Business Insider: 9 Lies About Fat
I recently read "9 Lies About Fat That Destroyed The World's Health" an article on the Business Insider web page by Kris Gunnars, a medical student from Iceland. Sadly this sensationalist title and article style serve to confuse the public about nutrition and therefore contribute to the growing trend of disease and death. Notice that as you read through this article, the author offers no prescription for health other than go back to what was killing us 30 years ago.
Let's start with some unequivocal, proven truths. A low-fat, whole foods plant-based diet has been shown to dramatically reduce or eliminate obesity, heart disease, stroke, diabetes, high blood pressure, cancer, and about 20 other diseases. Here are a couple of key studies: http://www.heartattackproof.com/reversal01.htm, http://www.thepermanentejournal.org/files/Spring2013/Nutrition.pdf and http://archinte.jamanetwork.com/article.aspx?articleid=1710093. A few doctors understand the power of a whole food plant-based diet and have patients with dramatic improvements in their health. You can talk to a growing number of individuals who live the proof.
1. Optimal diet. How can Gunnars claim that "A Low-Fat, High-Carb Diet is The Optimal Human Diet" is his number one "lie"? He starts by pointing out that the 1977 message to reduce fat in our diet has not led to a decrease in obesity, but in fact just the opposite. So far, he is correct. But let's look at what really happened. According to the CDC (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5304a3.htm) from 1976 to 2000, the average daily calorie consumption for men went from 2439 to 2618 and for women went from 1522 to 1877, a significant increase. And while the percent of fat calories went down a little during that time, most of that decrease was not because fat consumption went down but because the total calories went up. We can get some insight into the source of these extra calories from the USDA (http://www.usda.gov/factbook/chapter2.pdf). In their Table 2-3 on page 17, you can see that from the 1970s to 2000 added fats went up substantially from 53.4 pounds per person per year to 74.5. And in Table 2-6 on page 20 you can see that our average annual consumption of sugar and other sweeteners went from 123.7 pounds to 152.4 pounds during that same period. So Gunnars has a hint of truth by pointing out that replacing fat in our meat and milk with added fat and sugars with more total calories did not help our health.
But here is the critical point. Not all carbohydrates are the same. Complex carbs such as those in rice, potatoes, and other starchy vegetables behave very differently in our digestive tract than refined carbs like sugars. Complex carbs have a low calorie density primarily due to their water content, so we feel full and stop eating before we get too many calories. Then the carbs break down slowly in our digestive system, providing a long, steady supply of glucose to our blood stream which fuels the cells throughout our body. And the extended digestion time prevents our stomachs from feeling empty soon.
Sugars, especially in sodas, sweets, and other processed foods, are calorie dense, and so we can consume large quantities of calories from them and still not have full stomachs. So we eat more. And once in our stomachs, the sugars are broken down and absorbed quickly leaving our stomachs empty soon and calling for more. And the common sugars of sucrose and high-fructose corn syrup contain about 50% fructose, which can only be metabolized by the liver and leads to fat production as well as other problems.
So it is critical to know the difference: complex carbs = good; refined carbs = bad. Sadly, Gunnars does not make the distinction and therefore by attacking a diet that still contains a lot of fat but an even higher amount of sugar, by association he implies that all high carb diets are bad. This implication is dead wrong. A whole plant-based diet that actually has a low amount of fat (10% of calories) and a high amount of unrefined carbs (80%) has been shown to be an extremely healthy diet.
Gunnars cites the Women's Health Initiative study (http://en.wikipedia.org/wiki/Women%27s_Health_Initiative) to support that lowering fat doesn't improve health. However, if you read through the study, you will see that at years 1 and 6, the decrease in fat consumption was 10.2% and 8.2%. Given that they didn't accept anyone into this study group with starting fat consumption of less than 32% of their calories, then even the diet modification group was consuming at least 22% of their calories as fat. This is NOT in any way a low fat diet. A whole food plant-based diet that has been shown to have dramatic health improvement results has a fat content of about 10%. So it's not surprising that easing back from over 32% to over 22% fat is not going to show a statistically measurable result. In the words of this study "the lack of effect on CVD [cardiovascular disease] in the current study was attributable to the small decrease in saturated fat..."
Let me more quickly address some of Gunnars's other claims.
2. Eggs. Gunnars believes that eggs are the healthiest food on the planet because they contain the nutrients for turning a single cell into a newborn chick. As Gunnars urges you to "Just think about it..." so I urge you to just think about it. Do you really believe that the nutrient mix that is ideal for intravenous delivery in turning a growing avian embryo into a baby bird is the same nutrient mix that would be ideal for consumption through the digestive system of the adult of a human, a species that studies have shown dies sooner and has more illness when eating other animal-based foods?
3. Total cholesterol and LDL. The reason these health metrics came to be used is because of their effectiveness in predicting death, as shown by the decades long Framingham Heart Study. Gunnars is correct that lowering these metrics by taking statins is not accompanied by a corresponding decrease in death rate. But this result is just a testament to the poor effectiveness of statins. The level of total cholesterol and LDL in blood test measurements for those not taking statins is still a valuable indicator of death. Is it a perfect predictor? No. Should we always be looking for other better ones? Sure. But given the pervasiveness of problems throughout our body caused by eating our unhealthy standard American diet, it should come as no surprise that most of the predictors of death (e.g. cholesterol, blood pressure, blood sugar, BMI, rolls of belly fat, etc.) all move together. Continue eating poorly and all the indicators will get worse. Eat better, and they will all get better. So focusing on which metric is the best one is not entirely productive. Pick one, or several, improve your diet and see the result.
4. Added oils. Gunnars actually has this one right. Studies have shown that vegetable oils are harmful, despite the marketing efforts of their promoters. Plant oils are in part why the experts on nutrition who advocate for a plant-based diet put the word "whole" in front as in a "whole foods plant-based diet". Squeezing the oil out of olives, corn or other plants takes a whole healthy source and extracts an unhealthy concentrated component product.
5. Saturated fat. There certainly is a lot of confusion in the interpretation of various studies on fat. But here is one fact that you can hang onto. Eating animal products leads to heart disease and many other diseases. While some scientists would like to tease apart the components to determine exactly which ones are causing damage, these efforts are likely to be fruitless. Many experts believe it is the constellation of nutritional components, working in combination, that cause disease or protect us from disease. So minimizing or eliminating animal products from your diet will give you the best health and longevity result, independent of whether the bad actor in animal products is saturated fat, animal protein, cholesterol, other components or a combination of them. So don't let the lack of clarity about individual nutritional components sway you into unhealthy eating. Avoid the harmful components of animal products, whatever they are. Eat whole plants.
6. Trans fats yes and no. Gunnars is correct that trans fats (partially hydrogenated oils) are unhealthy and should be avoided. So don't eat margarine or peanut butter with partially hydrogenated oil. However, his recommendation is to eat butter, meat, and coconut oil. But don't. Studies show that people that eat animal products and extracted oils die sooner and are less healthy. Eat whole plants.
7. Fats for weight loss. It is true that eating a low-carb high-fat Atkins-style diet can lead to weight loss. And then shortly thereafter lead to heart attack and death. Don't do it. Any diet that restricts the set of foods that we can eat is likely to result in weight loss compared to an unrestricted diet. But don't confuse weight loss with health. I suggest to you that you choose a diet that has been proven to promote health, including weight loss. Being slim and dead is not something worth striving for. I know this is getting a little redundant, but eat whole plants.
8. Margarine vs. butter. Gunnars quotes studies showing margarine is not healthy and uses this as an excuse to promote butter consumption. They are both unhealthy. Don't eat either of them.
9. Processed low-fat foods. Gunnars is correct that processed foods with reduced fat and increased sugar are not particularly healthy. But he advocates eating the higher fat ones. Don't. Remember the "whole" in whole foods plant based? The more you eliminate processed foods, whether high fat or high sugar, the better off you will be.
From reading about Kris Gunnars on his web site I believe him to be an earnest, well-meaning young medical student. And he is right that medical schools do not teach doctors the relationship between nutrition and health. He is also right that there is a large amount of published research on nutrition. However, in his struggles to interpret the research, he has missed something really important - the power of a whole food plant based diet. I recommend that he study the lifetime work of Cornell nutritional biochemist T. Colin Campbell and the research and clinical results of Drs. Caldwell Esselstyn, John McDougall, Neal Bernard, Dean Ornish, Joel Fuhrman, and others. Gunnars currently recommends eating meat, fish, eggs, high-fat dairy, fats, and healthy oils while avoiding sugars, transfats, and highly processed foods. While this prescription might be a small improvement over where Americans are now, it would only take us back 30 years or so, and heart disease would still be a major killer. There is no need. If we eliminate the processed foods AND the animal products, and only eat low-fat whole plant foods with lots of complex carbs, heart disease isn't reduced by a few percent, it goes away entirely. And a whole host of other diseases go away too.
To Kris Gunnars,
So Kris, you need to learn about this diet. When you become a doctor, if you want the knowledge that can prevent the deaths of about 80% of your patients, learn about a whole food plant-based diet. One place to start is this web site. Or call me at (626) 872-4050 (Pacific Time).
You seem to want to provide nutrition advice based on the best scientific research. So do I. Let's talk.
John Tanner, PhD
Director, NuSci, The Nutrition Science Foundation