Another “Good” Diet Produces Lousy Results

In the speech I gave at the Office of Research Integrity conference, I listed this as the first ingredient for creating a crisis in nutrition:

Doctors, nutritionists, researchers, medical industry trade groups, government agencies and other established authorities handing out dietary advice that flat-out doesn’t work very well for an awful lot of people.

Today I saw another example of that ingredient in action.  A co-worker who heard from another co-worker that I know a thing or two about nutrition and health sent an email asking if he could drop by for a chat.  When we talked, he explained that he’s confused because his latest blood-work results aren’t good, even though he’s following the kind of “healthy” diet his doctor told him he should.

We’ll look at the results in a moment.  First let’s look at his typical diet, which he printed out for me.

Morning
Water, lime and honey (2 glasses), two egg-white omelet with little salt, 1 chili.

Breakfast
Oatmeal with water and fat-free milk, glass of fat-free milk
or
Milkshake with fat-free protein powder, fat-free milk, orange juice, fiber, blue berries, black berries, strawberries

Lunch
Bunch of carrots, cucumber, tomato, 1/2 cup rice and curry
or
Spaghetti and vegetables

Snack
Wheat bread or plain bagel with jam (fat free), peanut butter.

Dinner
Two whole-wheat tortillas, curry, apple or another fruit, 1 glass fat free milk.  (The curry is usually vegetable curry, but includes a little chicken cooked in olive oil twice per week.)
or
Spaghetti and vegetables

Snack
Mix of cashews, almonds and raisins

Now there’s a diet that would make your average doctor or dietician stand up and cheer!  Mostly plant-based, egg whites instead of whole eggs, fat-free milk instead of whole milk, very low in fat, devoid of red meat, lots of vegetables, and high in “good” carbohydrates:  oatmeal, orange juice, fruit, rice, whole-wheat bread, whole-wheat tortillas, and spaghetti.  This is the kind of diet the USDA believes everyone should be eating — and by gosh, we probably would if only we weren’t so gluttonous …  or so stupid that the Food Pyramid confuses us.  It’s also the kind of diet the USDA is pushing in schools.

Now let’s look at a couple of my co-worker’s lipid panels.

Two years ago
Total cholesterol: 212
LDL: 133
HDL: 46
Triglycerides: 161

Two weeks ago
Total cholesterol: 212
LDL: 140
HDL: 38
Triglycerides: 168

Notice anything?  The guy has been following the diet he was told is good for him, but his triglycerides are up and his HDL is down.  Those numbers may not look particularly alarming individually, but his triglycerides/HDL ratio is pretty bad.

For those of you who don’t already know, the most reliable predictor of heart disease you can calculate from a lipid panel is the triglycerides/HDL ratio.  You want that ratio below 3.0, preferably below 2.0.  If the ratio is above 3.0, it’s more likely that your body is producing small, dense LDL.  If the ratio is below 2.0, it’s more likely that your body is producing large, fluffy LDL.  A high ratio can also be an indicator that you’re becoming insulin resistant.

Thanks to that diet full of “good” carbohydrates and low in fat, my co-worker’s triglycerides/HDL ratio is 4.42.  And by the way, he’s a lean guy:  5’5”, 142 pounds.  Nobody can blame these lousy results on overeating or being overweight.  As he told me, his doctor is a bit frustrated as well, seeing those lousy numbers in a lean guy who eats a “healthy” low-fat diet.

In my speech, I talked about a common sequence in the treatment of type 2 diabetes:  a doctor tells a patient to start following the American Diabetes Association diet, the patient does, his blood sugar continues to spiral out of control, so the doctor prescribes a drug.  Frankly, I don’t know how any doctor with a functioning brain can recommend the ADA diet and then be surprised at the lousy results.  A diet based on foods that are rapidly converted to glucose raises fasting glucose levels?  Duh!

But I understand why doctors believe a low-fat diet will reduce triglycerides, since triglycerides are fats.  What they fail to realize is that high fasting triglycerides are a response to excess carbohydrates.  Here’s Dr. William Davis, the author of Wheat Belly, explaining the process:

One of the most common triglyceride myths is that eating fats increases triglyceride. But that’s only a half-truth, since fats do indeed increase triglycerides-but only if triglycerides are measured after eating (i.e., in the postprandial period). The real story is that fats in the diet decrease triglycerides-at all other times except after a meal. The higher the fat content of your diet, the lower your triglycerides will be in a fasting blood draw. This has been well-established in numerous diet trials comparing low-fat with low-carbohydrate diets.

Here’s where it gets confusing: While dietary fats cause triglycerides to increase after eating, carbohydrates cause triglycerides to increase at all other times. This means that carbohydrates (starches), like breads, pasta, breakfast cereals, pretzels, crackers, potatoes, soft drinks, and candies increase fasting triglycerides if consumed habitually.

A carbohydrate food like bread actually contains very little triglyceride . . .  So why would bread cause triglycerides to increase? Because carbohydrates are converted to triglycerides in the liver.

The human body has little capacity to store carbohydrates. So it needs a method to store the energy of excessive carbohydrates. It does so by converting carbohydrates to triglycerides, which are then converted to fat, especially the fat in your abdominal region (visceral fat).

Not surprisingly, the quickest way to reduce high fasting triglycerides is to cut back on the carbohydrates.  The easiest way to raise HDL is to eat more fat (natural fat, that is).  But since most doctors don’t know that, they see someone with a lipid panel like my co-worker’s and immediately recommend a low-fat diet with lots of fruit and whole grains.  In other words, they hand out dietary advice that doesn’t work.  When the dietary advice fails, as it did for my co-worker, they reach for the prescription pad.

That’s why we have a crisis in nutrition.  That’s why the advice the “experts” are handing out has to change.

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136 thoughts on “Another “Good” Diet Produces Lousy Results

  1. UltraVoltron

    Can you help me with the milk debate. I read on the Paleo sites that milk is a no go. While I don’t adhere to the premiss of the Paleo diet, I belive they have a lot of the right ideas. So why did you decide to drink milk in the end?I do at the moment and it feels great BTW.

    I’ve elected to go dairy-free during the week. On weekends, I indulge in a bit of full-fat dairy, which means cheese in my omelets and cream in my coffee.

    Reply
  2. Firebird7478

    @ Marilyn. Check out The Sugar Fix by Dr. Richard Johnson. It indicts fructose for many illnesses, including gout. But, he doesn’t go far enough and still believes in high carbs and that saturated fat is the enemy.

    Reply
  3. Gretchen

    You said this guy’s diet had lots of vegetables. What struck me was the *lack* of vegetables, especially greens. Not clear what was in the vegetable curry or the spaghetti and vegetables, but probably not greens, more likely potatoes or squash I’m on a LC diet but I eat lots of kale, broccoli, etc., sometimes at all three meals.

    Reply
  4. labrat

    But I understand why doctors believe a low-fat diet will reduce triglycerides, since triglycerides are fats.

    I can’t. I took the same biochem classes as they did back in the early eighties that taught us how carbs were converted to trigs, only difference between them and me is that I never mailed my applications. I knew even then that the days of Marcus Welby were over.

    Apparently they forgot a few lectures.

    Reply
  5. Peggy Holloway

    I recently reconnected with an old friend. She and I are about the same age (60-ish) and are highly educated, experienced college voice teachers who can’t find full-time employment in our field, primarily because most institutions are hiring adjuncts to avoid paying benefits. My friend has been supplementing her teaching with a hotel-reservationist job in order to get health insurance. She wants to give that up because of the difficulty of juggling her job requirements. I told her about my $125/month catastrophic policy (high-deductible and no out-patient benefits except for the “Obamacare” provision requiring a preventive care physical a year; sorry I’m a big fan of the Affordable Care Act). I saw her a few weeks later and she said that she had looked into my type of policy and that she didn’t think that would work for her because of her high blood pressure and cholesterol. She said her doctor wants to put her on statins. I suggested that she try life-style changes first, and she said “but I eat a really healthy diet. You know, I’m practically a vegan.” Bingo. I then noticed that in spite of looking very thin at first glance, she carries a pretty substantial “wheat belly.”
    My son just went through his second Whole Foods biometrics exam to try to increase his employee discount. Apparently, you can’t get the full discount if your total cholesterol is over 150! His LDL and total cholesterol were flagged as too high, and even though his triglycerides are 53 and HDL 70 and his BMI is about 20, he did not get a discount increase. Of course, they only use calculated LDL which is inaccurate with low triglycerides/high HDL and they do no particle analysis. He gets really bummed out about this, but as long as Whole Foods subscribes to the lipid hypothesis, he has no prayer of meeting their requirements with his ultra-strict low-carb, paleo diet – even though he is the picture of radiant health!

    Yee-ikes. Perfect examples of what’s wrong the standard advice.

    Reply
  6. Asclepius

    The reason his numbers are getting worse is twofold; an inevitable consequence of aging, and, a deficiency in medication.

    😉

    That must be it. Lack of medication has reached epidemic proportions.

    Reply
  7. Gretchen

    Is this blog censored? I made a comment, and it said it was awaiting moderation and then disappeared. No need to post your reply. If you reply privately I’ll know whether I should bother to post again, or even read.

    It’s not censored, but a couple of other people have mentioned comments disappearing lately. Maybe the spam filter is catching more than it should. I used to check the spam folder, but now it catches thousands per week and I don’t have the time to scroll through it.

    Reply
  8. Peter

    While waiting in my doc’s office, I leafed thru a magazine targeted at diabetic patients published by the American Diabetic Association. Inside was a recipe for banana bread. Ingredients included bananas, flour , 1/2 cup of brown sugar and 1/2 cup of canola oil.
    Good for controlling glucose and boosting HDL?
    Then my light bulb moment: it’s a very healthful recipe for the magazine’s advertisers.

    Bingo.

    Reply
  9. Firebird7478

    @ Marilyn. Check out The Sugar Fix by Dr. Richard Johnson. It indicts fructose for many illnesses, including gout. But, he doesn’t go far enough and still believes in high carbs and that saturated fat is the enemy.

    Reply
  10. Gretchen

    You said this guy’s diet had lots of vegetables. What struck me was the *lack* of vegetables, especially greens. Not clear what was in the vegetable curry or the spaghetti and vegetables, but probably not greens, more likely potatoes or squash I’m on a LC diet but I eat lots of kale, broccoli, etc., sometimes at all three meals.

    Reply
  11. labrat

    But I understand why doctors believe a low-fat diet will reduce triglycerides, since triglycerides are fats.

    I can’t. I took the same biochem classes as they did back in the early eighties that taught us how carbs were converted to trigs, only difference between them and me is that I never mailed my applications. I knew even then that the days of Marcus Welby were over.

    Apparently they forgot a few lectures.

    Reply
  12. Gretchen

    Is this blog censored? I made a comment, and it said it was awaiting moderation and then disappeared. No need to post your reply. If you reply privately I’ll know whether I should bother to post again, or even read.

    It’s not censored, but a couple of other people have mentioned comments disappearing lately. Maybe the spam filter is catching more than it should. I used to check the spam folder, but now it catches thousands per week and I don’t have the time to scroll through it.

    Reply
  13. DaiViet

    Marilyn says:
    March 23, 2012 at 7:53 pm

    Michael, I read some of that article about the guy with the gout. Maybe he should get on the internet and do some checking. Some people are blaming fructose for gout.

    The fructose can only metabolised by the liver. One of the byproduct is uric acid which not only causes gout, but also hypertension aka high blood pressure, by interfering with the nitrous oxide in the artery walls making them lose their elasticity. This is courtesy of Robert Lustig by the way, who cured hypertension in obese teenagers by giving them a drug for treating gout!!!

    Reply
  14. DaiViet

    Marilyn says:
    March 23, 2012 at 7:53 pm

    Michael, I read some of that article about the guy with the gout. Maybe he should get on the internet and do some checking. Some people are blaming fructose for gout.

    The fructose can only metabolised by the liver. One of the byproduct is uric acid which not only causes gout, but also hypertension aka high blood pressure, by interfering with the nitrous oxide in the artery walls making them lose their elasticity. This is courtesy of Robert Lustig by the way, who cured hypertension in obese teenagers by giving them a drug for treating gout!!!

    Reply
  15. Galina L.

    It is interesting how one of diseases of Western civilization like a gout could be blamed on a meat consumption. Poor guy!

    Apparently it only took meat about 2 million years to start causing us all kinds of problems.

    Reply
  16. Peter

    3 weeks ago in our local YMCA’s swimming pool observation deck where I sat and watched our girls taking their swimming lessons, I overheard a conversation of a rotund mom talking to her slightly rotund son, hair still damp from lesson, now famished.
    Mom: ‘ Drink the Juice Box. Look at the ingredients, apple & pear juice concentrate, grape juice. All good for you & natural. Got no added sugar.’

    Later at a vending machine, son:’ What should I get?’
    Mom:’ Something healthy: granola bar, animal crackers, fat-free chips, and fruit-roll.’

    The mom has such good intention. But actions based on a flawed dogma often have unintended consequences. I kept my mouth shut.

    Those are the people who have my sympathy. Some people go wild on sodas and french fries, knowing full well they’re eating fattening junk. Okay, that’s their choice. But the people who have been given bad information don’t deserve the results.

    Reply
  17. Galina L.

    It is interesting how one of diseases of Western civilization like a gout could be blamed on a meat consumption. Poor guy!

    Apparently it only took meat about 2 million years to start causing us all kinds of problems.

    Reply
  18. Peter

    3 weeks ago in our local YMCA’s swimming pool observation deck where I sat and watched our girls taking their swimming lessons, I overheard a conversation of a rotund mom talking to her slightly rotund son, hair still damp from lesson, now famished.
    Mom: ‘ Drink the Juice Box. Look at the ingredients, apple & pear juice concentrate, grape juice. All good for you & natural. Got no added sugar.’

    Later at a vending machine, son:’ What should I get?’
    Mom:’ Something healthy: granola bar, animal crackers, fat-free chips, and fruit-roll.’

    The mom has such good intention. But actions based on a flawed dogma often have unintended consequences. I kept my mouth shut.

    Those are the people who have my sympathy. Some people go wild on sodas and french fries, knowing full well they’re eating fattening junk. Okay, that’s their choice. But the people who have been given bad information don’t deserve the results.

    Reply
  19. Jose

    Now im a little confuse .. I had a lipid panel a couple of weeks ago and these was my results

    Choles- 127
    TRigly – 25
    Hdld – 43.5
    LDL – Chol – 78.5
    VLDL – 5

    If a do the ratio TRigly/HDLD its give me .5 ratio which is way below 2.0..

    Anyways those were my numbers which i dont understand

    You have very low cholesterol overall, with very low triglycerides and LDL as well. The ratio looks good, but I prefer to see higher cholesterol overall and higher HDL. Are you eating enough natural fat?

    Reply
  20. Jose

    Now im a little confuse .. I had a lipid panel a couple of weeks ago and these was my results

    Choles- 127
    TRigly – 25
    Hdld – 43.5
    LDL – Chol – 78.5
    VLDL – 5

    If a do the ratio TRigly/HDLD its give me .5 ratio which is way below 2.0..

    Anyways those were my numbers which i dont understand

    You have very low cholesterol overall, with very low triglycerides and LDL as well. The ratio looks good, but I prefer to see higher cholesterol overall and higher HDL. Are you eating enough natural fat?

    Reply
  21. Jenny

    @Justin B: I loved Fat Head et al. I try LCHF about once every two weeks, with steely resolve. I can’t do it. Yet.

    Reply
  22. Jenny

    @Justin B: I loved Fat Head et al. I try LCHF about once every two weeks, with steely resolve. I can’t do it. Yet.

    Reply
  23. Arlo

    No wonder there’s a perception that to he healthy means eating a bland diet that leaves you miserable. Outside of the curry I don’t see anything else there remotely appetizing.

    I’m surprised there weren’t rice cakes in their somewhere. I honestly didn’t realize those still existed. I thought they disappeared after the 90s like SnackWells.

    I remember repeating the meme that everything that tastes good is bad for you. Glad to find out how wrong I was.

    Reply
  24. Arlo

    No wonder there’s a perception that to he healthy means eating a bland diet that leaves you miserable. Outside of the curry I don’t see anything else there remotely appetizing.

    I’m surprised there weren’t rice cakes in their somewhere. I honestly didn’t realize those still existed. I thought they disappeared after the 90s like SnackWells.

    I remember repeating the meme that everything that tastes good is bad for you. Glad to find out how wrong I was.

    Reply
  25. Melissa

    I am a recovering anorexic. I became vegetarian so that I could be “healthy”. I ate virtually NO saturated fat. LOTS of fruits and veggies, beans, some whole grains but not much because I was restricting. OH and lots of fat free frozen yogurt! Anyways, I was at a bmi of 15.5 when I got blood tests done. I had high cholesterol! My total cholesterol was 223; LDL at 135; and triglycerides were normal-go figure. I was 21 years old, running 2-3 miles a few time a week and doing everything “right”. Approximately a year before that I had blood tests done as well. I seriously had a “horrible” diet in a nutritionists eyes. All I ate was fatty animal foods. I literally couldn’t eat anything without cheese. (yum!) No exercise, but I was at a healthy bmi between 20-21.
    Yes I did eat my burger with the bun, but the ratio of fats to carbs was probably 3:1. I never ate dessert, never was a big sweets person. After going to the hospital and being “trained” to eat the USDA’s guidelines, I seriously was never full. I get depressed after eating bowl after bowl of oatmeal w/ whey and not being satiated. Today I’ve had enough. I went to McDonald’s and had a sausage egg mcmuffin and milk. I was happy, content, not hungry again for 3-4 hours. No bullshit cravings. I am done with this low saturated fat junk.
    The lack of fats make me crave sugar/food. It is hard because I live in LA and everyone is vegan with their soy milk and tofu, but f that. I know I am doing the right thing.

    If you’re in L.A., you can get those awesome double-doubles from Inn N Out — protein style. Probably the only thing I miss about L.A.

    Reply
  26. Melissa

    I am a recovering anorexic. I became vegetarian so that I could be “healthy”. I ate virtually NO saturated fat. LOTS of fruits and veggies, beans, some whole grains but not much because I was restricting. OH and lots of fat free frozen yogurt! Anyways, I was at a bmi of 15.5 when I got blood tests done. I had high cholesterol! My total cholesterol was 223; LDL at 135; and triglycerides were normal-go figure. I was 21 years old, running 2-3 miles a few time a week and doing everything “right”. Approximately a year before that I had blood tests done as well. I seriously had a “horrible” diet in a nutritionists eyes. All I ate was fatty animal foods. I literally couldn’t eat anything without cheese. (yum!) No exercise, but I was at a healthy bmi between 20-21.
    Yes I did eat my burger with the bun, but the ratio of fats to carbs was probably 3:1. I never ate dessert, never was a big sweets person. After going to the hospital and being “trained” to eat the USDA’s guidelines, I seriously was never full. I get depressed after eating bowl after bowl of oatmeal w/ whey and not being satiated. Today I’ve had enough. I went to McDonald’s and had a sausage egg mcmuffin and milk. I was happy, content, not hungry again for 3-4 hours. No bullshit cravings. I am done with this low saturated fat junk.
    The lack of fats make me crave sugar/food. It is hard because I live in LA and everyone is vegan with their soy milk and tofu, but f that. I know I am doing the right thing.

    If you’re in L.A., you can get those awesome double-doubles from Inn N Out — protein style. Probably the only thing I miss about L.A.

    Reply

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