The NEW Track Your Plaque Diet: Part 1
Nutritional Chaos
How is it that, as a nation, we've dissected our diet, sliced it and diced it into its component saturated and polyunsaturated fats, complex and simple carbohydrates, analyzed it down to its flavonoids, polyphenols, and micronutrients, yet still emerge overweight, diabetic, and generally unhappy? How can populations consuming their traditional cultural fare, cultures with dietary habits as wildly different as the Japanese, the Inuits, the southern French, and Cretans, live longer with less heart disease, diabetes, cancer, and obesity, following eating habits arrived at by tradition rather than science?
Over the last 50 years, an unprecedented amount of information has poured into our lives about diet, nutrition, the right and wrong ways to eat. We've experienced broad systematic campaigns of information on "proper" nutrition delivered to us by the Surgeon General's office, the U.S. Department of Agriculture (USDA), the Federal Drug Administration (FDA), the American Heart Association (AHA), the American Diabetes Association, the American Cancer Society. They all pretty much agree on several principles: Eat low-fat, eat plenty of whole grains, and include abundant fruits and vegetables. The mantras of these "official" diets are surely familiar to everyone by now.
But what if they proved wrong on several basic points? What if the basic precepts that form the basis for advice to eat low-fat, for instance, originated with misinterpretations or limited observations? What if the advice somehow morphed into a style of eating and shopping that had little to do with health, but sprung from the considerable financial opportunity that appears when an "official" agency like the American Heart Association endorses a particular food or group of foods? What if the "culprits" in diet were replaced with foods that were worse health offenders than the original?
That is precisely what has happened. The original well-intended advice accomplished precisely the opposite of what it set out to do: Rather than reducing the burden of disease, an increase in conditions like diabetes and pre-diabetes, obesity, cancer, and heart disease has resulted.
The diet advocated by the AHA is a fat-restricted program designed to lower LDL cholesterol by 10%. Absent from the conversation is any mention of using diet to facilitate coronary disease control or reversal, tailoring diet to genetic or blood patterns, or weight loss. The AHA approach is simply meant to reduce cholesterol and it hardly even achieves that. Likewise, the USDA Food Pyramid advocates a diet that, in our experience, causes obesity, pre-diabetes and diabetes, fatigue, abdominal symptoms like cramping and diarrhea, and fuels heart disease. Surely we can do better. "Official" diets tend to be guilty of a one-size-fits-all and a people-really-can't-stick-to-diets-anyway mentality.
How about an ultra low-fat diet? In years past, I prescribed the Ornish diet, a vegetarian program with no added oils and less than 10% of calories from fat sources, compared to 40% in the average American diet. People following this diet showed two varying responses: A few (a minority) did well - reducing LDL cholesterol, losing weight, and apparently slowing their heart disease. Others - the majority - enjoyed little or none of these benefits. The larger second group gained weight, dropped HDL cholesterol and increased triglycerides, and increased blood sugar into near-diabetic or diabetic range. When lipoproteins were examined, there was increased small LDL. These are all changes that encourage growth in coronary plaque. Low-fat diets, including the ultra low-fat variety, do not represent a solution.
For further proof of the misguided consequences that result from conventional diet advice, you need only take a look at the American Heart Association "Check Mark" Program stamp of approval on boxes of Cocoa Puffs®, Count Chocula®, and Berry Kix® to understand that marketing and financial motivations lie behind much diet advice, rather than nutritional wisdom.
Throw into the mix all the varying opinions on how to best lose weight, reduce cholesterol, reduce risk for cancer, the dizzying explosion of health claims issuing from food manufacturers and the result is . . . nutritional chaos.
In search of the perfect diet
Having zig-zagged through countless variations, the American obsession with diet has amounted to a nationwide experiment. America leads the world in diet experimentation. Despite millions of "casualties," every diet fad has taught us something new. If we look back at all the mistakes made, we should be able to take a few lessons and extract some wisdom. There will surely be some areas of nagging uncertainty, even issues we differ on. But we should emerge from this 50-year national diet experiment with some practical, healthy strategies for our Track Your Plaque efforts, as well as overall health.
Can we construct a perfect diet?
There are undoubtedly many variations on the healthy eating theme. Every iteration on diet has pluses and minuses, strengths and weaknesses. Reductions in fat reduce LDL cholesterol but raise triglycerides. Reductions in carbohydrates exert another series of effects but many people complain about the limited food choices. Eating in a state of calorie deprivation vs. calorie excess causes the same foods to exert different effects. Genetic differences, such as apoprotein E variants, cause us to respond differently to the same diet. A diet that reduces one person's LDL cholesterol 30 points and weight 10 lbs. could cause someone else to increase LDL and gain weight.
The strength of the Track Your Plaque approach is that it is not a one-size-fits-all diet. There is no such thing. Nor do we want to get bogged down micromanaging every aspect of food choice.
The Track Your Plaque approach is to start with several basic principles that should be a part of every diet, regardless of genetic type. We then add the important variations that are necessary to accommodate several genetic and physiologic types. The result is a more rational approach that borrows from lessons learned over the past 50 years, but can also be tailored to suit specific genetic and lipoprotein patterns.
Are humans omnivores?
Does the ideal diet include animal products like meat, fish, cheese, eggs, and dairy products? Or should the ideal diet be devoid of all animal products - a vegetarian diet?
We can find proponents of both extremes. The Atkins' diet, for instance, advocates unrestricted intake of animal products, regardless of production methods or curing (sausage and bacon). At the opposite extreme are diets like Ornish (Dr. Dean Ornish's Program for Reversal of Heart Disease) and the experiences of Dr. Colin Campbell, articulated in his studies and book, The China Study, in which he lambastes animal products, including dairy, as triggers for cancer and heart disease.
So which end of the spectrum is correct, but more importantly, ideal?
Putting aside philosophical questions (like not wanting to eat animal products because of aversion to killing any living being) or ethical concerns (inhumane treatment of farm animals, cruel slaughtering practices, etc.), does the inclusion of animal products provide any advantage? Any disadvantage?
The traditional argument against animal products has been its saturated fat content. But, let's put aside the saturated fat question for a moment. Beyond saturated fat, several questions emerge:
* If humans were meant to be vegetarian, why do omega-3 fatty acids (mostly from wild game and fish) yield such substantial health benefits, including dramatic reduction in sudden death from heart disease?
* Why would vitamin K2 (from meats and milk, as well as fermented foods like natto and cheese), obtainable in only the tiniest amounts on a vegetarian diet, provide such significant benefits on bone and cardiovascular health?
* Why would vitamin B12 (from meats) be necessary to maintain a normal blood count, prevent anemia, keep homocysteine at bay, and lead to profound neurologic dysfunction when deficient?
Omega-3 fatty acids and vitamins K2 and B12 cannot be obtained in satisfactory quantities from a pure vegetarian diet. The consequences of deficiency are not measured in decades, but in a few years. The conclusion is unavoidable: Evolutionarily, humans are meant to consume at least some foods from animal sources.
It pains me to say this, since I've always favored a vegetarian lifestyle, mostly because of philosophical concerns, as well as worries about the safety of our factory farm-raised livestock and rampant inhumane practices. But, stepping back and objectively examining what nutritional approach appears to stack the odds in favor of optimal health, I believe that only one conclusion is possible: Humans are omnivorous, meant to consume some quantity of animal products in addition to vegetables, fruits, nuts, and other non-animal products.
Let's take this argument a step further: If humans were meant to consume the kill of the clan of wild Stone Age hunters, what role is there for cultivated grains? Grains, of course, had no role in the diet of hunter-gatherers, who were nomadic by necessity, never staying put long enough to till a field and plant seeds.
Vocal proponent of this "Paleolithic diet" concept, Dr. Loren Cordain, and author of the book, The Paleo Diet, has pointed out that the profile of human disease (judging by analysis of fossilized remains of primitive humans, examination of their last meals from stomach contents, and other such piecing-together-of-the-puzzle) shifted dramatically 8,000 years ago (a mere second on the evolutionary time scale) - just at the time when humans learned to cultivate wheat. While earlier hunter-gatherer predecessors died of trauma and infection, the grain-consuming humans that followed began to develop cancer, diabetes, and heart disease, diseases previously rare
Fast-forward to the 21st century and the "healthy whole grain" craze has seized everyone from the USDA and AHA, to Kelloggs and General Mills, all the way down to the grain-consuming obese pre-diabetics or diabetics on Main Street, U.S.A. While this grain-crazed phenomenon seized us to replace calories lost with the low-fat mistake, surely we've taken yet another wrong turn in the national nutritional experiment.
The new thinking on diet
"If the members of the American medical establishment were to have a collective find-yourself-standing-naked-in-Times-Square-type nightmare, this might be it. They spend 30 years ridiculing Robert Atkins, author of the phenomenally-best-selling ''Dr. Atkins' Diet Revolution'' and ''Dr. Atkins' New Diet Revolution,'' accusing the Manhattan doctor of quackery and fraud, only to discover that the unrepentant Atkins was right all along. Or maybe it's this: they find that their very own dietary recommendations - eat less fat and more carbohydrates - are the cause of the rampaging epidemic of obesity in America."
Gary Taubes
What If It's All a Big Fat Lie?
Since the original diet principles advocated in the Track Your Plaque program were released in 2004, a number of new developments have surfaced. While some are simply passing fads that should not impact our thinking, there are also some lessons to learn.
First of all, I believe that we can all agree that:
* Hydrogenated, or trans fats, synthetic fatty acids created by food manufacturers to replace saturated fats, are a failed experiment that has resulted in more heart disease (via its LDL-increasing, HDL-decreasing effects) and cancer. I believe that we can all agree that hydrogenated oils should be entirely removed from our diets. Any product with a label disclosing hydrogenated oils should be avoided.
* Polyunsaturated fats represent yet another failed experiment. The "official" dietary advice of the 1960s and 70s was dominated by advice to reduce saturated fat and replace them with polyunsaturates like corn oil, safflower and sunflower. While this reduces LDL and total cholesterol modestly (in some, but not all) people, it has more recently been shown to increase inflammatory responses substantially. Polyunsaturates are rich in the fatty acid, linoleic acid (not to be confused with the healthy linolenic), a precursor to the inflammatory prostaglandins like arachadonic acid. Polyunsaturated fatty acids are also readily incorporated into coronary plaque, more so than saturated fats. Polyunsaturated oils should play a very minor role in diet. (Their ubiquity, even in natural foods, makes them unavoidable to a degree.)
* Commercially-produced meat today is not the same as that eaten by our ancestors, particularly if compared to wild game caught by our hunter-gatherer predecessors. Factory farm-raised chicken, beef, and pork are modified by confinement in small spaces, being fed corn or other industrial meals, growth hormone, long-term exposure to antibiotics, among other "modern" strategies used to increase yield. The accelerated maturation (reducing time to slaughter from the traditional four or more years to around 18 months or less) and grain and corn feed yields an obese animal at time of its kill. The end-product that arrives on your dinner table has a greater saturated and polyunsaturated fatty acid content, along with reduced omega-3 fatty acids.
Some new developments that we should consider:
* Total fat composition of the diet is not important?In past, we often obsessed over what percentage of calories fats should comprise in the diet: 10%, 20%, 30% . . . certainly not 40% or more! The focus on saturated fat as a cholesterol-increasing fat fraction led us to initially believe that elimination of saturated fat along with a reduction in total fat would reduce risk for heart attack - it did not. The data on this are now clear. Reductions in saturated fat and across-the-board reductions in total fat do not result in reduced risk for cardiovascular events. Total fat intake is probably not an important aspect of health at all, although it can become an adverse factor if purposefully restricted - a phenomenon directly opposite to what we had previously thought.
* Saturated fat is not all bad - The low-carbohydrate craze has uncovered an unexpected phenomenon: When excessive carbohydrates are removed, the undesirable effects of saturated fat are reduced (though not eliminated). Journalist Gary Taubes articulated this idea best in his book, Good Calories, Bad Calories, as well as in a New York Times article, What If It's All a Big, Fat Lie? While saturated fat sources do indeed raise (large) LDL cholesterol (but also raises total HDL, large HDL, or HDL2b, and reduces lipoprotein(a)), the association with increased risk of heart disease is small at most. But combine saturated fats with excessive carbohydrates and the dreaded small LDL skyrockets. So, saturated fat is not the culprit. It is soaring small LDL triggered by carbohydrates, only somewhat worsened by saturated fats. The prime cultprit: carbohydrates, not saturated fat. (That's not to say, however, that saturated fat is good in unrestricted quantities. And not all saturated fat sources are equal, something we need to discuss in greater detail.)
* "Healthy whole grains" are not - This phenomenon has become a particular bugaboo for the Track Your Plaque program. In past, it was a real struggle to help people successfully lose weight and improve patterns associated with overweight and obesity, like low HDL, high triglycerides, small LDL, increased blood sugar and blood pressure. It began with advice to eliminate wheat flour-containing products - all breads, bagels, muffins, pretzels, crackers, breakfast cereals, pasta, etc. - simply to reduce blood sugar (since wheat raises blood sugar the same as table sugar). Lo and behold, people began to lose weight, often precipitously. Blood sugar dropped, blood pressure dropped, triglycerides dropped, HDL and small LDL corrected, appetites shrunk dramatically. Some diabetics became non-diabetics. Unexpectedly, many otherwise "well" people suffering chronic bowel problems like cramping and diarrhea experienced dramatic relief, rashes resolved, some arthritis improved or disappeared. The unavoidable conclusion was that grains, particularly wheat and cornstarch, were the causes of an entire panel of undesirable health effects; elimination reversed them. There has since been no turning back. Of course, this information goes against the "grain" of conventional advice from the AHA and USDA: Eat more whole grains. But the strategy of reducing, even eliminating, wheat and cornstarch from the diet to correct many common lipoprotein abnormalities is a powerful strategy that we will consider at greater length.
That's an awful lot of information, new and old, to consider just to reconstruct something basic as eating. It may help to heed Omnivore's Dilemma author Michael Pollan's advice to:
"Eat food. Not too much. Mostly plants."
If you're confused about what to eat, you're not alone. Even nutritionists now express confusion over what to believe, what to advise.
The Track Your Plaque program incorporates the collective wisdom gained through this grand nationwide nutritional experiment. But we also apply our unique perspective on applying healthy eating and nutrition in a program of coronary plaque control and reversal using lipoprotein patterns to light the way. Lipoprotein patterns provide invaluable insight into metabolic responses that abbreviate our path to success and yield superior results faster.
Coming soon: The New Track Your Plaque Diet: Part 2 (the specifics)
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