In this episode, Dr. T addresses a recent study that came out on the effects of low carbohydrate diets on mortality. What should we make of it?
The Study and Multiple Debunkings:
The Original Study Paper: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3059453/
Dr. Zoe Harcrombe debunks the study: http://www.zoeharcombe.com/2018/08/low-carb-diets-could-shorten-life-really/
Dr. Andreas Eenfeldt debunks the study: https://www.dietdoctor.com/all-over-media-low-carb-diets-could-shorten-life
Dr. Georgia Ede’s debunks the study: https://www.psychologytoday.com/us/blog/diagnosis-diet/201809/latest-low-carb-study-all-politics-no-science
Chris Kresser’s debunks the study: https://chriskresser.com/will-a-low-carb-diet-shorten-your-life/
Dr. Aseem Malhotra debunks the study (TV clip): https://www.dietdoctor.com/dr-malhotra-on-bbc-news-claim-that-low-carb-shortens-lifespan-is-completely-false
Stanford’s Dr. John Ioannidis article in the Journal of the American Medical Association calling for major reform in this field: https://jamanetwork.com/journals/jama/article-abstract/2698337
A Tour of the Migraine Miracle’s 9 Primary Resources: https://www.mymigrainemiracle.com/how-we-can-help
MIGRAI-NEVERLAND, our premier resource for those who want to find their pill free path to migraine freedom: mymigrainemiracle.com/endofmigraine
The “KETO BLAST” 30 Day Challenge: mymigrainemiracle.com/ketoblast
Migraine Miracle Facebook group: https://www.facebook.com/groups/899131986822364
The book that started it all – The Migraine Miracle: https://www.amazon.com/Migraine-Miracle-Sugar-Free-Gluten-Free-Inflammation/dp/1608828751
Hey, folks. Welcome to The Miracle Moment. In this week’s episode, I’m going to be covering a controversial study that recently came out about low-carb diets, a study that was covered by many of the major media outlets that maybe some of you heard about. It was also one that several of you asked about, so, I thought it’d be a good topic to cover for this episode of The Miracle Moment.
Before we get to that, a little bit of housekeeping. Our next Keto Blast challenge launches Saturday October 20th. So, the ketogenic diet has really taken off in the past couple of years as a treatment for many things, most notably obesity and diabetes.
Some of you are likely aware that it can also be a weapon against migraines. I’ve personally be using a ketogenic diet intermittently with really great success for almost eight years now, and with many patients and folks in our community. So, the Keto Blast gives a migraine-friendly way of taking advantage of this.
There is no one, single ketogenic diet, and as I’ve talked about before on the podcast, there are many ways to get into nutritional ketosis, and it’s entirely possible to eat a ketogenic diet that would be quite bad for migraines.
So, if you’d like to take part in our 30-day Keto Challenge with a migraine-friendly version of the ketogenic diet, head to KetoForMigraine.com where you can find more information and a link to sign up. And, if you happen to be listening to this after this last one has already gone, you’ll find the date of our next one, because we hold these every few months.
You can also take part in our Keto Blast Challenge by joining MigraiNeverland which gives you unlimited access to all of our 30-day challenges, among many other things. And so, you can learn more about MigraiNeverland at MyMigraineMiracle.com/EndOfMigraine.
You can also check out all nine of our primary resources for migraineurs with The Migraine Miracle Plan by going to MyMigraineMiracle.com and just clicking on the resources tab on the top menu. Until the migraine beast is wiped off the face of the earth, we plan to keep doing what we’re doing to help folks find their path to freedom without pills.
All right. So, like I said, in this episode I’m going to be covering a recent study that came out that generated a lot of press. It was specifically on the topic of low-carb diets and their relationship to mortality. As is usually the case with these controversial topics in nutrition, the story went viral and led to a lot of anxiety over its conclusions, or, at least, I should say, how the media reported its conclusions.
As much as I’d rather not have to give this sort of thing any attention, I know that it’s probably worth addressing at least once, because shielding yourself from the many forces out there that stand in the way of progress to migraine freedom is one really critical part of being successful.
Those forces include both the popular media and the field of nutritional epidemiology, and the lethal combination that often arises when those two power-houses of misinformation join forces.
First of all, what does this all have to do with The Miracle Moment podcast? Or the Migraine Miracle Plan? The foundational Migraine Miracle Plan isn’t necessarily a low-carb plan.
The basic plan is really agnostic with respect to the amount of carbohydrates. The essence of the food part of the plan is to eat whole, nutrient-dense foods that are appropriate for the human species, because many wonderful things ensue when you do so, including the elimination of migraines.
However, because elimination of added sugars, processed foods, and gluten grains is part of eating like a human, if you’re coming from a standard Western or American diet, which, by comparison, is a very high-carbohydrate diet, even the elimination of those things will almost certainly lead to a major reduction in carbs. Furthermore, we also do know that deliberately restricting carbs is an additional tool that one can use to accelerate their progress, including very low-carbohydrate diets that will lead to nutritional ketosis.
But, if this new study is to be believed, eating a diet that’s lower in carbs supposedly increases your risk of dying earlier, and we’ll get into the details of that in a minute. So, on the one hand we have all of this evidence for the therapeutic benefits of low-carbohydrate diets, not just for migraines, but for all sorts of other conditions, with results far beyond what any drugs can do and results that we know are associated with major health benefits.
So, there’s really no way to reconcile those facts with the results of this study.
Now, if you think it’s unlikely that the results of one study invalidate the direct observations of thousands of clinicians, scores of other clinical trials and the experiences of literally millions of people, and that as such it must mean the study is bogus, and you’re not really that interested in the details as to why that is, then feel free to stop and move on to the next episode.
But, I would encourage you to stick around, just because what I’m going to review may come in handy the next time this sort of thing rolls around.
Here’s just a hypothetical scenario that demonstrates how absurd this is: imagine if I eat a 2,000 calorie diet, 2,000 calories a day, and that includes drinking a six-pack of soda, so just water and sugar every day, each of those sodas containing 39 grams of sugar, which almost means 1,000 of my calories, or roughly half, are coming purely in the form of sugar. And then, I decide to cut out soda altogether and drink water instead, and I replace those calories with whole foods like meats, fruits and vegetables.
So, now I’ve replaced those sugar calories which contain zero nutrients other than carbs with a mix of protein, carbohydrates and fats, along with all the other micronutrients, like vitamins and minerals.
Any way you look at it, doing this sort of thing would be enormously beneficial to my health. That’s something there would be no debate about.
Yet, if I were to do this, I’ll have cut my carbs significantly, and if I were to interpret the conclusion of the study at face-value, I would conclude that doing this would make me die sooner. So, this study would say that getting those 1,000 calories a day from soda is better than 1,000 calories a day from meats, fruits and vegetables.
We’ll talk about, in a minute, how the reason we’ve ended up with such a ridiculous conclusion is because the study begins by asking the wrong kind of question. Really, the big danger to me with a study like this is not just the fact that it’s so objectionable from a scientific standpoint, but even more so because of its potential to lead people to abandon dietary changes they’ve made that will unquestionably improve their health and relieve suffering, and that makes it really hard to interpret the publication of a study like this in a charitable fashion and has led many folks to question the motivations of the authors of it.
Like I said, I’d rather spend no time on these things, but one of the problems right now in the world of health and nutrition, which leads to so much confusion and contradictory advice, is that it’s in a massive state of flux right now, and a lot of things are controversial. We’re in the process of a major correction after a half-decade or more of really bad advice from some of the authorities in this area.
Ironically, advice derived from exactly the same kind of research that we’re talking about today.
What this means is that on one hand, you have this major correction going on where we’re realizing that what we’ve been told was wrong, while at the same time, you have some pretty powerful groups and people with invested interests in maintaining the status quo, or keeping that old advice around, and we have entire industries that have been built, really, around the old story we were told. Things like, “sugar is a harmless calorie,” or, “fat and meat are bad,” or, “grains should be the foundation of our diet.”
So, you have powerful interests with a lot to lose if the entire population starts changing their eating habits.
As a result of all this, as we move through this correction and towards a better understanding of what’s true in matters of health and nutrition, you have these countervailing forces that are resisting those changes very hard. And those forces oftentimes come in the form of a big study that’s conducted or funded by these vested interest, that try to resist this correction. Whether it’s to say sugar is really quite harmless, or red meat or saturated fat is going to kill you, and so on.
On top of that, to add more fuel to the fire, because this stuff is controversial, it makes for great headlines. And the more sensational the headlines, the more clicks the story gets. So, the controversy and confusion gets amplified in the internet age. For almost the past decade or so we’ve had this repeating cycle every few months where one of these stories comes out, it gets massively circulated, people start to panic who’ve been making changes in the right direction, and then nobody knows what to think about anything.
All-in-all, I imagine this sort of thing is going to continue for the foreseeable future, with studies like this and this type of media response coming out every so often, leading to another round of fresh anxieties. So, my biggest concern with this sort of thing is that it can undermine people’s efforts to get control over their health, and in our case to slay the beast once and for all. The last thing I want is for some bad science and irresponsible journalism to lead you away from the thing that could potentially save you from many years of suffering.
So, this particular episode can serve not only as a response to this most recent study, but also to all the future studies of similar ilk that will undoubtedly come in the future. My hope is that I can do this one time and be done with it, and then go back to talking about what’s really true and helpful for you in your journey to slay the beast, and for better health. Like I said before, I know that part of being successful is insulating yourself from some of the forces that might derail you, and so this is part of that effort.
Okay, so, with that little rant out of the way, now I’m just going to give you the details of what was actually done in this study, and then you can decide for yourself how seriously you should take it. Because, I think whenever you hear a sensational new headline about health, just getting into the habit of asking how the researchers came to a particular conclusion, or whether or not the person reporting on it is actually reporting on it accurately, is really helpful.
Because, what typically happens with these things is that a study like this gets published, the major media outlets pick it up, do a terrible job of reporting on it, exaggerate it, try to make it as controversial and salacious as possible, and then hardly anyone, including those who were reporting on the study, actually go and look at what was done in the study, or go to the source and decide for themselves whether it’s significant or not.
That’s what we’ll do here, and I think when you hear the details, you’ll be quite astounded, and then the next time one of these things rolls around, you might not be swept up in the insanity. So, the subjects in this study were from four different communities across the United States. Roughly 15,000 people in all in the study population. In these particular kinds of studies, people in a community will sign up to be part of it, and then the researchers will track various lifestyle and health measures, and then look at that data to see if they can tease out certain associations between things.
So, in this case the subjects were part of the Atherosclerosis Risk in Communities Study. So, the primary intent of the study was to try to find factors that increase the risk of atherosclerosis, or hardening of the arteries. In this case, the authors are essentially mining this data that was collected from this study to look for other associations they can find, in this case between low-carb and mortality.
Essentially, then, you have these people in different communities that have had their health data collected for years, and for this particular study, what they did was analyze two different food frequency questionnaires that these people had filled out during their time in the study. One of these questionnaires was filled out in the late 1980s, and another questionnaire was filled out six years later.
So, they had two over the span of six years. They weren’t tracking what they ate in any way, and they weren’t monitored in any type of lab, they were just given a survey about what they’d eaten.
That survey asked them to report what they’d eaten over the past year, and then they took the data from those two surveys, which, again, asked people to report what they ate over the past year from memory, and these are people who hadn’t been keeping records of what they ate, and no, that’s not a joke.
And then, using the data that’s collected from those surveys, they then divided people into groups based on the estimated number of carbohydrates they ate each day, from those surveys, and then they looked at how the amount of carbohydrates they ate correlated with their risk of death over the next couple of decades.
So, after crunching those numbers, they concluded that those who got fewer than 30% of their calories from carbs had a slightly higher mortality rate. Again, based on two surveys they filled out about what they ate over the past year.
So, that’s the study. That’s what was done, and that’s the study who’s results were then picked up by media outlets everywhere with headlines saying “Low-Carb Diets Kill People”. I’d imagine after hearing those details that some major alarm bells are going off. “Surely,” you think, “there must be more to it? To lead to such strong statements?” Right?
Now, it turns out these food frequency questionnaires, as they’re known, they aren’t new, and they’ve been used in the past for research. You might wonder if anyone has looked at whether these questionnaires are actually accurate. So, are people able to accurately report on what they’ve eaten over the past year from memory? And the answer is, yes, they have looked at it, and you won’t be surprised to learn that food frequency questionnaires have been shown to be totally inaccurate, and unsuitable to be used in a scientific study like this.
Now, I imagine the vast majority of people who heard this headline would be pretty surprised to learn that this was what it was based on, and would assume it was from some kind of rigorous scientific analysis. But like I said earlier, most people aren’t going to dig up the original paper and look at the methods, but would rather accept what was reported. And most reporters are in the same boat as well.
While there’s actually many other things methodologically suspect about this study, I think for most people, just hearing how the study itself was conducted is enough to make it really hard to take the conclusion seriously. Another really big problem here, which I alluded to earlier, is that the question that’s being asked by this study, which is “Is carbohydrate intake associated with mortality?” Is a terrible one. That’s because it treats all carbohydrates as a single thing, meaning it’s not distinguishing between the carbs from, for example, sugar in a soda or a piece of cake, and the carbs from vegetables.
This is something that’s been done repeatedly in nutrition research, and people have been criticizing it for quite some time, because it renders that research useless. As an analogy to show why this makes the conclusions useless, imagine if I were to try to determine if playing sports increased your risk of concussion.
So, I do a study where I lump all sports, including things like ping pong and bowling, with other things like football and cliff diving and soccer, and I find that yes, indeed, people who play sports do have a higher rate of concussion. So, I caution people against playing sports.
Now, all the ping pong players and bowlers out there stop playing because they’re worried about a concussion, but, of course, we know that it was only specific sports that mattered in this analysis, and anyone who analyzed such a study, who had any understanding of what sports were, would wonder why the heck the researchers were lumping them all together. They might even wonder if they maybe had some hidden agenda against playing sports, and so deliberately designed the study in a way that would allow them to make a broad claim against it.
The other point that I want to make here is that these kinds of observational population studies are not intended to ever determine cause and effect relationships between things. Their only purpose is to try to find associations that might suggest a hypothesis or a potential cause and effect relationship. That’s because almost all the associations that you’re going to find in a study like this, like carbohydrates and mortality, for example, are almost never going to be because of cause and effect relationships.
They’re either going to be coincidental or because of other hidden factors, and so on.
So, while in principle this kind of research can conceivably be helpful if it’s performed and used rationally and responsibly, but the problem is in practice it’s been a disaster, largely because so often people are using these kind of associations as evidence of a cause and effect relationship in order to support a pet theory.
For example, if you think low-carb diets are evil, or if you want to promote sugar as a harmless, empty calorie, you can do these kind of studies, and mine this kind of low-quality population data, and give the illusion that you’re right.
This entire field of research, where people mine data from populations trying to find associations between diet and lifestyle factors and health outcomes, is referred to as nutritional epidemiology. There are increasing numbers of people saying that the entire field of nutritional epidemiology needs to either have serious reform, or be scrapped altogether, because it’s been a destructive force on balance.
This study is a perfect example of why that is. A study like this not only doesn’t advance our scientific knowledge in any meaningful way, but it has real potential to do harm. In fact, John Ioannidis, a professor at Stanford and one of the most respected epidemiologists in the world, recently wrote an editorial in JAMA calling for reforms, saying the emerging picture of nutritional epidemiology is difficult to reconcile with good, scientific principles, and you really couldn’t hold up a better example of that than this particular study. Especially given its potential negative impact.
One brief final point that I’ll make, those of you who are paying attention may have heard me say that in this study the low-carbohydrate group was defined as those eating fewer than 30% of their calories from carbohydrates. On a 2,000 calorie diet, that would be 150 grams a day, which nobody in the low-carb community would even consider to be a low-carb diet.
So, there’s also the problem that their analyses, even if those food questionnaires were accurate, weren’t even analyses of low-carb diets. But, again, you don’t find these things out unless you actually look at the original data from the study.
As I mentioned earlier, those of us who care for patients and have used carbohydrate restriction as a therapeutic tool know that this is false, and know that this was a silly question to even ask to begin with. Now, as I said, while this study has been almost par for the course in the field of nutritional epidemiology, I wouldn’t be surprised if this isn’t the last you’ve heard about this particular study, given how especially egregious it is. I think The Lancet, which is the journal that published it, and is generally a good journal, is catching some heat from the scientific community about their decision to publish it.
So, I wouldn’t be surprised if there was some kind of follow-up response about it.
There are lots of people out there doing careful, good science, and studies like this undermine their credibility. I feel particular bad for those who happen to be published in the same issue, not only because all of the coverage was about this particular study, but also because it brings their credibility under question by association.
Okay, so, that’s my short take on this with a little bit of a rant mixed in. Believe it or not, I only touched upon some of the issues with this study. Other folks have dug deeper into even more of the specifics, and perhaps one of the best analyses is from Dr. Zoe Harcombe, who has a PhD in Public Health Nutrition, provides two separate things that are suspect about this study, and I will link to that in the shownotes. It’s very well done, and I would recommend anybody who has more than a passing interest in it to take a look.
Some of you may think I’m being harsh here, but the main reason for that is because the stakes are so high. There’s poorly done research like this published all the time, but in this case, if it’s taken as fact, it has the potential to do a lot of serious damage to a lot of people. Myself and others who recognize this feel obligated to try to minimize the negative impact.
In fact, many of us in healthcare know that it’s this exact kind of bad research that’s to blame for the crisis that we now find ourselves in, including the numbers of folks with chronic migraines, and had more people spoken out about this kind of research in the last few decades, perhaps the hole we now have to dig ourselves out of wouldn’t be so large.
Okay, so, just to summarize, low-carb diets are not going to kill you. As I said, one of the worst parts about studies like this that come out periodically is just having to spend time analyzing them and talking about them. It’s like being forced to sit through a bad movie, and it feels like every few months we have to once again prove why 2+2 doesn’t equal 5, or discredit the latest UFO sighting that all of the media outlets are picking up and reporting as legitimate.
But, I know this kind of noise can derail folks, and I know if you’ve gone low-carb or keto, it’s quite likely you’re going to be sent an email about this study, or one like it, from friends or family. So, you can direct them to this podcast, or to the other links that I’ll put in the shownotes for this episode. Which, by the way, you can find links for all the episodes at MyMigraineMiracle.com/Moment.
Okay, so, that’s all for this episode. As I said at the beginning, our next Keto Blast launches October 20th. We’d love to have you, if you dare, and you can find the shownotes for this episode by going to MyMigraineMiracle.com/Moment, which will include links to some of the other analyses of this article, along with a link to the original article if you want to look through the study yourself.
As always, thank you so much for listening. Now it’s time to go out and slay the beast.