Women’s health initiative: post menopausal women with cardiovascular disease did worse on a “heart healthy” low fat diet

Photo by Monstera on Pexels.com

Adapted from BMJ: Hiding unhealthy heart outcomes in a low fat diet trial: The Women’s health initiative randomised controlled dietary modification trial finds that post menopausal women with established coronary heart disease were at increased risk of an adverse outcome if they consumed a low fat “heart healthy” diet. by Timothy David Noakes. Open Heart. 2021.

The WHI trial was designed to test with the US Department of Agriculture’s 1977 Dietary Guidelines for Americans protects against coronary heart disease (CHD) and other chronic diseases.

The only significant finding was that post menopausal women with CHD randomised to a low fat diet in 1993 were at a 26% greater risk of developing additional CHD events compared to women eating the control diet. In 2017 an additional 5 years of follow up data was published. It found that the risk for this group of women had increased to 47-61%.

The authors sought to explain why this was but author Tim Noakes has looked at the evidence and his opinion is that the women who had consumed 13 years of a low fat/high carbohydrate diet had inadvertently succumbed to the features of insulin resistance. Their risk of type 2 diabetes went up almost eleven fold and metabolic syndrome went up six fold.

Dr Noakes advises that according to the principle of “do no harm” the practice of putting women on low carb diets if they are diagnosed with cardiovascular disease is certainly not evidence based and probably not ethical.

The WHI is one of the most expensive long term dietary intervention trials ever undertaken. It started in 1993. Although the advice was given to cut dietary fat, particularly saturated fat in 1977, the policy had never actually been tested regarding its effects on weight, CHD, cancer and type two diabetes.

The idea was to replace the calories from saturated fat with increased carbohydrates from grains, fruits and vegetables. The effect of this was to lower blood cholesterol concentrations. The trial did not seek to replace saturated fat with polyunsaturated fat as studies of this had been published in 2013 and 2016.

Nutritionists led the first year 18 group sessions followed by individual follow up every 3 months. Feedback was given so as to encourage low fat intake.

A low fat diet was not found to improve rates of breast cancer, colorectal cancer, and only resulted in 0.4 kg weight loss over the first 8 years of the trial. The more women adhered to the low fat diet, the more weight they gained. The women who ate high fat, lower carb diets, the more weight they lost.

Blood sugar started to deteriorate in the first year of the trial for the low fat diet group. Post menopausal women who went on statins were at a 49% increased risk of developing type two diabetes. A prior meta-analysis had found that there was a 9% chance of developing type two diabetes with statin use.

The 2017 report analysed women in subgroups: No CHD or hypertension. Hypertension only. and pre-existing CHD. The idea was to see who may benefit or lose the most from the low fat intervention.

Women with hypertension only had neither benefit or harm from the low fat diet. Women who had no pre-existing hypertension or CHD had a small reduction in CHD risk but this was off set by a higher risk of stroke.

Regarding another study, the ERA trial, women who were on HRT who reported that they ate the most saturated fat over the trial time of three years, found that their coronary atheroma did not progress. In fact there was a modest regression in coronary artery narrowing. Both those who ate the most polyunsaturated fat, and those who ate the highest amount of carbohyrate and therefore the lowest amount of total fat showed worsening of their coronary atheroma.

Statin use was similar in both groups who were randomised to each diet, low fat versus usual. Indeed more than 40 percent of the women in each group were on statins.

Only post menopausal women who do not have CHD or hypertension are safe to eat the low fat diet, the others can expect some negative effects.

The Women’s health study (WHS) was established between 1992 and 1995 at Harvard Medical School to look into the effects of aspirin and vitamin E on the risks of developing CHD or cancer in women who started off with neither condition.

The study showed no benefit for either treatment.

A 21 year follow up programme of over 2,800 of these women evaluated more than 50 different clinical, lipid, inflammatory and metabolic factors.

Results showed that the development of Type two diabetes, and not high cholesterol levels were important factors in the development of CHD. Hypertension gives a 4.58 fold increase in CHD. Obesity gives a 4.33 fold risk. These factors as well as type two diabetes and metabolic syndrome were more predictive of CVD than smoking.

A Lipoprotein Resistance Score was developed looking at various factors particularly VLDL and HDL and a high level produced a 6.4 fold risk of cardiovascular disease. This is worsened in insulin resistance. LDL scores only gave a 1.38 fold risk of CVD by comparison.

The Progression of Early Subclinical Atherosclerosis Study looked at HbA1c in people who did not have type two diabetes. The higher the HbA1c, the higher the risk of CVD and the risk even started below HbA1c levels of 5.5%.

Women who had low HDL levels was associated with a higher breast cancer incidence and all cause mortality after breast cancer as well as an increased risk of cancer specific and all cause mortality.

The Recovered Minnesota Coronary Experiment (RMCE) study found that people randomised to eat more polyunsaturated fat in place of saturated fat were at a 22% higher risk of death with each 0.78 mmol/L reduction in blood cholesterol. This effect was worse in the over 65s.

The Recovered Sydney Diet Heart Study (RSDHS) showed that replacement of dietary saturated fat with linoleic acid was also associated with raised all cause mortality with increased deaths from cardiovascular disease and coronary heart disease.

Lawrence ( Lawrence GD Perspective: the saturated fat- unsaturated oil dilemma: relations of dietary fatty acids and serum cholesterol, atherosclerosis, inflammation, cancer and all cause mortality. Adv Nutr. 2021; 12: 647-56) concluded: PUVAs are unstable to chemical oxidation and their oxidation products are harmful in a variety of ways. They can initiate inflammation that can have dire health consequences. If saturated fats are replaced by carbohydrates in the diet there would be no significant improvement in serum cholesterol and it can result in a more atherogenic lipoprotein profile. …It appears that saturated fats are less harmful than the common alternatives.

This set of findings from four different studies effectively ends the debate about which diet should be eaten to lower the risk of CVD, especially in those with insulin resistance.

Two diets shown to prevent the clinical features of IR leading to type two diabetes are the restricted low calorie diet developed by Lim et al (Lim et al. Reversal of type two diabetes; normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetalogica 2011;54:2506-14.) and the ad libitum low carbohydrate higher healthy fat ketogenic diet.(Hite AH et al. In the face of contradictory evidence: report of the dietary guidelines for Americans Committee. Nutrition 2010;26:915-24.)

It is the ethical responsibility of those who manage those with cardiovascular disease or diabetes or other insulin resistance that they should NOT prescribe the never proven and now disproven low fat “heart healthy” DGA diet.

The Diabetes Diet price drop

the diabetes diet by emma bairdWe’re running a price promotion on The Diabetes Diet. Until 8 December, you can get our guide to low-carb eating and how this can balance your blood sugar levels for the bargain basement price of £1.99/$1.99.

(Gosh, I love alliteration. Can you tell?!)

Our book offers a wealth of advice about the low-carb lifestyle and how to adjust medications to cope with a reduced carbohydrate intake. It also includes meal plans and recipes covering everything from bread substitutes to main meals, breakfast ideas and veggie dishes.

Here are some of the reviews for the book:

“Still working my way through this book, an awful lot to ‘digest’! It’s given me ideas as to how I can change my diet to help with weight loss & better health too!”

“I’m in pretty bad shape but 2 weeks after starting on insulin and reading this book, I am completely hooked and feeling great. This book has more revelations than the Da Vinci Code and the more you read the more you realise how obvious it is that carbs are a bad idea.

“In under two weeks I’ve got my blood sugar down from an average 26mmol to between 9 and 13. Still a way to go but its a great start and now I’ve had a fright I’m determined to change my habits. The book is well written, informative and easy to follow. It has some great inspirational stories, plenty of recipes and good advice.”

“This is a potentially life changing must read for diabetics and their Medical Advisors. It is a well written, informative book based around the premise that type 2 diabetics can normalise their blood sugar levels and type 1 sufferers can better manage their condition by following a low carb diet.”

You can buy the Diabetes Diet on Amazon wherever you are.

Healthy Low-Carb Recipes for Chilling and Grilling — Nourishing World Blog

Some party and outdoor recipe ideas for low-carb courtesy of the Nourishing World Blog.

With the Summer Party season about to get underway, I wanted to share some great keto-Friendly Summer recipes. My Daughter and I recently did another round of the 21-Day Detox and found a few new healthy recipe favorites. This Buffalo Wing Sauce is keto friendly, Paleo and Whole30 friendly. My daughter ate this almost every […]

via Healthy Low-Carb Recipes for Chilling and Grilling — Nourishing World Blog

Low-carb veggie curry

vegetable curry in a bowlAs a one-time vegetarian, I love vegetable or pulse-based curries. I’d choose them over meat-based ones any day. I’m also a fan of tamarind paste—it adds amazing tangy flavour to any curry.

Last week, I made a veggie curry using the left-overs in the fridge and combining them in a rich sauce. Had I been the only one eating it, I would have added cauliflower but my husband hates the stuff and veggie dishes are a hard sell to him so I left it out.

Recipes often specify coconut milk, which is fine if you need a whole tin of it. I keep packets of creamed coconut in my store cupboards (fridge in the summer) as it’s much more versatile. You can use however much you need without waste, and it can be a thickener or made into a cream.

Vegetable Curry

  • Servings: 3-4
  • Difficulty: easy
  • Print

  • 300g mushrooms, sliced
  • 1 onion, sliced
  • 1 large carrot, cut into batons
  • Half a red pepper, sliced
  • 1 large courgette cut into chunks
  • 400g tinned tomatoes
  • 1 tbsp curry powder
  • 1tbsp tamarind paste
  • 50g creamed coconut, finely chopped
  • 1tbsp rapeseed oil
  • 2 chillies, chopped
  • Salt to taste.
  1. Heat the oil in a large saucepan. Strictly speaking, you should put the onions in first, fry till translucent, then add the peppers, courgette and carrot, cook for five minutes and add the mushrooms last. I’m too lazy to add the veggies one by one so I threw them all in at once and cooked for about six minutes.
  2. Add the curry powder, tamarind paste and chillies and cook for another minute. Add the chopped tomatoes and bring to the boil. Mix in the creamed coconut and turn down to a simmer. Cook for about five minutes. The creamed coconut will thicken the sauce. Add seasoning to taste.
  3. To make it more of a main meal, You could add some fresh chicken stock to this and turn it into a sauce for chicken thighs or throw in a good handful of cooked prawns and cook for a minute to warm through. Another worthy addition is two or three balls of frozen spinach. Defrost and warm through beforehand, obvs.

Allow about 15-18g of carbs per portion. Serve with naan breads (low-carb version here) or rice for the carb-lovers in your life.

Chicken Caesar Salad – crouton-free

picture of chicken caesar saladEaster greetings to you all… here’s an idea for lunch or dinner for you. Now, Caesar salad without the croutons?! C’est sacrilege, surely? But if you follow a low-carb diet, the concept of tearing up the rule book on food is one you embrace.

I’m back from a terrific few days in the Scottish Borders (abbey-visiting a-plenty), and my favourite meals while there was a Chicken Caesar salad I had in the Townhouse in Melrose. Now that one did feature croutons, albeit small ones, but the dressing and the juicy chicken made it stick out.

I decided to re-create it at home. Issue one—chicken breast, a dry and often flavour-free meat. Issue two—my husband hates anchovies and they’re are often added to the salad or at least the traditional dressing.

Poached, not fried or roasted chicken

To avoid dry chicken, I poached mine in chicken stock (I used two cubes) with a handful of sage and thyme added to the cooking liquor. And to make an anchovy-free dressing*, I found an American recipe online and adapted it.

Here it is—crouton-free Chicken Caesar Salad suitable for low-carb and gluten-free diets.

Chicken Caesar Salad

  • Servings: 2
  • Difficulty: easy
  • Print

<em>A fresh, light recipe that is still filling and perfect for a late spring or summer dinner</em>.


Ingredients

  • 2 chicken breasts (the best quality you can afford)
  • 500ml chicken stock
  • Handful fresh sage leaves and several thyme twigs)
  • 3 rashers smoked back or streaky bacon
  • 2 Little Gem lettuces
  • 10 baby plum or cherry tomatoes
  • 30g Parmesan shavings

Dressing

  • 4tbsp mayonnaise
  • 1tbsp fresh lemon juice
  • 1tsp Worcestershire sauce
  • 1tsp Dijon mustard

Steamed green beans to serve (and boiled new potatoes for your carb-lovers).

  1. Bring the chicken stock to a simmer and add the breasts. Depending on their thickness, they will take 10-15 minutes to cook, but you shouldn’t have any pink meat remaining.
  2. Meanwhile, wash the Little Gem lettuces and pull off the outer leaves. Use them to line a wide bowl so you have a ‘tray’ for your salad. Shred the rest of the leaves finely, slice the tomatoes and put in a bowl with the lettuce. Add the Parmesan shavings. Whisk together the dressing ingredients and toss the salad to coat it evenly with the dressing.
  3. Grill the bacon until crispy. Once the chicken is cooked, chop or slice it and add to the plate. Top with the grilled bacon (one and half slices each).

About 5-7g carbs per serving.

Please note—the dish is high in protein and protein can affect your blood sugar levels after a few hours. Test your blood glucose accordingly. Our book The Diabetes Diet outlines how to deal with the protein content in meals.

 

*Ssh, don’t tell my husband one of the main ingredients in Worcestershire sauce is… you guessed it, anchovies.

The Quirky Things About Being a Type 1 Diabetic

Because I am hyper-organised (crap), I scheduled time to write a post for World Diabetes Day—spot the deliberate mistake. Said designated day took place on 14 November, unmarked by we at the Diabetes Diet. Hey ho!

Instead, here I am posting about it more than a week later. You could argue that living with diabetes also takes place on the other 363 days (and the extra one every four years) of the year, so why make the 14th special, although awareness-raising exercises are always useful.

Anyway, I thought I’d list some of the quirky things about living with diabetes. We all know the big stuff, but there are some teeny-tiny bits you put up with which aren’t obvious to those who don’t have the condition…

Gnawing anxiety when parted from your bag. I have an industrial-sized handbag so I can carry around everything—blood testing equipment, two pens, spare needles, jelly babies and a full make-up kit*. When I visit people and they try to take my bag from me to put it with coats, I cling to it. I’m never more than a few metres from that bag.

a picture of a blood testing machine on The Diabetes Diet

A trail of litter that follows you everywhere. I do my best to dispose of it at the time, but I wish someone would invent a small bin that magically appears at your side every time you do a blood test or injection so you can throw away your used needles and blood testing sticks there and then. Every few days or so, I have to do a clear out of my bag where old needles, their wrapping and used sticks gather at the bottom. Once, I was in Regent’s Park in London and I spotted a used blood testing stick on the group and it delighted me. I knew it wasn’t mine**, but the thought that there was another type 1 in the vicinity felt comforting.

An aversion to ordering drinks when you are out that are in a glass. How do you know it’s the diet version? I only feel secure when my drink comes in its bottle or can. Otherwise, you might end up drinking the full-sugar one which will hit you like a sledge hammer almost immediately.

Puncture-marked fingers. I’m still on the waiting list for the FreeStyle Libre so in the meantime, my fingers keep that little collection of black dots that marks frequent finger pricking. You are supposed to vary the fingers, but my right hand bears the brunt of tests because I’m left-handed.

Toilets are very important. High blood sugars make you pee a lot and the first thing I work out whenever I go anywhere is—where’s the loo? Also, I’m not fussy. I have friends who won’t use dirty toilets such as the ones you get on trains. I don’t care. It’s a loo and it’s going to take me from bursting discomfort to huge relief in minutes.

It’s a full-time job. Managing diabetes takes up a lot of time and energy. You don’t get holidays and you can’t quit, and you have to do it on top of everything else you do. The boss is often a moody cow too. The skill-sets needed include arithmetic (figuring out insulin doses to match food), organisation (making sure you have everything you need when going out and keeping on top of your prescriptions), an understanding of biology and how your body works, and the ability to forward plan for most aspects of your life.

 

*Strictly speaking, not needed for diabetes

**On second thoughts, it could have been. Those things get everywhere. I’m always finding them in weird places.

Slow Cooker Low-Carb Beef Pot Roast

slow cooker pot roast beef recipe by Emma Baird of the Diabetes DietSeasonal eating is valuable, I know but here’s a confession… I don’t mind eating soup and stew all year round, even though the dishes are usually associated with autumn and winter.

Can you blame me? Imagine meat and vegetables soaked in lusciously thick and flavoursome sauces, or onions, carrots and celery melded together and used as the basis for the best soup in the world. [Cauliflower cheese soup, since you ask.]

That said, it’s now the tail end of autumn in the UK and I’m digging into beef stews a-plenty. The miracle of carrots and beef is a flavour combination you can’t beat. Cut those carrots in big chunks, nestle them in your stew and leave to bubble away for hours. I could almost fish them out and eat them as a soup with the juices from the stew.

Recently, I adapted a Mary Berry recipe for pot roast. Mary’s method used suede or turnip as we know it in Scotland. I’m not that fond of it (sorry Rabbie*) and I decided to substitute celeriac. It worked a treat.

One of the rules of stews and casseroles is that they improve the day after cooking. This depends on your self-discipline. If you’ve had a pot of stew simmering on your stove for a few hours or cooking away in your slow cooker, your whole home will smell heavenly and resistance will require added steeliness.

Slow cooker Beef Pot Roast with Winter Vegetables

  • Servings: 6
  • Difficulty: easy
  • Print

  • 2tbsp extra virgin olive oil
  • 1.2kgs (roughly) beef topside or brisket
  • 4 onions, cut into wedges
  • Half a celeriac, peeled and cut into chunks
  • 2 celery stalks, chopped
  • 3-4 large carrots, peeled and cut into chunks
  • 150ml white wine
  • 2-3 bay leaves
  • Salt and pepper

Put the oil in a large frying pan or wok and add the beef. Cook over a high heat, turning occasionally until it is browned all over. Place in your slow cooker along with the vegetables tucked all around the meat, and pour the wine around. You might want to add up to 100ml water, but the vegetables will give off a lot of water anyway.

Cook on slow for eight hours. Add plenty of salt and pepper and dot with a little butter to serve. The dish goes well with steamed cauliflower or broccoli.

Allow about 10-15g carbs per serving.

*Scotland’s national dish is haggis, neeps (turnips) and tatties, and it’s traditionally eaten on January 25 to celebrate Robert Burns’ birthday.

Sausage, Pepper and Red Lentil Casserole

Plate of sausage casserole on The Diabetes DietProving once again, a low-carb diet can be plant-based*, I bring you the sausage, pepper and red lentil casserole!

My ‘beef’ (see what I did there) with the hi-jacking of the term ‘plant-based’, is that it’s assumed to mean vegan, whereas I’d argue you can eat meat, fish and eggs and still have most of your diet made up of plants.

Sausages and lentils have a long dating history. The French twin them together for cassoulets as lentils soak up meat juices and add cheap bulk to a dish. Bulk’s important to me. Who wants a small bowlful of food when you can have a big one?

The better quality your sausages, the better the finished dish. The casserole is great with buttered cauliflower or broccoli. Or you could add another 250-300ml of vegetable or chicken stock to turn it into soup.

And a cheeky helping of grated cheese on top always adds extra deliciousness.

Sausage, red pepper and lentil casserole

  • Servings: 4
  • Difficulty: easy
  • Print

  • Two peppers, insides removed and chopped
  • 100g celery, sliced finely
  • 100g mushrooms, sliced
  • 75ml red wine
  • Four, good quality pork sausages, each cut into chunks
  • 75g chorizo, sliced
  • 75g red lentils
  • 2 cloves garlic, crushed
  • 400g tinned, chopped tomatoes
  • 1 chilli, chopped (optional)
  • 1tsp smoked paprika
  • Salt and pepper

Put everything into your slow cooker, stir well and put on the high setting for four hours.

The mix makes a soupy casserole because it’s done in the slow cooker. You might want to take the lid off yours for the last 20 minutes to get rid of some of the excess liquid.

To make the recipe on the stove, use a large saucepan. Place the chorizo slices in the pan, then turn on a gentle heat so the oils from the sausage run out. Add the other sausages, celery, peppers, mushrooms and garlic, mix well and cover. Cook over the gentle heat for ten minutes. Add the tomatoes, lentils, red wine, chilli and paprika, stir well and bring to the boil. Turn down to a simmer and cook for a further 30 minutes, mixing from time to time.

In both instances, add salt and pepper to taste.

Each portion has 17g carbs and 4g fibre.

*And also that my food styling and photography skills get no better.

 

Half-Marathon Training – an Update

 

a picture of a blood testing machine on The Diabetes Diet
Post-run blood sugar today. Ten out of ten for me (for smugness too).

“Stone the crows, Emma! Wouldn’t have thought excessive temperatures would be the weather issue throwing a spanner in the half-marathon training, hmm?”

Good people, the woman who signed up for the Glasgow half-marathon in January uttered various predictions about running in Scotland. Most of them involved rain. As it turns out, my lightweight shower-proof coat has needed minimal use. Instead, I’m reaching for the sun cream and hugging the walls in a bid to stay in the shadows as I pound the pavements.

Smell that sizzling tarmac! Scotland has just reported its hottest June ever. Let’s give a shout-out to the poor polar bears in Aviemore.

Fortunately, I’ve discovered I can run in the heat. Again, not something I’ve had the chance to test out much over the years. When I trained for a half-marathon ten years ago, there were two hot days in May. I ran during them and hated it.

Blood sugar levels

But now? I’m okay. Running’s so bloomin’ difficult for me, the heat isn’t the thing that’s bothersome. It’s still the breathing, the adjusting of blood sugar levels to minimise low or high blood sugars and my reluctance to build up my miles

My half-marathon is three months away. I’ve yet to go farther than six miles. Most training plans are for 12 weeks, so there’s still plenty of time to add them up. I’ve found my ‘pace’, a super-slow snail-like jog. I’m hoping my general fitness will stand me in good stead, so that if the pre-race miles don’t stack up, those walking miles will cover ‘em.

I ought to join a running group too. Nothing like surrounding yourself with like-minded idiots people to spur one on. And they might know some different routes. I run the same roads all the time, favouring the reassurance of knowing at what point I draw on my reserves of energy and where I get excited because the end’s in sight.

Jessica Smith TV

Last week, when it was very hot (32 degrees), I exchanged outdoor for indoor exercise. I found an indoor jogging work-out on YouTube. “T’uh!” smug self said, “This’ll be easier than running out there in that heat.”

Not so! Ten minutes in and I decided I’d have been better off running outside in the blazing sunshine.

The heatwave here is set to continue. I’ll be training in high temperatures for a little while yet. Again, I’m hoping this magically builds up my fitness so that when I do talk myself into running more than six miles, it’ll be easy.

 

 

 

Coping with T1D in the Heat

Inforgrpahic about the heat by The Diabetes Diet

A screenshot of the weather in Scotland on The Diabetes DietHeavens above—this isn’t a post I’ve needed to write before but the last few weeks of incredible sunshine and heat in Scotland (Scotland! I’ll say it again, Scotland!) necessitates it.

If you’re a type 1, what special precautions do you need to take when the mercury rises? I prepared this handy infographic to help…

Please note—if you have neuropathy (nerve damage) this can affect your ability to sweat and therefore cool down. Go out early in the morning or later in the afternoon if you can, drink water to stay hydrated and exercise in air-conditioned gyms. Cut down on drinks with caffeine and alcohol, and take care of yourself as best you can.

Inforgrpahic about the heat by The Diabetes Diet