Health Benefits Cutting 297 Calories A Day

Bob Crowther (68) highlights a July 11, 2019 article in THE LANCET - a two year study examining the effects of calorie restriction on cardiometabolic risk factors in healthy adults.   

Adho Mukha Svanasana

Downdog (2015)

 BACKGROUND

US Centers for Disease Control and Prevention
About 610,000 people die of heart disease in the United States every year - or, 1 in every 4 deaths

METABOLIC SYNDROME
A Cluster Of Metabolic Disorders 
[American Heart Association]

Medical diagnosis can be met when three or more of the following biomarker measurements are observed in an individual - increasing cardiovascular risk:

1 - Abdominal Obesity: waist circumference greater than 40 inches for men, greater than 35 inches for women

2 - Triglyceride: blood serum fat level of 150 milligrams per deciliter of blood or higher

3 - HDL Cholesterol: high density lipoprotein cholesterol values of less than 40 mg/dL in men, 50 mg/dL in women

4 - Blood  Pressure: systolic pressure (top number) of 130 millimeters  of mercury or greater; diastolic pressure (bottom number) of 85 mm Hg or greater

5 - Fasting Glucose: blood sugar levels at, in excess of 100 milligrams per deciliter

[Underlying causes of metabolic syndrome include overweight and obesity, physical inactivity, genetic factors, getting older]

2015 - 2020 US Dietary Guidelines

Recommended 

Daily Calorie Consumption Estimates

[Varies On Age, Height, Weight, Physical Activity]

Adult Women: 1600 - 2400

Adult Men: 2000 - 3000

YET
Pew Research Center Analysis
(Bob Curley)

. The average daily caloric intake for Americans rose 23% from 1970 to 2010

. In 2010, the average American consumed 2,481 calories

Evaluating Health Benefits

From
 CALORIE REDUCTION 

Anahad O'Conner of the New York Times reported on the Kraus investigation, its significant and noteworthy findings:

. it "was the first major clinical trial to examine the effects of caloric restriction in a group of middle-aged or younger adults who were either normal weight or just slightly overweight but not obese.

. The goal of the trial was to look at whether caloric restriction could influence healthy aging and disease."

[Kraus findings build on hypothesis that it's not just weight loss that leads to these improvements, but some more complex metabolic change triggered by eating fewer calories than what's expended. (Samiha Khanna)]

Authors

Prof William E. Kraus, MD (Duke University)
[There were 11 Co-Authors]

Article Title

2 years of calorie restriction and cardiometabolic risk (CALERIE): exploratory outcomes of a multicentre, phase 2, randomised controlled trial

[This study by Kraus, colleagues used data from CALERIE = Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy]

Journal 

THE LANCET Diabetes & Endocrinology

 (July 11, 2019)

Funding
(55 Million)

National Institute on Aging and National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health

Duration Of Study

May 8, 2007 to February 26, 2010

Involving

3 Clinical Centers in the USA

Participant
 Details

Healthy, Lean to Overweight 
Average Age Men & Women (38), Range: 21- 50 

Body Mass Index (BMI)
Average Baseline (25.1), BMI Range: 22.0 to 27.9 

BMI Defined

[= person weight in kilograms (kg) divided by height in meters squared]

Obese Individual Has A BMI of 30, Higer

Participant Pool

218 Individuals Selected, Randomly Assigned 
[238 Were Assessed, Some Eliminated Based On Concerns About Physical Or Mental Health] 

Participant Ethnic Backgrounds
 76% White, 15% African American
 9% Asian, Native American or Pacific Islander



Study Design

Experimental and Control Groups Composition

Experimental Group - 143 individuals were assigned to a 25% caloric restriction diet, 117 participated for 2 years:

• Initially 44 Men, 99 Women 
• Ate 3 Meals/Day Prepared At 3 Clinical Centers For First Month To Understand What A 25% Reduction In Calories Looked Like 
• Choice Of Six Meal Plans Made Available (Cultural Preferences)
• Received Individual, Group Behavioral Counseling For First Six Months On Basics Of Calorie Restriction, Learned To Cook Low Calorie Meals

Control Group - 75 individuals began, 71 completed full 2 years:

• Initially 22 Men, 53 Women
• 'Ad Libitum': Continued Usual Diet  
• Received No Behavioral Counseling
• Met With Researchers Every Six Months 

 Cardiometabolic Risk Factors Evaluated

Baseline data of known biomarkers impacting health span (for cardiovascular and metabolic risk factors including diabetes) were obtained for both groups:

1. Blood (Systolic, Diastolic) and Renal Pressure Values
2. Cholesterol (LDL Cholesterol, Total Cholesterol to HDL Cholesterol Ratio) ... LDL often referred to as 'bad' cholesterol
3. Metabolic Syndrome Score (based on data about abdominal circumference, blood pressure, cholesterol, triglycerides, glucose)
4. Glucose Homeostasis (Measures of Fasting Insulin, Glucose, Insulin Resistance, 2h-Glucose)
5. Inflammation: High Sensitivity C-reactive Protein (hs-CRP) linked to heart disease, cancer and cognitive decline

FINDINGS

Major Cardiovascular & Metabolic Health Benefits 

[Experimental Group]

"Calorie restriction caused a persistent and significant reduction from baseline to 2 years of all measured conventional cardiometabolic risk factors"

• Cut 297 Calories A Day: Average Calorie Reduction (from 2,467 to 2,170) After 2 Years [Over First Six Months, Cut Calories by 20%]
• This Was A 11.9% Reduction, Not The 25% Goal Sought
• Lost About 10% Weight [On Average, 7.5 kg (= 16.5+ pounds)]
• Decrease in Fat Mass Loss (71%), Did Not Change Protein Intake, Ate Slightly Fewer Carbohydrates

AND

• Lower Total Cholesterol, LDL Cholesterol Values - decreased significantly after one year; change was maintained at two years

• 24% Less Blood Serum Triglycerides (Fats)

• Improved Blood Pressure (Systolic, Diastolic) - lowering evident as early as six months, reached statistical significance by one year and persisted for the duration of the study

With Significant Improvement In:

• hs-CRP values (Less Inflamation)
• Insulin Sensitivity Index (Reduced Risk Of Type 2 Diabetes)
• Metabolic Syndrome Score (Lower Risk Of Heart Disease, Diabetes, Stroke)

Also Noted:

• Increase In Micronutrients (Vitamins A, K and Magnesium) 
• Better Sleep, Increased Energy, Improved Mood
• No Significant Increases In Hunger Or Food Cravings

[Control Group]

Mean Reduction Calorie Intake: 0.8% 
Increased Weight: 0.1 Kg (= 0.22 pounds)

Dr. Kraus noted the Control Group participants did not see any of these health benefits of the Experimental Group during the same 2 Year span

Towards Eliminating 297 Calories A Day

Kraus: "It's not hard to achieve that amount of calorie restriction." "That's essentially an after-dinner snack." ... Identify a non-essential component of your diet you can easily skip. (Anahad O'Conner, A. Pawlowski)

What 297 CALORIES Looks Like

(Anahad O'Conner, Susie Neilson, Bob Curley)

. A large bagel, a few chocolate cookies, a small Starbucks Mocha Frappuccino

. About six standard-size Oreos (cookies)

. A ham and cheese croissant at Starbucks (320)
. A regular cheeseburger at McDonald's (300)
. A grab-size bag of potato chips (274)
. A small order of french fries at McDonald's (230)
. A Snickers candy bar (280)

Nutrition experts point out that it's more important to focus on what kind of foods you're eating as opposed to overall calories. (Bob Curley)

Madelyn Fernstrom

(NBC News, Health and Nutrition Editor)

"The calorie-restriction diet can take a lot of mental focus and discipline to maintain, but it can be achieved by eating a variety of low-calorie fruits and vegetables, fiber-rich starch, lean plant and animal proteins, and heart-healthy fats." (A. Pawlowski)

 INTERPRETATION OF DATA

"2 years of moderate calorie restriction significantly reduced multiple cardiometabolic risk factors in young non-obese adults." 

" These findings suggest the potential for a substantial advantage for cardiovascular health of practicing moderate calorie restriction in young and middle-aged healthy individuals, and they offer promise for pronounced long-term population health benefits."

"The extent to which their metabolic health got better was greater than would have been expected from weight loss alone" 

The authors recognized calorie restriction could reduce the "ravages" of cardiovascular disease, diabetes and obesity, possibly boosting  longevity. (A. Pawlowski)

QUOTES, PERSPECTIVES
 On Various Topics

 Kraus On Calorie Reduction:

• "We expected there to be [some] improvement on cardiometabolic factors because of weight loss.' ... "But ... we didn't expect the degree of improvement we saw." (Susie Neilson)

• " ... the magnitude was rather astounding. In a disease population, there aren't five drugs in combination that would cause this aggregate of improvement (Anahad O'Connor)

• "Caloric restriction in this study improved [the biomarkers for metabolic syndrome] dramatically early, and maintained improvements in all five of these parameters rather remarkably."  & Modestly cutting calories "improved even normal biomarkers to be supernormal. Clearly caloric restriction is going to reduce risk of obesity and diabetes among those at greater risk, but it also may actually impact individuals who have minimal risk, so it has broad application over a wide population potentially." (Bob Curley)

Also

• On Why Calorie Restriction Would be So Beneficial: "That's the million dollar question. Its something we really don't know."

• "It's not just due to weight [change]. There is something else about restricting calories that seem to have benefits on cardiometabolic factors that we don't really understand." (A. Pawlowski) 

• Kraus speculates: "We could be resetting the baseline in normal people so it will be longer until they get certain diseases" adding an evaluation of study participants in 10 years was a way to see if there was a legacy effect (see Becky Upham section on Calorie Restriction: The New Fountain Of Youth? and comments on the Diabetes Prevention Program informing Kraus thinking)

Kraus On Study Design 
Using Younger, Mostly Normal-Weight Population

"We designed this study on the basis of the results we've seen in animal trials where calories have been restricted." 
In most cases, the earlier you start the calorie restriction, the greater its effects on the life span and health span.
Health span is the period between the start of the intervention and the start of the disease 
Kraus and his team also wanted to see what benefits, if any, calorie restriction could have for people who weren't overweight (Becky Upham)

&

Susan B. Roberts, Sr. Scientist (Co-Author)
U. S. Department of Agriculture Human Nutrition Research Center on Aging
 Tufts University (Boston)

About Experimental Group

They tended to eat less fat than the control group ... "At the same time they had big increases in vitamin K and magnesium intakes" (markers of a generally healthy diet) (Becky Upham)

"They were eating more healthy foods ... Things like nuts, whole grains, green vegetables and legumes." (Anahad O'Conner)

Editorial Commentary On Study

Frank Hu, MD, PhD Director Of Nutrition
 (Harvard T.H. Chan School of Public Health)

Combining calorie restriction with other strategies like intermittent fasting, a low carb diet or the Mediterranean diet could help people stick with a healthy lifestyle that ensures a lean body over the long term - "the optimal way to promote longevity" (A. Pawlowski)

"Calorie restriction may be a useful tool for better health and weight loss, but it's unclear whether the changes in the new study will ultimately translate into longevity and reductions in chronic disease." ... Hu questioned whether caloric restriction would be practical for most people given that "we are living in an obesogenic environment with an abundance of energy-dense, nutrient-poor foods that are cheap, accessible and heavily marketed." (Anahad O'Conner)

Whether these findings could have real-world application is unclear. Although participants in the study were highly motivated and the intervention was intensive, many people couldn't comply with the goals of the study." (Becky Upham)

1

"Because individual food choices are shaped by the food environment the long-term sustainability of calorie restriction and its benefits on bodyweight can be easily undermined."

2

"Therefore, improving the food environment by making healthy food choices more accessible, affordable, and the norm while reducing the accessibility of ultra-processed and highly palatable foods is essential to supporting healthy food choices."

3

"To this end, policy solutions including sugar taxes, financial incentives producing and purchasing healthy foods, food labelling, and better regulation of food marketing are needed to improve the global food environment." (1,2,3 Jacqueline Howard)

Another Viewpoint

Dr. Subbarao Myla, Director Cardiac Cath Labs
Hoag Memorial Hospital Presbyterian
(Newport Beach, California)

He noted the study was "well designed" ... adding: "it would be interesting to see what happens to the contestants in this study two years after the study ended, if they sustained these habits or not"

Myla was interested in expanding the small trial sample size 'to determine whether similar results would emerge among a larger and more diverse group of people over a longer period of time'

He added: "The study did not address measures of activity which is very hard to control for. Weight loss is best supplemented and sustained by increasing activity." (Jacqueline Howard)

Speculation
An Unresolved Question Of Interest

Dr. Krause asks: could decreasing calorie intake extend life of humans as done with other animals?  
[Calorie restriction has been shown to increase the life span of various organisms and reduce their rate of cancer and other age-related ailments. (Anahad O'Conner)]

" The question is does caloric reduction extend life span or health span - the period between birth and when people develop diseases. ... In all organisms, caloric restriction seems to effect both, while exercise affects health span but not life span." (Bob Curley) 

Future Analysis

Kraus:
"We have collected blood, muscle, and other samples from these participants and will continue to explore what this metabolic signal or magic molecule might be." (Samiha Khanna)

Other next steps for research would be to combine caloric restriction used in this study with other lifestyle interventions, such as modest physical activity (Becky Upham)

Another
 Perspective 
David Sinclair, Professor Of Genetics
(Harvard Medical School)

On Caloric Restriction And Aging
(Susie Neilson)

... the study demonstrates a significant problem with using caloric restriction to improve human health: It's really hard to maintain, even for motivated people. Of the 143 participants who originally began the restricted diet, 26 dropped out before the two years were up. (Small sample size was a limitation of the study.)

"You can't expect the elderly or frail to do this severe dietary regimen. We need alternatives, be they intermittent fasting or medicines that mimic calorie restriction."

 Sinclair is working to understand how caloric restriction works on a molecular level so that he and others can come up with medications that confer the same benefits without the pain and difficulty.

The goal of any caloric restriction research is the reduction - any maybe elimination - of aging-related diseases.

"Aging isn't considered a medical condition - it's just too common. Hopefully, in the near future, we won't accept it."

"That's what calorie restriction offers: It compresses the period of sickness. People one day will hopefully live into their 90s in a healthy way and pass away more quickly and [less] painfully than we do now."

Sources (Reporters, Organization)

 Anahad O' Conner (NYT), Bob Curley (Healthline), Jacqueline Howard (CNN health), Samiha Khanna (DukeHealth), Susie Neilson (npr), A. Pawlowski (TODAY DIET & FITNESS), Becky Upham (Everyday Health)

 STUDY REFLECTS MY EXPERIENCES

I too achieved significant improvements, reducing cardiometabolic risk factors, over several years: positive health outcomes similar to those participants in the Experimental Group described by Kraus and colleagues in their two year trial.

 [During one year I lost 13.2 pounds (10.3% body weight) and, while intentionally eating more, successfully maintained my weight in the 120's at the end of the following 12 months] 

Complementing this lifestyle focus on making better and more informed nutrition choices, I continued my daily yoga sessions - whole body physical asanas contributing to maintaining and enhancing my mobility.

Walking and hiking at times have further contributed to my current health status.

Trader Joe's and Whole Foods continue to be sources of many nutrient-rich and diverse food selections including frozen fruits and vegetables.

I have enjoyed adding whole black figs to the various small home prepared meals.

Whole Black Fig

(Trader Joe's)

Knowledge of some family medical history, potential genetic risk factors have continued to inform my decisions and behaviors over many years.

[My dad was diagnosed with late onset diabetes and later experienced metastasis of colon cancer; my mom was diagnosed with congestive heart failure, had a stoke leading to partial paralysis.] 

Eating better, moving daily, reducing sources of stress and ones genetics all undoubtedly have contributed to many welcomed health status updates enjoyed as a senior - including my recent (June) colon evaluation I remained awake to witness.  

It's encouraging knowing lifestyle choices can, do have significant positive consequences.

I look forward to reading future observations from studies by Dr. Kraus and his colleagues.

Your reaction(s) my comments are welcomed.

#BobCrowther #Nutrition #Yoga

Yoga, Nutrition & "THE TRUTH ABOUT FOOD"

Bob Crowther (67) attributes current yoga mobility to daily nutrition choices made, notes the influence of Michael Pollan among other authors writing, speaking about food and shares topics presented in the David Katz book, THE TRUTH ABOUT FOOD. 

BETTER MOBILITY WITH GOOD NUTRITION

Variation Of  "Spiderman"
In
 THE YOGA LOFT
PHOTO BY PATTY TREMBLAY

 Effective Asana To Prepare For Other Movements
(Upavistha, Compass Pose, Forwards Splits)

 Demonstrating
Whole Body Joint Mobility
&
Lengthening 
Of Muscle and Connective Tissues 

Limitations
 Raising Torso to Upright Position

ACKNOWLEDGING
 YOGA & NUTRITION CONTRIBUTIONS OF RAY HOYT 

MY CURRENT
&
STILL EVOLVING NUTRITION CHOICES 
Mostly Organic Selections

Meals I have prepared daily during the past two months have included the following ingredients among others in various combinations, at times enjoyed raw or heated with olive and avocado oils:

• Broccoli, brussel sprouts, dried and frozen mushroom species, leek, onion, red & yellow peppers, green and yellow beans, rainbow carrots, avocado, sauerkraut, squash (butternut, yellow), baby zucchini, cherry tomatoes

• Blueberries, raspberries, blackberries, apple varieties, goji berries, medjool dates, pitted dates

• Grains have been eaten in different forms: as Ezekiel cereal, different compositions of granola, muesli, grain and seed blends

•  Lentils, and over ten types of beans including black, adzuki plus occasional thin bread slices (quinoa  organic amaranth + quinoa, protein) 

• Mixed raw nuts (almonds, brazil nuts, cashews, hazel nuts, pecans, peanuts, walnuts), seeds (chia, flax, hemp, pepitas, sunflower) along with cocoa nibs, at times dark chocolate with high cocoa content ... also have eaten natural peanut butter at times

• Spices including basil, ground cinnamon, ground ginger, oregano, parsley, rosemary, rubbed sage, thyme leaves, ground turmeric

• Dairy consumption was limited to an organic egg at one time, infrequent addition of some cheese (teaspoon) to a meal of mixed vegetables

• Wild salmon (teaspoons at one time), sardines and frozen sea scallops along with vegetables

• The limited, infrequent meat consumed - usually only one or two teaspoons added to vegetables - have included grass fed bison, organic chicken, turkey preparations 

• Water, coffee and/or tea with no added sugar, dairy were enjoyed with my meals; one bottle of Kombucha but no wine, beer or hard alcohols  ... infrequent drinks (chocolate mocha) or a pastry were available at the Booklovers Gourmet in Webster, MA

My food selections reflect the influence by the journalist, author Micheal Pollan from reading his informative books including The Omnivore's Dilemma, Cooked, In Defense OF Food. 

FOOD RULES (Michael Pollan, 2009)
Eat Real Food, Mostly Plants, In Small Amounts

CONCISE
64 GUIDELINES
A GEM!

Michael Pollan has enlightened the public on food, nutrition topics over decades through his books, diverse articles including the microbiome and many interviews.

Authors also informing my food choices:

• Investigative reporting by Michael Moss that led to the publication of Salt Sugar Fat (2014)

• Mark Hyman's clinical experiences with nutrition for 35 years contributed to the value of his 2018 book: FOOD WHAT HECK SHOULD I EAT?  This informative, accessible resource is reader-friendly: a well organized presentation about our different food categories, providing useful consumer guidelines, available healthy options. 

This author, book was introduced in my March 28, 2018 yoga blog.

Hyman identified what we know, what we do not know about 12 different food categories - noting health & safety considerations, presenting useful options for public consideration.

Having been educated further on making more informed, healthy food choices by Pollan, Moss, Hyman and other authors over many years, it was encouraging to have the opportunity to read David L. Katz writing about known food truths and identifying perceived lies, seeking in his words "the whole truth".

I mentioned Dr. Katz, his most recent book in my January 28, 2019 post - the author being a subject of conversation with a friend attending a Primary Care Physician Convention in Boston.

THE TRUTH ABOUT FOOD
Why pandas eat bamboo, and people get bamboozled

I have highlighted various sources (his education & research, interactions with colleagues and vast publications from many authors with diverse backgrounds) that collectively have influenced the author's perspectives about the distortions, misrepresentations, fallacies, lies and a/the truth re: food, nutrition and related subjects he writes about - at times quoting at length his own words. 

My approach in expanding on the original TABLE OF CONTENTS was deemed necessary (1) to better identify, communicate the diverse, interesting and informative topics included in a book of 752 pages lacking an INDEX. 

EMPHASIS  OF BOOK  (691)

"The particular emphasis of this book is mostly on the truths that directly address the scourges of chronic disease and premature death in developed countries that have good choices but routinely make bad ones"

Katz continues: Calling the book "the truth about food relevant to the burdens of chronic disease and premature death in developed countries that have good choices but routinely make bad ones" seemed rather inelegant to both me, and my publisher. So, "the truth about food" is a proxy for that."

" ... the whole truth about food is a global truth, spanning deficiency and excess, choices and choicelessness."

ABOUT THE AUTHOR
Notable Selections:

• MD from Albert Einstein College Of Medicine (1988)
• MPH from the Yale University of Public Health (1993)
• Residency training in Internal Medicine, Preventive Medicine/Public Health
• Founding Director of Yale-Griffin Prevention Research Center
• Author of 15 books, ~ 200 articles, Textbook Chapters including Nutrition In Clinical Practice, 3rd Edition
• Radio, TV Appearances, Accomplished Conference Speaker
• Founder/President of the TrueHealthInitiative

Research Approach (578)

Katz has: "(1) relied on good, unbiased methods to defend against the biases of researchers alike;

(2) always required that funders defer study management and interpretation entirely to the research team;

(3) always required the right to publish the results, whether favorable to the funder or not; and

(4) limited our studies to those of genuine interest to us for reasons we could express and defend clearly."


 Sources Of Funding (578)

Katz has received financial support from "federal agencies, not-for-profit foundations, and industry"

"We- the researchers- and the funders, too, have been "biased" every time. We have never run a study without caring about the outcome, and wanting a particular outcome is bias."

Katz on "What Science is for" (579 - 580)

"Science is where knowledge extends, not where it begins."

"Science is a method, a set of tools, and the most powerful we know, for answering hard questions that do not yield to casual observation and common experience." 

"Science for all its marvels, depends on sense" ... "the global consensus of experts ... rely on" [science and sense]

Katz cites Tom Nichols multiple times (73, 86, 95, 476) emphasizing the importance of expertise when addressing nutrition, food topics

The author notes "that most physicians are still very, poorly trained in nutrition. But The 'MD' after one's name tends to convince others, and maybe even one's self, that you are an expert in all matters of health. ... doctors with no expertise in nutrition are all too often willing to offer expert opinion."

The author acknowledges (598): 

"Sure, experts can be wrong. And, it's even possible that the global consensus of experts can be wrong, although that's relatively rare in science. And it might even be possible for experts to be "all wrong," although that's vanishingly unlikely, since it's hard to become an expert without actually knowing something, and experts, in general, allow for uncertainty every step of the way."

What Katz Eats (108 -109)

 "... I am not a "vegan" per se. My diet is vegan on many days, and it is made up of wholesome, whole plant foods- vegetables, fruits, whole grains, beans, lentils, nuts, seeds and plain water ... I do not eat mammals at all ... I do ... include some animal foods in my diet.

My wife's *French Mediterranean-inspired cuisine ... makes selective use of cheese, and an occasional use of plain yogurt ... I eat a bit of both ... [cheese consumption has] shifted from bovine sources to goat and sheep in deference to the environmental and ethical issues in the mix.

I eat poultry rarely and reluctantly. ... it is locally sourced, organic, and the birds lived in a free-ranging, cage-free life. Eggs occupy a small place in my diet ... selection to free-roaming, cage-free, well treated, local birds.

... I eat less fish than I used to ... we are very careful about sustainable sourcing. I eat seafood ... careful about the sourcing ...

So, I am not a vegan. But all my sympathies are."

* See pp. 701 - 703  + RECIPES (706 -735) 

NOTE: The author provides brief comments, variations of what to eat in different sections of the book (15, 314, 330 - 331, 360, 442, 678)

Author's Ideal Nutrition
(679 -680)

Katz expands on Micheal Pollan "food, not too much, mostly plants" and offers what seems to him "a quite good, working definition of "best diet for health"":

"dietary patterns associated with the best health outcomes ... are variations on a common theme, ranging from quite low to quite high in total fat, and from moderately low to quite high in carbohydrate, and across a narrower range in total protein ...

 ... always sharing an emphasis on whole, wholesome, minimally processed vegetables, fruits, legumes, whole grains, nuts and seeds with plain water as the preferential answer to thirst-combined in balanced, sensible variety in patterns that are often time-honored and informed by heritage and cultural practices, such as traditional Mediterranean and traditional Asian diets. 

Such diets may or may not include dairy, fish, seafood, poultry, meat and/or eggs- but when these are included, they make up a modest portion of the diet in the aggregate ... tend to be minimally processed, and obtained from animals ... fed a native diet of wholesome plant foods and provided plentiful space for exercise."

Such diets often leave room ... for wine and chocolate, in moderation ... healthful beverages ... tea ... coffee ... but exclude, mostly or entirely, all hyper-processed foods and beverages ... sodas, sports drinks ..."

Other Factors
 Informing Author's Nutrition Viewpoints
(Longevity, Environment, Doubt)

Longevity Related To Nutrition (659)

THE BLUE ZONES

Katz (659):

"We have the real-world evidence of the Blue Zones populations telling us that the longest-lived, healthiest populations  on the planet all consume whole grains routinely. Whole grains figure prominently in variation of the Mediterranean diets, Asian Diets and vegetarian diets."

Dr. Steve Osofsky (682)

Katz: "I was doing all I could to extend the lives of the very creatures busily destroying the planet"

Katz: a part of his standard email signature as of November, 2016 (681)

"As I learn ever more from environmental experts, I find that our debates about diet for human health are apt to become moot very soon. The impact of our prevailing diets on the planet is fast becoming the only thing that really matters. There will be no point in debating diet for human health on a planet no longer hospitable to human habitation- and we ae blithely, and blindly, blundering in that very direction."

Bertrand Russel Quote (13, 670)

"The whole problem with the world is that foods and fanatics are always so certain of themselves, and wiser people so full of doubts."

Katz: "In the company of the wisest, the most thoughtful, most expert and knowledgeable people I know- I have many legitimate doubts about about many details of nutrition."

See

 Marion Nestle (Food Politics)

FDA 

Has Been Compromised Since Inception

[Public vs. Business vs. Political Interests]

FORWARD  (3-10)
Mark Bittman Comments (3 - 4)

NOTE
The Twelve Truths Of Diet (5)

The Five Attributes of Reliable Truths (6)

The Five Warning Signs Of Insidious Lies (7)

Face of Truth, Mask Of Lies? (8)
See 10 Comparisons

TABLE OF CONTENTS (9)

PROLOGUE: SIMPLE, JUST NOT EASY (11- 28)
Katz Quotations

" ... this is NOT a "how to" book ... there is no value in knowing "how to" if you do not know "what to." (11 - 12) ... "We must know how we know it. We must know why we know it ... to deny alternatives to it." (21-22)

"The truth about food is stunningly simple. It's the lies that are complicated." (12)

"Humans knew perfectly well what to eat since long before anyone devised ANY dietary intake assessment, let alone a placebo-controlled, double-blind RCT." (24)

"Lies, damned lies and statistics paint over the truth until it is hidden from view." (27)

"My intent here is to point out what is obvious at the level of sense, and then confirm it with science. The truth about food is on trial. You be the judge." (27)

Part 1: Lies  (29-35)

Chapter 1: Lies (37-245)

Citing Comments Of Author's Plan (40)

[1] ... I will provide what I hope is a reasonably complete inventory of the kinds of lies you are likely to encounter

[2] Then, I will explain each in general terms, and illustrate each with real world examples

[3] It is possible to offer a counter-claim to a falsehood that is, in turn, another falsehood. 

Logic, however, applied correctly, leads always to reliable and generalizable conclusions.

Katz prepared "A catalogue of common and important lies (and fallacies) about diet" (42)

I Identify The 25 Topics Listed By The Author 
Read Katz Example and Reality Check, Additional Comments 

About Time
(43 - 49)
[There is substantial uncertainty about the effects of essentially all foods and/or dietary patterns on health and weight]

Absence of Evidence Equals Evidence of Absence
(50 - 56)
[We can say something is false because we lack definitive evidence that it is true (or vice versa)]

AWARENESS EQUALS EXPOSURE
(57 - 61)
[News about any given toxic exposure is routinely interpreted as if the exposure is new]

BAD BEDROCK Fallacy
(62 -67)
[A valid argument can begin with a false contention]

CELEBRITY EQUALS EXPERTISE Fallacy
(68 - 73)
[Being famous for anything means being expert in everything (and especially nutrition)]

Doubt About This, Proves That Fallacy
(74 - 80)
[If I can raise doubts about the merits of your case, it proves my case]

EATING BREAKFAST EQUALS EXPERTISE FALLACY
(81 - 87)
[Any kind of experience with food equals nutrition expertise]

False Equivalence Fallacy
(88 - 96)
[All opinions expressed about nutrition are of equal merit]

Katz: 

Critical of Nina Teicholz investigative reporting, position of history re: nutrition studies (83)

See

THE BIG FAT SURPRISE

FOOT ON FIRE Fallacy
(97 - 106)
[Advances in our understanding of nutrition, and in ways to study nutrition, require us to renounce everything we knew before]

Mental Mission Creep- and the Menace of Frenemies
(107 - 117)
[If the case is valid, any argument in support of it can help]


ONE-SIZE-FITS-ALL SCIENCE FALLACY
(118 - 131)
[Writers untrained in nutrition, epidemiology, or research methods are qualified to tell us what nutrition studies mean]

READ
MICHAEL MOSS

Opinion Equals Expertise Fallacy
(132 - 139)
[Any opinion about nutrition is tantamount to expert opinion]
See Nichols: Experts can be wrong, their advice ignored

Katz: 
"The idea that every opinion about nutrition is the same as a genuinely expert opinion is, obviously, nonsense." (134)

"Admittedly, there are differences of opinion among even legitimate experts in nutrition." (135)

Mistaking Part for Whole Fallacy
(140 - 144)
[Whatever effect is attributed to some part of a food reliably tells us about the effects of that food]


Repetition Equals Reliability Fallacy
(145 - 154)
[Hearing some assertion about diet and health often enough is a reliable indicator that is true]

Revisionist History
(155 - 162)
[New, altered versions of history are reliable]
Katz is sensitive on this topic


NOTE
MARION NESTLE
food POLITICS

Conflicts Of Interest Discussed

Ripple-Free Pond Fallacy
(163 - 170)
[The effect of a given nutrient, ingredient, or food on health or weight can be understood independent of context]

SCIENCE OBVIATES SENSE Fallacy
(171 - 191)
[A scientific "answer" is always an inconvenient truth]

Straw Diet Deception
(192 - 197)
[Any diet study reporting that "this' diet beat "that" diet is reliable]

Theory Over Reality Fallacy
(198 - 206)
[A theoretical concern (or claim) may be used to dismiss established effects]

Tiny Parachute Fallacy 
(202 - 213)
[A study that fails to show the benefit of a diet or lifestyle intervention proves that intervention is ineffective]

Too Easy (Quick, Good, etc.) To Be True
(207 - 213)
[Being overweight or unhealthy can all be blamed on the right scapegoat, and fixed with the right silver bullet]

Toxic Telephone
(214 - 227)
[A message can be repeated multiple times and keep its integrity]

Unchanged Mind Equals Chained Mind Fallacy
(228 - 237)
[If you fail to change your mind about nutrition whenever the latest headlines say you should, you are dug in, stuck in the past, and rigid]

What's In A (Diet) Name?
(238 - 245)
[Any given diet study may be interpreted reliably based on what the assigned diets are called]

Cultural Currents and Currencies
(241 - 245)
[Our culture makes sense and is the way things ought to be]

 See
 Michael Pollan
Omnivore's Dilemma

Note
 Pollan's comments (130-131) On Joel Salatin and PolyFace Farms

[Pastoral, Perennial species, Polyculture, Solar energy, Local Market, Diversified, Biological, Local fertility, Chicken Feed]

CHAPTER 2: STATISTICS (246- 282)

The inclusion of this topic by the author is welcomed and significant: statistics is a important tool used by research investigators involved in nutrition studies.

Katz highlights, with examples, how statistics applied to nutrition has been used in positive and negative ways.

  Of Bad Apples, Good Baloney, and Culled Cherries

Bad Apple Fallacy (269 -272)
[If fault can be found with any particular nutrition study on any given topic, it tarnishes all studies] 

Chapter 3: DAMNED LIES (283- 306)

Katz:

 "The worst of all lies are damned lies- the willful deception for the sake of profit and personal gain." (283)

" Of course Big Food lies to us about the harms of big food!" (287)

See comments on BIG Ag, Big Food, Big Media, Big Publishing (288 - 298)

Part 2: TRUTH (307-308)

Chapter 4: The Truth  (309 - 667)

Katz Catalog of Dietary Truths lists 68 +1 topics (311-313)
 None of them appear in TABLE OF CONTENTS  (page 9)

I List The 48 Topics Katz Provides Truth About:
(note some topics are included in others)

For each topic, Katz includes an introductory section - bottom lines, up top-, provides comments and a list of citations by him, others - in some cases, the author suggests Additional Reading of Potential Interest.

Adaptation (317- 324)
author notes biological adaptation of our species

Food Addiction (325 - 332)
"eat wholesome food in sensible arrangement" (331)

Algae (333)
mentions powder from Spirulina as whole food ingredient

Calories (334 -351)
Yes, "Of course they count!" (334- 335)
see Table: activities, calories expended (340 - 341)
note 
comments relationship calories, hormonal responses (344) 
  Insulin comments (345)
missing word, second paragraph (348)

Chocolate (352 - 355)
about cocoa
note benefits with 60% content
antioxidant nutrients (flavonoids), stearic acid 
magnesium, fiber, arginine (nitric oxide precursor 
correct error: see to seen (352)

Cholesterol (356 - 366)
Cites 2015 Dietary Guidelines
optimal (plant based diet) will be low in cholesterol
see comments on Eggs (364)



Coffee (367 - 369)
"concentrated source of antioxidants" 
 "has anti-inflammatory properties"

Cooking Oils (370 - 383)
identifies oils used by 7 individuals (377)
comments on canola oil, olive oil
Note 
Soybean, Coconut, Canola Oil References (382-383)
 Dr. J. Thomas Brenna 
recognized as authority of fatty acids, health effects

The Cost Of Nutritious Food (384 - 391)
 not always more expensive, see comments

Dairy (392 - 412)  
 mentions DASH diet (to lower blood pressure)
 advises against Raw Milk
 seek alternatives to Butter (Olive Oil)

also see (668) comments on Dairy
See 
Mark Hyman book FOOD (76 - 93)

Dieting (413 -420)
encourages Lifestyle Changes

The Environmental Impact of Diet (421 - 425)
 a major concern of the author
notes Miriam Nestle book Soda Politics (423)

Watch DVD

Also
See Consumer Reports 
 on
 Meat Contamination 

October, 2018 Article


Read John Tickell book
 KISS THE GROUND 
for a more inclusive discussion on this topic 

Dietary Fats (427 -448)
note comments on Ancel Keys (428)

see informative omega discussion 
(Omega-3, Omega-6)
Omega-3 fats lower inflammation 

eat nuts and seeds for Omega-3

Saturated Fats
limit highly processed foods of any kind including meat and dairy, fast food to achieve low intake of saturated fats

olives and avocados for monounsaturated fats

Plant (seeds, nuts, algae), Seafood sources
suggests limit 

Katz critical of Nina Teicholz

Fish (449 - 458)
Mentions sustainability, environmental issues
John Robbins' book Food Revolution
See
Mark Hyman FOOD (94 - 110)

FODMAPS (459- 461)
"fermentable oligosaccharides, disaccharides, and polyols"
"are diverse sugars, and sugar-like compound"

Fortification (462 -467)

Fruit (468)
Many benefits, negative (kids junk food)
also see: sugar (625), lectin (510)

Gluten (469 - 476)
Comments on potential risk factors eating grains for some
for most people, grains can be eaten 

Glycemic Measures (Index; Load) (477 - 482)
Distinguishing
Index: food raising blood sugar level
Load: concentration of sugar in food

GMOs (485 - 496)
Katz supports technology used

 Legal, political concerns of others, unintended consequences of this technology are not addressed by Katz

See Marie-Monique Robin for another perspective on GMOs


Junk Food (497 - 501)
see 
 Michael Moss Salt Sugar Fat



Truth about Kid Food (502 - 506)
'Big Food' products unhealthy for children
see composite (20): 2017 new cereal marketing

Kombucha (507)
fermented tea with yeast and bacteria
little scientific evidence of benefits 

Lectins (508 - 512)
not an issue for most people

Another Perspective 
Steven Gundry Book

Macronutrients (513 -540)

Fats (514 - 518)


Proteins (518 - 532)
Plants a source of protein

see 
 comments on sarcopenia in adults (528)
T. Colin Campbell views on protein 
vs.
 Ancel Keys perspectives (529)


Carbohydrates (532 - 535)
Plants are mostly carbohydrate

Note:
diets low, high in total fat and relatively low, high in total carbohydrates can be good, bad or in-between

"All carbs are SO not created equal!"

see North Karelia Project references

See
 Gary Taubes
  Good Calories, Bad Calories 

Meat (541 - 558)
 see comments on Paleo
challenges Paleo assumptions about quality of meat then, now

No alternative, nuanced view on meat, dairy, fish in this section
also see comments on meat (678)

Read
Joel Salatin Book

Alternative Guidelines
To
 "Big Food" Meat Production 

Microbiome (559 - 563)
places emphasis on healthy foods, not microbiome
 note author Hadza tribe in Tanzania perspective

See
British Author
Alanna Collen (10% HUMAN)

HUMAN MICROBIOME PROJECT
I commented on the Collen book in my April 19, 2018 yoga blog
Nutrient Supplements (564 - 569)
eat real food, selective use when required

Nutrigenomics (570 - 575)
a young field of science
evaluating
single nucleotide polymorphisms variations

Nutrition Research (576 - 582)
Katz identifies his research and industry funding sources
yet
the history of nutrition science, studies subject to different interpretations of personalities, politics, industry & government

Nuts (583 - 584) 
include them in meals
rich in
 unsaturated fats, protein, minerals, antioxidants, fiber

Obesity (585 - 587)
read brief comments

Organic Foods (588 - 592)
Organic does not mean nutritious
note health, environmental benefits

Personalized Nutrition (593 - 596)
use common sense

Protein (597)   
also see Macronutrients comments 
replace animal protein with plant protein
protein increases insulin release
excess protein is converted to fat 

Salt/Sodium (598 - 604)
decrease consumption
eat foods in sensible combinations

Soy (605 - 608)
"use as component of a balanced diet"

Sugar Substitutes (Artificial Sweeteners) (609 -620)
see Table Sugar Substitutes (612 -613)

Sugar (621 - 628)
see comments
 on Katz's nutrient profiling system NuVal (623)
rejects sugar is poison, fructose is toxic
beware of stealth sugar
Challenges 2014 meta-analysis (628 -630)

Note
 John Yudkin, Investigator
Contemporary Of Ancel Keys

Superfoods (639 - 640)
misleading branding also see comments (668)

Tea (641 -642)
white, green, black varieties
antioxidant presence varies for each

TMAO = Trimethyamine-N-oxide (643 -644)
associated with
 meat consumption (protein l-carnitine)
eggs (choline found in lecithin)

see Mark Hyman comments in FOOD (64)

Veganism (645 - 652)
Katz cites WHAT THE HEALTH Documentary 
Acknowledges the positive benefits from this diet yet
expresses some caveats, its promotion

Documentary highlights funding conflicts of interest 
(with Big Food, Big Ag, Others)

 Anderson & Kuhn (2017)
Promoting Vegan Nutrition

Katz also  mentions documentary (59)

Water (653 -654)
needs related to
temperature, humidity, activity, body size

Whole Grains (655 - 662)
for most, health benefits from eating them
Note
 David Perlmutter, MD
Perspective 

Wine (663 - 665)
in moderation for pleasure

Other Truths (666)
Google Katz for info on topics of interest

 Recommended Sources About Nutrition Truths (667)

Katz names individuals and sources he follows

True Health Initiative Newsletter
Harvard Health Letter
Center for Science in the Public Interest
WebMD
Tufts University Health & Nutrition Letter
AND
The Vegan RD
Politico's Morning Agriculture
ScienceDaily Nutrition News
ConscienHealth

CHAPTER 5: NOTHING BUT TRUTH  (668-669)

CHAPTER 6: THE WHOLE TRUTH (670 -698)

See Author's Comments On:

The Right Way to Be Wrong About Diet

AND
The Right Way to BE Right About Diet
a thought experiment
Plus Alternative Facts

What we know

How we know it 

The Sad Reality: Knowledge Isn't Power

Holes in The Whole truth: Leaving Room for The Unknown
See comments about T. Colin Campbell, The China Study

The Whole Truth: of Science, Sense, and Solidarity

The whole truth: 

is the child of not just science, but also sense

the whole truth is modest, and allows for doubt

EPILOGUE: FREEDOM!

FROM THEORY TO PRACTICE, AND BEYOND ... (699-705)

If I ran the zoo

From theory to practice ...

RECIPES (706-749)
Author's wife "provides a sampling recipes from Cuisinicity"  

Summative Bibliography
Recommended Sources
[I have added page citations by Katz in this book of some authors listed below] 

• David A. Kessler (12), James Hamblin (3, 96, 106, 191, 512, 556, 694, 696), Mark Bittman (3-4, 366, 411), Michael Moss (28, 67, 162, 189, 245, 348, 351, 398, 409, 501, 619, 634), Michael Pollan (169, 390, 467, 530, 539, 562, 604, 694), Monica Reinagel (71), Stephan Guyenet, Yoni Freedhoff
• Berkeley Wellness, Blue Zones (79, 95, 106, 144, 190, 206, 240, 381, 456, 494, 539, 540, 555, 608, 636, 651, 661, 693), Center for Science in the Public Interest, Cuisinicity (2, 109, 375, 705), EAT Forum, Eat Drink and Be Healthy, Food Revolution Network, FoodTank, Harvard Health Letter, Oldways, The True Health Initiative

PLUS

Noteworthy Scientific Articles (737 - 749)

CONCLUSION (751- 752)

"There are various foods that might be good for us, but bad for that of the planet - such as fish from depleted fisheries, seafood from denuded oceans, and game animals from the world's vanishing wild places."

THOUGHTS

On 

THE TRUTH ABOUT FOOD

The author has exposed both lies and identified truths on a wide range of food, nutrition topics - providing informed perspectives and a wealth of resources to consult: from individuals, organizations and publications.

 The two chapters on STATISTICS and DAMNED LIES were accessible through examples cited by the author - effectively communicating information to better understand the ways food and nutrition information can be obscured, manipulated  

 Recommending KATZ Book, Sharing Some Perspectives

• A more expansive, inclusive alternative to the TABLE OF CONTENTS as presented on page 9 would have been appropriate. As written, it does little to identify the topics under consideration and it detracts from the authors presumed goal of both communicating and accessing information clearly, easily - this was not my experience 

• Likewise, the absence of an INDEX was inexplicable and diminished the book being easily consulted as a future resource - I used over 120 yellow Post-it, index cards to mark, to find different topics ... admittedly frustrating given my interest in the food, nutrition subjects addressed by the author 

• Additional editing of the book to make it more concise would have avoided the repetition of topics without compromising the content, intended message of the author 

Also

The history of nutrition science, the role of Ancel Keys, contemporaries plus competing political, health and business interests then and since is far more complex than presented by the author in different sections of this book based on other authors I have read

 [I look forward to reading the original Keys Seven Countries Study, the White Paper Katz published via the TrueHealthInitiative with colleagues, and written commentaries of others to access, attempt to evaluate their various viewpoints]

Investigative reporting on historical and contemporary nutrition topics - those without David Katz background, expressed expertise - have and continue to make important contributions to educate the public and should be evaluated on their merits without ad hominem attacks

Final Thoughts

Katz (415) wrote: "The only way to manage weight and health over timelines that truly matter is to master permanent lifestyle changes."

I take satisfaction knowing the daily nutrition focus, food choices during my senior years undoubtedly have contributed to the relatively good current health status being experienced, maintaining a comfortable weight in the 120's.  

Through my yoga and nutrition lifestyle focus, I have become quite good at listening to my body - appreciating the important connection of my yoga mobility with the foods I consume.

Thank You Ray Hoyt!

Share your thoughts.

#BobCrowther #Nutrition #Yoga