1. The Wall Street Journal runs an op-ed entitled "Carbs, Good for You? Fat Chance!" by NYT bestselling author Nina Teicholz on the harm done by the recent observational study published in Lancet Public Health (and the misleading headlines that followed). She writes, "defenders of the nutrition status quo continue to mislead the public and put Americans’ health at risk." For a longer, fully referenced piece, check out Teicholz's Medscape article.

2. More PURE results, this time on whole fat dairy foods, are published this weekin The Lancet. This observational data shows better health outcomes for those who ate more full-fat dairy. Both The New York Times and Newsweek summarize the questions raised by the study. The American Heart Association's dogmatic response is captured in MedPage: "Currently with the evidence that we have reviewed, we still believe that you should try to limit your saturated fat including fat that is coming from dairy products." #WillfulBlindness

3. The Guardian reports that Britain's NHS will begin a staged rollout of a trial prescribing a very low-calorie liquid diet to reverse diabetes. While It is terrific to see physicians and health systems treating type 2 diabetes as a reversible condition rather than a progressive chronic disease, remission with this approach is highly dependent on maintaining weight loss. Over the long term, maintaining weight loss by restricting calories has a very poor track record indeed. What makes more sense for reversing type 2 diabetes? Carbohydrate restriction.

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1. The CDC updates obesity data. What's the number? Forty percent. 40% of US adults age 20-74 were obese in 2016. That number, in 1960, was just 13.4%. For children, between 2014 and 2016, both overweight (16.6%) and obesity (18.5%) continue to rise... across all age groups and both genders, with one exception — teenaged girls saw a slight improvement.

2. The New York Times investigates an all-too-common problem in science: that could bias authors' perspectives.  "One of the world’s top breast cancer doctors failed to disclose millions of dollars in payments from drug and health care companies in recent years, omitting his financial ties from dozens of research articles in prestigious publications like The New England Journal of Medicine and The Lancet." Corporate influence is a huge problem affecting not just drug studies, but nutrition research as well.

3. The U.S. Departments of Agriculture and Health and Human Services seek nominations for the 2020 Dietary Guidelines Advisory Committee. What can we do to encourage a seat at the table for a member of the low-carb community? 
   

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1. Dr. George Lundberg, "ultimate insider" and former (longtime) Editor-in-Chief of JAMA, delivers an 8 minute soliloquy entitled "It's Not the Fat That Makes Us Unhealthy." How the mainstream medical and public health communities got it wrong.

2. Gary Taubes explains an emerging technique called Mendelian randomization, which uses genetics to mimic clinical trials. This number crunching tool could save researchers the time and expense of drug development and RCTs testing a promising association—like higher HDL and less CVD—that genetics can tell us is unlikely to be causal.

3. Stanford scientist John Ioannidas calls for radical reform of nutritional epidemiology in this viewpoint piece published in JAMA. "[S]tudies of nutritional epidemiology continue to be published regularly, spuriously affect guidelines, and confuse the public through heated advocacy by experts and non experts," writes Ioannidas.

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1. Unfortunate headlines abound. A new epidemiological study, published in The Lancet Public Health, makes waves with its claim that carbohydrate levels of 50-55% of calories are associated with a longer life. Of course, confounders and design flaws are abundant and easy to spot. Doctors Andreas Eenfeldt, Zoe Harcombe, Georgia Ede, Aseem Malhotra, and John Schoonbee each take a closer look and explain why this sort of study should be ignored. 

2. The Guardian runs an op-ed by George Monbiot that sets out to debunk many of the common myths about obesity. "It’s not that we’re eating more, that we exercise less, or that we lack willpower. The shaming of overweight people has to stop."

3. A new, large cohort study of Swedish patients with type two diabetes finds that managing five risk factors—elevated glycated hemoglobin level (HbA1c), elevated low-density lipoprotein cholesterol level, albuminuria, smoking, and elevated blood pressure—into the normal range eliminates most excess risk for illness and death. Treating patients with diabetes with a low-carb diet has been shown to normalize HbA1c and blood pressure in RCTs.

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1. Does carefully following our Dietary Guidelines for Americans (DGA) work to improve blood sugar control and blood lipids? This 8 week RCT, testing a near-ideal DGA diet versus a typical American diet, suggests the answer is "NO." "Fasting insulin, glucose, triglycerides, oral-glucose tolerance, and indexes of insulin resistance were not affected by either of the diets." The only improvement was a reduction in blood pressure. 

2. Cutting back on salt? Why bother? MedPage reports that new PURE study results, published in this week's The Lancet, show, for those consuming less than 4g sodium/day, reducing salt is associated with MORE heart events. (Average US consumption is 3.4g/day.)

3. NYT reporter, Anahad O'Connor, reports on another dietary advice switcharoo. The American Heart Association rolls back its longstanding advice to eat a variety of foods. Now, its researchers recommend a focus on quality and less worry about variety. Because sometimes, more variety means more bad choices.

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1. Stanford Medicine announces results of a stunning new study showing diabetic-level blood sugar excursions in healthy volunteers. The study utilized CGM (Continuous Glucose Monitoring) technology to document post-meal blood sugar levels. Senior author, Dr. Michael Snyder, explains: “We saw that some folks who think they’re healthy actually are misregulating glucose — sometimes at the same severity of people with diabetes — and they have no idea... We saw that 80 percent of our participants spiked after eating a bowl of cornflakes and milk. Make of that what you will, but my own personal belief is it’s probably not such a great thing for everyone to be eating.”

2. New York Times reporter Anahad O'Connor takes a look at time restricted feeding, also known as intermittent fasting. His piece, "When We Eat, or Don't Eat, May Be Critical for Health" explores the growing body of research that suggests we experience better health when we align our eating patterns with our circadian clocks. Hint: no more bedtime snacks. 

3. Nippon reports that a survey conducted by Japan's Ministry of Health, Labor, and Welfare found record levels of diabetes. Among Japanese adults, 16.1% of men and 9.3% of women have diabetes. Note that the article incorrectly states, "Once a person has contracted diabetes there is no cure." Experts now believe that for many patients with T2D, carbohydrate restriction can resolve their condition.

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1. A new Cochrane systematic review shows that fish oil (Omega 3) supplements do NOT improve health or longevity.  The review encompassed 79 randomized trials and included over 112,000 subjects. Lead author Dr. Lee Harper states, “The review provides good evidence that taking long-chain omega 3 (fish oil, EPA or DHA) supplements does not benefit heart health or reduce our risk of stroke or death from any cause.  The most trustworthy studies consistently showed little or no effect of long-chain omega 3 fats on cardiovascular health."

2. Fiona Godlee, editor in chief of The BMJ, pens an op-ed entitled "Pills are not the answer to unhealthy lifestyles." In it, she writes, "... Pills can’t be the answer to diseases caused by unhealthy living. As well as unsustainable cost for often marginal benefit, they always cause harm. Rather than medicating almost the entire adult population, let’s invest our precious resources in societal and lifestyle change, public health, and prevention." Amen.

3. Stanford scientists John Ioannidis and John Trepanowski write a prescription for improved nutrition research in review journal Advances in Nutrition. A key recommendation is pooling resources for larger randomized trials. "Pivotal megatrials with tens of thousands of participants and lifelong follow-up are possible in nutrition science with proper streamlining of operational costs."

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1. The Cato Institute makes the case that "the federal government may be institutionally incapable of providing wise dietary advice." The problems cited include divided and thus inconclusive science, risk avoidance, premature decision making, and distortions introduced by lobbyists.

2. Not all carbs are created equal. Harvard's prolific Dr. David Ludwig illuminates the connection between carbohydrate quality and health, this time in BMJ. A key message: "Replacing processed carbohydrates with unprocessed carbohydrates or healthy fats would greatly benefit public health."

3. The BBCruns a 5 minute feature on UK Deputy Labor Leader Tom Watson, who has lost 96 pounds in eleven months by cutting out sugar and starch and eating more fat. Given his personal transformation, Watson asks if government should be giving dietary advice when there is such scientific controversy surrounding nutrition. 
   

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1. One of the world's leading oncologists, Dr. Siddhartha Mukherjee of Columbia University Medical Center (and The Emperor of All Maladies fame), set to launch human trial of ketogenic diet therapy as an accompaniment to drug therapy in specific types of cancer treatments. Recent mouse studies demonstrate the efficacy of administering ketogenic diets—which lower insulin levels—while treating some types of cancer.

2. Is a calorie really a calorie? Harvard researcher and clinician, Dr. David Ludwig, makes the case for the "Carbohydrate-Insulin Model" and a low-glycemic load diet in JAMA Internal Medicine. Clinical Endocrinology News covers the debate, here.

3. Are ketones the "fourth macronutrient" and can a ketone supplements make you run faster? Runner's World reports on the trendy ($99 for three 2.2oz bottles) supplement.  Warning: "I liken the flavor to a mixture of raspberry-flavored vodka, cough syrup, and nail polish remover; others have described it as a mix of rubbing alcohol and toilet cleaner with a hint of fruit."

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1. FDA Commissioner, Scott Gottlieb, announces new steps to improve health through nutrition. The FDA reportedly regulates 80% of America's food supply, so potential to make a difference seems real. But announcement underwhelms, with bureaucratic double-speak and little, if any, meaningful innovation. Dr. Gottlieb pins his "Nutrition Innovation Strategy" on modernized nutrition labels, better ingredient lists, and resolving issues of 'identity' (as in should an almond beverage be called "milk"). Public comments may be submitted and a public hearing is set for July 26.

2. Dr. Amy McKenzie presents Virta Health's results for improving outcomes of patients with pre-diabetes at ADA conference. At one year, none of the 95 subjects who completed the study progressed to type 2 diabetes, and over 60% achieved HbA1c of less than 5.7mg/dL (~15% at baseline). 70% of participants lost more than 7% of their body weight.

3. A new CDC report shows that exercise rates among adults are increasing, while obesity is also on the rise. The AP explores possible explanations.

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1. Reinsurance giant, Swiss Re, hosted a "meeting of the minds" on nutrition and health in Zurich last week. Experts on many sides came together to highlight common ground and debate differences. A key message: type 2 diabetes is often reversible and offering patients options to do so should become the standard.

2. Pittsburgh area politician, John Fetterman, loses ~150 pounds by cutting out sugar/grains and walking more. Will this mayor and Democratic nominee for LT Governor help bring the message of reducing processed sugar and starch for better health to the people of Pennsylvania?

3. Former FDA Commissioner, Dr. David Kessler, argues with food pundit Marion Nestle about what we really know about healthful eating: "I think we have failed in giving nutritional advice to people. If diet & exercise were the answer, we'd all do it & there wouldn't be a problem...I would try to get answers to very basic questions...Is a calorie a calorie?" Unfortunately, NuSI's crusade to address this sort of question has been diminished.

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1. Professor Tim Noakes, a leading scientist in the field of sports medicine, acclaimed author of The Lore of Running, and now advocate for low-carb diets, was found innocent of endangering the public and unprofessional conduct for the second time. The Nutrition Coalition covers the ruling and the story behind it. Congratulations, Professor Noakes!

2. California mayor, Sean Wright, is sharing his success with a keto diet for weight loss, reversing prediabetes, and resolving fatty liver. He invites fellow residents of Antioch to learn more and join him in a journey to better health.

3. Problems with sugar start early and get worse. According to reports on a new CDC study, American toddlers build up to 7 teaspoons added sugar per day by age 2. "High amounts of added sugar can be hidden in seemingly healthy food: a single-size serving of yogurt with fruit at the bottom can contain up to six teaspoons of sugar. In a regular 8 ounce serving of apple or orange juice, there are 5.5 teaspoons of sugar, on average."

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1. New WHO study presented at European obesity conference in Vienna projects that without a change in course, global obesity and diabetes rates will reach 22% (obesity, up from 14% in 2017) and 12% (diabetes, up from 9% in 2017) by 2045.

2. Author Nina Teicholz's op-ed in the LA Times asks why our government has enacted new regulations that require chain restaurants to post calorie counts on menus when the science doesn't support the notion that this will make a difference in the battle against obesity.

3. New study shows lifestyle advice to "eat less, exercise more" fails to meaningfully reduce the progression from prediabetes to a type 2 diabetes diagnosis.

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1. A medical mystery: What happened to US healthcare spending, beginning around 1980? The New York Times documents how US spending has escalated relative to peer countries, but life expectancy gains have fallen behind. Could the low-fat, grain-heavy diet, introduced in the late 70s, be playing a role?

2. "Our livers are in trouble." Read more about The Hidden Liver Crisis in America and how a lower-carb, higher-fat diet can turn things around.

3. A public-private partnership to reverse type 2 diabetes? Working together with county and city governments, can Virta Health bring better health to a region of Indiana, and demonstrate the efficacy and cost saving potential of its virtual clinic model for reversing type 2 diabetes?

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1. A well written, detailed post from Drs. Wood, McKenzie, Volek and Phinney of Virta Health, discusses the impressive improvement in CVD markers seen after 1 year with Virta's T2D reversal protocol, which includes a low-carb, high-fat diet. Peer reviewed study published in Cardiovascular Diabetology.

2. The New York Times (and MedPage) report on a new survey out of Boston Children's Hospital, published in AAP's Pediatrics, demonstrating exceptional glucose control in patients (both adults and children) with T1 diabetes consuming a very low-carb diet and using less insulin. These patients also report fewer adverse events like hypoglycemia. This was not an RCT, but is nonetheless very encouraging data that documents an otherwise unheard of phenomenon: normal blood glucose levels for those with Type 1 diabetes.

3. Another small, short duration RCT published in the British Journal of Nutrition shows replacing carbohydrates with fat and protein improves glucose control and satiety in patients with type 2 diabetes.

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1. Given the failure of our national dietary prescriptions to reduce levels of chronic disease, it is no wonder that the "nutrition debate" continues. In the latest volley, nutritional epidemiologist Dr. Dariush Mozaffarian argues in the BMJ that nutrition science can indeed be relied upon to improve our understanding of the connection between food and health. But Gary Taubes and Nina Teicholz disagree, and make a strong case for "caution and humility" when interpreting epidemiological data for the purposes of population-wide dietary strategies for prevention of chronic disease.

2. On a related note, back and forth we go with epidemiological studies. The New York Times reports on a new Swedish analysis, published in Heart, which makes the case that when fully adjusted for confounding variables, nuts aren’t as heart healthy as previously reported. Case in point, the same NYT reporter published an article entitled, "Nuts may lower your risk of heart disease" in November, 2017. Similarly, the Star Tribune reports that many older Americans are paying for vitamin supplements that may cause harm, as early exuberance for vitamins outpaces the evidence and consumers can't keep up with the ever-changing recommendations.

3. Virta Health, a Silicon Valley startup reversing type 2 Diabetes with a virtual clinic model and strict, low-carb diet, receives a shot in the arm from the VC community—$45 million in additional funding to help bring its model to scale. This is a strong endorsement of Virta's excellent results.

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Plate of the Week

Click through for a basic recipe:

• Grilled Steak

• Asparagus Stalks

• Baby Beets

This plate is low carb and takes about 30 minutes to prepare.

This plate is low carb and takes about 30 minutes to prepare.

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1. Can a healthier diet help battle depression? The Wall Street Journal reports on a new field: nutritional psychiatry. Recommendations center around replacing sugar and processed foods with real, whole foods.
2.  A small West Virginia hospital—WVU Medicine Jefferson Medical Center—eliminates sugar-sweetened beverages. Here's to a health system practicing what it preaches!
3. FDA Commissioner Scott Gottlieb apparently believes that clearer food labels and salt reduction will improve American diets and save lives. But logic tells us that tweaks around the edges of a failing dietary paradigm will amount to nothing.

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1. A new, Czech epi study (a large-scale ecological analysis) of cardiovascular disease risk across 158 countries points the finger at dietary carbs, not fat. "Results... identify high carbohydrate consumption (mainly in the form of cereals & wheat) as the dietary factor most consistently associated with the risk of CVDs." For a thoughtful analysis of this study, see The Nutrition Coalition's post.
2. The CDC releases a new report on diabetes prevalence in US adults. The National Health Interview Survey was expanded to include questions about type 1 (0.55% of adults) vs. type 2 (8.6% or adults) and insulin status, so this report includes more robust information. Non-hispanic black adults have highest diabetes prevalence: 11.52%.
3. The "obesity paradox" is debunked once again. A large cohort study (of white Europeans) shows lowest risk of CVD events/death at BMI of 22-23. "Any public misconception of a potential ‘protective’ effect of fat on CVD risk should be challenged."

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1. Trouble in paradise... The American Diabetes Association and American College of Physicians (ACP) quibble over blood sugar targets & drugs. The ACP defends its new, higher, blood sugar targets for diabetic patients, claiming it wants to "minimize harms such as low blood sugar, other medication-related adverse effects, medication burden, and costs." Note that carbohydrate restriction—never on the table in mainstream conversations—meets all of those goals AND results in lower, rather than higher, blood sugar.
2. While on the topic of food and blood sugar management, Dr. Robert Lustig posts a pdf of a fantastic letter from a UK Member of Parliament to the British Prime Minister. The MP testifies to the potential of low-carb, full-fat eating for improved health, especially among citizens with diabetes. "My blood sugars are not only more stable, but I have managed to reduce my insulin requirements by almost 50%."
3. The New York Times reports on a new JAMA study (based on NHANES data) that confirms Americans are still getting heavier. Between 2007/8 and 2015/16, obesity rates among adults climbed from 33.7% to 39.6%. Meanwhile, The Hill reports on new data from NCHStats which shows that over the last 12 yrs (as obesity has escalated) more Americans are exercising. Now over 53% of American adults meet activity guidelines, versus just 41% in 2005. Something is not working, here.

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