2

votes

Eating nuts lowers risk of stroke by 46% . What about the omega 6 hypothesis?

Answered on August 19, 2014
Created February 26, 2013 at 3:01 PM

From:

http://health.yahoo.net/experts/dayinhealth/diet-prevents-heart-attacks

"Another startling finding was that eating a Mediterranean diet including extra servings of nuts trims stroke risk by a whopping 46 percent, compared to eating a low-fat diet. ???That???s a huge risk reduction,??? says Dr. Bale. ???It???s truly astonishing to see such a powerful effect from one food.???"

What if the lion's share of all the paleo benefits are simply from reducing sugar and refined, packaged & processed foods.

Am I driving myself crazy worrying about omega 6 in nuts?

Granted, they were eating just 1 ounce extra nuts per day, so maybe if they were eating 5 ounces of nuts / day, the results would not have been the same.

Thoughts?

Thanks, Mike

Medium avatar

(10611)

on February 26, 2013
at 10:29 PM

The improved risk is in comparison with the low fat control, not the Med which is also an improvement over low fat. Between the Med variants there isn't much difference. You really wouldn't expect a lot of effect from adding 100-200 cals of additional fat to it.

A2c38be4c54c91a15071f82f14cac0b3

(12682)

on February 26, 2013
at 10:00 PM

You're right thhq, this was not a mortality study. But even with strokes, CV events were not different between the two Mediterranean diet groups. So with that data the same, if we look at secondary endpoints, like total mortality and mortality from CVD, there does not seem to be a trend in favor of the nuts compared to EVOO and the opposite may even be true. This is the basis for my last sentence.

Medium avatar

(10611)

on February 26, 2013
at 08:28 PM

The graph only shows that mortality is about the same for everyone if an event occurs. The nut-eaters presumably had 46% less events compared to the control low fat diet.

Medium avatar

(10611)

on February 26, 2013
at 08:25 PM

While your point is well taken tat in the end we're all dead, this was not a mortality study which neatly ended with the deaths of all the participants. It was a study of the risk reduction of a CV event.

Medium avatar

(10611)

on February 26, 2013
at 08:16 PM

This wasn't a mortality study.

Medium avatar

(10611)

on February 26, 2013
at 08:12 PM

Yeah how much money do you have? How much money is there in the world?

Medium avatar

(10611)

on February 26, 2013
at 08:11 PM

This study had over 7000 at-risk-for-CVD participants, so it's not just a lab rat study.

Medium avatar

(39831)

on February 26, 2013
at 06:22 PM

Oh god, someone fund this please

B4e1fa6a8cf43d2b69d97a99dfca262c

(10255)

on February 26, 2013
at 06:03 PM

and this https://www.youtube.com/watch?v=RKmxL8VYy0M TedTalk is also interesting if you apply what he is saying to diet instead of pharmaceuticals.

6864d23c49952605b2a97d6256af804d

(726)

on February 26, 2013
at 06:00 PM

The articles states "Regarding components of the primary end point, only the comparisons of stroke risk reached statistical significance." Thus, the med diet reduced incidence of stroke while keeping mortality relatively constant. Maybe the nuts group was dying at a greater rate than the EVOO group due to some other mixture of causes.

7fc82eebafd44badc73c520f44660150

(3275)

on February 26, 2013
at 05:05 PM

The statin studies often get slammed for reporting relative risk reduction vs. absolute risk. Does your chart suggest there is not much absolute difference in any of them?

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7 Answers

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4
A2c38be4c54c91a15071f82f14cac0b3

(12682)

on February 26, 2013
at 04:33 PM

This study's primary endpoint was a composite of stroke, myocardial infarction, and death from cardiovascular cause. Despite lowering stroke risk compared to the extra virgin olive oil group (3.1% v. 4.1%), the nut group had no difference in primary endpoints compared to the EVOO group because the EVOO group died of cardiovascular causes non-significantly less (3.0% v. 2.2%).

And just for the record, here was total mortality:

It's worth looking I think, since the EVOO group had non-significantly less death from cardiovascular causes and death in general than the nuts group. The linoleic acid in nuts doesn't strike me as a pressing concern, but I also don't think this study proves the benefits of nuts or absolves omega-6 of its ill reputation.

7fc82eebafd44badc73c520f44660150

(3275)

on February 26, 2013
at 05:05 PM

The statin studies often get slammed for reporting relative risk reduction vs. absolute risk. Does your chart suggest there is not much absolute difference in any of them?

Medium avatar

(10611)

on February 26, 2013
at 08:25 PM

While your point is well taken tat in the end we're all dead, this was not a mortality study which neatly ended with the deaths of all the participants. It was a study of the risk reduction of a CV event.

Medium avatar

(10611)

on February 26, 2013
at 10:29 PM

The improved risk is in comparison with the low fat control, not the Med which is also an improvement over low fat. Between the Med variants there isn't much difference. You really wouldn't expect a lot of effect from adding 100-200 cals of additional fat to it.

Medium avatar

(10611)

on February 26, 2013
at 08:28 PM

The graph only shows that mortality is about the same for everyone if an event occurs. The nut-eaters presumably had 46% less events compared to the control low fat diet.

Medium avatar

(10611)

on February 26, 2013
at 08:16 PM

This wasn't a mortality study.

A2c38be4c54c91a15071f82f14cac0b3

(12682)

on February 26, 2013
at 10:00 PM

You're right thhq, this was not a mortality study. But even with strokes, CV events were not different between the two Mediterranean diet groups. So with that data the same, if we look at secondary endpoints, like total mortality and mortality from CVD, there does not seem to be a trend in favor of the nuts compared to EVOO and the opposite may even be true. This is the basis for my last sentence.

6864d23c49952605b2a97d6256af804d

(726)

on February 26, 2013
at 06:00 PM

The articles states "Regarding components of the primary end point, only the comparisons of stroke risk reached statistical significance." Thus, the med diet reduced incidence of stroke while keeping mortality relatively constant. Maybe the nuts group was dying at a greater rate than the EVOO group due to some other mixture of causes.

4
B36bbab16837fe6d60eb2b5a49a561ed

(314)

on February 26, 2013
at 04:46 PM

To answer your question directly, if you are worrying about the how much Omega 6 you are consuming through the consumption of various nuts, then, yes you are driving yourself crazy over nothing. The only caveat to that would be if you are consuming very large servings of nuts daily, and not consuming adequate amounts of Omega 3 from other sources. I think that the important thing to remember is that you are trying to keep a balance between O6 and O3 levels, any eating too much of anything can offset this balance. It is not about avoiding all Omega 6, as they have a place in a healthy diet as well, and I would rather get them from a whole food source like nuts, than other methods.

3
510bdda8988ed0d4b0ec0b738b4edb73

(20898)

on February 26, 2013
at 04:42 PM

I think I'm going to start posting this every time someone links to a single study and says "what about..." You need to look at the totality and quality of all studies (unfortunately including the unpublished ones). One study shouldn't ever change your mind about something. We should all be converging on the right answer, though very slowly because that's how real science works.

http://www.npr.org/blogs/13.7/2013/02/25/172779912/science-a-relationship-you-may-not-understand

B4e1fa6a8cf43d2b69d97a99dfca262c

(10255)

on February 26, 2013
at 06:03 PM

and this https://www.youtube.com/watch?v=RKmxL8VYy0M TedTalk is also interesting if you apply what he is saying to diet instead of pharmaceuticals.

Medium avatar

(10611)

on February 26, 2013
at 08:11 PM

This study had over 7000 at-risk-for-CVD participants, so it's not just a lab rat study.

2
6864d23c49952605b2a97d6256af804d

(726)

on February 26, 2013
at 05:42 PM

Consider the control group - it was simply a medical recommendation to reduce overall fat intake. No mention of n-6 fat estimates in the study from what I can tell, and plenty of n-3's in the mediterranean diet for balance. I'd be surprised if the mediterranean diet didn't have a lower n-6 content and a better n-3/n-6 balance. The study simply states that a mediterranean diet lowers CHD incidence relative to a standard spanish diet. It's similar to the apparent success of the Forks over Knives diet - some good features of the diet make it better than the SAD, but that doesn't make it optimal for health. And as for figuring out which components of these diets are effective by analyzing this study? Forget about it.

2
7e6644836cdbcbe2b06307ff7db92d31

(693)

on February 26, 2013
at 04:45 PM

Just from the news reports, it seems to say that med + nuts beat low fat, at least as much as the low fat was followed. This is the study you want.

  1. SAD
  2. low sat fat & chol
  3. med + nuts
  4. med + EVOO
  5. paleo with nuts
  6. low-carb paleo with nuts
  7. paleo without nuts
  8. low-carb paleo without nuts
  9. vegan
  10. eskimo 11...

Medium avatar

(39831)

on February 26, 2013
at 06:22 PM

Oh god, someone fund this please

Medium avatar

(10611)

on February 26, 2013
at 08:12 PM

Yeah how much money do you have? How much money is there in the world?

0
B4e1fa6a8cf43d2b69d97a99dfca262c

(10255)

on February 26, 2013
at 06:04 PM

low fat diets are not healthy. wouldn't almost any diet compare well?

0
Medium avatar

(10611)

on February 26, 2013
at 03:49 PM

A couple of comments.

The Med diet is not low fat, at about 50% carb/35% fat/15% protein. Adding an ounce of nuts to that would be another 100 cals of fat. Not a big deal, maybe raising fat % by 5% and dropping the others slightly.

Foods are not a neat Gilbert biochemistry lab. Lately I've been paying attention to the heart health benefits from eating or drinking certain grape varieties. Tannat are much more beneficial than merlot or Pinot. The right nuts are probably the same. Whatever makes them bitter or astringent is probably something that makes you healthy, and probably way more important than any detrimental effect Omega 6 might have.

Inclusion! Inclusion! Inclusion! Paleos knew nothing about Omega 6 and certainly ate any nut they could digest.

2/28/13 edit to add full text of the NEJM article:

http://www.nejm.org/doi/full/10.1056/NEJMoa1200303#t=articleResults

In reading through this, one thing that strikes me was the lack of diet definition. The only thing participants were clearly instructed to do was to eat generally low fat (control), eat a daily nut ration in addition to med diet, or eat a daily olive oil ration in addition to med diet. They ate ad libitum, and their CV events and mortality were tracked for 5 years. The big result was the fall-off in the occurrence of CV events for the two supplemented groups. Considering how little the study was controlled, it's astonishing that they would see so much effect.

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