Eating healthy fruit and vegetables won't stop cancer
* By Clair Weaver
* From: The Sunday Telegraph
* August 26, 2007 12:00AM
FRUIT and vegetables provide no protection against cancer, according to latest Australian research that has shocked nutritionists.
In a discovery that turns conventional advice on its head, experts have admitted there is "zero evidence" that eating fruit and vegetables can help people avoid a disease that kills nearly 40,000 Australians every year.
Research presented for the first time at last week's CSIRO Prospects for Cancer Prevention Symposium shows that what people eat is far less important in cancer prevention than previously believed.
Instead, the three prime risk factors driving up Australian cancer rates have been identified as obesity, drinking too much alcohol and smoking.
Staying within a healthy body weight range was found to be more important than following particular nutritional guidelines.
This means a slim person who doesn't eat enough fruit and vegetables would probably have a lower risk of developing cancer than someone who is overweight but eats the recommended daily amount of fruit and vegetables.
The findings emerged from the Cancer Council's Melbourne Collaborative Cohort Study, an ongoing research project involving 42,000 Australians who have been monitored since 1990.
Revealed exclusively to The Sunday Telegraph, they challenge widespread belief in the power of juices and vegetable-based "anti-cancer" diets to avoid or fight various types of the disease.
Dr Peter Clifton, director of the CSIRO's Nutrition Clinic, told The Sunday Telegraph there was "zero evidence" that eating fruit and vegetables could protect against cancer.
Heart disease is Australia's biggest killer, so fruit and vegetables are still regarded as important in maintaining health.
Professor Dallas English, of the Cancer Council of Victoria, told the symposium that despite decades of research, there was no convincing evidence on how Australians could modify their diet to reduce the risk of cancer.
"The most important thing about diet is limiting energy (kilojoule) intake so people don't become overweight or obese, because this has emerged as a risk factor for a number of cancers, including breast, prostate, bowel and endometrial (uterus)," he said.
The link between eating red meat and bowel cancer was "weak" and the Cancer Council supported guidelines advising people to eat red meat three or four times a week, Professor English said.
His advice comes after Health Minister Tony Abbott last week backed a report, funded by Meat & Livestock Australia, on the dietary role of red meat.
Surprisingly, fibre was deemed to have no significant benefit in avoiding bowel cancer _ although calcium was associated with a 20 per cent reduced risk.
Likewise, a high intake of fat, considered a prime culprit since the 1970s, was found to have only a "modest" link to breast cancer.
Smoking caused one in five cancer deaths, while regularly drinking too much alcohol boosted the risk of several cancers including breast and bowel, Professor English said.
He and Dr Clifton acknowledged that eating fruit and vegetables might help people avoid obesity, as they were lower in kilojoules than other foods.
"The risk of every type of cancer is increased by obesity," Dr Clifton added.
Both experts predict a surge in cancer as a result of Australia's obesity epidemic, but say exercise can play a vital role in cutting cancer rates, potentially halving the risk of some cancers.
Sydney mother Tauri Smart, 29, said the findings "take the pressure off" meal preparation.
She and her husband try to eat healthily and want to set a good example for their daughters Poppy, 3, and Sadie, six weeks.
"I've always tried to push fruit and vegetables, and have a vegetarian meal at least once a week," Ms Smart said. "Being able to have meat makes it easier."
Nutritionist Dr Rosemary Stanton cast doubt on the findings and suggested the study could be flawed.
Monday, 19 July 2010
Friday, 14 May 2010
Wednesday, 17 March 2010
Obesity and pacemakers
Obesity Reduces Risk Of Cardiac Death?
Being skinny confers no advantage when it comes to the risk of dying suddenly from cardiac causes, a study presented today at the American College of Cardiology Annual Scientific Session has found.
According to the authors, non-obese heart failure patients – including overweight, normal and underweight patients – had a 76 percent increase in risk of sudden cardiac death compared to obese heart failure patients. Normal and underweight patients showed a startling 99 percent increase in risk for sudden cardiac death compared to obese patients.
Risk of sudden cardiac death was studied in 1,231 patients who had suffered at least one prior heart attack and had been diagnosed with a low ejection fraction, a measurement of how much blood is pumped from the heart with each beat. The analysis found that decreased BMI or body mass index was associated with a large increase in the risk of sudden cardiac death.
Compared to the overweight, normal and underweight patients, obese patients were younger, had a higher ejection fraction, higher blood pressure, diabetes and were more likely to be smokers. BMI was calculated as weight in kilograms divided by the square of height in meters for all study participants. The clinical definition of obesity – BMI ≥30 kg/m2 – was used. Overweight patients fell into the 25 to 29 kg/m2 range of BMI values and normal/underweight patients fell into the < 25 kg/m2 range of values.
The findings highlight the "obesity paradox," a phenomenon long recognized by cardiologists that, once afflicted, obese heart failure patients fare better than their slimmer counterparts. This study adds to a growing body of conflicting data regarding the relation of BMI to outcome in patients with heart failure.
"When we started this study we were hoping the data would disprove the 'obesity paradox,'" said Bonnie Choy, co-lead author and a second year medical student at the University's School of Medicine and Dentistry. "Our study is the first to create and analyze subcategories within non-obese patients, looking at overweight, normal and underweight patients, but even with this advanced analysis we still the saw an inverse relationship between BMI and sudden cardiac death."
The science behind the obesity paradox in the heart failure population is unresolved, but some researchers believe timing may have something to do with it. One possible explanation is that the long-term negative effects of conventional risk factors, such as increased BMI, may be overwhelmed by the short-term effects of other factors on heart failure mortality. In addition, survival advantages that exist in obese patients with heart failure may, in the short term, outweigh the harmful effects of increased BMI.
"Obese patients are hard on their bodies; many don't eat right, don't exercise, and many smoke," explained Eric Hansen, co-lead author and also a second year medical student at the University of Rochester. "If their bodies are surviving this bad treatment then perhaps they are better equipped, from a genetic standpoint, to live with heart failure."
Researchers also assessed the effect of BMI on the benefit of implantable cardioverter defibrillator (ICD) therapy. An implantable cardioverter defibrillator is a medical device about the size of a pager that is surgically implanted in the chest under local anesthesia. The device detects irregular and potentially fatal heart rhythms (arrhythmias), which often lead to sudden cardiac death, and shocks the heart back into a normal rhythm.
Results indicated that implantable cardioverter defibrillator therapy was more effective in the non-obese patients with lower BMI values who were at higher risk for sudden cardiac death. These findings may help identify patients who would get the most benefit from an ICD – patients with a lower BMI.
Citation: Hansen et al., 'Relation of Body Mass Index to Sudden Cardiac Mortality and Defibrillator Efficacy in Patients With Left Ventricular Dysfunction,' March 2010, American College of Cardiology Annual Scientific Session
Being skinny confers no advantage when it comes to the risk of dying suddenly from cardiac causes, a study presented today at the American College of Cardiology Annual Scientific Session has found.
According to the authors, non-obese heart failure patients – including overweight, normal and underweight patients – had a 76 percent increase in risk of sudden cardiac death compared to obese heart failure patients. Normal and underweight patients showed a startling 99 percent increase in risk for sudden cardiac death compared to obese patients.
Risk of sudden cardiac death was studied in 1,231 patients who had suffered at least one prior heart attack and had been diagnosed with a low ejection fraction, a measurement of how much blood is pumped from the heart with each beat. The analysis found that decreased BMI or body mass index was associated with a large increase in the risk of sudden cardiac death.
Compared to the overweight, normal and underweight patients, obese patients were younger, had a higher ejection fraction, higher blood pressure, diabetes and were more likely to be smokers. BMI was calculated as weight in kilograms divided by the square of height in meters for all study participants. The clinical definition of obesity – BMI ≥30 kg/m2 – was used. Overweight patients fell into the 25 to 29 kg/m2 range of BMI values and normal/underweight patients fell into the < 25 kg/m2 range of values.
The findings highlight the "obesity paradox," a phenomenon long recognized by cardiologists that, once afflicted, obese heart failure patients fare better than their slimmer counterparts. This study adds to a growing body of conflicting data regarding the relation of BMI to outcome in patients with heart failure.
"When we started this study we were hoping the data would disprove the 'obesity paradox,'" said Bonnie Choy, co-lead author and a second year medical student at the University's School of Medicine and Dentistry. "Our study is the first to create and analyze subcategories within non-obese patients, looking at overweight, normal and underweight patients, but even with this advanced analysis we still the saw an inverse relationship between BMI and sudden cardiac death."
The science behind the obesity paradox in the heart failure population is unresolved, but some researchers believe timing may have something to do with it. One possible explanation is that the long-term negative effects of conventional risk factors, such as increased BMI, may be overwhelmed by the short-term effects of other factors on heart failure mortality. In addition, survival advantages that exist in obese patients with heart failure may, in the short term, outweigh the harmful effects of increased BMI.
"Obese patients are hard on their bodies; many don't eat right, don't exercise, and many smoke," explained Eric Hansen, co-lead author and also a second year medical student at the University of Rochester. "If their bodies are surviving this bad treatment then perhaps they are better equipped, from a genetic standpoint, to live with heart failure."
Researchers also assessed the effect of BMI on the benefit of implantable cardioverter defibrillator (ICD) therapy. An implantable cardioverter defibrillator is a medical device about the size of a pager that is surgically implanted in the chest under local anesthesia. The device detects irregular and potentially fatal heart rhythms (arrhythmias), which often lead to sudden cardiac death, and shocks the heart back into a normal rhythm.
Results indicated that implantable cardioverter defibrillator therapy was more effective in the non-obese patients with lower BMI values who were at higher risk for sudden cardiac death. These findings may help identify patients who would get the most benefit from an ICD – patients with a lower BMI.
Citation: Hansen et al., 'Relation of Body Mass Index to Sudden Cardiac Mortality and Defibrillator Efficacy in Patients With Left Ventricular Dysfunction,' March 2010, American College of Cardiology Annual Scientific Session
Sunday, 17 January 2010
liver and bacon after keep fit at 100
Diet the key for keep fit fan, 100
Friday, January 15 12:02 pm
Press Assoc.
*
Buzz Up!
* Print Story
A refusal to eat junk food, that is the secret of Georgina Easter, who at the age of 100 has emerged as possibly Britain's oldest keep-fit fanatic. Skip related content
Related photos / videos
Diet the key for keep fit fan, 100
Whether she's limbering up to the latest chart hits or stretching her legs on a wooden chair, Ms Easter rarely fails to miss one of her Keep-Fit For Mature Movers lessons in Derby.
Her secret to her youthful exuberance is a healthy diet, but even her fellow classmates, some 30 years her junior, are astounded how she keeps going despite reaching her century last month.
Derby Adult Learning Service, part of the city's council, organises the sessions at a church hall in the suburb of Chaddesden.
Officials at the service now want to know whether she is the oldest member of a keep-fit class in the country.
But for Miss Easter, who was born when Edward VII was still king and the Titanic was only being built, the keep-fit classes are just a bit of fun. She said: "What's my secret? Keep away from junk food. I also do a bit of gardening, I cook every day and I am going to have liver and onions ... when I get home.
"I enjoy the friendship of the classes. All the people who take part, we are all good friends. At the end of term we have a big get together and a meal. It's very enjoyable."
The council says the classes, which run in ten-week blocks, three times a year, are part of an effort to ensure the elderly in the area stay as independent as possible.
Ruth Skelton, in charge of adult services at the Council, said: "She's a brilliant example to all people her age and younger.
"It may well be that Georgina is the oldest keep-fit member in the county and we would be very interested to know whether she's the oldest person to go to keep-fit classes in the country."
Friday, January 15 12:02 pm
Press Assoc.
*
Buzz Up!
* Print Story
A refusal to eat junk food, that is the secret of Georgina Easter, who at the age of 100 has emerged as possibly Britain's oldest keep-fit fanatic. Skip related content
Related photos / videos
Diet the key for keep fit fan, 100
Whether she's limbering up to the latest chart hits or stretching her legs on a wooden chair, Ms Easter rarely fails to miss one of her Keep-Fit For Mature Movers lessons in Derby.
Her secret to her youthful exuberance is a healthy diet, but even her fellow classmates, some 30 years her junior, are astounded how she keeps going despite reaching her century last month.
Derby Adult Learning Service, part of the city's council, organises the sessions at a church hall in the suburb of Chaddesden.
Officials at the service now want to know whether she is the oldest member of a keep-fit class in the country.
But for Miss Easter, who was born when Edward VII was still king and the Titanic was only being built, the keep-fit classes are just a bit of fun. She said: "What's my secret? Keep away from junk food. I also do a bit of gardening, I cook every day and I am going to have liver and onions ... when I get home.
"I enjoy the friendship of the classes. All the people who take part, we are all good friends. At the end of term we have a big get together and a meal. It's very enjoyable."
The council says the classes, which run in ten-week blocks, three times a year, are part of an effort to ensure the elderly in the area stay as independent as possible.
Ruth Skelton, in charge of adult services at the Council, said: "She's a brilliant example to all people her age and younger.
"It may well be that Georgina is the oldest keep-fit member in the county and we would be very interested to know whether she's the oldest person to go to keep-fit classes in the country."
Saturday, 19 December 2009
Thursday, 5 November 2009
Interview with Dr Uffe Ravnskov MD PhD
Is High Cholesterol The Cause of Heart Disease? An Interview with Uffe Ravnskov M.D. PhD.
(not with me, the interviewer does not wish to be associated!)
When did you begin to suspect that the cholesterol theory of atherosclerosis might be wrong? What led you to this conclusion? Before then, had you believed in the cholesterol theory? Was this part of your training?
I have never thought that it was true. I heard about it for the first time in 1962 shortly after having got my MD. My biochemical knowledge was still intact at that time and I knew that cholesterol was one of the most important molecules in our body, indispensable for the building of our cells and for producing stress and sex hormones as well as vitamin D. The idea that cholesterol in the blood should kill us if its concentration is a little higher than normal, as they wrote in the Framingham paper, seemed to me just as silly as to claim that yellow fingers cause lung cancer.
Would you tell my readers about your training, publications, university appointments, other professional activities?
The first seven years as a doctor I worked on different medical departments in Denmark and Sweden. In 1968 I started my academic career at the Department of Nephrology, University Hospital in Lund where I got my PhD. After a few years I organized a research team investigating the association between hydrocarbon exposure and glomerulonephritis. Unfortunately I caught one of my coworkers in producing a fraudulent paper. It was unfortunate, because it is risky to be a whistleblower in the academic world. Instead of excluding the fraudulent researcher it was my research that was questioned. The resistance against my research from my superiors became intolerable and I therefore decided to go into private practice. Nevertheless I succeeded in publishing the main part of my research in major medical journals after having left the department. I have summarized my findings and conclusions on the web as well.
In the late eighties the cholesterol campaign was started in Sweden. I was much surprised because I couldn’t recall anything in the scientific literature in support. I started reading it systematically and I soon realized that I was right. Since then I have published about eighty papers and letter and also books, translated into five languages, where I have presenting my arguments and criticism.
How has your work believe received by your colleagues? By healthcare professionals and consumers around the world?
In the beginning nobody took notice. To ignore criticism is the most effective way to maintain a false idea. My first book was published in Sweden in 1991 and a Finnish edition shortly afterwards. The Swedish one made no impact whatsoever and the Finnish one was put on fire in a television show. Ridicule and slander have been used as well as a means to muffle me. After I had aired my warnings against statin treatment in Dutch television for instance, Dutch researchers described me in a following show as a crackpot who had been kicked from the universities of Copenhagen and Lund. The directors of the show offered my critics a possibility to discuss the issue with me on television, but all of them declined. On his blog Michael Eades has described how one of them later on belittled me in a scientific paper.
But I have also realized that I am not alone. Seven years ago I started THINCS, The International Network of Cholesterol Skeptics (www.thincs.org), which by now includes about eighty doctors, professors and other researchers from all over the world, who share my scepticism, and I have received two international awards for my contributions. Also encouraging is the hundreds of emails that I receive every year from patients, who have regained their health after having stopped their cholesterol-lowering treatment...
Your work seems to validate what many integrative health care professionals have been saying for decades. How does the alternative community respond to you?
There is a much more open attitude from these people.
If the cholesterol hypothesis is in error, does this mean that all of its therapies – low cholesterol diet, cholesterol lowering natural therapies and medications -- are wrong?
Absolutely. This kind of treatment is meaningless, costly and has transformed millions of healthy people into patients.
Specifically, what are your views on statins?
Their benefit is trivial and has been seen only in male patients who already have heart disease. Worse is that their many adverse effects are ignored or cleverly belittled by the trial directors. Independent researchers have found many more and in much higher numbers. If they are true it means that today millions of previously healthy people probably consider their weak and painful muscles, their bad memory, their sexual failure and their cancer to be a consequence of increasing age and so do their doctors. The risk of cancer is most alarming. Both animal experiments, epidemiological studies and several of the statin trials have shown that low cholesterol predisposes to cancer. The widespread use of statin treatment probably explains why the decrease of the smoking habit that has been going on in many countries hasn’t been followed by a decrease of cancer mortality. We should have seen a decrease because smoking predispose not only to bronchial cancer, but to all kinds of cancer.
Drug companies market vigorously the highest, strongest doses of statins. Lipitor is pushed at the highest dosage, 80 mg. This dosage is the most powerful for lowering cholesterol and LDL, but it also causes more adverse effects and costs more than lower doses. What are your thoughts about this?
The outcome from these trials is a further demonstration that the small benefit from statin treatment has nothing to do with cholesterol. For instance, although cholesterol plummeted and remained at about fifty percent below the initial value during the whole SEAS trial, it did not change mortality, but it increased the number of cancer with statistical significance. Even worse was the result of the ENHANCE trial, where atherosclerosis in patients with familial hypercholesterolemia progressed the most among those whose cholesterol was lowered the most.
If statins can be helpful in reducing the incidence of heart attacks, who should take them?
In my view nobody. When I was practicing I used to describe the benefit in this way: Considering your age and your previous heart attack your chance to be alive in five years is about 90%. You can increase that chance to 92% if you take a statin pill every day, but then you may also expose yourself to its many adverse effects.
From the data I have seen, statins have not produced a reduction in overall cardiac deaths. Do you have any idea of why this is?
You are right. Heart mortality in Sweden is going downwards, but the reduction started already in the sixties. The cause is most probably that treatment of acute myocardial infarction has improved because the mortality curve has not changed after the introduction of the statins. The reason may be that their small benefit is counteracted by an increasing frequency of heart failure. As you know the statins block not only the synthesis of cholesterol, but also of other vital molecules, for instance coenzyme Q10, and muscle cells, including those of the heart, can’t function properly without Q10.
Do you think mainstream medicine will ever relinquish its view that elevated cholesterol causes heart disease and that statins are the magic bullet?
I hope so. The failures of the most recent statin trials has been commented by several journalists in the major US newspapers. In Sweden a revolution is going on. Here, a general practitioner treated her own obesity successfully by eating a low-carbohydrate diet with a high content of animal fat. When she advised her obese and diabetic patients to do the same, she was reported to the National Board of Health and Welfare for malpractice. After a two-year-long investigation she was acquitted, as her treatment was considered to be in accord with scientific evidence. At the same time, the Board dismissed two experts, who had been appointed for updating the dietary recommendations for diabetics, because it came up that they were sponsored by the food industry. Instead the Board has asked independent researchers to review the scientific literature.
The subject has gained general attention due to a number of radio and television shows, where critical experts including myself have discussed the issue with representatives of the official view. Most important, thousands of patients have experienced themselves that by doing the opposite as recommended by the current guidelines they have regained their health. The effect has been that the sales of butter, cream and fat milk are increasing in Sweden after many years of decline, and a recent poll showed that a majority of Swedish people today think that the best way of losing weight is by a low-carbohydrate, fat-rich diet.
Further progress was achieved this spring. Several times colleagues of mine and also myself have asked the Swedish Food Administration for the scientific basis of their warnings against saturated fat. We have been met with the argument that there are thousands of such studies, or by referrals to the WHO guidelines or the Nordic Nutrition Recommendations. As the main argument in the latter two is that saturated fat raises cholesterol we were not satisfied with their answer and finally the Food Administration published a list with 72 studies that they claimed were in support of their view on saturated fat and twelve that were not.
We scrutinized the lists and found that only two of the 72 studies supported their standpoint; eleven studies did not concern saturated fat at all, and the unsupportive list was incomplete, to put it mildly. We published a short report with our comments to these lists in the Swedish medical journal Dagens Medicin. A response from the Food Administration appeared seven weeks later in which they pointed out that their recommendations were directed to healthy people, not to patients. They maintained that they were based on solid scientific evidence without mentioning anything about saturated fat and without answering our critical comments.
But this is not all. Earlier this year Sachdeva et al reported that the mean cholesterol in 137,000 patients with acute myocardial infarction was lower than normal. As usual, the authors didn’t understand their own findings, but concluded that cholesterol should be lowered even more. A few months later Al-Mallah et al. came up with the same result and conclusion, although they also reported that three years later, mortality was twice as high among those who had been admitted with the lowest cholesterol.
These results created a fierce debate in one of the major Swedish newspapers. It was opened by ninety-one-year old Lars Werkö, the ‘Grand Old Man’ in Swedish medical science, retired professor in internal medicine and former head of The Swedish Council on Technology Assessment in Health Care, together with Tore Scherstén, retired professor in surgery and former secretary of the Swedish Medical Research Council. “Now it is time to sack the cholesterol hypothesis and to investigate the reason of this scientific breakdown” they wrote. They also criticized American researchers in AHA and NHLBI and their followers for sloppy and fraudulent science.
They were of course attacked by two professors and representatives of the current view, but none of them came up with any substantial evidence, only by personalities.
Are there other risk factors that should be followed? Such as: C-reactive protein, fibrinogen, homocysteine, lipoprotein A. Any other factors?
Such analyses may be helpful for doctors to put the right diagnosis in patients with a disease of unknown origin. But to check healthy people’s blood to find deviations from normal is the freeway to unnecessary medication.
Are there other alternative therapies besides statins that people might consider?
There is no reason for healthy people to take drugs or anything else to prevent heart disease as long as we do not know the very cause. Don’t forget that people who die from a myocardial infarction have on average lived just s long as other people. On my talks I use to ask people, who put the same question to me, if they know a better way of dying.
What diet do you recommend people follow?
I do not give medical advice to people I haven’t seen and examined myself and as I am retired it means that I give no advice at all except to my family and nearest friends. I inform people by writing and lecturing. Then they have to decide themselves what to do.
In 20 years, do you expect changes in how we view heart disease, its causes and treatments?
I am confident that we will see a change in the next few years. There is a growing skepticism among medical scientists. What is happening in Sweden these days may hopefully inspire researchers in other countries to air their skepticism openly. Recently experts selected by WHO and FAO published a new report. Here the authors concluded that there was no satisfactory or reliable evidence to support the idea that saturated fat causes heart disease, or diabetes or obesity. A revolutionary change of direction, you may say. However, they did not change their recommendations.
Together with Kilmer McCully, the discoverer of the association between homocysteine and atherosclerosis, I have presented another hypothesis. We think it is much more likely because we are able to explain the many observations that do not fit with the present one. If anyone wants to read the full paper I shall send it on request.
EDIT Ted has a link to the full pdf in the comments section of the original post.
Finally, I assume that much of what I have mentioned here may seem incredible, but all the facts including references to the scientific literature are available in my new book Fat And Cholesterol Are GOOD For You!
(not with me, the interviewer does not wish to be associated!)
When did you begin to suspect that the cholesterol theory of atherosclerosis might be wrong? What led you to this conclusion? Before then, had you believed in the cholesterol theory? Was this part of your training?
I have never thought that it was true. I heard about it for the first time in 1962 shortly after having got my MD. My biochemical knowledge was still intact at that time and I knew that cholesterol was one of the most important molecules in our body, indispensable for the building of our cells and for producing stress and sex hormones as well as vitamin D. The idea that cholesterol in the blood should kill us if its concentration is a little higher than normal, as they wrote in the Framingham paper, seemed to me just as silly as to claim that yellow fingers cause lung cancer.
Would you tell my readers about your training, publications, university appointments, other professional activities?
The first seven years as a doctor I worked on different medical departments in Denmark and Sweden. In 1968 I started my academic career at the Department of Nephrology, University Hospital in Lund where I got my PhD. After a few years I organized a research team investigating the association between hydrocarbon exposure and glomerulonephritis. Unfortunately I caught one of my coworkers in producing a fraudulent paper. It was unfortunate, because it is risky to be a whistleblower in the academic world. Instead of excluding the fraudulent researcher it was my research that was questioned. The resistance against my research from my superiors became intolerable and I therefore decided to go into private practice. Nevertheless I succeeded in publishing the main part of my research in major medical journals after having left the department. I have summarized my findings and conclusions on the web as well.
In the late eighties the cholesterol campaign was started in Sweden. I was much surprised because I couldn’t recall anything in the scientific literature in support. I started reading it systematically and I soon realized that I was right. Since then I have published about eighty papers and letter and also books, translated into five languages, where I have presenting my arguments and criticism.
How has your work believe received by your colleagues? By healthcare professionals and consumers around the world?
In the beginning nobody took notice. To ignore criticism is the most effective way to maintain a false idea. My first book was published in Sweden in 1991 and a Finnish edition shortly afterwards. The Swedish one made no impact whatsoever and the Finnish one was put on fire in a television show. Ridicule and slander have been used as well as a means to muffle me. After I had aired my warnings against statin treatment in Dutch television for instance, Dutch researchers described me in a following show as a crackpot who had been kicked from the universities of Copenhagen and Lund. The directors of the show offered my critics a possibility to discuss the issue with me on television, but all of them declined. On his blog Michael Eades has described how one of them later on belittled me in a scientific paper.
But I have also realized that I am not alone. Seven years ago I started THINCS, The International Network of Cholesterol Skeptics (www.thincs.org), which by now includes about eighty doctors, professors and other researchers from all over the world, who share my scepticism, and I have received two international awards for my contributions. Also encouraging is the hundreds of emails that I receive every year from patients, who have regained their health after having stopped their cholesterol-lowering treatment...
Your work seems to validate what many integrative health care professionals have been saying for decades. How does the alternative community respond to you?
There is a much more open attitude from these people.
If the cholesterol hypothesis is in error, does this mean that all of its therapies – low cholesterol diet, cholesterol lowering natural therapies and medications -- are wrong?
Absolutely. This kind of treatment is meaningless, costly and has transformed millions of healthy people into patients.
Specifically, what are your views on statins?
Their benefit is trivial and has been seen only in male patients who already have heart disease. Worse is that their many adverse effects are ignored or cleverly belittled by the trial directors. Independent researchers have found many more and in much higher numbers. If they are true it means that today millions of previously healthy people probably consider their weak and painful muscles, their bad memory, their sexual failure and their cancer to be a consequence of increasing age and so do their doctors. The risk of cancer is most alarming. Both animal experiments, epidemiological studies and several of the statin trials have shown that low cholesterol predisposes to cancer. The widespread use of statin treatment probably explains why the decrease of the smoking habit that has been going on in many countries hasn’t been followed by a decrease of cancer mortality. We should have seen a decrease because smoking predispose not only to bronchial cancer, but to all kinds of cancer.
Drug companies market vigorously the highest, strongest doses of statins. Lipitor is pushed at the highest dosage, 80 mg. This dosage is the most powerful for lowering cholesterol and LDL, but it also causes more adverse effects and costs more than lower doses. What are your thoughts about this?
The outcome from these trials is a further demonstration that the small benefit from statin treatment has nothing to do with cholesterol. For instance, although cholesterol plummeted and remained at about fifty percent below the initial value during the whole SEAS trial, it did not change mortality, but it increased the number of cancer with statistical significance. Even worse was the result of the ENHANCE trial, where atherosclerosis in patients with familial hypercholesterolemia progressed the most among those whose cholesterol was lowered the most.
If statins can be helpful in reducing the incidence of heart attacks, who should take them?
In my view nobody. When I was practicing I used to describe the benefit in this way: Considering your age and your previous heart attack your chance to be alive in five years is about 90%. You can increase that chance to 92% if you take a statin pill every day, but then you may also expose yourself to its many adverse effects.
From the data I have seen, statins have not produced a reduction in overall cardiac deaths. Do you have any idea of why this is?
You are right. Heart mortality in Sweden is going downwards, but the reduction started already in the sixties. The cause is most probably that treatment of acute myocardial infarction has improved because the mortality curve has not changed after the introduction of the statins. The reason may be that their small benefit is counteracted by an increasing frequency of heart failure. As you know the statins block not only the synthesis of cholesterol, but also of other vital molecules, for instance coenzyme Q10, and muscle cells, including those of the heart, can’t function properly without Q10.
Do you think mainstream medicine will ever relinquish its view that elevated cholesterol causes heart disease and that statins are the magic bullet?
I hope so. The failures of the most recent statin trials has been commented by several journalists in the major US newspapers. In Sweden a revolution is going on. Here, a general practitioner treated her own obesity successfully by eating a low-carbohydrate diet with a high content of animal fat. When she advised her obese and diabetic patients to do the same, she was reported to the National Board of Health and Welfare for malpractice. After a two-year-long investigation she was acquitted, as her treatment was considered to be in accord with scientific evidence. At the same time, the Board dismissed two experts, who had been appointed for updating the dietary recommendations for diabetics, because it came up that they were sponsored by the food industry. Instead the Board has asked independent researchers to review the scientific literature.
The subject has gained general attention due to a number of radio and television shows, where critical experts including myself have discussed the issue with representatives of the official view. Most important, thousands of patients have experienced themselves that by doing the opposite as recommended by the current guidelines they have regained their health. The effect has been that the sales of butter, cream and fat milk are increasing in Sweden after many years of decline, and a recent poll showed that a majority of Swedish people today think that the best way of losing weight is by a low-carbohydrate, fat-rich diet.
Further progress was achieved this spring. Several times colleagues of mine and also myself have asked the Swedish Food Administration for the scientific basis of their warnings against saturated fat. We have been met with the argument that there are thousands of such studies, or by referrals to the WHO guidelines or the Nordic Nutrition Recommendations. As the main argument in the latter two is that saturated fat raises cholesterol we were not satisfied with their answer and finally the Food Administration published a list with 72 studies that they claimed were in support of their view on saturated fat and twelve that were not.
We scrutinized the lists and found that only two of the 72 studies supported their standpoint; eleven studies did not concern saturated fat at all, and the unsupportive list was incomplete, to put it mildly. We published a short report with our comments to these lists in the Swedish medical journal Dagens Medicin. A response from the Food Administration appeared seven weeks later in which they pointed out that their recommendations were directed to healthy people, not to patients. They maintained that they were based on solid scientific evidence without mentioning anything about saturated fat and without answering our critical comments.
But this is not all. Earlier this year Sachdeva et al reported that the mean cholesterol in 137,000 patients with acute myocardial infarction was lower than normal. As usual, the authors didn’t understand their own findings, but concluded that cholesterol should be lowered even more. A few months later Al-Mallah et al. came up with the same result and conclusion, although they also reported that three years later, mortality was twice as high among those who had been admitted with the lowest cholesterol.
These results created a fierce debate in one of the major Swedish newspapers. It was opened by ninety-one-year old Lars Werkö, the ‘Grand Old Man’ in Swedish medical science, retired professor in internal medicine and former head of The Swedish Council on Technology Assessment in Health Care, together with Tore Scherstén, retired professor in surgery and former secretary of the Swedish Medical Research Council. “Now it is time to sack the cholesterol hypothesis and to investigate the reason of this scientific breakdown” they wrote. They also criticized American researchers in AHA and NHLBI and their followers for sloppy and fraudulent science.
They were of course attacked by two professors and representatives of the current view, but none of them came up with any substantial evidence, only by personalities.
Are there other risk factors that should be followed? Such as: C-reactive protein, fibrinogen, homocysteine, lipoprotein A. Any other factors?
Such analyses may be helpful for doctors to put the right diagnosis in patients with a disease of unknown origin. But to check healthy people’s blood to find deviations from normal is the freeway to unnecessary medication.
Are there other alternative therapies besides statins that people might consider?
There is no reason for healthy people to take drugs or anything else to prevent heart disease as long as we do not know the very cause. Don’t forget that people who die from a myocardial infarction have on average lived just s long as other people. On my talks I use to ask people, who put the same question to me, if they know a better way of dying.
What diet do you recommend people follow?
I do not give medical advice to people I haven’t seen and examined myself and as I am retired it means that I give no advice at all except to my family and nearest friends. I inform people by writing and lecturing. Then they have to decide themselves what to do.
In 20 years, do you expect changes in how we view heart disease, its causes and treatments?
I am confident that we will see a change in the next few years. There is a growing skepticism among medical scientists. What is happening in Sweden these days may hopefully inspire researchers in other countries to air their skepticism openly. Recently experts selected by WHO and FAO published a new report. Here the authors concluded that there was no satisfactory or reliable evidence to support the idea that saturated fat causes heart disease, or diabetes or obesity. A revolutionary change of direction, you may say. However, they did not change their recommendations.
Together with Kilmer McCully, the discoverer of the association between homocysteine and atherosclerosis, I have presented another hypothesis. We think it is much more likely because we are able to explain the many observations that do not fit with the present one. If anyone wants to read the full paper I shall send it on request.
EDIT Ted has a link to the full pdf in the comments section of the original post.
Finally, I assume that much of what I have mentioned here may seem incredible, but all the facts including references to the scientific literature are available in my new book Fat And Cholesterol Are GOOD For You!
Saturday, 31 October 2009
Drug Decriminalization in Portugal
With apologies to Salon for stealing their text. I'll take it down if anyone objects, but the original article does seem to have disappeared already. Here it is.
Glenn Greenwald is a civil rights attorney, a blogger for Salon, and the author of a new Cato Institute policy study called “Drug Decriminalization in Portugal: Lessons for Creating Fair and Successful Policies.” The paper examines Portugal’s experiment with decriminalizing possession of drugs for personal use, which began in 2001. Nick Gillespie, editor of reason.com and reason.tv, sat down with Greenwald in April.
Q: What is the difference between decriminalization and legalization?
A: In a decriminalized framework, the law continues to prohibit drug usage, but it’s completely removed from the criminal sphere, so that if you violate that prohibition or do the activity that the law says you cannot do you’re no longer committing a crime. You cannot be turned into a criminal by the state. Instead, it’s deemed to be an administrative offense only, and you’re put into an administrative proceeding rather than a criminal proceeding.
Q: What happened in Portugal?
A: The impetus behind decriminalization was not that there was some drive to have a libertarian ideology based on the idea that adults should be able to use whatever substances they want. Nor was it because there’s some idyllic upper-middle-class setting. Portugal is a very poor country. It’s not Luxembourg or Monaco or something like that.
In the 1990s they had a spiraling, out-of-control drug problem. Addiction was skyrocketing. Drug-related pathologies were increasing rapidly. They were taking this step out of desperation. They convened a council of apolitical policy experts and gave them the mandate to determine which optimal policy approach would enable them to best deal with these drug problems. The council convened and studied all the various options. Decriminalization was the answer to the question, “How can we best limit drug usage and drug addiction?” It was a policy designed to do that.
Q: One of the things you found is that decriminalization actually correlates with less drug use. A basic theory would say that if you lower the cost of doing drugs by making it less criminally offensive, you would have more of it.
A: The concern that policy makers had, the frustration in the 1990s when they were criminalizing, is the more they criminalized, the more the usage rates went up. One of the reasons was because when you tell the population that you will imprison them or treat them as criminals if they identify themselves as drug users or you learn that they’re using drugs, what you do is you create a barrier between the government and the citizenry, such that the citizenry fears the government. Which means that government officials can’t offer treatment programs. They can’t communicate with the population effectively. They can’t offer them services.
Once Portugal decriminalized, a huge amount of money that had gone into putting its citizens in cages was freed up. It enabled the government to provide meaningful treatment to people who wanted it, and so addicts were able to turn into non–drug users and usage rates went down.
Q: What’s the relevance for the United States?
A: We have debates all the time now about things like drug policy reform and decriminalization, and it’s based purely in speculation and fear mongering of all the horrible things that are supposedly going to happen if we loosen our drug laws. We can remove ourselves from the realm of the speculative by looking at Portugal, which actually decriminalized seven years ago, in full, [use and possession of] every drug. And see that none of that parade of horribles that’s constantly warned of by decriminalization opponents actually came to fruition. Lisbon didn’t turn into a drug haven for drug tourists. The explosion in drug usage rates that was predicted never materialized. In fact, the opposite happened.
Glenn Greenwald is a civil rights attorney, a blogger for Salon, and the author of a new Cato Institute policy study called “Drug Decriminalization in Portugal: Lessons for Creating Fair and Successful Policies.” The paper examines Portugal’s experiment with decriminalizing possession of drugs for personal use, which began in 2001. Nick Gillespie, editor of reason.com and reason.tv, sat down with Greenwald in April.
Q: What is the difference between decriminalization and legalization?
A: In a decriminalized framework, the law continues to prohibit drug usage, but it’s completely removed from the criminal sphere, so that if you violate that prohibition or do the activity that the law says you cannot do you’re no longer committing a crime. You cannot be turned into a criminal by the state. Instead, it’s deemed to be an administrative offense only, and you’re put into an administrative proceeding rather than a criminal proceeding.
Q: What happened in Portugal?
A: The impetus behind decriminalization was not that there was some drive to have a libertarian ideology based on the idea that adults should be able to use whatever substances they want. Nor was it because there’s some idyllic upper-middle-class setting. Portugal is a very poor country. It’s not Luxembourg or Monaco or something like that.
In the 1990s they had a spiraling, out-of-control drug problem. Addiction was skyrocketing. Drug-related pathologies were increasing rapidly. They were taking this step out of desperation. They convened a council of apolitical policy experts and gave them the mandate to determine which optimal policy approach would enable them to best deal with these drug problems. The council convened and studied all the various options. Decriminalization was the answer to the question, “How can we best limit drug usage and drug addiction?” It was a policy designed to do that.
Q: One of the things you found is that decriminalization actually correlates with less drug use. A basic theory would say that if you lower the cost of doing drugs by making it less criminally offensive, you would have more of it.
A: The concern that policy makers had, the frustration in the 1990s when they were criminalizing, is the more they criminalized, the more the usage rates went up. One of the reasons was because when you tell the population that you will imprison them or treat them as criminals if they identify themselves as drug users or you learn that they’re using drugs, what you do is you create a barrier between the government and the citizenry, such that the citizenry fears the government. Which means that government officials can’t offer treatment programs. They can’t communicate with the population effectively. They can’t offer them services.
Once Portugal decriminalized, a huge amount of money that had gone into putting its citizens in cages was freed up. It enabled the government to provide meaningful treatment to people who wanted it, and so addicts were able to turn into non–drug users and usage rates went down.
Q: What’s the relevance for the United States?
A: We have debates all the time now about things like drug policy reform and decriminalization, and it’s based purely in speculation and fear mongering of all the horrible things that are supposedly going to happen if we loosen our drug laws. We can remove ourselves from the realm of the speculative by looking at Portugal, which actually decriminalized seven years ago, in full, [use and possession of] every drug. And see that none of that parade of horribles that’s constantly warned of by decriminalization opponents actually came to fruition. Lisbon didn’t turn into a drug haven for drug tourists. The explosion in drug usage rates that was predicted never materialized. In fact, the opposite happened.
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