Food For Thought

Everywhere you look there's a different diet to follow with different claims. One might help you lose weight. One might help lower blood sugar. Another is geared towards low fat or lowering carbs. Others with claims to reverse heart disease. It's overwhelming. And so many diets, while they are all well-intentioned, may be tough tough to sustain long-term. We develop habits and cravings over time that are tough to break. We also have favorite recipes and family traditions that we are emotionally attached to and want to continue to celebrate. Even more, we may have a family to cook for, time constraints, social obligations that require eating out -- all of which could cause you to fail in diet compliance.

So, what should you do?

• First, ask your physician for critical blood work to determine if the foods you are currently eating might be leading to artery damage and inflamation. See critical bloodwork on page ( ).
• Secondly, ask your physician for a referral to a certified dietitian to have a candid discussion about your dietary needs.
• Third, Read the pros and cons of each of the 'popular' diets below as explained by Dr. Michael Dansinger.
• Fourth, ease yourself into any diet for more sustainable results. Making healthier substitutions for meals and recipes you are already used to making can be easier to stick with and make the biggest difference in your health because of it.

My goal is to help you navigate the landscape of “popular diets” and maybe even help find the right eating style for you.

I’ll be discussing the following topics:

No one best diet

The “Popular Diet Spectrum”

Low-carb diets

Moderate-carb diets

Moderate-fat diets

Low-fat diets

Putting it all together

There are hundreds of thousands of diet books that form what I call the “popular diet spectrum”. In their totality, these books form a symmetrical pattern that beautifully reflects some principles of human nutrition. Some scientists and nutrition experts emphasize the dangers of certain (or most) fats, while others emphasize the dangers of certain (or most) carbohydrates, or they emphasize that both unhealthy fats and unhealthy carbs are bad. Some are saying “don’t eat fat with your carbs” and others are saying “don’t eat carbs with your fat” and every possible variation of the middle ground. The result is a broad diversity of options that fall symmetrically along a spectrum, and the science indicates they are all “equivalently” correct and incorrect for health improvement.

In my own research study, published in 2005, my colleagues at Tufts Medical School and I showed that the Low Carb, Moderate Carb, Moderate Fat, and Low Fat eating strategies all improved cardiovascular risk factors to a similar extent according to how closely a person followed their assigned diet. Adherence level, rather than diet type, was the greatest determinant of health improvements. Each eating strategy had strengths and drawbacks, and each diet type had the same rates of adherence (and non-adherence) over time. This was a groundbreaking study result at the time, and there have been many more research studies that have confirmed and reinforced this concept. Since then, I’ve focused my interest on the matchmaking process, which aims to help people figure out which is the best eating strategy for them specifically.

The most famous low-carb diet is the “Atkins diet”, which is one version of the “Keto diet”. Other variations of low-carb diets include “Protein Power”, “Carbohydrate Addict’s Diet” the “Dukan Diet”, and dozens of other variations. They all emphasize that too much sugar is harmful, and that starchy foods rapidly turn to sugar, which raise insulin levels, resulting in fat storage rather than fat-burning. They each have a prescribed method for substantially cutting and managing carbohydrate foods (like bread, cereal, pasta, rice, low-fat dairy, fruits, starchy vegetables), and tell you what to eat instead, especially fats and proteins (like meat, poultry, seafood, eggs, high-fat dairy). By doing so, your hunger and overall calories are reduced, and your body will burn fat for fuel resulting in weight loss.

Research shows this strategy can reduce body fat at least as well as any other eating strategy. It improves (especially with weight loss) high blood sugar and insulin levels in people with diabetes/prediabetes, and high blood pressure levels in people with hypertension. It improves triglycerides, HDL cholesterol, and LDL particle size, at least as well as any other eating strategy, especially when accompanied by weight loss. Unfortunately this approach is highest in saturated fat and least effective for lowering LDL cholesterol, and not enough studies have looked carefully at the effects on artery health. Low-carb diets also have the highest rates of constipation and the highest carbon footprint. Many people find it counter-intuitive to lose weight by eating fat instead of fruits, vegetables, and whole grains, and start to question themselves. Or they “get tired of eating meat, cheese and eggs” or find it “too extreme”, and eventually slip off track (or discontinue abruptly). However, most low-carb eating strategies prescribe an approach to gradually moderate by gradually bringing in more vegetables and fruits over time once you have lost significant weight

Some of the most famous examples of moderate carbohydrate eating plans include the “Zone diet”, “South-beach diet”, and “Paleo diet”. Others you may have heard of include “The glycemic index diet”, “SugarBusters”, “Suzanne Somers diet” “The Biggest Loser diet”, and there are scores of others. These eating plans all highlight concerns about sugar, starch, grains, and excess animal fat. They encourage low-starch vegetables, moderate fruit, nuts/seeds, seafood and lean proteins. They each have differing approaches to starchy vegetables, legumes, fruits, whole grains, and red meat depending on the specific diet rules. For example, the idea behind the Paleo diet is to use modern foods to mimic the “natural human diet” prior to farming (such as vegetables, fruits, nuts, meat, eggs, and seafood) and avoid grains, dairy, and legumes which were not eaten for the vast majority of human evolutionary history.

Research shows that when people closely follow any of these moderate-carb eating strategies all the health indicators improve. People routinely lose excess body fat and improve elevated blood sugar, blood pressure, and/or blood test results. As with any eating strategy, these plans have specific “rules” that many people find hard to follow. These eating plans are sometimes less “black and white” or “all or none” when it comes to carbohydrates, which for some people makes it more realistic, while for others more “lenient” resulting in gradual backsliding and loss of focus. There are no significant health concerns with moderate-carb eating plans, and if you can find one that has a set of rules you can embrace and follow consistently then it can potentially improve your health dramatically.

This type of eating plan fits best with “standard medical advice” and emphasizes calorie/portion control, moderation, balance, and flexibility. Famous examples of this eating strategy include the “American Heart Association diet”, “American Diabetes Association diet”, “DASH diet”, “Mediterranean diet”, “Volumetrics” and “Weight Watchers diet”. All of these variations emphasize that fats are loaded with calories (a gram of pure fat has more than twice the calories as an ounce of pure carbohydrate or protein). These eating plans encourage replacing fats, especially saturated animal fats, with whole grains, legumes, fruits, and vegetables. They generally favor small portions of unsaturated fats from vegetable oils, olives, nuts, avocados, and seafood. The Mediterranean diet is more liberal with olive oil and red wine than most other moderate-fat diets, while strongly emphasizing small portions and minimal snacking between meals, as is customary where this eating style originates.

Research shows these types of moderate-fat diets improve all health indicators, including lifespan. Communities and societies throughout the world that closely follow such eating styles are healthy and enjoy excellent longevity and reduced risk of cardiovascular disease, diabetes, obesity, and related conditions. Unfortunately, in America and other countries that are becoming more “Americanized”, too many people are not following standard medical/nutrion advice. Many people have tried unsuccessfully to cut calories and portion sizes, or use “moderation” to limit how much unhealthy food they eat. A major criticism of this dietary strategy is that most people aren’t nearly strict enough when they try to follow a moderate-fat eating plan. Cardiovascular disease remains the leading cause of death in America, which has also had a growing obesity and diabetes problem over the past half-century despite long-standing advice to limit fat and calories.

Unlike moderate-fat diets, which typically aim for 25-35% of calories from fat, low-fat diets aim for closer to 15-25% of calories from fat. We’re talking about a whole different level of fat awareness and strictness. Famous examples of low-fat diets include the “Pritikin diet”, “Ornish diet”, “Low-fat vegan diet”, and “Japanese diet”. A core principle of such eating strategies is that pushing the dietary fat level very low allows for great abundance of very low-fat foods (as long as they are not sugary processed foods). People who successfully follow a low-fat eating plan typically keep track of their daily fat intake (for example 25 to 50 grams per day), and eat lots of fiber from vegetables, legumes, fruits, and whole grains. Soy foods are common, and egg whites and non-fat dairy products are usually popular with non-vegans. Some low-fat eating strategies may include low-fat seafood and/or poultry breast in moderation. This eating style has a relatively low carbon footprint, which is a very important feature to many advocates.

Research shows significant improvements in major health measures. When followed properly, a low-fat eating strategy improves obesity, diabetes, hypertension, and cardiovascular disease risk. It improves LDL-cholesterol better than any other eating style, although it can worsen HDL-cholesterol, triglycerides, and LDL particle size in the absence of significant weight loss. It requires a level of commitment, focus, strictness, and advanced planning that exceeds what most people are ready or able to achieve on a long-term basis. For others, the clear strict rules are exactly what they need in order to break the cycle of disease caused by counter-productive eating habits.

The vast body of existing nutrition research strongly supports the concept of “many effective eating strategies”, each with their own set of strengths and drawbacks. Like many aspects of life, a variety of options can be both a blessing and curse. Finding a good eating style that is a proper fit for your specific health goals, medical situation, and food preferences, is all about finding an effective approach you can stick to on a long-term basis. This always requires commitment, focus, persistence and lots of advanced planning until the eating style becomes a normal automatic part of your everyday life. It’s even possible to switch between different types of eating plans, as long as you’re carefully following the “rules” of whatever plan you are following at the time. It’s the fact that you’re carefully following a set of rules that makes the plan work. All effective plans help protect their followers, in one way or another, from certain unhealthy aspects of the “standard American diet” which is ultimately how any good eating strategy gets the job done.

Research shows significant improvements in major health measures. When followed properly, a low-fat eating strategy improves obesity, diabetes, hypertension, and cardiovascular disease risk. It improves LDL-cholesterol better than any other eating style, although it can worsen HDL-cholesterol, triglycerides, and LDL particle size in the absence of significant weight loss. It requires a level of commitment, focus, strictness, and advanced planning that exceeds what most people are ready or able to achieve on a long-term basis. For others, the clear strict rules are exactly what they need in order to break the cycle of disease caused by counter-productive eating habits.