Bad What?: Science? -- Reporting? -- Blogging/Sharing?

Confession time.  I found out about that recent LC v. LF diet study from Andreas Eenfeldt's blog.  Andreas seems woefully misguided into thinking that obese Americans got that way listening to US Government guidelines and eating a low fat diet.  Any and every study that shows some advantage for LC is rapidly added to his list demonstrating that LCHF is superior and LF diets are nothing short of criminal at this point.  I'll have some personal things to say about all of this at the end of the post.  Gossip Mongers can skip to there if you like ;-) (scroll down to line, or browser search on "And so now")

In any case, in a blog post entitled New Study: High Fat Food is Good for Diabetics, Andreas cites this "news" article:  High-fat diet lowered blood sugar and improved blood lipids in diabetics.  Another low carb advocate, Dr. Eades, also tweeted the following:  RCT shows better glycemic control & improved lipid labs seen in diabetics on #lowcarb as compared to lowfat diets.  The tweet links to this report:  Questioning Carbohydrate Restriction in Diabetes Management.

Now this was an RCT = Randomized Controlled Trial.  The type of study generally considered to be the gold standard of trials, but we've discussed here before how not all RCT's are created equal, and as serendipity would have it, Andreas was one I called out in:  A Matter of Control.  In his short blog post, Andreas calls the current study at hand "a new high-quality Swedish study".  Does the study itself deserve that label?  After looking at it more closely the past few days, no.  If for no other reason, because the study participants didn't report eating the diets as prescribed.  The intended control is also limited to caloric intake.  I contend that when one is comparing diets of different macronutrient composition, one of the three must be controlled for -- e.g. held constant -- varying the other two, or the results will forever be tainted.  

In any case, both of the "news" reports contain the same following statement:

In the low-carbohydrate diet, 50% of the energy came from fat, 20% from carbohydrates, and 30% from protein. For the low-fat group the distribution was 30% from fat, 55-60% from carbohydrates, and 10-15% from protein, which corresponds to the diet recommended by the Swedish National Food Agency.

What we know from looking at the study itself, C / F / P

    Low Fat          Target:  55-60 /30/10-15      Range:  47-49/29-31/20-21    2 yr. Actual:  47/31/20

    Low Carb        Target:  20/50/ 30                Range:  25-31/44-49/              2 yr. Actual:  31/44/24

The Diabetes In Control article contains this rather ridiculous quote from one of the researchers:

All 61 participants remained in the study for the follow-up.  Dr. Hans Guldbrand who was also part of the study says, "In contrast to most other studies of this type, we lost no patients at all, which vouches for the good quality of our data." 

First off, that's a bit of a misrepresentation because:

• three in the LFD group and four in the LCD group expressed that they had severe difficulty following the prescribed diets and were not willing to participate in the group meetings. Data on the main outcomes from these seven patients were used in statistical analyses according to intention-to-treat analysis , and
• At 24 months, 14 individuals (four in the LFD group and ten in the LCD group) did not provide diet records, but data on the main outcomes were used in calculations.

So they had data from all 61 patients, but data incomplete enough (I think missing dietary intake records for one third of one group is rather incomplete) as to draw into question the quality of their data, eh? For the macro they appear to be looking at -- e.g. fat content -- number of compliant LF'ers at 24 months (<35% fat) was 20, and the number of compliant LC'ers (>45% fat) was only 12.  When one looks at the "quality data" from this subgroup of the subjects, it's all a wash on the HbA1c front but LF is noted to demonstrate statistically significant reductions in blood pressure that were not seen for the LC group.  Why was this analysis -- the one that truly compared the diets intended to be tested -- relegated to online supplementary material status and not included in the text of the main article?  After all, they included the calorie compliant (17LF/18LC) analysis -- and, although they attempted to control for calories, that wasn't the main intervention now, was it?

Indeed the numbers of the Fat Energy compliant throw the quality of the data presented in this study into grave question.  The data for all who completed surveys is shown again here (you can click to enlarge).  There were only 12 LC'ers (out of 20 because that's how many filled out the intake logs at 24 months) eating the "high fat" diet (over 45% fat), while there were 20 LF'ers (out of the 27 submitters of intake logs) eating "low fat" (under 35%).  A more accurate description of the real retention rates from which quality analysis can be done would be:

LF:  65%      LC:  40%

How about the numbers for true compliance?  As in how many LF'ers were <30 (or 31, or 32 for a little leeway) and how many LC'ers were >50 (or 49, or 48 for a little leeway)?  I'm just guessing here that the 5% fudge factor was used to include as many LC'ers as they could , given that the average of the 20 loggers was 44% (6% shy of target) while the average of the 27 LF loggers was 31% (only 1% over target).  And in doing so, they are also then including people eating diets that do not qualify as LF diets.  We'll get the usual poo pooing (as I received in comments) over how the LC diet was not really LC.  Well, I submit that the LF diet is not really LF either, especially if you're talking 35% fat, which is the usual content of most Western diets.  If LC'ers can claim the effects of carb restriction can only be correctly studied in <10% ketogenic contexts, then is it too much to ask to represent LF with a true fat restricted diet?  25% at most, generally 20%?!  More from the DIC article:

Dr. Fredrik Nyström, who was part of the study, said, "You could ask yourself if it really is good to recommend a low-fat diet to patients with diabetes, if despite their weight loss they get neither better lipoproteins nor blood glucose levels.

But there wasn't any significant weight loss in this study for anybody!  I suppose one could conclude that if you prescribe a diet too high in calories to elicit substantial weight loss it doesn't matter how much fat or carbs someone eats.  That's really what this study ended up demonstrating.  Because at the end of the day, neither diet was effective as consumed.   Oddly enough, the word *transient* is in the title of the journal article, and yet this study is still being touted.  Andreas gushes:

• Diabetes patients randomized to a high fat (20% carb) diet improved their blood sugar, cholesterol and could reduce their diabetes medications.
• Patients randomized to conventional (obsolete) low fat advice did not improve anything

Had he read the study rather than relying on a second hand report, he would realize this is not really true.  The HbA1c "gains" were short-lived and rather insignificant when measured as %.  The difference was negligible in the real "completers" in the oh-nevermind supplemental analysis.  As for low fat not improving anything?  Well it did improve blood pressure in the compliant.  The study sure as heck didn't show that "high fat food is even good for diabetics". 

So very often well-designed and conducted scientific studies are mangled hopelessly by the media hype over the supposed result.  I think this blog post highlights a good example of this:  How Fatty Diets Cause Diabetes.  Science Daily used that title for a study that demonstrated that NEFA disrupted glucose transport in beta cells.  The LC blogosphere jumped on this to say it was horrible, no good, very bad science -- mostly, I might add, without benefit of access to the full text of the paper if they even bothered to look there. When, in fact, the study itself was quite solid, it was the reporting that was horrendous.  Chris Masterjohn agreed: Fat and Diabetes: Bad Press, Good Paper, and the Reemergence of Our Good Friend Glutathione.

And then you get well-designed and conducted scientific studies that are pretty well covered by the media, yet low carbers see fit to trounce on it anyway.  Two of many examples would be Jimmy Moore's Australian Researchers Conclude That A High-Fat, Low-Carb Diet Puts You In A Permanent Bad Mood! Grrrrrr! (where that study was actually an extension of the work of the same research group who put out a study Jimmy claims they ignored!), and Fat Head's Low-Carb Brain Damage? (where he guffaws over cognitive/motor skills related brain damage having nothing to do with possible hypothalamic damage).  

And then you get studies with such serious design and/or implementation flaws as to render them moot.  These are my "favorites" because you can be dang sure the media will farkle them beyond recognition.  But you can be even more sure that the die-hard advocates will jump on the "look at this latest great study" bandwagon and share the "important" information with their readers who gobble it up with nary a whiff of skepticism.  This is good science to these ideologues folks!!  They'll try and try and pick apart studies that don't show what they want until they are blue in the face, but they can't be bothered to look past the headlines when they play to their downtrodden martyr complex.   At this point it would appear that this study fits that bill.

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And so now that non-science, personal, gossipy stuff and whatnot.

One of the common comments I keep hearing in the fall-out over this whole Kruse Missile Strike is that:

• All I ever do here at the Asylum is tear people down.  I do nothing productive or that adds to the community or anyone's knowledge base or anything of the sort

I also get the distinct impression that:

• Everyone else is so damned afraid of being seen as just tearing people down they stood totally or selectively silent whilst the Kruse Missiles were designed, built and finally launched.

Since the inception of this blog, I have been prolific putting out detailed analyses of various studies.  That I focused on Taubes somehow was a product of the fact that since I first heard of him and his theories, they just didn't mesh with what I learned in biochemistry and physiology classes.   For merely disagreeing with him and putting forth the scientific case, long before I started blogging, on Jimmy's forum, I was vilified, laughed at and far worse.  I just didn't *get* it, you see.  It was probably what I came across in this thread over on LLVLC forum (I'm Low Carb Cheater, some may recognize Griff as one of Mark Sisson's interim success stories, and  wolfstriked ) that this blog was born.  The byte-mountain of PDF's on my HD and attempts to keep the links straight led me to start the blog just to organize (somewhat!) all this stuff with labels.  

Taubes can deny all he wants, but the whole G3P was central to his hypothesis, even in GCBC.  It unleashed legions of low carbers who parroted the meme.  Which is why, I think, my like 200 page hit post on this obscure little talking-to-myself blog touched the nerve that changed the history of the Asylum.  I have laid out the case -- using his own references -- for what can only be described as journalistic malfeasance.  I've never poked fun at his looks or engaged in ad hominem attacks, and frankly neither did his critics like James Krieger before me.  My goal was not to tear Gary Taubes down, it was to get the science right!  I was interested in whether or not remaining mostly VLC for the long term, with the changes in my body fat distribution and still weighing too much was healthy.  I was NOT interested then, nor am I now, in dogmatic non-science based arguments for how LC is the dawning of the Age of Aquarius and cures all ills and whatnot.  I wanted to be able to share my diet with my physician and be confident it was healthy.  If there were all these ex-obese low carbers out there in stellar health shouting me down, I suppose I'd be more open to their arguments, but I cannot ever set aside my common sense and knowledge to buy into nonsense.  I blindly bought into Atkins' first premise -- which was based on peeing out enormous amounts of calories as ketones, it's right there in his first book and that's that.  Almost everyone knows that not to be true, but now we have the promotion of ketogenic diets on other equally ill-substantiated theories.

When I read garbage science, I'm going to blog on it.  I don't care who writes it.  If they are nice, mean, pretty, pretty ugly, fat, skinny, whatever.  This has NEVER been about the messenger for me, always the message.  And if folks can relate to the frustration of obese people who are angry because they've "tried everything" and can't lose the weight and keep it off, I don't understand why they accept as their fate the frustration that LC does not work any better in the long run for the vast majority.  Pictures from the LC cruise have been landing in my Inbox and posted around the web.  As Andreas pokes fun once again at obese Americans, I wonder if he noticed whether his audience/organizers at his presentation looked any different than the "body constitution of [all of the rest of the] ordinary Americans on the cruise", while trying to convince you that Asians stay slim because they really eat brown rice.  

If you think all I do here is tear people down, you have not read my blog.  Period.   I don't know of anyone else who's looked into these LoBAG diets, one of which was a study that looked the very same diets the current study purported (but failed) to be testing.  I think it is important to get the message out that carbohydrates do NOT cause insulin resistance.  I think it is important to get the message out that we don't "poop out" our pancreas eating carbs ... that beta cells are far more resilient than we think ... that calories count ... that circulating free fatty acids and lipotoxicity are at least as important as glucose and glycation but probably moreso ... that 1500 cal/day is nowhere near starvation ... that low fat diets are satiating when high in protein ... and I could go on, but you get my point.  A Chronological List of All Posts.  I may not have thousands of people worshiping me for helping them, but that's not my goal here.  Still, I have helped many escape the throes of carbohydrate and insulin obsessions and break through long time plateaus, and saved a few from getting sucked in in the first place.

So when I hear that ALL I do here is tear PEOPLE down I must admit it upsets me.  First, I dispel and debunk IDEAS, not people.  I don't know how many times, despite him being pretty much an asshat in our direct communications,  I've said I basically like Jack and if I met him under other circumstances might well be friends with him or at least enjoy a right party with him.  Yes, I have some fun with names and Leptin Man, but every time I've addressed him it was to discuss his whack theories and why his science is simply wrong.  I did it with Taubes.  I've done it with Wheat Belly's over the top hyperbole (hey ... for a relatively thin guy, anyone notice the moobs on him? ... just sayin' of course since he likes to poke fun at men in the lingerie department), and the list goes on ... and unfortunately on and on because there is just so much garbage BS being passed off as "real" science-based nutrition these days.  

I'm sure most of these people are nice, upstanding citizens and all that.  I'm even willing to believe that most  fully believe in their own dogma (as opposed to hawking something they don't really believe in/practice/etc  just to make a buck).  I bet most are loving husbands/wives/mothers/fathers/sisters/brothers/friends-of-all-sorts/etc.  I'm sure many give a lot to help others -- just like quite a few fat people eating whole grains I might add.  This is where it is just so frustrating to be part of this community -- although mostly I blog about here on the fringe.   If I criticize Nora Gedgaudas' absolutely absurd contention that all body fat comes from glucose, I'm a hater?  I have attacked her personally?  Or Cate Shanahan's rationale for not snacking because it diverts liters of fluid from circulation to your intestines?  For that she called me a hater.  I'd say writing and disseminating utter nonsense under the initials MD is far more egregious behavior.  LDL made from carbs makes us fat ... sheesh!

I've been doing the Mat Lalonde here since long before his speech to this effect.  By that I mean that if you're going to put forth a scientific argument, it better well be accurate because somebody's going to call you on it and that will ultimately undermine your message.  I believed it back when I started this blog, and I believe that all the more strongly today.  Which is not to say we'll ever know even a small percent of all the answers, but more that we need to be honest about what it is we do know and the certainty with which we know it.  If the Jack Kruse phenomenon had occurred in 2007-9, I would have understood how it happened.  Those were the heady days of TWICHOO and Jack would have just added a charismatic kooky twist.  But no.  This happened starting in mid 2011 and snowballed as TWICHOO was suffering smackdown after well-deserved smackdown.  And many at PH and a few on their blogs tried to sound the alarm.  And others remained silent.  And it kept rolling and gathering and those who tried to stop it were called haters and just too stupid to understand the brilliant mind that is Jack, pee pee enlargement model (grin).  And still they remained silent.  

And then we get the cruise debacle.  No doubt it did NOT go down as Jack tells it.  The man has been officially sanctioned by his professional society for lying in a court deposition.  His science from leptin receptors not being able to handle electrons from carbs vs. fats to polar bears with shredded abs just doesn't hold water at any temperature ... not to mention the tales of MRSA injection and hours long ice baths.  I must thank all of my regular readers for their support during that whole time.  While I had nothing to worry over, it's still not fun listening to a mad man on a news program fingering you, and lives have been ruined by far less serious accusations getting out of hand.  And I also must thank the many people who reached out behind the scenes with support.  It is so very much appreciated, although I hope you won't be too disappointed when I say I wish you would all speak more publicly when this sort of thing happens.  Doesn't have to be in support of me, but just speaking out on your own stance.  I DO understand why so many don't -- I'm bound far less by law, professional/economic interests, and frankly time than most -- but maybe?    

I cannot express enough how disgusted I was when Andreas Eenfeldt posted this about Kruisegate:  

Rumor says that the offending tweet came from a long time stalker of prominent low carb people such as Gary Taubes and Jimmy Moore. Perhaps she will not laugh as hard when questioned by police about false terror warnings, apparently a felony that could result in 20 years of jail time…

I plan to address the stalking BS very soon.  But it is clear Andreas is fingering me here.  On rumor ...  Would it be too much to ask that Andreas walk that one back given current knowledge?  Eh ... he had a post on Jack's fake pic, but took that one down.  Wonder why?   You see Andreas apparently can't think for himself and relies too much on his own gossip network.  Amid the fallout of AHS11, I wrote Guyenet v. Taubes: Is There a Working Hypothesis for Obesity?

With his English language blog, appearances at various conferences and LLVLC events/cruises, and the apparent rise in popularity of low carbing in Sweden, Andreas Eenfeldt is a rising star promoting low carb diets.  Therefore, I think his comments on Stephan's recent debunking of Taubes Wrong Insulin Carbohydrate Hypothesis Of Obesity, TWICHOO, and the post on his blog about same deserve some attention.

which elicited the following response:  Diet Doctor: rising star or fraud?.  He ended that with 

"PS:  Regarding the title of this post: I have not been called a fraud by CarbSane yet. But judging from earlier events that may just be a question of time."   

Call someone a rising star and take on their "science" and yep, you're gonna call fraud next thing, eh?  I've yet to see fraud from this guy, but irresponsible behavior.  Yeah.  So to wrap this up, I don't know how many witnessed the short Twitter exchange between Andeas and I (hay, at least he's capable of communicating which is more than can be said for so many others ... kudos for that!), I copy it here:

Andreas Eenfeldt ‏@DietDoctor1

Dr Jack Kruse: Low Carb Bioterrorist? http://bit.ly/K2EGjC

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9 MayEvelyn ‏@CarbSane

@DietDoctor1 72+ hours since LC Cruise sailed. No FBI at my door Andreas. Rumor has it anyway.

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6:21 PM - 9 May 12 via web · Details

Somewhere there was a reply that he was glad to hear it.  Can't find that.  Then

Andreas Eenfeldt ‏@DietDoctor1

@CarbSane @rexhungus Building something yourself is better than focusing on tearing others down. That never gets old, right? ;)

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14 MayEvelyn ‏@CarbSane

@DietDoctor1 What have you built yourself Andreas?

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Andreas Eenfeldt ‏@DietDoctor1

@CarbSane Not much yet I guess. But still, that should be the ambition. I'm sure you agree.

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Evelyn ‏@CarbSane

@DietDoctor1 @rexhungus You don't read my blog Andreas. I tear bogus theories down, not people. Same can apparently not be said for you.

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5:00 PM - 14 May 12 via web · Details

Evelyn ‏@CarbSane

@DietDoctor1 Who says otherwise? You are under the false impression about my work. Will not stop debunking bad science though.

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This is the new meme.  The stalker thing can't hold up much longer because it's just too ridiculous.  So now folks will try to silence me by implying all I do is tear things down and add nothing positive to the discussion.  Just because I add nothing to your version of science doesn't mean I add nothing.  But if folks want to call it tearing down, you know what?  I'm damn proud of that which I do!  Few others have had the guts to take on fakes, phonies and frauds, and just plain profiteering at the expense of desperate obese people.  Dick Nikoley sought to advise me on how better to use my talents ... presumably to expose the real problems??  I dunno, he's too hard to decipher.  If we've learned anything, albeit in almost caricature "bad guy" style, from this Jack Kruse debacle it's that you cannot let those "little" things go unquestioned.  "The Cause", whatever that is, will be better for some inner skepticism, debate and disagreement, because we can all see where going along to get along has gotten things.  I'm all in to work towards science-based nutrition and lifestyle recommendations. Perhaps we can agree that so long as the "science-based" part is on solid ground, we don't all have to agree on everything and let the facts sort themselves out.  It seems, however, more like folks have decided what science they deem right and therefore any dissent must be stifled or it will bring down the cause.

You know, over a decade ago my husband made a career switch from working for himself in his own business to working for supervisors and a company.  I know this was hard for him, and I'm not sure I could have done it.  But one of his first bosses told him once that it was more important to "have your ducks in a row" than meet every goal and expectation the company/he had for him.  In other words, so long as he was putting in the time, dedication, diligence, etc.etc., everything would be OK.  But if you're slacking off or taking long lunches so that's why you didn't finish the job expected of you, it won't fly.  You might get away with it once or twice, but there will come the time you're caught and that's when things fall apart for you.  It's sort of similar to the it's not the crime it's the cover-up thing we see so often in the news.  I think this is the problem with too many in this community.  They have hitched their cart to a one-trick pony and have to keep going with that and hope it survives.  I think some of these folks truly believe that pony is the bestest pedigree, but I also think many of them know it's riddled with cancer.  I think this is why folks like me are threatening to them.  If your ducks are in a row, your science solid, then what can little-old-me do to you?  Nothing.  You respond with a sound, solid, science based smackdown of my "nonsense" ... right?   But they don't do that, because they apparently can't, and their ducks are swimming about willy nilly in all directions.  It is telling.  

From Andreas Eenfeldt you get uncritical praise of a rather unremarkable study in furtherance of dogma -- Bad Science, Bad Media, Bad Blogging.  From me you get the sort of scrutiny and analysis praised when directed at the George Brays of this world.  Sometimes you need to tear things down to build up knowledge.