By 1982, the idea of the "prudent diet" was well ingrained in American medicine, despite a lack of direct evidence to support it, and even a certain amount of evidence at odds with it (such as the ill-fated Anti-Coronary Club trial). The prudent diet was designed to reduce the risk of heart attack, and suggests reducing total fat, saturated fat and cholesterol intake, while increasing consumption of vegetables, whole grains, fruit and fiber. Some versions of the diet replace saturated fat with polyunsaturated vegetable oils.
MRFIT involved 12,866 men at high risk of heart attack, making it one of the largest controlled trials of all time. Half of the group were told to keep doing what they were doing, under medical supervision, and the other half were given intense diet and lifestyle counseling. The intervention group was counseled to quit smoking and reduce their consumption of saturated fat and cholesterol, and increase polyunsaturated vegetable oil consumption.
After 6 years, 46% of the intervention group had quit smoking, compared to 29% in the control group. The intervention group reduced their cholesterol intake by 40% and their saturated fat intake by more than one-fourth, and increased their consumption of polyunsaturated fat (omega-6) by one third relative to the control group (source).
The results? After seven years, total mortality was 41.2 per 1,000 in the intervention group and 40.4 in the control group, a difference that was not even close to statistically significant. There were also no significant differences in heart attack rate or heart attack death rate. The authors and their apologists tried to wiggle out of the obvious conclusion through an avalanche of slippery math and editorials.
The results were mirrored by a later intervention trial published in 2006, the Women's Health Initiative dietary modification trial. This one was even larger, involving 48,835 postmenopausal women! This was another test of the prudent diet, in which participants were intensively counseled to
reduce total fat intake to 20% of calories and increase intakes of vegetables/fruits to 5 servings/d and grains to at least 6 servings/d.After 6 years, the intervention group was eating 22% less fat, 23% less saturated fat, 20% less cholesterol, 15% more carbohydrate, 22% more fruits and vegetables, and slightly more fiber and whole grains than the control group. LDL dropped a bit in the intervention group.
I think you know what's coming...
Over a mean of 8.1 years, a dietary intervention that reduced total fat intake and increased intakes of vegetables, fruits, and grains did not significantly reduce the risk of CHD, stroke, or CVD in postmenopausal women...Oh and you forgot to mention, 4.9% of women died in the intervention group as opposed to 5.0% in the control group. A "minor detail" that I couldn't find in the paper so I had to look up elsewhere. The study also showed that the diet modifications didn't reduce the incidence of breast or colorectal cancer, two of the most common cancers. RIP, prudent diet. Although it still seems to be struggling along, despite the beating. Another set of editorials appeared claiming that the diet didn't work because it wasn't extreme enough. How far do we have to move the goalposts before we give up?
There was one interesting finding that came out of MRFIT, which foreshadowed the result of the Lyon trial. MRFIT participants eating the most omega-3 from fish were at a 40% lower risk of coronary heart disease and a 22% lower risk of dying of any cause. This was not part of the intervention, so it doesn't necessarily reflect cause and effect. For that, we'll have to look at the Lyon trial.
46 comments:
Another jawdropping very thought provoking excellent succinct and to the point blog that must have take a lot of time to arrive at.
Fascinating
Very well done and thank you.
What was the change in waist size and body fat %?
Any data on mental effects? Depression anxiety or any mental disorders?
What was the drop-out rate? We know the adherence effect will skew results to the positive.
Bone health? Organ health eg diabetes, fatty liver, etc?
Life and death are the ultimate measures, but not the only ones...
In the WHI study, women with history of CHD (3.4% of the group) had an increased HR that was statistically significant.
I'm trying to remember off the top of my head because we used some of this data in a graduate stats class back in the day, but wasn't one of their possible explanations that the intervention simply didn't work?
It seems to me it was and then quickly glossed over with some other ridiculous explanation as to why it didn't work.
In either case, the data are pretty remarkable. With significant drops in smoking, saturated fat and cholesterol, you'd think they'd be able to combine that and make some intelligent conclusions. But no.
I only have one beef with your post. I don't think the "prudent diet" is struggling along. I think it's gaining momentum quite nicely.
Great post.
Brian
If adopting a "prudent diet" for a 6-year period led to no statistically meaningful changes in the health parameters that were measured, then doesn't this mean that both diets ("prudent" and control) are equally healthy? I'm sure the truth is that they were equally unhealthy, as by the 1980s vegetable shortening and vegetable oils had largely replaced animal or fruit/nut based oils from industrial cooking, processed foods, and home use. That plus the "no difference in effects of omega6 consumption beyond 4% of diet" that you've discussed in previous posts would lead to ceiling effects.
Hello,
I've been following this blog for several weeks now in an effort to determine what a healthy diet actually is.
It's really stunning how wrong the medical establishment may be.
Strokes and heart attacks run in my family, and I've already had a mini stroke at 36 (I’m 43 now.) That is an experience I don't care to repeat, and I know that one was just a teaser.
Although the posts here are technical, and I'm not a scientist, I think I've got most of the message:
Cut out the sugar, low omega 6 balanced with omega-3; Saturated fats in and of themselves are neutral; Some animal products contain important fat soluble vitamins.
Stephan and the gang about have me convinced that low fat is not the way for me to go. But I'm very confused on the issue of carbohydrates on two counts:
1. The amount. Is there a consensus here that low-carb is the way to go? (I realize everyone's a little different, but what might the macro nutrient ratios look like as recommended here?)
2. What kind of carbs? If grains and wheat are out, then what exactly? (I’m talking ideally.)
I can cook up some salmon or liver in butter, but what am I going to eat with it?
Somebody please help me out here.
To Glenn
Have you looked at Dr. William Davis's Track Your Plaque web site? Along with Stephan's superb analyses and insights that would give you the most concrete, intelligent and credible advice on the planet for your questions - along with a forum where you can do Q&A with people in the same boat as you who are more than beating the odds.
www.trackyourplaque.com
Ed,
The WHI intervention group dropped about a kilo in 8 years, which was statistically significant. If I recall, that came out of body fat. Dropout rate was low in both groups, around 4-5% I think.
I don't know about bone health, mental health etc. They didn't measure those things. The trial was designed to measure the effect of the diet intervention on cardiovascular disease and cancers.
I agree with you that there's more to it than life or death, but death is an endpoint that people care about and that's difficult to misinterpret!
Brian,
Yes, they mentioned that possibility in the paper, it would have been ridiculous if they hadn't. But then they got mealy-mouthed in subsequent editorials.
Hi Glenn,
Was your stroke ischemic or hemorrhagic? Ischemic stroke risk will probably be greatly improved by balancing n-6:3. Hemmorhagic stroke risk can be exacerbated if your blood is too "thin", so be careful about supplementing omega-3. The Japanese have a high rate of stroke, mostly hemorrhagic. In the U.S. our stokes are typically ischemic. I don't know anything specific about preventing hemorrhagic stroke, but I suspect a good diet and exercise will reduce the risk like it does with most common disorders.
About carbohydrate, I think it depends on the person. If we want to talk about the absolute optimum, it's probably less than 50% of calories from carbohydrate for most people in my opinion. But it varies. I also believe that if the quality of your diet is good, you can be very healthy eating high-carb.
I also think the ideal source of carbohydrate is starchy tubers like potatoes (peeled), sweet potatoes, taro, plantains, etc. Fermented non-gluten whole grains are probably good as well.
"1. The amount. Is there a consensus here that low-carb is the way to go? (I realize everyone's a little different, but what might the macro nutrient ratios look like as recommended here?)"
I looked into and now follow a Paleo diet. There's quite a few of them out there, all vary somewhat in their rules, but the idea is that you should stick to eating pre-neolithic foods that humans have been eating for a longer time than things like grains and dairy. Or at least most of the time, most of your diet should consist of them. Your level of adherence may vary.
It does end up being low carb-ish but that's just because the diet humans evolved to eat is low carb.
BTW, the effects have been terrific. My autoimmune issues have backed off quite a lot.
Glenn,
Just for comparison, I get roughly 35% of my calories from carbohydrate, 50% from fat and 15% from protein. My carbs come primarily from peeled potatoes, ground and fermented brown rice, and legumes.
I have some constraints on my diet, but if I were to eat exactly to my tastes, I'd eat more protein and fat and less carbohydrate.
Mealy-mouthed is an excellent descriptor.
Stephen,
Why peeled potatoes? I often cook a bag of those organic small potatoes (forget what they call them)--peel and all--from whole foods with my roasts. Should I peel the potatoes even if they are organic? I thought the skin was supposed to be quite nutritious.
Aaron,
I don't feel super dogmatic about it. However, from what I can gather, in places where potatoes are used as a staple, people peel them. That includes Peru, the birthplace of the potato where they've been cultivating it for more than 6,000 years. Those people know what they're doing.
As you mentioned, the skin is disproportionately nutritious. But it's also where the toxins are. The potato make sure that if anything is going to get to the starchy center, it's going to have to eat poison first. Potatoes contain solanine and other alkaloids, most of which are greatly reduced by peeling. Those alkaloids are the main reason Cordain recommends against nightshades (potatoes, tomatoes, peppers, etc). According to some studies, they may be able to increase intestinal permeability, not a good thing.
I doubt a few potato skins every now and then is a problem. Potato breeders are well aware of solanine and they are required to keep it below a certain level. But in the end, I'm going to go with what has worked for potato-based cultures that have been eating them for hundreds and thousands of years.
Thanks for your response Stephan/everyone,
“Was your stroke ischemic or hemorrhagic?”
My bad. It was ischemic as far as I know. My dad’s definitely ischemic.
I awakened 8 years ago almost to the day unable to arise for several hours with very severe vertigo.
I called my dad (still supine) and he said “that’s exactly what happened to me with my stroke.” Dad had his at 44, (I'll be 44 in 3 days!) and he’s 66 now. Except he had some numbness and mental confusion to go with it I didn’t have.
They diagnosed him with blockage of the small blood vessels leading to the brain. Grand-dad had a stroke at 64 and died at 66, so I have great genes!
My episode was never officially diagnosed when I saw my doc, but I believe that’s what it was. Dad is still alive and just went through a bypass with 90% blockage in 3 arteries, and that rekindled my interest in changing my diet.
I have not had a complete health disaster yet, and no angina as of yet.
Stephen: “I also think the ideal source of carbohydrate is starchy tubers like potatoes…”
Does this mean I can have scrambled (free-range) eggs with hash browns (made by grating potatoes and frying them up in butter) and call that healthy?
That’s one of my favorites anyway.
(Sorry this post got a little long.)
Glenn,
In my opinion, yes.
If I remember correctly, in the MRFIT they found something like 20% of participants had no detectible omega-3s in their tissues.
Don
Very interesting stuff. Looks like the benefits of reducing smoking may have been counteracted by the increased consumption of veggie oils.
Glenn,
It still may be better to do high-fat/low-carb paleo.
If you're overweight or obese with low muscle mass and activity level, you may have metabolic issues — especially if you have history of both. High-fat paleo should dramatically better your body's insulin or leptin sensitivity beyond a one like to Stephan's. He hasn't had those issues.
“It still may be better to do high-fat/low-carb paleo.”
Think so? One of my last concerns about a high Saturated fat diet (I assume that is what’s being recommend here) is whether it will make my blood platelets too sticky (especially as I sleep,) increasing the possibility/severity of a transient ischemic attack.
I’ve taken aspirin or drink red wine at night to counter this ever since my TIA.
Also, I had chronic, undiagnosed high b/p up until 3 years ago which is now controlled with Lisinopril HCTZ 20/25. I plan on trying to phase it out with adherence to a better diet.
Jack, should I gradually ease into a low-carb diet if I go that route to allow for my body to adjust to it? I briefly tried it before and felt exhausted.
P.S. I know folks are giving opinions here and not medical advice. I alone am responsible for my dietary choices.
Hi Glenn,
I started a low carb diet about five months ago. I felt fatigued and head-achy for a little over a week. I have since read various accounts that feeling this way initially is quite common. Starting slowing makes sense, but you will likely feel some effects. Please don't be tempted by low-carb packaged products. Most will not be good for you.
Someone recommended Dr. Davis -- you can get some ideas about him if you haven't already on his blog - http://heartscanblog.blogspot.com/.
Between Dr. Davis and Stephan, you may find yourself realizing that giving up wheat and limiting sugar are giant steps toward better health.
Some of the best no-nonsense information on LC dieting can be found on Jenny's website - http://www.phlaunt.com/diabetes/
Don't be put off by the fact that it is a diabetes website. She explains a great deal about what to expect when eating LC and I found that information was right on. You will also find a calculator on her site that gives a good starting point for how much protein and fat you should eat during the first three weeks given your weight and age. I keep seeing more and more references to a need for a minimum of 30gms of protein per meal to maintain your lean mass.
I personally don't worry about saturated fat any longer, but I don't think you should assume that a LC diet means a high saturated fat diet. It does mean a high fat diet, though. You might enjoy taking a look at Tom Naughton's blog and DVD -- http://www.fathead-movie.com/
Not quite as objective as Jenny's website, but quite helpful to me, was Protein Life Plan by the Eades. A new version will be published soon, but you can find the old version at the library.
Don't miss Stephan's nutrition Hall of Fame either.
I know you're not asking, but if you are interested in research on exercise, check Stephan's blogroll. I began high intensity strength training in March and added about three pounds of lean mass. I used to go to the gym 3-4 days a week, but have never had such results. A great book on the topic is 'Body by Science' by McGuff.
Glenn,
In my opinion, the amount of carb intake for anyone is directly dependent on Blood Glucose and fasting Triglyceride levels. Whatever amount of carbs allow you to have a 2 hours after meals (Breakfast/Lunch/Dinner), if the blood sugar comes down to <90 range and if your fasting triglycerides is ~80-90 - you can consume that much amount of carbs.
This is what I use to control my carb intake.
Thanks, Venkat
Glenn,
To add, I consume only 40g of netcarbs per day. This excludes the fiber portion.
Another thing we need to note wrt Blood glucose level is, what is the maximum does the blood glucose peaks and comes back to <90 in 2 hours? The less the peak is - the better.
Thanks
Venkat
in terms of hemorrhagic stroke, it seems that animal fat and protein help (as it did in Japan). I speculate the reason probably having something to do with the artery integrity.
As to ischemic, and regarding plaque and heart disease... there are a multitude of factors likely involved. In no specific order, here's what i can think of:
*the endothelial glycocalyx (this is a slimy barrier that covers the artery wall preventing particles in the bloodstream from attaching to it). Studies have shown this glycocalyx becomes toast in the presence of high glucose in a matter of hours.
*ox-LDL, allegedly this is usually small, dense LDL (allegedly pattern B) with few saturated fatty acids inside and enough polyunsaturated fatty acids (allowing it to become ox)
*glycated fats, sort of like ox-LDL, glycated fats are damaged by sugars and if the tissue that they incorporate into adopts them as healthy fats, it may suffer damage. saturated fats are not easily glycated,unsaturated ones are.
*once there is a breach in the endothelium (glycocalyx bald-spot?), the immune system gets involved and gobbles up the invader, causing something like a pimple/pus pocket, in the artery wall. Eventually the body isolates this infection, and it may calcify (this is observed in may instances)
*plaque begins to form on the inside of the artery, almost as a protection to prevent that pus-like mess in the artery wall, from bursting into the bloodstream to prevent ischemia, this results in a hardening and narrowing. The earliest autopsies discovering this plaque, would conclude the cholesterol found in this plaque was likely to blame.
that's what I can think of right now, after endulging in a crustless quiche Loraine made with bacon, cream and eggs.
dGlenn said "Does this mean I can have scrambled (free-range) eggs with hash browns (made by grating potatoes and frying them up in butter) and call that healthy?"
Well that would depend on the triglycerides. Triglyceride levels over 100 have been observed in people with the small dense LDL (pattern B). This is apparently the type of LDL pattern in diabetics and in ischemic heart disease patients.
In my experience its not just wheat or sugar that raises triglycerides, but rather anything that converts to glucose. It's been said that 1 potato converts into 1/2 cup of "sugar" through the process of digestion (whereas polysaccharides become mono and disaccharides).
Undoubtedly this is also associated with insulin levels and insulin sensitivity. If you have no health issues and healthy insulin-sensitivity (no propensity to gain weight easily in response to carbohydrates), then you may be ok to eat a whole bunch of hash browns. Insulin also stimulates cell growth in the artery, allegedly contributing to the hardening.
possibly excellent insulin sensitivity, would make the triglycerides a non-issue (Stephan's trigs are pretty low IIRC). Mine would get pretty high if I ate too many carbs.
I didn't finish in my earlier post that triglycerides below 100 are associated with large, "fluffy" LDL (pattern A), which is the type not associated with heart disease.
On a funny side-note... when I was commenting to my chiropractor who is a trained nutritionist about how ApoB (the protein in LDL and VLDL) interferes with quorum sensing of bacteria such as Staph Aureus, thus preventing them from launching an attack... she said "you know why it does that?"
I asked, why. She said "because LDL makes the blood sticky" and somehow said that if we're sick it gets sticky to provide nutrients in the sick area or something along those lines. I was in disbelief of what I had just heard. I've never read that LDL makes the blood sticky, and Idk what that has to do with staph infections. lol. any clarification or reiteration that it was a quacky statement is welcome.
Mtflight
Thanks for you though provoking comments.
Looking for more on AGEs I found this which was helpful.
http://www.maedica.ro/articole/nr2/09_Advanced%20glycation%20endproducts.pdf
Glen
I do not know if Mtflight is suggesting that frying of hash browns may create AGEs, and oxidise some of the fats in butter.
Damage is time and temperature sensitive.
thanks for that link Robert, it includes an interesting segment on atherosclerosis and vascular dysfunction, Peter hyperlipid wrote about AGE and RAGEs.
I wasn't implying that butter would be bad at all for frying. It would be my choice fat alongside coconut oil and bacon grease for frying due to it's high saturation (compared to vegetable oils which would indeed be much more vulnerable to heat damage).
Glycation (and other types of damage to fats such as oxidation) was mentioned in the context of what is probably part of the ischemic vascular disease complex. Just having an elevated cholesterol or the wrong size particles is probably not enough (including my tie-in with increased triglycerides associating with the smaller lipoprotein particle diameter, and that itself determining a higher liability for damage)
Glenn said "Also, I had chronic, undiagnosed high b/p up until 3 years ago which is now controlled with Lisinopril HCTZ 20/25. I plan on trying to phase it out with adherence to a better diet."
This is a tell-tale of insulin resistance and a symptom in the metabolic syndrome cluster.
high insulin levels causing excessive sodium retention by the kidneys. My mom probably had this problem. I took her off vegetable oils, and told her to only get carbs from fibrous, non-starchy vegetables, but to mostly rely on animal foods, going light on dairy and nuts. She lost a few lbs and her blood pressure and pain medications are a thing of the past. The only pain medication she takes is an occasional Alka Seltzer (more gentle on her stomach than undiluted aspirin). She's very happy.
Thanks everyone again for the info
Mtflight,
“If you have no health issues and healthy insulin-sensitivity (no propensity to gain weight easily in response to carbohydrates), then you may be ok to eat a whole bunch of hash browns.”
I do have fat around the middle, and my triglycerides are a little high.
I assume you’d advocate a low-carb non-starch diet then?
This still seems radical to me. We need some blood sugar to function don’t we. What about developing chronic hypoglycemia?
I tried low-carb once and felt very tired, and chalked it up to low blood sugar and decided it wasn’t for me. I’m a little hesitant to eat that way long term. But maybe I’d feel fine in a week or 2 on it?
Venkat,
Your idea of testing Blood Glucose and fasting Triglyceride levels seems good. I assume I can get a decent test kit at the drug store?
Stephan,
Only if you have time: You estimated your fat intake at 50% of calories. I’m assuming the majority of it is saturated correct? Then what are your saturated fat staples? I’m sure fats found naturally in meats/organs, pastured butter…
What else? (Cream?, coconut?)
Glenn,
I agree with Alex that low-carb diets are remarkably effective for high blood pressure. It's always hard to tell whether that's really the carbohydrate or whether it's cutting back on wheat and sugar and eating more nutrients. But I'm open to the possibility that the carbohydrate itself can be problematic for some people. Exercise should help too.
My primary fats are butter and coconut oil; I put them in everything. I also use tallow, and a little bit of olive oil. The rest of my fat comes from eggs, nuts (toasted hazelnuts and macadamias), and meat. Also a little bit (1/3 tsp) of high-vitamin cod liver oil in the morning, and occasional restaurant meals that are probably loaded with bad oils.
My justification for eating the fats I eat has less to do with the nutrient breakdown than the fact that they've been used by some of the healthiest cultures on Earth for millennia, and they resemble the fats that we evolved to thrive on.
Robert Andrew Brown,
It just happens that I was born in Cluj so I was interested in the link you posted. On top of that my mother has diabetes. But what I can understand from that article, because of the lack of clear dietary recommendations in the conclusion, is that carbs produce less AGE than meat and that one should rather cook the meat on the stove than in the oven. Is that so?
Glenn said "This still seems radical to me. We need some blood sugar to function don’t we. What about developing chronic hypoglycemia?"
100% of all the blood sugar you need will be manufactured in the liver from dietary protein (gluconeogenesis). Dietary sugar/carbs are not essential at all (Inuit, etc).
Furthermore your body will switch to fat for energy (lipolysis), using up the fat in your liver (the same way that geese get fatty livers a la foie gras, then migrate for thousands of miles using up this fat as fuel), and your middle. This is a normal process that as hunter gatherers we were probably in most of the time. This will lower your insulin levels and your triglycerides should drop like a rock within 2 weeks of this.
Glenn said "I tried low-carb once and felt very tired, and chalked it up to low blood sugar and decided it wasn’t for me. I’m a little hesitant to eat that way long term. But maybe I’d feel fine in a week or 2 on it? "
It is a major metabolic change, and if you're not used to it your body takes a while to make the necessary enzymes required.
Your glycogen stores (stored carbohydrate in the liver and muscle) will deplete within a day or so, and then you switch into ketosis.
One of the biggest problems in my experience is dehydration. Once your sugar/starch intake virtually disappears, your insulin levels go right down with that, (allowing hormone sensitive lipase to do it's job letting the fat out of the adipose cells) therefore your kidneys will no longer retain sodium and you will basically lose a lot of fluid. With this fluid comes a potassium and sodium loss, which means feeling miserable.
During the adaptive stages, I found that using morton "lite salt" liberally on everything for a while helps this greatly. I sprinkle it on water (potassium chloride and sodium chloride are the ingredients in Gatorade that make it special), and use it to "salt" my foods.
At first you can avoid that by eating more non-starchy veggies and more fat... but the lite salt does wonders (due to the sodium and potassium). Would not be a bad idea to also take magnesium, and make yourself stay hydrated--avoid thirst, and you'll avoid the miserable feeling/headache.
triglycerides are apparently an excellent marker of the type of LDL pattern you have. remember the LDL pattern associated with IHD is the small dense type (when triglycerides over 100).
I'm not familiar with chronic hypoglycemia unless you have major metabolic problems. As a matter of fact low carbers tend to have slightly more elevated fasting glucose (but much lower HbA1c).
Good luck and it would be great to use a good resource for low carb such as Protein Power/protein power Lifeplan my the Drs. Eades, most your questions will be answered there.
Glenn, I've been eating a low starch, low sugar diet for more then 5 years, due to hyperglycemia (my first phase insulin response seems to be gone, but 2nd phase is still robust and can drive BG too low if I eat carbs). I've never been more than 20 pounds overweight, and that weight was lost easily with a switch to low carb. My doctors caught my BG problem when I was pregnant 11 years ago, but they failed to realize it probably wasn't due to the pregnancy and that it continued afterward. I figured it out and took steps to manage my BG.
Now that I recognize it, I hate the BG roller coaster and how it feels so I eat to keep it even and steady. I take no meds for my impaired glucose intolerance, I just avoid or limit the foods that raise glucose and use a glucose meter sometimes to monitor my BG. My goal is to avoid progression to frank diabetes and CVD.
I choose and prepare all the food for my family, and for the most part, the rest of the family also eats low starch, low sugar. Our kitchen is now wheat-free and gluten -free, too. Being low carb and low grain already has made that restriction easier.
I serve high quality protein at every meal (eggs, meat, poultry, or fish, etc., though I rarely use premium boneless cuts, both for flavor and ease of slow cooking, the minerals from bones, and to avoid the expense. I choose naturally raised pastured and non-CAFO most of the time, often purchased in bulk from a rancher or farmer. It;s sometimes more expensive (not always, though, esp when buying in bulk and direct), but I save $ by not buying soda, chips, and very many prepared foods. I make most from scratch, but have learned how to save my efforts for where they count, too.
What used to be starchy side dishes is now non-starch veggies. Salads are large and sometimes complex, not simply iceberg lettuce; dressings are homemade and no industrial n-6 oils. And there are often more veggie side dishes (we subscribe to a generous weekly box of organic produce from a nearby farm). So one third of my plate might be the protein, but the remaining 2/3 is piled high with veggies. I don't spare the naturally saturated fats, either, so the veggies are satisfying, even without starchy side dishes.
I used to be quite a carboholic (much of it whole grain and homemade), but when I cut the carbs and experienced the excess weight coming off (without a lot of hunger), and seeing the BG meter ring up normal BG levels instead of diabetic levels, it was a powerful motivator to change my tastes and habits to substitute non-starchy veggies for the carbs and increase the fat content. I don't measure or count, so I can't tell you ratios or %, but the fat calories are quite high and my carb intake is probably under 60 gms most days, some days much lower.
It can be done, it doesn't happen overnight, there are slip-ups, but tastes and habits can change with far more ease when and if your paradigm shifts. If you try to straddle paradigms, it's harder to cope.
And this week in particular, my resolve to understand and do what's needed to maintain my own health is strengthened, as my mom underwent an angiogram last week and is facing bypass surgery soon. I'm not that surprised and expected something like this at some point, but it's always too soon, right? She's 66 yo.
She grew up with skim milk/margerine (which I think at least partly explains her own father's premature death of CAD at age 50), though she was influenced by Adele Davis when she was a very young mother and tried to do many of the "right things" with us, but skim milk and margerine were probably big mistakes.
In the 80s my mom, her mother, and her siblings were really "taken over" by that "AHA prudent diet", and haven't shaken loose that influence. I'm sure the premature loss of her father was a big factor in their early use of cholesterol drugs, HRT, PUFA oils, etc. I think an underlying genetic version of mild diabetes (MODY) that is showing up in some of my mother's siblings and now our family, plus a 25+ year career at a struggling private hospital as a night shift nurse that turned very stressful in recent years (also creating Vit D deficiency and chronically sleep deprivation) form the perfect crucible for CAD development, doncha think?
In recent years my mom fell into the Low Glycemic web and adhered to South Beach variety of "lowish fat and lowish carb", and had regular servings of "smart" whole grains like barley (not good because I suspect a family genetic issue with gluten, as I have two copies of genes that predispose to gluten issues, so my mom has at least one copy). None of the typical and "prudent" prevention measures worked for her - clearly - and I'm sure she thinks it's just her genetic fate.
I don't deny the genetics - it's probably an underlying mild form of MODY diabetes at the root of the CAD - but the diabetes has been increasingly expressed in my mom's generation and mine just in the last 10-12 years with an uncle and his son also diagnosed with T2 DM about the time I was diagnosed with GDM. Back then, it was a mystery why my BG was screwy - no family history of it, or so I thought. Now it makes a lot of sense.
I just don't think CVD and T2DM has to be our fate if we avoid the modern environmental factors (to the best of our ability) that express that genetic trait (or we can at least try to slow or delay expression an disease progression). But I seem to be the only family member who is curious about it, facing it head on, and trying to make surewe get the right care from our doctors (or inadvertently make things worse).
My mom's situation is a classic example of complying with most of the mainstream medical protocol, and failing anyway. No one sees that as an issue.
I'm not a "young" mom (47), and we've got a 10yo kid to finish rearing. I have a responsibility to my husband and child to stay as healthy as I can. I don't want to be in my mother's shoes in 20 years (or even earlier), so the convention advice isn't very good for me to follow. If I hadn't followed my curiosity and intuition, I probably would heavier, more diabetic, already right behind in her footsteps to the same diagnosis; my diagnosis of impaired glucose regulation came long before my mother's, so I was actually lucky. But still, my cautionary tale of prevention and management falls on deaf ears in my family, because it's so contrary to to conventional medical advice and it requires some work and time to find, understand, and put into practice.
It might be a bumpy summer. I'm really glad to be able to learn from Stephan and the resources he so freely shares, plus all his incredibly insightful readers who comment, ask questions, discuss, and gently challenge each other to tease out how to apply the fruits of the research to our lives. It's a great reality check and very encouraging.
Anna,
I wanted to thank you for all of your thoughtful posts on this blog, I gain so much from them - not just the information but I also really appreciate your philosophy.
And of course Stephan is wonderful for providing thought-provoking articles and for providing this forum that attracts this type of discussion.
Glenn,
Blood Glucose testing can be done at home using a test meter. This is available in all stores - I use One touch ultra from Johnson and Johnson.
I am not sure of Triglycerides testing at home. I was searching for this meter sometime back and saw at Costco online. I did not buy as it was expensive and secondly - was not sure how accurate the reading would be.
Thanks Venkat
Thanks, Senta, I really appreciate the compliment. I really enjoy the readers comments on this blog so very much, but wow, the level of expertise has risen so much sometimes there's not much I can add. But I'm soaking it all up in the audience.
And yes, Stephan has created something wonderful for us, hasn't he? There are few other places where I've learned so much and been able to "gel" vague ideas into "news I can use" with the knowledge that sound science is backing it up.
Aw shucks y'guys. *group hug*
Stephan-- I have a question for you that allows your ability to find research shine (a bit unrelated to the previous comments). Is there any data out there to show that consuming too many MCTs could be deleterious to liver function (or even fatty liver at large amounts). I seem to remember reading 1 study that seemed to show that (but studies trying to prove coconut unhealthy usually have design flaws) If it proven that MCTs could cause problems- why consume them (why stress our liver?)? Especially when LCTs in the form saturated fats really seem to support liver function. Maybe a little is good (of MCTs) by a hormetic effect (by stressing liver to deal with them)? I am asking what you might think is too much-- 3-4 tablespoons a day- or is 1-2 tablespoons a more reasonable amount?
This is in the light that lots of people here consume a lot of coconut oil.
I feel much safer with butter, tallow, and olive oil.
"I wanted to thank you for all of your thoughtful posts on this blog, I gain so much from them - not just the information but I also really appreciate your philosophy."
Ditto. Nice posting work Anna. I enjoyed reading it. Really, the entire group.
Everyone including Stephan has been very helpful. I wish I had somebody like Anna close at hand to help me learn some of these new techniques. I'm not much of a cook. Perhaps in Anna can share with us a few your secrets you spoke about.
I really need to get something done. With a rather embarrassing BMI, a family history of ischemic disease, and some fat around the middle, I'm quite sure I am a ticking time bomb.
mtflight,
Another thing is, I've got a monkey wrench in this thing in that I'm on blood pressure medication (Lisinopril HCTZ) so I'm not quite sure what to do about that. As my diet improves, I may just start trying to phase it out and see how my blood pressure does. I know I can skip a day and still have a reading of like 120/70.
Here is some of my blood test work I found from April 2007:
Blood sugar 91
triglycerides 148
total cholesteral 189
LDL 120
HDL 39
thyroid 2.88
Hematocrit 45.5
white blood cell 7.40
It'd be interesting to check it again if I can get a diet like this going.
I may just start off by including all the healthy fat Stephan talks about, limiting starchy carbohydrates (mainly from root vegetables,) and eliminating all wheat, sugar, and refined western carbohydrates.
Thanks again everyone.
Glenn,
Those results would keep a cardiologist happy.
You could cut out the starch and sugars (From fruit, juice, and sucrose), and measure your bp in a week, then in 2 weeks... usually they have free machines to check it by the pharmacy counter at most grocery stores.
cutting out the sugar and starch will lower your triglycerides in 2 weeks... this will also increase your insulin-sensitivity, so insulin production will down-regulate resulting in lower blood pressure, and lower risk for many types of endocrine cancers.
When you reach a happy weight, and reduce your bp, you can play with certain carbs in moderation to maintain balance.
I do believe that in insulin-resistant folks, carbs are generally not good. I'm not sure if the body could be trained to tolerate them (and remain at a healthy weight). maybe once sensitivity is gone, it's gone.
I have to stay low carb or I gain weight, easily. I've never had blood pressure issues but my HDL was lower and trigs were higher. I love food.
Stephan, sorry to chime in again- but any thought of what i mentioned earlier? Is there any danger to the liver from MCTs?
thanks for your great blog--
Aaron,
Sorry it slipped my mind. What study showed liver damage from MCTs?
You can cause fatty liver and NASH feeding rodents large amounts of industrial vegetable oil, but not coconut oil.
I'd have to imagine that if MCTs were bad for the liver, a lot of Polynesian cultures would have fried livers. As far as I know, that's not the case.
Then again, your point is well taken that we probably evolved more on animal fats than coconut fat. So it may not be the "ideal" predominant fat source, if there is one.
Stephan, hopefully i didn't sound too demanding in my question. In my question, I was just wondering if 'you' had ever come across any studies showing negative effects on the liver from coconut oil (i can remember reading 1 study, but can't find it now). The study was kinda saying that the liver dysfunction was similar to when the liver was overfed with fructose (both fructose and MCTs get sent directly to the liver for processing). I figure it is good policy to not overwork your liver if you don't need to.
This may have been where i read something on MCTs causing fatty liver:
http://weightytalk.blogspot.com/2009/04/nonalcoholic-fatty-liver-disease-new.html
Aaron,
That study was an abstract from a meeting of the American Association for the Study of Liver Diseases, not a peer-reviewed publication. It's a preliminary result in rats that needs to be confirmed. So I wouldn't take it too seriously.
The other thing to keep in mind is they didn't feed the rats coconut oil, they fed them MCTs, which is an isolated fraction of coconut oil. Mainstream medicine is becoming fascinated with MCTs because of their unusual effects on metabolism. But it really gets on my nerves that they have to take a perfectly good food-- coconut oil-- and turn it into a processed industrial food for their studies. They can't just study coconut oil, they have to turn it from a food into a medicine.
You can feed rats huge amounts of coconut oil and they don't get fatty liver or inflammation, that's already been published. So I can't take this one abstract seriously at this point. If it's confirmed and it makes it into the peer-reviewed lit, I'll take a closer look at it.
I've never cone across anything suggesting that coconut oil damages the liver.
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