Go Back   Bloggingheads Community > Diavlog comments
FAQ Members List Calendar Search Today's Posts Mark Forums Read

Notices

Diavlog comments Post comments about particular diavlogs here.
(Users cannot create new threads.)

Reply
 
Thread Tools Display Modes
  #1  
Old 11-27-2011, 01:03 PM
Bloggingheads Bloggingheads is offline
BhTV staff
 
Join Date: Nov 2007
Posts: 1,936
Default Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

Reply With Quote
  #2  
Old 11-27-2011, 02:34 PM
Markos Markos is offline
 
Join Date: Jan 2008
Location: NYC
Posts: 334
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

I'm puzzled by Bob's reference to dark chocolate as being a negative in terms of good health. Dr. (I-forget-his-first-name) Weill, the preventive health advocate, always says that eating dark chocolate increases GOOD cholesterol.
Reply With Quote
  #3  
Old 11-27-2011, 02:46 PM
Markos Markos is offline
 
Join Date: Jan 2008
Location: NYC
Posts: 334
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

I would suppose that moderate drinking of, say, red wine might reduce stress, which might be beneficial to the heart.
Reply With Quote
  #4  
Old 11-27-2011, 03:03 PM
SkepticDoc SkepticDoc is offline
 
Join Date: Jan 2008
Location: Argleton
Posts: 1,168
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

The "dry belt" is also the "stroke belt", the issue is that some individuals cannot stop at 1-2 drinks/wine glass a day and can become alcoholics.
Reply With Quote
  #5  
Old 11-27-2011, 02:59 PM
SkepticDoc SkepticDoc is offline
 
Join Date: Jan 2008
Location: Argleton
Posts: 1,168
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

That was fantastic! Please bring him back for a true Science Saturday/Sunday.
Reply With Quote
  #6  
Old 11-27-2011, 03:09 PM
Ocean Ocean is offline
 
Join Date: Jun 2008
Location: US Northeast
Posts: 6,784
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

Quote:
Originally Posted by SkepticDoc View Post
That was fantastic! Please bring him back for a true Science Saturday/Sunday.
How about Medical Sunday?
Reply With Quote
  #7  
Old 11-27-2011, 03:11 PM
SkepticDoc SkepticDoc is offline
 
Join Date: Jan 2008
Location: Argleton
Posts: 1,168
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

Quote:
Originally Posted by Ocean View Post
How about Medical Sunday?
I nominate you!
Reply With Quote
  #8  
Old 11-27-2011, 04:26 PM
stephanie stephanie is offline
 
Join Date: Dec 2007
Posts: 3,921
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

Quote:
Originally Posted by Ocean View Post
How about Medical Sunday?
Good idea!
Reply With Quote
  #9  
Old 11-27-2011, 03:19 PM
Markos Markos is offline
 
Join Date: Jan 2008
Location: NYC
Posts: 334
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

BOB! - Sunflower seeds are NOT inseparable from salt intake! I eat raw, unsalted sunflower seeds. And you can too.
Reply With Quote
  #10  
Old 11-27-2011, 04:21 PM
Olavus Olavus is offline
 
Join Date: Aug 2008
Posts: 26
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

Salt, not too little, not too much...

Sodium J-curve? High and low levels of sodium intake track with CV risk

http://www.theheart.org/article/1316609.do
Reply With Quote
  #11  
Old 11-27-2011, 04:25 PM
Kevin Kevin is offline
 
Join Date: Jun 2008
Location: San Francisco
Posts: 84
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

I enjoyed this. It brought to mind the Barbara Ehrenreich / Hanna Rosin diavlog from a while back, so I was listening for something that would help me reconcile the use of the word "Positive" and figure out where it is with respect to Ehrenreich's critique of positive thinking. I didn't quite find the hooks I was listening for, so I'm still a little puzzled about whether or not I am skepticial of "positive cardiovascular health". I appreciated Dr. Labarthe's criticism of the "ideology of wellness" and reference to commercial products. Basically meaning snake oil, profiteers, isn't that right? The idea of its being an ideology is that people are following no matter what, rather than properly splitting hairs based on the outcomes of controlled studies, and probably losing money to scams and suffering negative health effects when they fall for snake oil and false promises.
__________________
cantmakeanomelette.blogspot.com

Last edited by Kevin; 11-27-2011 at 04:28 PM..
Reply With Quote
  #12  
Old 11-27-2011, 06:38 PM
hilbert90 hilbert90 is offline
 
Join Date: Nov 2011
Posts: 13
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

I've bit my tongue on several Bloggingheads discussions when supposed experts either perpetuate myths or at least don't correct them. This one went too far and I had to create an account to post about it.

Bob continually repeats a phrase similar to "my total cholesterol is bad/too high". This is nonsense. Darwin should have immediately pointed out that no correlation has ever been demonstrated between total cholesterol and heart health. Total cholesterol has essentially no predictive value. This is well-known and not at all controversial today.

The second thing I want to point out is a little easier to let slide because it is much harder to explain. LDL is not "bad". Again, your total LDL number has essentially no predictive power. There are many types of LDL and you need a more thorough blood test done to find out the ratio of "large" LDL particles and "small" LDL particles. The large are actually quite good and it is the small that are the predictor of heart problems.

I'm really hoping that our expert knew this and just didn't feel like going into some long biochemistry lecture. There is a good chance that he was just parroting the misinformation that has perpetuated our culture and doesn't actually realize it is inaccurate.
Reply With Quote
  #13  
Old 11-27-2011, 06:48 PM
ragamuffinman ragamuffinman is offline
 
Join Date: Aug 2009
Posts: 12
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

hilbert -

As Chris Masterjohn points out, LDL particle size is a proxy for lipoprotein oxidation, which is the fundamental cause of atherosclerosis. Attention should be paid to exactly how the oxidation process occurs and why LDL particles might spend a long time circulating around the body (which gives more time for the lipoproteins to oxidize), as opposed to the particle size numbers themselves.

I agree, though, that the conventional wisdom about "cholesterol" is absolutely terrible.

Last edited by ragamuffinman; 11-27-2011 at 06:51 PM..
Reply With Quote
  #14  
Old 11-27-2011, 06:59 PM
ragamuffinman ragamuffinman is offline
 
Join Date: Aug 2009
Posts: 12
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

Quote:
Originally Posted by hilbert90 View Post
Darwin should have immediately pointed out that no correlation has ever been demonstrated between total cholesterol and heart health. Total cholesterol has essentially no predictive value.
Somewhat correct - for the typical person with medium-low to medium-high total cholesterol, increasing cholesterol doesn't much increase the risk of heart trouble. People with familial hypercholesterolemia, however, have off-the-charts-total cholesterol and a much-increased risk of heart trouble. Still, obsessing over mid- to middle-high- range total cholesterol numbers is pointless.

Once again, seek out stuff by Chris Masterjohn. Taubes is great for clearing your head of nonsense, but there is better work being done in the blogosphere. I can also recommend Stephan Guyenet.
Reply With Quote
  #15  
Old 11-27-2011, 06:42 PM
ragamuffinman ragamuffinman is offline
 
Join Date: Aug 2009
Posts: 12
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

I agree with Gary Taubes that the state of public and physician understanding of heart disease today is depressingly bad. Public health authorites (Mr. Labarthe is a good example) give vague, useless and contradictory advice. The saturated fat and salt hypotheses collapse when subject to any scrutiny (read Taubes on these matters). Gallons of ink are spilled about whether or not chocolate or red wine reduces one's risk of a heart attack by 0.0001%. People are told to lose weight without being told how.

The Gary Tabues diavlog last spring was a gateway drug that led me into the world of non-terrible thinking about nutrition. I bought Taubes's insulin-is-the-devil theory initially, but it misses the mark. The "diseases of civilization" method of thinking though degenerative disease in Good Calories Bad Calories is a great starting point, however. I think the smarter corners of the Paleo and Weston A. Price nutrition universe (people like Kurt Harris and Chris Masterjohn) are getting closer to the truth about degenerative disease. There is still much we don't understand.

For one thing, no attention is paid to the actual mechanism behind atherosclerosis! Start with this article: http://www.cholesterol-and-health.co...ease-Myth.html. You'll end up knowing more than most doctors (which is quite sad).
Reply With Quote
  #16  
Old 11-27-2011, 07:00 PM
hilbert90 hilbert90 is offline
 
Join Date: Nov 2011
Posts: 13
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

Thanks! I completely forgot to mention the absurdity of the salt part of the conversation in my last post.
Reply With Quote
  #17  
Old 11-27-2011, 07:48 PM
SkepticDoc SkepticDoc is offline
 
Join Date: Jan 2008
Location: Argleton
Posts: 1,168
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

What makes you think that Mr. Masterjohn is an expert?

His peer reviewed papers are irrelevant to CV disease:

http://www.ncbi.nlm.nih.gov/pubmed/17466237?

http://www.ncbi.nlm.nih.gov/pubmed/17145139?

Vitamin E should not be recommended

Quote:
Conclusion In this meta-analysis, vitamin E increased the risk for haemorrhagic stroke by 22% and reduced the risk of ischaemic stroke by 10%. This differential risk pattern is obscured when looking at total stroke. Given the relatively small risk reduction of ischaemic stroke and the generally more severe outcome of haemorrhagic stroke, indiscriminate widespread use of vitamin E should be cautioned against.
http://www.nejm.org/doi/full/10.1056...99605023341802

Quote:
Conclusions

After an average of four years of supplementation, the combination of beta carotene and vitamin A had no benefit and may have had an adverse effect on the incidence of lung cancer and on the risk of death from lung cancer, cardiovascular disease, and any cause in smokers and workers exposed to asbestos.
http://jama.ama-assn.org/content/294/1/56.short

Quote:
Conclusions The data from this large trial indicated that 600 IU of natural-source vitamin E taken every other day provided no overall benefit for major cardiovascular events or cancer, did not affect total mortality, and decreased cardiovascular mortality in healthy women. These data do not support recommending vitamin E supplementation for cardiovascular disease or cancer prevention among healthy women.
http://ukpmc.ac.uk/abstract/MED/1576...3DE101EC110287

Quote:
CONCLUSION: In patients with vascular disease or diabetes mellitus, long-term vitamin E supplementation does not prevent cancer or major cardiovascular events and may increase the risk for heart failure.
I hope you don't bleed much from biting your tongue
Reply With Quote
  #18  
Old 11-27-2011, 11:31 PM
ragamuffinman ragamuffinman is offline
 
Join Date: Aug 2009
Posts: 12
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

I was referring more to his popular writings, which try to explain the mechanisms behind things instead of relying on simplistic admonitions and impossible-to-interpret numbers from observational studies. I dig that kind of thing. As with most writers, I try to be skeptical about positive part of his argument.

Please provide a little more detail about why that article demonstrates that the guy is a clueless idiot...?
Reply With Quote
  #19  
Old 11-29-2011, 09:08 PM
thelaker thelaker is offline
 
Join Date: Dec 2008
Posts: 7
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

I found this diavlog kind of aggravating. Labarthe avoided Wright's question about what specific indicator (e.g. LDLs, HDLs, ratio of HDL to LDL) is predictive of cardiovascular events. Instead, we got a lecture about what has become the conventional advice about preventive medicine and being "healthy". This in spite of recent evidence that the conventional wisdom might be wrong. The questions about the true link between salt and heart disease brought out by Taubes has already been mentioned in this forum, but JAMA only a couple of years ago also poured some cold water on the idea that a "healthy lifestyle" has any survival benefit. This link (http://junkfoodscience.blogspot.com/...ifestyles.html) has all of the details, but here is the punchline for the time pressed:

'The findings from two major clinical trials testing the effects of lifestyle modifications for the primary and secondary prevention of cardiovascular events and in reducing premature deaths from all causes were presented. The emphasis and significance of his article, though, was not in the studies themselves, but in the discussions of lifestyle medicine that followed.

Both major trials “failed to achieve their primary endpoints, which were to lower levels of low-density lipoprotein cholesterol (LDL-C) and mortality and hospitalization,” he said.'

***************

My own pessimistic view (oops, I guess that means I'll have a short lifespan) is that unless we all die of something, and unless we are lucky enough to get hit by a bus, that death will be expensive regardless of what preventive measures you took early in your life. Over the last 150 years or so, the medical community has made great progress in grabbing the low hanging fruit. Infant mortality is way down, we have much better control of infections and communicable disease, and progress has even been made in treatment of cardiovascular disease. Now we are left with the hard stuff - the fundamental effects of aging. As George Johnson alluded in the previous diavlog, no universal cure for cancer is imminent. And even if you do follow the healthiest of diets and run 8 miles a day and make it to age 85, you still have even odds of having dementia and needing long term care.

That thought makes me just want to go out and have that bacon double cheeseburger and beer now.....
Reply With Quote
  #20  
Old 11-29-2011, 09:38 PM
graz graz is offline
 
Join Date: Mar 2007
Posts: 3,162
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

Quote:
Originally Posted by thelaker View Post
That thought makes me just want to go out and have that bacon double cheeseburger and beer now.....
Don't forget the fries ... I heard that when cooked in duck fat they actually lower cholesterol ... According to seven out of ten doctors who's patients chew gum.
Reply With Quote
  #21  
Old 11-29-2011, 10:09 PM
Wonderment Wonderment is offline
 
Join Date: Jul 2007
Location: Southern California
Posts: 5,694
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

Quote:
My own pessimistic view (oops, I guess that means I'll have a short lifespan) is that unless we all die of something, and unless we are lucky enough to get hit by a bus, that death will be expensive regardless of what preventive measures you took early in your life.
I don't think the stats will support that view. Smokers and heavy drinkers will cost more on average in lifetime healthcare than non-smokers and moderate or zero drinkers.

Also, getting hit by the bus can be very expensive if it doesn't kill you. Buckle up, don't text and drive, and obey the rest of the rules of the road. Those are lifestyle choices that save healthcare dollars.
__________________
Seek Peace and Pursue it
בקש שלום ורדפהו
Busca la paz y síguela
--Psalm 34:15
Reply With Quote
  #22  
Old 11-28-2011, 12:21 AM
Swamymaximus Swamymaximus is offline
 
Join Date: Apr 2009
Posts: 9
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

Chris Masterjohn is indeed an expert. Listen to his lectures or read his writings. He can quote studies, conclusions and methodologies in a way very few can. You aren't going to find many people who can match him on the issue of diet, cholesterol and heart disease. There's a bunch of bogus stuff out there, and I didn't get the feeling Darwin was familiar with much of it.
Reply With Quote
  #23  
Old 11-28-2011, 07:52 AM
SkepticDoc SkepticDoc is offline
 
Join Date: Jan 2008
Location: Argleton
Posts: 1,168
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

Quote:
Originally Posted by Swamymaximus View Post
... There's a bunch of bogus stuff out ...
Yes, there is a lot of BS...

The facts are actually very simple, to prevent CV disease humans should not smoke, eat a low fat diet (look up "Mediterranean Diet"), keep the blood pressure between 110-130/60-85 and exercise regularly.

Once a persons condition becomes a disease statistic, adoption of the above and medications prescribed by a properly trained Health Professional will extend life.

Watch out for snake oil salesmen, hucksters and charlatans.
Reply With Quote
  #24  
Old 11-28-2011, 08:12 AM
Ocean Ocean is offline
 
Join Date: Jun 2008
Location: US Northeast
Posts: 6,784
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

Quote:
Originally Posted by SkepticDoc View Post
Yes, there is a lot of BS...

The facts are actually very simple, to prevent CV disease humans should not smoke, eat a low fat diet (look up "Mediterranean Diet"), keep the blood pressure between 110-130/60-85 and exercise regularly.

Once a persons condition becomes a disease statistic, adoption of the above and medications prescribed by a properly trained Health Professional will extend life.

Watch out for snake oil salesmen, hucksters and charlatans.
I guess you realize that you're responding to a group of commenters who believe that some blogger who had a bad experience when he tried to become vegetarian and then started to read a whole bunch of popular books, and guys who defend the caveman diet as the answer to all problems, are the source of all knowledge.

At the same time they dismiss what Darwin Labarthe states and seem to find it ludicrous. Let's look at Darwin's credentials:

Quote:
Darwin R. Labarthe, MD, MPH, PhD, FAHA

Director, Division for Heart Disease and Stroke Prevention, NCCDPHP, CDC

Darwin R. Labarthe, MD, MPH, PhD, FAHA, is Director of the Division for Heart Disease and Stroke Prevention (DHDSP), National Center for Chronic Disease Prevention and Health Promotion. The Division works with funded states and partners, conducts public health research, develops resources, and evaluates programs to help advance prevention and early detection efforts throughout the nation.

Dr. Labarthe received his AB from Princeton University, his MD from Columbia University, and his MPH and PhD degrees in epidemiology from the University of California at Berkeley. From 1970 to 1999 he worked primarily in the School of Public Health at the University of Texas in Houston, where he was the James W. Rockwell Professor of Epidemiology, Preventive Medicine, and Public Health.

He joined CDC in 2000 where he led the development and implementation of the long-range public health strategic plan, A Public Health Action Plan to Prevent Heart Disease and Stroke. He is the Past Chair of the National Forum for Heart Disease and Stroke Prevention and founding Director of DHDSP.

Dr. Labarthe′s research and teaching activities have primarily been in the area of cardiovascular epidemiology and prevention, with special interest in early development of risk factors in childhood and adolescence. At CDC, his work has turned to public health policy and practice in the prevention of heart disease, stroke, and other chronic diseases.

He has published more than 200 research articles and book chapters as well as the textbook, Epidemiology and Prevention of Cardiovascular Diseases: A Global Challenge. Dr. Labarthe has served in several key leadership roles with the American Heart Association over the past 40 years and just recently received the 2008 Charles C. Shepard Science Award for Assessment and Epidemiology.
Go figure.
Reply With Quote
  #25  
Old 11-28-2011, 01:01 PM
SkepticDoc SkepticDoc is offline
 
Join Date: Jan 2008
Location: Argleton
Posts: 1,168
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

Quote:
Originally Posted by Ocean View Post
I guess you realize that you're responding to a group of commenters who believe that some blogger who had a bad experience when he tried to become vegetarian and then started to read a whole bunch of popular books, and guys who defend the caveman diet as the answer to all problems, are the source of all knowledge.
No, I did not analyze it in such an elegant way!

Thanks
Reply With Quote
  #26  
Old 11-28-2011, 07:08 PM
ragamuffinman ragamuffinman is offline
 
Join Date: Aug 2009
Posts: 12
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

Quote:
I guess you realize that you're responding to a group of commenters who believe that some blogger who had a bad experience when he tried to become vegetarian and then started to read a whole bunch of popular books, and guys who defend the caveman diet as the answer to all problems, are the source of all knowledge.
Just to clarify, Masterjohn is a doctoral student at UConn, finishing up his PhD, I think. Also, his position is more nuanced than "the caveman diet is the answer to all problems." I don't even think he would consider himself a "paleo" person, just a guy who is sympathetic to a lot of paleo claims.

I understand the "why don't you read all these links I posted" defense is a tired contrarian tactic, but I beg you to simply read some of his stuff, or listen to an interview with him.

Ocean, I understand that anything tainted with the paleo label seems ridiculous to people not steeped in the stuff. I would agree that the Paleo crowd is filled with folks making all kinds of unsupported claims. Mat Lalonde gave these people a good blasting. Like anyone, Masterjohn probably has a few pet hypotheses that will be soundly falsified in the coming years, but mostly I've been impressed by his knowledge and epistemic humility (like Swamymaximus).

I'm not sure how to respond. I'll just beg you to reconsider your quick, blanket dismissal. I recall reading months ago that you were benefiting from a low-carbohydrate (and necessarily high-fat) diet. Many people would you a clueless dupe for adopting such a faddish diet, just as you consider people who embrace a paleo-esque diet to necessarily be clueless dupes.

EDIT: I apologize for being rude to the guest. It's just that my inner Taubes comes out when hear the tired stuff about losing weight, avoiding salt, correlations, cholesterol, etc.

Last edited by ragamuffinman; 11-28-2011 at 08:36 PM..
Reply With Quote
  #27  
Old 11-28-2011, 09:50 PM
Ocean Ocean is offline
 
Join Date: Jun 2008
Location: US Northeast
Posts: 6,784
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

Quote:
Originally Posted by ragamuffinman View Post
Just to clarify, Masterjohn is a doctoral student at UConn, finishing up his PhD, I think. Also, his position is more nuanced than "the caveman diet is the answer to all problems." I don't even think he would consider himself a "paleo" person, just a guy who is sympathetic to a lot of paleo claims.

I understand the "why don't you read all these links I posted" defense is a tired contrarian tactic, but I beg you to simply read some of his stuff, or listen to an interview with him.

Ocean, I understand that anything tainted with the paleo label seems ridiculous to people not steeped in the stuff. I would agree that the Paleo crowd is filled with folks making all kinds of unsupported claims. Mat Lalonde gave these people a good blasting. Like anyone, Masterjohn probably has a few pet hypotheses that will be soundly falsified in the coming years, but mostly I've been impressed by his knowledge and epistemic humility (like Swamymaximus).

I'm not sure how to respond. I'll just beg you to reconsider your quick, blanket dismissal. I recall reading months ago that you were benefiting from a low-carbohydrate (and necessarily high-fat) diet. Many people would you a clueless dupe for adopting such a faddish diet, just as you consider people who embrace a paleo-esque diet to necessarily be clueless dupes.

EDIT: I apologize for being rude to the guest. It's just that my inner Taubes comes out when hear the tired stuff about losing weight, avoiding salt, correlations, cholesterol, etc.
My response was in great part due to the way that Labarthe's opinion and authority in the topic was dismissed. If someone here wants to counter his ideas, it is perfectly legitimate, but one would expect that such counterarguments are going to be backed up by someone who has at least a comparable stature to the diavlogger.

We've had debates about positions taken by well meaning journalists, writers and other aficionados, that go counter all accepted knowledge. I don't dismiss dissent or varied opinions. It is healthy and good for science and progress to have people who challenge established norms. But, the attitude of dismissal, reflected in the comments by hilbert90, Swamymaximus and you, are not constructive. At least there should be a clear acknowledgment that Labarthe is a recognized authority in the subject, with superb credentials. Saying things like "unbelievable how little these physicians know!", is plainly ridiculous when it refers to Labarthe.

Every few years some fad diet comes around. Many of them work. They can work well for some, and as long as they follow them. There is an understanding that although many diets work (for weight loss, lowering lipids or other health reasons), the problem is that many people can't follow them. So perhaps what's practical is to follow some of the advice that Labarthe was suggesting, because his advice isn't too hard to follow and allows for people to make some choices that adapt to their preferences. Perhaps Labarthe is looking at the whole picture from a distance, having processed all the different levels of understanding of the problem and he's giving us the bottom line advice that works for most people.

You made reference to a previous diavlog, Taube's, in which I mentioned low carb diets. I'm pretty convinced that at least for some people, low carb is essential for weight loss. Perhaps it is after a certain age, or for those who have a certain genetic make-up. I never followed a high fat diet. I've been following a moderate to low fat content in my diet for years, without fanaticism. I tried low carb, low-moderate fat content and higher protein. I think it was working while I more or less followed it. I probably will go back to something like that soon. My lipid profile (for whatever that's worth) is very low risk. It may well be that certain diets work better for some and not others.

I don't think anyone will deny the benefits of exercise, or keeping your weight down, or eating a balance diet which contains moderate amounts of the most important nutrients. And that's the core message given in this diavlog.
Reply With Quote
  #28  
Old 11-29-2011, 01:57 AM
hilbert90 hilbert90 is offline
 
Join Date: Nov 2011
Posts: 13
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

Being an "expert" doesn't make you infallible. "My response was in great part due to the way that Labarthe's opinion and authority in the topic was dismissed." You realize that this is one of the most common logical fallacies in existence. It is called an appeal to authority. What does his "opinion" or "authority" have to do with the actual data?

I purposely avoided phrases like "low-carb" and stuck to well-established facts like total cholesterol is an essentially meaningless predictor of heart disease so as not to say anything controversial. If he doesn't realize this, then yes he is clueless (regardless of credentials). Bias affects everyone and it is hard to shake dogma that you've been steeped in. Even some of the most highly credentialed people still haven't come around on this fact, but in time they will because the data continually refutes that hypothesis.
Reply With Quote
  #29  
Old 11-29-2011, 08:14 AM
Ocean Ocean is offline
 
Join Date: Jun 2008
Location: US Northeast
Posts: 6,784
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

Quote:
Originally Posted by hilbert90 View Post
Being an "expert" doesn't make you infallible.
We all know that. No need to point out the obvious.

Quote:
"My response was in great part due to the way that Labarthe's opinion and authority in the topic was dismissed." You realize that this is one of the most common logical fallacies in existence. It is called an appeal to authority. What does his "opinion" or "authority" have to do with the actual data?
You are misunderstanding what "appeal to authority" means if you think that's what's driving this part of the discussion. This is not some nonsense idea that has no support at all except for some authority source that holds it.

First, the discussion in this diavlog didn't get in the technical details that are more controversial. My impression was that the discussion was kept at a level of general advice to the public based on the putting together all the pieces that go into making public health recommendations. You're looking at one piece only. At least, out of acknowledgment of the "authority" that Labarthe represents, you could consider that there are perhaps other factors taken into account that go beyond diets or particular metabolic effects into public health reality.

Quote:
I purposely avoided phrases like "low-carb" and stuck to well-established facts like total cholesterol is an essentially meaningless predictor of heart disease so as not to say anything controversial. If he doesn't realize this, then yes he is clueless (regardless of credentials).
Do you know that he doesn't realize this? I had the impression that he was trying to make it simple instead of getting into fine detail. Perhaps you (and I) would have appreciated more detail and more discussion of controversial aspects of the topic, but I wouldn't jump to the conclusion that he isn't aware of something that almost any person who's ever looked into this topic knows.

Labarthe seemed to avoid giving Bob a direct recommendation. I agreed with his attitude. It was okay to discuss Bob's lab results as a starting point for the topic, but it would be inappropriate to have this diavlog become a televised medical consultation for Bob. Labarthe could have engaged in more detail or clarify other points. No diavlog is perfect.

Rather than saying: "Clueless!" I think it would be wiser to say something like: "Hmmm... he's an expert, how come he's saying this? Perhaps he actually knows another side to the story that I don't know." And then you can start a discussion here or elsewhere trying to clarify his opinion. At least you may learn something that way, don't you think?

Quote:
Bias affects everyone and it is hard to shake dogma that you've been steeped in. Even some of the most highly credentialed people still haven't come around on this fact, but in time they will because the data continually refutes that hypothesis.
Sure, bias exists. Fad followers also have their bias. And beginners in a field sometimes think they have discovered the world. That's the way it is and has always been.

It's not terribly bad, it allows creativity and progress, but from time to time a little bit of humility and respect for those who are in a position to teach you doesn't hurt.

I think it would be by far more constructive to make your claim, present some simple facts (please no links to blogs) summarized from your understanding and then see if there's a discussion.

I repeat, it was the dismissive attitude, in spite of Labarthe's credentials, without serious consideration to other factors that seemed off to me. And I'm not exactly a slave to authority in case you're wondering.
Reply With Quote
  #30  
Old 11-29-2011, 11:54 AM
hilbert90 hilbert90 is offline
 
Join Date: Nov 2011
Posts: 13
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

Alright, I'll agree with everything you say. All I wanted to see was a few words about why it might be overly simplistic to say "my total cholesterol is bad." The reason is that there are many general physicians out there who have not educated themselves (through no fault of their own, they are incredibly busy trying to keep up with all the stuff that could ail their patients!) on this topic and do prescribe statins for high cholesterol (because this is what they were taught to do 20 years ago in med school).

It would be nice if someone who had watched this episode would have come away more educated (the opportunity presented itself many times) so that as a patient you could say, "Wait. Before you do something that drastic I've heard experts say that the situation is more delicate than 'total cholesterol'. Can we take a closer look at some of the details to see if statins are necessary?"

Sorry about seeming overly dramatic in the last post, but I was worked up about the claim that my post was about a "fad diet" when I had no diet recommendation in my post. SkepticDoc seems to think a "low fat" approach will keep cholesterol down (something I think there is no evidence or even proposed mechanism for), when in fact I'd claim that "low fat" is itself a fad diet that will be fringe in 10 or 20 years. Just because that idea is mainstream right now doesn't mean it won't turn out to have been a (terrible, terrible) fad.
Reply With Quote
  #31  
Old 11-29-2011, 08:07 PM
Ocean Ocean is offline
 
Join Date: Jun 2008
Location: US Northeast
Posts: 6,784
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

Quote:
Originally Posted by hilbert90 View Post
Alright, I'll agree with everything you say. All I wanted to see was a few words about why it might be overly simplistic to say "my total cholesterol is bad." The reason is that there are many general physicians out there who have not educated themselves (through no fault of their own, they are incredibly busy trying to keep up with all the stuff that could ail their patients!) on this topic and do prescribe statins for high cholesterol (because this is what they were taught to do 20 years ago in med school).
Fair enough.

I admit that if you're talking about knowing the difference between total cholesterol, HDL, LDL, VLDL, etc, is what you're referring to, I have never met a primary care physician (internal medicine, generalist, family medicine) who isn't aware of the same. But, of course, anything is possible.


Quote:
It would be nice if someone who had watched this episode would have come away more educated (the opportunity presented itself many times) so that as a patient you could say, "Wait. Before you do something that drastic I've heard experts say that the situation is more delicate than 'total cholesterol'. Can we take a closer look at some of the details to see if statins are necessary?"
Yes, it would be nice to have more talks about health in general, and perhaps make them a bit more detailed.

Quote:
Sorry about seeming overly dramatic in the last post, but I was worked up about the claim that my post was about a "fad diet" when I had no diet recommendation in my post. SkepticDoc seems to think a "low fat" approach will keep cholesterol down (something I think there is no evidence or even proposed mechanism for), when in fact I'd claim that "low fat" is itself a fad diet that will be fringe in 10 or 20 years. Just because that idea is mainstream right now doesn't mean it won't turn out to have been a (terrible, terrible) fad.
The fad diet part may have been my fault before when I followed one of the links provided it lead to something like the caveman diet, and generally I think the public tends to get carried away with the latest miraculous solution to all problems. Sometimes people become skeptical of the current accepted knowledge, but they go all the way to the other end and accept new theories too enthusiastically, before we have solid evidence to support it.

Anyway, interesting discussion after all.
Reply With Quote
  #32  
Old 11-29-2011, 11:11 PM
SkepticDoc SkepticDoc is offline
 
Join Date: Jan 2008
Location: Argleton
Posts: 1,168
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

Quote:
Originally Posted by hilbert90 View Post
The reason is that there are many general physicians out there who have not educated themselves (through no fault of their own, they are incredibly busy trying to keep up with all the stuff that could ail their patients!) on this topic and do prescribe statins for high cholesterol (because this is what they were taught to do 20 years ago in med school).
...Can we take a closer look at some of the details to see if statins are necessary?"
http://summaries.cochrane.org/CD0048...scular-disease

Quote:
Reductions in all-cause mortality, major vascular events and revascularisations were found with no excess of cancers or muscle pain among people without evidence of cardiovascular disease treated with statins. Other potential adverse events were not reported and some trials included people with cardiovascular disease. Only limited evidence showed that primary prevention with statins may be cost effective and improve patient quality of life. Caution should be taken in prescribing statins for primary prevention among people at low cardiovascular risk.
http://www.crd.york.ac.uk/CRDWeb/Sho...er=12008005204

Quote:
Statins reduce all-cause mortality in elderly patients. The magnitude of effect is larger than had been estimated previously.
I wondered if if your post merited a response, I am always cautious of engaging a pig in mud wrestling, since everybody gets muddy and the pig likes it!

Since this forum is of a higher caliber than others in the web, I rationalized that a cautious clarification of some of your points would help the understanding of the medical profession and dispel frequent misunderstandings among the lay population.

Your statement that general practitioners may not be up to date in current EBM (evidence based medicine) may be partly true. The ABMS http://www.abms.org/ has taken steps over the last several years to assure that diplomates recertify every 7-10 years with current test modules, clinical simulations and computer based tests. Most Health Insurance Plans require "Board Certification" to participate in a "provider panel" to somewhat assure that their subscribers get competent care. Most Hospitals require "Board Certification" to be on the "staff". Most, if not all, of the State Medical License Boards require at least 100 hours of CME (continuing medical education) credits every 2 years.

I hope that most of the forum audience members get their medical care from "Board Certified" Physicians, even if that Physician has stopped "learning", the knowledge basis is not older than 7 years, and most likely not more than 2 years "old". The statement that "because this is what they were taught to do 20 years ago in med school" is a cheap shot not based on reality.

I can only encourage you seek unbiased information from sites like http://www.tripdatabase.com/
Reply With Quote
  #33  
Old 11-28-2011, 02:39 PM
Wonderment Wonderment is offline
 
Join Date: Jul 2007
Location: Southern California
Posts: 5,694
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

Quote:

The facts are actually very simple, to prevent CV disease humans should not smoke, eat a low fat diet (look up "Mediterranean Diet"), keep the blood pressure between 110-130/60-85 and exercise regularly.
Also, no heavy boozin'. Oh, and while I'm at it, avoid tweaking:

Quote:
Crystal meth is damaging to many areas of the body -- including the brain, kidneys and liver -- but the heart damage can be extensive. Its use can cause symptoms such as irregular heartbeat (arrhythmia), rapid pulse, high blood pressure, inflammation of the small blood vessels near the brain and/or inflammation of the heart lining (endocarditis).

Research has indicated that methamphetamine abusers have a significantly heightened risk of heart attacks and strokes because of this damage. Scientists who examined data from more than 3 million Texas hospital patients ages 18 to 44 found a link between heart attack and amphetamine use and reported it in 2008 in the journal Drug and Alcohol Dependence.
__________________
Seek Peace and Pursue it
בקש שלום ורדפהו
Busca la paz y síguela
--Psalm 34:15
Reply With Quote
  #34  
Old 11-28-2011, 08:25 PM
ragamuffinman ragamuffinman is offline
 
Join Date: Aug 2009
Posts: 12
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

Sorry, I should have made this an omnibus post, but I'm somewhat exercised about this topic. After all, I've just been called a clueless moron.

This is the central empirical claim made by paleo-type folks:

There exist many populations around the world with "traditional" or "pre-industrial" diets* that have strikingly low incidences of the diseases of civilization.

The question becomes: what features of the modern diet cause these diseases of civilization? This is were people get into trouble - if they get some notion that a food is "paleo" they deem it awesome. Still, this general approach, when done in a data-driven way and supplemented with modern medical research, seems like a non-insane way of finding an optimal diet.

The macronutrient ratio doesn't seem to be too important - the Inuit and certain Pacific island cultures eat colossal amounts of fat (especially saturated), while several South American cultures eat large amounts of high glycemic-index carbohydrate. The Kitavans also eat plenty of carbohydrate. All groups enjoy very low rates of heart disease and diabetes. Taubes and many others have blasted away at the flimsy case against saturated fat and dietary cholesterol.

The "food toxin" approach is popular among paleo people. Consumption of n-6 fat and fructose (in the form of corn syrup AND table sugar) increased along with obesity. Lustig is prominently beating the fructose drum, of course. I'm not sure about the n-6 thing.

Others lay the finger on poorly prepared grains and other plant foods (plants contain surprising amounts of poisons and compounds that prevent absorption of important nutrients). Traditional cultures typically have very complicated ways of processing plant foods that maximize the available nutrients and minimize poisons. (I'm avoiding the oft-abused word "toxin.) This is a devilishly complex area of research - one must account for the effects of cooking, other foods consumed, and genetic variation before damning a particular plant food. The micronutrient deficiency hypothesis and the arguments against grain agriculture (where we force plants to grow in more and more depleted soil) are related to this.

Stephan Guyenet (obesity researcher at the University of Washington) has done good writing on the vast literature about food reward. Addictive, highly palatable foods screw up body and brain chemistry in distrubing ways - this goes far beyond vague crap about "willpower". Traditional diets typically consist of plain, low-reward foods. (Note: "low-reward" does not mean unsatisfying or disgusting, simply non-addictive.)

I hope I've convinced you that there's a whole universe of good inquiry about nutrition that goes beyond the inane "exercise, willpower and skinless chicken breasts" recommendations of public health authorities. And yes, some of it might be "paleo" and therefore totally outrageous.

*These seem like buzzwords, I know

Last edited by ragamuffinman; 11-28-2011 at 08:29 PM..
Reply With Quote
  #35  
Old 11-28-2011, 09:06 PM
SkepticDoc SkepticDoc is offline
 
Join Date: Jan 2008
Location: Argleton
Posts: 1,168
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

You have to think "out of the box" and extrapolate observations, civilization as we know it, sprung from Mesopotamia and the Middle East when humans conquered agriculture. We don't have a great deal of objective data, since there are no written records.

As Dr. Kessler has pointed out repeatedly, the problem has been when "Food, Inc." combined salt, sugar and fat to sell us more of what we don't need...

Meat hunters never advanced beyond the limits of spoilage.

As Diamond has pointed out, New Guinea existence is subsistence because of the poor soil, he argues the other point: http://www.ditext.com/diamond/mistake.html

Maybe the right path is the middle one, mostly grains and vegetables, some animal protein from efficient convertors (chicken vs. turkey vs. cattle?), if we go vegan we lose essential amino acids or delude ourselves in the denial of being omnivores, if we just eat meat and potatoes, we get fat and clog our arteries.

It will be up to us to pick and choose the best options guided by facts uncovered by scientific research.
Reply With Quote
  #36  
Old 11-29-2011, 10:58 PM
cbjones1943 cbjones1943 is offline
 
Join Date: Jul 2011
Posts: 12
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

Mr. Wright: Bon chance re: The Atlantic position. Calculating and/or forecasting risk for cardio disease is challenging for several reasons. Perhaps the most important of these are gene effects & gene interactions as well as error/stochasticity. Other variegating factors would be age & sex effects and metabolic differences (these co-vary with sex & age &, to a lesser extent, with body size, diet, others).

Blog: http://vertebratesocialbehavior.blogspot.com
Twitter: http://twitter.com/cbjones1943
Reply With Quote
  #37  
Old 12-03-2011, 09:51 AM
T.G.G.P T.G.G.P is offline
 
Join Date: Nov 2006
Posts: 278
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

The "golden era" of salt Bob talks about I thought was right now. Some studies have shown that reducing salt intake resulted in higher mortality and/or morbidity. I have not heard responses that those studies were wrong, misinterpreted etc (and for all I know, maybe they are). The official recommenders and pronouncers Darwin refers to don't seem to care. Darwin is arguing from authority, which can make sense because most of us laymen are less knowledgeable and don't have time to learn but have to trust experts. But I'd like him to actually educate us rather than just pass on pronouncements.
Reply With Quote
  #38  
Old 12-03-2011, 10:46 AM
SkepticDoc SkepticDoc is offline
 
Join Date: Jan 2008
Location: Argleton
Posts: 1,168
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

Even the Devil can cite scripture for its purpose...

This is the official Cochrane summary:

Quote:
Plain language summary

Advice to reduce the amount of salt eaten reduces blood pressure but there is insufficient evidence to confirm the predicted reductions in people dying prematurely or suffering cardiovascular disease

Cardiovascular disease includes heart attacks, strokes, and the need for heart surgery and is a major cause of premature death and disability. This review set out to assess whether intensive support and encouragement to cut down on salt in foods reduced the risk of death or cardiovascular disease. This advice did reduce the amount of salt eaten which led to a small reduction in blood pressure by six months. There was not enough information to detect the expected effects on deaths and cardiovascular disease predicted by the blood pressure reductions found. There was limited evidence that dietary advice to reduce salt may increase deaths in people with heart failure. Our review does not mean that asking people to reduce salt should be stopped. People should continue to strive to do this. However, additional measures - reducing the amount of hidden salt in processed foods, for example – will make it much easier for people to stick to a lower salt diet. Further evidence of measures to cut dietary salt is needed: (1) randomised controlled trials of advice to reduce salt in individuals with heart failure assessing mortality and cardiovascular events and (2) experimental or observational studies of population based interventions to reduce salt in hypertensives or healthy individuals assessing mortality and cardiovascular events.
Many patients with CHF are hospitalized after a high salt "feast, you may call them N=1 studies if you wish.

Just remember GIGO, in our "urban lifestyle" a truly low salt diet is very hard to accomplish, how many people do you know that cook everything from "scratch", that do not consume any canned or processed food items?
Reply With Quote
  #39  
Old 12-03-2011, 05:06 PM
stephanie stephanie is offline
 
Join Date: Dec 2007
Posts: 3,921
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

Quote:
Originally Posted by SkepticDoc View Post
Just remember GIGO, in our "urban lifestyle" a truly low salt diet is very hard to accomplish, how many people do you know that cook everything from "scratch", that do not consume any canned or processed food items?
Not so few, actually.
Reply With Quote
  #40  
Old 12-03-2011, 10:40 PM
SkepticDoc SkepticDoc is offline
 
Join Date: Jan 2008
Location: Argleton
Posts: 1,168
Default Re: Positive Cardiovascular Health (Robert Wright & Darwin Labarthe)

Quote:
Originally Posted by stephanie View Post
Not so few, actually.
How many?

Would you mind sharing with us your blood pressure and cholesterol?

Are you taking any medications?

Are you one of the individuals that are healthy because of a healthy diet and lifestyle in spite of a sub-optimal family history, or are you healthy because you grew up in a healthy environment and you were lucky to get good genes?
Reply With Quote
 


Currently Active Users Viewing This Thread: 1 (0 members and 1 guests)
 
Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off

Forum Jump


All times are GMT -4. The time now is 01:44 PM.


Powered by vBulletin® Version 3.8.7 Beta 1
Copyright ©2000 - 2019, vBulletin Solutions, Inc.