studies should allow more detailed observations.
Recently the number of papers by nutrition specialists who doubt or challenge results of studies about saturated fats and CVD has increased because the statistical reality as assessed by meta-analysis or recalculating old data is indeed against any detrimental effect of saturated fats on cardiovascular health.
Eventually authors concluded that in this synthesis of observational evidence they found nuclear association between the hiring take of saturated fats and all-cause mortality, CHD , CHD mortality, ischemic stroke, or type 2 diabetes among apparently healthy adults.
Limitations of this paper are very well discussed and they shed a mixed light on nutritional studies especially in the past era.

Atheroma and CVD are complex issues which are not caused by fat (nor cholesterol) in your plate

For sure we are at the beginning of the end of a myth. The only surprise is the slowness of the process id est the extraordinary conservatism of the scientific community about the diet heart hypothesis. No doubt that economic interests (the low fat industry, the sugar industry and at large the agrofood industry) and the traditional reluctance to change of highly centralised bureaucracy are key explanations for exceptional lasting of this myth, but enough is enough, because those advices are not neutral but deleterious to populations which follow them and consequently do not engage in actual and efficient prevention of CVD.

Some misleading assertions on paleo diet (in french)

Carb calculations

A major drawback for usual dietary guidelines

Paleodiet in an econiche

Look at nutritional studies with rationality

Another piece on coffee

I wonder if green coffee roasted to get black coffee still contains antioxidants.
Nevertheless there are proves that caffeine is a brain stimulant but not a healthy molecule for endothelial cells.
If your coffee addict follow this simple advice:
Use gently roasted coffee beans which contain less caffeine.
Maragogype is one of my favorite.

mardi 10 novembre 2015

TG/HDL cholesterol: is it a useful ratio?

The answer is yes because TG are high in postprandial and could be atherogenic through the chylomicrons remnants.
HDL cholesterol which is measured in the blood is the cholesterol content of HDL particles which clear lipids from tissues including arteries to the liver.
So a low TG and a high HDL cholesterol is a good marker of low carb and low calories diet combined to an transporter profile of lipid particles from the periphery to the liver.
It predicts LDL particle size: and

The number of LDL particles is of paramount importance. Each LDL particles bear an Apo B100 protein. You can measure ApoB to have an idea of the number of LDL particles.

What happens with TG?
And the piece of Gary taubes:

CHO or Fat in sport?

samedi 7 novembre 2015

Jean Louis Denois en Chardonnay: l'Aude miraculeuse des vins

"Elevage sur lies pour plus de gras."
Oui et cela se sent.

Son Chardonnay est excellent car il est légèrement mais finement gras. Je déguste le 2010, qui a dit qu'on ne pouvait les conserver?

Il est très bon, un peu alcoolisé à 13,5.
Beaucoup de fruit on imagine un rendement bas...

Je vais gouter prochainement sa grande cuvée et son merlot...

Another fake study about sugar

An interesting interview of J Hibbeln: the rational approach of essential fat acids

A good example for critical appraisal of fake studies on sugar and carbs

vendredi 6 novembre 2015

No need for sugar

Tuna or seafoods

A contrarian view`

Corn and beet sugars

L'ANIA sacrifie au rituel citoyen c'est à dire à rien du tout...

  • Prenez 3 minutes et répondez à 5 questions pour participer, dire vos priorités, donner votre avis sur ce qui devrait changer.

  • de un mot et jusqu à 1 caractères maximum

  • de un mot et jusqu à 91 caractères maximum

    • la qualité, la fraîcheur
    • la composition des aliments
    • le bio
    • le goût
    • le prix
    • les labels
    • le lieu d’origine et de fabrication des aliments
    • la marque
    (Classez par ordre de priorité en faisant glisser les items. L’item en haut de liste est le plus important pour vous.)

  • A votre avis, pour que vous puissiez manger mieux, que pourraient faire :
  • Ameliorer la qualité de leurs produits et étiquetter correctement

    de un mot et jusqu à 235 caractères maximum
  • cesser de faire des cartes de fidélité qui favorisent l'achat de produits et non d'aliments (Auchan)

    de un mot et jusqu à 200 caractères maximum
  • cesser de taxer pour soi disant changer les comportements
  • s'assurer que l'étiquettage est sincère (acides gras trans, sucre...)
  • contrôler la conformité des ingrédients

  • de un mot et jusqu à 179 caractères maximum
  • Choisir, choisir et encore choisir des aliments avant des produits...

    de un mot et jusqu à 231 caractères maximum

Communication, PR and IARC about the recent advice on meat
After the suprising Lancet Oncology abstract without the substance, here is a .pdf which is another PR piece of the puzzle. And all of that for a bunch of foods very different from each other that we call processed meatS...
Indeed there is no such food as a processed meat, there are millions of processed meatS.
look at this:

You can easily understand that any conclusion is about processed meatS is completely impossible due to the complexity and number of processes.
This survey although biased by a question is sufficiently clear: physicians are not sheeps.
The question for those who will not change anything is biased.
1/ they will either do that way because they did since a long time advice their patients about the potential risk of processed meatS cooked above the flame OR because they don't believe at all the IARC analysis of the past literature.
2/ a better question would have take in account this ambivalence.
3/ any advice in medicine which is not personalized is waste of time and money. If your patient eats less than 50g/d of processed meatS why focusing his or her energy on this topic? Less than 18% of RR is nothing and this patient should have other goals for a better health.

Current Survey      Past Surveys »

Time to Take Hot Dogs Off the Grill?
The World Health Organization's cancer agency has classified processed meat as carcinogenic to humans.
Will you:
Change youradvice topatients aboutmeatconsumptionChange yourown eatingbehaviorBothNeither9.4%46.4%38.6%
Change your advice to patients about meat consumption75
Change your own eating behavior125
MedPage Today® surveys are polls of those who choose to participate and are, therefore, not valid statistical samples, but rather a snapshot of what your colleagues are thinking

jeudi 5 novembre 2015

Fat sugar and exercise

Food questionnaires are fake science: let us look at spoons

All is for water
tea spoon UK = 3,5516328125 g no more no less
tea spoon US = 4,92892161458 g more precise
coffee spoon Fr = 5 g

You understand why I am not going through the details of the different cups bowls and other subtle differences of our culinary ware...

But I don't resist to quote the WHO:
 A new WHO guideline recommends adults and children reduce their daily intake of free sugars to less than 10% of their total energy intake. A further reduction to below 5% or roughly 25 grams (6 teaspoons) per day would provide additional health benefits."
We are in a mess.

From 1965 to 2011: Less fat, more calories from carbs and a higher BMI

Wheat: science is not believing

Childhood obesity

mercredi 4 novembre 2015

Saturated Fat and Heart Disease

1/ There is no reduction of CHD with low fat diets it's a myth. The problem is that this myth was endorsed all over the planet because "american researchers had proved it"...
2/ When LF diets are not compensated by an increase in CH, LF diet is a low caloric diet and consequently it does produce a reduction in CHD because weight does not increase nor waist and insulin too.
3/ When LF diet is compensated by a high refined CH diet it is worse because this diet produce by transformation in the liver small dense LDL particles which are more atherogenic than large buoyant ones.
4/ Statins do have pleiotropic effects. They lower LDL cholesterol which means that statins reduce the number of LDL particles which are circulating in the blood. If these particles are atherogenic (small dense LDL and VLDL) statins will reduce LDL accumulation in plaques and consequently the rate of coronary or cerebral ischemic events. But statins are also anti-inflammatory drugs which means that statins reduce humoral and cellular response to oxidized lipids in the plaque. This could reduce the rate of plaque rupture and ischemic events.
So the main goal of a preventative program about cardiovascular diseases is to stop smoking. Then increase physical activity on a daily basis id est stop sitting and then decrease the amount of calorie especially CH, especially refined CH and suppress or slash added sugars. 
It is not a new fancy program it is the state of the art of human nutrition. But it is very difficult to move on agencies, governments physicians and people...

Le plus grand hoax concernant l'alimentation est lié à l'incroyable stupidité des slogans officiels

Chaque jour on peut se rendre compte de l'inefficacité des slogans officiels concernant l'alimentation.
Faire trois repas par jour toute sa vie la jamais été évalué.
Manger équilibré n'a aucun sens.
Manger X fruits et légumes par jour est une standardisation inadaptée aux besoins et aux individus.
Eviter les aliments gras salés sucrés.
Ce dernier slogan est probablement le plus confus. Que signifie éviter ? Que signifie aliments ? On comprend bien que s'il s'agit de produits industriels gras et que ce gras est représentée par des graisses partiellement hydrogénées ce n'est plus éviter qu'il faut c'est ne jamais à manger. En revanche un morceau de jambon cru bardé de 2 cm de graisse n'est pas à éviter, c'est un excellent aliment.
Il est impossible en suivant ces slogans d'avoir une alimentation adaptée. C'est-à-dire une alimentation faite d'aliments entiers peu transformés ingérés de manière modérée.

Example of non sense experimental protocols in the debate about fat and sugar

These two papers show that experimental protocols are of paramount importance in studies about the differential effect of fat and sugar.
Instead of comparing high-fat versus hi carbohydrate diet they indeed compared high fat diet with normal carb diet vs low-fat high carb diet.
The result is that insulin is higher in the so-called high fat diet because carb are not restricted.
All the interpretations are are irrelevant because they don't try a high fat low carb diet.

I observed that on a lot of patients

Cheeses and atheroma

Too much medicine too few whole foods

Don't fear fats in food

More on meat