Tag Archives: diet

RD Turn-About: Fat Not So Bad

The American Dietetic Association is a low fat bastion, with member dietitians rarely advising patients to embrace a low-carb lifestyle. Doctors routinely refer their patients to Registered Dietitians for guidance, and their advice is normally horrendous. So it was with great interest that I read the news item regarding a presentation at the American Dietetic Association’s (ADA) Food and Nutrition Conference and Expo this month (November, 2010). From a news story in Food Navigator USA:

During a symposium called “The Great Fat Debate: Is There Validity In the Age-Old Dietary Guidance?” at the American Dietetic Association’s (ADA) Food and Nutrition Conference and Expo, four leading experts presented evidence suggesting that low fat diets may be less healthy than those containing at least a moderate amount of fat. In particular, all four agreed that replacing saturated fat with carbohydrates – as has been widely recommended in the United States – is likely to raise the risk of cardiovascular disease.

Emphasis mine. Just thought I’d bold that statement in case any deaf Dietitians were in attendance.

It is not that this is “new news”. The evidence has been mounting, and Low Carb Age has been documenting the end of the low fat diet craze for over a year now. But to have the ADA admit it is a very big deal indeed.

Just to recap some stories in the past year:

Dietary intakes of saturated fats are not linked to cardiovascular disease, so says a meta-analysis of 21 studies from across the world.

Data from almost 350,000 subjects obtained from 21 studies indicated that dietary intakes of saturated fat are not associated with increases in the risk of either coronary heart disease (CHD) or cardiovascular disease (CVD), US researchers report in the American Journal of Clinical Nutrition.

“Our meta-analysis showed that there is insufficient evidence from prospective epidemiologic studies to conclude that dietary saturated fat is associated with an increased risk of CHD, stroke, or CVD,” wrote the researchers, led by Dr Ronald Krauss from the Children’s Hospital Oakland Research Institute in California.

Japanese researchers noted an increase in mortality – that means death, folks – from strokes in those that adopted a low fat diet:

Very low intakes of saturated fats may be just as bad for you as very high intakes, and could lead to an increased risk of death from stroke – according to new Japanese research.

The study, published by the American Journal of Clinical Nutrition, suggests that a very low dietary intake of saturated fatty acids (SFA) is associated with an increased risk of stroke.

“SFA [saturated fatty acids – saturated fat] intake was inversely associated with mortality from stroke. This inverse association was similarly observed for intraparenchymal hemorrhage and ischemic stroke,” wrote the researchers.

Some of the stories show the conflicted nature of researchers facing unpleasant results. One study looked at low fat diets and concluded that it was the type of carbohydrates in the diet that were at fault:

People who cut saturated fats while increasing intake of refined carbohydrates like white bread and pasta have a higher risk of heart attack, according to a study published in the American Journal of Clinical Nutrition.

However, the Danish researchers found that reducing saturated fats while increasing intake of non-refined carbohydrates – such as wholegrain bread and vegetables – could improve heart health. A recent meta-analysis published in the same journal earlier this year called into doubt the widely held theory that high saturated fat intake is linked to high rates of heart disease – but the researchers behind that review said that other dietary elements of the 350,000 subjects involved could be more important.

. . .

They found a statistically significant correlation between replacing saturated fat calories with refined carbohydrates – those described as ‘high-GI’ and thought to cause a spike in blood sugar levels – and heart attack risk. For those subjects with the highest average dietary glycemic index, heart attack risk increased by 33 percent for every five percent increase in calorie intake from carbohydrates.

See the disconnect? I have emphasized the pertinent passage. They are still preaching the “whole grain breads” line while simultaneously saying that High Glycemic Index (GI) foods should be avoided. Yet whole grain bread often has a higher GI than plain old white bread (average of 62 vs. 59). You can see the official GI of different foods at http://www.glycemicindex.com/

Not that the gycemic index should really be a guide. For most Americans, cutting out refined carbs, including all breads, cookies, muffins and cakes, would go a long way toward curing the obesity problem in this country. Whole wheat and whole grain breads are still refined carbs, and spike blood sugar. Wheat may be implicated in numerous health issues due to allergies and sensitivities, sometimes hidden behind nebulous diagnoses of Chronic Fatigue Syndrome or PCOS.

Following a true low carb lifestyle, or adopting a paleo outlook to eating, would greatly enhance health while avoiding the hunger that plagues low fat dieters, and may clear up other health issues (as I found with eliminating GERD and insomnia).

Welcome to the club, dietitians!

Loser: Biggest Loser

I’ve avoided the show The Biggest Loser on purpose, but Dr. Doug McGruff happened upon it in the break room between patients in the emergency ward:

I have never watched this show, as I assumed it would be ridiculous. I was shocked how much I had underestimated. I could not believe the amount and types of exercise these poor people were being put through. They even showed one contestant collapsing on a treadmill and being spit off the back of the machine by the spinning tread. Then there were multiple scenes of the contestants being screamed at by that Gillian lady in the tank-top/midriff shirt (talk about narcissistic) and some sadistic guy with tattoos all over his arms. The instructors’ contempt for the obese was obvious as they spewed insults (and saliva) in the faces of the contestants. I don’t care how fat or desperate I was, if someone did this to me I would punch them in the face and storm off the set. I checked in on the show between patients. The diet and exercise shown were prescriptive for ravenous hunger and ultimate failure. As I continued to work, I kept thinking about the importance of biologic signaling, and why it does not have to be this hard.

Dr. McGruff graduated from the University of Texas Medical School at San Antonio in 1989 and studied Emergency Medicine at the University of Arkansas in Little Rock, where he served as Chief Resident. He is one of the “smart guys” I like; not a researcher in some academic office running computer queries to do some fancy meta analysis, but a practicing physician who sees real people with real problems every week.

Every person who has struggled with a “diet and exercise” program to lose weight knows the problem Dr. McGruff identifies:

Overtraining (especially in the obese) triggers cortisol and other stress hormones. A low fat, high carbohydrate diet signals insulin release. These signals defend a high level of stored fat and drive huger…a true prescription for misery and failure.

Theories abound in what passes for dietary science. The ones based on science rather than just observation appeal to me the most. Dr. McGruff explains why a short high intensity workout is better than the Biggest Loser’s cardio-based workouts:

The key to turning around these sorts of metabolic disasters is to send the correct biologic and hormonal signals. If the correct signals are given, there is a disproportionate improvement in the metabolic state and body composition. This disproportionate response is courtesy of a second messenger system. Most hormones do not act directly on their target organ or tissue.

The cell wall protects the cell; most hormones cannot pass through the cell wall easily. Instead, the hormone’s fat soluble receptors bind the hormone on the outside of the cell wall and transmit the signal to a messenger inside the cell itself. I always think of the way an amplifier can take the puny signal from an iPod, process it, and play it through big, power hungry speakers. And in this case, amplification does indeed happen. The second messenger, on the inside of the cell, amplifies the signal:

The unique thing is that the second messenger then activates a chemical cascade that multiplies the signal at the target. This way a single molecule of primary messenger can produce thousands of second messenger signals at the target.

In other words, your cellular stereo amplifier is set on “10” (or “11” if you are a This is Spinal Tap fan).

This is why a proper signal is so important…the beneficial effect is hugely magnified. A brief, but intense workout that fatigues the musculature activates growth hormone, testosterone and adrenaline which all signal to empty glycogen and fat, both short and long-term. A hunter-gatherer diet creates a low insulin signal which triggers the body to defend a lower body fat set point.

The fact is, you don’t need a skinny person who has never fought a weight battle yelling at you to lose weight or become healthier. And chances are, even after that ordeal, your weight problems will return:

On camera, Zwierstra seemed giddy and brash, interrupting host Caroline Rhea, hollering at her friends in the audience, tipsy on her 3-inch heels. Secretly, she was woozy, having dehydrated herself by avoiding liquids, baking in a sauna and fasting for days to skim off those last few pounds.

The studio audience went wild as the cameras panned in. Zwierstra stepped on the scale. Rhea hollered, “Your current weight is …”

The scale heightened the tension: Beep. Beep. Beep.

144 pounds!

She’d lost 45 percent of her body weight.

But it wasn’t enough.

In the end Erik Chopin, a New York deli owner, took home the big check, losing more than 200 pounds from a starting weight that topped 400.

In January he appeared on Oprah to describe how he’d gained half of it back.

The top two contestants of The Biggest Loser’s third season have not solved their problems. The impossible standard set by the program’s extreme exercise program won’t work for them, or for many people. At its heart, The Biggest Loser uses the “calories in / calories out” principle, comparing the human body to a gas engine rather than to a metabolic organism. It is rooted in the 19th century science that measures food content in how much heat it gives off when burned in a furnace, rather than using modern science to understand how the human body actually works.

Dieting for Risk Factors

With the usual caveat that I am not a medical professional, I want to propose an idea for your consideration. I would encourage you to discuss this idea with your doctor before embarking on any diet plan.

I think it makes sense to first identify your individual risk factors for the things that kill us. The Centers for Disease Control (CDC) publishes charts showing the leading causes of death for men and for women. Looking at the charts you see that heart disease is the leading cause of death at about 27% of all deaths. We tend to focus on those stats and work to minimize our chances of dying from heart disease. That’s certainly the approach taken on a society-wide level with the low-fat diet recommendations (the low fat diet is thought to reduce serum cholesterol levels leading to less heart disease, although many of us find that it increases cholesterol instead.) What I think we are ignoring is that our individual risk factors may be for something entirely different. Remember, that heart disease is not the cause of death for a majority of the people … 73% of them, in fact. Are we increasing our risk of dying early by trying to reduce our risk for heart disease?

The American Heart Association (AHA) identifies the risk factors for heart disease in two categories, those you can change and those you cannot. The categories are a mistake, in my view. It is the risk factors you cannot change that may be the most susceptible to changes in diet: age, sex and heredity. 83% of the deaths due to heart disease happen after age 65, so time is on your side if you are younger than that. Males are more susceptible to heart disease, and have a higher incidence of dying younger than that age 65 statistic. And family history, including race, plays a factor.

The factors you “can change”, according to the AHA, are things like tobacco use, obesity, high blood pressure, serum cholesterol levels, activity levels, and diabetes.

The standard treatment to reduce risk factors for heart disease is a low fat, relatively high carbohydrate diet and prescription drugs to lower cholesterol. The prescription drugs are necessary because many people find a low fat, high carbohydrate diet raises cholesterol (especially triglycerides). Low carb diet advocates challenge this view, and note that many people find a low carb diet improves their lipid profile without the use of prescription drugs (as well as improving weight, high blood pressure and other factors).

The problem is that there is no easy way to score these factors. Do you check off each factor, and if you have more than three, start to worry? Or is family history such an important factor that it, by itself, compels you to work to reduce your risk? Certainly, if your parents and all your siblings died of heart attacks, you probably realize it “runs in your family.” But for most of us, even getting the full list of risk factors isn’t enough to tell us if we, personally, are at risk.

The place to start is a doctor who knows your medical history. Ask him point blank: what do you think I’m going to die from? The answer will be about risk factors for the diseases on those CDC charts, and which one your history indicates the greatest risk for you. Heart disease and cancer are at the top, by a large margin. But as you read down the list, you see stroke, respiratory disease, and diabetes.

Its interesting that diabetes is a risk factor for heart disease, and diabetes itself is the 6th leading cause of death.

My largest risk factor, given my family history and age, sex and physical condition is diabetes. Several people in my family, a brother and my mother, have adult-onset diabetes. I’m male, over 50, and have more than two of the markers for “metabolic syndrome” (pdf file from CDC on metabolic syndrome). In contrast to that, I have very little heart disease in my immediate family.

My doctor recommended a low carb diet to reduce my high triglyceride level; success is shown by lowering triglycerides from 462 to 113 on my last blood test. I’m staying on it to lower my weight and blood glucose level, as well as meet the other cholesterol goals (HDL, LDL, etc., as shown on the About Page).

The term “diet” is often associated with a reduced calorie, temporary eating regimen that you abandon after reaching a weight goal. The problem with this approach is that it ignores the very real impact your diet has on your health. The real goal should be to live longer, not simply to lose weight and “look good”. A pretty corpse is still dead.

Your diet should reflect the best bet to protect against your individual risk factors, and not to fulfill a broad societal goal.