
Dietary carbohydrate intake and mortality: a prospective cohort study - YeGoblynQueenne
https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(18)30135-X/fulltext
======
shanev
“There are limitations to this study that merit consideration. This study
represents observational data and is not a clinical trial; however, randomised
trials of low carbohydrate diets on mortality are not practical because of the
long duration of study required. Another limitation of this study is that diet
was only assessed at two time intervals, spanning a 6-year period, and dietary
patterns could change during 25 years.”

This study is based on a 66 question FFQ (food frequency questionnaire)
spanning a six year period. Do you remember what you ate last month? A year
ago? Six years ago? Maybe a more modern version of these types of studies can
be done if the subjects are required to take pics of everything they ate
instead of reporting from memory on a questionnaire.

“LMS receives grant funding from the California Walnut Commission”

Oh?

“SC reports grants from the National Institutes of Health (NIH), and personal
fees from Novartis and Zogenix”

Novartis and Zofenix are in the business of making statin drugs.

------
GateCrasher
So overweight people (high carbohydrate),and people with dietary restrictions
(for whatever reason) have a lower lifespan. Shocking.

------
mrnobody_67
So the 18 month Keto diet I've been on has been lowering my lifespan? At least
I'll look good in the open casket.

~~~
inawarminister
This study's definition of low carb diet doesn't reach ketosis though.

I do want a proper study on a keto diet, on one hand it's an unnatural
biochemical process for the majority of non-starving humanity, on the other
hand there seems to be no downside to ketosis under than the Flu in the short
term.

------
nurblieh
If you're looking to make dietary choices based on the results of high-quality
dietary studies, my goto is "How Not to Die"[1] and the author's non-profit
website at, [http://nutritionfacts.org](http://nutritionfacts.org)

[1] [https://www.amazon.com/How-Not-Die-Discover-
Scientifically/d...](https://www.amazon.com/How-Not-Die-Discover-
Scientifically/dp/1250066115)

~~~
mrnobody_67
I found that the author used a lot of animal/mouse studies to draw conclusions
and make recommendations... most things that work in mice, don't work in
humans.

~~~
nurblieh
In my experience the author avoids animal/mouse based studies if at all
possible.

He mentions only those that are frequently cited so as to address their
results.

------
theprotocol
Results vary so widely in this field. My general understanding is:

• Polyunsaturated fats, the supposedly "good" fats in the classical model,
actually go rancid really easily and cause damage.

• Saturated fats are associated with high cholesterol, which is a marker of
some misunderstood kind of arterial and vascular inflammation. Not everyone
gets an increase in cholesterol from consuming saturated fats, and we don't
know why. It may be determined by the intestinal flora. But these "bad" fats
are actually very stable, and do not appear to cause damage via oxidation as
they don't go rancid easily.

• Monounsaturated fats have the best qualities of both.

tl;dr (imho): Have some of everything in moderation and with the due awareness
of what you're having vs. your particular body.

Consume limited PUFA and be very aware of the potential rancidness vs. the
effectiveness of antioxidants present in the source. Whole foods with
antioxidants e.g. fruits tend to mitigate the oxidation of any PUFA that they
contain. Consume limited saturated fat as per your propensity for LDL. You
can't go wrong with monounsaturated fats, which are relatively stable and tend
to come in high-antioxidant sources, and also do not cause LDL to rise. But
overall, eat a moderate amount of fat.

Don't go too low carb as it causes a stress state (cortisol + damage-inducing
free fatty acids). Get your carbs from buffered, whole food sources (e.g.
fruits, whole wheat bread), but don't go high carb because it's damaging.

Have as much fiber (incl. resistant starches / FOS / FODMAP / "soluble fiber")
as you can stomach. If they make you feel especially sick, you probably have
gut fermentation (SIBO or similar). Some people like myself cannot tolerate
anything fermentable.

Be aware of your idiosyncrasies, e.g. I can't tolerate histamines, so I must
avoid high histamine or histamine-releasing foods like avocado, as well as
anything fermentable or fermented.

Moderate exercise is superior to intense exercise. Exercise that is too
intense is damaging and is linked with poorer health.

~~~
agumonkey
I asked above but since you seem to be knowledgeable, I'm looking for some
super solid textbooks on fats/fatty acids. Because as you say, you can read
contradictory statements in different books.

~~~
theprotocol
Sorry, I don't know of any books that I can recommend. I don't read health
books. I find they require too big an investment in a single source.

~~~
agumonkey
no worries, I'll keep searching

------
olalonde
Some interesting discussion on /r/keto:
[https://www.reddit.com/r/keto/comments/97zwph/science_bbc_lo...](https://www.reddit.com/r/keto/comments/97zwph/science_bbc_lowcarb_diets_could_shorten_life/)

~~~
nonbel
From a comment there:

> _' The findings "will disappoint those who, from professional experience,
> will continue to defend their low carb cult, but contributes to the
> overwhelming body of evidence that supports a balanced approach to caloric
> intake recommended globally by public health bodies," Collins added.'_
> [https://www.cnn.com/2018/08/17/health/low-carb-high-
> carbohyd...](https://www.cnn.com/2018/08/17/health/low-carb-high-
> carbohydrate-diet-risk-of-death-intl/)

Given the obvious problems with this study (their definition of "low carb" is
wrong), this is just an astounding display of hubris.

~~~
davidmr
That to me read more as CNN getting someone uninvolved in the research to give
a quote that makes for good copy. I agree that it's not a particularly useful
thing to say, but it's important to note that Collins is not involved in the
core study.

------
throwawaylalala
37% of your dietary intake from carbs is not low carb.

~~~
boltzmannbrain
+1. Keto is vastly lower, typically 5%. Someone eating a 37% carb diet will
receive none of the health benefits that spending substantial periods in
ketosis can bring, e.g. lowering cholesterol.

~~~
anewone
Alternatively: the study was about "low carb", while keto is "extremely low
carb".

------
nefasti
Sorry, but I stopped reading here “who completed a dietary questionnaire”

~~~
std_throwaway
Who uses a certain (previously uncommon) diet that is said to help with
diabetes and other serious issues? Those who are of average good health or
those who experience some issues that already start to manifest? I wonder if
the study corrects for those factors. Does the average person even participate
in those studies?

We really need multiple long-running (50+ years) randomized study that
controls for all influence factors to really answer the questions. Something
that is unlikely to be accomplished in our current political lifetime and
unlikely to be completed within our lifetime.

~~~
nonbel
> "We really need multiple long-running (50+ years) randomized study that
> controls for all influence factors to really answer the questions. Something
> that is unlikely to be accomplished in our current political lifetime and
> unlikely to be completed within our lifetime."

This would be a waste of money. Its not going to tell you anything about the
effect of diet in any real people, only "average" people.

------
pestkranker
It is really great to see more studies regarding low carbs diets. They are
widely used in the fitness industry based on ‘Broscience’ and many Instagram
models are paid to promote this kind of lifestyle.

~~~
mattmanser
What's eye opening about this as well is low carb diets lose you 4 years of
life, compared to 1 year of life in a high carb diet.

 _we estimated that a 50-year-old participant with intake of less than 30% of
energy from carbohydrate would have a projected life expectancy of 29·1 years,
compared with 33·1 years for a participant who consumed 50–55% of energy from
carbohydrate (difference 4·0 years [95% CI 2·6, 5·3]). Similarly, we estimated
that a 50-year-old participant with high carbohydrate intake ( >65% of energy
from carbohydrate) would have a projected life expectancy of 32·0 years,
compared with 33·1 years_

~~~
totemizer
No, it means that the people who were compelled to follow a low carbohydrate
diet for one reason on another lived shorter. It doesn't tell you anything
unless you know why they followed the diet they followed.

~~~
mattmanser
Hi ho, greetings to the rabid HN paleo crew, how you doing?

You're all over this thread like a bad rash.

~~~
totemizer
Wha? I was never into paleo, I think it's stupid, every damn vegetable and
animal has changed since, and it's not like we are sure people actually were
so much better of back then...

------
Leary
Note this from this study: "Low carbohydrate dietary patterns favouring
animal-derived protein and fat sources, from sources such as lamb, beef, pork,
and chicken, were associated with higher mortality, whereas those that
favoured plant-derived protein and fat intake, from sources such as
vegetables, nuts, peanut butter, and whole-grain breads, were associated with
lower mortality"

So if you want low carbs, don't eat too much meat.

Plant based diets, such as the Mediterranean diet have been shown lead to
reduced all cause mortality in randomized control trials [1]. Getting your
diet right really isn't that hard, just eat fresh plant based food.

[1][https://www.nejm.org/doi/full/10.1056/NEJMoa1800389?query=fe...](https://www.nejm.org/doi/full/10.1056/NEJMoa1800389?query=featured_home)

~~~
bkovacev
When someone mentions Mediterranean diet the first association I have is fish,
white cheese, olive oil, fresh fruit and veggies, and whole grain bread.
Correct me if I'm wrong - but I wouldn't classify that as a plant based diet.

~~~
mrnobody_67
The mediterranean diet study that was made the diet famous is fundamentally
flawed as described in The Big Fat Surprise. It was done on a small
population, self-reported, and during a time of war when supplies were short
and people were eating atypical altered diet based on available food stuffs.

~~~
YeGoblynQueenne
I hadn't heard of The Big Fat Surprise, so I had a look around and found its
author's Wikipedia page:

[https://en.wikipedia.org/wiki/Nina_Teicholz](https://en.wikipedia.org/wiki/Nina_Teicholz)

I quote from it:

>>"Nina Teicholz is a journalist who became an advocate opposed to the idea
that saturated fat is unhealthy and should be minimized in the American diet."

So, to begin with, she's a journalist who wrote a book about fat. In fact, she
advocated that people should load up their diets on fat, particularly
saturated fat:

>>Teicholz advised readers to "eat butter; drink milk whole, and feed it to
the whole family. Stock up on creamy cheeses, offal, and sausage, and yes,
bacon"

This advice runs counter to the advice of public health organisations and the
opinionts of scientists:

>> Teicholz' claims were harshly criticized by the DGAC, the US Department of
Health and Human Services, the Center for Science in the Public Interest, and
others, _including a petition signed by 180 scientists_ , and they called for
BMJ to retract the article or issue corrections

My underlining.

I wouldn't trust that lady to tell me what to eat, or to criticise a
scientific study's methodology. A journalist with a book has very clear
incentives to "shake things up" by going against the scientific consensus.
But, it's the opinion of experts that have studied the matter at length, who
know the relevant bibliography well and understand its subtleties that one
should trust more than outsiders who "rock the boat" for their own reasons.

Finally- it's really dangerous to listen to someone who tells you that, that
thing you love to eat (or smoke, or drink, etc) that you always knew was not
very good for you is actually very healthy. You have a big, fat incentive to
blieve them unconditionally.

~~~
crphilipp
I have read her book, and it is fascinating. Go ahead and make your
assumptions about her motives, but I believe you are doing yourself a
disservice. Before the 20th century, we ate a lot of saturated fats, and it
wasn't until the creation of vegetable oils (which are made through extensive
industrial processes), was there a move to start restricting saturated fat.
The current low-fat diet is an experiment that has America has been on for
forty some years. Please take a look at this.

[https://www.hsph.harvard.edu/news/hsph-in-the-news/low-
fat-d...](https://www.hsph.harvard.edu/news/hsph-in-the-news/low-fat-diets-
failed-experiment/)

And in general, the American population has been following this diet, and we
are fatter than ever before, suffering from Type 2 Diabetes. And the "science"
behind our current health policy is driven by organizations like the American
Soybean Asociation who are more concerned with making money and less on
science. And when you start talking about money, the science research will
follow the money, because the scientists need to eat.

Please take a look at this videos,

[https://youtu.be/Q2UnOryQiIY](https://youtu.be/Q2UnOryQiIY)
[https://youtu.be/7Lww5WH7INI](https://youtu.be/7Lww5WH7INI)

I would read her book before you pass judgment.

~~~
YeGoblynQueenne
>> Before the 20th century, we ate a lot of saturated fats, and it wasn't
until the creation of vegetable oils (which are made through extensive
industrial processes),

This can't be right. Olive oil is a vegetable oil and it's been known since
antiquity. Its preparation requires an olive mill and a donkey to turn the
millstone. Not "extensive industrial processes!

~~~
crphilipp
Certainly, Olive Oil has been around for a very long time, it wasn't until the
20th century that it became a major food product. Olive Oil was more valued
for cosmetics, medicine, and in lamps. Actually, the original Olympic torch
burned olive oil. Also, note that Olives are actually a fruit, but I
understand why you bring it up as an example.

I am talking about those other vegetable oils, like grapeseed oil, canola oil,
sunflower oil, cottonseed oil. Do you remember Crisco short, this was a new
product produced from cottonseed oil which had been hydrogenated though
intensive industrial processes and sold as a cheaper alternative to the normal
saturated fats used as the time.

I hope you actually look at the links and videos I put up in my previous
comment. Your ad hominem attacks against Nina Teicholz, like "I wouldn't trust
that lady to tell me what to eat" and "she's a journalist" don't go unnoticed.

I also want to point out her BMJ article was not retracted. The petition
signed by 180 scientists was found to be without merit. I do find it telling
you bring up the petition, yet you fail to say that article was not retracted.

~~~
YeGoblynQueenne
>> Your ad hominem attacks against Nina Teicholz, like "I wouldn't trust that
lady to tell me what to eat" and "she's a journalist" don't go unnoticed.

That sounds threatening. Could you please clarify- who is it that noticed and
what happens now that they noticed?

~~~
crphilipp
I am just saying that when you make these kinds of statements to support your
arguments, you are not doing yourself any favors. It is the sign of a weak
argument. Am I supposed to assume that because Nina is a woman and journalist
that she is a liar? I find these type of statements very sexist. As for who
noticed, I did.

I am going to give you another video, you really should watch it.

[https://youtu.be/Zc_e5ME_5Cg](https://youtu.be/Zc_e5ME_5Cg)

------
YeGoblynQueenne
I know the majority of those who read that study will either ignore it,
dismiss it out of hand, or "study it carefully" and find all sorts of problems
with it, the best to convince themselves that it's not conclusive, or that
it's badly designed and its results can't be trusted, etc.

The truth is, it is extremely hard to accept that something that directly hits
your fabled pleasure centers -like fat, sugar, salt, nicotine, alcohol etc- is
so bad for you it's decreasing the time you have to enjoy it. There is an
extreme form of denial that seizes the human mind when someone tells you "this
thing you really like, it's very bad for you".

Our pleasures are immense sources of bias. Take what your heart desires with,
um, a huge pinch of salt and don't listen to the people who tell you salt,
fat, sugar, smoking, drinking etc are good for you when this contradicts years
of research and hundreds of trials, especialy when the evidence for keeping
your dietary habits unchanged is based on a couple of studies with poor
practices and few participants.

~~~
nonbel
Sorry, but there is really no debate about this study. Their definition of
"low-carb" is not the one used by people who are adopting a "low carb" diet,
so there is no reason to think their conclusions apply.

~~~
YeGoblynQueenne
I think "the people who adopt a low-card diet" would do well to pay attention
to a study that reports increased mortality for people who reduced their
carbohydrate intake _less_ than they have.

If a moderate reduction of carbohydrates in your diet is bad for you, almost
entirely eliminating them does not look very promising.

~~~
nonbel
>"If a moderate reduction of carbohydrates in your diet is bad for you, almost
entirely eliminating them does not look very promising."

Why?

~~~
YeGoblynQueenne
According to the study, because minimal risk was observed at 50-55%
carbohydrate intake. So extreme consumption on either end can't be very close
to the minimum.

~~~
nonbel
>"According to the study, because minimal risk was observed at 50-55%
carbohydrate intake. So extreme consumption on either end can't be very close
to the minimum."

Your conclusion does not follow from the premise, so there are some additional
assumptions you are making somewhere.

~~~
YeGoblynQueenne
>> Your conclusion does not follow from the premise (...)

Why not?

~~~
nonbel
Because you have provided no reason that it is reasonable to extrapolate the
trend from a 50% to 40% carb diet to 5% carb diet.

~~~
YeGoblynQueenne
I think it's reasonable to expect that if a small reduction is bad, a big
reduction is worse. The opposite is not impossible, but it would be
surprising.

~~~
nonbel
>"I think it's reasonable to expect that if a small reduction is bad, a big
reduction is worse."

As I originally asked: why?

~~~
YeGoblynQueenne
Why not?

~~~
nonbel
Because wildly speculating and passing judgement on others based on it
generally leads to poor outcomes.

~~~
YeGoblynQueenne
This is surprising. I didn't think I was passing judgement on anyone, in this
thread.

~~~
nonbel
>"I think "the people who adopt a low-card diet" would do well to pay
attention to a study that reports increased mortality for people who reduced
their carbohydrate intake less than they have."

You think the low carb diet people would be mistaken if they dont pay
attention to this study that contains no data for low carb diet people at all.

~~~
YeGoblynQueenne
I didn't say anything about anyone making any mistakes. If I thought that X
people are making a mistake by doing Y, wouldn't it be simpler for me to just
say that, rather than say something else that could possibly be interpreted as
my saying that?

Now, this _is_ passing judgement and I apologise, but I don't think you
replied to the strongest interpretation of what I wrote.

