Professional Documents
Culture Documents
Conclusions
In
this
module,
Dr.
Campbell
critiques
the
design
of
the
Harvard
Nurses
Health
Study.1
As
you
will
recall
from
the
lecture,
researchers
speculated
that
the
nurses
consuming
less
fat
would
have
lower
rates
of
breast
cancer.
However,
breast
cancer
rates
did
not
decrease
among
the
study
subjects
consuming
less
fat.
Researchers
therefore
stated
that
there
was
no
evidence
a
lower
intake
of
total
fat
or
specific
major
types
of
fat
was
associated
with
a
decreased
risk
of
breast
cancer.
Dr.
Campbell
points
out
that
although
the
women
were
divided
into
two
groups
(a
high-fat
group
and
a
low-fat
group),
all
of
them
were
actually
consuming
very
similar
diets
overallat
least
as
far
as
their
animal-to-plant
food
ratios
were
concerned.
He
points
out
that
the
design
of
the
study
overlooked
this
confounding
factor,
leading
to
erroneous
conclusions
that
have
promoted
public
confusion.
An
Alternate
Interpretation
Dr.
Campbell
interprets
the
results
of
the
Nurses
Health
Study
quite
differently.
When
Americans
on
animal-food-based
diets
decrease
their
fat
consumption,
they
actually
tend
to
increase
protein
consumptionparticularly
animal
protein,
because
they
tend
to
consume
more
skim
milk,
low-fat
meats,
etc.
When
the
fat
is
removed,
the
percentage
of
protein
in
these
products
increases;
as
a
result,
a
diet
high
in
low-fat
foods
can
raise
the
consumption
of
animal-based
protein
up
to
80-85%
of
total
protein
intake.
And
if
diets
high
in
animal
protein
are
associated
with
an
increased
risk
of
cancer,
lowering
fat
intake
by
raising
protein
consumption
may
not
lower
cancer
risk.
But
even
if
this
explanation
is
illuminating,
it
raises
questions
for
us
as
consumers.
Most
of
us
are
more
than
accustomed
to
feeling
confused
by
conflicting
messages
about
what
is
good
for
us
and
what
isnt.
But
how
do
we
know
if
studies
are
well
designed?
And
what
should
we
bear
in
mind
when
interpreting
media
messages
about
nutrition?
Making
Sense
of
Media
Messages
Is
There
a
Single-Nutrient
Focus?
First,
note
whether
a
report
seems
to
be
focused
on
single
nutrients,
chemicals,
or
drugs or
whether
it
involves
broader
patterns
of
diet
and
disease.
The
single-nutrient
study
may
provide
useful
information
on
a
very
specific
function,
but
that
information
may
not
be
1
If
you
wish
to
find
out
more
about
the
Nurse's
Health
Study,
including
study
findings,
you
can
do
so
at:
http://www.channing.harvard.edu/nhs/
For
individual
student
use
only:
please
do
not
copy
or
distribute.
2012,
T.
Colin
Campbell
Foundation
and
TILS
integrated
into
the
bigger
picture
about
diet
and
healthand
it
may
not
apply
to
the
big
picture
in
the
manner
suggested.
If
nutrients
are
being
canonized
or
demonized,
take
note!
All
nutrients
play
a
role
in
maintaining
health,
and
the
promotion
of
certain
nutrients
over
others
is
misleading.
Keep
in
mind
too
that
there
is
no
single
mechanism
that
creates
disease
within
the
symphony
of
interactions.
If
conclusions
suggest
supplements
or
drug
treatments
rather
than
diet
and
lifestyle
adjustments,
be
wary.
What
Kinds
of
Studies
and
What
Kinds
of
Conclusions?
If
a
report
is
based
on
an
animal
study,
remember
that
results
do
not
give
us
the
full
picture
of
multiple
relationships
among
lifestyle
factors
and
health
results
in
context,
and
cannot
provide
practical
evidence
on
diet
and
disease
in
humansfindings
should
be
regarded
as
indications
of
what
might
be
possible
in
humans.
If
the
message
is
based
on
a
human
study,
note
whether
it
was
done
with
Western
subjects.
The
Nurses
Health
Study
highlights
a
common
difficulty
in
exploring
the
relationship
between
diet
and
disease:
virtually
all
human
studies
are
conducted
on
Westerners
consuming
Western
diets.
And
although
some
studies
may
seem
to
be
examining
a
wide
range
of
factors
(like
the
different
levels
of
fat
intake
in
the
Nurses
Health
Study),
scientists
actually
tend
to
study
people
consuming
more
or
less
the
same
diet:
one
that
is
rich
in
animal
foods
and
likely
to
be
related
to
Western
diseases.
Finally,
human
studies
should
not
set
forth
conclusions
about
single
nutrient
effects.
If
they
do,
remember
that
conclusions
like
these
actually
lie
outside
the
scope
of
these
studies.
Who
Is
Behind
the
Claim?
If
you
find
a
message
particularly
compelling
and
wish
to
investigate
further,
you
can
also
determine
whether
or
not
there
is
a
serious
paper
behind
a
particular
claim,
and
read
it.
Most
authors
of
diet
books,
articles,
and
blogs
are
not
scientists,
do
not
publish
studies,
and
therefore
do
not
have
to
defend
their
assertions
to
their
peers.
However,
you
might
search
for
evaluations
of
an
author,
message,
or
study
by
others
whose
opinions
you
respect.
Where
Are
the
Industry
Connections?
To
evaluate
further
the
claims
set
forth
by
a
particular
author,
research
paper,
or
organization,
you
may
want
to
look
for
funding
sources
and
associations:
what
institutions
or
industries
have
been
involved,
and
what
might
their
interests
be?
The
funding
for
a
particular
study
may
or
may
not
be
mentioned
in
the
published
paper.
Another
way
you
might
get
a
sense
of
a
particular
authors
or
researchers
slant
is
to
look
up
the
researchers
name
online
to
discover
the
other
papers,
institutions,
or
funding
sources
with
which
he
or
she
has
been
associated.
If
a
researcher
is
connected
to
an
educational
institution,
an
online
profile
could
provide
additional
information.
Facts,
Judgments,
and
Opinions
Of
course,
it
is
also
important
to
distinguish
among
three
different
types
of
assertions
when
you
are
evaluating
information:
facts,
judgments,
and
opinions.
Note
that
statements
of
For
individual
student
use
only:
please
do
not
copy
or
distribute.
2012,
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Colin
Campbell
Foundation
and
TILS
scientific
fact
are
largely
judgments
that
can
be
evaluated
as
to
quality
of
thinking
and
the
research
underlying
them.
Facts,
Judgments,
and
Opinions
Scientific
Facts
Objective,
verifiable
observations
that
are
not
relative
to
the
speaker;
our
best
articulations
of
natural
laws.
For
example:
Humans
need
protein
to
survive.
Judgments
Judgments
are
assertions
that
may
be
well
reasoned
or
poorly
reasoned,
and
based
on
more
or
less
evidence.
Most
information
and
advice
we
hear
about
nutritionalthough
it
may
be
stated
as
factactually
falls
into
this
category!
Examples
of
judgments
include:
Theories:
Principles
that
are
confirmed
by
available
evidence
and
can
be
used
to
predict
phenomena.
Theories
are
intended
to
explain
certain
aspects
of
the
way
the
world
works;
however,
theories
do
not
become
facts,
but
describe
facts.
In
science,
the
term
theory
connotes
ample
evidence
and
a
high
degree
of
confidencethat
is,
its
just
a
theory,
is
not
a
valid
dismissal
of
scientific
theory.
For
example:
Plant-based
foods,
as
a
class,
promote
health,
whereas
animal-based
foods,
as
a
class,
carry
health
risks.
Hypotheses:
Formally
(as
it
is
used
to
describe
a
part
of
the
scientific
method,
for
instance),
a
hypothesis
is
a
specific,
testable
prediction
about
the
relationship
between
two
or
more
variables.
More
generally,
however,
we
can
think
of
a
hypothesis
as
a
proposed
explanation
for
a
phenomenon
(based
on
evidence).
For
example:
Higher
levels
of
dietary
protein
will
lead
to
greater
tumor
severity
over
a
rats
lifetime,
and
if
we
alter
the
level
of
dietary
protein
during
tumor
formation,
we
will
influence
the
development
of
the
tumors.
Speculation:
An
explanation
or
proposal
constructed
without
fully
supporting
data.
For
example:
After
learning
about
the
best-fed
Filipino
childrens
developing
primary
liver
cancer,
Dr.
Campbell
speculated
that
their
greater
protein
intake
was
associated
with
more
cancer.
Opinions
Beliefs,
judgments,
or
views
that
are
not
necessarily
based
on
knowledge
or
evidence.
Example:
People
like
eating
meat,
so
they
wont
go
for
a
vegetarian
diet.
A
Note
on
Researcher
Intent
As
you
examine
the
study
design,
reasoning,
and
industry
involvement
behind
particular
nutrition
claims,
you
may
find
yourself
wondering
what
these
factors
reveal
about
researcher
intent.
Please
bear
in
mind
that
the
answer
may
be
nothing
at
all.
Single-
For
individual
student
use
only:
please
do
not
copy
or
distribute.
2012,
T.
Colin
Campbell
Foundation
and
TILS
nutrient
studies
and
studies
done
on
Western
subjects
are
accepted
parts
of
scientific
practice
in
our
current
paradigm,
and
the
role
of
industry
in
our
socioeconomic
system
often
includes
funding
research.
Industry
backing
does
not
necessarily
indicate
intent
to
deceive
or
manipulate
the
public.
Indeed,
the
vast
majority
of
scientists
working
within
our
system
have
the
best
of
intentions
about
discovering
how
best
to
promote
human
health.
How
to
Analyze
Nutrition
Claims
Use
the
tool
below
to
help
you
analyze
specific
claims
you
may
hear
about
nutrition.
Weve
provided
two
completed
examples
to
show
you
how
to
use
it,
each
preceded
by
the
brief
article
on
nutrition
to
which
it
refers.
Critical
Questions
for
Analyzing
Nutrition
Messages
The
science-
and
nutrition-related
messages
we
get
from
the
media
often
focus
on
study
conclusions
or
recommendations
without
giving
us
much
information
about
who
arrived
at
those
conclusions,
or
how.
As
a
result,
we
seem
to
be
bombarded
with
confusing,
contradictory
assertions.
How
can
we
become
more
confident,
critical
consumers
of
the
messages
we
receive?
Here
are
some
questions
we
can
ask
ourselves
to
critique
what
we
hear
and
identify
where
we
might
need
more
information.
1. What
is
the
message
recommending
or
promoting?
2. What
problem
is
this
recommendation
intended
to
solve?
Is
it,
in
your
opinion,
an
important
problem?
3. What
questions
are
being
asked
about
this
problem
(by
the
author,
or
in
the
research
cited)?
What
questions
are
not
being
asked?
4. What
kinds
of
evidence
are
being
used
to
answer
these
questions?
How
does
it
relate
to
other
evidence
on
this
topic,
if
you
know?
5. What
kinds
of
assumptions
are
being
made
about
the
problem?
(An
assumption
is
a
belief
that
may
be
unstated
or
taken
for
granted
without
evidence.)
6. What
can
you
tell
about
the
authors
approach
to
nutrition
science?
What
might
be
missing?
7. Are
the
conclusions
well
reasoned
and
warranted
by
the
evidence?
Explain.
8. What
might
be
some
important
consequences
of
accepting
these
conclusions
(for
society,
the
environment,
etc.)?
For
individual
student
use
only:
please
do
not
copy
or
distribute.
2012,
T.
Colin
Campbell
Foundation
and
TILS
Example 1 Nutrient Found in Dark Meat of Poultry, Some Seafood, May Have Cardiovascular Benefit ScienceDaily (a popular science news website at www.sciencedaily.com)
Article:
Source:
ScienceDaily
(Mar.
1,
2012)
A
nutrient
found
in
the
dark
meat
of
poultry
may
provide
protection
against
coronary
heart
disease
(CHD)
in
women
with
high
cholesterol,
according
to
a
study
by
researchers
at
NYU
Langone
Medical
Center.
The
study,
published
online
in
the
European
Journal
of
Nutrition,
evaluated
the
effects
of
taurine,
a
naturally-occurring
nutrient
found
in
the
dark
meat
of
turkey
and
chicken,
as
well
as
in
some
fish
and
shellfish,
on
CHD.
It
revealed
that
higher
taurine
intake
was
associated
with
significantly
lower
CHD
risk
among
women
with
high
total
cholesterol
levels.
The
same
association
was
not
seen
in
women
with
low
cholesterol
levels,
however.
There
is
very
little
information
available
about
taurine,
said
principal
investigator
Yu
Chen,
PhD,
MPH,
associate
professor
of
epidemiology
at
NYU
School
of
Medicine,
part
of
NYU
Langone
Medical
Center.
While
there
have
been
some
animal
studies
that
indicate
taurine
may
be
beneficial
to
cardiovascular
disease,
this
is
the
first
published
prospective
study
to
look
at
serum
taurine
and
CHD
in
humans,
she
explained.
"Our
findings
were
very
interesting.
Taurine,
at
least
in
its
natural
form,
does
seem
to
have
a
significant
protective
effect
in
women
with
high
cholesterol."
Coronary
heart
disease
is
the
leading
killer
of
American
men
and
women,
causing
one
in
five
deaths.
Also
known
as
coronary
artery
disease,
it
is
caused
by
the
buildup
of
plaque
in
the
arteries
to
the
heart.
Large
prospective
epidemiologic
studies
have
provided
evidence
that
nutritional
factors
are
important
modifiable
risk
factors
for
CHD.
Dr.
Chen
and
colleagues
conducted
their
study
using
data
and
samples
from
the
NYU
Women's
Health
Study.
The
original
study
enrolled
more
than
14,000
women,
34
to
65
years
of
age,
between
1985
and
1991
at
a
breast
cancer
screening
center
in
New
York
City.
Upon
enrollment,
a
wide
range
of
medical,
personal
and
lifestyle
information
was
recorded
and
the
data
and
samples
continue
to
be
utilized
for
a
variety
of
medical
studies.
For
the
serum
taurine
study,
funded
by
the
American
Heart
Association,
the
researchers
measured
taurine
levels
in
serum
samples
collected
in
1985
before
disease
occurrence
for
223
NYUWHS
participants
who
developed
or
died
from
CHD
during
the
study
follow-up
period
between
1986
and
2006.
The
researchers
then
compared
those
samples
to
the
taurine
levels
in
serum
samples
collected
at
the
same
time
for
223
participants
who
had
no
history
of
cardiovascular
disease.
The
comparison
revealed
serum
taurine
was
not
protective
of
CHD
overall.
However,
among
women
with
high
cholesterol,
those
with
high
levels
of
serum
taurine
were
60
percent
less
likely
to
develop
or
die
from
CHD
in
the
study,
compared
to
women
with
lower
For
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2012,
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serum
taurine
levels.
If
future
studies
are
able
to
replicate
the
findings,
taurine
supplementation
or
dietary
recommendations
may
one
day
be
considered
for
women
with
high
cholesterol
at
risk
for
CHD.
"It
is
an
interesting
possibility,"
she
said.
"If
these
findings
are
confirmed,
one
day
we
might
be
able
to
suggest
that
someone
with
high
cholesterol
eat
more
poultry,
specifically
dark
meat."
Dr.
Chen
explained
that
Caucasian
women
comprised
more
than
80
percent
of
the
study
population
and,
therefore,
the
results
may
not
at
this
time
be
generalized
to
men
or
other
races,
but
suggested
that
future
studies
should
be
conducted
in
these
populations.
In
addition,
she
explained,
it
is
unclear
whether
synthetic
taurine
as
an
additive
in
food
and
drink
products
will
have
the
same
benefit
observed
in
this
study,
and
health
effects
of
these
products
should
be
investigated
separately.
"We
studied
taurine
found
in
the
blood
that
originated
from
natural
sources,"
Dr.
Chen
said.
"The
nutrient
being
added
to
energy
drinks
or
supplements
is
human-made
and
is
added
in
unstudied
amounts.
These
products
also
often
contain
not
only
very
high
amounts
of
taurine,
but
a
multitude
of
other
ingredients
as
well
such
as
caffeine
and
ginseng
that
may
influence
CHD
risk."
The
researchers
are
currently
using
NYUWHS
data
to
evaluate
the
effect
of
taurine
on
the
occurrence
of
stroke
in
another
study
funded
by
the
National
Heart,
Lung,
and
Blood
Institute
(NHLBI).
Co-authors
on
the
European
Journal
of
Nutrition
paper
are:
Oktawia
P.
Wojcik,
PhD,
Karen
L.
Koenig,
PhD,
Anne
Zeleniuch-Jacquotte,
MD,
Camille
Pearte,
MD,
and
Max
Costa,
PhD,
all
of
NYU
School
of
Medicine.
Source:
NYU
Langone
Medical
Center/New
York
University
School
of
Medicine
(2012,
March
1).
Nutrient
found
in
dark
meat
of
poultry,
some
seafood,
may
have
cardiovascular
benefits.
ScienceDaily.
Retrieved
March
24,
2012,
from
http://www.sciencedaily.com-
/releases/2012/03/120301113353.htm
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Using
the
Critical
Questions
Tool:
Example
1
Article
or
media
piece:
Nutrient Found In Dark Meat of Poultry, Some Seafood, May Have Cardiovascular Benefits (from ScienceDaily)
1. What
is
the
message
recommending
or
promoting?
Its not quite a recommendation yet, but Dr. Yu Chen thinks that if her findings are confirmed, we might one day recommend that people with high cholesterol eat more poultry, specifically dark meat (and, perhaps, seafood).
2. What
problem
is
this
recommendation
intended
to
solve?
Is
it,
in
your
opinion,
an
important
problem?
Coronary heart disease is the problem. It is indeed an important one to address because its the leading killer of American men and women, causing 1 in 5 deaths.
3. What
questions
are
being
asked
about
this
problem
(by
the
author,
or
in
the
research
cited)?
What
questions
are
not
being
asked?
What is the impact of the single nutrient taurine on CHD? The researchers do not seem to be looking at the impact of whole foods (or classes of foods) on CHD.
4. What kinds of evidence are being used to answer these questions? How does it relate to other evidence on this topic, if you know? Dr Chen and her colleagues used data and samples from the NYU Womens Health Study. They measured taurine levels in serum samples collected in 1985 (before disease occurrence) for 223 NYUWHS participants who developed or died from CHD between 1986 and 2006. They compared these data with taurine levels in serum samples collected at the same time for 223 participants with no history of CHD. They noted that higher taurine intake was associated with significantly lower CHD risk among women with high cholesterol. They also noted that there have been some animal studies suggesting that taurine may be beneficial to CHD. They dont appear to be looking at any studies on the impact of whole animalbased foods on CHD.
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5. What kinds of assumptions are being made about the problem? (An assumption is a belief that may be unstated or taken for granted without evidence.) The researchers seem to assume that higher serum taurine levels are due to higher taurine intake from consuming certain types of meat (rather than that synthesized in the human liver), and that food-source taurine can be differentiated from supplemental taurine in these samples. Dr. Chen and colleagues also seem to assume that high levels of a single nutrient (taurine) can be expected to have a consistent impact on CHD (in women with high cholesterol), and that this impact may be achieved by eating more poultry, without regard to the rest of the diet. They also seem be assuming that health outcomes can be optimized within the context of the Western diet, and that women with high cholesterol can only make dietary adjustments within the context of that diet.
6. What can you tell about the authors approach to nutrition science? What might be missing? See above. Dr. Chen and her team seem to be approaching this issue by examining the relationship of a single nutrient with a particular disease, absent the total context of the diet. They do not seem to have a wholistic approach to nutrition science.
7. Are
the
conclusions
well
reasoned
and
warranted
by
the
evidence?
Explain.
I would say the evidence is insufficient and there are too many assumptions in play for me to believe conclusions are well founded. Dr. Chen and her colleagues found that among women with high cholesterol, those with high levels of serum taurine were 60% less likely to develop or die from CHD. They suggest that if future studies replicate these findings, taurine supplementation or dietary recommendations might be considered for women with high cholesterol who are at risk for CHD. However, these recommendations seem ill conceived without confirming evidence that women with the lowest risk for CHD are consuming diets high in poultry!
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The approach is also focused on dealing with symptoms of health issues, rather than causesserum taurine was not protective of CHD overall, but only in women with high cholesterol.
8. What might be some important consequences of accepting these conclusions (for society, the environment, etc.)? Given such recommendations, women with high cholesterol may be less likely to take measures to actually lower their cholesterol levels. Instead they may be more likely to consume poultry and seafood (thus increasing their risk of chronic degenerative diseases), and even to supplement taurine. And there might be an increased market for taurine supplements and even taurine-spiked food productsIm not sure what the health consequences of that would be!
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Example 2 Article: Source: Low-Fat Diet Not a Cure-All The Nutrition Source (a website maintained by the Department of Nutrition at the Harvard School of Public Health, accessible at http://www.hsph.harvard.edu/nutritionsource)
Results
from
large,
long
Women's
Health
Initiative
Dietary
Modification
Trial
shows
no
effect
on
heart
disease,
breast
cancer,
colorectal
cancer,
or
weight.
The
low-fat,
high-starch
diet
that
was
the
focus
of
dietary
advice
during
the
1990s
as
reflected
by
the
USDA
food
guide
pyramid
is
dying
out.
A
growing
body
of
evidence
has
been
pointing
to
its
inadequacy
for
weight
loss
or
prevention
of
heart
disease
and
several
cancers.
The
final
nail
in
the
coffin
comes
from
an
eight-year
trial
that
included
almost
49,000
women.
Although
the
media
have
made
much
of
the
"disappointing"
results
from
the
Women's
Health
Initiative
(WHI)
Dietary
Modification
Trial,
it
would
be
a
serious
mistake
to
use
these
new
findings
as
reason
to
load
up
on
sausage,
butter,
and
deep-fried
fast
food.
The
trial
and
its
findings
The
Women's
Health
Initiative
Dietary
Modification
Trial
was
started
back
in
1993,
at
a
time
when
dietary
fat
was
seen
as
a
dietary
evil
and
the
low-fat
diet
was
thought
to
be
a
straightforward
route
to
preventing
heart
disease,
some
cancers,
and
the
epidemic
of
obesity
that
was
beginning
to
sweep
the
country.
With
funding
from
the
National
Heart,
Lung,
and
Blood
Institute,
researchers
recruited
almost
50,000
women
between
the
ages
of
50
and
79
years.
Of
these,
19,541
were
randomly
assigned
to
follow
a
low-fat
diet.
Their
goal
was
to
lower
their
fat
intake
from
almost
38%
of
calories
to
20%.
They
were
helped
in
this
effort
by
a
series
of
individual
and
group
counseling
sessions.
Another
29,294
women
were
randomly
assigned
to
continue
their
usual
diets,
and
were
given
just
generic
diet- related
educational
materials.
After
eight
years,
the
researchers
looked
at
how
many
(and
what
percentage)
of
women
in
each
group
had
developed
breast
cancer
or
colorectal
cancer.
They
tallied
up
heart
attacks,
strokes,
and
other
forms
of
heart
disease.
They
also
looked
at
things
like
weight
gain
or
loss,
cholesterol
levels,
and
other
measures
of
health.
The
results,
published
in
the
Journal
of
the
American
Medical
Association,
showed
no
benefits
for
a
low-fat
diet.
Women
assigned
to
this
eating
strategy
did
not
appear
to
gain
protection
against
breast
cancer,(1)
colorectal
cancer,(2)
or
cardiovascular
disease.(3)
And
after
eight
years,
their
weights
were
generally
the
same
as
those
of
women
following
their
usual
diets.(4)
The
researchers
saw
a
trend
toward
a
lower
risk
of
breast
cancer
among
women
in
the
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low-fat
group.
This
trend
was
not
statistically
significant,
meaning
it
could
have
been
due
to
chance.
It
could
also
have
been
due
to
the
very
small
weight
loss
during
the
early
years
of
the
study
among
women
in
the
low-fat
group,
who
received
intensive
dietary
counseling.
There
is
strong
evidence
from
many
studies
that
being
overweight
increases
the
risk
of
breast
cancer
after
menopause,
and
that
staying
slim
after
menopause
is
an
effective
way
to
reduce
risk
of
breast
cancer,
along
with
many
other
diseases.
Limitations
of
the
study
Some
nutrition
experts
say
that
the
WHI
Dietary
Modification
Trial
doesn't
really
lay
to
rest
the
low-fat
hypothesis
because
the
women
in
the
study
only
modestly
lowered
their
fat,
from
38%
to
29%.
Had
they
reached
the
trial's
target
of
20%,
benefits
from
the
low-fat
approach
may
have
become
more
apparent,
these
nutritionists
suggest.
It
is
possible
that
the
participants
in
the
low-fat
group
may
have
actually
overstated
how
much
they
reduced
their
fat
intake.
This
has
happened
in
other
studies,
as
shown
by
comparisons
between
self-reported
changes
and
biochemical
measures
of
dietary
change.
Significant
reductions
in
fat
intake
are
usually
reflected
in
a
decrease
in
HDL
(good)
cholesterol
and
an
increase
in
triglycerides.
Yet
in
the
WHI
trial,
there
were
no
differences
in
blood
levels
of
HDL
cholesterol
or
triglycerides
between
the
low-fat
and
usual
diet
groups.
This
casts
doubt
on
the
degree
of
fat
reduction
achieved
in
this
study.
Two
other
limitations
of
the
trial
are
the
study
population
and
duration.
The
trial
included
women
who
were
aged
50
to
79
years
at
the
beginning
of
the
trial.
By
this
time
in
life,
it
may
be
too
late
for
changes
in
diet
to
reduce
risks
of
cancer
and
other
chronic
conditions.
In
addition,
it
takes
years
for
the
effects
of
dietary
change
to
be
seen,
and
so
it
is
possible
that
eight
years
wasn't
enough
time
to
see
the
true
impact
of
a
low-fat
diet.
The
debate
will
likely
continue
as
to
why
the
WHI
observed
little
benefit
for
a
low-fat
diet.
Was
it
because
reducing
the
intake
of
dietary
fat
truly
has
little
benefit?
Was
it
because
the
women
in
the
trial
didn't
lower
fat
intake
enough?
Or
had
the
study
focused
on
a
younger
population,
or
lasted
longer,
would
it
have
revealed
a
benefit?
In
any
case,
the
dietary
intervention
didn't
work,
even
though
the
WHI
trial
was,
by
far,
the
most
expensive
study
of
diet
ever
conducted
(costing
many
hundreds
of
millions
of
dollars)
and
even
though
the
women
in
the
low-fat
group
received
intensive
dietary
counseling
from
some
of
the
best
nutritionists
and
dietitians
in
the
country.
Change
was
already
in
the
air
The
dietary
fat
reduction
arm
of
the
WHI
(it
also
has
a
hormone
replacement
therapy
component
and
a
calcium
and
vitamin
D
component)
was
controversial
from
the
beginning.(5-8)
Members
of
the
HSPH
Department
of
Nutrition
argued
that
the
hypothesis
that
a
reduction
in
total
fat
intake
would
have
major
health
benefits
was
not
supported
by
existing
data.
It
also
noted
that
maintaining
a
contrast
in
diets
between
two
groups
over
many
years
was
difficult,
and
for
this
reason
the
study
might
not
provide
a
clear
answer
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even
if
the
hypothesized
benefits
were
true.
Such
a
study
had
failed
in
the
past.
The
Multiple
Risk
Factors
Intervention
Trial
(MRFIT,
often
called
Mister
Fit)
aimed
to
decrease
risk
of
coronary
heart
disease
by
a
program
aimed
at
controlling
key
risk
factors
for
the
disease.
Some
of
the
participants
received
intensive
counseling
to
stop
smoking,
control
high
blood
pressure,
and
reduce
their
intake
of
saturated
fat.
At
the
end
of
the
trial,
there
was
no
significant
difference
in
rates
of
coronary
heart
disease.(9)
Even
so,
the
investigators
argued
that
their
hypotheses
were
still
correct
because
the
members
of
the
control
group
had,
on
their
own,
began
to
stop
smoking
and
eat
less
saturated
fat,
making
differences
in
smoking
rates
and
diet
between
the
two
randomized
groups
very
small.(10)
The
results
of
the
WHI
add
further
evidence
that
clear
answers
to
questions
about
the
long
term
effects
of
diet
on
risks
of
cancers
and
other
major
diseases
may
not
be
obtainable
by
large
randomized
intervention
trials,
no
matter
how
much
money
is
spent
conducting
them.
Type
trumps
percentage
The
findings
from
the
Women's
Health
Initiative
Dietary
Modification
Trial
came
as
a
surprise
to
many
Americans
who
have
been
hearing
for
years
that
reducing
fat
is
important
for
long-term
health.
Yet
long-term
follow-up
studies
such
as
the
Nurses
Health
Study
have
consistently
found
little
relation
between
the
percentage
of
calories
from
fat
and
risks
of
breast
cancer,
colon
cancer,
or
coronary
heart
disease.
Such
studies
are
one
reason
why
major
reviews
of
diet
and
health
during
the
last
five
years,
including
those
conducted
by
the
U.S.
Institute
of
Medicine
and
the
U.S.
Dietary
Guidelines
Committee,
have
moved
away
from
advocating
low
fat
intake
to
an
emphasis
on
the
type
of
fat.
Many
lines
of
evidence
indicate
that
the
type
of
fat
is
very
important
to
long-term
health.
Replacing
saturated
and
trans
with
natural
vegetable
oils
can
greatly
reduce
the
risk
of
heart
disease
and
diabetes.
In
the
Nurses'
Health
Study
II
we
have
seen
that
women
who
consume
high
amounts
of
red
meat
and
high-fat
dairy
foods
during
their
early
adult
years
are
at
increased
risk
of
developing
breast
cancer.
Making
good
dietary
choices
does
really
matter,
but
it
is
the
type
of
fat,
not
the
amount,
that
is
most
important.
And
keep
in
mind
that
too
many
calories
from
both
fat
and
carbohydrate
will
lead
to
weight
gain,
which
will
increase
risks
of
breast
cancer,
colon
cancer,
and
heart
disease.
References
1. Prentice RL, Caan B, Chlebowski RT, et al. Low-fat dietary pattern and risk of invasive breast cancer: the Women's Health Initiative Randomized Controlled Dietary Modification Trial. JAMA. 2006; 295:629-42. 2. Beresford SA, Johnson KC, Ritenbaugh C, et al. Low-fat dietary pattern and risk of colorectal cancer: the Women's Health Initiative Randomized Controlled Dietary Modification Trial. JAMA. 2006; 295:643-54.
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3. Howard BV, Van Horn L, Hsia J, et al. Low-fat dietary pattern and risk of cardiovascular disease: the Women's Health Initiative Randomized Controlled Dietary Modification Trial. JAMA. 2006; 295:655-66. 4. Howard BV, Manson JE, Stefanick ML, et al. Low-fat dietary pattern and weight change over 7 years: the Women's Health Initiative Dietary Modification Trial. JAMA. 2006; 295:39-49. 5. Michels KB, Willett WC. The women's health initiative: will it resolve the issues? Recent Results in Cancer Research. 1996; 140:295-305. 6. Prentice RL, Sheppard L. Dietary fat and cancer: consistency of the epidemiologic data, and disease prevention that may follow from a practical reduction in fat consumption. Cancer Causes and Control. 1990; 1:81-97; discussion 99-109. 7. Prentice RL, Sheppard L. Dietary fat and cancer: rejoinder and discussion of research strategies. Cancer Causes and Control. 1991; 2:53-8. 8. Willett WC, Stampfer MJ. Dietary fat and cancer: another view? Cancer Causes and Control. 1990; 1:103-109. 9. Multiple risk factor intervention trial. Risk factor changes and mortality results. Multiple Risk Factor Intervention Trial Research Group. JAMA. 1982; 248:1465-77. 10. Willett W. Nutritional epidemiology. New York: Oxford University Press, 1998.
Source:
Low-Fat
Diet
Not
a
Cure-All.
The
Nutrition
Source.
Harvard
School
of
Public
Health.
Web.
March
2012.
http://www.hsph.harvard.edu/nutritionsource/nutrition-news/low-fat/
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13
Using
the
Critical
Questions
Tool:
Example
2
Article
or
media
piece:
Low-Fat Diet Not a Cure-All (from The Harvard school of Public Health Nutrition Source) 1. What
is
the
message
recommending
or
promoting?
Recommendations: Pay attention to type of fat consumed (it is more important than amount) Replace saturated and trans-fat with natural vegetable oils Avoid red meat and dairy foods Keep in mind that calories will lead to weight gain, which will increase risks of breast cancer and colon cancer
2. What
problem
is
this
recommendation
intended
to
solve?
Is
it,
in
your
opinion,
an
important
problem?
Chronic diseases like heart disease and cancer What to make of the surprising NHS findings I think both of these problems are worthwhileheart disease and cancer are serious diseases, and we should certainly try to understand why the NHS findings turned out as they did.
3. What
questions
are
being
asked
about
this
problem
(by
the
author,
or
in
the
research
cited)?
What
questions
are
not
being
asked?
The authors were mostly focused on why the NHS findings contradicted expectations. Specifically, the article asks: 1. Did women in the low-fat group not lower their fat intake enough? 2. Did study participants not report their consumption of fat accurately? 3. Was the study focused on a population too old for dietary changes to make a significant difference to their health? 4. Did the study not last long enough for us to see results? 5. Was it too difficult to maintain a contrast in diets between the two groups over many years? It is notable that all these questions relate to study methodology as opposed to the studys central hypothesis! Authors do not ask if researchers were asking the wrong question, if perhaps fat alone is not responsible for disease outcomes
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(that is, they do not look at the larger dietary context), or if perhaps neither group of women was consuming a diet likely to protect against cancer.
4. What
kinds
of
evidence
are
being
used
to
answer
these
questions?
How
does
it
relate
to
other
evidence
on
this
topic,
if
you
know?
The article merely comments that some nutritionists are asking question no. 1. It gives a little more explanation about questions 3 and 4. It looks in slightly more detail at question 2 by citing a previous study wherein subjects self-reports didnt match biomedical measures. For question 5, it suggests that researchers in a previous study believed subjects werent able to maintain dietary differences over many years. However, authors mainly seem to be saying all these questions could be correctthey dont really answer any of them. They dont examine any studies that look at the impact of the total diet on cancer (e.g., The China Project). 5. What
kinds
of
assumptions
are
being
made
about
the
problem?
(An
assumption
is
a
belief
that
may
be
unstated
or
taken
for
granted
without
evidence.)
They assume that fat alone might be responsible for cancer and heart disease (not diet in the larger sense). They assume study methodology is at fault, not study design (i.e., investigating the impact of a single nutrient). They also assume a study on Western subjects can provide us with enough data to draw meaningful conclusions.
6. What
can
you
tell
about
the
authors
approach
to
nutrition
science?
What
might
be
missing?
These authors do seem to assume or believe that science is best practiced when researchers examine the impact of single nutrients on disease. They do not seem to see disease formation as multi-mechanistic, nor to be examining the big picture, including the full complement of nutrient intakes.
7. Are
conclusions
well
reasoned
and
warranted
by
the
evidence?
Explain.
At the end of the article, the writers seem to give up on trying to explain the NHS findings, and suddenly conclude that it must be the type of fat that matters, not the amount of fat. They suggest this is so because we know that replacing saturated and trans fats with vegetable oils can reduce the risk of heart disease and diabetes; they also comment that the Nurses Health Study II
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15
showed that women who consume lots of red meat and high-fat dairy foods during early adult years are more at risk for breast cancer. In addition, they comment that too many calories from carbohydrates can cause weight gain and cancer/heart disease. In a way, these conclusions are reasonable, as far as they go. They do pull in information from other studies. But they arent putting the big picture together, in which the NHS findings AND the other data they cite would make sense without our assuming major flaws in NHS methodology. They arent going far enough. 8. What might be some important consequences of accepting these conclusions (for society, the environment, etc.)? If we accept these conclusions, its likely well go on trying to reduce fat consumption (but not consumption of animal products), and perhaps even try to reduce the consumption of carbohydrates to some extent (perhaps embracing the low-carb philosophy in part?). We would certainly go on counting calories and worrying about fat, and possibly trying to change the specific types of fat we eat. Traditional dieting would continue.
For individual student use only: please do not copy or distribute. 2012, T. Colin Campbell Foundation and TILS
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