Chicken Salad Salad

Guys. I am so excited about the jar salads I made this week. They were so good.

We got home from Japan late Friday, so I had all weekend to meal plan and prepare food for the week. (Side fact: I’m doing another Whole30! My third. I started Monday, so this is only day 3. The last I did was a year ago. I’d pretty much decided to do it post-Japan even before I left for the trip. I’d been eating crap just because it’s there and not feeling great and not being mindful and just wanted to take time to be more intentional about my food choices. Actually, it’s about habits. I like to reset and reform good habits. Then eventually they wear away, and I come back to reset them. Anyway, and then, when I was in Japan, I was craving vegetables. I usually eat so many vegetables and could not find enough vegetables. I loved the food there, but I was very excited to come home and do a Whole30. We’ll see how long that enthusiasm lasts. :-). Anyway.) Instead of falling back on my default salads, I googled for some inspiration. I found this Chicken, Apple, and Pecan Salad from Damn Delicious, and it is damn delicious.

Chicken salad is still sort of a new thing for me. I had never liked mayo until I started eating frites several years ago (they were sort of a thing for a while, right?) and realized that aioli is mayo. So I started making my own. Store-bought mayo still just seemed unappetizing, but homemade was yummy. I used to make it with canola or vegetable oil, you know, before I knew better. Now that I limit those oils, I haven’t found a good way to make it anymore. I tried avocado oil once and really didn’t like it. However, I do like the Primal Kitchen mayo from Thrive Market made with avocado oil. I still don’t use it a lot, so it’s been sitting in my fridge for a while, and it was nice to find an excuse to use it.

To Whole30-ify the recipe, I did not use dried cranberries nor Greek yogurt. Instead, I used a little bit more mayonnaise and a lot more freshly squeezed lemon. Also, my experience with kale in jar salads is that it smells terrible after even a day in a jar (tastes okay, but coworkers give you funny faces), so I used spinach instead.

Ohmygod, so good. I took the picture below after my first bite while sitting at my desk at work because I was so excited.

For better or worse, it takes a while to eat. Not sure why – so many chopped up parts maybe. I was trying to eat really quickly at my desk in between two meetings yesterday. My coworkers were waiting for me to walk with them to the second meeting in another building. I finally had to give up and put some of it back in the jar to eat later. Probably better to not force eating so quickly anyway.

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Japan – Part 1: Itinerary

This will be my first of at least three posts about my trip to Japan (which I’m currently on – four days to go! – but I probably won’t be when I publish this). In this one, I’m just going to share my itinerary. And some observations. In the other two, I’ll talk about food and hiking. Of course.

You can visualize our itinerary and get more details here on the Google map I made. It went like this:

  • Tuesday, July 4: Flew to Japan via Toronto from BWI. Arrived in Haneda airport in Tokyo a bit late due to a mechanical issue (just what you want to hear before embarking on a 13-hour flight around the world, eh?), around 4 or 5 pm on July 5.
  • Wednesday, July 5: Basically lost this day by crossing the international date line. But arrived at our airbnb in the Bunkyo neighborhold in Tokyo (near Ueno). Got dinner nearby (our first meal in Japan!) at a nearby izakaya called Shinsuke, recommended by our Lonely Planet guidebook.
  • Thursday, July 6: Walked around the Imperial Palace gardens. Subwayed to Shibuya to see Shibuya Crossing (a very busy intersection), found ramen lunch in a small side street. Walked up Cat Street (boutiques and other shops) to the Harajuku neighborhood. Fancy stores. Then we needed to kill time before going to Kodokan (judo training facility and museum), so we crossed over to the Meiji-jingu grounds (a Shinto shrine dedicated to the Emperor Meiji and Empress Shoken). We walked around the Gyoen (inner garden) and up to the Yoyogi-Keon (a park). Then we made it to the Kodokan. After touring the small museum, we realized there would be a competition in 1.5 hours. So we left, got a beer at Hub, a chain ‘British’ pub that we’ve seen in almost every city here, and came back to watch. It was quite entertaining. Finally went back to the apartment for a bit before heading out for conveyor belt sushi dinner in Ueno, recommended by our airbnb host. 33,631 steps that day.
  • Friday, July 7: Woke up early (Ok, I always wake up early. This means I woke Dan up early. Maybe before 6). Went to stand in line for super-fresh sushi at Tsukiji Market, the largest fish market in the world. We considered waiting in line for the most popular Sushi Dai but decided instead to wait in line for the second most popular Daiwa Sushi. It was amazing. Walked around the nearby Ginza neighborhood. Then did the Lonely Planet guide recommended walking tour of Ueno and Yanaka, including the main building of the Tokyo National Museum. Which was super cool – the main building is organized chronologically with select pieces/ exhibits showcasing a lot of Japan’s history. Then a sake and beer at a hostel in Asakusa followed by tonkatsu ramen dinner at a chain ramen place (Ippudo). Then Tokyo Sky Tree! We arrived right at dusk and were 450 meters up to see the city light as night fell. It was pretty cool. All indoor, so I wasn’t freaking out like I did at the Eiffel Tower. There was some weird anime film projected on the walls while we were there about a villain trying to capture Sky Tree? It was super loud and not my favorite thing.  27,059 steps.
  • Saturday, July 8: Mt. Fuji day!! I’ll talk more about the actual hike in my hiking post. We took a bus from Shinjuku Station to the Subaru Fifth Station. We’d reserved and bought the bus tickets a week prior, and already couldn’t take the bus of our choosing. So we went an hour later than we would have liked (and the bus was 45 minutes late to the destination due to crazy traffic leaving Tokyo all the way into the mountains), but it was fine. Started hiking just after 2pm. Stayed in the Fujisan Hotel hut at 3,400 meters that I’d reserved months ago via Mt Fuji Hut Reservations Service. 15,834 steps.
  • Sunday, July 9: Woke up (without really having been asleep much) just before 2am. Left the hut at 2:30 or so. Again, I’ll talk about this more later. But we almost missed the sunrise due to RIDIC TRAFFIC (yes, on foot). I have never experienced anything like it. But we made it just in time and saw the sunrise, which was awesome. Then, after circling the summit, we experienced more traffic going down, but were back at the Fifth Station before 9:30am. Grabbed our packs from the locker we’d stuffed them into the previous day, got on a bus bound for Kawaguchi-ko station, and then took some trains to Matsumoto in the Japan Alps. Including this cute Thomas the Engine train. Got slightly lost before finding our Matsumoto Marunouchi hotel. Dinner at an izakaya found on Yelp. We were the only customers. The attentive proprietress (read: we had an audience the entire time) spoke no English. It was delicious, but an experience. Also walked around Matsumoto a little. It is SO cute. There is a lovely little street along the river with several coffee shops and small restaurants as well as shops carrying pottery, printed paper, printed cloths, fans, etc. Very charming and pretty stuff. (There is also a castle in Matsumoto that we walked by while lost looking for our hotel, but didn’t really see otherwise, which is a little too bad.) 24,833 steps.
  • Monday, July 10: Lovely hotel buffet breakfast in a fancy dining room, followed by an early bus further into the Alps to Hiroyu Onsen and then a transfer to another bus to the Shin-Hotaka Ropeway. The ropeway was a set of two trams up the mountain to an AMAZING view. Also to the start of a hike over the mountain to Kamikochi in a valley on the other side. Kamikochi was not really a town. It was more like a series of ryokans (traditional Japanese inns) and small restaurants, plus a bus terminal, on both sides of a river surrounded by incredible mountains. Really lovely. Returned to Matsumoto by bus. Dinner at a cold soba and tempura place found on Yelp. A specialty of this region is horse meat, including raw horse meat. Dan ordered it. I had a bite, yes. 24,727 steps.
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View from the top of the Shin Hotaka Ropeway
  • Tuesday, July 11: More Alps. We left Matsumoto after another delicious breakfast and headed to Hakuba, a ski town and site of some of the 1998 Winter Olympics. We took a bus from the train station to the bus terminal in the center of town and then found our way to the ryokan  (Shiramou-so) we were staying at (it was a two-minute walk!). Even though it was only noon, they let us check in, drop our stuff, and leave immediately to go for another hike. We took a gondola and two chair lifts up the Happo One ski resort and then hiked to Happo Ike pond. We were back at the ryokan by 3, just in time for the skies to open up. We had our first onsen (hot spring) experience and then relaxed in our room wearing yukatas (light kimonos) until our DELICIOUS ryokan dinner, and then relaxed some more. 15,623 steps.
  • Wednesday, July 12: Early morning onsen time at the ryokan followed by amazing ryokan breakfast. Then we walked to the ski jump that was used in the 1998 Olympics, and is still used today. We weren’t planning on it, but ended up taking the chair lift to the top. It was actually so cool. And terrifying. Then a series of trains, including our first Shinkansen (bullet train), along the west coast for a bit and then down to Osaka. This was our longest day of travel (almost 7 hours total), but that included layovers, etc. and didn’t seem that bad. And then… OSAKA at night. We came here to eat. And we did. We first dropped our stuff at our hotel (Hotel Code) and then did the Lonely Planet guide walking tour from our hotel through Amerika Mura, down the Shinsaibashi shopping street, across the Ebisu-bashi bridge, and along the Dotombori street. Mostly along Dotombori, we ate some takoyaki and then okonomiyaki that I’ll talk more about in my food post. We also drank a fair amount. We ended the night looking for a simple bar and ended up in a place where… hmm. It wasn’t unclear. Two young women were serving, and there were only male customers. They served us some sake very nicely (one using google translate on her phone to confirm we didn’t want food and to see how we liked the sake). And then we left. It was awkward. Osaka was awesome though. My favorite big city. Super funky, super hipstery. Lots of lights and energy and people out.
  • Thursday, July 13: Osaka morning. We headed straight to the Kuromon Market, which was a street food paradise. I’ll say more in my food post. It was incredible. There wasn’t much else we wanted to do in Osaka, so we trained to Kyoto, dropped our bags in a locker in Kyoto Station, and made our way to Fushimi Inari-Taisha, a large mountainside complex of many Shinto shrines and torii gates. We took a detour off the main path and ended up on a hiking trail to the top of the mountain, where we met up again with the main path. This was the hottest day ever, and I was fairly unhappy. We finished, grabbed our packs from Kyoto Station, and made our way to our airbnb where I passed out from heat exhaustion. Or just took a nap. We went to dinner at a nearby okonomiyaki place recommended by our airbnb hosts. 20,815 steps.
  • Friday, July 14: Kyoto. Kyoto has amazing temples. We started the day at Nanzen-ji, a large temple not far from us. Then we made our way across town to Otsuka, a small steak restaurant, for a truly delicious wagyu beef lunch recommended by one of Dan’s colleagues. We hadn’t originally planned it, but since we were over there, we walked through the Arashiyama bamboo grove and then along the river. We then intended to do a walking tour of Southern Higashiyama from our guidebook, but ended up on the right bus going the wrong direction, so instead took a bus tour around Kyoto and got off in a more northerly bit to visit Ginkaku-ji, a temple, and walk the Path of Philosophy. We ate dinner of sort of Japanese tapas at a small restaurant that also served fancy cotton candy by day. We’d passed it on the previous night in our neighborhood. 28,824 steps.
  • Saturday, July 15: Kyoto still. We spent the morning doing the walking tour we’d intended to do the previous day and visited two more temples: Koidi-ji and Shoren-in. Shoren-in was very close to our apartment, and less crowded and very lovely. Then we took the train out of the city to Kibune, where we walked along the road until we found a restaurant that would take us (sans reservations, on a busy Saturday) for kawa doko – eating a set course meal while seated on platforms over the river. It was great. Then we did the hike over the mountain to the next valley over, Kurama, and trained back to Kyoto. That night was the first of two eve festivals for Gion, an annual festival in Kyoto involving portable shrines (floats). On the 17th, the floats would parade through the city, but were parked for visiting as part of the street festival before then. It was awesome to be part of this. We ate lots of food from vendors. 28,664 steps.
  • Sunday, July 16: We left Kyoto and headed to Onomichi, a small part town that is the beginning or end of the Shimanami Kaido – a 75km bike route across bridges and islands between Onomichi and Imabari. We stayed at Hotel Cycle, which is part of a larger market that contains the hotel, a coffee shop, a restaurant, a gift/wares shop, and a Giant bicycle store. Except for the Giant, they are all essentially the same company, it seems. We arrived too early to check in, so got ice cream and sat on the outside chairs to relax. We got our rental bikes from the Giant, ate dinner at the restaurant, and just took it very easy. 10,301 steps.
  • Monday, July 17: We got up early to take a 7:10 cycle express bus to Imabari where we started cycling around 8:30am and did the entire Shimanami Kaido! We were tired and hot (and a little sunburned) by the end, but I think this was my favorite thing. It was so awesome. Bridges, gorgeous views, citrus groves, gelato, biking. All the things. When we were done, we showered in the public shower stalls outside our hotel, relaxed for a bit in the coffee shop, and then made our way to our Hiroshima airbnb. We walked to dinner at Okonomi Mura – a crazy three story building filled with various okonomiyaki shops. 7,016 steps. But 76km of biking!
  • Tuesday, July 18: Dan wasn’t feeling well this day, so we took a super relaxed morning. Then we visited the A-bomb dome, the Peace Memorial Park, and the Peace Memorial Museum. I actually learned a lot about the development of nuclear weapons and some of the politics and the museum. This was generally very sobering. Afterward, we ate lunch at a place recommended by Lonely Planet, which was really cute and wonderful, and then had a lazy afternoon. We were really losing steam by this point in our trip. We went to a Japanese curry place around the corner from our apartment recommended by our airbnb host. 8,905 steps.
  • Wednesday, July 19: We traveled via Shinkansen to Kagoshima, another port town. From there, we took a taxi to the ferry terminal and then a hydrofoil ferry to Yakushima. The car rental company we’d booked through met us as we disembarked the ferry and miraculously handed Dan keys to drive away, on the left side of the road. He drove us to the south side of the island to our hotel (JR Hotel Yakushima), which was also heaven. After settling in, we partook of the onsen and then the amazing set course dinner. 5,949 steps.
  • Thursday, July 20: Last real vacation day! After the excellent buffet breakfast at the hotel, we (Dan) drove back north and we made our way up the mountain to the Shiratani Unsuikyo Ravine where we hiked for approximately 5 miles by waterfalls, across streams, and past HUGE very old cedars that the island is known for (the largest/oldest, which we did not see, is estimated to be 3000-7000  years old). We then stopped at the Senpiro waterfall on the way back to the hotel. Our evening was very similar to the previous… except! After dinner we made our way to the Hirauchi Onsen, which is part of the rocky sea shore and only accessible within two hours of low tide. Low tide that night was around 11pm, and we arrived sometime after 9. It was dark and we had trouble finding it, but we made it, and it was a really incredible experience. Unlike other onsen we’d been to, it was mixed gender. There were other people there, but no staff or system or lights or anything – just an honesty pay box and a place on the sidewalk to leave one’s shoes. There were several pools. It was hard to tell how many with no light. And there were STARS! It was amazing. A kind of bizarre, otherworldly sort of experience – bathing with strangers on the beach in the almost pitch darkness, staring at the sky. 15,751 steps.
  • Friday, July 21: We ate another great breakfast, then left :-(. We returned our rental car at the tiny Yakushima airport and took a flight from there back to Kagoshima, then Kagoshima to Tokyo. Then, after a bit of delay, we flew 11 hours to Toronto and then a few more hours back to Baltimore. All told, it was four flights and over 30 hours of travel. It was nice to get home.

And that’s that! The trip was really incredible. It all worked out almost exactly is planned, which is amazing. We had no major (or really even minor) disasters. Partly that was due to a ton of planning (it takes hours and hours and hours, and recommendations from friends are super helpful – feel free to ask me if you want more information about how we went about planning this), but it was mostly due to just how organized, efficient, and punctual traveling in Japan is. A few general observations about the trip and Japan:

  • Obviously Dan and I prioritize being outside (hiking, walking, gardens, paths) to doing more cultural things like museums. But Japan has it all, whatever you’re interested in.
  • The food is delicious. But I missed vegetables. I eat so many vegetables.
  • Trains not only run on time, but run super-frequently. Everywhere. Which was awesome.
  • Japan is hot and humid in July. I’m not sure if this is consistently true or if it was just the weather while we were there, but Kyoto was by far the hottest. Tokyo was warm, but not as bad. Osaka was also probably hot, like Kyoto, but we were really only there and out and about at night. I had some periods of misery in Kyoto.
  • There are many wonderful hikes in Japan. I’m sure we missed a bunch. But based on the ones we didn’t miss… they are also crowded. Our hike from the Shin Hotaka Ropeway to Kamikochi was the least crowded.
  • People stand on the right and walk on the left on escalators (opposite of DC, which makes sense, because Japan also drives on the opposite side of the road). Except in Osaka, they do the opposite – stand on the right and walk on the left.
  • Japan has got it figured out with the ryokans. Bathe in hot spring waters, eat delicious food, sleep in a super-relaxing room on futons and tatami mats, repeat.
  • We never had to use many of the Japanese phrases I spent time trying to learn. Even in the more rural areas, there was enough English to get by.

I’ll try to get the other two posts up soon!

Fat

The paleo/real-food sphere had a mini freakout a few weeks ago when headlines started popping up that coconut oil is bad for you (for example: here). These headlines were precipitated by (trying not to use words like ‘the result of’ or ’caused by’ given what’s coming below) an American Heart Association (AHA) presidential advisory that was published in Circulation (an AHA publication). The article reviewed the literature on effects of reducing saturated fat and replacing it with unsaturated fat on cardiovascular disease. It had one short section on coconut oil, but coconut oil specifically was not a main point of consideration in the literature reviewed. The article ultimately concluded that reducing saturated fat and replacing it with polyunsaturated and monounsaturated fats reduces cardiovascular disease (heart attacks, strokes). Since coconut oil is high in saturated fat (and the specific studies related to coconut oil the article cited indicated that coconut oil increases LDL cholesterol, which the article cites as being a cause of cardiovascular disease), the AHA advises against using coconut oil.

Polyunsaturated and monounsaturated fats, which the AHA recommends, include canola oil, corn oil, soybean oil, peanut oil, safflower oil, olive oil, and walnut oil, among others.

Ok.

My initial reaction, like that of many others who eat the way I do (or the way I try to), was to sort of roll my eyes and wonder how they’re manipulating or selectively interpreting the evidence this time. But. Right there with my initial reaction was the thought, “But what does the article actually say? What evidence does it cite? Are there methodological flaws to that evidence, or is it pretty strong?” The truth is that I don’t really know. I assume there must be something wrong with it, because I feel pretty confident in these two things:

  1. Naturally occurring, real food is good for you. This includes naturally occurring, saturated fat, like that found in coconut oil, lard, and butter, which humans have had access to and subsisted on forever and ever, amen.
  2. Industrially-produced ‘vegetable’ and seed oils, like canola oil and soybean oil, are bad for you.

And part of me feels like I don’t care what the evidence says, for the following reasons:

  • The two points above make sense. It makes sense that what humans ate up until 50-100  years ago and what occurs naturally in nature is good for you. And it makes sense, especially considering the rise in chronic disease over the past 50 years, that the industrial production of food generally is not good for you.
  • I am becoming increasingly skeptical of the body of scientific literature that exists, at least around food and nutrition. Corporate interests and funding are so intermingled with so much research. In this case, big agriculture, like corn and soybean growers.

That said, I am a generally rationale person who wants evidence. I have a masters of public health – not a science degree, but I’m trained in epidemiology and evidence-based thinking. I insist on others having data and evidence to back up their claims.

And, I’m married to a very critical-thinking evidence-based medicine-supporting physician who cares about knowing the evidence.

I’ve never been good or comfortable at making strong arguments off the cuff, especially without really knowing what I’m talking about. So – new personal research question:

  • What does the evidence say regarding health outcomes of eating different types of fats, from different sources? What are the strengths and weaknesses of the evidence?

So, I’m going to embark on a little personal journey to really try to understand the AHA’s article, the evidence it cites, the other evidence that’s out there that it doesn’t cite, and really try to wrap my arms around this. Some people (like the authors of AHA’s paper, presumably) conduct literature reviews as part of their full time jobs, and I’m not sure how much time and energy I’ll really be able to put into this. Because I know I’m going to want to go deep. But we’ll see. I’m going to start by reading the article closely, summarizing what it says, and determining what additional questions it raises for me that I might want to look into. Starting now.

Summary of Article:

Okay, as it turns out, I’ll need to do this in chunks. Below is a summary of the first 6 pages, with the additional questions I have (in italics). I’m not answering them now – just taking note of where I want to look into things more.

Introduction:

  • Purpose: Review and discuss the scientific evidence on the effects on CVD of dietary saturated fat and its replacement by other types of fats and carbohydrates
  • Rationale for decreasing saturated fat:
    • Saturated fat raises LDL cholesterol.
      • How well-established is this?
    • LDL cholesterol causes atherosclerosis (plaque buildup in arteries).
      • How well-established is this?
    • Populations with low saturated fat have low rates of CVD.
      • I can believe that this is well-established, but it doesn’t necessarily mean that populations with high saturated fat have high rates of CVD.
  • Current AHA guidelines:
    • Keep saturated fat to 5-6% of daily calories if you have elevated LDL and under 10% for the general population.
    • Replace saturated fats with poly and monounsaturated fats (I’ll use PUFA and MUFA from here on).
  • Summary of evidence: Randomized controlled trials and observational studies both have come to different conclusions regarding the effects of reducing saturated fat on CVD. However, RCTs and prospective observational studies in which saturated fats were replaced by PUFAs rather than carbohydrates (usually refined carbs) show reductions in the incidence of CVD whereas studies that replace saturated fat with carbohydrates do not.

Then the article discusses RCTs that looked at replacing saturated fat with PUFAs.

  • First, AHA looked at 3 meta-analyses looking at this question. It seems that within those 3 meta-analyses, 10 studies were identified. AHA chose four of those ten that it deemed to be the highest quality, having met the following criteria:
    • Compared high saturated fat with high PUFA intake
    • Did not include transf fat as a major component
    • At least 2 years of sustained intake of diets
    • Controlled dietary intake of the intervention and control groups
      • How did they do this? Is this reliable?
    • Proved adherence by objective biomarkers such as serum cholesterol or blood or tissue levels of PUFAs.
      • I’ll say right here that I am super confused about using serum cholesterol as a biomarker demonstrating adherence to a low saturated fat diet. It must be pretty well-established that replacing saturated fat with PUFA reduced serum cholesterol. Is it? Above, they said that high saturated fats increase LDL cholesterol. Is this the same thing? If saturated fats increase it then PUFAs decrease it? They use this biomarker a lot… sometimes seeming to use it as a result, sometimes as evidence that the control group actually adhered to a high PUFA diet. I’m just confused.
    • Collected and validated info on cardiovascular or coronary disease events
      •  So, a general question I have is how important are these qualities? If a study didn’t have them, is it right to not consider as high-quality evidence?
  • Study 1: Wadsworth Hospital and Veterans Administration Center in LA.
    • Date of published study: 1969
    • Double-blind.
      • Need to look up how this was done double-blind. They don’t explain.
    • N=846 men. 30% had CVD.
    • Diet:
      • The two groups were served meals in separate dining rooms at the center.
      • Control – usual diet (I assume, it doesn’t specify).
      • Experimental – Replaced saturated fat with PUFAs: corn, soybean, safflower, and cottonseed oils
      • Adherence measures\d by ‘enrichment with linoleic acid in blood, adipose tissue, and atherosclerosis specimens.’
        • I assume these are good biomarkers…. I don’t know.
    • Duration: 8 years
      • Were all the same people in it for 8 years? What was the average duration of individuals in the study?
    • Results:
      • Serum cholesterol reduced by 13%.
        • Is this a result or a biomarker that the experimental diet was adhered to?
      • Statistically significant 34% reduction in CVD, myocardial infarction (MI aka heart attack), sudden death, or stroke.
        • I believe this is measuring whether ANY of these outcomes happened. Looked at individually…:
      • 20% fewer MI or sudden death events, but not statistically significant
      • 41% fewer men with strokes (p=0.055)
        • This is on the edge of being ‘statistically significant’ if you’re going for a p-value of <5, but it’s close, so I think this is reasonable.
      • 31% reduction in CVD events, statistically significant.
        • So, this seems to be the main driver of the 34% reduction in any of these events above.
        • Also, how are ‘CVD events’ defined? What is a CVD event that is different from the other ones being measured?
  • Study 2: Oslo Diet Heart Study
    • Date of published study: 1970
    • N=412. Men that had had a myocardial infarction (heart attack)
    •  Diet
      • Control – their ‘usual high-saturated fat diet.’
        • Was this confirmed? Did they indeed have high saturated fat diets?
      • Experimental – participants and wives taught how to select and prepare foods low in saturated fat and high in PUFA vegetable oils.
        • Again, was this monitored? Was it confirmed that it was a) lower than the control group and/or b) lower than what they were eating before the study?
        • PUFA diet lowered serum cholesterol by 14%, confirming adherence
          • Here’s where I’m still confused. I think this is not a result. It’s meant to demonstrate that the low saturated fat diet was adhered to.
      • Duration: 5-year trial.
        • Again, were the same participants in it for all five years?
      • Results:
        • 29% reduction in recurrent MI and new cases of angina pectoris or sudden death (p=0.011)
          • MI reduced by 37% (statistically significant)
          • Angina pectoris reduced by 66% (statistically significant)
          • Sudden death the same in both groups
        • 25% reduction in MI or sudden death (p=0.05).
          • Are these just different ways of grouping all the potential outcomes?
        • 27% fewer cardiovascular deaths (p=0.09)
      • Study 3: British Medical Research Council
        • Date of published study: 1968
        • N=393, men that had had an MI.
        • Diet:
          • Control – ? Not specified in article.
            • Presumably their normal diet?
          • Experimental – participants told to drink soybean oil with fruit juice and also use it in cooking. Participants also counseled on reducing saturated fat.
            • Did they actually reduce saturated fat? Did they adhere to the protocol? Is a reduction of serum cholesterol evidence of this?? Clearly this is something I need to get figured out first.
          • Reduced serum cholesterol by 16%.
        • Results
          • 18% reduction in a recurrent coronary event (MI, angina, sudden death), but not statistically significant.
        • Study 4: Finnish Mental Health Study
          • Date of published study: 1972-1983 (three different publications)
          • N=1222 patients at 2 psychiatric hospitals
            • Also, two cohorts studied. One cohort had some participants that had evidence of coronary heart disease (arterial blockage starting) and some participants that did not. The other cohort only had participants that did not have evidence of coronary heart disease.
          • Diet:
            • In one hospital, high PUFA (mainly soybean oil) diet given first, followed by the sat fat diet. Each diet period lasted 6 years.
            • In other hospital, reverse.
              • But not all people were there the whole 6 or 12 years, right??
            • Serum cholesterol 14% lower in high PUFA diet groups.
            • Adherence also demonstrated by 3-fold enrichment of linoleic acid in adipose tissue.
          • Results
            • Coronary heart disease death reduced by 41%.
              • I’m confused. This is within the 95% confidence interval, but the accompanying chart has a p-value of 0.19. I’ll need to look up this result.
  • AHA Meta-Analysis of these four studies: AHA “performed a fixed-effects met-analysis of these 4 core trials.”
    • Result: Lowering saturated fat and replacing it with PUFA-rich vegetable oil lowed coronary heart disease by 29%.
      • I have to say, I do not understand their analysis at all. Especially from looking at the chart they provided. I’m not familiar with ‘inverse-variance fixed-effects meta-analysis,’ and I do not know how to interpret the chart. And do not see how the chart translates to their finding (29% reduction in CHD).

______

Initial thoughts

I have a lot of questions to answer, for which I’ll need to go look at the original studies. And do some additional background research probably.

Some of the criticisms I’ve seen to this include:

  • AHA ‘cherry-picked’ the studies. Well. AHA (presumably) identified criteria and then identified which studies met those criteria. To determine whether I think this is cherry-picking, I need to better understand the criteria and their value, and I also need to review the other studies and confirm that I agree they didn’t meet the criteria. For me to agree that AHA cherry-picked these studies, I would need some evidence or rationale that indicated that AHA chose the studies first and then chose criteria that matched those studies, rather than the reverse. We’ll see.
  • The studies are old. Well. So what? Good science is good science (and bad science is bad science). If something was done really well, why re-do it? This doesn’t necessarily mean the studies aren’t valuable – unless something else has changed since then that would invalidate these findings. I’m not sure if there is.

Generally, it seems like there are some meaningful, valid results. But I especially want to understand the implication of the durations more. These sound like long study durations… but if the same individuals weren’t in them for the full length, is that still as valid? And I’m also not convinced that the participants actually adhered to their assigned diets! Maybe I should be – maybe reduction in serum cholesterol is evidence of this. I just don’t know yet.

This might be the last you hear me talk about this, or it might not. Next steps are to continue summarizing the article and start to answer my own questions. Cheers.