Tuesday, January 01, 2008

Fruit and vegetables WHEL study

There are people, like these "scientific" committee members, who believe that if "powerhouse" fruit and vegetables were eaten more often in the USA, there would be major health benefits. Don't bother getting the full text.

Here's a flavour of the outpourings of Nanney, Haire-Joshu, Hessler and Brownson:

"Epidemiological (yawn) data published from large longitudinal cohort studies such as the Women’s Health Study, Health Professionals Follow-Up Study, Physician’s Health Study, and National Health and Nutrition Examination Survey (NHANES) have helped to identify food constituents (dietary folate, vitamin C) 3, 4, 5 and 6, food patterns (cruciferous vegetables) 4, 7 and 8, and specific food outcomes (carrots, tomatoes) 6, 8, 9, 10, 11 and 12 as more directly linked to reduced risk for selected chronic diseases. For example, consumption in the highest quintiles of green leafy vegetables is associated with a risk reduced by 6% to 30% for cardiovascular disease and stroke 4, 7 and 8. High intakes of broccoli and spinach are associated with reduced risk for some cancers 11 and 12 and cataract formation 13, 14 and 15. The Netherlands Cohort Study on Diet and Cancer (1986–1992; n=62,573) further specified that women with the highest consumption of cooked cauliflower and cooked spinach were associated with 38% to 49% risk reduction in colon cancer (11)."

Oops, I fell asleep after the first word.

The first word is epidemiological. That is; only useful for generating speculation.

OK, let's speculate, I mean generate an hypothesis. I hypothesise that a massive, intensive and long duration intervention trial, to get women to eat "powerhouse" fruit and vegetables, will do nothing to prevent or reduce the recurrence of previously operated breast cancer. Someone else generated a very different hypothesis. They got mega funded to check it out.

They set up the WHEL (Women's Healthy Eating and Living) study. Nice catchy name.

How might one change women's eating habits? Let's try this:

"The Women’s Healthy Eating and Living Study’s principal strategy to promote dietary change involves a telephone-counseling protocol that facilitates one-on-one advice tailored to the needs of the individual participant. The highly-structured, computer-assisted protocol facilitates standardization of the intervention. Quality control is enhanced by providing this telephone service from a centralized location at the Study Coordinating Center, thus enabling weekly case management meetings and considerable flexibility in scheduling. Counselor performance is carefully monitored, and regular feedback comparing individual to group performance has led to considerable consistency across counselors. Additional intervention strategies include an orientation meeting, monthly cooking classes, and monthly newsletters. The intervention protocol recommends 28 to 36 intervention contacts during the first 12 months (Table 1), with the majority (54% to 64%) of these contacts made by telephone."

This will work. It did work. What did it achieve?

It achieved "5 vegetable servings plus 16 oz of vegetable juice; 3 fruit servings; 30 g of fiber; and 15% to 20% of energy intake from fat."

It worked for 7.3 years. This is hard core long term intervention stuff. No groups of 10 people for 8 weeks and measure a few lipid parameters. This is big research using big money to make a big point. To confirm all of the benefits of those mysterious micro-nutrients in the vegetable juice.

What did it achieve? I can't say anything. I just have to leave it to the WHEL study team 2007 report:

"CONCLUSION: Among survivors of early stage breast cancer, adoption of a diet that was very high in vegetables, fruit, and fiber and low in fat did not reduce additional breast cancer events or mortality during a 7.3-year follow-up period."

Pretty conclusive. No mincing of words.

You could say it didn't do any harm I guess.

Phew.

Peter

13 comments:

Stan said...

Hi Peter,

Your essays are supporting and confirmed my suspicion that some positive effects of vegetables and fruit are purely accidental and occur only if they displace and reduce the overall carbohydrate intake. This could also explain some anecdotical reports of cancer remissions on raw vegan diets. The telltale sign of this is a reported correlation between body fat and cancer: - those patients who lose a lot of weight on a hypocaloric vegan diet may fight their cancer better not because of vegetables but because of less glucose and less insulin. Those vegetarians who do are not hypocaloric experience no difference.

Loosing weight versus not loosing weight on a vegetarian diet is a function of calories which in the vegetarian context means of course calories from carbohydrates. Obesity may be in this context a proxy marker for carbohydrates. The same with a cancer risk: vegetables or not - more carbs = more cancer, less carbs = less cancer regardless of the specific choice of green vegetables versus white starches etc.

You have referenced some very interesting papers. I hope you don't mind if I requote your linked papers (and your blog) on the WebMD?

Best regards,
Stan (Heretic)

Peter said...

Hi Stan,

Best wishes for the New Year btw! Been off line over most of the celebrations.

Yes, I think we agree here.

The other HUGE point in favour of hypocaloric vegetarian diets, even vegan diets, is that they are based on saturated fat in large amounts. After all, if you eat 800kcal of leaf vegetables and some tofu, your body will be desperate ANY nutrition. Obviously first port of call is your big butt, stored for just such a catastrophe. Stored palmitic acid is a safe source of energy. It was probably initially generated as the detoxification product of the HFCS that promoted the cancer (and the big butt) in the first place. Anyway, during weight loss a human is primarily running on saturated fat, self generated and self stored and now self nourishing. If the total of ingested calories is low enough there will even be ketone bodies too. Now you're talking health.

One of my major nutritional tenets is that fructose, and to a lesser extent glucose, are converted to long chain SATURATED fatty acids as these are metabolically stable and thus safe for use as long term stored energy reserves. I'll concede a proportion of monounsaturates are acceptable too but palmitic acid, now there's a neat molecule!

They're light too, as an extra benefit, which is useful in the mobile-animal kingdom's on going fight against gravity, but that's another idea...

Obviously weight stable vegetarianism would do nothing.

The WHEL study generated weight stability!!!!!!!!!!!!!!!!

A mean change of +0.04kg in 7.3 years...........

Peter

Re WebMD, feel free. I can't visit there, most are too committed to the WHEL paradigm. Hopeless. As in, for most of them, there is no hope. Too sad.

Stan said...

Re: Anyway, during weight loss a human is primarily running on saturated fat, self generated and self stored and now self nourishing. If the total of ingested calories is low enough there will even be ketone bodies too. Now you're talking health.

Absolutely! That's one of the things I noticed looking at (researching) those people on the Ornish vegan forum - there is a pattern:

- almost all people who are overweight report benefits, sometimes very enthusiastically, when they initially start their low fat vegan diets. Those who are already of the normal weight or underweight do not seem to thrive.

After a while however, when the overweight lose enough body fat a vast majority of them tend to fall off the wagon complaining of various difficulties, usually of some persistent craving and experience food binging. At this stage (typ 6m-1y) they usually quit posting on those boards and I never here from them again, unfortunately.

It would be interesting to examine the aftermath of veganism more closely but that is very difficult because all vegan support boards I know of, routinely delete all postings that may be unenthusiastic, report failures or just ask too many questions.

Since their information is so heavily filtered, most of the vegans seems totally unaware that a vast majority of them are probably poised for a long term failure.

All the best in the New Year!

Stan (Heretic)

P.S.

There are some interesting new articles on Kwasniewski's website:

"Glucose as a source of endogenous oxygen"

http://dr-kwasniewski.pl/media/2/bib-1/Krystyna.txt/news%20831.doc

"Comparison of concetration of Pb,Cd and Hg in bodies of people on normal nutrition versus Optimal"

http://dr-kwasniewski.pl/media/2/bib-1/Krystyna.txt/news%20826.doc

http://dr-kwasniewski.pl/media/2/bib-1/Krystyna.txt/news%20827.doc

team smith said...

hello peter, i just discovered your very interesting blog and i had a question that does not relate necessarily to this particular post, but i was unsure where to ask it. i am very familiar with the need for more saturated fats and fewer carbs as i have studied this via the Weston A. Price Foundation and from there found more resources.

i am curious about your own diet as you say you eat about 80% fat and extremely little carbohydrate. would you be willing to share an example of what your diet looks like on a daily basis? and what would you suggest to a person who has a difficult time digesting fats and finds most of them unpalatable--how can a person revamp their diet towards more fat if they don't like them?

thank you!
amanda

Peter said...

Hi amanda

It's up

Peter

PS

Re the increased fat intake, well the palatability aspect is learned and usually amenable to relatively hidden fat like ice cream if home made (see post). But it really is possible to "learn" to enjoy fat. To cut much of the meat from a chop (give it to the cat) and eat the fatty bit....

Re digestion, well this is interesting. I am very suspicious that poor fat absorption is a marker for sub clinical gluten intolerance. If you have poorly developed brush border cells you may not up take lipids well. There is a post as to the hows and whys which needs writing but but but... Also I blame gluten for every illness that's not due to fructose....

maurile said...

"CONCLUSION: Among survivors of early stage breast cancer, adoption of a diet that was very high in vegetables, fruit, and fiber and low in fat did not reduce additional breast cancer events or mortality during a 7.3-year follow-up period."

Unfortunately, the "high in vegetables, fruit, and fiber" aspect of the diet was not isolated from the "low in fat" aspect. It's possible that the fruits and vegetables helped, but were offset by the lack of fat.

Peter said...

Hi maurile,

Absolutely, a lack of control of variables. But the problem is always that putting something in means taking something out, unless you add bran to an unchanged diet, and the DART study was not too supportive of this approach. The other thing I feel strongly is that fruit and vegetables are very different from each other. No one (except perhaps a type 1 diabetic) spikes their blood sugar level with a serving of cabbage. Not so the large juicy orange. Even if you stay normoglycaemic you spike your insulin levels with the orange... Hard to say whether the sugar or the insulin does most damage, I guess a bit of both.

In many ways the high fat approach wins because it is quite difficult to make fat unhealthy. OK, we "trans" it, we drink rancid vegetable oil, we are probably looking to breed cows which only have monounsaturated fats in their milk, but there are limits to the ability of our stupidity here. A cow's rumen protects us from a lot of grain.

Compare that to what we have done to apples, oranges, strawberries, plums etc. Just bags of sugar. Vegetables, especially the leaf ones seem closer to food. Full of plant toxins of course, but better on the glucose insulin front, less agriculturalised.

Also I think it was sasquatch somewhere else on the blog who suggested that we humans, when we can, add butter to vegetables when we cook/serve them, so vegetable intake could be a surrogate for butter intake (outside the WHEL study). Well, it made me laugh! But what gets added to stewed fruit? Modern ice cream and custard are just sugar...

So yes, the WHEL study designers were given a blank cheque and didn't control their variables. Much of the trouble with medical research is it is not done by scientists. My wife gets annoyed we me for being anti scientist (she is one!). Absolutely wrong, I'm very pro science. Scientists give us facts. Most nutrition research gives us belief structures, not science.

Peter

LeonRover said...

Like "military intelligence", "dietetic science" is an ox-y-moronic.

LeonRover

Cloud Tiger said...

Hi Peter,

Enjoying your blog as usal..

I am trying to figure the science on fructose. I love fruit but also love fat! I do not think they are compatible and am confused.

"Even if you stay normoglycaemic you spike your insulin levels with the orange" you say.
The following study says not
http://jcem.endojournals.org/content/89/6/2963.long
What would you say?
Thanks

Peter said...

Hi Cloud Tiger,

Havel is working on the basis that insulin, which acts as an anorexic agent post prandially, does this 24/7. Which I personally think is completely incorrect.

If you load up your link and click on the last author you get a list of all of that author's publications and number one on the list at the moment is

http://jcem.endojournals.org/content/96/12/E2034.abstract?sid=b18a551f-8f8e-4f25-8e23-4971b651c164

where he nicely demonstrates that increased fructose consumption is all you need to worsen metabolic syndrome. You would have thought that drinking all that HFCS would have you skeletal in 10 weeks if chronic fasting hyperinsulinaemia was an anorexic hormone but you have to remember these papers are written by obesity researchers who... shrug! You notice they consider pro inflammatory cytokines cause metabolic syndrome, they didn't measure insulin. It went up, it aleways does on increased fructose intake! Personally I have no issues with 10g/d but 200g/d is another matter.

Peter

Cloud Tiger said...

Thank you, Peter. A very helpful reply.
I am looking into it.

jpatti said...

I don't buy that it's the fresh produce; I think it's the low fat.

I do agree that modern fruit isn't... well, food. Take those bland seedless green grapes that taste like nothing except sweet. Compare to Concord grapes, which taste like something specific and pretty yummy; I buy some every fall.

More and more fresh foods are like this... becoming bland, tasteless, and boring... basically, the produce equivalent of junkfood.

You can TELL real food. Real heirloom tomatoes basically are edible in the garden - modern cherry and beefsteak tomatoes taste like nothing. Peas rarely make it into the house around here - they get eaten in the garden cause they're so yummy.

This is one of the big advantages of local produce from farmer's markets or your own backyard, not having to produce food that is good for transport, we can grow heirloom varieties that are yummy.

If I could grow coffee, avocados, pomegranates, coconut and citrus, my food would be perfect!

Anyway, the distinction I make is low-sugar fruits (mostly berries and small portions of melon) and nonstarchy veggies. These tend to be both low-carb and relatively nutrient-dense (in micronutrients, not macronutrients).

I make exceptions for REALLY GOOD food. Peaches, Concord grapes, clementines and pomegranates in season. They're yummy, but very briefly.

And I also agree veggies are a great substrate for fat... salad dressings on raw veggies, butter on cooked veggies. Or veggies fried in coconut oil or bacon grease - I just love fried veggies. Half my cooking starts with frying alliums in coconut oil or bacon grease...

IMO, veggies increase fat consumption quite a bit if you aren't silly enough to steam them and eat them plain, which is more a penance than a meal.

I can't put nearly the fat on/in eggs or meat as I can on veggies. Around here, meat and egg dishes are RELATIVELY low-fat compared to veggie foods. And it is just naturally yummy, fat GOES with veggies.

I do not think plant foods should crowd animal foods from the diet, but think it's doubtful they ever would since they are all mostly water and thus very low-calorie (excluding grains, of course). And if the fat you use on them is animal-based, you're not crowding animal foods out at all.

My own advice when asked is that the diet by volume should be half low-sugar fruit and nonstarchy veggies, one quarter protein, all the healthy fats you want all on top of the veggies and protein, and anything else in the other 25%. My theory is that eating sufficient fresh produce, animal protein, and healthy fat will crowd out most garbage most people eat, and even if they fill that 25% with garbage, it'll be better than the vast majority of folks eating SAD.

But I don't think produce crowds out crap by itself; it needs fat to be at all satisfying. You just can't ever eat enough celery to be full, but if the celery is stuffed with cream cheese, sure you can.

While human anatomy makes it obvious to me that we are not herbivores, I think it's rather clear we're not carnivores either. I live with two carnivores and my anatomy does not resemble theirs much more than it does a cow's.

jpatti said...

I don't buy that it's the fresh produce; I think it's the low fat.

I do agree that modern fruit isn't... well, food. Take those bland seedless green grapes that taste like nothing except sweet. Compare to Concord grapes, which taste like something specific and pretty yummy; I buy some every fall.

More and more fresh foods are like this... becoming bland, tasteless, and boring... basically, the produce equivalent of junkfood.

You can TELL real food. Real heirloom tomatoes basically are edible in the garden - modern cherry and beefsteak tomatoes taste like nothing. Peas rarely make it into the house around here - they get eaten in the garden cause they're so yummy.

This is one of the big advantages of local produce from farmer's markets or your own backyard, not having to produce food that is good for transport, we can grow heirloom varieties that are yummy.

If I could grow coffee, avocados, pomegranates, coconut and citrus, my food would be perfect!

Anyway, the distinction I make is low-sugar fruits (mostly berries and small portions of melon) and nonstarchy veggies. These tend to be both low-carb and relatively nutrient-dense (in micronutrients, not macronutrients).

I make exceptions for REALLY GOOD food. Peaches, Concord grapes, clementines and pomegranates in season. They're yummy, but very briefly.

And I also agree veggies are a great substrate for fat... salad dressings on raw veggies, butter on cooked veggies. Or veggies fried in coconut oil or bacon grease - I just love fried veggies. Half my cooking starts with frying alliums in coconut oil or bacon grease...

IMO, veggies increase fat consumption quite a bit if you aren't silly enough to steam them and eat them plain, which is more a penance than a meal.

I can't put nearly the fat on/in eggs or meat as I can on veggies. Around here, meat and egg dishes are RELATIVELY low-fat compared to veggie foods. And it is just naturally yummy, fat GOES with veggies.

I do not think plant foods should crowd animal foods from the diet, but think it's doubtful they ever would since they are all mostly water and thus very low-calorie (excluding grains, of course). And if the fat you use on them is animal-based, you're not crowding animal foods out at all.

My own advice when asked is that the diet by volume should be half low-sugar fruit and nonstarchy veggies, one quarter protein, all the healthy fats you want all on top of the veggies and protein, and anything else in the other 25%. My theory is that eating sufficient fresh produce, animal protein, and healthy fat will crowd out most garbage most people eat, and even if they fill that 25% with garbage, it'll be better than the vast majority of folks eating SAD.

But I don't think produce crowds out crap by itself; it needs fat to be at all satisfying. You just can't ever eat enough celery to be full, but if the celery is stuffed with cream cheese, sure you can.

While human anatomy makes it obvious to me that we are not herbivores, I think it's rather clear we're not carnivores either. I live with two carnivores and my anatomy does not resemble theirs much more than it does a cow's.