Re: Fat Free/Vegetarian Theory of Heart Disease
Posted: Sat Mar 05, 2011 10:19 am
My comments in red.
Donjman wrote:The idea of avoiding fat and animal products is flawed and will lead to malnourishment. This has not been proven for Esselstyn protocol, which features the plant diet with no added oils. On the other hand, those patients using Esselstyn's protocol were not reported as presenting malnourishment symptoms anytime during the 12 year study.
Most now agree that man evolved for a few million years on a diet consisting of meat (and fat), fish and some plants. No bread, no rice, no pasta, no cereals. This is believed by some practitioners of the Religion of Evolution. Practitioners of other religions believe that man was a created being and that he was a created thousands (not millions) of years ago and that he was first created as a plant eater and the consumption of animal flesh came later. Different strokes for different folks. In any event, the particulars of one's belief system are irrelevant to a scientific critique of Esselstyn's study.
Read the Frammingham study, it's massive and has been running for years and shows the correlations between dietary fat (including sat) are low with heart disease. This therefore shows that Esselstyn's idea of removing animal products and reducing fat intake to 10% is totally unnecessary. Given the risks of undernourishment it's not wise to do so. That is the bulk of his protocol and its wrong, his model of heart disease is flawed. His model may be flawed but not his clinical results. His patients probably cared little about the model but cared greatly about the results. Esselstyn's protocol may be unnecessary but it certainly was sufficient. The Framingham study also showed that nobody had heart attacks when their total cholesterol was 150 or less.
Here's another study. In this one women were asked to decrease total fat intake, increase fruit and veg intake, and increase grains. The womens health initiative 2006 trial, involving 48 835 people. Method was: Intensive behavior modification in group and individual sessions designed to reduce total fat intake to 20% of calories and increase intakes of vegetables/fruits to 5 servings/d and grains to at least 6 servings/d. The comparison group received diet-related education materials. Conclusion: Over a mean of 8.1 years, a dietary intervention thatreduced total fat intake and increased intakes of vegetables, fruits, and grains did not significantly reduce the risk of CHD, stroke, or CVD in postmenopausal women and achieved only modest effects on CVD risk factors, suggesting that more focused diet and lifestyle interventions may be needed to improve risk factors and reduce CVD risk. This was the WHI of NIH study reported in 2006 in JAMA. The devil is in the details, as some of the Vitamin C studies have revealed. In the WHI study, those on the "low fat" diet actually ended up getting 29% of daily calories from fats/oils (according to Esselstyn) while the others got a little more. Not really much distinction. The main conclusion is thus not surprising. However, in any case, to extrapolate the WHI conclusion to an Esselstyn protocol wherein 10% of calories are derived from fat is not legitimate. Extrapolations can be done over ranges of a couple percent but not over ranges of a factor of 2 or 3. The secondary WHI conclusion that "more focused diet interventions...........may be needed" has some legitimacy as Esselstyn has proved.
I'd love to hear what Esselstyn's theory is on why he gets the handful positive results. My theory is that his patients will have lowered BG levels, lower adipose tissue, lower insulin requirements leading the more C being available as well as other factors such as increase magnesium intake. They probably have lowered LP(A) and lower risk of clots. What's his theory? That fat causes heart disease? How? By "clogging" the arteries? The point is that his protocol does have some benefits. But there are far too many drawbacks. All because of Esselstyn's misguided idea that dietary fat is causing or is linked to heart disease due to some outdated 1950's schoolboy theory on cholesterol. The diet could be far better. From what I can tell, Esselstyn asserts that his protocol simply restores the health & integrity of the endothelium as a whole and that when total cholesterol, driven by diet, is below 150, people don't have heart attacks. Perhaps not exactly theory but certainly defendable observation. His cardiac PET scans, which demonstrated remarkable blood flow restoration after just a few weeks on his protocol, are not ignorable. I'll leave it to the theoreticians to explain why. It certainly is possible/probable that his protocol could be improved but it was sufficient (if not necessary) to get some good results. And the "drawbacks" did not seem to present any reported issues in his patients over the duration of the 12 years.
It seems to me you've just gone and bought the low fat T-shirt and don't want to have to buy some butter when you next go shopping. Irrelevant comment that does nothing to buttress your claims.