Swiss Re AG · SIX:SREN

Swiss Re — Investor Presentation (October 2023)

64 slides from Swiss Re's investor presentation, October 2023

  1. Slide 1: Nutritional guidelines and their impact on Metabolic Health

    Nutritional guidelines and their impact on Metabolic Health By, Nina Teicholz Author, Science journalist Founder, Nutrition Coalition

  2. Slide 2: Disclosures

    Disclosures • I am an independent journalist. Receive no funds from any industry or interest group. © Nina Teicholz

  3. Slide 3: Dietary Guidelines for Americans

    Dietary Guidelines for Americans | Ka Sugars (added) Fats, Oils & Sweets USE SPARINGLY USDA menue HHS.gov — . . DEPARTMENT OF AGRICU LT RE U.S. Department of Health and Human Services weeu + voery 18h, Dry Beane, Cheese Group Eggs & Nuts Group 2-3 SERVINGS 2-3 SERVINGS SS FtultGroup 2-4 SERVINGS Bre

  4. Slide 4: Canadian Dietary Guidelines

    Eat a variety of healthy foods each day Have plenty of . vegetables and fruits [Ea [rien \ / {E> Make water your drink of choice Canadian Dietary Guidelines © Nina Teicholz

  5. Slide 5: Nordic Nutrition Guidelines

    Nordic Nutrition Guidelines MORE Vegetables, fruit and berries fish and shellfish nuts and seeds exercise SWITCH TO wholegrain healthy fats low-fat dairy products LESS ted and processed meat salt sugar alcohol © Nina Teicholz =

  6. Slide 6: Dietary Guidelines influence over America's food choices

    HHS Dietary Guidelines for Americans USDA Feeding Programs 1/4 of Americans eat one of these meals/month ‘Special Nutritional Program for Women, infants & Children (WIC) Feeding School Programs Lunch for Elderly Program 14.5% of toddlers Life expectancy in U.S. in WIC are obese is declining: obesity

  7. Slide 7: Rise in U.S. Overweight/Obesity Coincides with Beginning of Dietary Guidelines

    Rise in U.S. Overweight/Obesity Coincides with Beginning of Dietary Guidelines 80 Launch ofthe Dietary Guidsines for Americans (1960) |= 70 65 a 60 55 50 - 45 Percentage of Overweight and Obese 40 T T T T T T T T 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 Source: Centers for Disease Cont

  8. Slide 8: Trends and Disparities in Cardiometabolic Health Among U.S. Adults

    Journal of the American College of @ Jacc ei. Cardiology ELSEVIE Volume 80, Issue 2, 12 July 2022, Pages 138-151 Original Investigation Trends and Disparities in Cardiometabolic Health Among U.S. Adults, 1999-2018 Meghan O’Hearn MS“ © &% @, Brianna N. Lauren MS “, John B. Wong MD Dig. David D. Kim P

  9. Slide 9: Concern Goes Back to the Beginning of the Guidelines (1980)

    Concern Goes Back… to the Beginning of the Guidelines (1980) • A report, Toward Healthful Diets. by the National Academy of Sciences in 1980 • the proposed diet had “generally unimpressive results” • The Director of the National Heart, Lung and Blood Institute urged restraint • The American Society

  10. Slide 10: Defenses: No one even knows about them

    When you start questioning the Guidelines, there are many defenses. #1 No one even knows about them •More fruits and vegetables •Eat whole grains •Low-fat dairy, lean meat •Use vegetable oils, not butter •Emphasize legumes, beans, peas, nuts and seeds © Nina Teicholz

  11. Slide 11: People don't follow the Dietary Guidelines

    #2 People don’t follow the Dietary Guidelines © Nina Teicholz

  12. Slide 12: © Nina Teicholz

    © Nina Teicholz -28% -79% -13% -27% -9%

  13. Slide 13: © Nina Teicholz

    a a © Nina Teicholz

  14. Slide 14: Macronutrient Shift in the U.S. 1965-2011

    Macronutrient Shift in the U.S. 1965-2011 60 Carbs up by 30+% o 350 2 = be oc 2 Fats down by 25% c $s 30 —o Ee = 2 20 10 i Saturated Fat down by 17% 0 1965 1971 2011 Source: Cohen et. al., Nutrition, 2015; chart by Nina Teicholz. es © Nina Teicholz

  15. Slide 15: So, yes, Americans have followed the US Dietary Guidelines

    So, yes, Americans have followed the US Dietary Guidelines © Nina Teicholz

  16. Slide 16: Mediterranean-style, US-style, Vegetarian

    • “Mediterranean-style” • “US-style” • Vegetarian © Nina Teicholz

  17. Slide 17: USDA-HHS Dietary Patterns

    USDA-HHSS 3 “Dietary Patterns” Carbohydrates Proteins “U.S.-Style” “Mediterranean” — “Vegetarian” (DASH) Source: CNPP, Food and Nutrition Services, U.S. Department of Agriculture, "Food Pattern Modeling: Ages 2 Years and Older: 2020 Dietary Guidelines Advisory Committee Food Pattern Modeling Report,

  18. Slide 18: Scientific Report of the 2015 Dietary Guidelines Advisory Committee

    USDA fo Ka re Scientific Report of the 2015 Dietary Guidelines Advisory Committee Advisory Report to the Secretary of Health and Human Services and the Secretary of Agriculture © Nina Teicholz

  19. Slide 19: © Nina 2015;351:h4962 Teicholz, N, The BMJ,

    © Nina 2015;351:h4962 Teicholz, N, The BMJ, Teicholz

  20. Slide 20: PREDIMED trial and DASH trials

    1. PREDIMED trial 2. DASH trials © Nina Teicholz

  21. Slide 21: PREDIMED

    PREDIMED Th NEW ENGLAND JOURNAL of MEDICINE ESTABLISHED IN 1812 APRIL 4, 2013 VOL. 368 NO. 14 Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Ramén Estruch, M.D., Ph.D., Emilio Ros, M.D., Ph.D., Jordi Salas-Salvad6, M.D., Ph.D., Maria-Isabel Covas, D.Pharm., Ph.D., Dolores Cor

  22. Slide 22: DASH or US-Style Diet

    DASH or “US-Style” Diet Tested on no more than 1,200 people (Mainly on hypertensive, middle-aged men) Only one trial has lasted longer than 8 weeks (that trial was 5 mo) While LDL-C usually drops, so does HDL-C. Overall, arguably equivocal data regarding CVD risk improvement © Nina Teicholz

  23. Slide 23: PREDIMED trial and DASH trials

    1. PREDIMED trial 2. DASH trials © Nina Teicholz

  24. Slide 24: Single trial of subjects with metabolic syndrome

    A single trial: 180 subjects with metabolic syndrome, 2 years. Outcome: 2.7 kg more weight loss for patients on Mediterranean diet vs. low-fat controls. Esposito et al., JAMA. 2004 Sep 22;292(12):1440-6.© Nina Teicholz

  25. Slide 25: Zero clinical trials for USDA Dietary Patterns and Type 2 diabetes

    Zero clinical trials presented to show that any of the USDA Dietary Patterns can prevent or reverse Type 2 diabetes. © Nina Teicholz

  26. Slide 26: Vegetarian Diet

    Vegetarian Diet •The US Dietary Guidelines advisory committee review could find no randomized, controlled trials to support this diet. •The government’s review of the “Healthy Vegetarian” diet concluded that the evidence for any disease- fighting powers of this diet was “limited”— the lowest rank gi

  27. Slide 27: What is the evidence for the US Dietary Guidelines?

    If not clinical trials, then what is the evidence for the US Dietary Guidelines? It is all epidemiological. © Nina Teicholz

  28. Slide 28: Pyramid of Evidence

    Pyramid of Evidence

  29. Slide 29: Are those all the major clinical trials on diet?

    Is that really all the major clinical trials that have been conducted on diet? © Nina Teicholz

  30. Slide 30: Trials on the Low-Fat Diet

    Trials on the Low-Fat Diet • Women’s Health Initiative, 2006 Multi-center, NIH-funded trial, on ~49,00 women, for avg of 8 years Conclusions: the low-fat diet did not help fight obesity, cardiovascular disease or any type of cancer. (This trial looked at hard endpoints). Source: Howard BV, Van Horn

  31. Slide 31: Randomized Controlled Trials on Saturated Fats

    Randomized Controlled Trials on Saturated Fats • There were actually a large number of government-funded, randomized, controlled clinical trials. The “Core Trials” • On altogether at least 67,000 men and women, in experiments lasting 1 to 8 years • Most in in-patient settings; therefore highly contr

  32. Slide 32: Trials never reviewed by Advisory Committee

    None of these trials, on the low-fat diet or on saturated fat, have ever been directly reviewed by any US Dietary Guidelines Advisory Committee © Nina Teicholz

  33. Slide 33: Randomized controlled clinical trial (2018)

    Randomized controlled clinical trial (2018) USDA Diet (DGA) vs ”typical American diet” (TAD) VS. Source: Krishnan, Sridevi et al. “A randomized controlled-feeding trial based on the Dietary Guidelines for Americans on cardiometabolic health indexes.” The American journal of clinical nutrition vol. 1

  34. Slide 34: Trial design: DGA vs typical American diet

    •52 women over 8 weeks •All food provided •TAD: higher in refined grains, saturated fat, and sugar • 3 ½ additional servings of refined grains per day, including lemon cheesecake, and “all day condiments” that included candy and “Jelly Bellies” • DGA: had more fruits, vegetables, and whole grains ©

  35. Slide 35: Results?

    Results? •DGA women scored 98/100 on “Healthy Eating Index” •TAD women scored 65-69 •Outcomes measured: markers for diabetes and heart disease • Except: systolic blood pressure slightly better for the DGA women © Nina Teicholz

  36. Slide 36: What can we learn from these clinical trials?

    What can we learn from these clinical trials? •They do not support our current official dietary guidance •Their findings were ignored or suppressed •Our guidelines can therefore be seen, on key issues, as being non-evidence-based. © Nina Teicholz

  37. Slide 37: First-ever outside peer-review of the Guidelines process

    First-ever outside peer-review of the Guidelines process “The current DGA process for reviewing the science falls short of meeting the best practices for conducting systematic reviews. “Methodological approaches and scientific rigor for evaluating the scientific evidence need to be strengthened…. …r

  38. Slide 38: National Academies recommendations to the USDA

    The National Academies issued 11 recommendations to the USDA on how to improve the Guidelines’ process Source: https://www.nutritioncoalition.us/news/usda-fails-to-fully-implement-natl-academies-recs-for-transparency © Nina Teicholz

  39. Slide 39: Resistance to change

    Resistance to change… © Nina Teicholz

  40. Slide 40: Types of Dietary Fat and Cardiovascular Disease: A Systematic Review

    Dietary pag ogee or Americans USDA =~: 2020 - 2025 Types of Dietary Fat and Cardiovascular Disease: A Systematic Review 2020 Dietary Guidelines Advisory Committee, Dietary Fats and Seafood Subcommittee Published date: July 15, 2020 Nina Teicholz

  41. Slide 41: Studies on saturated fats reviewed for the 2020 US Dietary Guidelines

    Studies on saturated fats reviewed for the 2020 US Dietary Guidelines Astrup, A. et al.. Dietary Saturated Fats and Health: Are the U.S. © Nina Guidelines Evidence-Based? Nutrients 2021, 13, 3305. Teicholz

  42. Slide 42: Cardiovascular Disease Endpoint Outcomes: Adults

    Cardiovascular Disease Endpoint Outcomes: Adults Strong evidence demonstrates that replacing saturated fatty acids with polyunsaturated fatty acids in adults reduces the risk of coronary heart disease events and cardiovascular disease mortality. Grade: Strong © Nina Teicholz

  43. Slide 43: Dietary Cholesterol

    Dietary Cholesterol © Nina Teicholz

  44. Slide 44: No more cholesterol caps

    No more cholesterol caps •Dropped by the American Heart Association in 2013 • “Insufficient evidence” Source: https://doi.org/10.1161/01.cir.0000437740.48606.d1Circulation. 2014;129:S76–S99 •Dropped by the US Dietary Guidelines for Americans in 2015 • “no appreciable relationship between consumption

  45. Slide 45: No more cholesterol caps

    No more cholesterol caps •Reviewed again by the US Dietary Guidelines in 2020 • -> “insufficient evidence” to link dietary cholesterol with blood cholesterol. © Nina Teicholz

  46. Slide 46: US Recommended Dietary Patterns are lower in cholesterol

    US Recommended Dietary Patterns “are…lower in cholesterol” © Nina Teicholz

  47. Slide 47: On low-carbohydrate diets

    On low-carbohydrate diets “Hi SC2 members, As you all know, there has been a continued, and perhaps growing, interest in low-carbohydrate diets, and we have been asked on numerous occasions why the Dietary Guidelines do not recommend low- carbohydrate diets as the dietary pattern of choice to the ge

  48. Slide 48: USDA review on low carb

    Folks, [The USDA] did conduct a review on low carb for us though we are not adding it as a formal question…[and we are putting the results in the Methodology section] © Nina Teicholz

  49. Slide 49: Committee comments on low-carb diets

    “People who are familiar with the field may complain “Given the popularity of [a low-carb] pattern and that we gloss over recent evidence and don’t give low- enormous amount of research that has been generated carb diets…sufficient attention that they deserve.” in the past several years, I was wonde

  50. Slide 50: Expert committee could find no studies on low-carbohydrate diets

    Expert committee could find NO studies on a low- carbohydrate diets © Nina Teicholz

  51. Slide 51: There are no questions on low-carbohydrate diets

    There are no questions on low-carbohydrate diets © Nina Teicholz

  52. Slide 52: Expert committee conflicts of interest

    95% of the expert committee had at least one potential conflict of interest with a food or pharmaceutical company 60% had 20 such conflicts or more One woman had 152 conflicts © Nina Teicholz

  53. Slide 53: USDA Strategic Partners

    USDA Strategic Partners USDA's Center for Nutrition Policy & Promotion Office that produces the US Dietary Guidelines for Americans EP a 2-8 won SD OH OQ |e ers scat ae 7 PASTA a, Lewis ra — —— : a 2 Sabra USDA United States Welch's nutella nation =e «(Department of —— Chobani Agricutture [—~ Waceee

  54. Slide 54: Have the US Dietary Guidelines caused harm?

    Have the US Dietary Guidelines caused harm? © Nina Teicholz

  55. Slide 55: Law of Unintended Consequences

    Law of Unintended Consequences © Nina Teicholz

  56. Slide 56: 2000 expert committee concern about low-fat advice

    In 2000, expert committee for the Guidelines expressed concern that the government’s low-fat advice… “could engender an overconsumption of total calories in the form of carbohydrates, resulting in the adverse metabolic consequences of high-carbohydrate diets.” “Further, the possibility that overcons

  57. Slide 57: 2015 Expert Committee on low-fat diets and dyslipidemia

    2015 Expert Committee (Dietary Guidelines Advisory Committee: Low-fat “diets are generally associated with dyslipidemia (hyper-triglyceridemia and low HDL-C concentrations)” which are indicators of increased risk for heart disease. © Nina Teicholz

  58. Slide 58: Metabolic Health: Tackling wellbeing from the inside out

    @ Swiss R Fatty liver Arthritis Alzheimer's Metabolic Health . ay Tackling wellbeing from the inside out ee ie “7 Lt blood pressure Sie Erectile dysfunctions © Nina Teicholz

  59. Slide 59: Hiding unhealthy heart outcomes in a low-fat diet trial

    Review > Open Heart. 2021 Jul;8(2):e001680. doi: 10.1136/openhrt-2021-001680. Hiding unhealthy heart outcomes in a low-fat diet trial: the Women's Health Initiative Randomized Controlled Dietary Modification Trial finds that postmenopausal women with established coronary heart disease were at increa

  60. Slide 60: Findings

    Findings: • Postmenopausal women with heart disease put on a low-fat 'heart-healthy' diet were at 26% greater risk of developing additional CHD events compared with women with heart disease eating the control diet. • A later publication (2017) from the Women’s Health Initiative, with 5 years of foll

  61. Slide 61: Concerns raised by scientists about the guidelines

    • In the past 15 years, scientists including at least 7 members of previous expert committees overseeing the science for the Dietary Guidelines, have raised serious concerns about the guidelines’ methodology and/or the resulting recommendations. • A 2010 DGAC member wrote, “Despite our evidence-base

  62. Slide 62: In sum, Some myths dispelled

    In sum, Some myths dispelled •When people say the Dietary Guidelines are not to blame… •In fact: • People are very aware of the Guidelines • People have followed the Guidelines •When people say clinical trials are too high a standard, in fact… • There’s no lack of clinical trials that the Guidelines

  63. Slide 63: Summary

    Summary • The Guidelines were based on weak evidence from the outset • Have since ignored many important clinical trials that refute their efficacy • The evidence base for the Guidelines is most epidemiological (weak science) • The Guidelines therefore cannot be considered a trustworthy, reliable do

  64. Slide 64: Thank you!

    Thank you! Nina Teicholz Science journalist, Researcher Founder, The Nutrition Coalition @bigfatsurprise ninateicholz ninateicholz Unsettledscience.substack.com © Nina Teicholz

Swiss Re — Investor Presentation (October 2023) on 6ix