Errors in The Queen of Fats

Susan Allport’s The Queen of Fats is the best introduction to omega-3 fatty acids and their importance that I know of. I learned a lot from it (and interviewed the author). This is why its errors are interesting; they shed light on the big nutritional misconceptions of our time (as Weston Price, the subject of yesterday’s post, did in a different way). Joel Kauffman, a chemist, made a list:

1. On p1 low-carb bread and beer are ridiculed despite evidence (see Nielsen JV, Joensson EA, Low-carbohydrate diet in type 2 diabetes. Stable improvement of body weight and glycaemic control during 22 months follow-up, Nutrition & Metabolism 2006;3(22) doi:10.1186/1743-7075-3-22) to the contrary. There are at least 10 studies supporting Nielsen. Low-carb means low insulin demand. Insulin converts carb to fat. Allport’s claim that the world’s leanest peoples mostly eat carbs neglects to mention that they are malnourished.

3. On p2 and later Allport calls saturated fatty acid chains “straight,” then still later by the correct term “zigzag,” but never by the chemist’s term “unbranched.” She is not aware that a saturated fatty acid chain of 22 carbons has many more conformations than the 22-carbon DHA with 6 carbon-carbon double bonds, or that double bonds keep 4-carbon groups rigid. If DHA “is constantly on the move” there must be some other reason.

5. On p10 canola oil, which is not rapeseed oil, is not usually promoted for its linolenic acid content, but for its low saturated content, lower than olive oil. This is not a real advantage, according to all the books (except Sears’) I have listed above.

6. The conundrum of eating fish for its omega-3s despite the mercury content was not resolved on p11 or elsewhere. There are two long-term studies showing that there is not a big problem: The Chicago Western Electric Study followed the effects of fish consumption in 2,107 men aged 40-55, and followed for 30 years. Those who ate an average of *35 g daily (about 1 big fish dinner every 5 days) had only 9/10 of the all-cause mortality rate of men who ate no fish. The Nurses’ Health Study on 84,688 women aged 34-59 years and followed for 16 years for outcomes vs. fish and omega-3 fatty acid intake, had the following findings: women consuming fish five times weekly had only 7/10 the all-cause mortality rate of those eating fish once a month. Pregnant women have been cautioned to restrict their intake of fish (https://www.cbc.ca/storyview/CBC/2002/10/21/Consumers/mercuryfish_021021) despite evidence that children receive most of their mercury from vaccines. Hepatitis b vaccine carries 12.5 micrograms per dose; influenza and other common vaccines carry 25 micrograms per shot, over 830 times the amount in a can of tuna. It has been reported that vaccines said not to contain the mercury compound, thimerosal, still might have it. The long duration of the diet studies makes it very clear that the mercury content of fish, in general, is not shortening life.

7. On p14 eating fat in general was used as a straw man and implied to be the major cause of heart disease. Not so; see below (section titled More at bottom of post).

8. On p15 the Framingham Study was claimed to have shown a positive link between serum cholesterol and risk of heart disease. This was disproven by 1937 by experiments on cadavers. See The Cholesterol Myths and either Great Cholesterol Con [there are two books with this title]. See above for evidence that the Seven Countries Study was a fraud. A more recent study on free-living elderly in Manhattan showed the opposite — those with the highest cholesterol and LDL0C levels lived the longest. See Schupf N, Costa R, Luchsinger J, et al. (2005). Relationship Between Plasma Lipids and All-Cause Mortality in Nondemented Elderly. Journal of the American Geriatrics Society 53:219-226.

10. On p20 the excessive bleeding in Eskimos is said to be unimportant vs. lower heart attack rates than those of Danes, but external bleeding, as with aspirin, probably indicates internal bleeding.

11. On p21 it was written that polyunsaturated fats held down cholesterol levels. Actually HDL levels were held down and there was no drop in mortality: Rose GA, Thomson WB, Williams RT (1965). Corn Oil in Treatment of Ischaemic Heart Disease. British Medical Journal 12 Jun:1531-1533.

12. On p22 gas-liquid chromatography was said to have been developed in the 1950s by oil companies. A Google search showed its invention in the 1940s to separate fatty acids: see James A T & Martin A J P. Gas-liquid partition chromatography: the separation and microestimation of volatile fatty acids from formic acid to dodecanoic acid. Biochem. J. 50:679-90, 1952. [National Institute for Medical Research, Mill Hill, London, England]

13. On p22-3, 25 it is implied that the increase in heart disease in Eskimos who adopted aspects of a Western diet is solely due to differences in omega-x fat intake. No attention was paid to the effect of carbs on a very carb-sensitive population.

14. On p25 Allport insults Spam for being “highly saturated.” This is nonsense, since lard is only 40% saturated. See Know Your Fats by Mary G. Enig, 2000.

17. On p49 the “pure cholesterol” fed to rabbits has been shown to be oxycholesterol, which is not healthful.

18. On p51 Ancel Keys, MD, was said to link serum cholesterol to heart disease, but this link had already been shown to be false in 1937 by work on cadavers.

19. On p54 Allport wrote that EPA was responsible for low cholesterol in Eskimo blood on traditional diets, but linoleic acid based fats do this also, and human fat is 10% linoleic (lard 6%).
20. On p57 was written that pork and dairy fats are very saturated. Actually, the former is about 40% saturated and the latter 62%. See Know Your Fats.

31. On p66 a crack was made about an unbalanced diet. Since some populations have survived for centuries on all animal diets, a balanced diet turns out to be a fantasy designed to raise carb consumption despite a lack of evidence that there is any requirement for carb at all in the human diet. See the Ottoboni’s book. Also, there is vitamin C in fresh meat, so worrying about scurvy was not justified.

32. On p68 the claim that fats and carbs make up over 80% of the calories in every diet consumed by humankind is absurd, based on traditional Eskimo and Masai diets, among others.

33. On p 69: “so fat gives foods their distinctive aromas and tastes.” What about the odor of fresh bread, hot marshmallow, citral and neral in fruit, licorice, mint, wine, beer, etc.? These are not fats.
34. On p71 the statement that the increased energy in fats compared with carbs or proteins comes from their dense packing. The no-nonsense explanation is that carbs and proteins are partially oxidized because they contain oxygen and nitrogen, so oxidizing them the rest of the way to CO2 and water gives less energy than the all-hydrcarbon parts of fats.

35. Also on p71 is the fantasy that unsaturated fats contain less energy than than saturated because a double bond contains 10% less energy than a single bond. My old physical organic chemistry text has 80 kcal/mole for the C—C single bond, and 142 kcal for the C=C double bond, a far cry from Allport’s fantasy. And the energy available on digestion is given above — much less from mostly saturated fatty acids.

36. On p74 the slow melting of butter is not due to the melting points of the fatty acids in its triglycerides (fats), but the different melting points of the fats themselves.

37. On p78 and elsewhere Allport wrote of the high concentration of arachidonic acid and DHA in brain and nerve tissue. Her conflicted position on cholesterol is shown by her refusal to mention that the highest concentration of choleserol in the body is in the brain. But on p148 she writes that cholesterol is a necessary component of brain function

39. On p88 the fantasy begun by Ancel Keys that overconsumption of fats was the major health problem in the West was reiterated without any of the evidence from the books cited above that this was false.

40. On p89 domestic cow fat is said to be only 2% unsaturated. Know Your Fats says it is 42% unsaturated, and the CRC Handbook of 1983-4 says 52% unsaturated.
43. On p100: “In men, it [aspirin] cuts mortality from heart disease by more than half.” This is one of the most flagrant misquotations of the aspirin findings I have yet seen. Actually Bufferin cuts the number of non-fatal heart attacks by half with no change in mortality, and plain aspirin maybe by 1/3, also with no change in mortality.

44. On p104 a common omission characteristic of drug ads is found: “…mortality from heart disease goes up linearly with the increase in omega-6s…” does not include the crucial all-cause mortality, without which no amount of lowered mortality from some single cause has any meaning for action.

46. On p107 Allport implies that the incidence of heart disease in the US has not changed from 1909-1985. In Heart Frauds by Charles T. McGee (2001), p59, heart disease death rate was shown to have changed from 15/100,000 in 1910 to a peak of 331/100,000 in 1968, then falling to 194/100,000 by 1990. McGee shows that this drop corresponded well with an increase in vitamin C intake.

47. On p109 there is a disconnect between Allport’s generalization that seeds contain mostly omega-6s and leaves mostly omega-3s. Both canola and linseed oils are high in omega-3s which are in their seeds.

49. On p114 it was written that certain Nigerians with high omega-3 levels, presumably in blood, ate “a lot of greens” and most fat was palm oil, high in saturated fats, meaning that sat fats (and the other half of palm oil, the monounsaturated oleic acid 18:1*9) do not interfere with the transformation of linolenic acid from those greens into DHA and EPA. OK, then, why did she not relent on her anti-sat fat position?

50. On p118, Allport actually said that “…small amounts of saturated fats are better than large amounts of omega-6s.” This shows her conflict: such small amounts would require much less total fat consumption, and the value of this move has no positive evidence.

51. Also on p118 and 142, Allport minimized the dangers of trans fats, being totally unaware that controlled tests in human subjects showed serious adverse effects. Risérus U, Abner P, Brismar K, Vessby B (2002a). Treatment with Dietary trans10cis12 Conjugated Linoleic Acid Causes Isomer-Specific Insulin Resistance in Obese Men with the Metabolic Syndrome. Diabetes Care 25(9):1516-1521; Risérus U, Basu S, Jovinge S, Fredrikson GN, Årnlov J, Vessby B (2002b). Supplementation with Conjugated Linoleic Acid Causes Isomer-Dependent Oxidative Stress and Elevated C-Reactive Protein. A Potential Link to Fatty Acid-Induced Insulin Resistance. Circulation 106:1825-1929.

52. On p126 in an otherwise good discussion of bad aspects of leaky membranes, a bad simile was used: “…we all know what happens to engines when they run constantly…” Do we? It was found by the 1960s that most car engine wear occurred immediately after startup from cold, while there was no measurable wear during constant running at moderate rpms.

54. On p129 Allport notes that there was not a single known case of diabetes (no type given) in Eskimos of the Umanak district in 1971 on their traditional diet. The implication is that omega-3s did the job, but no airtime was ever given to the zero-carb diets.

55. On p134, again, diabetes (type not given) and obesity were equated to caloric intake, not, as so often demonstrated, carb intake.

56. On p135 one of the classic objections to the Atkins low-carb diet is given — that it causes kidney and liver failure due to higher protein consumption. This was twice false, since no such damage was seen by Atkins in his patients who did raise protein intake; but more important, the missing carbs are ideally to be replaced by fat, which has no glycemic index, unlike protein with a GI of 20 or so.

58. On p139 the blanket recommendations to eat “… lots (and lots) of fruits…” is very destructive to diabetics (both types) and pre-diabetics. Many kinds of fruit are high in sugars. Barry Groves, PhD, Nutrition, Richard K. Bernstein, MD, and William Cambell Douglass, Jr., MD, have avoided fruit for decades and are all in their seventies in good health.

59. Also on p139 the advice to avoid any high omega-6 oil is OK, but the advice to minimize butter is not. Not only is there no danger in butter, but its medium-chain fatty acids have antimicrobial properties. See Know Your Fats, above.

60. On p140 and 142 the advice to eat a wide variety of fish does not account for differences in EPA and DHA content, or differences in mercury content. Benefits of supplements of EPA and DHA have been shown in controlled trials.

61. On p143 saturated fats come in for another absurd hit, this time with the epithet “solid.” Phew! Of course lard and tallow are not solid at body temperature! And they do not cause heart disease: Ravnskov U (1998). The Questionable Role of Saturated and Polyunsaturated Fatty Acids in Cardiovascular Disease. Journal of Clinical Epidemiology 51:443-60.

62. On p144 Allport reverses herself from her position on p138 and gives amounts of EPA and DHA supplements to take daily. She wisely cautions against supplements containing omega-6s since we get too much of them anyway. But she says that strict vegetarians need more linolenic acid as though they are not getting it from eating massive amounts of leafy vegetables.

65. On p149 a study within the Physicians’ Health Study (the one with the misquoted and misinterpreted info on aspirin) there was a finding that 94 of 15,000 of them who experienced sudden cardiac death were 90% less likely to do so if they had the highest omega-3 levels in their blood. First, in the absence of all-cause mortality, you cannot tell whether high omega-3 levels did any overall good. Next only 0.6% of the total or 1 in 170 had this cause of death, so the benefit is pretty small. Dietary intake of omega-3s was not even given.

66. On p151 it is not clear whether all omega-3s in blood are measured by the commercially available tests, or whether the individual ones are assayed and reported. If EPA and DHA levels are not reported, there will be little if any value in the tests.

67.On p192 Allport wrote that rapeseed oil “…has a high alpha linolenic acid content.” My CRC Handbook of 1983-4 lists 1%!! Such is the result of confusing rapeseed and canola.

You can see from the numbering I’ve omitted some of them; for the full list, contact Dr. Kauffman at kauffman at bee dot net. For more on health misconceptions, read his book Malignant Medical Myths, Infinity Publ., West Conshohocken, PA, 2006. ISBN 0-7414-2909-8 326 pp. $24.95.

Science, especially health science, is so important yet it is remarkably hard to learn about. Part of the problem seems to be that those who can write well (such as journalists) don’t understand the science and those who understand the science (such as scientists) can’t write well. (Another part of the problem, as Veblen pointed out, is that among academics to write clearly is low status, to write mumbo-jumbo is high status.) This is why I like Leonard Mlodinow‘s work so much; he writes well and understands the science.

But don’t misunderstand this post. The Queen of Fats is an excellent book. The most impressive and hopeful thing about it is that it was written by a non-scientist — in other words, that a non-scientist was able to figure out that the common neglect of omega-3 fats was seriously wrong. (Omega-3 fats receive almost no attention in Eat Drink and Be Healthy by Walter Willett et al. for example. There is no RDA for them.) I like to think it’s some sort of turning point that non-scientists have become able to grasp how wrong the health establishment can be; another example is Taubes’s Good Calories, Bad Calories.

More. The list of errors unfortunately omitted some general comments:

The Seven-Country Study by Ancel Keys that was so influential (cholesterol and saturated fat being “bad”) was not presented as the fraud it was. For a great description, see The Great Cholesterol Con (GCC), by Anthony Colpo (2007). For an honest Fourteen Country Study see another GCC of 2007, this one by Malcolm Kendrick, in which Kendrick showed that the 7 countries with the lowest saturated fat consumption had the highest mortality from heart disease (450/100,000 per year), while the 7 countries with the highest saturated fat intake had the lowest mortality from heart disease (170/100,000). See also The Cholesterol Myths by Uffe Ravnskov, 2000. Low-carb high-fat diets were ridiculed from start to finish as destructive and a fad, despite overwhelming evidence that they are not. See Nielsen JV, Joensson EA, Low-carbohydrate diet in type 2 diabetes. Stable improvement of bodyweight and glycaemic control during 22 months follow-up, Nutrition & Metabolism 2006;3(22) doi:10.1186/1743-7075-3-22. While Allport may be correct in claiming that omega-3s will prevent or reverse diabetes (and she is not always clear on which type), the evidence is clear that type-1 is much more easily controlled with a low-carb high-fat diet, and type-2 may be controlled so well on a low-carb diet that no medication is needed. See Dr. Bernstein’s Diabetes Solution, rev. ed. by Richard K. Bernstein, MD, Boston, MA:Little, Brown, 2003. So Allport’s recommendation to eat large amounts of fruit (p139) could be a disaster for diabetics. Eskimos are often obese albeit healthy, so omega-3s for weight loss seems too much to claim. And she seems unaware of the prevalence of grain allergies. See Natural Health & Weight Loss, Barry Groves, 2007; Know Your Fats by Mary G. Enig, 2000. Also Allport seems to equate eating linolenic acid as the equivalent of eating EPA and DHA in fish, and does not recommend supplements of the latter two. Neither idea had any supporting evidence presented. Nor was the ideal range of omega-3 intake given. A study of the conversion of radioisotopically-labeled linolenic acid to EPA in humans showed poor conversion, and even poorer conversion to DHA. Adequate intakes of pre-formed DHA are needed for good health. See Burdge G, alpha-Linolenic acid metabolism in men and women: nutritional and biological implications, Curr Opin Clin Nutr Metab Care 2004;7:137-144.