As it’s the
last day before the summer holidays for my kids, I was hoping for a nice
chilled out day where I can get some work done so I don’t need to worry about
it so much over the coming weeks, so I thought I’d watch some TV I’d recorded
whilst I get on. Well now that’s not
happening! There are not many times I
absolutely despair at a TV programme (although quite a few when I do threaten
to throw things!) but last night’s ‘Trust Me I’m A Doctor’ has got me to that
point, hence dropping all the work and chilled out-ness I had planned to write
this blog post instead before I implode and make even more of a mess than there
is already in my living room.
 |
| Takes a bit more than that I'm afraid! |
I always
watch these kind of programmes for research purposes, as I like to know what
I’m up against. And like to torture myself too evidently. Now obviously I’m not a doctor so people
wouldn’t necessarily come to someone like me for advice, but in an ideal world
they wouldn’t need to look elsewhere as doctors and the powers that be would
give good advice that is actually going to help people rather than just
churning out the same old stuff year in year out, despite building evidence to
the contrary. As I am talking about
advice which probably goes against that of a doctor, you will find links to a
selection of information and studies that I have used so you can at least make
your own mind up. Just to cover myself a
bit for the ‘this does not constitute medical advice’ disclaimer type thing you
normally see on health type websites.
What’s my
beef this time? Cholesterol. Again. It really does seem to be one of the most
misunderstood aspects in health. We’re
constantly told that it shouldn’t be high and that we need to reduce it and if
we’re really unlucky, we’ll be told we need to take statins to sort it
out. I have mentioned this before to
some extent in a previous blog post but will try and give a bit of a
basic explanation (remember, I’m no doctor so this is just how I understand it!
Chris
Kresser gives a good explanation with further info in his ebook which is
mentioned at the bottom of this post).
 |
Cholesterol
is split into 2 main types, HDL (high density lipoproteins) and LDL (low
density lipoproteins). We are told that
HDL = good and LDL = bad which is sort of true, but it isn’t that simple as there
is one more aspect to it that doesn’t get mentioned but is important. LDL comes in 2 different particle sizes;
large and fluffy, and small and dense.
It’s the small dense ones which are more likely to cause plaque in the
arteries which leads to heart attacks.
You can have a high LDL number but if it’s made up of the large fluffy
particles then there’s no real health risk.
The trouble is, this doesn’t get measured as part of a cholesterol test
so you don’t know what you’re actually working with. Maybe it’s just too much effort or seen as
too expensive to look deeper, but if it happened then maybe it could actually
save time and money by giving people the correct information to be able to
choose the correct solution for them based on their actual detailed cholesterol
profile? There is plenty of evidence
(you can find a lot of it from the links at the end) which shows that
cholesterol and heart disease aren’t actually linked. My favourite analogy is that just because a
fireman (cholesterol) is at a fire (a heart attack), doesn’t mean they caused
it.
So onto the programme. I shall start with a positive to try and
weigh up against plenty of negatives!
The general premise was to see if they could reduce cholesterol levels
by changing diet rather than using something like statins. An honourable cause. After the usual incomplete explanation of
what cholesterol is and why we need to keep it low, they move on to the dietary
interventions which make up their experiment.
The first
group are cutting out foods traditionally said to raise cholesterol so eggs,
red meat and high fat dairy products such as cheese. Oh. My. Actual. God. Are they really still saying that? This is possibly the part that infuriates me
the most, that highly nutritious foods such as eggs (which some people have heralded as the perfect food) are still being demonised as
they contain cholesterol. How outdated
can their advice actually get?!! Then they actually say to replace these with
things like vegetable oil spreads. I
nearly passed out at this point. Moving
on…
The second
group are still eating normally (with no information as to what their ‘normal’
actually is) but adding in oats to their diet.
This has been recommended because of the beta-glucan which is in oats
and as they explained, attaches itself to the cholesterol in the stomach before
it can be absorbed into the blood stream.
This has been shown to reduce cholesterol levels, especially LDL so could
well be helpful.
The third
group are also eating normally (again, no info as to what that means) but are
adding in almonds. These were chosen
because “they are rich in fibre and plant sterols which may delay fat and cholesterol
absorption” (from BBC article). Can’t
say anything negative about almonds really.
Michael (Mosley)
chose a fourth option of the “Portfolio Diet” which is based on trying all of
the so-called cholesterol lowering approaches at once, as well as including
soya, vegetables and plant sterol-enriched margarines (Flora Pro-Activ played
quite a big part in this #justsaying).
So onto the results.
The “cholesterol-lowering
approach” group’s average reduction was 11.1% in general cholesterol and 13.2%
of ‘bad’ cholesterol. Pretty good on the
face of it. But without knowing more
about the LDL particle size it’s pretty much useless as they could have reduced
the useful particles instead of the damaging ones; the whole problem of measuring
cholesterol in this way. Plus, as we don’t
know what they were eating instead of and alongside the foods they cut out,
then we can’t accurately know what produced the results. Had they had a group eating the opposite,
lots of bacon, eggs and cheese, then the results may have meant a bit more as
they could be compared. But it still
doesn’t solve the issue of us not knowing what else they were eating!
The oat
group’s average reduction was 8.7% general and 10.2% of bad so pretty
good. But again, we don’t know what else
they were eating to be able to attribute the results solely to the oats. And if the rest of their diet wasn’t great,
then they may have increased their risk factors for other conditions or
diseases even though their cholesterol is now lower.
The almonds’
group showed no significant change, but this was expanded upon to show that
about half the people showed a reduction but half showed an increase which
cancelled each other out in effect. Not
massively useful then apart from to emphasise that different approaches can
work differently for people.
My main issues:
No
information as to what else the groups were eating apart from the ‘less
cholesterol-causing foods’, added oats or almonds. There could be a wild difference in results
if they were chowing down on microwave ready meals, or eating their bodyweight
in bread and marg, or following a high fat low carb diet. With any good scientific test, you need to
have some kind of control group to measure results against and also know what
other factors are involved that may affect the results. Without knowing what else they were eating,
the results have less validity as it can’t be shown that the changes for the
programme were the thing that caused the difference in cholesterol levels. They may well have done, but we don’t know.
Why no
group on a low carb high fat diet (or some variation of this) for
comparison? A significant amount of research
over the last few years has shown that this type of diet (including
Paleo/Primal) doesn’t raise cholesterol, although it may not especially reduce
it either, however it does come with other health benefits such as reducing
metabolic syndrome (this increases your risk factors for heart disease, strokes
etc). An example I often use is from the
film/documentary Cereal Killers
where Donal O’Neill ate a diet very high in saturated fat including a huge
amount of eggs yet had one of the best cholesterol profiles you can have. Yes this is just the results for one person,
but it shows it can be done and would have been good to see it used as a
comparison and alternative option for the approaches used in the programme
(which also admits that results can be very personal). Why can’t any health-related TV programme
bring themselves to step out of the box and say that fat can be OK?!
.
A
complete absence of any mention of what a good general diet should be based
on more modern research and opinions. It
wouldn’t have been that hard to say that the optimal diet for general health
(yes, in my opinion) is something along the lines of being based on real,
non-processed foods which limit starchy carbs, includes plenty of fruit and
veg, and includes all types of fat from a variety of sources. Instead, it came across that if you just eat
almonds and oats as well as your crisps/cakes/bread/sweets/ready meals/fizzy
drinks you’ll probably be OK.
Pandering
to food companies by still adopting an annoying middle ground. They may have effectively said that you don’t
need statins which may have not pleased drugs companies (although there’s a bit
of a caveat on the website which says some people may still need to consider
them) but they just can’t bring themselves to say that you shouldn’t limit food
that requires factories, processing and packets as there is just too much
influence and money from food companies.
In my general internet wanderings, it never ceases to amaze me how many
places companies such as PepsiCo, Kelloggs, Nestle etc pop up when looking at ‘partnerships’
for events and programmes or funding for research; no doubt there’s some kind
of influence with TV companies too which may well affect what they can say or
advise in their programmes. Or maybe I’m just getting a bit too cynical, but it's not just me!
My overall conclusion:
Another ‘health’
TV programme that produced something a bit half arsed and didn’t show the whole
picture. The extra info that they didn’t
mention plays a very important part in understanding the cholesterol issue, and
how to effectively deal with it without opening yourself up to other potential health
problems. As ever, take this kind of
thing with a pocketful of salt and use it as a starting point to do your own
research. I do agree that different approaches
can work for different people, but for the majority of the population, a diet
based on what I (and the experts on my links) favour is likely to be a good
base; a small percentage of people may just need some tweaks. Sorry, I still don’t trust you even if you
are a doctor.
Anyway, if
you haven’t watched it yet, give it a look and see what you think. If you have, maybe watch it again with fresh eyes
and see if you get anything different from it.
If you want
some advice from experts in the field of food and health that might actually do
you some good, then look at these links rather than anything from the NHS or
your doctor, including ones on TV (ooh, controversial!):
http://realmealrevolution.com/the-facts
- Dr Tim Noakes from Cereal Killers
