Dr Caryn Zinn talks LCHF and dietetics – a must watch

This is an outstanding 15 min presentation by our own Dr Caryn Zinn, Registered Dietician, about her growth , development, practice and ethics of LCHF practice.  Recorded at the recent Low Carb Down Under conference in Auckland, she is the first of the videos released. Enjoy.  Send this to your dietician friends (and even the ones who are not friends!). Click here or below.

46 Comments on “Dr Caryn Zinn talks LCHF and dietetics – a must watch

  1. This is such a refreshing and reassuring talk!
    Loved it and will share the ‘good news’

    Thanks again for the encouragement that LCHF is on the right track.

  2. Excellent presentation from an awesome change leader. It was great to be at the event and thank you to all the people who made it happen.

  3. Hi Grant. Thank you for posting this, definitely is a must see. Quite a bit of an emotional watch (for me at least), not unlike Peter Attia’s TED Talk https://www.youtube.com/watch?v=UMhLBPPtlrY. Now kicking myself that I didn’t take the day off work to attend the conference! Dr Caryn you are very inspiring and it’s so good to see that there are dieticians who are taking this on board and challenging conventional wisdom. Every little bit helps. I look forward to seeing more from both of you and hopefully more of the sessions from the conference posted over time. Kindest regards.

  4. Hi
    This is awesome but I was wondering if the rest of the conference is also going to go online?

    Sent from my iPhone


  5. Dr Caryn, what a wonderful sweetheart of a woman!! I think she is amazing, and what guts to stand up and say everything you stood for and believed in professionally, was wrong and has been turned upside down. By being strong enough, and open minded enough to look at the evidence she is a lone sane voice in the desert of current nutritionists and their dogma, but hopefully not for long. How lucky you are down under.

    • Caryn is fortunately not the lone sane nutrionist / dietician voice. There are a number of us who are supporting the ancestral health movement here in NZ, started by nutritionist Jamie and his doctor partner Anastasia. Look out NZ, there will be much more in the media in the next year 🙂 http://ancestralhealthnz.org/

      • Yes, Julianne is absolutely right. We are very lucky Down Under to have quite a few health professionals who are using evolutionary principles to guide their practice. We are very happy to now have Caryn join our voices. Congratulations on the video, Caryn. It was a very insightful talk.

  6. This and what will follow will be a fantastic resource. Glad I was there and now I will be able to catch every word that at times missed because the 70 yo ears not quite what I would like. 12 years LCHF but never tire of learning more and relishing the growth of this movement.

  7. Thanks for posting this! This was one of our favourite talks at the seminar – a must see video.

  8. Fab thank you very much. Similar situation in the UK re: LCHF, complete ignorance and dogma.

  9. Thanks for this Grant (and to Lynda) for sharing this great video.

    We need to pass on and keep passing on the good news that is LCHF

    All the best Jan

  10. Not sure if my earlier comment came through but just to say many thanks for posting the great video.

    We need to keep on posting the good news that is LCHF and keep on sharing and passing on good news.

    All the best Jan

  11. I am surprised that Dr Zinn did not find any evidence to support recommendations for populations to consume wholegrain cereals. A simple “google scholar” search will bring up a number of large epidemiological studies showing clear associations between wholegrain/dietary fibre consumption and reduced risk of all cause mortality, coronary heart disease, diabetes and cancer. While the randomised controlled trial is considered the best level of evidence to support health recommendations you will know that these are incredibly difficult to do when examining hard endpoints for diseases that take many years to develop and which occur in relatively small numbers of individuals. Nevertheless I am sure you are familiar with the Diabetes Prevention Study, The Diabetes Prevention Progamme and the Da Qing Study (large, long-term RCTs conducted in adults with pre-diabetes) which showed that in comparison with usual diets, dietary advice that included saturated fat reduction, increased dietary fibre/wholegrains, moderate alcohol and regular exercise resulted in clinically large and statistically significant reductions in the rate of progression to diabetes after up to 20yrs of follow up. In one of these studies type of diet was even superior to the best practise drug therapy. On the other hand there has been no comparable long-term study to show that a LCHF diet has similar benefits. Obviously absence of evidence does not equate with absence of effect, but there is certainly no justification for claiming that there is no basis for recommending wholegrain consumption as part of a healthy diet. You are simply wrong.

    If I was a dietitian, I would take great offense at Caryn’s suggestion that she is one of the “good dietitians” as if most dietitians are not good? Dietetics is an evidence-informed practice. Contrary to the beliefs of your followers we nutritional scientists spend a large amount of time evaluating the scientific literature, conducting trials and constantly reevaluating our understanding of nutritional science when presented with new evidence. The practice of dietetics relies on this evidence and knowledge to inform best practice.

    There is no question that some people will find a LCHF diet to be the health epiphany that they have been looking for. However you will also find individuals who swear by a LFHC diet, a high protein diet, a Mediterranean diet, the 5/2 fasting diet, low GI diets etc etc. You will also find people who fail to succeed on any diet.

    Public health recommendations rely on better evidence than currently exists for the LCHF approach. Anecdote is certainly not sufficient evidence! Moreover, given the limitations that Caryn alluded to in her talk (people misunderstanding what a LCHF diet actually is and consuming HCHF diets instead) it is not an approach that we think is appropriate to push to a public with relatively limited food knowledge.

    • What a shame we are seen as ‘ignorant peasantry’…… Dr. Lisa I think you will find that most of us, myself included have researched and tried out the LCHF CORRECTLY (that means low carbohydrate, moderate protein and higher healthy fats) that have produced excellent laboratory proven results, which puzzles my GP but thrills me. In case you are unaware, we ignorant peasants have access to scientific articles these days, and with brains and good eyesight can read and research as well as you can.

      …………………Moreover, given the limitations that Caryn alluded to in her talk (people misunderstanding what a LCHF diet actually is and consuming HCHF diets instead) it is not an approach that we think is appropriate to push to a public with relatively limited food knowledge.

      • Please don’t read things into my post that I do not intend. I do not mean to denigrate you or anyone anyone else. You clearly are an individual who can make informed decisions about your own health and diet.

        However this does not mean that the LCHF diet can be ethically recommended to the general public. The evidence to support this approach as being 1) safe and 2) of benefit to population health over the long term is simply not adequate. Health practitioners would be acting unethically if they were promote this approach at the population level given the current evidence base.

        Just because the LFHC diet works for you this does not mean that the current dietary guidelines for populations are rubbish. They are not. They are based on the best peer-reviewed evidence we have, and are the consensus position of the BEST nutritional scientists in the world.

        Why people would think that internet blogs and books written by journalists or lay scientists are a more credible source of dietary information is beyond me.

      • There you go again, putting yourself above the rest of us sheeple. I am not alone in my education and choice of lifestyle. I do not belong to the HERD you want to manage and manipulate. I am an individual with a brain and, as you can read – an opinion. The science is NOT settled, but that does not mean that the previous science must remain static…. it evolves, just like we do. Foreword Ho!

      • Lisa, we just need to keep all of this civil please. No one is against actual scientific debate. My preference is to not to have to moderate this.

    • Lisa, you make some good points here. One is, that we need to define a diet approach such as LCHF consistently if it is to be used as a public health measure.
      The reality is that there are variant LCHF approaches in use, some prefer a more “Mediterranean Diet” choice of foods, others are happy with lard and butter on the menu. A cardiologist like Dr Aseem Malhotra prefers the Mediterranean version, but of course not everyone needs the care of a cardiologist.
      The issue of long term safety is more dubious. In the first place, LCHF doesn’t need to be used long-term to produce health benefits. Even Dr Atkins re-introduced carbohydrate after a relatively short period of ketogenic dieting. In practice, this seems to be a common pattern among low-carb dieters. At some stage many work out that their problems have been solved, and that they can reintroduce vegetable carbohydrate foods if they do so selectively (usually along Paleo lines, i.e. without grains or sugars). The LCHF diet is always available as a fix if problems recur.
      However, you are wrong when you say that “Public health recommendations rely on better evidence than currently exists for the LCHF approach”. This is certainly not the case with the current recommendations to replace “saturated fat” with “polyunsaturated fat” or carbohydrate. It is true that evidence exists, but it has not provided results to support this advice to a degree that would justify giving it. In fact, the recommendations to replace butter (a known quantity) with margarine (a very diverse group of products without a consistent formula) are a very good example of the sort of pseudoscientific thinking that makes “conventional” dieticians an easy target. You may think that nuts, olive oil, and fish are healthy foods, and you may theorize that the polyunsaturated fats they contain are partly responsible for their health benefits, but it is a leap of faith to think that refined and highly polyunsaturated oils can replicate these benefits.

      Studies showing a benefit from whole grains are only comparing whole grains with carbohydrates from refined flour and sugars. They are not proof that wholegrains are healthier than other vegetable foods. In particular, New Zealand public health thinking should at least consider the fact that grains played absolutely no role in the pre-European diets of Maori and Pacific Islanders. And even in the case of Europeans, the bread we ate as little as 50 years ago was made to a very different formula from almost all the bread it is possible to buy today.
      In fact, if LCHF is too loosely defined for your liking, surely “wholegrains” in the modern diet is an even looser definition. Most of what people think of as wholegrain foods are in fact highly processed food products with multiple additives and ingredients, including sugar, salt, milk, soy and oil. Furthermore, coeliac disease is now a growing epidemic in the parts of the world where most wheat is eaten, and where people should be most expected to have adapted to gluten, were it possible to do this within a few thousand years. There is no corresponding disease of butter or lard intolerance, nor indeed of potato or kumara.

      Perhaps it is too early to expect LCHF or Paleo diet reform to dominate public health thinking, as it seems to have done in the 1960s, judging by educational films like this one from 1967 http://www.youtube.com/watch?v=CiSRfan2dgw
      (interestingly, when the advice given to the overweight tended to be of the LCHF, and indeed Paleo, pattern as in 1967, we didn’t have an obesity epidemic. The problem seems to have coincided with a change in the advice given to the most vulnerable at the end of the 1970s, based on the the novel, and still unproven, fear that fat is especially bad for us.)
      But it is, I believe, reasonable to expect that LCHF and Paleo will now be given a fair shake by public health experts. The one-size-fits-all approach has been tried and failed. It has resulted in recommendations that are confused and inappropriate, and it has given comfort and assistance to an industry profiting from the adulteration of the food supply in a nation where too many are still malnourished. This aspect – typified by Heart Foundation ticks on processed sugar and oil products – is a scandal, for which public health policy of the past few decades deserves much of the blame.

      I appreciate that public health nutritional policy in New Zealand now exists under a political model where partnership with industry is expected, lobbyists have a voice that is hard to ignore, and diluted, voluntary guidelines are much more likely to get approval than the proscriptive regulations of the past. In such a model, public opinion and the example of trend-setters has a lot to offer the public health authority in the way of assistance. Which is why internet blogs and books written by journalists or lay scientists, as well as the many written by scientists and experienced clinicians, are especially valuable – they can be useful to you and your peers as a counterweight to the overbearing voice of money.

      • I said “You may think that nuts, olive oil, and fish are healthy foods, and you may theorize that the polyunsaturated fats they contain are partly responsible for their health benefits, but it is a leap of faith to think that refined and highly polyunsaturated oils can replicate these benefits.”
        But it is also a leap of faith, at best, to assume that the “saturated” fats from dairy, meat, coconut, cocoa in the diet need to be restricted, in order for the benefits of fish, nuts, and olive oil to be felt.
        There is more evidence, and much more in the scientific literature about plausible mechanisms, to say that sugar, refined starches, and refined omega 6 oils need to be limited for the benefits of fish, nuts, and olive oil to be optimized, and that “saturated fats” need not be limited for such benefits. For example, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3609096/

      • It is certainly becoming increasingly accepted in public health circles that there is no benefit to replacing saturated fat with refined carbohydrate. However there is good evidence to show that reducing saturated fat intakes by replacing with poly and mono-unsaturated fats does improve both cardiovascular risk factors and hard cardiovascular disease outcomes. I personally think the Mediterranean diet approach has most merit – of course this is compatible with international public health dietary recommendations.

        I am also not arguing that there is a one-size fits all approach to diet. In fact dietary recommendations allow a lot of flexibility in terms of macronutrient composition so that dietary advice can be tailored to an individual based on risk factors, food preferences and budget. However I am arguing that there is not currently sufficient evidence to recommend very low carbohydrate diets in population level advice.

        Moreover many of us question whether the LCHF approach is environmentally sustainable at the population level. Paleo Maori society would have viewed well-being as being more than just physical well-being, as would, I imagine, many Paleo communities.

      • Another dare I use the term? historical example, which is well documented for all to read is that of Mr William Banting who wrote his letter on Corpulence in 1863. Even then those suffering from corpulence or obesity as some would now call it, were treat with abstaining from carbohydrates to produce measurable results. It is not as if this is some new fangled yuppie (is that word still used?) trend that will pass out of fashion next week. I would also ask where (is there any) is evidence /scientific proof that by drastically reducing our carbohydrate and PUFA intake and returning to Ancestral Type Lifestyles – harm is done to the human body? I greatly admire and appreciate good conversation on this, that is how I myself learn.

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  13. Lisa, I do not have a reply link in your comments, and replying to my own comment will put this thread out of sequence, so I will comment here.

    The environmental sustainability issue is an interesting sideline. Personally I can think of nothing more wasteful than throwing away the fat from animals, and their fatty organs, because someone has recommended we eat only lean meat. Unless it is overfishing to supply extra omega 3 fats, which we would not be requiring if we did not consume so much omega 6 fat from vegetable oils.

    New Zealand, with a population of 4 million people, can easily feed its population better than it does without any additional environmental degradation. It is the amount and the type of extra food, surplus to local requirements, that we grow to export overseas that causes our problems.

    I have read your BMJ letter before, and noticed a few things I would like to point out. There is no link between saturated fat and CVD, but there is a link between high cholesterol and CVD. This can be explained by the fact that refined carbohydrates elevate LDL more reliably than saturated fats do. In fact your letter draws attention to the effect of sugars on cholesterol (http://www.anzos2013.org/2013-program/) Recent analysis has showed a strong correlation between sugar consumption and CVD. Even at the height of fat phobia, the correlation attributed to saturated fat was never as strong as that currently attributed to sugar.
    But, it is possible to eat only pure sugar. It is not possible to eat only saturated fat. Even butter, the usual whipping boy, contains MUFA, some PUFA, and some fats commonly believed to be beneficial such as MCTs and butyrate.

    If replacing SFA with PUFA does produce a benefit, (albeit a small one), this represents two (or three) interventions. One is, increasing PUFA. The other is, decreasing SFA. How is it determined that BOTH of these were essential for the effect? The third intervention is, increasing omega 3 relative to omega 6. The trials that tipped the meta-analysis in favour of PUFA were those that supplied omega 3 oils. Unfortunately at least one of those trials, the Finnish hospital one, was so poorly controlled it should probably have been excluded. In any case, if you only count trials of omega-6 PUFAs, these increased CVD risk in meta-analysis.

    The inference I would draw from the research is that replacing sugar and flour with fish, nuts and olive oil is probably going to do some good, if one is at risk of CVD. Arguably this is medicine, not nutrition, but at least it doesn’t seem to be a bad idea.
    But, to put it crudely, if replacing SFA with refined carbs is a bad thing, then replacing refined carbs with SFA is a good thing. I don’t see how one can avoid drawing this reciprocal conclusion from Jakobsen et al.

    The evidence you cite in your BMJ letter supports the view that it is not necessary to limit saturated fats in order to get benefits from unsaturated fats and the restriction of refined carbohydrates, which is basically Malhotra’s position, more than it supports the view that Malhotra is wrong. This struck me when I first read the letter, and is equally clear now on rereading it.
    One can also factor in the important issue of food quality – Malhotra is not recommending PUFA and MUFA from margarine or refined oil – and all the additional information about omega 3 and omega 6 available (a very important distinction which the letter doesn’t mention).

    • I fear that this paragraph in the BMJ letter, while accurate, is disingenuous.

      “The direct evidence for an association between saturated fat intake and CHD is less clear, but this is hardly surprising. A recent meta-analysis of prospective cohort studies by Siri-Tarino et al (2010) suggested no association between saturated fat intake and CHD (11). However cohort studies may be confounded by not taking into account sources of replacement energy, misreporting of dietary saturated fat intakes or measurement error resulting in regression dilution effects, and by inappropriate adjustment for lifestyle factors (12). In pooled analyses of cohort studies inconsistent adjustment for potential intermediates in the diet-disease pathway, as well as for energy intake, may also result in residual confounding.”

      You must be aware that exactly the same criticisms apply to every single diet observational study you cite in defense of your current view.
      Most of the recommendations made around diet are based on weak correlations that may or may not be the product of error. Often someone has been asked to remember what they ate on one day, then this is assumed to play a part in whatever happens to them during the rest of their life. A significant proportion of participants will always report eating too few calories to keep them alive, let alone maintain them at their recorded BMI.
      In real life people, after completing questionnaires about diet, can turn vegan, give up sugar, eat meat again if vegetarian, go on a diet, get addicted to some new junk food product or obsessed with some superfood, become alcoholic, dry out, and so on. Most observational studies take little account of any of this, at least when the results are given to the media.

      I am only aware of one diet study series that tried to avoid the pitfalls associated with the unreliability of remembered food intakes.


      You can make of this what you will, but at least it is designed in a way that avoids the vagaries of self-reported intake, it uses a real disease diagnosis as an endpoint (i.e. the outcome is not dependent on the “metabolic risk factors” the importance of which may itself be debatable) and the hazard ratios is so strong (0.38) that it is unlikely to be due to chance.

      • Regarding the comment on the Siri Tarino paper: Our next paragraph (below) clarifies our argument – reporting findings by Jakobsen et al and Mozaffarian et al that showed that there was indeed a benefit of saturated fat reduction only when saturated fat is replaced with PUFA. The Mozaffarian article was a meta-analysis of randomised controlled trials (gold standard evidence!) so the confounding of associations by inaccurate dietary intake reporting shown in prospective cohort studies (such as Siri-Tarino study) is minimised.

        “The findings are more clear when also considering what replaces saturated fat. In a data pooling study of 11 prospective cohort studies examining the effect on CHD risk of substituting carbohydrates or unsaturated fats for saturated fats, Jakobsen et al (2009) showed that replacing saturated fat with polyunsaturated fat resulted in a significant reduction in CHD risk whereas substitution with carbohydrate resulted in a modest increase in risk (13). Arguably the strongest confirmation of the diet-disease relationship comes from randomised controlled trials. In a metaanalysis of 8 relatively long-term trials Mozaffarian et al (2010) showed a significant reduction in CHD events in studies where saturated fat reduction was achieved by substitution primarily with polyunsaturated fat, thus confirming the findings of Jakobsen et al (14).

        The limitations with dietary assessment are well recognised and research into novel “biomarkers” (such as phospholipid trans-palmitoleate) for better estimating nutrient intakes is an emerging field. Indeed I currently have a phd student working on urinary and red blood cell biomarkers for measuring free sugars intake. Good biomarkers that show a clear and consistent relationship with dietary intake will help us be more confident in determining nutrient-disease relationships.

        How the phospholipid trans-palmitoleate biomarker relates to dietary intakes is not yet well understood and few studies have examined it. Although it reflects dairy intake in some way the biomarker is not entirely related to total dairy fat intake. So while interesting, this preliminary research cannot support overturning recommendations reduce butter intake.

      • Lots of poor RCTs isn’t an indication of gold standard, they are just poor RCTs. I’ve enjoyed the contribution of the lay public who frankly are going to change the world because their collective consciousness beats all of academia

      • “this preliminary research cannot support overturning recommendations to reduce butter intake”.

        Well maybe not if those recommendations had been based on sound science to begin with. But if we look at the science that supported that recommendation initially, it was very poor indeed.

        Amongst many other considerations, the “PUFA for SFA” never answered the question, what will happen if we keep SFA (including from butter, which has rarely if ever been isolated) the same, but increased PUFA from wholefoods in place of junk carbohydrate. There is no evidence whatsoever that this would not have been a much sounder recommendation.
        Instead, we have seen attempt after attempt to shore up the Ancel Keys theory. Meanwhile, a population eating 1/4 of the butter once consumed is sicker and fatter.
        If a population eating less animal fat and more polyunsaturated vegetable fat than formerly, which is the world-wide reality according to WHO and very much the case in NZ, had become healthier as a result, we would not have this debate.
        In fact, New Zealanders no longer eat enough butter for advice about replacing it to mean anything.
        And when we talk about SFA in the diet, we increasingly measure palm oil, hydrogenated fats used in shortening etc. Because of the idea that vegetable fats are healthier than animal fats.
        Which is just one of the ways in which the PUFA concept has been twisted.

        Anyone who recommends replacing “butter with margarine” has never read all the labels on all the non-dairy spreads in the supermarket. And I would say they have lost touch with the concept of nutrition, and have become enamoured instead with an illusion of being able to medicate people with foods that aren’t real foods, but are more like patent medicines, rather than nourishing them. And above all, they are ignoring the obvious sickness all around them, which the confusion caused by this effort has helped to spread.
        That people who are sick get better when they reverse this madness, ignoring some of the well-meant advice about the evils of animal fats and the essentiality of wholegrains, but accepting wholeheartedly other advice about sugar and deep-fried food (there is not one LCHF person who thinks the fat in a donut is its saving grace), ought to point the way back to reality, real food, and recognisable nutritional principles. Public health nutrition has had its incontrovertible victories, and these have included whole milk in schools, iodine in salt, restrictions on margarine, and cod liver oil for children; a list that now includes some of the very gains that have been undermined by current fads.

  14. Grant, Mozaffarian and collegues address the issue of the limitations of these studies in his paper. But the findings are compatible with totality of the evidence around saturated fat replacement with PUFA. Forgive me if I have more confidence in the research of these Harvard epidemiologists than the lay public!

    “Given these limitations of each individual trial, the quantitative pooled risk estimate should be interpreted with some caution. Nevertheless, this is the best current worldwide evidence from RCTs for effects on CHD events of replacing SFA with PUFA, and, as discussed above, the pooled risk estimate from this meta- analysis (10% lower risk per 5%E greater PUFA) is well within the range of estimated benefits from randomized controlled feeding trials of changes in lipid levels (9% lower risk per 5%E greater PUFA) and prospective observational studies of clinical CHD events (13% lower risk per 5%E greater PUFA). The consistency of the findings across these different lines of evidence provides substantial confidence in both the qualitative benefits and also a fairly narrow range of quantitative uncertainty.”

    • Lisa, I think it is possible for the evidence in favour of replacing SFA with PUFA to be interpreted in ways that are more compatible with the totality of evidence, including meta-analyses exonerating SFA in CHD.
      These show no benefit from the lowest SFA intakes.
      Replacing SFA with carbohydrate – no benefit from reduced SFA
      Replacing SFA with MUFA – no benefit from reduced SFA
      Replacing SFA with PUFA – benefit in terms of CHD events and lipid profiles (not so sure about mortality).
      These results don’t seem to support the reduction of SFA, so much as they seem to indicate a special role for PUFA. PUFA is mainly made up of essential fatty acids, thought to be essential in the same way vitamins and amino acids are. Therefore deficiencies can exist, and individuals may have unusual requirements for various reasons (the instability of these fats can be a factor here).
      To correct a nutritional deficiency, or to use a nutrient for medical purposes, it is not usually necessary to restrict intake of a different nutrient, though there are exceptions.

      What happens if advice to replace SFA with PUFA is followed zealously by a population eating processed food?
      “Israel has one of the highest dietary polyunsaturated/saturated fat ratios in the world; the consumption of omega-6 polyunsaturated fatty acids (PUFA) is about 8% higher than in the USA, and 10-12% higher than in most European countries. In fact, Israeli Jews may be regarded as a population-based dietary experiment of the effect of a high omega-6 PUFA diet, a diet that until recently was widely recommended. Despite such national habits, there is paradoxically a high prevalence of cardiovascular diseases, hypertension, non-insulin-dependent diabetes mellitus and obesity-all diseases that are associated with hyperinsulinemia (HI) and insulin resistance (IR), and grouped together as the insulin resistance syndrome or syndrome X. There is also an increased cancer incidence and mortality rate, especially in women, compared with western countries. Studies suggest that high omega-6 linoleic acid consumption might aggravate HI and IR, in addition to being a substrate for lipid peroxidation and free radical formation. Thus, rather than being beneficial, high omega-6 PUFA diets may have some long-term side effects, within the cluster of hyperinsulinemia, atherosclerosis and tumorigenesis.”

      Diet and disease–the Israeli paradox: possible dangers of a high omega-6 polyunsaturated fatty acid diet.
      Yam D1, Eliraz A, Berry EM.

      There is an interesting discussion here re: The case for not restricting saturated fat on a low carbohydrate diet http://www.nutritionandmetabolism.com/content/2/1/21
      context does matter. A LCHF diet is usually going to be high in MUFA, and will be high enough in PUFA even if you try to limit this.

  15. It’s their experience and research quality rather than their eminence that I respect.

    • Surely we are not just faced with a choice between the Harvard School of Epidemiology, and everyone else, the latter being only the lay public!
      In my estimate a clinician with years of experience with real people will always beat an epidemiologist. I’m not implying that all clinicians agree, but that their opinions are based on sounder foundations, having been tested against the realities of health and disease, so are much harder to discount (If you experiment needs statistics, you should have designed a better experiment – Sir Ernest Rutherford).
      The results you mention talk of, for example, “13% lower risk per 5%E greater PUFA”.
      Why is it necessary to restrict SFA to produce this benefit from PUFA? Just because this is what was done, that SFA was never left as is because the rest of the Keys theory required changing it, does not prove that it was necessary.
      And what is the baseline? At what % PUFA do benefits start to reverse? Does every 5% increase keep on giving a 13% reduction in risk? What of the high ratio of PUFA to SFA in the deep fryer at Macdonalds or KFC, is this lowering risk if it is substituted for butter?
      Why is CHD the bully boy of public health? Because it is the only outcome that still seems to support, just a little, depending who you ask, the recommendations that were once expected to produce wider benefits?
      What of obesity, diabetes, stroke, cancer, macular degeneration, susceptibility to infection, autoimmune diseases? Morbidity as well as mortality? Quality of life?
      What is the role of omega 3 fatty acids? In the RCTs of fatty acid substitution, if you take away the omega 3 interventions, you are left with a tendency for harm with increasing PUFA.
      The RCTs are the gold standard, aren’t they? Even if only a fraction of the possible and practicable interventions have ever been accorded the privilege of repeated large-scale RCTs – those that the general population seems to have been persuaded into, well before the results of those RCTs have been settled.

  16. I thought it good to take stock of where we are at, by checking the nutritional advice currently available from the NZ Ministry of Health:
    Even knowing what to expect, there is much in this that shocks me and seems contrary to sound nutritional practice, even of a conservative sort. This is definitely a high-carbohydrate, low-fat eating plan, one which limits added sugar yet encourages the free consumption of refined starches (“Fill up on breads, cereals, pasta and rice”)
    What fats are in this diet seem to come from deep fried food, which should be cooked at higher temperatures.
    Any food that has natural fat in it is to be trimmed. We may not add olive oil to salads or butter to cooked veges (and presumably the limitless amounts of bread are to be eaten dry).
    The advice is said to be “under review” (this may have been the case for years). It will be interesting if the next version tries the “replace SFA with PUFA” trick, because there is so little natural fat left to substitute.
    In the light of this procrustean advice, which has been passing for a Public Health approach to diet by our Government for the past decade, Caryn Zinn’s implied criticisms seem far too kind.

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  18. Interesting discussion going on here. As a lay person, my introduction to a low carb diet came about in 2012 when I read Dr Steven Gundry’s book “Diet Evolution”. Soon after my husband’s heart operation in July of that year, I supported my husband as we both changed our diets and started following Dr Gundry’s recommendations.

    We have understood the guidelines and have completely cut out all grains and sugar from our diets. We eat good quality healthy fats like olive oil, coconut oil, avocado and nuts. As we do not eat bread, we do not eat butter or margarine. We eat very little animal fat.

    As a result I have dropped two dress sizes to size 10, and my husband has dropped almost 25kg. We both have more energy, and we do not get hungry. We do not crave sweet foods or grains. We do not plan to revert to eating grains again – the thought makes me feel ill.

    As my husband was also diagnosed with diabetes we are watching with interest as to how that will be affected by his eating lots of fresh veggies and healthy fats!

    BTW before starting Diet Evolution I thought I ate a healthy diet. We home grow many of our veggies and eat home cooked meals. However as soon as I stopped eating my “healthy” wholemeal sandwich for lunch, my bloated stomach and sticking out back side started to shrink – I now feel very comfortable wearing skirts!

    It is very refreshing to hear from a dietician who has opened her mind and not stayed stuck in the past!

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