Saturday, January 19, 2008

The heart-healthy diet: does it protect your health?

At least where nutrition is concerned, comments that follow articles published on the internet indicate how schooling, advertising, consensus of opinion, authority, experience, and even personal preference can instill prejudice. Consider, for example, the following response to this ABC News segment by a student majoring in nutrition:

"You all should be sued for every penny you are worth for airing and promoting the Gary Taubes section. I guess the fact that he has NO research of his own to prove his theories and the fact that what he says HAS been proven incorrect by scientific studies holds no merit with your network. For the average person, with no nutrition education background, this could easily be believed (Taubes info) and if his methods are practiced, America's obesity, high cholesterol and heart disease epidemic will continue to increase. As a nutrition major in college, I am appalled that anyone would publicize such nonsense. I have always enjoyed watching your morning show, however, after seeing what kind of harmful information you advocate, I will never again watch GMA OR any other program aired by ABC, and I will be sure to inform my colleagues of the information you are advocating (I am sure they will follow suit and boycott your network). As I mentioned in beginning, I hope that every health organization and medical association responds as appropriate. As a respected (or formerly respected, in my case) news network, you really should evaluate what you choose to air more carefully, as many people accept what you air as fact. You should really be ashamed for advocating information that is so blatantly wrong and potentially harmful for the health of America. At least I know now where to go if I ever get any random ideas that I want all of America to hear."

As an interesting comparison, here is comment about the same ABC News segment by a more experienced person, also with health science schooling.

" I am a RN. I had all the typical nutrition and biology classes while achieving my degree. The nutrition advice was the same low fat dogma that is preached today. Over the course of time, looking for answers to my own health problems; morbid obesity, hypertension, insulin dependent diabetes, PCOS, Bipolar Disorder, yeast over growth, etc. I found the carb restricted approach, higher fat and moderate protein consumption. I have since lost 200+ lbs. I no longer require medications for all but one of my diagnoses, Bipolar Disorder. Those have been decreased to the minimum doses.The brain functions better on a higher fat diet, as does the heart, saturated fat at that."

Here's more comment by another health professional with some sage advice at the end.

"I'm a hospice nurse, and I am amazed at the amount of surprising cancer cases I see. I'm talking people in their 40's, 50's, 60's, with active lives, just totally struck down and they have no idea why. I heard some oncologists I've worked with talk about sugar and carbohydrate, and how it feeds cancer cells. Those of you who are a bit older, and following standard very, very careful with your diets. Don't assume that what the media tells you isn't paid for by big business. Do your research."

Finally, with permission from Fred Ottoboni, PhD and Alice Ottoboni, PhD, authors of The Modern Nutritional Diseases, here are some insights as to how science works shared by two retired public health scientists who became suspicious of conventional wisdom rather late in their careers:

It is not unusual nowadays to see family members and friends taking costly prescription drugs or being hospitalized for such illnesses as heart attack, stroke, or cancer. At the same time, a day seldom passes without some message in the public media from nutrition and government agencies advising that these same health problems can be prevented - or even cured - by a heart-healthy diet. This recommended diet severely restricts red meat, eggs, butter, and saturated fat and promotes low-fat, low-cholesterol foods plus an abundance of grain-based breads, cereals, and polyunsaturated vegetable oils.

The national education program touting the diet for heart disease prevention began about a half century ago. The great increases in sales of low-fat, low-cholesterol, and high-carbohydrate foods and polyunsaturated vegetable oils that have resulted since then is good evidence that this public education program has been very effective. Today, millions of Americans are following the recommended low-fat, low-cholesterol, high-carbohydrate dietary regime.

Despite this major dietary change, national health statistics show that attack rates (new cases) of cardiovascular diseases and a number of other chronic conditions, including high blood cholesterol, high blood pressure, stroke, and type-2 diabetes, have been steadily increasing. It is becoming evident that we are now in the midst of an epidemic of what we call the modern nutritional diseases.

When we were growing up, there was little public awareness that cardiovascular diseases might be related to diet. Obesity and adult-onset diabetes 9 type-2 diabetes) were uncommon and few people had ever heard of cholesterol. People had an intuitive feeling that nutrition was important to health, but what knowledge they had did not extend much beyond a few vitamins, primarily vitamin C and B vitamins. There was a general consensus that a hearty meal of meat and potatoes was a healthful one.

We learned about the heart-healthy diet when we entered the field of public health over 40 years ago. By that time the statistical association between cardiovascular diseases and saturated fats and cholesterol in the diet was accepted by the medical and nutrition communities as being more than a chance relationship. It formed the basis for official government policy and dietary recommendations. People were advised to reduce their consumption of animal fats and replace them with vegetable fats, which contain little saturated fat and no cholesterol.

People were further urged to restrict or eliminate the use of animal foods (because of their saturated fat and cholesterol content) and replace them with grains, breads, and pasta to make up for the loss of calories. At the time we had no reason to doubt that these changes were healthful ones. we reduced our intake of saturated fats by substituting vegetable oils and margarine for butter and switched from whole milk to skim milk. We reduced our consumption of red meats, ate cereal instead of eggs, and added more whole grain products to our daily fare.

By the mid-1970s, in the course of our work, we were becoming aware of some reports in the scientific literature that hinted of a conflict with the prevailing nutritional philosophy. The wisdom of the low-fat, high-carbohydrate diet was beginning to be challenged more frequently and more openly. We were starting to hear about the observations and theories of scientists who found the official heart-healthy nutritional recommendations potentially dangerous. At the same time, we were also aware that the rates of cardiovascular diseases, obesity, and type-2 diabetes had increased dramatically over the past several decades and were reaching epidemic proportions. However, at the time, we did not make an association between the increasing incidence of these diseases, which normally are associated with the aging process, and the dietary changes that had occurred over the past several decades.

We followed the controversy with only academic interest until a few years later when a routine physical examination showed that one of us had slightly elevated blood levels of cholesterol and triglycerides - not life threatening, but something to follow. These findings disturbed us. We were only in our mid-fifties at the time. We had been following the low-fat, high-carbohydrate diet that traditional nutritional science recommended as a healthful one. The controversy now assumed a personal interest. Was there merit in the reports we had been hearing that the heart-healthy diet might not be what it was labeled? What should we do? These thoughts prompted us to do what our professional training had taught us to do - go to the library, delve into the scientific literature, and try to find the answers to our questions.

We were both scientists who had worked for many years in the field of disease investigation and prevention. This work had taught us that disease, even in older adults, does not just happen but is caused by something. And, time and again, this work taught us that the answers to most questions involving the causation and prevention of disease were already known - they were just buried in the scientific literature that resides in the libraries of all major universities.

We decided to examine the heart-healthy diet and why it had become the national panacea for cardiovascular diseases. We also decided to investigate the overall relationship between diet and the chronic diseases that were thought to occur only in older people but were now beginning to afflict young adults and even children. Why had the dietary changes that had been imposed on the public many years before not been effective? Why were the numbers of new cases of cardiovascular disease, obesity, type-2 diabetes, and perhaps even some forms of cancer increasing instead of decreasing?

With these thoughts in mind we began our long search of the literature, both scientific and popular. In general we learned that lifestyle and nutrition, not genetics and not luck, were the most powerful factors affecting health and well being. Further, it became apparent that unhealthful lifestyles and faulty nutrition were affecting the health not only of older adults but also of people in all age groups. We learned that popular notions concerning the adverse effects of dietary fats and cholesterol, which were the foundation of the heart-healthy diet, were not based on scientific facts. What we read in the popular press was not what we read in the scientific literature.

Reports in the popular press, which are the major source of information on nutrition for the average person, are not always reliable. Many reporters are not experts in the fields they write about. The do not check the accuracy of information in press releases, and usually do not include references to the scientific literature to document the statements and recommendations made. This lack of documentation by health reporters has long been a concern to us. It is a circumstance that makes it difficult for readers to check the accuracy of reporting.

Finding trustworthy information in bookstores also is not easy. Popular books on health and nutrition, like media reports, health newsletters, and direct mail advertising, run the gamut from total quackery to solid science. How can the average person distinguish between the two? The answer is, "he can't - at least not without a lot of work." Despite the difficulty, the question of whom and what to believe is a very important one to anyone interested in good health and long life. Perhaps the best advice is: approach all recommendations for health and well being with a large quantity of skepticism; study all sides of an issue before coming to a conclusion; investigate the source or sources of the recommendations; and learn the clues to pseudo science (Chapter 9).

Our primary sources of information were scientific journals and textbooks. We reviewed the epidemiological studies that examined the association between diet and various diseases. We returned to our human biochemistry texts that outlined the pathways followed by nutrients in the body. We looked more closely at leading causes of disability and death among adults. The hard facts were startling. They clearly pointed to a strong association between the major causes of death, particularly among older people, and the highly touted low-fat, low-cholesterol, high-polyunsaturated vegetable oil diets that had been promoted for the last 40 or more years. But even more disconcerting, we discovered in our research that modern nutritional dogma, as epitomized by the famous Food Pyramid (1), is based, at best, on bad epidemiology or, at worst, fiction.

Our investigations confirmed our suspicion that the scientists that were challenging the validity of the heart-healthy diet were correct; the long-standing national dietary policy probably was causing disease rather than preventing it. Published epidemiological, biochemical, and dietary studies did not support the idea that the heart-healthy diet prevented heart disease, stroke, high blood pressure, or hypercholesterolemia. Other studies made clear that these atherosclerotic diseases plus adult-onset diabetes, obesity, and cancer probably all shared the same underlying cause, namely the modern American heart-healthy diet.

Especially reassuring were the number of well-documented, popular books on health and nutrition that also supported such a conclusion (2,3,4,5,6,7,8,9). Further, it is an accepted truth that once the cause of a disease is known, good preventive programs can usually be formulated. Such programs have been developed and published by these authors. We not only refer to them frequently throughout this book but also recommend them highly. They are easy to read and understand and, what is more important, they can also stand the test of scientific scrutiny.

During the years of our study of the relationship between diet and the modern nutritional diseases, we often discussed the subject with our family and friends. They expressed interest during our conversations and asked many questions, so we finally decided to write a few pages that we thought would be helpful to them. The volume of information we gathered kept growing until it was many pages, and then finally it became a book.

This book would have been shorter if it included only our personal views and opinions accompanied by recommendations of what and what not to do. However, to merely tell people that the diet recommended for the past 50 years by nutrition and medical associations and government agencies was wrong was not acceptable. Such a publication would be no more worthy of belief than the nutritional nonscience that appears every day on television, in the newspapers, and in direct mail advertising. We could not expect our family and friends, much less strangers, based on our words alone, to reject the dietary advice of organizations that presumably had been created to protect and preserve their health.

With recognition that a credible book would require clear documentation of the information it contained, we began assembling the data, including figures and references to the published scientific literature required to support the conclusions and advice we offered. Thus, at the expense of brevity, we have included explanations of the reasons for our conclusions accompanied by numerous references to the scientific literature and texts that we used as our authorities.

Two chapters in this book, "The New Epidemics and the New Diet" and "The Connection," describe the current American diet and its impact on health, particularly in older adults. These two chapters were especially difficult to write, because they obviously conflict with long-standing and widely followed American dietary policy. In order to leave little doubt about their veracity, these two chapters are purposely detailed and amply referenced with citations to the scientific literature. Details of biochemical pathways and mechanisms are also included, because they are required not only to explain and document important nutritional concepts but also to illustrate the beauty and logic involved in the construction of the human body.

We expect that much of what we have written in the following chapters will be challenged by advocates of traditional nutrition, because the proposition that the heart-healthy diet is an underlying cause of many of today's chronic diseases is contrary to longstanding nutritional teachings and governmental policies. In view of this, it is important to stress that the biochemistry presented in this book is established scientific fact. The references we cite are from recognized scientific journals and textbooks, not cryptic writings hidden in obscure or ancient papers. A question that has baffled us through the years, given that all this information is freely available, why is it largely ignored by nutrition academia and government agencies?

What follows here is what we have learned over a period of years and what we have practiced in our daily lives. It is not a panacea. It will not stop the march of time. It will not stop the onset of gray hair and the progression of years. But we know our study and research has improved the status of our own health and the quality of our lives, and we believe that the information contained herein can have a positive impact on the lives and health of all people, not just the elderly. In this book we describe what we consider of value for improved health at any age and the reasons for our conclusions.

The information in this book should help you feel better, live longer, avoid the modern nutritional diseases, and be happier and more active as you grow older. The ideal is to keep all systems functioning well until that point where everything wears out and fails all at once, like the fabled one-hoss shay (10). How tragic it is, for example, to have a sound body and mind capable of functioning efficiently for twenty or more years stilled by a heart attack or stroke.


1.) USDA Center for Nutrition Policy and Promotion, The Food Guide Pyramid.
2.) Atkins, Robert C. Dr. Atkins New Diet Revolution. New York, NY: Avon Books, Inc. 1999.
3.) Eades, Michael R., and Mary Dan Eades, Protein Power, Paperback Edition. New York, NY: Bantam Books, 1999.
4.) Enig, Mary G. Know Your Fats: The Complete Primer for Understanding Fats, Oils, and Cholesterol. Silver Springs MD: Bethesda Press, 2000.
5.) Pauling, Linus. How to Live Longer and Feel Better. New York, NY: W.H. Freeman and Co., 1986.
6.) Sears, Barry. Enter the Zone. New York, NY: Harper Collins Publishers, 1995.
7.) Simopoulos, Artemis P. The Omega Plan. New York, NY: Harper Collins Publishers, 1998.
8.) McCully, K. and McCully, M. The Heart Revolution: The Vitamin Breakthrough that Lowers Homocysteine, Cuts your Risk of Heart Disease, and Protects your Health. New York, NY: Harper Collins Publishers, 1999.
9.) Ravnskov, Uffe. The Cholesterol Myth: Exposing the Myth that Saturated Fat and Cholesterol Cause Heart Disease. Washington, DC: New Trends Publishing Inc., 2000.
10.) Oliver Wendel Holmes. The One Hoss Shay, Copyright 1891 by Houghton, Mifflin & Co.

Here's a review (15 New And Essential Diet & Health Books I've Been Reading Lately) of The Modern Nutritional Diseases by low-carb enthusiast Jimmy Moore.

So much of the research into the most destructive health ailments we now face is focusing on the role of the diet. This is something Dr. Fred Ottoboni and his wife Dr. Alice Ottoboni know a thing or two about. Before retirement, they had spent many years of their career investigating, studying, and researching disease occurrence among various people groups around the world and they discovered something quite revealing in light of our current crisis with obesity, diabetes and worse: much of it is preventable by simply ignoring the high-carb, low-fat, low-cholesterol advice that has sadly become accepted as the "healthy" diet.

In Modern Nutritional Diseases, Drs. Ottoboni explain in meticulous detail why those diets are useless against most modern diseases and shares the research showing the elimination of sugars and starches will put us back on the road to health faster than removing saturated fat and cholesterol from our diet. There's even an invaluable chapter on how to distinguish good science from bad science among the many voices telling us what the facts are.

The references and charts contained in this book make it well worth having in your low-carb library. I'll warn you now that it does get a bit technical in some areas, but this stuff isn't simple either. There are many things to evaluate and analyze in the process of coming to the conclusions about nutrition and metabolism that Drs. Ottoboni do. This is every bit as good a book to read as Gary Taubes' Good Calories, Bad Calories was because it complements much of the same concepts and ideas.

My favorite part is at the end in a chapter called "What do you do now?" the authors give you practical instructions about making the changes you need in order to ward off the modern nutritional diseases in your own life. Specifics about diet, supplements, exercise, and suggested resources for further education are provided. This is an invaluable tool for anyone following a controlled-carbohydrate nutritional approach or who wants to learn more about why this way of eating works so well.

Saturday, January 5, 2008

Is saturated fat a health hazard?

If there's a doctrine that has achieved universal acceptance in the political arena, in public health, in medicine, and in the commercial sector, it's the idea that saturated fat is an artery-clogging health hazard.

Over the past five decades this idea has spread about the globe. Here in the USA it has both undermined the health of Americans and caused politicians to squander unimaginable sums of taxpayer dollars. Arguably, it is the major reason why vascular diseases remain the number 1 cause of death in many developed countries.

This doctrine is also largely responsible for the current epidemic of type 2 diabetes among young and old alike. As for obesity, fear of developing clogged arteries prevents many from consuming the amount and kinds of fats that would promote weight loss.

Who adheres to this doctrine? Just about everybody; all the major health organizations including the American Medical Association, the American Heart Association, the National Heart Lung and Blood Institute, the American Dietetic Association, and the American Diabetes Association, federal government agencies such as the FDA, CDC, USDA, NIH, and HHS, the food manufacturing, sweeteners, and edible oils industries, vegetarian activists, and the CSPI. In addition, most schools of public health teach that saturated fat is a health hazard. Here is documentation from various websites:

Health Organizations

American Medical Association

"The Council is deeply concerned about any diet that advocates an 'unlimited' intake of saturated fats and cholesterol-rich foods."

American Heart Association

"Limit foods high in saturated fat, trans fat and/or cholesterol, such as whole-milk dairy products, fatty meats, tropical oils, partially hydrogenated vegetable oils and egg yolks. Instead choose foods low in saturated fat, trans fat and cholesterol."

National Heart Lung and Blood Institute

Be Heart Smart!
Eat Foods Lower in Saturated Fat and Cholesterol.

Why should you be concerned about saturated fat?

Saturated fat raises blood cholesterol the most. Over time, this extra cholesterol can clog your arteries. You are then at risk for having a heart attack or stroke.

Why should you be concerned about cholesterol?

Your body makes all the cholesterol you need. Eating foods high in saturated fat can raise your blood cholesterol levels. The higher your blood cholesterol, the greater your risk for heart disease. Too much cholesterol can lead to clogged arteries. You are then at risk for having a heart attack, a stroke, or poor circulation.

American Dietetic Association: Nutrition standards ...

"Although intake of fat and saturated fat has declined, it still is consumed in amounts that exceed recommendations."

"Healthy, growing children need a balanced diet that includes fruits, vegetables, whole grains, lean meats and/or legumes, and low-fat dairy products to achieve a dietary pattern that maintains appropriate blood cholesterol levels and optimal energy."

American Diabetes Association

"Everyone (emphasis mine) should eat less saturated fat. Saturated fat can raise your cholesterol level which increases your chances of having heart disease."

Government Agencies:

Food and Drug Administration

"Diets high in saturated fat and cholesterol increase total and low-density (bad) blood cholesterol levels and, thus, the risk of coronary heart disease."

U.S. Department of Agriculture

"Saturated fat raises blood cholesterol more than other forms of fat. Reducing saturated fat to less than 10 percent of calories will help you lower your blood cholesterol level."

Health and Human Services: New Dietary Guidelines

"Consume less than 10 percent of calories from saturated fatty acids and less than 300 mg/day of cholesterol..."

Center for Disease Control

"Although the findings in this report indicate a decline in the mean percentage of total fat energy intake derived from total dietary fat and from saturated fat, these intake levels remain higher than the year 2000 objective."

"The findings in this report can assist in tracking progress toward achieving the goals of public health initiatives aimed at reducing and modifying total dietary fat and saturated fat intakes."

National Institutes of Health

"These are the biggest dietary cause of high LDL levels ("bad cholesterol"). When looking at a food label, pay very close attention to the percentage of saturated fat and avoid or limit any foods that are high. Saturated fat should be limited to 10% of calories. Saturated fats are found in animal products such as butter, cheese, whole milk, ice cream, cream, and fatty meats."

(Note: the above statement is blatantly false. Excessive refined carbohydrate consumption is the major cause of high LDL levels.)

Vegetarian Activists:

Physicians for Responsible Medicine

1. A Vegan Diet: Avoiding Animal Products
"Animal products contain fat, especially saturated fat, which is linked to heart disease, insulin resistance, and certain forms of cancer. These products also contain cholesterol, something never found in foods from plants."

"Well-planned vegetarian diets provide us with all the nutrients that we need, minus all the saturated fat, cholesterol, and contaminants found in animal flesh, eggs, and dairy products."

Center for Science in the Public Interest

"Senators Harkin and Murkowski plan to offer their school nutrition bill as an amendment to the Farm bill."

"Notably, the soft drink industry and many major food manufacturers are supporting, not opposing, the Harkin-Murkowski amendment. The amendment also is supported by 100 organizations, including the American Medical Association, American Public Health Association, American Dental Association, National PTA, American Association of School Administrators, and the American Federation of Teachers."

"The amendment also would set limits for calories, sodium, saturated fat and trans fat in school snacks."

Public Health:

Harvard School of Public Health

"Saturated fats raise total blood cholesterol levels more than dietary cholesterol because they tend to boost both good HDL and bad LDL cholesterol. The net effect is negative, meaning it's important to limit saturated fats."

Public Health | Monroe County, NY

Trans fat is made when an otherwise healthful liquid (vegetable) oil is chemically changed to make a semi-solid product called "partially hydrogenated" vegetable oil. Food manufacturers began using these altered products a number of years ago because it was shown to increase shelf life, texture, and flavor and at the time it was thought to be a healthful alternative to saturated fat. Trans fat is commonly found in deep fried foods, baked goods, snack foods, and many processed foods.

All fats are not the same. There are "good" fats and "bad" fats. When we eat foods high in saturated fat or trans fat, it raises the bad (LDL) cholesterol in our blood. Having high LDL cholesterol increases the risk for heart disease, the leading cause of death in the US, in New York, and in Monroe County. Trans fat is even worse than saturated fat because it actually lowers the good (HDL) cholesterol in the blood. Eating foods high in poly and monounsaturated fat have a good effect on cholesterol levels and are encouraged.

Federal guidelines recommend that total fat intake be 20-35% of total calories. Saturated fat intake should be less than 10%, and trans fat consumption should be kept as close to zero as possible.

Journals and mainstream press:

The Journal of Nutrition

"Saturated fat (SF) intake contributes to the risk of coronary heart disease (CHD) mortality."

Science Daily

"Dr. Carter emphasized he does not advocate strict low-carbohydrates for long-term weight management. Such diets may adversely overload the kidneys with protein and lead dieters to consume more artery-clogging saturated fats and cholesterol, he said."

Back to my comment:

Public health at the state level marches in lockstep with the federal government. For example, the Montana Department of Health and Human Services is still using the Cardiovascular Disease State Plan adopted and implemented during the Racicot administration. The main focus is toward reducing cholesterol levels. Here are some excerpts from the report:

On page 13 one reads, "In 1999, Montanans who participated in a CVD telephone survey and who had high cholesterol were asked how they planned to decrease their cholesterol levels.The most common responses were to reduce their fat intake and increase their exercise levels."

On page 22 one reads, "Educate patients who have high cholesterol or who have had a myocardial infarction about the AHA and National Cholesterol Education Program guidelines for managing high cholesterol."

Page 27 "HP2010 Objective - Fat intake: Increase to at least 75% the proportion of persons aged 2 and older who consume no more than 30% if calories from fat."

Page 28 "Promote 1% (milk) as the standard to be served in Montana Schools."

Since government agencies at the federal level are either controlled or heavily influenced by special interests such as the food manufacturing, edible oils, sweeteners, and beverage industries, it makes sense for public health at the state level to develop dietary guidelines and strategies for prevention of chronic diseases based on the best science available, not federal recommendations. In my state, current recommendations aimed at persuading Montanans to eat fewer calories (by restricting fat calories) and exercise more (MTNAPA) reflect an inadequate understanding of factors such as biochemical variability and fat and carbohydrate metabolism.

While the best science available regarding fat metabolism is not to be found in textbooks and government publications, the internet increasingly provides ready access to the truth about saturated fats. For example, view this webcast (The Quality of Calories: What Makes Us Fat and Why Nobody Seems to Care) of a recent lecture by science writer Gary Taubes delivered at the University of California Berkeley. I also encourage you to read the book (Good Calories, Bad Calories) which will take considerably more time as it consists of 550 pages of text and 100 pages of notes.