Higher fat diets are better than lower fat diets in the treatment of diabetes

This study was published in Diabetes Care 1994 Mar;17(3):177-82

Study title and authors:

The high-monounsaturated fat diet as a practical alternative for NIDDM.

Campbell LV, Marmot PE, Dyer JA, Borkman M, Storlien LH.

Diabetes Centre, St. Vincent's Hospital, Camperdown, Sydney, New South Wales, Australia.

This study can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/8174444

The objective of the study was to examine the effects in patients with type two diabetes of a home-prepared high-fat diet compared with a low-fat, high-carbohydrate diet. Ten men were included in the trial in which they consumed each diet for two weeks.

The composition of the diets was:
(i) 52% carbohydrate, 24% protein, 24% fat (low-fat, high-carbohydrate diet).
(ii) 40% carbohydrate, 22% protein, 38% fat (high-fat diet).

The study found:
(a) The high-fat diet lowered unhealthy high triglycerides levels.
(b) The high-fat diet lowered unhealthy high blood glucose levels.

This study shows that a high fat diet is better than a low-fat, high carbohydrate diet in the treatment of diabetes.

Low fat diets induce unhealthy effects in type two diabetics

This study was published in Diabetes Care 1990 Apr;13(4):446-8

Study title and authors:

Effects of changing amount of carbohydrate in diet on plasma lipoproteins and apolipoproteins in type II diabetic patients.

Rivellese AA, Giacco R, Genovese S, Patti L, Marotta G, Pacioni D, Annuzzi G, Riccardi G.

Institute of Internal Medicine and Metabolic Diseases, 2nd Medical School, Naples, Italy.

This study can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/2318105

This 15 day study investigated the effects of a low fat diet and a high fat diet on eight nonobese, mildly type two diabetic patients, average age 45 years old.

The two diets comprised of:
(i) 60% carbohydrate, 20 % protein, 20% fat (low fat diet).
(ii) 40% carbohydrate, 20% protein. 40% fat (high fat diet).

The study found:
(a) Triglycerides were 24% higher on the low fat diet.
(b) Apolipoprotein CII levels were 15% on the low fat diet. (Apolipoprotein CII (apoCII) is a protein found in large fat particles absorbed from the gastrointestinal tract. It is also found in very low density lipoprotein (VLDL) cholesterol. High levels of apoCII are associated with angina and heart attacks).
(c) Very-low density lipoprotein (VLDL) levels were 43% higher on the low fat diet. (High VLDL levels are linked to diabetes. See here).

The results from the study show that a low fat diet induces harmful effects on cholesterol values in nonobese, mildly type two diabetic patients.

High levels of von Willebrand Factor implicated in diabetes complications - high fat diets lower the levels of von Willebrand Factor

This study was published in Metabolism 1994 Nov;43(11):1406-9

Study title and author:
Decrease in von Willebrand factor levels after a high-monounsaturated-fat diet in non-insulin-dependent diabetic subjects.

Rasmussen O, Thomsen C, Ingerslev J, Hermansen K.
Medical Department of M (Diabetes & Endocrinology), Aarhus Kommunehospital, Denmark.

This study can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/7526126

High levels of von Willebrand factor (a protein used in blood clotting) have been reported in diabetics with cardiovascular complications, suggesting a role for this protein in the development of cardiovascular complications in type two diabetics.

This study investigated the effects of a low fat, high carbohydrate diet and a high fat diet on the blood levels of von Willebrand factor. 15 patients with type two diabetes received either diet for three weeks and their levels of von Willebrand factor was measured.

The diets were:
(i) 50% carbohydrate, 20% protein, 30% fat (low fat, high carbohydrate diet).
(ii) 30% carbohydrate, 20% protein, 50% fat (high fat diet).

The study found:
(a) The levels of von Willebrand factor decreased by 12.5% on the high fat diet.
(b) The levels of von Willebrand factor increased by 5.7% on the low fat, high carbohydrate diet.

This study shows how a high fat diet decreases the levels of von Willebrand Factor, and therefore decreases the risk of complications from diabetes.

Links to other studies:
A high fat/low carbohydrate diet reduces high blood sugar levels
High fat diets reduce dangerous C-reactive protein levels by 52.6%
Professor says that low-carbohydrate, high-fat diets are the preferred method for treating type 2 diabetes

High fat diets may be beneficial in the treatment of diabetes

This paper was published in Diabetes Care 2009 May;32(5):959-65

Study title and authors:

Influence of fat and carbohydrate proportions on the metabolic profile in patients with type 2 diabetes: a meta-analysis.

Kodama S, Saito K, Tanaka S, Maki M, Yachi Y, Sato M, Sugawara A, Totsuka K, Shimano H, Ohashi Y, Yamada N, Sone H.

Department of Lifestyle Medicine and Applied Nutrition, Ochanomizu University, Tokyo, Japan.

This paper can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/19407076

This paper is a meta-analysis of 19 studies which compared the effects of replacing dietary fat with carbohydrate in patients with type II diabetes.

The average composition of the diets were:
(i) 58% carbohydrate, 24% fat (low fat, high carbohydrate diet).
(ii) 40% carbohydrate, 40% fat (high fat diet).

The study found:
(a) The (bad) fasting insulin levels were 8% higher on the low fat, high carbohydrate diet compared to the high fat diet.
(b) The (bad) triglyceride levels were 13% higher on the low fat, high carbohydrate diet compared to the high fat diet.
(c) The beneficial high density lipoprotein (HDL) cholesterol levels were 6% lower on the low fat, high carbohydrate diet compared to the high fat diet.

The findings of the study suggest that a high fat diet may be beneficial in the treatment of diabetes compared to a low fat, high carbohydrate diet.

Links to other studies:
Diabetes rates have tripled since the low fat crusade started in 1977
High fat, low carbohydrate diets are an effective tool in the treatment of diabetes
High dietary intake of fructose leads to diabetes

Low fat diets increase the risk of heart disease in diabetics

This study was published in the Journal of Clinical Endocrinology and  Metabolism 1993 Feb;76(2):347-51

Study title and authors:

Effect of variations in dietary fat and carbohydrate intake on postprandial lipemia in patients with noninsulin dependent diabetes mellitus.

Chen YD, Swami S, Skowronski R, Coulston AM, Reaven GM.

Department of Medicine, Stanford University School of Medicine, California.

This study can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/8432777

The effect of dietary composition on concentrations of triglyceride levels was studied in eight patients with type II diabetes. In the study two diets were consumed by each patient for two weeks.

The diets consisted of:
(i) 60% carbohydrate, 15% protein, 25% fat (low fat diet).
(ii) 45% carbohydrate, 15% protein, 40% fat (high fat diet).

The study found that triglyceride levels were higher after the low-fat (high carbohydrate) diet, and as high triglyceride levels are associated with an increased risk of heart disease, the low-fat diet should not be consumed by patients with type II diabetes.

Links to other studies:
Low-fat, high-carbohydrate diets, similar in composition to the recommendations of the American Diabetes Association, have deleterious health effects when consumed by patients with type 2 diabetes
High-fat, carbohydrate-restricted diets are a superior treatment option for type 2 diabetes compared to a low-calorie, low fat diet
LDL cholesterol size: does it matter?

Higher-fat diets are a more effective treatment for diabetes than low-fat diets

This study was published in Diabetes Research and Clinical Practice 2004 Sep;65(3):235-41

Study title and authors:

Beneficial effect of low carbohydrate in low calorie diets on visceral fat reduction in type 2 diabetic patients with obesity.

Miyashita Y, Koide N, Ohtsuka M, Ozaki H, Itoh Y, Oyama T, Uetake T, Ariga K, Shirai K.

Center of Diabetes, Endocrine and Metabolism, Sakura Hospital, School of Medicine, Toho University, 564-1 Shimoshizu, Sakura-City, Chiba 285-0841, Japan.

This study can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/15331203

The aim of this 4 week study was to compare the effects of a low calorie high fat diet and a low calorie low-fat diet in obese subjects with type II diabetes.

22 diabetics received diets of either:
(i) 1000 calories per day, 65% carbohydrate, 25% protein, 10% fat (low-fat diet).
(ii) 1000 calories per day, 40% carbohydrate, 25% protein, 35% fat (higher-fat diet).

The study found:
(a) The harmful fasting high blood insulin levels were reduced by an extra 20% in the higher-fat diet group compared to the low-fat diet group.
(b) The beneficial high-density lipoprotein (HDL) cholesterol increased in the higher-fat diet group by 15% but did not increase in the low-fat diet group.
(c) There was a four-fold larger decrease in visceral fat area in the higher-fat diet group compared to the low-fat diet group. (Abdominal, or visceral, fat is of particular concern because it’s associated with a variety of health problems, such as high blood pressure, diabetes, heart disease and stroke — much more so than subcutaneous fat, which is found just under the skin. Visceral fat, on the other hand, lies out of reach, deep within the abdominal cavity, where it pads the spaces between the abdominal organs).
(d) The ratio of visceral fat area to subcutaneous fat area did not change in the low-fat diet group, but it decreased significantly in the higher-fat diet group.

The results of the study suggest that, a low-calorie/higher-fat diet might be more effective treatment for a reduction of visceral fat, improved insulin sensitivity and an increase in high-density lipoprotein (HDL) cholesterol levels than a low calorie/low-fat diet in obese subjects with type II diabetes.

Links to other studies:
Diabetes treated successfully by high fat, low carbohydrate diets
High fat/low carbohydrate diet decreases risk of heart disease
The case for high fat/low carbohydrate diets in diabetes management

The metabolic syndrome may be caused by a high fructose, and relatively low fat, low cholesterol diet

This paper was published in the Archives of Medical Science 2011 Feb;7(1):8-20

Study title and authors:
Is the metabolic syndrome caused by a high fructose, and relatively low fat, low cholesterol diet?

Seneff S, Wainwright G, Mascitelli L.
Department of Electrical Engineering and Computer Science, MIT, Cambridge, MA, USA.

This paper can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/22291727

The metabolic syndrome is a term that has been used to describe a number of risk factors such as elevated triglyceride levels, small sized dense low density lipoprotein (LDL) cholesterol particles, low levels of high-density lipoprotein (HDL) cholesterol, obesity, insulin resistance, glucose intolerance and elevated blood pressure, and it is associated with an increased risk of type II diabetes and coronary heart disease.

The authors have developed a new hypothesis regarding metabolic syndrome; namely it is a consequence of a high intake in carbohydrates and food with a high glycemic index, particularly fructose, and relatively low intake of cholesterol and saturated fat.

The authors show how the risk factors for metabolic syndrome may be exacerbated by the above way of eating:
(a) Elevated triglyceride levels: Studies show that higher levels of dietary fructose lead to increased triglyceride levels and that zero-cholesterol diets have been shown to increase triglyceride levels.
(b) Small sized low density lipoprotein (LDL) cholesterol particles: The liver normally clears the dangerous small sized dense low density lipoprotein (LDL) cholesterol. However in conditions of excess dietary fructose (fructose is converted to fat by the liver) the liver is overwhelmed and cannot keep up in clearing all the dangerous small sized dense low density lipoprotein (LDL) cholesterol.
(c) Low levels of high-density lipoprotein (HDL) cholesterol: The scientific literature shows that low levels of high-density lipoprotein (HDL) cholesterol is the best predictor of heart disease and is associated with an increased risk of type II diabetes. This may be because that low concentrations of bile salts correspond to a reduction of HDL levels and that low-fat, high fructose diets lead to reduced bile salts because of the reduced need for the bile salts to digest fats.
(d) Obesity: Studies reveal that the obese are often deficient in vitamin D. The best sources of vitamin D are foods rich in saturated fat such as lard, butter and egg yolk.
(e) Insulin resistance: Scientific papers reveal that the overconsumption of fructose leads to liver insulin resistance.
(f) Glucose intolerance: In high carbohydrate, low fat diets, glucose and fructose enter the bloodstream very rapidly due to the abundance of carbohydrates and the lack of buffering in the gut by dietary fats. This causes a sharp rise in blood glucose levels and the excessive glucose and fructose may damage proteins.
(g) Blood pressure: Depleted amounts of cholesterol in the outer shells of fat cells weaken the structure of the cell walls and leads to sodium leakage, which results in excess sodium in the bloostream. This causes the blood vessels to constrict with the resulting increase in blood pressure.

The findings of this paper suggest the metabolic syndrome may be caused by a high fructose, and relatively low fat, low cholesterol diet.

Seneff concludes: "We would urge medical practitioners to encourage individuals exhibiting metabolic syndrome to strongly limit the consumption of dietary fructose and other high-glycemic-index carbohydrates, and to stop discouraging them from consuming foods rich in cholesterol."

Links to other studies:
High dietary intake of fructose leads to diabetes
LDL cholesterol size: does it matter?
Beneficial effects of a high fat, low carbohydrate diet on fat reduction in type 2 diabetic patients with obesity

Meat, eggs and saturated fat reduce the risk of diabetes

This study was published in the European Journal of Clinical Nutrition 2003 Apr;57(4):523-30

Study title and authors:

Diet and glucose tolerance in a Chinese population.

Woo J, Ho SC, Sham A, Sea MM, Lam KS, Lam TH, Janus ED.

Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Republic of China. jeanwoowong@cuhk.edu.hk

This study can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/12700613

The study investigated the dietary patterns in 988 Hong Kong Chinese subjects with or without diabetes to determine if there is any association between diet and diabetes.

The study found:
(a) Those with diabetes consumed 4.5% more rice, noodles and pasta than those without diabetes.
(b) Those with diabetes consumed 17% more vegetables than those without diabetes.
(c) Those with diabetes consumed 25% more soy than those without diabetes.
(d) Those with diabetes consumed 13% less meat than those without diabetes.
(e) Those with diabetes consumed 25% less eggs than those without diabetes.
(f) Those with diabetes consumed 12% less saturated fat than those without diabetes.

This study shows that a higher consumption of meat, eggs and saturated fat reduces the risk of diabetes, whereas a higher consumption of soy and carbohydrate rich foods increases the risk of diabetes.

Links to other studies:
Beneficial effects of a high fat, low carbohydrate diet on fat reduction in type 2 diabetic patients with obesity
Diabetes rates have tripled since the low fat crusade started in 1977
High-carbohydrate diets cause a significant rise in blood sugar

High fat diets have beneficial effects in the treatment of diabetes

This study was published in Diabetes Care 1993 Dec;16(12):1565-71

Study title and authors:
Effects on blood pressure, glucose, and lipid levels of a high-monounsaturated fat diet compared with a high-carbohydrate diet in NIDDM subjects.

Rasmussen OW, Thomsen C, Hansen KW, Vesterlund M, Winther E, Hermansen K.
Medical Department M, Aarhus Community Hospital, Denmark.

This study can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/8117360

This study compared the influence of a diets high in carbohydrates or fats on 15 type two diabetics. The patients were assigned to each diet for a three week period, with a three week gap in between the diets.

The diets consisted of:
(i) 50% carbohydrate, 20% protein, 30% fat (high carbohydrate diet).
(ii) 30% carbohydrate, 20% protein, 50% fat (high fat diet).

The study found:
(a) The high fat diet reduced harmful high blood pressure levels compared to the high carbohydrate diet.
(b) The high fat diet reduced the harmful blood glucose levels compared to the high carbohydrate diet.

The results of the study show that a high fat diet has beneficial effects in the treatment of diabetes.

Links to other studies:
A high fat/low carbohydrate diet reduces high blood sugar levels
High fat, low carbohydrate diets are an effective tool in the treatment of diabetes
High-carbohydrate diets cause a significant rise in blood sugar

Diets high in fat and low in carbohydrate may decrease the risk of diabetes

This study was published in the American Journal of Clinical Nutrition 2008 Feb;87(2):339-46

Study title and authors:
Low-carbohydrate-diet score and risk of type 2 diabetes in women.

Halton TL, Liu S, Manson JE, Hu FB.
Department of Nutrition, Harvard School of Public Health, Boston, MA 02215, USA.

This study can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/18258623

The study examined the association of dietary carbohydrate, protein and fat with type II diabetes. The study included 85,059 women and lasted for 20 years.

The study found:
(a) Those that ate the most carbohydrate had a 26% increased risk of type II diabetes compared to those who ate the least carbohydrate.
(b) Those that consumed diets with the highest glycemic load had an 147% increased risk of type II diabetes compared to those who consumed the lowest glycemic load.
(c) Those that ate the most fat had a 9% decreased risk of type II diabetes compared to those who ate the least fat.
(d) Those that ate the most animal fat had a 4% decreased risk of type II diabetes compared to those who ate the least animal fat.

This study shows that diets high in fat and low in carbohydrate may decrease the risk of diabetes.

Obese and diabetic patients lose more weight on a high fat diet compared to a high carbohydrate diet

This study was published in the Annals of Internal Medicine 2004 May 18;140(10):778-85

Study title and authors:

The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial.

Stern L, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J, Williams M, Gracely EJ, Samaha FF.

Philadelphia Veterans Affairs Medical Center, University of Pennsylvania Medical Center, and Drexel University College of Medicine, Philadelphia, Pennsylvania 19104, USA.

This study can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/15148064

This study, of one years duration, compared the effects of of either a high carbohydrate diet or high fat diet on 132 obese adults of whom 83% had diabetes or the metabolic syndrome.

After one year the composition of the two diets was:
(i) 50% carbohydrate, 16% protein, 34% fat (high carbohydrate diet).
(ii) 30% carbohydrate, 18% protein, 52% fat (high fat diet).

The study found:
(a) Those on the high fat diet lost an extra 2 kg compared to those on the high carbohydrate diet.
(b) The unhealthy triglyceride levels decreased by 28.2% on the high fat diet, whereas they increased by 2.7% on the high carbohydrate diet.
(c) The unhealthy high HbA1C levels decreased by an extra 9.6% in diabetic patients on the high fat diet compared to the high carbohydrate diet.

This study shows that a high fat diet had produced more favourable health outcomes for obese and diabetic patients compared with a high carbohydrate diet.

Type I diabetics have better blood sugar control on a high fat diet

This study was published in Diabetologia 1985 Apr;28(4):208-12

Study title and authors:
A prospective comparison of 'conventional' and high carbohydrate/high fibre/low fat diets in adults with established type 1 (insulin-dependent) diabetes.

McCulloch DK, Mitchell RD, Ambler J, Tattersall RB.

This study can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/2991051

This study tested the effects on blood sugar control in 40 type I diabetic adults in either a high carbohydrate/high fibre/low fat diet or a low carbohydrate/low fibre/high fat diet.

The diets comprised of:
(i) 45% carbohydrate, 34% fat, 32 grams fibre per day (higher carbohydrate diet).
(ii) 38% carbohydrate, 43% fat, 20 grams fibre per day (higher fat diet).

After 4 months, HbA1c levels were 1.8% higher in those on the higher carbohydrate diet compared to those on the higher fat diet.

This study reveals that a higher fat diet enables better blood sugar control than a higher carbohydrate diet in type I diabetics.

High-carbohydrate, low-fat diets increase the risk of heart disease in diabetic patients

This study was published in Diabetes Care 1989 Feb;12(2):94-101

Study title and authors:

Persistence of hypertriglyceridemic effect of low-fat high-carbohydrate diets in NIDDM patients.

Coulston AM, Hollenbeck CB, Swislocki AL, Reaven GM.

Department of Medicine, Stanford University School of Medicine, California.

This study can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/2539286

Coulston notes that although low-fat high-carbohydrate diets are recommended for patients with diabetes in an effort to reduce the risk of coronary artery disease, the results of short-term studies have shown that these diets can actually lead to an increased risk of heart disease.

In this study Coulston observed the effects of such diets compared to higher-fat diets over a longer period of 6 weeks in diabetic patients.

 

The diets were either:

• 60% carbohydrate, 20% protein, 20% fat (high-carbohydrate diet).
• 40% carbohydrate, 20% protein, 40% fat (high-fat diet).

The study found:

• The (bad) blood glucose and insulin concentrations were significantly elevated throughout the day when patients consumed the high-carbohydrate diet.
• The (bad) triglyceride concentrations increased by 30% when patients consumed the high-carbohydrate diet.
• The (bad) Very low density lipoprotein (VLDL) cholesterol was significantly increased when patients consumed the high-carbohydrate diet.
• The (good) High density lipoprotein (HDL) cholesterol levels were significantly decreased when patients consumed the high-carbohydrate diet.

This study shows that a high-carbohydrate, low-fat diet increases the risk of heart disease in diabetic patients. 

High fat, low carbohydrate diets are an effective tool in the treatment of diabetes

This study was published in Upsala Journal of Medical Sciences 2005;110(2):179-83

Study title and authors:
Lasting improvement of hyperglycaemia and bodyweight: low-carbohydrate diet in type 2 diabetes. A brief report.

Nielsen JV, Jönsson E, Nilsson AK.
Dept of Medicine, Blekingesjukhuset, Karlshamn, Sweden. jorgen.vesti-nielsen@ltblekinge.se

This study can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/16075898

This study, which lasted for 6 months and involved 31 obese patients with type 2 diabetes, compared the effects of 2 different diets with regard to blood sugar levels and body weight.

The diets were made up of the following:

• 1800 daily calories men, 1600 daily calories women, 20% carbohydrate, 30% protein, 50% fat (high fat diet).
• 1600-1800 daily calories men, 1400-1600 daily calories women, 60% carbohydrate, 15% protein, 25% fat (high carbohydrate diet).

After 6 months the results of the study revealed:

• Fasting blood glucose levels had decreased by 2.8 mmol/l (50.4 mg/dL) more on the high fat diet compared to the high carbohydrate diet.
• HbA1-C levels had decreased .8% more on the high fat diet compared to the high carbohydrate diet.
• Those on the high fat diet lost 9.6 kg (21 lbs) more than those on the high carbohydrate diet, despite having a slightly higher calorie intake.

Nielsen concludes; "A low-carbohydrate diet is an effective tool in the treatment of obese patients with type 2 diabetes."

Diabetes rates have tripled since the low fat crusade started in 1977

This paper was published in Nutrition Volume 26, Issue 10, Pages 915-924 (October 2010)

Study title and authors:
In the face of contradictory evidence: Report of the Dietary Guidelines for Americans Committee
Adele H. Hite, M.A.T.a, Richard David Feinman, Ph.D.b, Gabriel E. Guzman, Ph.D.c, Morton Satin, M.Sc.d, Pamela A. Schoenfeld, R.D.e, Richard J. Wood, Ph.D.f

This paper can be accessed at: http://www.nutritionjrnl.com/article/PIIS0899900710002893/fulltext#sec18
 
Over 30 years ago the initial Dietary Goals for Americans (1977) proposed increases in carbohydrate intake and decreases in fat, saturated fat, cholesterol, and salt consumption that are carried further in the 2010 Dietary Guidelines Advisory Committee (DGAC) Report.
 
In the three decades since the dietary goals were issued:
(a) Carbohydrate consumption has increased
(b) Overall fat, saturated fat, and cholesterol consumption have decreased to near or below targeted levels
(c) Caloric intake remains within recommended levels
(d) Leisure-time physical activity has increased slightly
 
The author notes that since these dietary changes have been successfully accomplished the prevalence of overweight and obesity in the US has increased dramatically in the past three decades and the number of Americans diagnosed with diabetes has tripled.
 
Hite finds:
(i) There is a lack of supporting evidence for the proposed dietary recommendations.
(ii) It is time to reexamine how US dietary guidelines are created and ask whether the current process is still appropriate for our needs.
(iii) An impartial panel of scientists consisting of biochemists, anthropologists, geneticists, physicists, etc., who are not directly tied to the public health nutritional policy should decide the dietary guidelines as such a panel would be able to hear all sides in the debate with few preconceived notions. They could advise impartial recommendations which would be based on a complete and accurate assessment of available science rather than a narrow perspective of accepted nutritional practice.
 
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