Tag Archives: dietary guidelines

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!

Scientific American and the Low Carb Age

The May, 2010 issue of Scientific American has an article with the headline “Carbs against Cardio“:

… while Americans have dutifully reduced the percentage of daily calories from saturated fat since 1970, the obesity rate during that time has more than doubled, diabetes has tripled, and heart disease is still the country’s biggest killer. Now a spate of new research, including a meta-analysis of nearly two dozen studies, suggests a reason why: investigators may have picked the wrong culprit. Processed carbohydrates, which many Americans eat today in place of fat, may increase the risk of obesity, diabetes and heart disease more than fat does—a finding that has serious implications for new dietary guidelines expected this year.

The article includes a quick recap of different studies that have shown fat intake unrelated to heart disease, including a large meta-analysis of 350,000 people. There is now compelling evidence that carbs, not saturated fat, are the greater health risk.

But will the upcoming dietary recommendations include the “new” information? It seems like a slam-dunk, but this is the government we’re talking about …

Will the more recent thinking on fats and carbs be reflected in the 2010 federal Dietary Guidelines for Americans, updated once every five years? It depends on the strength of the evidence, explains Robert C. Post, deputy director of the U.S. Department of Agriculture’s Center for Nutrition Policy and Promotion. Findings that “have less support are put on the list of things to do with regard to more research.” Right now, Post explains, the agency’s main message to Americans is to limit overall calorie intake, irrespective of the source. “We’re finding that messages to consumers need to be short and simple and to the point,” he says.

In other words, rather than telling Americans to eat the right kind of food, the USDA will persist in telling them to do the most unnatural and dangerous thing you can do: starve yourself.

“Short and simple and to the point” translates to “people are idiots.” Funny that the American public has indeed reduced fat consumption (to its detriment), all the while absorbing the numbers and ratios promulgated as “healthy” by the government. Perhaps the real reason the story has to be told obliquely is that “the people” will see they have been misled. The government told us to eat this way, and its killing us.

The article goes on to slam the “sugared beverage industry”, one of the media’s favorite whipping boys these days, as lobbying heavily in favor of keeping the current dietary guidelines. But the problem is not just sugary drinks, but carbs; the difference between 16 ounces of Coke and 16 ounces of fresh orange juice is slight (and even then, the orange juice gives you more sugar than the Coke.) And loading up on a white rice side dish may have the same effect on your blood sugar levels as that Coke.

Its the carbs, stupid. The carbs.

The article is welcome, of course. And it is a sign of things to come as we transition into the Low Carb Age.

Its about time.

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.

Those Carbs are Gonna’ Kill You

More from the world of medical research:

Reuters reports:

The amount of carbohydrates a woman eats, as well as the overall “glycemic load” of her diet, impact her chances of developing breast cancer, Swedish researchers report.

snip … snip … snip …

Dr. Susanna C. Larsson of Karolinska Institute in Stockholm and colleagues analyzed data on 61,433 women who completed “food frequency” questionnaires in the late 1980s.

In addition, carbohydrate intake, glycemic index and glycemic load were all positively associated with risk of a certain type of breast tumor – namely, estrogen receptor (ER)-positive/progesterone receptor (PR)-negative breast cancer.

Women with the highest “glycemic index diet” had a 44% increased risk of developing ER+/PR- breast cancer compared to women with the lowest glycemic index diet.

Women in the highest category of “glycemic load” had an 81% increased risk of ER+/PR- tumors, and those with the highest carbohydrate intake had a 34% increased risk, compared to those in the lowest groups.

The latest euphemism for “low carb” is “low gycemic index”, a way for the carb-o-lites to keep trying to get people to eat carbs but “the right kind” (i.e., the ones you can’t actually digest that taste like cardboard). The results of epidemiological studies … the most common kind in dietary studies … are showing an increased cancer risk in women who eat a lot of carbs according to the Reuters story. The risk seems particularly high for the estrogen receptor (ER)-positive/progesterone receptor (PR)-negative breast cancer. And colon cancer in men. There’s something about the “sugar rush” in the bloodstream that either feeds or induces the cancer cells.

Meanwhile, it appears the USDA has changed the “food pyramid” yet again. Instead of horizontal slices of the pyramid, with cancer-feeding carbs at the base as the foundation, the new pyramid uses vertical slices. Its a more complex model, and represents … to me … the quandary they find themselves in: carbs are killing people, and they have been pushing them. The new pyramid is so confusing that I hope people will ignore it. Maybe they will find a food guide provided when the nation was thinner, had less heart disease and less cancer:

USDA Food Guide from 1943 - 1955
USDA Food Guide from 1943 - 1955

Diabetics and those with insulin resistance would have to cut down on the carbs, still, but that diet is far and away a better one than the one we have today. With all the knowledge we have gained, we find ourselves looking back at “more ignorant times” to see that, yet, Grandma was right. Get plenty of protein, a couple of tablespoons of butter per day, and limit the bread, Johnny.

Now, that’s good eating.