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The official website of Drs. Michael and Mary Dan Eades, low carb pioneers and authors of Protein Power.

Nominees for the Reckless Award

The day before yesterday a group of doctors from the nutrition committee of the American Academy of Pediatrics came out with a couple of the most absurd recommendations imaginable. Not only were these recommendations silly beyond belief, one was downright dangerous to boot. I’m talking, of course, about the recommendations that children as young as 8 years old who have LDL concentrations ≥ 190 mg/dL be prescribed statins. (The other one marinated in idiocy is the recommendation that low-fat dairy products be be used in overweight children between the ages of 12 months and 2 years. These two are among 7 recommendations published in the July issue of the journal Pediatrics. All 7 recommendations are listed below*)

Drs. Stephen R. Daniels, Frank R. Greer and the rest of those on the nutrition committee are nominees for the Reckless Award. In fact, their recommendations are so egregious that had they come before the eponymous Dr. John Reckless’s suggestion that statins be put in the drinking water the award would be named after them instead.

Why is the recommendation to give statins to children aged 8 and greater so dangerous? Because no drug therapy is without risk. When as a physician you give drugs to patients, you know there are risks involved, but you balance these risks with the rewards to the patient from taking the drug. In the case of statins, there is absolutely no evidence whatsoever that statins will reduce the incidence of early heart disease and/or death in these children as they reach adulthood. And there is no evidence whatsoever that years of statin therapy in these kids as they age won’t cause disastrous problems later on.

Why did these people recommend statins to kids?

As reported in the New York Times yesterday, Dr. Nicolas Stettler, a member of the nutrition committee that made this recommendation, says:

We extrapolate from the information we have in adults,.

We know that in adults, decreasing cholesterol and giving some of those drugs decreases risk of heart disease or death. So there’s really no reason to think that would be any different in children.

Is he out of his mind? There is no evidence that decreasing cholesterol in adults reduces the risk of heart disease or death. Show me the papers, Dr. Stettler. And there is no evidence that statin drugs prevent early death in adults except for one small subset. It has been shown that in males under the age of 65 with diagnosed heart disease – not putative risk factors, but actual diagnosed heart disease – achieve some small benefit from statin drugs. But even these benefits are so small as to make many scientists wonder if they are worth the risk of giving statins to all the people in this particular group.

Let me repeat. Double-blind, placebo-controlled studies – the only ones that really count – have shown that statin drugs provide no benefit in terms of increasing lifespan in women of all ages and in men of all ages who have not been diagnosed with heart disease. These same studies have shown that statins provide no benefit for women of any age who have been diagnosed with heart disease and no benefit for men over 65 who have been diagnosed with heart disease. And, remember. an elevated cholesterol level is not a diagnosis of heart disease. ( If you’re interested in more detail, see this long post I wrote on the subject.)

So please tell me how in God’s name drugs that don’t provide benefit for the vast majority of adults are supposed to provide benefits to kids?

And what about the side effects? Many adults have experienced muscle aches and pains (sometimes to a disabling extent) and cognitive impairment. Some have had liver problems that ended up being fatal. And the Doctors on this committee recommend that children get these same drugs that are known to have side effects yet have never been shown to be of benefit. Un-frigging-believable!

I find these recommendations absolutely pernicious for a number of reasons other than the obvious ones above.

First, these recommendations are for kids with elevated cholesterol levels during childhood. In my opinion we don’t have enough evidence on the normal changes in cholesterol level throughout childhood and adolescence to be making any kind of recommendations based on one cholesterol test. Dr. George Mann meticulously evaluated the cholesterol levels of Masai children from the ages of 2 through adolescence and found that

Children show a high (for Masai) cholesterolemia [cholesterol in the blood] in infancy which declines until about age four, to near adult levels. The babies are typically nursed to age two to three years and then fed the food available for women and elders. Cholesterolemia increases in older children until puberty and reaches levels well above those of the muran [the warrior age, typically from 12-30]. After initiation and during the 15 years of warrior life, cholesterolemia is at the lowest level.

I find this interesting on a couple of levels. Masai consume a diet composed primarily of meat and milk. There entire subsistence revolves around their cattle. If these Masai children were evaluated at age 8 as per the recommendation of the people on this nutrition committee, they would be found to have elevated cholesterol and would probably be started on statins. If left alone, however, their cholesterol levels would drop naturally to a much lower level. How do the people who made these recommendations know that an elevated cholesterol level in a kid aged 8 won’t spontaneously drop as the kid ages, just like it did in the Masai kids. The answer is: they don’t.

Second, we don’t have a clue what the long term effects might be of children having a lower cholesterol. Cholesterol is a structural lipid. What happens if it is artificially lowered during the growth years? Who knows? I don’t. The people on the nutrition committee of the American Academy of Pediatrics don’t. I certainly wouldn’t recommend it for my own children or grandchildren.

Third, we’ve all seen kids who were fat in school who lost their weight and became thin as they got older. And we’ve all seen skinny kids who got fat as they got older (I’m a case in point). How can we be so sure we can reliably predict what’s going to happen as a kid ages that we can with good conscience put that kid on a drug that is designed to be taken daily for life? And a drug not without the potential for serious side effects. It beggars belief.

Fourth, statin drugs have been around only since the mid 1980s and haven’t been in total widespread use until the last decade. We don’t have a clue as to the long-term problems – if any – with statin use in adults. How can we possibly inflict them on kids?

Finally, as far as I’m concerned, the most pernicious part of this whole fiasco is that the recommendations were made by the American Academy of Pediatrics (AAP), the ultimate authority as to what is the standard of care for pediatric patients. Why is this so bad? Because when pediatricians treat kids, they accept the liability for their treatment until the kid is 18. In other words, they’re liable for medical malpractice for a long, long time. As a consequence, pediatricians are attuned to what the standards of care are, and can’t really be faulted for adhering to whatever the AAP deems is correct. If pediatricians follow these standards – no matter how misguided – they then can’t be held accountable if the standards turn out to be totally misguided and the kids who get the medications have bad outcomes years later. If pediatrician don’t hold to these standards, i.e., they don’t give kids with elevated LDL levels statins, then should one of their patients develop problems later the doc could get hammered with a big malpractice suit. And it’s tough trying to defend yourself when the governing body of your specialty has made recommendations and you haven’t followed them and your patients suffer. So, pediatricians will be giving statins to protect themselves.

I believe these recommendations to be far, far out of line. Already some pediatricians have gone on the attack against them. My hope is that good sense will ultimately prevail here and these recommendations will be ditched. But with all the money involved in this fiasco, I’m not holding my breath.

* The recommendations in full are below:

  1. The population approach to a healthful diet should be recommended to all children older than 2 years according to Dietary Guidelines for Americans. This approach includes the use of low-fat dairy products. For children between 12 months and 2 years of age for whom overweight or obesity is a concern or who have a family history of obesity, dyslipidemia, or CVD, the use of reduced-fat milk would be appropriate.
  2. The individual approach for children and adolescents at higher risk for CVD and with a high concentration of LDL includes recommended changes in diet with nutritional counseling and other lifestyle interventions such as increased physical activity.
  3. The most current recommendation is to screen children and adolescents with a positive family history of dyslipidemia or premature (≤ 55 years of age for men and ≤ 65 years of age for women) CVD or dyslipidemia. It is also recommended that pediatric patients for whom family history is not known or those with other CVD risk factors, such as overweight (BMI ≥ 85th percentile, < 95th percentile), obesity (BMI ≥ 95th percentile), hypertension (blood pressure ≥ 95th percentile), cigarette smoking, or diabetes mellitus, be screened with a fasting lipid profile.
  4. For these children, the first screening should take place after 2 years of age but no later than 10 years of age. Screening before 2 years of age is not recommended.
  5. A fasting lipid profile is the recommended approach to screening, because there is no currently available noninvasive method to assess atherosclerotic CVD in children. This screening should occur in the context of well-child and health maintenance visits. If values are within the reference range on initial screening, the patient should be retested in 3 to 5 years.
  6. For pediatric patients who are overweight or obese and have a high triglyceride concentration or low HDL concentration, weight management is the primary treatment, which includes improvement of diet with nutritional counseling and increased physical activity to produce improved energy balance.
  7. For patients 8 years and older with an LDL concentration of ≥190 mg/dL (or ≥ 160 mg/dL with a family history of early heart disease or ≥ 2 additional risk factors present or ≥ 130 mg/dL if diabetes mellitus is present), pharmacologic intervention should be considered. The initial goal is to lower LDL concentration to < 160 mg/dL. However, targets as low as 130 mg/dL or even 110 mg/dL may be warranted when there is a strong family history of CVD, especially with other risk factors including obesity, diabetes mellitus, the metabolic syndrome, and other higher-risk situations.

40 Comments

  1. John on July 10, 2008 at 12:47 am

    Is there a single part of this culture that has not been corrupted? We are the largest, most pretentious banana republic that has ever existed.

  2. Robin on July 10, 2008 at 5:01 am

    I remember reading in Gary Taube’s book that the Framingham heart study said that when cholesterol levels dropped below 160, cancer rates tripled. I think that this number was for total cholesterol. Does the magic number of 160 apply to LDL levels as well? I just wonder because these recommendations seem to get lower and lower.

  3. Joe Matasic on July 10, 2008 at 5:57 am

    When this article was in my wife’s paper two days, it was on the front cover as we were having breakfast. She told me not to read it because I would just get livid. For some reason it wasn’t in my paper (different one), but the next day there was one about some of doctors protesting it. Still got angry at the whole deal. At least some of them have some sense.

    I have a hard enough time convincing my brother and sister (who’s a vegetarian) of diet and health matters. My niece must eat 90% sugar I would swear. Luckily its never seemed to cause a cholesterol “problem” in my brother (he’s only 33 and active) yet, hopefully nothing will show in her if their doctor would have no cause to prescribe them. Unfortunately, they live away and I would only get a couple times a year to physically beat some sense into him. Let’s hope it doesn’t happen.

  4. Dave on July 10, 2008 at 7:13 am

    Not only is cholesterol a structural lipid, of course, it is functional as well, being the precursor to steroid hormones. Those steroid hormones might come in handy during growth and development, like in puberty. Thank God for the Internet, so parents at least have some chance to make health decisions based on a broader set of information than that provided by a particular segment of treatment providers.

    BTW, I’m guessing a lot of readers of this blog have seen this already, but there’s a killer post at the hyperlipid blog on the topic of LDL. In short, it gives a very well thought out hypothesis on how hyperglycemia results in elevated LDL, a result of glycation damage fouling up the ability of LDL to bind to cellular receptors. This hypothesis requires testing, of course, but it is at least head and shoulders above what biochem textbooks give as the explanation for how saturated fat raises LDL, which is basically “We have no clue.”

  5. Judy B. on July 10, 2008 at 7:30 am

    One of the scarier things about this is that if these guidelines are accepted by the profession, pediatricians will have to follow them or risk being sued. How did medicine get to this point? Following guidelines and avoiding malpractice are not practicing medicine in my humble opinion! Evidently it is OK to do harm if you are following those omni-present guidelines…..

  6. Max on July 10, 2008 at 7:35 am

    I like Larry Niven’s motto for things like this:
    “Think of it as Evolution in Action”

    So, you have a divergent species… we’ll call the two groups Free Thinkers (FT) and Sheeple (S). FT’s develop cognitive abilities that allow them to evaluate everything they read with a skeptical mind set, looking for truth beneath all that is venal and bent. S don’t, so they do what they’re told.

    What happens initially: FT’s (in a modern, non-agrarian world) tend to have smaller families. S tend to breed like, well, sheep. So, in the early going, S tends to outnumber FT. An application of Malthusian economics (known to be flawed, but still a worthwhile model) suggests that at some point, group S will create enough population pressure that war, famine or some other catastrophe will wean them out. FT’s will be affected, but will probably have bunkers to hide out the catastrophe. Or it could be something that doesn’t effect them. One reason why I oppose motorcycle helmet laws. Helmet laws inure S from making a bad decision, hence facing evolutionary pressure. Consider the choice to wear a motorcycle helmet as an evolutionary one. You can increase your risk of insulting your brain by not wearing one or you can decrease your brain insult risk by not. Without the law, a certain number of S motorcycle riders skip helmets (I see many here in Chicago) and probably leave messy red and gray splatters on area curbs. That was their choice. Now, they may have impaired judgment going in, but that’s evolution for you. The smarter (and luckier) survive to pass on their genes. The reckless morons who are unlucky lose the lottery (As a side note: I’m in favor of the irony of state funded lottery proceeds funding education… lotteries are more evolutionary pressure… me likey though me no play).

    Back to Statins for Kids. A few facts.
    1- Statins promote cognitive difficulty.
    2- Cholesterol is a structural fat.
    3- The brain is mostly fat.
    So, the S population posited above take their kids (with their chip and soda induced hypercholesterolemia) to their S pediatrician. They get statin drugs at age 8. The kids get the statin induced fuzzy head (one of my supervisors describes it as having only one marble in her head, and her mind works well only when the marble is properly aligned with the hole) and fall behind in their coursework at their S population funded (through state lottery) public school (yes, people who play lotteries pay a larger share of their school bill than regular homeowners… granted they probably have lower value homes, but let’s call it larger than their fair share). Oh, and they probably don’t repair and grow their brain quite as well as the non-statin population kids. So there’s less chance for a FT kid to come from an S home.

    The two groups diverge further. The apocalypse rages through the S population.
    Think of it as evolution in action.

    The flaw here is that kids who might be FTs get snuffed by their S doctors and parents. That’s the true crime here.

    Hey Max–

    Good to hear from you! When did you make the move from DC to Chicago?

    Are you still a gumment drudge or have you made the move to the private sector where your abilities will be more appreciated? How many true FTs do you know who work for Uncle Sam?

    Great theory, BTW. Thanks for sending.

    Cheers–

    MRE

  7. Bob Keim on July 10, 2008 at 8:48 am

    Thanks, I was hoping that you would give a fervent response to this travesty. I find it unethical to recommend a drug to children with growing brains that is known to have cognitive side effects in adults. We do not even have animal tests on growing brains.

    I experienced these side effects myself. After two years on statins (Lipitor) my memory seemed to be aging at a faster rate. It was harder for me to remember names. When I read the Brain Book that you reviewed, I discovered that this might be due to statins. Since I am over the age 65 cutoff, I stopped the statins and problem decreased. I have added a small (100 mg) dose of CoQ-10 and several other of the chemicals recommended in that book and am back to my memory of a few years ago. Now I occasionally remember someone’s name 🙂

  8. Razwell on July 10, 2008 at 9:06 am

    Hi Dr. Eades

    I wish the mainstream media would give attention to Dr. Ravnskov, Dr. Kendrick, and Dr. McCully to present the public with the truth about cholesterol . Perhaps Gary Taubes can mention them?

    I think getting the message of THINCS out in a major media oulet would battle the current nonsense .

    Take Care

    Razwell

  9. Rita on July 10, 2008 at 10:25 am

    Unbelievable, I wanted to vomit when I read this in the newspaper. Glad I’m out of practice and no longer FAAP. Excellent post.

  10. Robert on July 10, 2008 at 12:11 pm

    I’m so confused about the cholesterol/statin issue! I had some blood work done a few days ago and got a call from the nurse and later the doctor that they had found an “abnormality”, and that I needed to come in and see about getting on some medication. I don’t know what to believe anymore; I’m afraid to see my doctor out of fear that he will talk me into beginning a statin regimen. I am now leaner at 40 than I was in high school, middle school even and I don’t want to lose that!

    Its all very confuscing and I just don’t know what to do.

    Enter ‘cholesterol’ in the search function of this site. The resulting information should help.

  11. David MacPhail on July 10, 2008 at 1:55 pm

    In reading through a number of media articles on the subject of this thread one MD was quoted as saying that the recommendation to prescribe statins to children as young as 8 was supported by several studies that have shown that statins will clean plaque out of arteries. Based on this he posited that starting children on statins at an early age would improve their CV system and help head off future CVD.

    I have never seen a study that showed that statins cleaned plaque out of arteries. Yet, several of my friends who are on statins were told this by their cardiologists. The Vytorin study showed that statins actually accelerated plaque build up.

    Can anyone shed any light on the origins of the plaque clearing claim being made for statins?

    It’s right there by the study showing that Leprechauns come out and dance during the full moon.

  12. Alyssa on July 10, 2008 at 4:05 pm

    Hi Dr. Eades – I am subverting my ire at the whole prescribing-kids-statins thing into a curiousity about the recent studies re: sunblock and rising melanoma rates. This was a part of your book I found completely new and fascinating. I’d be curious as to your take on this.

    In particular, one write up I read commented that the level of cancer for young men has not risen, but it has for young women. As a (somewhat) young woman, I know my friends have been religious about applying sunscreen. My male friends, not so much. Gives me reason to wonder…

    It will be interesting to see what happens with the new sunscreens available now that block both UVB and UVA. UVB rays are the ones that burn – UVA rays are the ones that cause melanoma. When you slather on sunscreens that block only UVB (the only ones available in the past), it allows you to spend a lot more time in the sun. During that extra time, you are getting a lot of melanoma-causing UVA.

  13. ML Harris on July 10, 2008 at 4:06 pm

    Hey Dr. Mike

    Moved about a month ago.
    Still a FED. The vaycay and low expectations are pretty sweet. Plus, I got a big raise. So, I’m a higher paid fed. You’ll be happy to know, I’m doing accounting controls, and we’re consolidating, so I will have some responsibility for making sure gummint money doesn’t go to waste in like 18 states.

    I’d say it’s about 75:25 S:FT in here. If I bolted to private sector (for probably 40% more money), I’d probably be in the 50:50 realm. Really, a lot of people I did my MBA with are Sheeple. A lot of education will sometimes do that.

    Why don’t you do a study. Ask all your co-workers whether they view themselves as sheeple or free thinkers. I’ll bet all the FTs will deem themselves FTs. But so will the sheeples. They’ll all deem themselves FTs as well. Then ask all the people to estimate the ratio of S:FT. I’ll bet they would all come out to a ratio similar to yours. It would be like that famous study where 85 percent of drivers rated themselves as being better than average drivers.

    Cheers–

    MRE

  14. steve on July 10, 2008 at 4:30 pm

    Let’s roll the clock back 50 years or so when all US children were eating meat, milk,cheese,etc with minimal processed foods. Imagine these wise pediatricians measured cholesterol levels of all children 10 years old. Result: They would have put the entire population of 10 year olds on statins! And guess how guess how many of those 10 year olds eventually develped heart disease? Not many i bet Simply ridiculous.

    I do believe statins benefit adults who have heart diseease or who have some developing heart disease as measured by calcium scores, or carotid artery thickening seen through ultrasound with perhaps a family history of heart disease; but without these factors should not be prescribed.

  15. steve on July 10, 2008 at 5:12 pm

    after fully reading this blog i would like to comment on several things:
    1. Non smoker who had heart attack at 52: my brother- not overweight and physically active. Perhaps family history of heart attack of father in 60’s and grandfatiher at about age 55. No history of hypercholesterldemia; lvels around 200
    2. Sounds like genetics may play a greater role than any kind of diet

    3. I am approaching 58 and have avoided any issue(hopefully for now) except VAP test shows way to much LDL being produced-1900 vs 1000 whatever that means. Triglycerides are only 75. IMT shows slight thickening for age. Perhaps to much carbs in diet, but no junk/refined carb and very little sugar.
    4. Would like to try this diet, but am nervous; doc says diet not matter it is in the genes, but will gingerly move to it- eliminate starch altogehter. Starting statin .

    5. Possible some of us just make to much bad small particle LDL?

    If you had a heart attack at age 52 (and I assume you are a male), you are one of the few legitimate candidates for statin therapy.

    I think your VAP test is measuring apoB100, which is a measure of the number of LDL particles. It’s difficult to tell what’s really going on without an LDL number and a previous LDL number. The low triglycerides typically mean that one isn’t making a lot of small, dense LDL particles.

  16. Lynn on July 10, 2008 at 5:32 pm

    To the patient’s detriment, there too often seems to be a disconnect between medical science and public health recommendations.

    As you state, “Double-blind, placebo-controlled studies have shown that statin drugs provide no benefit in terms of increasing lifespan…” and yet most physicians continue to recommend statins. For whatever reason (greed? ignorance?), current science does not rule the day so instead we get “extrapolations” and sheer guesswork. Scary.

    But then, for years doctors have prescribed antibiotics to treat colds. Surely that science is not in dispute, but it is still ignored. Why?

    Briefly, my personal experience with statins included a severe bout of arrhythmia and then, after six years of increasing dosages, joint and muscle pain. My doctor declined to make any serious connection between my symptoms and my statin use.

    Finally, about four months ago, after enduring increasing joint and muscle pain, I was virtually unable to lift one leg to climb a set of stairs. I then took into my own hands and stopped statinating myself. The pain continues to gradually diminish and is almost completely gone.

    You web site (found via Fred Hahn’s site) has proved a valuable resource.

    Thank you, Lynn

    Hi Lynn–

    Welcome aboard. One other step you can take to help with your statin related problems is to add the supplement CoQ10 to your regimen if you haven’t done so already. The pathways through which statins work is the same pathway that synthesizes your own CoQ10. People on statins or who have taken them invariably have low CoQ10 levels.

    Best–

    MRE

  17. labrat on July 10, 2008 at 9:09 pm

    What I find appalling is the reporting on this. The reporters state plain as day that there is a paucity of evidence and a whole lot of “believing” and “hoping” going on with these recommendations, but they don’t challenge any of the assumptions and extrapolations being made.

    I wish Nick Regush was still alive – at least I know he’d be out there questioning the experts on the advisability of making sweeping recommendations with no evidence of their utility.

  18. Brian Clark on July 10, 2008 at 10:07 pm

    Here is the comment I posted on Dr Graveline’s forum in response to that news :

    “The first comprehensive study into psychopathy was published by Hervey Cleckley MD in 1941 as “The Mask of Sanity”. It described how psychopaths could effectively mimic the non-psychopathic to win trust, gain influence and manipulate others to their advantage.

    The behaviour of pharmaceutical corporations (and other corporate entities) echoes psychopathic behaviour and amplifies that of the psychopathic types that they recruit and promote for their undeniable effectiveness in ruthlessly promoting the “bottom line”.

    We have marketing-based medicine cleverly mimicking science-based medicine. The outward appearance belying the dirty little secret within.

    Needless to say this has had a devastatingly corrupting effect on the non-psychopaths practising medicine and government decision-makers.
    Also on the senior academics responsible for seeking research funding.

    Journalists too are enchanted and ensnared. ”

    There will be no hope of real progress until this is recognized and understood by the majority of the medical profession.

  19. ob on July 11, 2008 at 12:39 am

    I’m speechless. Lets hope (and try and ensure) it doesn’t go mainstream.

    Too late. The American Academy of Pediatrics is about as mainstream as you can get.

  20. Chris on July 11, 2008 at 1:10 am

    Hi Dr Mike,

    It isn’t all bad news! Statin lunacy may be spreading, but the Paleo fightback has also begun. This article attracted a reasonable amount of attention in the UK press.

    http://www.nature.com/ejcn/journal/v62/n5/abs/1602790a.html

    Here is the media view:

    http://www.metro.co.uk/news/article.html?in_article_id=146672&in_page_id=34
    http://www.dailymail.co.uk/health/article-564859/Caveman-diet-lowers-risk-heart-disease-new-research-shows.html
    http://www.telegraph.co.uk/news/uknews/1938069/Eat-like-a-caveman-for-a-healthy-heart.html

    Of all diets, the low carb diet under the guise of a paleo diet, I find, is the easiest to understand and follow. Unlike all those other diets, the results also deliver on the promise.

    Keep up the good work.

    I read this article when it first came out. Here’s another one from Nutrition & Metabolism.

  21. Bill on July 11, 2008 at 8:12 am

    Iam on statins 10 mg lipotor my toatal cholesteral was 152, 8 months ago.But last week i quite taking them the more i read the more i disaprove of them.The big drug companies should be ashamed of there selves it’s all about the money they dont care about anyones health.The funniest thing i ever read was in the southbeach diet book DR Agustin says he takes statins and recomends them.Wonder how much he got for that statement, money talks.

    Another thing I don’t like about the South Beach Diet.

  22. Marxist-Socialist on July 11, 2008 at 9:35 am

    HEY I HAVE A QUESTION: DOES PROTEIN ELEVATE INSULIN OR NOT?

    Here is an article, which claims that protein elevates insulin, and that fat is the only macro-nutrient not having effect on insulin levels:

    I thought that protein didn’t elevate insulin. I was wrong. Protein elevates insulin

    ——————————————————————————–

    Read this article which claims that a diet high in fat, moderate in protein and carbs is best for people who get fat easily. This is because fat is the only macronutrient which doesn’t elevate insulin. I thought protein didn’t have any effect on insulin as well:

    INSULIN SENSITIVITY AND FAT LOSS

    http://bodyrecomposition.com/Fat%20loss/lylemcdonald-ins.html

    Putting it into practice

    If you have good insulin sensitivity and low insulin secretion, odds are you will do well with a traditional bodybuilding type of diet which means high protein, highish carbs and low fat. Let’s say you’re consuming 1 g/lb of protein at 12 cal/lb. That’s 40% protein. If you go to 1.5 g/lb, that’s 50% protein. That leaves you with 50-60% of your calories to allocate between fat and carbohydrate. 15-20% dietary fat is about the lower limit. it becomes impossible to get sufficient essential fatty acids. So your diet will be roughly 40% protein, 40-45% carbs and 15-20% fat. If protein goes to 50% of the total, carbs should come down to 35% of the total with 15% fat.

    If you’re not insulin sensitive and/or have high insulin secretion, a diet lower in carbs and higher in fat (don’t forget that protein can raise insulin as well) is a better choice. Assuming, again, 40% protein, a good starting place might be 40% protein, 20-30% carbs and 20-30% fat. A further shift to a near ketogenic (or cyclical ketogenic) diet may be necessary, 40% protein, 10-20% carbs and the remainder fat may be the most effective. If protein is set higher, up to 50% protein, carbs woul be set at 10-20% with the remainder (20-30%) coming from dietary fat.

    Summing up

    Hopefully the above has given you some insight into choosing what might be an optimal fat loss diet without having to go through so much tedious trial and error. However, please don’t treat the above as more than a starting point. Adjustments to diet in terms of calories or nutrient intake should always be based on real world fat loss. You should be tracking your fat loss every 2 weeks (4 at the most); if you’re not losing at a reasonable rate (1-1.5 lbs fat loss/week), you need to adjust something.

    Bio: Lyle McDonald received his BS in physiology from UCLA in 1993 and has been obsessed with all aspects of human performance (training, nutrition, supplements) since then. He has written extensively about fat loss, especially low carbohydrate dieting. He is currently working on a book covering all aspects of protein nutrition for athletes as well as an approach to getting rid of stubborn bodyfat. His website is http://www.bodyrecomposition and his books can be ordered there by clicking on the store link.

    References:

    1. Blundell JE, Cooling J. High-fat and low-fat (behavioural) phenotypes: biology or environment? Proc Nutr Soc. 1999 Nov;58(4):773-7.
    Pittas AG, Roberts SB. Dietary composition and weight loss: can we individualize dietary prescriptions according to insulin sensitivity or secretion status? Nutr Rev. 2006 Oct;64(10 Pt 1):435-48. Review.
    Cornier MA et. al. Insulin sensitivity determines the effectiveness of dietary macronutrient composition on weight loss in obese women. Obes Res. 2005 Apr;13(4):703-9.
    Pittas AG et. al. A low-glycemic load diet facilitates greater weight loss in overweight adults with high insulin secretion but not in overweight adults with low insulin secretion in the CALERIE Trial. Diabetes Care. 2005 Dec;28(12):2939-41.

    A great deal of recent research has found that low-carbohydrate diets are superior for individuals with insulin resistance or the metabolic syndrome.

    The Ketogenic Diet: A Complete Guide for the Dieter and Practitioner takes an in-depth look at the topic of low-carbohydrate/ketogenic diets.

    This book serves as a reference for the dieter who has questions regarding the physiology, adaptations, and effects of a ketogenic diet. The contents are fully referenced for health professionals such as dietitians, physicians, personal trainers and nutritionists. Anyone interested in the ketogenic diet will find this book a valuable resource.

    Note: This book does not cover the ketogenic diet for pediatric epilepsy. I highly suggest The Ketogenic Diet: A Treatment for Epilepsy, 3rd Edition (Paperback) by Freeman, Freeman and Kelly (link will take you to Amazon.com page)

    Protein does indeed elevate insulin levels, a subject described in depth in Protein Power. Protein also elevates glucagon (insulin’s counter-regulatory hormone) levels, which counters insulin’s effects.

  23. Marxist-Socialist on July 11, 2008 at 9:45 am

    Hello, but the article i posted contradicts many other studies which claims that high protein diets, increase glucagon levels. So that article contradicts the fact that when people take a lot of protein, glucagon levels increase.

    Here is another article which says that high protein intake elevates glucagon hormone (The fat burning hormone):

    http://www.lowcarbfriends.com/bbs/weight-loss-journals/466675-just4me-charge-taking-control-4.html

    Protein is very dehydrating. The main reason this is so, is because the metabolism of protein increases glucagon, and glucagon pretty much does everything insulin doesn’t do (whereas insulin makes us store stuff, which leads to water retention… glucagon makes us get rid of stuff, which leads to storing less fluid and dehydration). THis is why one of the cardinal signs of diabetes (insulin insufficiency, relative or absolute) is polyuria (frequent urination) and polydipsia (extreme thirst) often with severe dehydration. At the same time blood glucose rises, the individual is finding it incredibly difficult to maintain fluid balance because of the metabolic derrangements from insulin insufficiency – they urinate and drink water frequently. With no insulin to store minerals/fluid, and too much (unopposed) glucagon to stop releasing/wasting, this is bound to occur.

    A similar, but non-pathogenic effect is observed when protein intakes are high (in the context of a low carbohydrate, thus low insulin-producting diet). A high protein low carb diet switches up the balance between glucagon (higher) and insulin (lower) which makes us drink and pee more frequently. It’s healthy and normal in this condition, and it has the nice little perk of showing up rapid, and motivating weight loss on the scale (and often in our clothes, too, since a lot of fluid is in the interstitial spaces, especially if we’ve glucose metabolism & insulin problems, comming off a high carbo diet).

  24. steve on July 11, 2008 at 11:42 am

    Thanks for the response Doc: I have not had a heart attack, my brother at 52 did, a non smoker in good physical shape, but with family history:father in ’60’s and grandfather(paternal) in 50’s although both of them were smokers! Brother was not, nor overweight.

    Lipid profile is mine. Approaching 58 I am trying to avoid having one, but doc says IMT is showing increase in thickening slightly above what see for my age, and so he did the VAP with the results as i stated. Never have had high triglycerides,but have learned lots from your site: THANKS! I will eliminate the starch and sugar and up the protein(lots of fat still scares me) and see what profile shows

    Yes, I am male.

    Your comment: I think your VAP test is measuring apoB100, which is a measure of the number of LDL particles. It’s difficult to tell what’s really going on without an LDL number and a previous LDL number. The low triglycerides typically mean that one isn’t making a lot of small, dense LDL particles.
    If your comment is correct why is there narrowing of the carotid artery? Could it be a genetic profile that just produces to much bad LDL in my body?
    Thanks again: REAL STOREHOUSE OF KNOWLEDGE HERE

    If you’re worried – and it’s obvious that you are – why don’t you get a calcium score? A calcium score is a much better predictor of whether or not you’ve got developing heart disease than is carotid intimal thickening. A way better than any kind of a lipid lab evaluation. Try to find someone who has an EBT machine, which uses much, much less radiation as compared to the normal CAT scan machines. Get a calcium score, then you’ll know what’s going on.

    Read Dr. Davis’s blog and book to learn about calcium scans and what they can and can’t do.

  25. Anne on July 11, 2008 at 1:10 pm

    I haven’t been so angry in a long time.
    This would be so disasterous on so many levels.

    As I said to my brother the other day, I am now 100% convinced that the easiest way to commit suicide in this country is to do exactly what your doctor says without asking a single question or educating yourself further. (Present company an exception, of course.) Really want to do yourself in? Check into a hospital–it is a scary day when you can find healtier things on a McDonald’s menu than on a hospital menu. They will also happily prescribe all manner of unneeded meds and give you an antacid every evening whether you need it or not.

    Speaking of food in the hospital, see Peter’s comment just a few down the list from yours. Truly a sad state of affairs.

  26. Katy on July 11, 2008 at 5:19 pm

    Yes, what Judy B. said above (“Evidently it is OK to do harm if you are following those omni-present guidelines….”) is absolutely true. Protocol is everything, even if it means giving blood thinners to patients admitted to hospitals before it’s been determined that they need them or not. My elderly friend, in the hospital for a hip replacement, refused all blood thinners until they could show him what his levels were. The pharmacist showed up in his room to beg him to take it, because it was “protocol.” A few years earlier, this same friend’s wife nearly died from a lung hemorrhage due to too much heparin, and he also knows that quite a few of his deceased friends died of hospital-induced strokes. We have to be our own health advocates and I pray that parents do not allow statins to be given to their children.

    I wouldn’t believe this story if I hadn’t seen it happen too many times myself. There is so much to learn in the art and science of practicing medicine that far too many people substitute reliance on various protocols instead of relying on their common sense. If you use your common sense and are wrong, you get sued and lose; if you correctly follow protocols that are wrong (giving kids statins, for example), you can’t be blamed. That’s why so many doctors and other health professionals follow protocols instead of using common sense.

  27. Kim on July 11, 2008 at 8:22 pm

    I can’t even say how bad I feel about this news. I hope the generation of kids who go through this don’t end up permanently harmed.

    On a more general level, though…how did we let our medical system get to this, where we’re diligently working at starving primary care providers out of existence, and instead throwing more and more money down the hole of lifelong med regimens of questionable value? And of course ignoring the big elephant in the room that is poverty and its attendant morbidity. I feel like we as a nation are well and truly screwed.

    And if we end up going the socialized medicine route, we’ll be even more screwed. We’ll have the same screwed up system, but run by substandard doctors.

  28. David MacPhail on July 12, 2008 at 9:15 am

    Further to my earlier post about claims that statins would clean arteries I found an article on Medical News Today that cites the following study:
    http://www.medicalnewstoday.com/articles/39470.php

    Intensive Statin Therapy Can Partially Reverse Plaque Build-up In Arteries
    ATLANTA, GA (March, 2006)
    A study presented today at the American College of Cardiology’s 55th Annual Scientific Session demonstrates, for the first time, that very intensive cholesterol lowering with a statin drug can regress (partially reverse) the buildup of plaque in the coronary arteries. This finding has never before been observed in a study using statin drugs, the most commonly used cholesterol lowering treatment.

    Dr. Nissen will present the results of the “Effect of Very Low LDL-C Levels on Regression of Coronary Atherosclerosis: Results of the ASTEROID Trial” study on Monday, March 13, 2006 at 2:20 p.m.

    I could not find any reference to a paper as having being published on this study. So I do not know if the study was subject to any form of peer review. Nonetheless it is interesting how the plaque clearing claim has influenced the opinion of medical professionals in the face of peer review studies that have shown that plaque build up actually continues to increase with the use of statins.

    It’s because these presentations are not peer reviewed. They are peer reviewed in the sense that the peers of the presenters are in attendance and ask questions, but they aren’t rigorously reviewed as they should be in the peer-review process before publication. Since this study hasn’t been published, and since all medical journals (subsidized by the drug companies) would love to publish such a study, there must have been real problems with the way the study was done or how the results were calculated.

  29. Brad on July 12, 2008 at 10:55 am

    I wondered how long it would take you to pick up on this one. I saw it on the news and the first thing I thought of was your likely response. 🙂

  30. peter on July 12, 2008 at 12:06 pm

    Dr. Mike, thought you might get a kick out of this, though it really should be no laughing matter:

    http://www.heraldguide.com/details_archive.php?id=3539

    I am of course referring to the body shape and size of dietitian lady.

    And that’s not to mention her boss, the hospital’s head of food and nutrition.

  31. Ken on July 12, 2008 at 12:18 pm

    Dr. Eades,

    When I read the BBC article on prescribing statins to children I was shocked. I had just finished reading another news article on a new CJD variant found in the US, and the combination put me over the top. This is a bit convoluted, but hear me out.

    Back when I was a technician in a diagnostic toxicology lab, one of my supervisors told me about a study he did using alpha-napthyl-thiourea. It was being explored as a compound to kill fire ants by blocking glutathione synthesis. Unfortunately, it caused small vacuolation lesions in the hearts and brains of the test guinea pigs and chickens used to evaluate safety. In my doctoral studies for neuroscience, I learned that glutathione is the major compound responsible for free radical absorption and prevention of oxidative damage in the brain and heart. More recently I learned that coQ10 is also required for glutathione synthesis. Since statins cause coQ10 depletion, I suspect that much of the cardiomyopathy seen with statin use is due to oxidative damage as a result of glutathione depletion. After reading the article on the new CJD variant, which has a rapid onset and none of the typical clinical predictors, it would not surprise me if it was also due to statins.

    With all that you and others have pointed out about the negative side effects of statin use, and their limited benefits, I am outraged at the suggestion that children should be prescribed them. From a neurodevelopmental point of view alone, I know that there are periodic spikes in sex hormones throughout normal development that are necessary for normal brain development and sexual differentiation.

    I’m glad you brought this up. In my rage over these stupid recommendations, I forgot to list cardiomyopathy as one of the side effects of statins. Your theory on how this comes about makes sense. Thanks for commenting.

  32. Robert on July 12, 2008 at 4:54 pm

    Why are doctors so easy to hand out these statins? Is it all about money? I wonder if my PCP is pushed by someone (he is part of a medical group) to bring in dollars. Is the cost of having your own practice now so prohibitive that individual doctors must tow the line in order to practice medicine at all?

    I no longer trust my doctor. He prescribed me two meds in the past that had serious side effects; one was taken off the market, and for the other one, he didn’t tell me about the serious side effect (which occurred!!)

    This is insane.

  33. Daryl on July 13, 2008 at 4:11 am

    In response to one of the above comments, you said:

    “If you had a heart attack at age 52 (and I assume you are a male), you are one of the few legitimate candidates for statin therapy.”

    What benefit would he get from the drug?

    Thanks for the incredible information you share with us, Dr.

    He probably wouldn’t get a lot of benefit, but men under the age of 65 who have had a heart attack are the one and only group of people who have been shown to receive benefit from statin therapy in terms of lower all-cause mortality as compared to that same group of subjects not taking statins. The benefit is small, meaning that it doesn’t help most, but it is still there.

  34. Wil B. on July 13, 2008 at 9:42 am

    Hi Dr. Mike.

    In your response to Ken you said: “I’m glad you brought this up. In my rage over these stupid recommendations, I forgot to list cardiomyopathy as one of the side effects of statins. Your theory on how this comes about makes sense. Thanks for commenting.”

    Just wanted to mention that your thincs colleague Peter Langsjoen (a practicing cardiologist in Texas I think) has written about this and related topics extensively. He also recommends supplementing with CoQ10. For your other readers, here’s a link.

    http://www.thincs.org/public.htm#Peter

    Thanks again for all you do.

    Regards,

    W

  35. Cindy Moore on July 13, 2008 at 7:33 pm

    I cringed when I read this.

    What happens when the girls (accidentally or deliberately) get pregnant?

    If they stop the drugs before they get pregnant, how long a time is necessary before it would be considered “safe” to conceive? And just what are the “side effects” of being on a statin during pregnancy?

    Even the drug companies say statins should not be taken by “women who may be pregnant or may become pregnant”!!

    Precisely. Another contingency I hadn’t thought of. The worst part of this whole affair is that the kids will get these drugs without any choice on their part. Adults at least have the opportunity to do their own research and say no if they don’t want to take them. The kids – who will suffer in the long run (and maybe in the short) won’t have that option.

  36. Leslie on July 14, 2008 at 4:25 pm

    Hey Dr. Mike – did you know that posting vocabulary gets more difficult the angrier you get (i.e. putative, pernicious, etc.)? You’ll need to start dumbing down your posts if you have any hope of reaching the statinated masses with the voice of reason. They don’t have their complete mental facilities anymore, you know!

    Yes, I guess rage just brings out the sesquipedalian in me. 🙂

    Cheers–

  37. Monica on July 14, 2008 at 8:08 pm

    Dr. Mike — wow. You are not only right about diet, you’re right about socialized medicine, too 🙂 Way off topic, but I thought you might like this article:

    http://www.theobjectivestandard.com/issues/2007-winter/moral-vs-universal-health-care.asp

    I’m a newcomer here and really enjoy your site. Keep up the great work!

    Hi Monica–

    Welcome aboard. I’m glad to hear you’re enjoying the site. And thanks for the link; it’s a great article.

    Here’s one back you might enjoy; it’s a real eyeopener.

    Best–

    MRE

  38. Guy on July 15, 2008 at 7:28 pm

    Interesting articles! Thanks for the links.

  39. W. NIddery on July 16, 2008 at 10:20 am

    Bill said “big drug companies should be ashamed of there selves it’s all about the money they dont care about anyones health”.

    Your blame is misplaced. Doctors wanted a drug to reduce cholesteral, drug companies responded *as they should*. After investing to develop any drug, it is perfectly proper for them to want to sell enough of it to not only cover that cost, and make a profit.

    It is up to *doctors* to make sure any drug is prescribed appropriately. Any doctor that becomes a shill *knowingly doing so contrary to his good sense as a doctor” deserves the most blame. Secondarily are those doctors that will prescribe medicines only to satisfy political masters and/or avoid malpractice, though it is really difficult to blame then in the latter case, the blame then belongs on the political side and all those that keep voting for socialized medicine.

    I agree and disagree with you. It is the doctor’s responsibility to know the facts about the drugs he/she prescribes. But regular practicing physician’s don’t have the time nor the training to track down and decipher the scientific studies on all the prescription drugs in existence. Most doctors rely on information provided them by the pharmaceutical companies and rely on the FDA that has approved the drugs. Doctors don’t make a penny when they prescribe a drug, so greed isn’t involved on their part.

    In the case of cholesterol-lowering drugs, it was the pharmaceutical companies that persuaded the doctors that their patients needed to have their cholesterol levels lowered. Doctors didn’t come up with this idea then demand that the drug companies develop a drug for them.

  40. Patricia on July 16, 2008 at 11:53 pm

    I propose that we use the offspring of the drug company execs, salespeople, and researchers as the first guinea pigs. (Why is it that I foresee a time when kids will be forced to take drugs in order to enroll in school, kind of like they are forced to have immunizations ?)

    Btw Dr. Eades, I saw your Blackburn Award entry but could not comment on it because it was so old, but now I am re-reading Alicia Mundy’s “Dispensing With The Truth” (about Fen-Phen, for those of you not familiar with the book) and taking great fearful interest in the new drug lorcaserin (in clinical trials right now), and I came across a news article from 2006 which said: “Dr. George Blackburn says the practice is untested, and patients who seek off-label drugs for weight loss are desperate and vulnerable. “They need therapy,” he said. “They need counseling, they do not need an off-label medication.”” What a hypocrite ! In the mid 90’s he was an active proponent of the off-label Fen-Phen cocktail !! This is well-documented in Mundy’s book. I guess all of those lawsuits, if not the deaths of patients, made him jumpy.

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