good news about bad habits

[Guest guest]

I like McDougall's newsletter because he

frequently does articles like this -- summaries

and critiques of articles recently published in

the medical and nutrition journals. If these

articles get mentioned at all in the popular

press, usually the reporting is noncritical and

tends to tell readers what they want to hear,

which only confuses them (because it appears to

contradict that other study from a month or a

year ago).

 

For instance, I was suspicious of the Gardner

study comparing Atkins, Zone, Ornish, and LEARN

diets, because the local paper's headline said

weight loss was greatest on Atkins, which I know

is a fad diet and a nutritional trainwreck. But I

learned from McDougall's gloss that the main

problem with the study is that subjects did not

in fact follow the diets, with the " Ornish " group

logging 29 percent fat (the Ornish diet is 10

percent fat). I also learned that the actual

amount of weight lost on any of these " diets " was

an unimpressive 3-10 pounds over a year.

 

 

 

http://www.drmcdougall.com/misc/2007nl/mar/defend.htm

 

Defending the McDougall Diet-If I Must

 

Headlines are made worldwide when a study is

published that suggests people can continue to

indulge in lobster drawn in butter, bloody-raw

tri-tip beefsteaks, and crispy fried cheese. How

can a single study be so convincing? The answer

is simple: People love to hear good news about

their bad habits. " Now I don't have to eat more

vegetables. "

 

Those of us who follow a healthy diet and have

experienced the benefits know the truth. What is

disturbing to me, and must be to you, is how

intelligent researchers can come to conclusions

so contrary to ours. Money is at the root of

many of these studies, but often there is no

apparent financial conflict of interest. The

dinner table is a common source of confusion.

Even the most honest scientific researchers are

befuddled when in their right hand they hold a

forkful of bacon and eggs and in their left hand

they hold a study saying heart disease is caused

by eating foods high in cholesterol and fat.

Subconsciously, their right to gluttonous eating

is defended at all costs-even in the design and

interpretation of their research. From

experience, most of us know how threatened people

become over a vegetarian (vegan) diet.

 

So how do I really feel about research appearing

as national headlines that contradicts my beliefs

and findings? I love it! Finally, these subjects

are being discussed. Throughout my career, my

enemy has been being ignored. I have been

silenced by shunning. Now, attention given to

these matters of human nutrition will bring the

facts to light and they can be debated.

Eventually, the truth will be known and commonly

practiced.

 

In the past few weeks three headline-grabbers

have gained worldwide attention. Each one

deserves consideration, but their overall

findings do not change the bulk of the scientific

research, common sense, and what I have taught

for the past four decades. Allow me to explain

these studies and give you my viewpoint.

 

Vegans Have More Fractures

 

Comparative fracture risk in vegetarians and

nonvegetarians in EPIC-Oxford by Paul N Appleby

published in the European Journal of Clinical

Nutrition found a 30% increased risk of fractures

in vegans compared to people following other

diets and concluded, " In this population,

fracture risk was similar for meat eaters, fish

eaters and vegetarians. The higher fracture risk

in the vegans appeared to be a consequence of

their considerably lower mean calcium intake. " 1

 

Meat eaters were the fattest (the highest mean

BMI) and tended to be the least active group,

with vegans having the lowest mean BMI and

reported the highest levels of walking, cycling

and vigorous exercise. The causes of the

fractures for all groups were falls, traffic

accidents, other accidents, and unspecified or

multiple causes. More than 70% of the fractures

were caused by a fall. The most common fracture

sites were wrist/arm and ankle. Current use of

hormones (HRT) was highest in the female meat

eaters. The difference in age between the meat

eaters and vegans was nearly 11 years, with the

vegans younger.

 

For vegan subjects who consumed at least

525 mg/day calcium, there was no increase in

fractures rates. As a result, the authors

suggested vegans should consume for extra calcium

more almonds, sesame seeds, tahini (sesame

paste), calcium-set tofu, calcium-fortified

drinks and low-oxalate leafy green vegetables,

such as kale.

 

Additional Information directly from the authors:

 

I communicated with one of the lead authors, Tim

Key, about this well-publicized study.

 

Dear Dr. McDougall,

 

Thank you for your e-mail and interest in our

recent paper. Paul (Appleby) and I have just

discussed your questions. As you point out, the

optimal intake of calcium for preventing

fractures has been controversial and the evidence

is somewhat conflicting. In our data, the only

nutrient clearly associated with fracture risk is

calcium, with a high risk among people with an

intake below the UK EAR of 525 mg/d. In the

current paper, the vegans eating at least 525

mg/d of calcium did not have an increase in

fracture risk (risk ratio 1.00). The calcium

comes from a range of foods and it is hard to

single out any particular foods as the major

sources for vegans (in contrast to non-vegans

where dairy products are the major source). We

don't think that our results should be taken as

an argument to eat dairy products; simply that

vegans do need to eat enough calcium. Would you

agree with the UK EAR of 525 mg/d as a reasonable

minimum?

 

With best wishes, Tim Key

 

In another communication, Mr. Key felt his

research methods accounted for the differences in

age, HRT use, and activity. He wrote, " The fact

that we saw no increase in fracture risk in

vegans with calcium of at least 525 suggests that

this is likely to be the explanation for the

overall findings¾For physical activity the

measurements are not as good, and vegans did

report more activity which increases the risk for

accidents, but we have adjusted for this as well

as we can. "

 

I asked Mr. Key, " In general, how do you explain

your findings in face of world population data

showing populations worldwide with the lowest

calcium intakes have the fewest fractures - and

the exact opposite results for protein?2,3 His

answer was, " As you know this is complex and

controversial. The ecological comparisons need

to consider other factors too, like vitamin D,

height, weight, environment, completeness of

statistics, and weight-bearing physical activity. "

 

Comments:

 

The reason I believe this study found more

fractures in the vegan group is these healthier,

younger people were far more active and as a

result sustained more injuries. Their increased

physical activity leading to more fractures is

noted by the fact that they were on average 11

years younger, were less fat (lower BMI), and

were reported to walk, cycle and do other

vigorous activities more than the meat, fish, and

dairy groups.

 

The most serious kind of fracture caused by weak

bones (osteoporosis) is a broken hip. In this

study the vegans had no hip fractures, compared

to 30 in the meat eaters, 9 in the fish eaters,

and 14 in the vegetarians (dairy). The

observation that the fractures were of the wrist,

arm, and ankle, and not the hip, to me, means the

fractures were due to trauma caused by physical

activity and not due to weakened bones.

 

The average intake of calcium for the vegans was

603 mg/day for men and 586 mg/day for women-these

levels exceeded those intakes of populations

where osteoporosis is rare to unknown-like in

rural Asian and African populations where intakes

are commonly 400 to 500 mg daily. 2,3 Since the

vegans frequently participated in outdoor

activities it is highly unlikely they had any

deficiency of vitamin D-made from sunlight.

 

The conclusion of this study that the lack of

calcium was the reason for the increased

fractures in the vegans is in direct conflict

with the bulk of the scientific research.4 For

example, results of two excellent studies

reported in 2006 in leading medical journals

found no reduction in fractures following the use

of large doses of calcium supplements.5,6 In the

Women's Health Initiative study of 36,282

postmenopausal women taking 1000 mg of calcium

daily, and in a double-blind, placebo-controlled

study of elderly women receiving an extra 1200 mg

of calcium daily, fractures were not prevented by

even these extraordinary intakes.

 

In contrast to these studies, and most others, on

the lack of influence of calcium intake on

fracture risk, the authors of this study conclude

calcium is the problem and this is based on

findings in only 74 people with fractures

following a vegan diet. You should be asking, how

could such meager and contradictory evidence be

so influential? Answer: People love to hear good

news about their bad habits.

 

1) Appleby P, Roddam A, Allen N, Key T.

Comparative fracture risk in vegetarians and

nonvegetarians in EPIC-Oxford. Eur J Clin Nutr.

2007 Feb 7; [Epub ahead of print]

 

2) Abelow B. Cross-cultural association between

dietary animal protein and hip fracture: a

hypothesis. Calcific Tissue Int 50:14-8, 1992.

 

3) Frassetto LA . Worldwide incidence of hip

fracture in elderly women: relation to

consumption of animal and vegetable foods. J

Gerontol A Biol Sci Med Sci. 2000

Oct;55(10):M585-92.

 

4) Lanou AJ. Bone health in children. BMJ. 2006 Oct 14;333(7572):763-4.

 

5) Wactawski-Wende J, Kotchen JM, Anderson GL,

Assaf AR, Brunner RL, O'Sullivan MJ, Margolis KL,

et al. Calcium plus vitamin D supplementation

and the risk of fractures. N Engl J Med. 2006 Feb

16;354(7):669-83.

 

6) Prince RL, Devine A, Dhaliwal SS, Dick IM.

Effects of calcium supplementation on clinical

fracture and bone structure: results of a 5-year,

double-blind, placebo-controlled trial in elderly

women. Arch Intern Med. 2006 Apr 24;166(8):869-75.

 

Atkins Is Better Than Ornish, Stanford Study Says

 

Comparison of the Atkins, Zone, Ornish, and LEARN

diets for change in weight and related risk

factors among overweight premenopausal women: the

A TO Z* Weight Loss Study: a randomized trial by

Christopher Gardner in the March 7, 2007 issue of

the Journal of the American Medical Association

found, 'In this study, premenopausal overweight

and obese women assigned to follow the Atkins

diet, which had the lowest carbohydrate intake,

lost more weight and experienced more favorable

overall metabolic effects at 12 months than women

assigned to follow the Zone, Ornish, or LEARN

diets.1 While questions remain about long-term

effects and mechanisms, a low-carbohydrate,

high-protein, high-fat diet may be considered a

feasible alternative recommendation for weight

loss. "

 

*The " A to Z " stands for the four diets

investigated: Atkins, Traditional (LEARN),

Ornish, and Zone.

 

This twelve-month randomized trial was conducted

in the United States from February 2003 to

October 2005 among 311 free-living, overweight or

obese, nondiabetic, premenopausal women, who were

divided into four equal groups. Participants were

recruited from the community by media (like the

newspaper) advertisements. They were given one

of four books: Dr. Atkins' Diet Revolution,

Enter the Zone, The LEARN Manual for Weight

Management, Eat More, Weigh Less. Each group

attended a one hour weekly class headed by a

dietitian for eight weeks. The Zone and the

LEARN diets had specific goals for calorie

restriction, while the Atkins and Ornish groups

had no specific energy restriction goals. The

weight losses after one year were Atkins 10.3

pounds (-4.7 kg), Zone 3.5 pounds (-1.6 kg),

LEARN 5.7 pounds (-2.6 kg), and Ornish 4.8 pounds

(-2.2 kg). For me, a 3 to 10 pound weight loss

for overweight and obese women after a year of

dieting is not very impressive.

 

Comments:

 

Twenty-four years ago, when I started

windsurfing, 500,000 more people worldwide were

sailors than there are today. Why is the

popularity of this sport falling when it provides

an unsurpassed adrenaline rush of traveling 32

miles per hour across the water's surface while

standing on a two-inch thick foam board? The

answer is: the learning curve is huge. I

remember how it took me six agonizing days before

I got my first ride. Once past the difficulty of

learning days, windsurfing has meant 24 years of

fun and great exercise for me.

 

Whether or not someone follows a diet depends

upon how easy it is to learn. The Atkins Diet is

the easiest to follow-you simply drive by a fast

food window, order a burger, throw away the bun,

and scrape off the pickles and ketchup, and

you're on the diet. The Ornish (like the

McDougall Diet) is much harder to learn. The

foods are unfamiliar. They can take time and

effort to prepare. The social stigma associated

with being a vegetarian is daunting. With such a

steep learning curve few people succeed. This

conclusion is substantiated by the observation

that at 12 months the group on the Ornish diet (a

diet of 10% of the calories as fat) was actually

consuming 29.8% fat.

 

So what this study really means is changing

eating habits is difficult and the majority of

people are unwilling or unable to make meaningful

dietary changes for any length of time. We need

no more studies like this one to remind us of the

fact that " diets fail " for most people-but not

for everyone. How about for those people who have

gotten past the learning phase and adopted a diet

for a lifetime? I, for example, have discovered

that a healthy plant-food based diet is the most

delicious and the healthiest way to eat (kind of

like windsurfing is a really fun exercise).

 

Studies of successful dieters needed

 

What we now need are studies that look at the

long-term results for people who do follow

various diets. (It may be difficult to find

people who follow low carbohydrate diets

long-term. Atkins, himself, could not follow his

own recommendations-when he died he was reported

to be obese with heart and artery disease.2)

 

The first place food affects the body is the

bowels. Future investigations need to report the

results of the effects of a McDougall-Ornish type

diet and the Atkins Diet on bowel movements. In

his own research Robert Atkins reported 70% of

people following his diet are constipated.3

Anyone following the McDougall Diet knows the

effects on bowel movements (often 3 times daily,

easy to pass, and large).

 

Next investigators should look at calcium balance

and see what happens to the bones on these

high-protein, high-acid diets, like Atkins, the

Zone, and South Beach. As a first phase, this

can be simply done by measuring the amount of

calcium excreted in the urine over 24 hours.

Research consistently shows that a decrease in

animal protein decreases loss of calcium from the

bones into the urine.4 Next biochemical markers

of bone turnover can be measured in the urine.

These reflect the rate at which bone material is

being lost. High protein diets have been shown

to increase bone turnover based on these markers.5

 

Decreases in blood sugar, cholesterol, and

triglycerides have been found with the Atkins

Diet, but these changes are a result of

suppression of appetite, followed by

semi-starvation, which are the underlying

mechanisms of this ketogenic diet. Similar blood

chemistry results can be accomplished by giving

patients cancer chemotherapy, which causes them

to lose their appetite and starve-the same as the

Atkins Diet.6

 

Rather than checking risk factors, like

cholesterol and triglycerides, more direct

measurements of the effect of diet on the heart

and blood vessels needs to be made. For example,

a relevant measure would be the compliance of the

artery walls, which is determined by ultrasound

measurements over the ascending aorta (the large

artery leading from the heart) and the right

carotid artery (neck). Previous results show a

27% decrease in arterial compliance after a

single meal consisting of 67% of the calories as

fat.7 Reduction in blood flow in the heart

arteries is also seen after one high-fat meal by

use of a PET scan.8 Immediate effects of a

single high-fat meal can be seen by a visual

examination of the eye (conjunctival capillaries)

and the oxygen content of the arterial blood.

Research has shown that a diet high in fat (67%

of the calories) fed to people causes the

circulation in the eye to visually sludge, along

with a decrease in the oxygen content of the

blood by 20%.9,10

 

Long-term effects on the heart arteries would

require months and years to assess. Reversal of

atherosclerosis has been demonstrated by

angiograms and PET scans after following the

Ornish Diet for 12 months and longer.11 The only

study of patients on the Atkins Diet has shown a

worsening of blood flow at one year from all that

saturated fat and cholesterol with an overall

cumulative progression of artery disease

(atherosclerosis) of 39.7%.12

 

I believe the trend has shifted away from the

popularity of high-protein diets of the 90s and

the first half of this decade. People have tried

to lose weight eating all meat and cheese-they

felt sick and were constipated, and their weight

loss was temporary and trivial. In addition, we

are learning that one of the planet's greatest

sources of pollution is livestock-so even if

these high animal-food diets were good for

humans-and they are not-they are undeniably

killing our planet.

 

1) Christopher D. Gardner; Alexandre Kiazand;

Sofiya Alhassan; Soowon Kim; Randall S. Stafford;

Raymond R. Balise; Helena C. Kraemer; Abby C.

King. Comparison of the Atkins, Zone, Ornish, and

LEARN Diets for Change in Weight and Related Risk

Factors Among Overweight Premenopausal Women: The

A TO Z Weight Loss Study: A Randomized Trial.

JAMA. 2007;297:969-977.

 

2) McDougall Newsletter. Atkins Was Grossly

Overweight and Sick- But the Media Loves the Dead

Guy. February 2004.

 

3) Yancy WS Jr, Olsen MK, Guyton JR, Bakst RP,

Westman EC. A Low-Carbohydrate, Ketogenic Diet

versus a Low-Fat Diet To Treat Obesity and

Hyperlipidemia: A Randomized, Controlled Trial.

Ann Intern Med. 2004 May 18;140(10):769-777.

 

4) Giannini S, Nobile M, Sartori L, Dalle

Carbonare L, Ciuffreda M, Corro P, D'Angelo A,

Calo L, Crepaldi G. Acute effects of moderate

dietary protein restriction in patients with

idiopathic hypercalciuria and calcium

nephrolithiasis. Am J Clin Nutr. 1999

Feb;69(2):267-71.

 

5) Harrington M, Bennett T, Jakobsen J, Ovesen

L, Brot C, Flynn A, Cashman KD. The effect of a

high-protein, high-sodium diet on calcium and

bone metabolism in postmenopausal women and its

interaction with vitamin D receptor genotype. Br

J Nutr. 2004 Jan;91(1):41-51.

 

6) McDougall Newsletter. Proof that the Atkins Diet Works Like Chemotherapy

By Sickness-Induced Starvation. September 2003.

 

7) Nestel P. Post-prandial remnant lipids impair

arterial compliance. J Am Coll Cardiol

37:1929-35, 2001.

 

8) Cook B, Cooper D, Fitzpatrick D, Smith S,

Tierney D, Mehy S. The Influence of a High Fat

Meal Compared to an Olestra Meal on Coronary

Artery Endothelial Dysfunction by Rubidium

(Rb)-82 Positron Emission Tomography (PET) and on

Post Prandial Serum Triglycerides. Clin Positron

Imaging. 2000 Jul;3(4):150.

 

9) Friedman M. Serum Lipids and conjunctival

circulation after fat ingestion in men exhibiting

type-A behavior pattern. Circulation 29:874,

1964.

 

10) Kuo P. The effect of lipemia upon coronary

and peripheral arterial circulation in patients

with essential hyperlipemia. Am J Med 26:68,

1959.

 

11) Ornish D, Scherwitz LW, Billings JH, Brown

SE, Gould KL, Merritt TA, Sparler S, Armstrong

WT, Intensive lifestyle changes for reversal of

coronary heart disease.

JAMA. 1998 Dec 16;280(23):2001-7.

 

12) Fleming RM. The effect of high-protein

diets on coronary blood flow. Angiology. 2000

Oct;51(10):817-26.

 

Fish Is Now Health Food for Pregnant Women

 

Maternal seafood consumption in pregnancy and

neurodevelopmental outcomes in childhood (ALSPAC

study): an observational cohort study by Joseph

R. Hibbeln in the February 17, 2007 issue of the

Lancet reported, " Maternal seafood consumption of

less than 340 g per week in pregnancy did not

protect children from adverse outcomes; rather,

we recorded beneficial effects on child

development with maternal seafood intakes of more

than 340 g per week, suggesting that advice to

limit seafood consumption could actually be

detrimental. These results show that risks from

the loss of nutrients were greater than the risks

of harm from exposure to trace contaminants in

340 g seafood eaten weekly. "

 

The study examined 11,875 pregnant women living

in Bristol, UK, who completed a food frequency

questionnaire assessing seafood consumption at 32

weeks gestation. Outcomes of the children from

age 6 months to 8 years were reported in women

consuming none, some (1-340 g per week), and >340

g per week.

 

This study reported that the women in the high

seafood group compared to the low seafood group

were: more likely to breast feed (87% vs. 72%),

have higher incomes (49% vs. 30%), own their

homes (87% vs. 70%), and be non smokers (77% vs.

61%). All these factors tell about a better

educated, more successful group of people who

have come to believe through instructive messages

that eating fish is healthful. These same

advantaged people rear children with measurably

better development compared to the children of

disadvantaged people.

 

Comments:

 

There are no greater emotional issues than the

unborn and children; not surprisingly this

article received much attention in the press.

Unfortunately, the interpretation as reported in

national headlines was incorrect. This study

actually showed women who eat less fish have

lower incomes, less education, and more difficult

living conditions in general-and their offspring

suffer proportionally. During pregnancy, these

women also eat a less nutritious diet (more junk

and fewer plants). A study published in 1998 by

these same investigators of these same women

found, " Women with greater difficulty in

affording food had lower intakes of protein,

fibre, vitamin C, niacin, pyridoxine, iron, zinc,

magnesium and potassium than did women with

little or no difficulty. They were more likely to

use cooking and spreading fats with a high

saturates content, and less likely to eat fish,

fruit, vegetables and salad. " These

investigators took on an impossible task of

separating fish intake out from all the other

variables in these women's life and came to an

erroneous conclusion.

 

The primary explanation given in this study for

why women who ate fish had children with higher

levels of mental and emotional function was

because they received a higher quality of fat

before birth from their mothers eating more fish.

These omega-3 " good " fats are found in high

quantities in fatty fish. However, it is

important to understand that animal systems lack

the ability to synthesize omega-3 fats, thus fish

cannot make essential fats. Sea weeds and algae

synthesize these fats which are then stored in

the fish flesh; along with contaminants,

cholesterol, animal protein, and calories. The

human body has no difficulty converting

plant-derived omega-3 fat, alpha linolenic acid,

into DHA or other n-3 fatty acids, supplying our

needs even during gestation and infancy.3

 

Therefore, the wise consume will choose plant

foods as their source of essential fats and other

nutrients and avoid all the harmful ingredients

of animal products higher up on the food chain.

 

There are many adverse consequences from

consuming fish. The focus of recommendations by

two US government agencies-the US Department of

Health and Human services, and the US

Environmental Protection Agency-to limit fish

intake by pregnant women to less than 340 grams

(10 ounces) a week was based on contamination of

the fish with environmental chemicals, especially

methylmercury (a known neurotoxin).1 Fish also

causes a rise in blood cholesterol levels similar

to the rise caused by beef and pork.4 Their

highly-acidic animal proteins accelerate calcium

loss,5 contributing to osteoporosis and kidney

stones. No dietary fiber or digestible

carbohydrates are present in fish-thus having a

negative impact on bowel function and endurance.

Although omega-3 fats " thin " the blood,

preventing thrombus formation (heart attacks);

this same anticoagulant activity can increase the

risk of bleeding.6 These fats also have

antiinflammatory properties, which can be

beneficial (reducing arthritis pain) as well as

deleterious (causing immune suppression,

increasing the risk of cancer and infection).7

Fatty fish, commonly recommended salmon for

example, is half fat and loaded with calories,

adding to one's risk for developing obesity and

type-2 diabetes. Furthermore, omega-3 fats

inhibit the action of insulin, thereby increasing

blood sugar levels and aggravating diabetes.8

 

Finally, let's not forget the environmental

consequences of telling people they need to eat

more fish. Since I was a child (fifty years ago)

90% of the large fish that swam in the oceans

have been eaten-these big ones are the ones that

make little ones. Soon there will be no fish

left and then people will have to seek the truth

about where to obtain essential fats and other

nutrients for their health. They will discover

plants are the sources of these life-giving

substances. Unfortunately, by then, billions of

people will have suffered needlessly and damage

to the environment will be unrecoverable.

 

References:

 

1) Hibbeln JR, Davis JM, Steer C, Emmett P,

Rogers I, Williams C, Golding J. Maternal

seafood consumption in pregnancy and

neurodevelopmental outcomes in childhood (ALSPAC

study): an observational cohort study. Lancet.

2007 Feb 17;369(9561):578-85.

 

2) Rogers I, Emmett P, Baker D, Golding J.

Financial difficulties, smoking habits,

composition of the diet and birthweight in a

population of pregnant women in the South West of

England. ALSPAC Study Team. Avon Longitudinal

Study of Pregnancy and Childhood. Eur J Clin

Nutr. 1998 Apr;52(4):251-60.

 

3) ) Langdon JH. Has an aquatic diet been

necessary for hominin brain evolution and

functional development? Br J Nutr. 2006

Jul;96(1):7-17.

 

4) Davidson MH, Hunninghake D, Maki KC,

Kwiterovich PO Jr, Kafonek S. Comparison of the

effects of lean red meat vs lean white meat on

serum lipid levels among free-living persons with

hypercholesterolemia: a long-term, randomized

clinical trial. Arch Intern Med. 1999 Jun

28;159(12):1331-8.

 

5) Robertson WG, Heyburn PJ, Peacock M, Hanes

FA, Swaminathan R. The effect of high animal

protein intake on the risk of calcium

stone-formation in the urinary tract. Clin Sci

(Lond). 1979 Sep;57(3):285-8.

 

6) Dyerberg J, Bang HO. Haemostatic function and

platelet polyunsaturated fatty acids in Eskimos.

Lancet. 1979 Sep 1;2(8140):433-5.

 

7) Meydani SN, Lichtenstein AH, Cornwall S,

Meydani M, Goldin BR, Rasmussen H, Dinarello CA,

Schaefer EJ. Immunologic effects of national

cholesterol education panel step-2 diets with and

without fish-derived N-3 fatty acid enrichment. J

Clin Invest. 1993 Jul;92(1):105-13.

 

8) Hendra TJ, Britton ME, Roper DR, et al.

Effects of fish oil supplements in NIDDM

subjects. Controlled study. Diabetes Care. 1990

Aug;13(8):821-9.

 

 

2007 John McDougall

[Guest guest]

Didn't he used to post his newsletters here at one time?

 

Jo

 

, yarrow wrote:

>

> I like McDougall's newsletter because he

> frequently does articles like this -- summaries

> and critiques of articles recently published in

> the medical and nutrition journals. If these

> articles get mentioned at all in the popular

> press, usually the reporting is noncritical and

> tends to tell readers what they want to hear,

> which only confuses them (because it appears to

> contradict that other study from a month or a

> year ago).

>

> For instance, I was suspicious of the Gardner

> study comparing Atkins, Zone, Ornish, and LEARN

> diets, because the local paper's headline said

> weight loss was greatest on Atkins, which I know

> is a fad diet and a nutritional trainwreck. But I

> learned from McDougall's gloss that the main

> problem with the study is that subjects did not

> in fact follow the diets, with the " Ornish " group

> logging 29 percent fat (the Ornish diet is 10

> percent fat). I also learned that the actual

> amount of weight lost on any of these " diets " was

> an unimpressive 3-10 pounds over a year.

>

>

>

> http://www.drmcdougall.com/misc/2007nl/mar/defend.htm

>

> Defending the McDougall Diet-If I Must

>

> Headlines are made worldwide when a study is

> published that suggests people can continue to

> indulge in lobster drawn in butter, bloody-raw

> tri-tip beefsteaks, and crispy fried cheese. How

> can a single study be so convincing? The answer

> is simple: People love to hear good news about

> their bad habits. " Now I don't have to eat more

> vegetables. "

>

> Those of us who follow a healthy diet and have

> experienced the benefits know the truth. What is

> disturbing to me, and must be to you, is how

> intelligent researchers can come to conclusions

> so contrary to ours. Money is at the root of

> many of these studies, but often there is no

> apparent financial conflict of interest. The

> dinner table is a common source of confusion.

> Even the most honest scientific researchers are

> befuddled when in their right hand they hold a

> forkful of bacon and eggs and in their left hand

> they hold a study saying heart disease is caused

> by eating foods high in cholesterol and fat.

> Subconsciously, their right to gluttonous eating

> is defended at all costs-even in the design and

> interpretation of their research. From

> experience, most of us know how threatened people

> become over a vegetarian (vegan) diet.

>

> So how do I really feel about research appearing

> as national headlines that contradicts my beliefs

> and findings? I love it! Finally, these subjects

> are being discussed. Throughout my career, my

> enemy has been being ignored. I have been

> silenced by shunning. Now, attention given to

> these matters of human nutrition will bring the

> facts to light and they can be debated.

> Eventually, the truth will be known and commonly

> practiced.

>

> In the past few weeks three headline-grabbers

> have gained worldwide attention. Each one

> deserves consideration, but their overall

> findings do not change the bulk of the scientific

> research, common sense, and what I have taught

> for the past four decades. Allow me to explain

> these studies and give you my viewpoint.

>

> Vegans Have More Fractures

>

> Comparative fracture risk in vegetarians and

> nonvegetarians in EPIC-Oxford by Paul N Appleby

> published in the European Journal of Clinical

> Nutrition found a 30% increased risk of fractures

> in vegans compared to people following other

> diets and concluded, " In this population,

> fracture risk was similar for meat eaters, fish

> eaters and vegetarians. The higher fracture risk

> in the vegans appeared to be a consequence of

> their considerably lower mean calcium intake. " 1

>

> Meat eaters were the fattest (the highest mean

> BMI) and tended to be the least active group,

> with vegans having the lowest mean BMI and

> reported the highest levels of walking, cycling

> and vigorous exercise. The causes of the

> fractures for all groups were falls, traffic

> accidents, other accidents, and unspecified or

> multiple causes. More than 70% of the fractures

> were caused by a fall. The most common fracture

> sites were wrist/arm and ankle. Current use of

> hormones (HRT) was highest in the female meat

> eaters. The difference in age between the meat

> eaters and vegans was nearly 11 years, with the

> vegans younger.

>

> For vegan subjects who consumed at least

> 525 mg/day calcium, there was no increase in

> fractures rates. As a result, the authors

> suggested vegans should consume for extra calcium

> more almonds, sesame seeds, tahini (sesame

> paste), calcium-set tofu, calcium-fortified

> drinks and low-oxalate leafy green vegetables,

> such as kale.

>

> Additional Information directly from the authors:

>

> I communicated with one of the lead authors, Tim

> Key, about this well-publicized study.

>

> Dear Dr. McDougall,

>

> Thank you for your e-mail and interest in our

> recent paper. Paul (Appleby) and I have just

> discussed your questions. As you point out, the

> optimal intake of calcium for preventing

> fractures has been controversial and the evidence

> is somewhat conflicting. In our data, the only

> nutrient clearly associated with fracture risk is

> calcium, with a high risk among people with an

> intake below the UK EAR of 525 mg/d. In the

> current paper, the vegans eating at least 525

> mg/d of calcium did not have an increase in

> fracture risk (risk ratio 1.00). The calcium

> comes from a range of foods and it is hard to

> single out any particular foods as the major

> sources for vegans (in contrast to non-vegans

> where dairy products are the major source). We

> don't think that our results should be taken as

> an argument to eat dairy products; simply that

> vegans do need to eat enough calcium. Would you

> agree with the UK EAR of 525 mg/d as a reasonable

> minimum?

>

> With best wishes, Tim Key

>

> In another communication, Mr. Key felt his

> research methods accounted for the differences in

> age, HRT use, and activity. He wrote, " The fact

> that we saw no increase in fracture risk in

> vegans with calcium of at least 525 suggests that

> this is likely to be the explanation for the

> overall findings¾For physical activity the

> measurements are not as good, and vegans did

> report more activity which increases the risk for

> accidents, but we have adjusted for this as well

> as we can. "

>

> I asked Mr. Key, " In general, how do you explain

> your findings in face of world population data

> showing populations worldwide with the lowest

> calcium intakes have the fewest fractures - and

> the exact opposite results for protein?2,3 His

> answer was, " As you know this is complex and

> controversial. The ecological comparisons need

> to consider other factors too, like vitamin D,

> height, weight, environment, completeness of

> statistics, and weight-bearing physical activity. "

>

> Comments:

>

> The reason I believe this study found more

> fractures in the vegan group is these healthier,

> younger people were far more active and as a

> result sustained more injuries. Their increased

> physical activity leading to more fractures is

> noted by the fact that they were on average 11

> years younger, were less fat (lower BMI), and

> were reported to walk, cycle and do other

> vigorous activities more than the meat, fish, and

> dairy groups.

>

> The most serious kind of fracture caused by weak

> bones (osteoporosis) is a broken hip. In this

> study the vegans had no hip fractures, compared

> to 30 in the meat eaters, 9 in the fish eaters,

> and 14 in the vegetarians (dairy). The

> observation that the fractures were of the wrist,

> arm, and ankle, and not the hip, to me, means the

> fractures were due to trauma caused by physical

> activity and not due to weakened bones.

>

> The average intake of calcium for the vegans was

> 603 mg/day for men and 586 mg/day for women-these

> levels exceeded those intakes of populations

> where osteoporosis is rare to unknown-like in

> rural Asian and African populations where intakes

> are commonly 400 to 500 mg daily. 2,3 Since the

> vegans frequently participated in outdoor

> activities it is highly unlikely they had any

> deficiency of vitamin D-made from sunlight.

>

> The conclusion of this study that the lack of

> calcium was the reason for the increased

> fractures in the vegans is in direct conflict

> with the bulk of the scientific research.4 For

> example, results of two excellent studies

> reported in 2006 in leading medical journals

> found no reduction in fractures following the use

> of large doses of calcium supplements.5,6 In the

> Women's Health Initiative study of 36,282

> postmenopausal women taking 1000 mg of calcium

> daily, and in a double-blind, placebo-controlled

> study of elderly women receiving an extra 1200 mg

> of calcium daily, fractures were not prevented by

> even these extraordinary intakes.

>

> In contrast to these studies, and most others, on

> the lack of influence of calcium intake on

> fracture risk, the authors of this study conclude

> calcium is the problem and this is based on

> findings in only 74 people with fractures

> following a vegan diet. You should be asking, how

> could such meager and contradictory evidence be

> so influential? Answer: People love to hear good

> news about their bad habits.

>

> 1) Appleby P, Roddam A, Allen N, Key T.

> Comparative fracture risk in vegetarians and

> nonvegetarians in EPIC-Oxford. Eur J Clin Nutr.

> 2007 Feb 7; [Epub ahead of print]

>

> 2) Abelow B. Cross-cultural association between

> dietary animal protein and hip fracture: a

> hypothesis. Calcific Tissue Int 50:14-8, 1992.

>

> 3) Frassetto LA . Worldwide incidence of hip

> fracture in elderly women: relation to

> consumption of animal and vegetable foods. J

> Gerontol A Biol Sci Med Sci. 2000

> Oct;55(10):M585-92.

>

> 4) Lanou AJ. Bone health in children. BMJ. 2006 Oct 14;333

(7572):763-4.

>

> 5) Wactawski-Wende J, Kotchen JM, Anderson GL,

> Assaf AR, Brunner RL, O'Sullivan MJ, Margolis KL,

> et al. Calcium plus vitamin D supplementation

> and the risk of fractures. N Engl J Med. 2006 Feb

> 16;354(7):669-83.

>

> 6) Prince RL, Devine A, Dhaliwal SS, Dick IM.

> Effects of calcium supplementation on clinical

> fracture and bone structure: results of a 5-year,

> double-blind, placebo-controlled trial in elderly

> women. Arch Intern Med. 2006 Apr 24;166(8):869-75.

>

> Atkins Is Better Than Ornish, Stanford Study Says

>

> Comparison of the Atkins, Zone, Ornish, and LEARN

> diets for change in weight and related risk

> factors among overweight premenopausal women: the

> A TO Z* Weight Loss Study: a randomized trial by

> Christopher Gardner in the March 7, 2007 issue of

> the Journal of the American Medical Association

> found, 'In this study, premenopausal overweight

> and obese women assigned to follow the Atkins

> diet, which had the lowest carbohydrate intake,

> lost more weight and experienced more favorable

> overall metabolic effects at 12 months than women

> assigned to follow the Zone, Ornish, or LEARN

> diets.1 While questions remain about long-term

> effects and mechanisms, a low-carbohydrate,

> high-protein, high-fat diet may be considered a

> feasible alternative recommendation for weight

> loss. "

>

> *The " A to Z " stands for the four diets

> investigated: Atkins, Traditional (LEARN),

> Ornish, and Zone.

>

> This twelve-month randomized trial was conducted

> in the United States from February 2003 to

> October 2005 among 311 free-living, overweight or

> obese, nondiabetic, premenopausal women, who were

> divided into four equal groups. Participants were

> recruited from the community by media (like the

> newspaper) advertisements. They were given one

> of four books: Dr. Atkins' Diet Revolution,

> Enter the Zone, The LEARN Manual for Weight

> Management, Eat More, Weigh Less. Each group

> attended a one hour weekly class headed by a

> dietitian for eight weeks. The Zone and the

> LEARN diets had specific goals for calorie

> restriction, while the Atkins and Ornish groups

> had no specific energy restriction goals. The

> weight losses after one year were Atkins 10.3

> pounds (-4.7 kg), Zone 3.5 pounds (-1.6 kg),

> LEARN 5.7 pounds (-2.6 kg), and Ornish 4.8 pounds

> (-2.2 kg). For me, a 3 to 10 pound weight loss

> for overweight and obese women after a year of

> dieting is not very impressive.

>

> Comments:

>

> Twenty-four years ago, when I started

> windsurfing, 500,000 more people worldwide were

> sailors than there are today. Why is the

> popularity of this sport falling when it provides

> an unsurpassed adrenaline rush of traveling 32

> miles per hour across the water's surface while

> standing on a two-inch thick foam board? The

> answer is: the learning curve is huge. I

> remember how it took me six agonizing days before

> I got my first ride. Once past the difficulty of

> learning days, windsurfing has meant 24 years of

> fun and great exercise for me.

>

> Whether or not someone follows a diet depends

> upon how easy it is to learn. The Atkins Diet is

> the easiest to follow-you simply drive by a fast

> food window, order a burger, throw away the bun,

> and scrape off the pickles and ketchup, and

> you're on the diet. The Ornish (like the

> McDougall Diet) is much harder to learn. The

> foods are unfamiliar. They can take time and

> effort to prepare. The social stigma associated

> with being a vegetarian is daunting. With such a

> steep learning curve few people succeed. This

> conclusion is substantiated by the observation

> that at 12 months the group on the Ornish diet (a

> diet of 10% of the calories as fat) was actually

> consuming 29.8% fat.

>

> So what this study really means is changing

> eating habits is difficult and the majority of

> people are unwilling or unable to make meaningful

> dietary changes for any length of time. We need

> no more studies like this one to remind us of the

> fact that " diets fail " for most people-but not

> for everyone. How about for those people who have

> gotten past the learning phase and adopted a diet

> for a lifetime? I, for example, have discovered

> that a healthy plant-food based diet is the most

> delicious and the healthiest way to eat (kind of

> like windsurfing is a really fun exercise).

>

> Studies of successful dieters needed

>

> What we now need are studies that look at the

> long-term results for people who do follow

> various diets. (It may be difficult to find

> people who follow low carbohydrate diets

> long-term. Atkins, himself, could not follow his

> own recommendations-when he died he was reported

> to be obese with heart and artery disease.2)

>

> The first place food affects the body is the

> bowels. Future investigations need to report the

> results of the effects of a McDougall-Ornish type

> diet and the Atkins Diet on bowel movements. In

> his own research Robert Atkins reported 70% of

> people following his diet are constipated.3

> Anyone following the McDougall Diet knows the

> effects on bowel movements (often 3 times daily,

> easy to pass, and large).

>

> Next investigators should look at calcium balance

> and see what happens to the bones on these

> high-protein, high-acid diets, like Atkins, the

> Zone, and South Beach. As a first phase, this

> can be simply done by measuring the amount of

> calcium excreted in the urine over 24 hours.

> Research consistently shows that a decrease in

> animal protein decreases loss of calcium from the

> bones into the urine.4 Next biochemical markers

> of bone turnover can be measured in the urine.

> These reflect the rate at which bone material is

> being lost. High protein diets have been shown

> to increase bone turnover based on these markers.5

>

> Decreases in blood sugar, cholesterol, and

> triglycerides have been found with the Atkins

> Diet, but these changes are a result of

> suppression of appetite, followed by

> semi-starvation, which are the underlying

> mechanisms of this ketogenic diet. Similar blood

> chemistry results can be accomplished by giving

> patients cancer chemotherapy, which causes them

> to lose their appetite and starve-the same as the

> Atkins Diet.6

>

> Rather than checking risk factors, like

> cholesterol and triglycerides, more direct

> measurements of the effect of diet on the heart

> and blood vessels needs to be made. For example,

> a relevant measure would be the compliance of the

> artery walls, which is determined by ultrasound

> measurements over the ascending aorta (the large

> artery leading from the heart) and the right

> carotid artery (neck). Previous results show a

> 27% decrease in arterial compliance after a

> single meal consisting of 67% of the calories as

> fat.7 Reduction in blood flow in the heart

> arteries is also seen after one high-fat meal by

> use of a PET scan.8 Immediate effects of a

> single high-fat meal can be seen by a visual

> examination of the eye (conjunctival capillaries)

> and the oxygen content of the arterial blood.

> Research has shown that a diet high in fat (67%

> of the calories) fed to people causes the

> circulation in the eye to visually sludge, along

> with a decrease in the oxygen content of the

> blood by 20%.9,10

>

> Long-term effects on the heart arteries would

> require months and years to assess. Reversal of

> atherosclerosis has been demonstrated by

> angiograms and PET scans after following the

> Ornish Diet for 12 months and longer.11 The only

> study of patients on the Atkins Diet has shown a

> worsening of blood flow at one year from all that

> saturated fat and cholesterol with an overall

> cumulative progression of artery disease

> (atherosclerosis) of 39.7%.12

>

> I believe the trend has shifted away from the

> popularity of high-protein diets of the 90s and

> the first half of this decade. People have tried

> to lose weight eating all meat and cheese-they

> felt sick and were constipated, and their weight

> loss was temporary and trivial. In addition, we

> are learning that one of the planet's greatest

> sources of pollution is livestock-so even if

> these high animal-food diets were good for

> humans-and they are not-they are undeniably

> killing our planet.

>

> 1) Christopher D. Gardner; Alexandre Kiazand;

> Sofiya Alhassan; Soowon Kim; Randall S. Stafford;

> Raymond R. Balise; Helena C. Kraemer; Abby C.

> King. Comparison of the Atkins, Zone, Ornish, and

> LEARN Diets for Change in Weight and Related Risk

> Factors Among Overweight Premenopausal Women: The

> A TO Z Weight Loss Study: A Randomized Trial.

> JAMA. 2007;297:969-977.

>

> 2) McDougall Newsletter. Atkins Was Grossly

> Overweight and Sick- But the Media Loves the Dead

> Guy. February 2004.

>

> 3) Yancy WS Jr, Olsen MK, Guyton JR, Bakst RP,

> Westman EC. A Low-Carbohydrate, Ketogenic Diet

> versus a Low-Fat Diet To Treat Obesity and

> Hyperlipidemia: A Randomized, Controlled Trial.

> Ann Intern Med. 2004 May 18;140(10):769-777.

>

> 4) Giannini S, Nobile M, Sartori L, Dalle

> Carbonare L, Ciuffreda M, Corro P, D'Angelo A,

> Calo L, Crepaldi G. Acute effects of moderate

> dietary protein restriction in patients with

> idiopathic hypercalciuria and calcium

> nephrolithiasis. Am J Clin Nutr. 1999

> Feb;69(2):267-71.

>

> 5) Harrington M, Bennett T, Jakobsen J, Ovesen

> L, Brot C, Flynn A, Cashman KD. The effect of a

> high-protein, high-sodium diet on calcium and

> bone metabolism in postmenopausal women and its

> interaction with vitamin D receptor genotype. Br

> J Nutr. 2004 Jan;91(1):41-51.

>

> 6) McDougall Newsletter. Proof that the Atkins Diet Works Like

Chemotherapy

> By Sickness-Induced Starvation. September 2003.

>

> 7) Nestel P. Post-prandial remnant lipids impair

> arterial compliance. J Am Coll Cardiol

> 37:1929-35, 2001.

>

> 8) Cook B, Cooper D, Fitzpatrick D, Smith S,

> Tierney D, Mehy S. The Influence of a High Fat

> Meal Compared to an Olestra Meal on Coronary

> Artery Endothelial Dysfunction by Rubidium

> (Rb)-82 Positron Emission Tomography (PET) and on

> Post Prandial Serum Triglycerides. Clin Positron

> Imaging. 2000 Jul;3(4):150.

>

> 9) Friedman M. Serum Lipids and conjunctival

> circulation after fat ingestion in men exhibiting

> type-A behavior pattern. Circulation 29:874,

> 1964.

>

> 10) Kuo P. The effect of lipemia upon coronary

> and peripheral arterial circulation in patients

> with essential hyperlipemia. Am J Med 26:68,

> 1959.

>

> 11) Ornish D, Scherwitz LW, Billings JH, Brown

> SE, Gould KL, Merritt TA, Sparler S, Armstrong

> WT, Intensive lifestyle changes for reversal of

> coronary heart disease.

> JAMA. 1998 Dec 16;280(23):2001-7.

>

> 12) Fleming RM. The effect of high-protein

> diets on coronary blood flow. Angiology. 2000

> Oct;51(10):817-26.

>

> Fish Is Now Health Food for Pregnant Women

>

> Maternal seafood consumption in pregnancy and

> neurodevelopmental outcomes in childhood (ALSPAC

> study): an observational cohort study by Joseph

> R. Hibbeln in the February 17, 2007 issue of the

> Lancet reported, " Maternal seafood consumption of

> less than 340 g per week in pregnancy did not

> protect children from adverse outcomes; rather,

> we recorded beneficial effects on child

> development with maternal seafood intakes of more

> than 340 g per week, suggesting that advice to

> limit seafood consumption could actually be

> detrimental. These results show that risks from

> the loss of nutrients were greater than the risks

> of harm from exposure to trace contaminants in

> 340 g seafood eaten weekly. "

>

> The study examined 11,875 pregnant women living

> in Bristol, UK, who completed a food frequency

> questionnaire assessing seafood consumption at 32

> weeks gestation. Outcomes of the children from

> age 6 months to 8 years were reported in women

> consuming none, some (1-340 g per week), and >340

> g per week.

>

> This study reported that the women in the high

> seafood group compared to the low seafood group

> were: more likely to breast feed (87% vs. 72%),

> have higher incomes (49% vs. 30%), own their

> homes (87% vs. 70%), and be non smokers (77% vs.

> 61%). All these factors tell about a better

> educated, more successful group of people who

> have come to believe through instructive messages

> that eating fish is healthful. These same

> advantaged people rear children with measurably

> better development compared to the children of

> disadvantaged people.

>

> Comments:

>

> There are no greater emotional issues than the

> unborn and children; not surprisingly this

> article received much attention in the press.

> Unfortunately, the interpretation as reported in

> national headlines was incorrect. This study

> actually showed women who eat less fish have

> lower incomes, less education, and more difficult

> living conditions in general-and their offspring

> suffer proportionally. During pregnancy, these

> women also eat a less nutritious diet (more junk

> and fewer plants). A study published in 1998 by

> these same investigators of these same women

> found, " Women with greater difficulty in

> affording food had lower intakes of protein,

> fibre, vitamin C, niacin, pyridoxine, iron, zinc,

> magnesium and potassium than did women with

> little or no difficulty. They were more likely to

> use cooking and spreading fats with a high

> saturates content, and less likely to eat fish,

> fruit, vegetables and salad. " These

> investigators took on an impossible task of

> separating fish intake out from all the other

> variables in these women's life and came to an

> erroneous conclusion.

>

> The primary explanation given in this study for

> why women who ate fish had children with higher

> levels of mental and emotional function was

> because they received a higher quality of fat

> before birth from their mothers eating more fish.

> These omega-3 " good " fats are found in high

> quantities in fatty fish. However, it is

> important to understand that animal systems lack

> the ability to synthesize omega-3 fats, thus fish

> cannot make essential fats. Sea weeds and algae

> synthesize these fats which are then stored in

> the fish flesh; along with contaminants,

> cholesterol, animal protein, and calories. The

> human body has no difficulty converting

> plant-derived omega-3 fat, alpha linolenic acid,

> into DHA or other n-3 fatty acids, supplying our

> needs even during gestation and infancy.3

>

> Therefore, the wise consume will choose plant

> foods as their source of essential fats and other

> nutrients and avoid all the harmful ingredients

> of animal products higher up on the food chain.

>

> There are many adverse consequences from

> consuming fish. The focus of recommendations by

> two US government agencies-the US Department of

> Health and Human services, and the US

> Environmental Protection Agency-to limit fish

> intake by pregnant women to less than 340 grams

> (10 ounces) a week was based on contamination of

> the fish with environmental chemicals, especially

> methylmercury (a known neurotoxin).1 Fish also

> causes a rise in blood cholesterol levels similar

> to the rise caused by beef and pork.4 Their

> highly-acidic animal proteins accelerate calcium

> loss,5 contributing to osteoporosis and kidney

> stones. No dietary fiber or digestible

> carbohydrates are present in fish-thus having a

> negative impact on bowel function and endurance.

> Although omega-3 fats " thin " the blood,

> preventing thrombus formation (heart attacks);

> this same anticoagulant activity can increase the

> risk of bleeding.6 These fats also have

> antiinflammatory properties, which can be

> beneficial (reducing arthritis pain) as well as

> deleterious (causing immune suppression,

> increasing the risk of cancer and infection).7

> Fatty fish, commonly recommended salmon for

> example, is half fat and loaded with calories,

> adding to one's risk for developing obesity and

> type-2 diabetes. Furthermore, omega-3 fats

> inhibit the action of insulin, thereby increasing

> blood sugar levels and aggravating diabetes.8

>

> Finally, let's not forget the environmental

> consequences of telling people they need to eat

> more fish. Since I was a child (fifty years ago)

> 90% of the large fish that swam in the oceans

> have been eaten-these big ones are the ones that

> make little ones. Soon there will be no fish

> left and then people will have to seek the truth

> about where to obtain essential fats and other

> nutrients for their health. They will discover

> plants are the sources of these life-giving

> substances. Unfortunately, by then, billions of

> people will have suffered needlessly and damage

> to the environment will be unrecoverable.

>

> References:

>

> 1) Hibbeln JR, Davis JM, Steer C, Emmett P,

> Rogers I, Williams C, Golding J. Maternal

> seafood consumption in pregnancy and

> neurodevelopmental outcomes in childhood (ALSPAC

> study): an observational cohort study. Lancet.

> 2007 Feb 17;369(9561):578-85.

>

> 2) Rogers I, Emmett P, Baker D, Golding J.

> Financial difficulties, smoking habits,

> composition of the diet and birthweight in a

> population of pregnant women in the South West of

> England. ALSPAC Study Team. Avon Longitudinal

> Study of Pregnancy and Childhood. Eur J Clin

> Nutr. 1998 Apr;52(4):251-60.

>

> 3) ) Langdon JH. Has an aquatic diet been

> necessary for hominin brain evolution and

> functional development? Br J Nutr. 2006

> Jul;96(1):7-17.

>

> 4) Davidson MH, Hunninghake D, Maki KC,

> Kwiterovich PO Jr, Kafonek S. Comparison of the

> effects of lean red meat vs lean white meat on

> serum lipid levels among free-living persons with

> hypercholesterolemia: a long-term, randomized

> clinical trial. Arch Intern Med. 1999 Jun

> 28;159(12):1331-8.

>

> 5) Robertson WG, Heyburn PJ, Peacock M, Hanes

> FA, Swaminathan R. The effect of high animal

> protein intake on the risk of calcium

> stone-formation in the urinary tract. Clin Sci

> (Lond). 1979 Sep;57(3):285-8.

>

> 6) Dyerberg J, Bang HO. Haemostatic function and

> platelet polyunsaturated fatty acids in Eskimos.

> Lancet. 1979 Sep 1;2(8140):433-5.

>

> 7) Meydani SN, Lichtenstein AH, Cornwall S,

> Meydani M, Goldin BR, Rasmussen H, Dinarello CA,

> Schaefer EJ. Immunologic effects of national

> cholesterol education panel step-2 diets with and

> without fish-derived N-3 fatty acid enrichment. J

> Clin Invest. 1993 Jul;92(1):105-13.

>

> 8) Hendra TJ, Britton ME, Roper DR, et al.

> Effects of fish oil supplements in NIDDM

> subjects. Controlled study. Diabetes Care. 1990

> Aug;13(8):821-9.

>

>

> 2007 John McDougall

>