AerobicsMainstream medicine’s latest multimillion dollar effort to prove the effectiveness of the low-calorie, low-fat diet once again blew up in their collective faces, but that’s not what this post is about. This post is about how mainstream medicine deals with data it doesn’t like. How instead of presenting the data for what it is, mainstream medicine tries desperately to sweep its failures under the rug.
Despite not showing what their authors want them to show, the important point about these ‘failed’ studies is that they move science forward. They sometimes nullify dearly held theories, which is exactly what scientists are supposed to want to do.
Sadly, all too often, scientists (who should know better) fall in love with an hypothesis and set up an experiment to confirm it instead of trying to falsify it. Then when their machinations fail and the experiment is a bust, they try to put a good face on and make like the experiment really showed what they wanted it to show all along.
Just as there is no doubt a bias in the mainstream news media, sad to say, there is also a bias in the mainstream medical scientific media.
Most academic nutritional researchers hold two progressions near and dear to their hearts.
Eating saturated fat —> elevated cholesterol —> heart disease.
Exercise plus cutting calories and fat —> weight loss —> a longer, healthier life
The first of those progressions is known as the lipid hypothesis; the second is the eat less, move more hypothesis.
If any part of one of the above equations breaks down, then the whole thing falls apart. So God forbid that anyone should make the case that any segment of the above pathways doesn’t hold up to scrutiny. Should that happen, the infidel needs to be prepared to pay the price.
How do these infidels pay the price? Usually by having their data and/or their conclusions attacked in the very same journal in which their study was published.
Typically, when important studies are published, the editors of the publishing journal recruit someone in the field to write an editorial about the study. Depending upon what the study in question showed and the bias of the particular journal, the editorial can be positive or negative. Unfortunately, more researchers/doctors read the editorial than read the actual paper. So, more often than not, the editorial is what spreads the word. If the study has an outcome that flies in the face of the editorial writer’s bias, you can bet that the editorial will be a denunciation. Or sometimes, the editorial will even make it seem as if the paper showed a different outcome than it really did.
Let’s look at an example.
A couple of years ago, Ron Krauss, as mainstream a researcher as you could find and holder of all sorts of academic credentials, started thinking that maybe saturated fat wasn’t the demon everyone thought it was. He dug up all the studies he could find looking at whether or not saturated fat actually did cause heart disease. He put all these studies together in a meta-analysis, and got it published in the prestigious American Journal of Clinical Nutrition (AJCN). The article, titled Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease, came to the following conclusion:

there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD. More data are needed to elucidate whether CVD risks are likely to be influenced by the specific nutrients used to replace saturated fat.

And, as if to rub salt in the wounds of the lipid hypothesis folks, Krauss published another paper in the same issue of the same journal looking at a nutrient that often replaces saturated fat.
This second paper, titled Saturated fat, carbohydrate, and cardiovascular disease, concluded

there are few epidemiologic or clinical trial data to support a benefit of replacing saturated fat with carbohydrate. Furthermore, particularly given the differential effects of dietary saturated fats and carbohydrates on concentrations of larger and smaller LDL particles, respectively, dietary efforts to improve the increasing burden of CVD risk associated with atherogenic dyslipidemia should primarily emphasize the limitation of refined carbohydrate intakes and a reduction in excess adiposity.

As you might imagine, the mainstream lot didn’t take this lying down.
The very first article in this issue of AJCN is an editorial by Jeremiah Stammler, a low-fatter of the deepest dye and one of the scientists who worked in Ancel Keys’ lab throughout his years of fighting to establish the lipid hypothesis. The Stammler piece, Diet-heart: a problematic revisit, is the editorial equivalent of foaming at the mouth. Here’s a sample so you can see what I mean.

Coupled with the statement in the Abstract and Conclusions in the meta-analysis (2), ‘‘there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD,’’ the authors seem to be dissociating themselves from prevailing national and international dietary recommendations to the general population for primordial, primary, and secondary prevention of CHD/CVD and the established major metabolic risk factors. But they are not explicit. Is that their intent? Specifically, do they disagree with the merits of heart-healthy fare on the basis of DASH-, OmniHeart-, Mediterranean-, East Asian–type eating patterns, which emphasize vegetables, fruit, whole grains, legumes/seeds/nuts, fat-free/ low-fat dairy products, fish/shellfish, lean poultry, egg whites, seed oils in moderation, alcohol (if desired) in moderation, and portion size/calorie controlled and deemphasize red and processed meats, cheeses, ice cream, egg yolks, cookies/pastries/ pies/cakes/other sweets/sweetened beverages, snacks, and salt/ commercial foods with added salt. Estimated nutrient composition of this fare is as follows: total fat ’20–25% of kcal, SFA 6– 7%, MUFA 7–9%, PUFA 7–9%, cholesterol ,100 mg/1000 kcal, total protein 18–25%, vegetable protein 9–12%, carbohydrate 55–60% (mostly complex), fiber 30–35 g/d, 50–65 mmol Na/d (2900–3770 mg NaCl/d), mineral/vitamin intake high (6). A vast array of concordant multidisciplinary research evidence is the sound foundation for these recommendations.

See what I mean? And it goes on and on in this same vein. As in, the data be damned. How can these guys have the temerity to go against all these recommendations we’ve spent years coming up with?
The average doc picking up this copy of the AJCN might take a look at this editorial first and then may not even bother reading the actual studies.
Unfortunately, this happens all too often.
The Stammler editorial is the attack kind of editorial. But as I mentioned before, there is another kind. One even more treacherous, because it pretends the study says something it doesn’t. People don’t recognize the editorial as a polemic, so don’t get their critical faculties involved and often accept it at face value.
Recently the New England Journal of Medicine published the results of the Look AHEAD study in an article that pretty much put paid to the ‘low-calorie, low-fat diet along with exercise’ as the optimal therapeutic modality for diabetics. (Several years back the Women’s Health Initiative did the same thing for women without diabetes – but that study seems to have been forgotten by the mainstream crowd.)
Here is the set up. The study, published as Cardiovascular Effects of Intensive Lifestyle Intervention in Type 2 Diabetes, randomized 5145 obese, diabetic subjects into two groups, one of which underwent intensive lifestyle modification with all kinds of hands-on care, up to and including adding weight loss drugs if the lifestyle modification didn’t work. The other group, the control group, had a few educational sessions about diabetes.
The lifestyle intervention group was encouraged to commit to 25 minutes of moderate intensity exercise daily and to follow a low-calorie, low-fat, low-saturated fat diet. If interested, you can read the entire Look AHEAD protocol (click the link and go to study protocol) to see for yourself the extent to which the researchers went to make this study work. And as I mentioned above, going to the extreme of giving the interventional subjects weight-loss drugs if the diet and exercise didn’t work.
The study was designed to run 11.5 years with the following conditions being end points:
Death from cardiovascular causes
Nonfatal myocardial infarction (heart attack)
Nonfatal stroke
The study authors felt strongly that within the 11.5 years enough subjects would suffer one of the above endpoints to show a statistically significant difference between the lifestyle intervention group and the control group. Their hope, of course, was that the intervention group would live on while the control group died like flies, proving the efficacy of the eat-less, move-more philosophy so near and dear to their mainstream hearts.
It didn’t quite work out that way.
As the years dragged on and the control subjects refused to die or suffer any of the other endpoints at greater rates than the intervention group, the researchers decided to change the stakes.
They increased the length of the study to 13.5 years, figuring, I suppose, if we let it run on long enough, the damn controls should finally start kicking off. And to goose it even a little more, they added another endpoint: hospitalization for angina (chest pain of cardiac origin).
At the 9.6 year mark, the endpoints reached in the control group were not statistically different from those in the lifestyle intervention group. The study was stopped on the basis of a futility analysis. In other words, the writing was on the wall. There was not going to be a major difference between the two groups, so why continue spending money in a futile effort.
The abstract of the study pretty much says it all.
The intervention group lost more weight, which is pretty much proof they adhered to their diets (or took their weight loss drugs). And

the intensive lifestyle intervention also produced greater reductions in glycated hemoglobin and greater initial improvements in fitness and all cardiovascular risk factors, except for low-density-lipoprotein cholesterol levels.

Which is interesting, because it also shows they stuck with their exercise regimens and their diet. The decreased LDL is the give away. LDL levels always go down on low-fat diets. (But as readers of this blog know, that’s far from the whole story.)
So, subjects who followed the low-fat, low-calorie diet and exercised at moderate intensity for 175 minutes per week did as hoped. They lost a little weight and improved some fitness parameters, but they didn’t avoid the serious outcomes any better than the couch potatoes did.
Remember the hypothesis from earlier:
Exercise plus cutting calories and fat —> weight loss —> a longer, healthier life
The eat less, move more therapy brought about weight loss but no difference in ultimate outcome. So
Exercise plus cutting calories and fat —> weight loss -X-> a longer, healthier life
What we can say from this study is that diabetics, who are on an accelerated aging trajectory, did lose weight on a low-fat, high-carb, low-calorie diet and moderate intensity exercise program. But they did not live longer, healthier lives.
We can’t say what would have happened had these subjects been on low-carb diets because those diets weren’t studied. As you might imagine, I have my own ideas, but the results aren’t known because that study wasn’t done.
In large long-term studies such as this one, it’s common for researchers to carve out certain subgroups within the greater group of study subjects and look at other outcomes. Which they did in this case and found that some of the subjects in the intensive lifestyle intervention improved in some of these other outcomes as compared to their control counterparts. But, the group as a whole didn’t die at lower rates or have any fewer serious problems.
The Look AHEAD study was an expensive, high-profile undertaking involving 216 centers all over the United States. It was a flop. So, you would expect an accompanying editorial to such a study, and you wouldn’t be disappointed.
The editorial, Do Lifestyle Changes Reduce Serious Outcomes in Diabetics?, appeared in the same issue of the NEJM.
The simple (and correct) answer to the question the title asks is no.
But the author doesn’t see it that way. He ends the editorial on a high note, pretending that the study kicked tail. He tells doctors that the results of the study empower them to go out and recommend these same lifestyle modifications to all their diabetic patients.
Don’t believe me?
Here is concluding paragraph:

Clinicians can now use the results of the Look AHEAD study, as well as the group’s previously published findings, to inform their care of patients with diabetes. They can clearly assert that changes in activity and diet safely reduce weight, reduce the need for and cost of medications, reduce the rate of sleep apnea, improve well-being, and (in some cases) achieve a diabetes remission. With respect to cardiovascular outcomes, inspection of the confidence intervals should allow clinicians to reassure their patients that intensive lifestyle interventions are unlikely to cause harm (i.e., the upper limit of the hazard ratio for the primary outcome was 1.09) and may provide a modest benefit. However, even with no clear evidence of cardiovascular benefit, the Look AHEAD investigators have shown that attention to activity and diet can safely reduce the burden of diabetes and have reaffirmed the importance of lifestyle approaches as one of the foundations of modern diabetes care.

And have reaffirmed the importance of lifestyle approaches as one of the foundations of modern diabetes care?!?!
Jesus wept.
Remember, doctors are busy, and they often just skim the actual studies and read the editorials instead. I’ll leave it to you to draw your conclusions as to the message a busy physician would take away from this editorial.

Photo source


  1. Interesting article. Um, I’ve been doing low carb as a mostly very sedentary individual (writing software, sitting behind a computer). I do get up every hour or so, but almost no exercise. Low carb by itself hasn’t done much for me, and I guess you’ll have to believe me when I say I eat < 20g carbs every day. In fact, I think I've gained weight and yet I am also sure that my total caloric intake (as logged at my fitness) is about 1800 calores (50ish year old male.)
    I've added walking 1 – 2 1/2 miles daily (1 mile one day (20 min), 2 1/2 miles the next (60 min)), in part just because I feel I should move around more.
    Still not sure what I need to do. It would be difficult to take in fewer carbs, and when I reduce the calories I do get hungry, sometimes very hungry.
    All that said the real reason I am entering this comment is to suggest you increase the font size on your web page. Most designers agree that the default fonts are way too small for optimal easy reading by most age groups (and yeah, I do have over 50 eyes.) In Chrome, when I enlarge your site to 125%, it is much easier to read, and I think actually looks better.

    1. Thanks for the advice on font size. I hate the small font size myself. I’m working on changing our website and redoing the blog, and one of my changes will be the font size. I’m working with a custom design right now, and with my own limited technical abilities, I don’t know how to increase the font size on the design I have. Any suggestions will be appreciated.

      1. I just do [ctrl+plus sign]. It’s not a big deal for me, though I’d love to see it larger for the sake of holding more readers. Great post! You make the world a better place. Thank you!

      2. I’ve been on LCHF for 2 years now. Lost a lot of weight initially. I’ve now reached a plateau. I am a moderate exerciser but maybe i’m eating too much protein. What kind of fats should I replace protein with?

          1. So you’re saying not avocados, nuts and coconut oil, but fatty meat and chicken skin?

          2. Coconut oil is a saturated fat. Avocados and nuts are fine. What I was talking about avoiding is pure vegetables oils, i.e., Wesson oil and other corn oils, soybean oils, etc.

    2. Jay – you left a few things out of your low-carb concern/complaint to properly diagnose.
      – How long have you been doing it?
      – How do you know it’s only 20g carbs? Are you eating fruit too? Artificial sweetener? What are you eating exactly?
      – Are you getting enough fat?
      – Are you eating too much protein?
      If done properly, you will rarely be “hungry,” as eating almost becomes an afterthought. That walking you’ve added seems negligible really. Get a dog?

      1. Perry, I caught that right away too. He needs more fat; eat fat first, then have modest amount of carb (1/2 cup of cooked green, 2 cups raw greens (not packed down), 1/2 cup of starchier items). I’m into my fourth year on Protein Power, doing well, feeling great, will continue this as long as life lasts. I’m NEVER hungry, if I eat fat, restrict carbs, my weight doesn’t fluctuate though exercise isn’t my priority.

        1. Hi guys. With regard to Jay’s issues, and someone please correct me if I’m wrong, isn’t it true that there is a small percentage of individuals who do not lose weight on low carb? I believe Atkins recognized this in his book and I think I’ve seen it mentioned other places. But good advice from both Perry and SueQ. Jay, don’t give up!

    3. Jay:
      I agree on the font size (though I changed my computer settings so everything looks bigger).
      I think most people reading your comment will not believe you are eating < 20g carbs and lost no weight or gained. Are you eating enough fat? (as opposed to all protein). You don't say how much you think you have to lose, but interval training and weight training/body weight exercise could be the ticket.

      1. Losing body fat by keeping carbs low and fat high, protein modest, may cause muscle-building, which could cause scale weight to remain higher than desired. Abandon worry about scale; is body trimmer? Are clothes looser? Can muscle be felt beneath skin? Then no worries about scale weight, be happy.

      2. Some folks don’t lose, even on very low carbs, various fat/protein levels for numerous biochemical reasons. I’m one of those. I’ve been at this for 15 years, weighed my food, documented every bite manipulated fat/protein/carb levels and though I can eat 1200 calories on low carb to maintain weight vs. 800 on lfhc, losing is very hard unless I drop below it. I was very slim when I started low carbing and I’m heavier now, at much lower carb levels.
        There are so many hormones that determine how one uses calories or not, how much fat is stored and where. High cortisol, either from chronic stress, medications (even antibiotics) or HPA axis dysfunction, thyroid, and ghrelin, leptin resistance, or combinations of all the above.
        Eating more than 50% fat never works for me, it just made me gain; I know other have a very different result. I need more, not less protein to avoid gaining: the insulin response it evokes helps to control adrenal steroid levels and if I don’t get a high amount of protein, vs fat, I get intensely hungry, craving it.
        One size does not fit all and that includes low carbers. Everyone is better off without dietary starches and sugars, IMO, but not everyone is better off with very high fat or restricting protein.

    4. Any medications? My mom is finally losing weight now that she doesn’t have to take much insulin.
      What about protein? Jimmy Moore lost weight and had the last laugh on all his haters when he limited his protein and increased his fat intake.

    5. Try increasing your fat intake and maybe lowering your protein intake a bit. The ketogenic diet is high fat/moderate protein/low carb. If your fat intake is low and protein intake high, your body will convert the protein to glucose thinking you are still a sugar burner and not a fat burner.

    6. Carbs look great. If not losing, try swapping some of the protein you’re eating for additional fat. That should do it. Some amount of the protein you eat gets converted to glucose. The more consumed protein is in excess of you actual need for it, the more becomes glucose. Glucose is what ALL carbs become. Once in the blood stream, absolutely nothing in your body can tell a glucose molecule which came from carbs from one which came from protein.
      We need to re-name it a “low-glucose” diet, to avoid this mistake which literally millions of people are making.

    7. Jay,
      I’m sorry to hear about your poor outcome on a LC diet. Why don’t you become part of the virtual communities at, Mark’s Daily Apple, and Paleohacks? People there love to troubleshoot issues like yours.
      Regarding font size, I know that both FireFox and IE for Windows have mechanisms (View > Zoom) to enlarge text on a page. Even Windows itself has a mechanism (Ctrl+Scroll Wheel) to do this. In addition, in Windows 7 > Control Panel > Display, you can set the default magnification of fonts to 100%, 125% or 150%.

      “The negative results are much more trustworthy; for the case where the power is 0.8 there are 875 negative results of which only 20 are false, giving an accuracy of over 97%. But researchers and the journals in which they publish are not very interested in negative results. They prefer to accentuate the positive, and thus the error-prone. Negative results account for just 10-30%”

  2. I’ve lost 12 lbs eating less carbs. I am an RN. You should see the looks I get at work and the comments made when I eat bacon and cheese twice a day. When I suggested an RT eat more eggs instead of bagels another RN chirped in to say that you shouldn’t eat egg yolks because choline is bad for your arteries. We looked it up. Choline is used to treat atherosclerosis. A resident argued with me about his peanut butter full of trans fat. He doesn’t know that trans fats aren’t good. Sigh.

    1. Frightening. Someone at work was commenting on how their egg whites had no points. I just shook my head thinking they are missing the most nutrient dense food.

      1. Oh yes. And people who order skim milk coffee drinks with mucho sugar.
        They are effectively mainlining sugar.

    2. OMG! I can understand an RD or RT being ignorant, but an MD ignorant of the dangers of trans fats?! Does he recommend regular bleeding of patients, too?

  3. Great stuff, as usual, Dr. Eades. It’s going to be interesting to see how/when the nutrition science Flat-Earth-ery finally caves in. I’ll be standing on the sidelines with some bacon, if anyone wants a snack.
    On a separate note, thanks again to you and Fred for writing Slow Burn. At 37, I’m WAY stronger than I was at 30. I cannot stop evangelizing this way of exercising to everyone who asks (and even many who don’t ask!).
    Lastly, have you been checking out Sam Feltham’s crazy 5000 kcal/day overfeeding experiments? Pretty amazing stuff:

    1. I’m glad the book helped you. I have seen Sam Feltham’s 5000 kcal/day n=1 studies. Pretty phenomenal! I probably should post on them at some point.

  4. I agree, exercise is not the recipe for a weight loss and for an immortality, but it makes many people feel young and improve their quality of life (especially if they avoid injuries and do not use it as a compensation for a poor diet).Improved fitness markers could be markers of better quality of life. It is better to live with stronger muscles, good posture and a good sense of balance. I bet only better balance alone would be able to save some older people from the complications of falling down and influence statistic results, may be the fitness program in experiment didn’t address the balance issues strong enough. The yoga instructor in my health club has a lot of old clients who she trains to move better (after a stroke, to stopped shuffling feet, to improve posture to ease a back pain), by being couch potatoes we would loose very basic movement skills.

    1. Don’t get me wrong. I’m a big proponent of exercise – it provides a multitude of benefits. But the evidence shows that, in general, the prescription of a low-fat, high-carb diet along with a moderate amount of exercise doesn’t equate to a longer, healthier life.

      1. I don’t understand. If these people in the intervention group exercised, and the control group didn’t, and you are a big proponent of exercise for the multitude of benefits how come there was no statistical difference in outcomes between the control group and the intervention group?
        If exercise is so great how come it didn’t show up in this study?

        1. I’m not sure exercise in the amounts followed in this study will do much. I’m a proponent of pretty hard exercise, i.e., high-intensity resistance exercise.

      2. It is easy to believe even without doing a research, the low-fat/more exercise combination sounds like too much stress on several levels for a body, it could be especially taxing for older individuals.

    2. Exercise never made me feel young. It made me feel sick and miserable. Until I started eating low-carb, then everything changed.

      1. I also on a LC diet last 6 years (almost-since Nov.2007), and I have much more energy than before. The right amount of exercise makes people feel younger . It is easy to over-do like many good things in life, and as a result to feel sick and miserable, or even get injured. I had to have a foot surgery – the result of too much high impact aerobic and attempts to train to run, most of my life I though it would be a ticket to slimmer body. After I got adopted to the exercising in a fasted state and ketosis, my endurance greatly increased.

    3. In my clinical experience, better balance alone is insufficient to prevent falls. Fall risk is the sum total of brain health, muscular strength and power, range of motion, and balance. An alert senior who is watching out for obstacles who is powerfully strong and has good flexibility has low fall risk and will likely land well if they do fall.
      I’ve worked with many seniors who lack these qualities and the most important ones to train are flexibility, strength and power. Work hard on range of motion and power in the hip and ankle and fall risk subsides substantially. Balance training is important but must be combined with flexibility and strength for optimum results.
      That said, any activity that seniors will actually get out and do is a good thing. But assuming that balance training alone is a panacea in and of itself is supported by contradictory evidence. For instance, some studies show excellent balance and falls improvement for Tai Chi Chuan practice, and others do not. The study, “Lack of effect of Tai Chi Chuan in preventing falls in elderly people living at home: a randomized clinical trial” (J Am Geriatr Soc. 2009 Jan;57(1):70-5) was particularly disappointing, and leads to questions of methodology and practice. Why are some Tai Chi Chuan studies so glowingly positive and others are dismal failures? More research is needed, but seniors need help now.
      Increase range of motion, get them powerfully strong, then work on balance. Of course, also improving diet to ward off brain fog is an incredibly important and usually totally overlooked part of the puzzle. A baffled and confused senior will fall regardless of their positive physical factors since they won’t be alert to potential fall risks. That’s where eliminating excess carbs and increasing brain healthy fats like coconut oil can help.

      1. Thanks for this insight, Ben. I’ve been doing some self-devised exercises on an upside-down Bosu ball in hopes of being more stable in my later years. Now, I’ll modify my routine to conform to your recommendations.

      2. Almost all elderly folks are deficient in vitamin D. When my otherwise very active and fit elderly mother developed balance issues, I had read that supplemental D3 could improve balance and prevent falls in this group. The effect was really striking and pretty immediate for her. My endocrinologist rx’s 50,000 iu of D3 gel caps once per week in those who test deficient, but I gave my mother an initial dose of 5000 iu, then 1000 daily.
        Has worked for others I’ve mentioned it to.

      3. Yes, I absolutely agree with you that just practicing balance exercises alone will be absolutely not enough for a frail person. It could be a good addition for fit and physically active old person(like my 76 yo mom) to avoid fall on an icy road, but not enough for somebody who,for example, shuffles his/her feet. We just received a call from my almost 95 years old grandma’s adult care facility that she has fallen badly despite all precautions such places usually take. Grandma is frail, has an Alzheimer, her problem is way more than just the luck of a balance, rather that her loss of balance is the result of her conditions.
        I have a guess why Tai-Chi doesn’t not always look particularly beneficial in research. I practice it myself for last 3 years, and at the beginning I took several “sample” classes in different places in order to find a good fit. I am late middle-aged, in a good physical form, have no cardiovascular conditions, with a normal blood pressure, i practice yoga last 15 years, and it was difficult for me to find a fitness-level appropriate class for myself because mostly people with already compromised health were choosing to enroll , and the instructors had to adjust accordingly. My impression is that way too often Tai-Chi classes are exclusively senior-oriented as a result, they put the most attention on the rather complicated choreography which is often hard enough to seniors to learn, as a result much less attention is payed on the appropriate physical form, and usually zero time is spent on the body conditioning in order to make it stronger and more flexible . Doing Tai-Chi properly is really physically demanding, it actually requires even more range of motion than yoga, and strong low-body and core muscles. Unfortunately, most people who choose to start a Tai-Chi (according to what I personally observed) have already lost a lot of their physical fitness, and while it is always a room for an improvement, it is still definitely beneficial anyway as any mild physical activity, sometimes too much is lost to recover.
        It looks like, it is always possible to do different forms of exercise in a not particularly efficient way, and Tai-Chi is just one of examples.

      4. I taught tai chi for a number of years, including some to older folks… It’s very easy for some tai chi teaching to have little effect, because so many “teachers” aren’t actually teaching tai chi! My local Y had a fellow come in to teach a class, and I sat in once to see what he was doing. He had some weird Amer. Heart Association “version” of tai chi — that was *SO* *NOT* tai chi!! So, unless these studies look at what the teachers are teaching — you cannot help but get wildly varying results! GOOD tai chi, with a good teacher, who knows the point, uses, and form of tai chi — will absolutely have good results.
        I never understood why, as a couch potato — and an editor who spent all day and often well into the evening at a computer, I got such fantastic “cardio” effects from teaching (an hour of) tai chi 2-3 evenings a week. But I did! I even attribute to my tai chi my ability to continue all my “usual” activities when my hematocrit had dropped to 6 (anemia, hypothyroid, and I had cut out red meat (still ate fish and fowl — and, alas, lots of soy and pasta {wince}). Beyond some tachycardia when I climbed hills or whatever, I ‘kept on ticking’! My M.D. teaching partner, when I mentioned it, sent me right to my doc, who treated the anemia… (Sorry, got distracted… )
        Anyway, tai chi IS superb for fitness and balance — IF (and only if!) it’s taught correctly and well! There is now WAY too much idiocy masquerading as tai chi… Alas.

        1. Elenor said, “There is now WAY too much idiocy masquerading as tai chi… Alas.”
          Indeed there is.
          I was fortunate that when I went to practice tai chi at my local YMCA the instructor was a fully trained sifu in qigong, multiple forms of gung fu and multiple forms of tai chi. We WORKED and we got down low in our forms or he FUSSED at us. He taught the combat uses of every movement we did and every participant got worked as hard as they could stand regardless of age.
          Any tai chi research done with him as the lead instructor would get statistically significant results, no doubt about it.
          But that’s not what you find most places and the difference is what makes the difference. Pseudo tai chi returns pseudo results. It’s a small step up from sitting in an easy chair… but only a small step.
          That’s why I like heavy low rep (<12 rep) resistance training combined with range of motion work. It works. People get stronger and more flexible and strong people who can move well fall much less.
          I love tai chi and would gladly recommend it to every senior if I knew they would be doing REAL tai chi. Unfortunately, the current state of tai chi instruction I've seen is far from encouraging.

          1. I always told my students that even though I was about 99.9% SURE they were not going to become martial artists, that I was going to teach them as if they were — because if they knew the purpose of each move: “this movement is to “block” a punch” (although “block” is wrong, because it was to redirect the incoming force…) but — if they knew the move’ purpose, then they would be flailing about trying to catch a bird in the sky, or rake leaves: they’d “see” the incoming attack and their movement would suit it…
            In fact, if I may brag, I had an article published in Tai Chi magazine (back in 1994!), which I’ve posted here:
            (Oh, and I had a woman who attended a demo/class (held by one of my students to teach her own karate students about tai chi) came up after the class and said I was being “offensive by teaching tai chi as a martial art.” (!!) “Tai chi,” she said, “was supposed to be all about peace and harmony.” “Uh. No. No, it’s not.”

          2. oh, oops — “if they knew the move’ purpose, then they would NOT be flailing about trying to catch a bird in the sky, or rake leaves”

          3. Great tai chi article! Thanks!!
            It put into words many things I’ve experienced working on movement. Maintaining relaxation and responsiveness in as many muscles as possible while tensing and relaxing the muscles needed to move as efficiently as possible… not easy, not easy at all.
            Watching top players in any sport you can see how this ability makes them superior. The other player knows what they are about to do but can’t stay relaxed enough to respond to it as well as the superior player initiates their attack from a position of engaged relaxation. You’ve watched all the film. You know what they do best, but you still can’t stop it because in person it all happens so darn fast.
            This guy makes it look easy:
            Applied Silk Reeling with Li Lairen
            Combat oriented Chen style. Don’t think the “peace and harmony” lady would recognize this as tai chi at all. LOL!
            P.S. Love the pics of your Siamese. Especially the one of your Dad writing with Siamese kittens draped on him. Classic!

          4. Thanks Ben, I’m glad you enjoyed it! I taught Cheng Man’Ching Yang style, but was studying (for my own pleasure) Chen style. (And yeah, loved silk reeling too.) Glad you liked my kitties. We were always a Siameser family!

        2. Well,probably the instructors in bad classes just didn’t know what they were doing, not adjusting for not-fit audience, but finding a good class to attend was not easy at all. When something gets too fashionable or popular, rising demand could result in a poor quality.

          1. Indeed Galina!
            Look at CrossFit as a prime example. There are some fantastic CrossFit gyms… and then there’s the ones where some dingbat got a weekend certification and opened up a box and is injuring people almost as fast as they come in the door.
            Caveat emptor. Buyer beware. Being associated with a good brand does not equal quality exercise instruction. Don’t just join wherever; kick the tires, read the reviews, talk to members, talk to ex-members if you can find them. Do your due diligence before you trust your precious body to someone who might or might not know anything.
            Don’t figure that someone with the body of a Greek god or goddess knows anything. They could just have great genetics.
            Especially watch out for how they deal with anyone with special needs. If they either destroy someone with special needs, or they lay off so much nothing positive is accomplished, that’s a red flag for a lack of competence. The best trainers can scale up or down to serve just about anyone who walks through the door regardless of age, shape, or disability. That’s the sign of a real pro.

          2. Excellent advice! I SO loved teaching “stiff old” folks tai chi — because you could just see them unfreeze and gain extension and easy movement! One of my 70-yr-olds came to class one night just *glowing* — her grandson (a ‘young tough’ ) was dubiously talking to her about tai chi and what she was learning and he gently ‘threw a punch’ at her. Without even realizing she was doing it, she raised her arm in a “blocking” movement and ‘slid’ his force away. She was SO chuffed! Both that it worked, and the she had done it without conscious thought! Such fun!

  5. Great post but a sad state of affairs for medical science. Somewhere down the line 10 or 20 or 30 years from now there will be a shocking disconnect in the state of health between people who have been eating some sort of low carb,paleo, primal diet for that length of time and those eating the SAD.

    1. I know this is anathema in our “everyone must be fixed by others” world, but as in all “real” life we make our own choices and then learn from, and/or suffer, our own consequences.

  6. It was that editorial response to Krauss’s study that finally convinced me that Gary Taubes was right. The editorial claimed that had 30 years of research going back to the Women’ Health Initiative and MRFIT demonstrating that higher levels of fat in the diet lead to higher levels of heart disease.
    Which fascinated me, because I knew that those trials had been considered failures precisely because they hadn’t shown such a link.
    And that the writer either assumed that they had, because he’d accepted as true the intentionally misleading statements that had been made about them, or he knew they had not, and was expecting that his readers had not read the studies, and was intentionally trying to perpetuate the misconception.

    1. …which is why so many millions are sick, getting sicker, costing a fortune for palliatives only, and probably will die (avoidably) terrible deaths on the SAD. Calculate the demographics; disaster for the US unless something drastic changes quickly.

  7. Buried deep in the supplementary appendix (page 27), there is a figure that clearly shows medication use going up in both groups.
    And the only adverse event to reach statistical significance was an increase in “All Reported Fractures” in the intensive intervention group (page 33 in the supp)… had it gone the other way, this would’ve made headlines.
    I posted the figure & table:
    med use:
    adverse events:

    1. 41% more amputations and 17% more fractures is certainly not a good report card for the Intensive Lifestyle Intervention used in Look Ahead.

  8. Thank you for this article. I have wondered why the Look Ahead failure has been basically swept under the rug. It would have been so much more beneficial if only they had decided to reveal what it disproved rather than trying to extrapolate their own biases. What a colossal waste.

  9. Nice one as always Mike,
    I’ll say this – it’s a good thing they did all that aerobic exercise to keep their blood sugar in the normal range eating a high carb diet. It’s the only way you can get away with eating like this.
    One day, someone smart will do a long term low carb/sugar, high fat + strength training intervention study. You’d see men and women turn into supermen and superwomen is my guess.

    1. Nice article. @Fredrick Hahn, how could one be a part of such a study. I was diagnosed with DM2 in November 2011. Watched “Fathead” in December and changed my life. Without being totally faithful I’ve still managed BG levels and A1c was 5.3 yesterday. I’ve been strong the past 2 weeks and weight is coming off again. I would love to be a LCHF subject for a study. I’ve been wanting to add strength training back in my life anyways. Thanks for any info. Again Dr Eades, excellent article!

  10. There’s a lot in the UK press at the moment about the Swedish health authority’s turnaround in diabetes advice – they have changed to low carb/high fat ! It is all over the press here in the UK (and I think the New York Times ?) that high fat/low carb is better for heart health too ! Here’s an article in the BMJ: and Dr Malcolm Kendrick has written a brilliant pice about the Swedish turnaround: Things are changing.

  11. In the conclusion they mention that some people (one?) experienced a remission of their diabetes. How was that achieved I wonder? Is it true that if you lose enough weight your diabetes will magically go away?

    1. Your predisposition to diabetes will always be there. If you lose enough weight, you can in some cases get rid of the symptoms.

      1. You can do it without weight loss, too. I was slim, on very low fat, high carb 15 years ago when I developed PCOS, severe dyslipidemia, had advanced kidney damage and severe peripheral neuropathins, hands and feet. Also new onset fibromyalgia pain.
        It is not an exaggeration, my PCOS and FMS disappeared literally the say after I restricted starches and sugars and started to eat protein and fat again. The residual foot and lower leg numbness from neuropathy took another few months and some alpha lipoic acid to go away. All these years, I’ve been able to keep my glucose in low normal range using diet alone.
        This means I’ve reversed the progress of my diabetes and many of its effects, but not the diabetes itself, which went undiagnosed for years due to my then, “normal” fbg of 109. I bought meter and found I was routinely above 200 after meals and cut carbs even more.
        Because most type 2 diabetics have lose 50% of our pancreatic insulin producing beta cells before diagnosis, the diabetes does not go away, but its progress and damage can be reversed, and surprisingly quickly. Here’s an interesting case study about end stage renal failure , which wrongly credits weight loss for an effect easily acheived without it:

  12. Dr. Eades,
    Since reading PPLP and drastically reducing carbs I feel better @ 62 than I did at 22 or 32. I am stronger, can work harder and think better. Keep reinforcing the message like you do.
    IMO the best thing about reading your book was how clearly and well you communicate the biology of what is happening. Bravo!

  13. I ate less, moved more, and the scale didn’t budge until I got bioidentical hormones and compounded thyroid medication. No one believed me, not even my husband. Only the 5th doctor I visited–the hormone doctor–believed me, and now I’ve gotten back to my lifetime adult weight. Hormones are it!

  14. Why are there editorials anyways in scientific journals? The purpose of a journal is to present scientific studies. The abstracts provide summaries.

    1. Probably for all the reasons I listed in the post.
      These editorials serve the same purpose for the mainstream as political pundits do for their followers. You watch a political debate or a political speech then tune into your favorite brand of pundit to learn what the speakers or debaters ‘really’ said.
      Most people don’t even watch the speech or debate, they simply tune into their confirmation bias channel of choice to be told how the speech or debate fit their bias.

      1. “…confirmation bias channel of choice…”
        An excellent turn of phrase, Mike!
        As the old joke opines, “How can you tell when a politician is lying? When their lips move.”
        The phrase “media pundit” easily and often accurately swaps out for politician in this old joke.
        Unfortunately, we like to hear what we agree with, not what’s accurate. The only way to overcome confirmation bias is to regularly ram the doors of perception open over and over again and look at reality without judgment. Much more easily said than done.

          1. Dr. Eades,
            When you try to pry open the gates of perception only with facts, it *is* damned near impossible. As Jonathon Haight points out in “The Righteous Mind,” though, if one can skillfully appeal to the emotions, intuitions, instincts, and most importantly, the moral pillars that filter our perceptions, persuasion is almost a certainty.

          2. Reminds me of the great Far Side comic where the one sheep stands up in the middle of the herd and yells,
            “Wait! Wait! Listen to me!… We don’t HAVE to be just sheep!”
            It’s a daily choice to maintain a sufficiently open mind… but not so open your brains fall out. Perhaps it’s impossible, but I’m not giving up. I’m descended from obdurate individualists after all… no sense bucking the trend and becoming a conformist now. Not like I can pass for a sheeple anyway. I’m too weird for that. LOL!

  15. Yes, people are very reluctant to accept new ideas that fly in the face of their dogma! (resistant starch..cough, cough)

    1. If you’re referring to me, you’re wrong. I’m more than happy to look into it when I get the time. All I said was that I didn’t really know much about it – not that I disapproved of it.

      1. Tim and Nikoley, if you can convince the good Dr. Eades that RS improves a glass of Jameson’s somehow, then you might have a shot…

        1. Good angle, we’ll have to work on that! I realize that taking up RS as a ’cause’ seems strange. It’s just that when you get into the gut health aspect of things, you realize it’s hard to do on an LC platform. RS supplies gut microbes with a substrate they can use to increase numbers of beneficial microbes.
          There are still unanswered questions, which is why we keep harping on this. For instance, on a long-term ketogenic/VLC diet do you need the same gut microbiome as when on a moderate or high carb diet? Our small intestine is basically that of a carnivore, sterile and non-leaky, while our large intestine is that of an herbivore–filled with microbes that digest plant matter with an active gut-blood barrier. The microbes in the large intestine are credited with many things…increased vitamin and mineral absorption, hormone production, glucose regulation, and lipid stability.
          It’s going to take critical thinkers to suss out the nuances of balancing gut microbes with carb and RS intake.

  16. regarding the comment upstream about BG control on a hi carb diet, i would ask this:
    What can be said if someone has BG level in normal range 75-85 on hi carb, but on lo carb hi fat it is 90-100?
    Would this not indicate Insulin Sensitivity with Trgs in both cases no more than 60? There are people who fit this profile
    If so, not all demonstrate metabolic derangement on a hi carb diet

    1. Your last comment first. There are plenty of people who seem to do fine on high carb diets. I don’t think I’ve ever denied that. What they don’t know, however, is whether they would do better on a low-carb diet if they tried. I’m sure some do try and feel that they do better on their high-carb diet and go back to it. I have no problem with that as long as they are happy with their state of health.
      The issue of blood sugar going up on a low-carb diet is an interesting one. I had it happen to me and then puzzled out what I think the cause is. People on low-carb diets tend to stay in mild dehydration if they don’t consciously keep their fluid intake up. If you are dehydrated, your blood volume falls a bit. The concentration of the substances in your blood increase because there is more sugar or cholesterol or whatever in a smaller amount of fluid. Increase the fluid by making sure you’re hydrated, and the blood sugar drops into the normal range. I really need to write a post on this phenomenon. Over the space of about two years, I, myself, had a series of blood sugars that were in the 90-100 range, which is high for me. I went in for another blood draw, and the phlebotomist couldn’t find my usually robust vein. She suggested I drink 16 ounces of water, which I did, and in about thirty minutes my veins were bulging as normal. And my blood sugar was in the low 80s.

      1. I blogged about this phenomenon here: See Figure 5 at the end of the blogpost showing the results of a nondiabetic . I think the high PP numbers on a LC diet and a home GTT are because she didn’t “carb-up” for three days before the test, but the fastings are also higher.
        There are also links to the research that shows that although nondiabetic (non metabolic syndromic) people can do well on any diet, those with a tendency to metabolic syndrome/diabetes do better on a LC diet.
        Yes, please do blog about the higher fastings on LC. Many people wonder about this.

        1. I gave myself an OGTT when I started low-carb (ate carbs for three days, fasted for 12 hours, then ate enough white bread to equal 70 grams of carbs).
          My fasting was 98, I peaked at 177 after 60 minutes, and at 120 minutes I was still at 105.
          After six months of low carb, I repeated the test. Fasting was 80, I peaked at 131 after 30 minutes, and at 105 minutes I was down to 83.
          Then again, after a year of low carb – fasting was 84, I peaked at 114 after 35 minutes, and at 70 minutes I was down to 86.
          Eating low-carb healed me. (And in the process, I lost 80 pounds).

      2. Thank you. I hear you on the dehydration, but if robust vein is a marker, I would have to think about it. Could it more likely be excess protein, perhaps, or even dairy? Each of those alone or in combo and may be combined with undetectable dehydration might explain it.
        When your BG was hi for you, had there been any change in your carb consumption prior to the draw, or protein or dairy intake?
        I was thinking of more perhaps as a normal response for one who is not insulin resistent?
        Note: I was not accusing you of saying hi carb(non junk diet) no good; to many others do that!

        1. No change in protein or dairy consumption (I eat very little dairy). No real change in carb consumption. My diet doesn’t change a lot, so the former blood draws were all during the same diet. I started thinking about it after the BGs normalized (and have stayed normal) after the water consumption. I rarely drank anything other than coffee, wine and Jameson, all of which are diuretics. I didn’t drink much water. Now that I consciously consume more water during the day, my blood sugars are normal.

          1. maybe it is that simple; was thinking that for others it might also be that they are eating less from LC diet, losing weight, and therefore until weight normalizes might see higher BG reading.

      3. Yes! Please write that article. My last A1c was lower than usual and I think it was because I drank extra water before the blood draw that day.

    2. It could indicate high cortisol, too. Where hyperinsulinemia inhibits steroidogenesis and cortisol binding globulin. Less cortisol = lower bg.
      Cortisol is responsible for the early a.m. rise in blood glucose, due to its diurnal rhythm, highest in the a.m. about zero by midnight, tapering all day.
      This is also why diabetics tolerate carbs without epikes late in the day, especially after 3-5 p.m.

  17. You wrote:
    “Which is interesting, because it also shows they stuck with their exercise regimens and their diet. The decreased LDL is the give away. LDL levels always go down on low-fat diets. (But as readers of this blog know, that’s far from the whole story.)”
    Did you intend to say LDL always goes down on low fat diets? Or was it the study itself that said everything improved except for LDL?
    I’m not getting something, and either is my wife who understands all this stuff, god bless her.

    1. Typically LDL levels fall on low-fat diets. That’s been known for years. Problem is, the HDL levels fall more than the LDL levels do, so overall the lipid picture worsens even though LDL falls. On higher fat diets, especially higher saturated fat diets, LDL levels go up a little but the HDL levels go up to a much greater degree. So the overall lipid picture improves even though LDL levels rise a bit. This is all well established in the medical literature.

      1. Bill is on to something – I was going to ask the SAME question.
        You have stated that LDL goes down on low-fat diets, and the STUDY seems to say that the intervention group’s LDL did NOT go down:
        “the intensive lifestyle intervention also produced . . . . greater initial improvements in fitness and all cardiovascular risk factors, except for low-density-lipoprotein cholesterol levels.”
        That implies that they were *not* following the diet. UNLESS, the LDL-related risk factor they are alluding to is the HDL/LDL ratio which could have worsened.
        …that’s what I was confused/curious about.

        1. You have to get into the supplement to the study to actually see the values. In that supplement it shows that LDL levels fell in the study group from a starting level of 112 mg/dl to 89.5 mg/dl. The strange thing that I didn’t notice when I first looked at this data is that LDL levels fell in the control group as well. From a starting level of 112 mg/dl to 88 mg/dl. Maybe what this evidence suggests is that a few counseling sessions (which the control group got) brings about similar changes as those induced by intensive lifestyle modification.

  18. Great, informative article. These sorts of stories always remind me of the classic case of Ignaz Semmelweiss – ego getting in the way of the science of saving lives. Sigh.

    1. Thanks. The Semmelweiss story is a sad one. Both for the women who died unnecessarily and for Semmelweis himself, who couldn’t overcome his own overbearing personality.

      1. There is some interesting speculation that Dr. Semmelweiss may not have been to blame for his behavior. During his years as an obstetrician in the era before sterile methods, he may have contracted syphilis from his patients.
        Who knows?

  19. And where’s the damn RNAi (interferon) CURES for the epidemiological genetic disease CAUSES (e.g., diabetes)?
    No PROFIT in That!

  20. Dr Eades
    you wrote
    “Despite not showing what their authors want them to show, the important point about these ‘failed’ studies is that they move science forward. They sometimes nullify dearly held theories, which is exactly what scientists are supposed to want to do.”
    I think this is a great point and one that Brian Cox talks about in Science Britannica episode 3 how this conflict needs to be addressed in science and how the conflict has existed for as long as modern science has, and go on to say they have designed the Francis Crick Institute with this problem in mind, maybe there is hope yet.

  21. Jay, I have also been doing low-carb since August 2012. I also am relatively sedentary 50ish female. Have you tried upping your dietary fat to something more along the lines of 100g/day perhaps more?
    I’m guessing the amazing editorial conclusion came from “the intensive lifestyle intervention also produced greater reductions in glycated hemoglobin and greater initial improvements in fitness and all cardiovascular risk factors, except for low-density-lipoprotein cholesterol levels.”
    The fact that people in the intensive lifestyle intervention group didn’t die less is only incidental and barely worth mentionning…. I guess??!!
    I always knew ‘exercise’ was incidental 🙂

  22. We saw the same happen with the anti-smoking campaign. Data that did not fit the “theory” (an excessively generous word) were marginalized, written off, explained away, hidden, or ignored.
    That is what Jacob Sullum was referring to in his book’s subtitle by “the tyranny of public health.”

    1. We saw the same happen with the anti-smoking campaign. Data that did not fit the “theory” (an excessively generous word) were marginalized, written off, explained away, hidden, or ignored.
      Please elaborate.

  23. @Sandy Baynes,
    I advice you to be very careful with the consistent cutting on a protein, occasional fat fast is fine.
    I advice you to try IF pattern of eating first (for example, 8 am – cup of coffee with a heavy cream, noon – LC lunch, 6 pm – LC dinner, NOTHING in-between exept green tea with a lemon, one day a week skip one meal), it took me from one of several weight-loss stalls. It is better for your body that muscle-wasting which is very possible on a protein limitation.
    Be prepared to stall some day indefinitely – our bodies naturally fight a fat loss , it is especially true for middle-aged females. I got lucky – it happened to me 10 -15 lbs off my preferable weight, but it could be different for you.

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