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.
Water, lime and honey (2 glasses), two egg-white omelet with little salt, 1 chili.
Oatmeal with water and fat-free milk, glass of fat-free milk
Milkshake with fat-free protein powder, fat-free milk, orange juice, fiber, blue berries, black berries, strawberries
Bunch of carrots, cucumber, tomato, 1/2 cup rice and curry
Spaghetti and vegetables
Wheat bread or plain bagel with jam (fat free), peanut butter.
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.)
Spaghetti and vegetables
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
Two weeks ago
Total cholesterol: 212
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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