Nice discussion. 

 One area of discussion that did not come up was the distinction between the various forms of fat.  The Women's Health Initiative Study did suggest to us that polyunsaturated fats were less atherogenic than for example trans fat. 

On a long term basis the substitution of, for example, brown rice for french fries cooked in partially hydrogenated vegetable oil. i.e. trans fat. suggests a higher relative risk for cardiovascular disease. 

Thanks for listening and the comment.  Good point.  The discussions on diet and lifestyle are critical ones to have in any conversation around vascular disease. We intend to do more of these in 2011.  

Bob H 

I teach metabolism to medical students using carbohydrate restriction.

Carbohydrate restriction is not a revealed subject.  Bob is correct that there is passionate rejection of the principles that I teach but when I challenge the critics they waffle and try to blame the patient (even though they may never have actually tried  to keep a patient on a low carbohydrate diet).

It is not a revealed subject.  If you want to criticize Dr. Westman, it is reasonable to:

1. Read the New Atkins book (Chapters 12 and 13), and/or

2. Try a low-carbohydrate diet and/or

3. Read the recent papers from Volek, Westman and other papers explaining benefit of carbohydrate restriction  (even Feinman's paper). and/or

4. Encourage a patient to be on a low-carb diet and/or

5. Review side-effects of statins, the Avandia story, the ACCORD study and ask, after 40 years of voicing "concerns," whether there has ever been any of these kinds of effects in people on low-carbohydrate diet.  

But, as Bob says, it is very emotional. No need to be reasonable. Nothing reasonable about Robert Eckel.  He thinks we should ban research on low-carb diets.

I think diabetes and heart disease are serious.  It should be reasonable not emotional.

Richard David Feinman

Professor of Cell Biology

SUNY Downstate Medical Center 

Bob,

  Where can I find the forum discussion you alluded to that Dr westman participated in on the heart.org site? Thanks

Dear Dr Wingate-

You can find the previous discussions at http://www.theheart.org/article/1137677.do

Thanks for listening.  More to come in 2011.

Bob H 

Interesting discussion.  One of the main concepts that needs to be thrown away is the calories-in-calories-out hypothesis.  Yes, hypothesis, not a theory nor a law.  Too many studies have already shown that energy balance is not as simple as calories-in vrs. calories-out, so it is just a hypothesis, and a very poor one as its predictions do not conform with the evidence. Borrowing/paraphrasing from Gary Taubes' last book (Why We Get Fat), eating less has not shown the benefits that are predicted by physics when applied to the human body (i.e. eating less doesn't revert or cure obesity); what makes us think that overeating is even a cause of obesity?  When we all understand that obesity has more to do with biology (effect of hormones and enzymes) than physics (calories-in-calories-out), then the effects of carbohydrate restriction will actually be seen not as paradoxical but as a logical outcome of our own physiology.

With respect to the fat in the diet being atherogenic... Critics and/or 'experts' that use that line of criticism need to get updated on the actual dynamics of cholesterol. The magic number of LDL-cholesterol means nothing unless we know what type of LDL size particle is more abundant.  It is well documented that the smaller, more dense LDL particle size is more associated to atherosclerosis than the larger (fluffier) particles.  Of course, the way LDL is measured in the clinic is based on a formula, a subtraction (which renders itself to error when triglyceride levels are too high), not direct measurement.  Knowing this, a better way to measure LDL is to look at the LDL 'profile'.  Triglyceride levels are, perhaps, more important even if LDL profiles are not measured, as smaller LDL particles contain more triglycerides than the larger LDL particles. So... high triglycerides say a lot more than whatever the LDL number is; lowering triglycerides is a better indication of improving blood profiles, instead of a decreasing LDL number.  And as it has also been shown, triglyceride levels react very quickly to carbohydrate restriction, not to fat restriction.  Again, this is what our biochemistry and physiology  predicts, but until physicians are willing to change their beliefs structure, what science dictates won't see the application in the clinic and the benefits won't trickle down to the patient.

 The "calories in, calories out" hypothesis survives because few physicians understand (really understand) the laws of thermodynamics. 

 Here is how a physicist reacts to the hypothesis (in this case as propounded by George Bray):

---

 This conservation of energy argument is on the same scientific level as the ridiculous "drink cold water to lose weight" idiocy. A human organism is:

1. Not in thermal equilibrium with their environment. Last time I checked I have a body temperature around 38 °C and spend most of my time in 21 °C rooms.
2. Capable of significant mass flows (e.g. respiration).
3. Capable of sequestering entropy (e.g. protein synthesis).

Let me make my position very clear. Obesity is the result of a prolonged small positive energy surplus with fat storage as the result. An energy deficit produces weight loss and tips the balance in the opposite direction from overeating.

 ---

source:

http://entropyproduction.blogspot.com/2009/02/all-medical-science-is-wrong-within-95.html