Journalists need to embrace Detective Sgt. Joe Friday’s line from “Dragnet,” “Just the facts, ma’am.”
Caught up in intense public passions, journalists can either throw their opinions at the inflamed cacophony or they can seize an opportunity to do something that has escaped most politicians: Represent broader interests.
We live in a world of spin, where claims and counterclaims come out so rapidly that reality has become a blur. The challenges in sifting through fact and fiction have increased as officials of all stripes shout their truths from the rooftops, even if they have an obstructed view of the world down below.
When I was in journalism school more than two decades ago, a good friend from Bulgaria, who was one of the few people who could pronounce my name correctly when she read it in my mailbox, shared her writing with me.
I noticed a flaw in the way she recorded dialogue. The quotes in her story often lacked the syntax and vocabulary that native English speakers possess. When I asked if she only spoke with other Bulgarians, she playfully punched my shoulder and said she needed to hear better.
That was an unintentional consequence of the way someone who spoke three languages translated the world.
The chasm today between what people say and what others hear, even those who speak the same language, has gotten wider. Editors and reporters return to their desks or take out their laptops, ready to share quotes, events and facts.
These fellow members of the media may find themselves seeing what they want to see, much like the parent of an athlete on a field or a coach who has become an advocate or cheerleader. In editorials, where we’re clearly sharing an opinion, that works, but in news reports we should share the facts, offer context — and increase the value of fact-based reporting.
With facts under regular assault, the search for them, and the ability to verify them, becomes even more important.
A divided nation needs balanced, fair, accurate and defensible reporting. In their publications, scientists share materials and methods sections, which should allow other researchers to conduct the same experiments and, presumably, find the same results. Far too often, opinions disguised as news urge people to trust the writer. Why? Readers should be able to pull together the same raw materials and decide for themselves.
I know government officials don’t always deal in facts. I also know numbers can be repackaged to suit an agenda, turning any conclusion into a specious mix of farce and mental acrobatics. To wit, he’s the best left-handed hitter every Tuesday there’s a full moon below the Mason-Dixon line. Just because it’s presented as a fact doesn’t mean we have to report it or even mock it. If it’s meaningless, then leave it alone. The argument that other journalists are doing it doesn’t make it acceptable.
Several years ago, someone called to berate me for what he considered errors in my story. Rather than shout him down, I gave him the chance to offer his perspective. Eventually he calmed down and we had a measured, detailed discussion. This became the first of numerous conversations and interactions in which he provided important perspectives and shared details I might not otherwise have known.
Reporters face a public acutely aware of its own anger. Almost by definition in a country where the two major political parties struggle to find common ground, some group of readers disagrees with our coverage. We shouldn’t try to please everyone. In fact, we should try to please no one — we should merely work harder. It’s time to allow facts to speak for themselves.
Adding cruciferous vegetables to your diet significantly decreases the risk of developing multiple cancers. Stock photo
Small studies show diet may affect gene expression
By David Dunaief, M.D.
Dr. David Dunaief
Cancer, a word that for decades was whispered as taboo, has become front and center in the medical community. Cancer is the number one killer of Americans, at least those less than 85 years old, even ahead of cardiovascular disease (1). We have thought that diet may be an important component in preventing cancer. Is diet a plausible approach?
An April 24, 2014, article published in the New York Times, entitled “An Apple a Day and Other Myths,” questioned the validity of diet in the prevention of cancer. This article covered cancer in general, which is a huge and daunting topic.
The article’s author referenced a comment by Walter Willet, M.D., a professor at the Harvard School of Public Health’s Epidemiology and Nutrition Department, as indicating that the research is inconsistent when it comes to fruits and vegetables. The article went on to state that even fiber and fats may not play significant roles in cancer.
I don’t necessarily disagree with this assessment. However, I would like to emphasize that Willet also commented that there are no large, well-controlled diet studies. This leaves the door open for the possibility that diet does have an impact on cancer prevention. I would like to respond.
As Willet hinted, the problem with answering this question may lie with the studies themselves. The problem with diet studies in cancer, in particular, is that they rely mainly on either retrospective (backward-looking) or prospective (forward-looking) observational studies.
Observational studies have many weaknesses. Among them is recall bias, or the ability of subjects to remember what they did. Durability is also a problem; the studies are not long enough, especially with cancer, which may take decades to develop. Confounding factors and patient adherence are other challenges, as are the designs and end points of the studies (2). Plus, randomized controlled trials are very difficult and expensive to do since it’s difficult and much less effective to reduce the thousands of compounds in food into a focus on one nutrient. Let’s look at the evidence.
The EPIC trial
Considered the largest of the nutrition studies is the European Prospective Investigation into Cancer and Nutrition (EPIC). It is part of what the author was using to demonstrate his point that fruits and vegetables may not be effective, at least in breast cancer. This portion of the study involved almost 300,000 women from eight different European nations (3). Results showed that there was no significant difference in breast cancer occurrence between the highest quintile of fruit and vegetable consumption group compared to the lowest. The median duration was 5.4 years.
Does this study place doubt in the dietary approach to cancer? Possibly, but read on. The most significant strength was its size. However, there were also many weaknesses. The researchers were trying to minimize confounding factors, but there were eight countries involved, with many different cultures, making it almost impossible to control. It is not clear if participants were asked what they were eating more often than at the study’s start. Risk stratification was also not clear; which women, for example, might have had a family history of the disease?
Beneficial studies with fruits and vegetables
Also, using the same EPIC study, results showed that fruit may have a statistically significant impact on lung cancer (4). Results showed that there was a 40 percent decrease in the risk of developing lung cancer in those that were in the highest quintile of fruit consumption, compared to those in the lowest quintile. However, vegetables did not have an impact. The results were most pronounced in the northern European region. I did say the answer was complex.
Ironically, it seems that some other studies, mostly smaller studies, show potentially beneficial effects from fruits and vegetables. This may be because it is very difficult to run an intensive, well-controlled, large study.
Prostate cancer
Dean Ornish, M.D., a professor of medicine at UC San Francisco Medical School, has done several well-designed pilot studies with prostate cancer. His research has a focus on how lifestyle affects genes. In one of the studies, results of lifestyle modifications showed a significant increase in telomere length over a five-year period (5).
Telomeres are found on the end of our chromosomes; they help prevent the cell from aging, becoming unstable and dying. Shorter telomeres may have an association with diseases, such as cancer and aging and morbidity (sickness). Interestingly, the better patients adhered to the lifestyle modifications, the more telomere growth they experienced. However, in the control group, telomeres decreased in size over time. There were 10 patients in the lifestyle (treatment) group and 25 patients in the control group — those who followed an active surveillance-only approach.
In an earlier study with 30 patients, there were over 500 changes in gene expression in the treatment group. Of these, 453 genes were down-regulated, or turned off, and 48 genes were up-regulated, or turned on (6). The most interesting part is that these changes occurred over just a three-month period with lifestyle modifications.
In both studies, the patients had prostate cancer that was deemed at low risk of progressing into advanced or malignant prostate cancer. These patients had refused immediate conventional therapy including hormones, radiation and surgery. In both studies, the results were determined by prostate biopsy. These studies involved intensive lifestyle modifications that included a low-fat, plant-based, vegetable-rich diet. But as the researchers pointed out, there is a need for larger randomized controlled trials to confirm these results.
Cruciferous vegetables
A meta-analysis involving a group of 24 case-control studies and 11 observational studies, both types of observational trials, showed a significant reduction in colorectal cancer (7). This meta-analysis looked at the effects of cruciferous vegetables, also sometimes referred to as dark-green, leafy vegetables.
In another study that involved a case-control observational design, cruciferous vegetables were shown to significantly decrease the risk of developing multiple cancers, including esophageal, oral cavity/pharynx, breast, kidney and colorectal cancers (8). There was also a trend that did not reach statistical significance for preventing endometrial, prostate, liver, ovarian and pancreatic cancers. The most interesting part is that the comparison was modest, contrasting consumption of at least one cruciferous vegetable a week with none or less than one a month. However, we need large, randomized trials using cruciferous vegetables to confirm these results.
In conclusion, it would appear that the data are mixed in terms of the effectiveness of fruits and vegetables in preventing cancer or its progression. The large studies have flaws, and pilot studies require larger studies to validate them. However, imperfect as they are, there are results that indicate that diet modification may be effective in preventing cancer. I don’t think we should throw out the baby with the bath water. There is no reason not to consume significant amounts of fruits and vegetables in the hopes that it will have positive effects on preventing cancer and its progression. There is no downside, especially if the small studies are correct.
References: (1) CA Cancer J Clin. 2011;61(4):212. (2) Nat Rev Cancer. 2008;8(9):694. (3) JAMA. 2005;293(2):183-193. (4) Int J Cancer. 2004 Jan 10;108(2):269-276. (5) Lancet Oncol. 2013 Oct;14(11):1112-1120. (6) Proc Natl Acad Sci U S A. 2008 Jun 17;105(24):8369-8374. (7) Ann Oncol. 2013 Apr;24(4):1079-1087. (8) Ann Oncol. 2012 Aug;23(8):2198-2203.
Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.
PORT JEFFERSON MORNING Patricia Conway of Port Jefferson captured this view of Port Jeff Harbor with Queen Anne’s lace flowers in the foreground on July 26. She writes, ‘It was just one of countless beautiful summer mornings on my daily meditative walk through the village. With not a person in sight around seven in the morning on a Wednesday at Centennial Park, the scene set itself but what was interesting was the wild flowers were actually white and my iPhone 7 took on more of a blue tone — kind of seemed like a reflection from the water.’
If the bins at a farm stand in August were a stage, corn would surely be the star. Occupying a massive spot in the produce limelight, freshly picked ears of corn tumble over each other vying to be selected after ruthless ripping of their husks, a procedure, by the way, that is useless for determining an ear of corn’s soundness and useful only to render it exposed and passed over. More effective is to run one’s hand or fingers lightly up and down the ear of corn to feel for indentations, a symptom most likely of an earworm or borer having gotten to it.
Nothing beats a freshly picked ear of corn, boiled for 3 to 5 minutes, then slathered with butter, salt and pepper. Want something a little different? Read the recipes below for some ideas for cooking with the queen of summer produce, corn.
Fresh Corn Pancakes
Fresh Corn Pancakes
YIELD: Makes 4 servings
INGREDIENTS:
3 to 4 ears fresh-picked corn
1 cup flour
1 tablespoon plus 1 teaspoon baking powder
1 tablespoon sugar
1 level teaspoon salt
½ cup whole milk
¼ cup heavy cream
2 large eggs
2 tablespoons canola, sunflower or vegetable oil
½ cup unsalted butter, melted and cooled
DIRECTIONS: Cut kernels from cobs. Set aside. In a small bowl, whisk or sift together the flour, baking powder, sugar and salt. In a medium bowl, whisk together the milk, cream, eggs, oil and butter. Add flour mixture and corn kernels to liquid mixture; stir to thoroughly blend. Heat a greased griddle or heavy skillet until hot enough that water sprinkled on it produces dancing bubbles. Ladle batter onto skillet, by one-third cupfuls. Cook over medium heat until edges start to brown and bubbles form in batter. With a spatula, turn pancakes and cook about one minute more, until undersides are golden brown. Serve hot with blueberry or maple syrup and bacon.
Corn, Pepper & Manchego Quiche
Corn, Pepper & Manchego Quiche
YIELD: Makes 6 servings
INGREDIENTS:
One 9-inch pie crust
1 cup shredded manchego cheese
3 large eggs
1 tablespoon flour
1 teaspoon salt
1½ cups half and half
¼ cup melted butter
Kernels from 2 ears fresh-picked corn
1 small onion, minced
1 small green pepper, diced
Freshly ground black pepper, to taste
DIRECTIONS: Preheat oven to 375 F. Line a pie plate or quiche pan with pie crust. Sprinkle cheese evenly over crust. In a food processor, combine eggs, flour, salt, half and half and melted butter until well blended. Stir in corn, onion, green pepper and ground black pepper. Pour over cheese in crust. Bake 45 to 50 minutes until top is golden, filling is slightly puffed and a knife inserted in the center comes out clean. Serve with tomato and arugula salad and crusty French bread.
Grilled Corn with Cilantro-Lime Butter
Grilled Corn with Cilantro-Lime Butter
YIELD: Makes 6 to 8 servings
INGREDIENTS:
12 ears fresh-picked corn in the husk
2 large cloves garlic, chopped
6 tablespoons fresh lime juice
1½ teaspoons coarse sea salt
¾ teaspoon dried red pepper flakes
½ to ¾ cup melted unsalted butter
¹/3 to ½ cup chopped fresh cilantro
DIRECTIONS: Pull back corn husks but leave attached at bottom. Discard silks; pull husks back up around ears. Prepare grill for cooking on medium-high heat. In a blender, puree garlic with lime juice, salt, and red pepper flakes until smooth. Add melted butter and cilantro and puree again until well blended. With cover on grill, cook corn, turning frequently, until kernels are tender, 15 to 20 minutes; let stand until cool enough to handle. Completely remove husks and discard. With a sharp knife remove kernels from cob. In a medium-large bowl toss kernels with butter mixture. Serve hot or warm with grilled eggplant, sliced garden tomatoes with olive oil and scallion and crusty bread.
MEET BRUCE! Big Bruce is the man! This handsome guy knows it all … he can sit, lay down and even roll over! A 3-year-old Shepherd mix who made it here all the way from the Cayman Islands, he is now at Kent Animal Shelter ready to find his forever home. Could that be with you? Bruce comes neutered, microchipped and up to date on all his vaccines. Kent Animal Shelter is located at 2259 River Road in Calverton. For more information on Bruce and other adoptable pets at Kent, please call 631-727-5731 or visit www.kentanimalshelter.com.
Observe, educate yourself and then make your voice heard. Stock photo
By Lisa Scott
The League of Women Voters (LWV) has a strong commitment to open government and civic engagement. Protecting our right to know is integral to the health of our democracy. One important way to ensure that decisions are made with public input and oversight is for citizens to observe government meetings.
New York State’s Open Meetings Law, often known as the Sunshine Law, went into effect in 1977. Amendments that clarify and reaffirm your right to hear the deliberations of public bodies became effective in 1979.
In brief, the law gives the public the right to attend meetings of public bodies, listen to the debates and watch the decision-making process in action. It requires public bodies to provide notice of the times and places of meetings and keep minutes of all action taken.
The Open Meetings Law provides the public with the right to attend meetings of public bodies, but it is silent concerning the ability of members of the public to speak or otherwise participate. Although public bodies are not required to permit the public to speak at their meetings, many have chosen to do so. In those instances, it has been advised that a public body should do so by adopting reasonable rules that treat members of the public equally. (To learn more about the Open Meetings Law, visit www.dos.ny.gov/coog/right_to_know.html.)
To start exercising your rights, go to a government meeting as an observer so that you become familiar with the procedures and rules and the issues. Acquaint yourself with the protocols for public comment, so that you can speak to these issues when appropriate.
In order to encourage every Suffolk County resident to become familiar with their elected officials, the LWV compiles and prints a 28-page booklet annually called the Directory of Public Officials (DPO), a guide to elected federal, state, county, town and local officials. You’ll know how to contact them — addresses, telephone numbers, email addresses and websites. You’ll see salaries, terms of office, whether there are term limits and whether they are up for election each year.
The DPO includes a section with a breakdown and details of the Suffolk County budget, as well as a color map of Suffolk County legislative districts and a list of Suffolk County legislative committees with members, meeting days and times. Phone contacts for key Suffolk County departments and agencies are included too. (The Directory of Public Officials can be viewed by visiting www.lwv-suffolkcounty.org/files/DPO2017_ 2.pdf.)
State, county, town, village, library and school district websites are good sources for general, committee and board meeting schedules, as well as agendas for upcoming meetings and minutes of those that have already occurred.
Local media (newspapers and community websites) report on a great many issues and government meetings. However, you may have concerns about issues that are not covered by local media and should take responsibility to observe and participate when these issues are discussed at government meetings. Be an informed, engaged citizen and participate. Democracy is not a spectator sport!
Lisa Scott is the president of the League of Women Voters of Suffolk County, a nonprofit, nonpartisan organization that encourages the informed and active participation of citizens in government and influences public policy through education and advocacy. For more information, visit www.lwv-suffolkcounty.org, email [email protected] or call 631-862-6860.
It’s become an Abbott and Costello comedy routine, except in the nation’s capital. Let’s take a look:
Trump: “Strange as it may seen, they give ball players nowadays very peculiar names.”
Costello: “Funny names?”
Trump: “Nicknames, nicknames. Now, on the Washington team, we have who’s on first, what’s on second, I don’t know is on third.”
Costello: “That’s what I want to find out. I want you to tell me the names of the fellows on the Washington team.”
Trump: “I’m telling you. Who’s on first, what’s on second, I don’t know is on third.”
Costello: “You know the fellows’ names?”
Trump: “Yes.”
Costello: “Well, who’s playing first?”
Trump: “Who was playing first, but I fired him.”
Costello: “You fired him? Who did you fire?”
Trump: “Yes. I most certainly did. It was time for a new first baseman. We’ve got a better one coming in to play first.”
Costello: “Oh yeah? Who is that?”
Trump: “No, who was on first.”
Costello: “What are you asking me for?”
Trump: “I’m not asking you, I’m telling you. Who was on first.”
Costello: “I’m asking you, who’s on first?”
Trump: “I already told you, not anymore.”
Costello: “Not anymore is on first?”
Trump: “Yes.”
Costello: “You won’t tell me the name of the fellow on first base?”
Trump: “Yes, not anymore.”
Costello: “OK, so not anymore is playing first?”
Trump: “He was, but he just left, too, so now I have no one.”
Costello: “You don’t have a first baseman?”
Trump: “Yes, I do, no one.”
Costello: “How can no one play first?”
Trump: “He’s very talented. He’s one of the best players I’ve ever seen at the position. He’ll win games for us.”
Costello: “When you pay the first baseman every month, who gets the money?”
Trump: “He did, but no one gets it now.”
Costello: “So, you’re not paying anyone?”
Trump: “No, we’re paying no one. Sometimes his wife comes down and collects his paycheck.”
Costello: “No one’s wife?”
Trump: “Yes. After all, the man earns it.”
Costello: “No one does?”
Trump: “Absolutely.”
Costello: “Washington has a good outfield?”
Trump: “Oh, it’s great again.”
Costello: “The left fielder’s name?”
Trump: “Why.”
Costello: “I don’t know, I just thought I’d ask.”
Trump: “I just thought I’d tell you.”
Costello: “Then tell me who’s playing left field?”
Trump: “No, who was playing first, but he was fired.”
Costello: “Stay out of the infield! The left fielder’s name?”
Trump: “Why.”
Costello: “Why?”
Trump: “I’m thinking of moving why to center field after he did such a great job in left.”
Costello: “Who did a great job in left field?”
Trump: “No, who only plays first and he’s not on the team anymore, so I don’t want to talk about him.”
Costello: “You got a pitcher.”
Trump: “Wouldn’t this be a fine team without a pitcher?”
Costello: “Tell me the pitcher’s name.”
Trump: “Tomorrow.”
Costello: “Why not now?”
Trump: “No, why is in left field. He never pitches, but he might play center field.”
Costello: “Now when the guy at bat bunts the ball against tomorrow — me being a good catcher — I want to throw the guy out at first base, so I pick up the ball and throw it to no one.”
Trump: “Now, that’s the first thing you’ve said right.”
Costello: “I don’t even know what I’m talking about.”
The hottest real estate in Japan these days is a bomb shelter, with a starting price from $19,000. When I heard that reported on the radio, I was instantly transported back to my first-grade class where, upon a signal, we covered our heads with our coats and slid under our desks. It was the Cold War: Stalin and the Soviets were the enemy, and we had drills to prepare for an atomic blast. One day, there were moviemakers at the school, before television became popular, and they recorded us taking cover for the newsreel that preceded the feature film in every movie theater. In fact, there were two feature films in those days, usually referred to as A and B movies, but first the viewers were treated to the news of the week. I was in the front row of my class, so I could be clearly seen on the screen crouching beneath my desk. But I never saw myself because my parents usually didn’t go to the movies. Neighbors told us that I was front and center.
Just as the movie seemed unreal to me, so did the Cold War and the atomic bomb from whose blast my raincoat was supposed to protect me. World War II had ended, and I grew up in the subsequent Cold War generation.
I heard people talking about building bomb shelters, but I couldn’t imagine having one since we lived in an apartment in the middle of the city. It did occur to me to wonder where we would find shelter in the event we needed to, and I think I questioned my parents about that once, but they didn’t seem to want to discuss the subject so it never came up again. My schoolmates may have been fearful, but we never talked about the bomb.
Then Stalin died, there was eventually detente with the Soviets, a popular novel appeared by Ian Fleming called “From Russia with Love,” we watched the touring Bolshoi Ballet at the old Metropolitan Opera House, something in my gut unclenched, and no one had atomic bomb drills anymore.
I hate the idea that children in Japan are now growing up under the shadow of a nuclear bomb threat. Those in South Korea are surely afraid and, for that matter, now those in Seattle. In fact, fear seems to be rearing its ugly head in the United States, a country ordinarily known for its optimism and “pursuit of happiness.”
For example, I would not like to be an immigrant here today and certainly not an illegal one. Those in that category must be living in fear day and night. I have no sympathy of course for illegal immigrants who have committed serious crimes and are therefore most likely to be deported. But the idea that ICE representatives are patrolling the courthouses, looking for illegals, certainly creates an atmosphere of people being hunted. I would also not like to be an employer whose business depended on the seasonal help of immigrants. Industries like hospitality, restaurants and farming haven’t known if their legal immigrant workers would arrive. Without that extra help, many businesses cannot survive because there are not enough Americans willing to do those low-level jobs. Ditto for those with special needs who require aides at home.
On the other side of the ledger, our economic picture seems rosy. The stock market is setting new records almost every day, as corporations are being rewarded for making profits and the prospect of deregulation encourages investment. The unemployment rate is the lowest in some 20 years. Yet there is a great divide between financial and political happiness. Many of the same people happy with the economy are unhappy with the political picture, bemoaning the chaos in Washington, D.C.
As we have always done, we will soldier on with our domestic problems. We are doing less well reacting to the foreign challenges, fear prompting us to answer threats with threats.
Weight loss should be a rather simple concept. It should be solely dependent on energy balance: the energy (kilocalories) we take in minus the energy (kilocalories) we burn should result in weight loss, if we burn more calories than we consume. However, it is much more complicated. Frankly, there are numerous factors that contribute to whether people who want or need to lose weight can.
The factors that contribute to weight loss may depend on stress levels. High stress levels can contribute to metabolic risk factors such as central obesity with the release of cortisol, the stress hormone (1). Therefore, hormones contribute to weight gain.
Another factor in losing weight may have to do with our motivators. We will investigate this further. And we need successful weight management, especially when approximately 70 percent of the American population is overweight or obese and more than one-third is obese (2).
Focus on improving your health by making lifestyle modifications like walking your dog.
Obesity, in and of itself, was proclaimed a disease by the American Medical Association. Even if you don’t agree with this statement, excess weight has consequences, including chronic diseases such as cardiovascular disease, diabetes, osteoarthritis, autoimmune diseases and a host of others. Weight has an impact on all-cause mortality and longevity.
It is hotly debated as to which approach is best for weight loss. Is it lifestyle change with diet and exercise, medical management with weight loss drugs, surgical procedures or even supplements? The data show that, while medication and surgery may have their places, they are not replacements for lifestyle modifications; these modifications are needed no matter what route is followed.
But the debate continues as to which diet is best. We would hope patients would not only achieve weight loss but also overall health. Let’s look at the evidence.
Low-carbohydrate vs. low-fat diets
Is a low-carbohydrate, high-fat diet a fad? It may depend on diet composition. In the publication of a randomized controlled trial (RCT), the gold standard of studies, results showed that a low-carbohydrate diet was significantly better at reducing weight than low-fat diet, by a mean difference of 3.5 kg lost (7.7 lb), even though calories were similar and exercise did not change (3).
The authors also note that the low-carbohydrate diet reduced cardiovascular disease risk factors in the lipid (cholesterol) profile, such as decreasing triglycerides (mean difference 14.1 mg/dl) and increasing HDL (good cholesterol). Patients lost 1.5 percent more body fat on the low-carbohydrate diet, and there was a significant reduction in an inflammation biomarker, C-reactive protein (CRP). There was also a reduction in the 10-year Framingham risk score. However, there was no change in LDL (bad cholesterol) levels or in truncal obesity in either group.
This study was 12 months in duration with 148 participants, predominantly women with a mean age of 47, none of whom had cardiovascular disease or diabetes, but all of whom were obese or morbidly obese (BMI 30-45 kg/m²). Although there were changes in biomarkers, there was a dearth of cardiovascular disease clinical end points. This begs the question: Does a low-carbohydrate diet really reduce the risk of developing cardiovascular disease (CVD) or its subsequent complications? The authors indicated this was a weakness since it was not investigated.
Digging deeper into the diets used, it’s interesting to note that the low-fat diet was remarkably similar to the standard American diet; it allowed 30 percent fat, only 5 percent less than the 35 percent baseline for the same group. In addition, it replaced the fat with mostly refined carbohydrates, including only 15 to 16 g/day of fiber.
The low-carbohydrate diet participants took in an average of 100 fewer calories per day than participants on the low-fat diet, so it’s no surprise that they lost a few more pounds over a year’s time. Patients in both groups were encouraged to eat mostly unsaturated fats, such as fish, nuts, avocado and olive oil.
As David Katz, M.D., founding director of Yale University’s Prevention Research Center, noted, this study was more of a comparison of low-carbohydrate diet to a high-carbohydrate diet than a comparison of a low-carbohydrate diet to a low-fat diet (4).
Another study actually showed that a Mediterranean diet, higher in fats with nuts or olive oil, when compared to a low-fat diet, showed a significant reduction in cardiovascular events — clinical end points not just biomarkers (5). However, both of these studies suffer from the same deficiency: comparing a low-carbohydrate diet to a low-fat diet that’s not really low fat.
Diet comparisons
Interestingly, in a meta-analysis (a group of 48 RCTs), the results showed that whether a low-carbohydrate diet (including the Atkins diet) or a low-fat diet (including the Ornish plant-based diet) was followed, there was a similar amount of weight loss compared to no intervention at all (6). Both diet types resulted in about 8 kg (17.6 lb) of weight loss at six months versus no change in diet. However, this meta-analysis did not make it clear whether results included body composition changes or weight loss alone.
In an accompanying editorial discussing the above meta-analysis, the author points out that it is unclear whether a low-carbohydrate/high-animal protein diet might result in adverse effects on the kidneys, loss of calcium from the bones, or other potential deleterious health risks. The author goes on to say that, for overall health and longevity and not just weight loss, micronutrients may be the most important factor, which are in nutrient-dense foods.
A Seventh-Day Adventist trial would attest to this emphasis on a micronutrient-rich, plant-based diet with limited animal protein. It resulted in significantly greater longevity compared to a macronutrient-rich animal protein diet (7).
Psyche
Finally, the type of motivator is important, whatever our endeavors. Weight loss goals are no exception. Let me elaborate.
A published study followed West Point cadets from school to many years after graduation and noted who reached their goals (8). The researchers found that internal motivators and instrumental (external) motivators were very important.
The soldiers who had an internal motivator, such as wanting to be a good soldier, were more successful than those who focused on instrumental motivators, such as wanting to become a general. Those who had both internal and instrumental motivators were not as successful as those with internal motivators alone. In other words, having internal motivators led to an instrumental consequence of advancing their careers.
When it comes to health, an instrumental motivator, such weight loss, may be far less effective than focusing on an internal motivator, such as increasing energy or decreasing pain, which ultimately could lead to an instrumental consequence of weight loss.
There is no question that dietary changes are most important to achieving sustained weight loss. However, we need to get our psyches in line for change. Hopefully, when we choose to improve our health, we don’t just focus on weight as a measure of success. Weight loss goals by themselves tend to lead us astray and to disappoint, for they are external motivators. Focus on improving your health by making lifestyle modifications. This tends to result in a successful instrumental consequence.
References: (1) Psychoneuroendocrinol. online 2014 April 12. (2) JAMA 2012;307:491-497. (3) Ann Intern Med. 2014;161(5):309-318. (4) Huffington Post. Sept 2, 2014. (5) N Engl J Med. 2014 Feb 27;370(9):886. (6) JAMA. 2014;312(9):923-933. (7) JAMA Intern Med. 2013;173:1230-1238. (8) Proc Natl Acad Sci U S A. 2014;111(30):10990-10995.
Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.
Jane Edsell of Mount Sinai was in the right place at the right time when she snapped this photo at Heritage Park in her hometown on July 27. She writes, ‘As I waited for a good shot of the larger butterfly, a smaller butterfly landed on the same butterfly bush flower!’
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