[Did I ever tell you that a long time ago, when we found out Sweetie had a cholesterol rate in the high 200s, I put him on a strict diet--the American Heart Association diet. After three months, his cholesterol was significantly higher. That's when we turned vegetarian. The cholesterol dropped but not enough, so Sweetie went on Lipitor. Now I'm on that crap too. If we're gonna have to take that nasty stuff, then I think we'll up the protein and fats, since the cholesterol will be controlled by the statin drug.]

New thinking on diets: Low fat might be bad

What's more, high carbs may be cause of obesity By Gary Taubes New York Times Magazine

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.

Or, just possibly this: They find out both of the above are true.

When Atkins first published his "Diet Revolution" in 1972, Americans were just coming to terms with the proposition that fat — particularly the saturated fat of meat and dairy products — was the primary nutritional evil in the American diet.

Atkins managed to sell millions of copies of a book promising that we would lose weight eating steak, eggs and butter to our heart's desire, because it was the carbohydrates, the pasta, rice, bagels and sugar, that caused obesity and even heart disease. Fat, he said, was harmless.

Atkins was by no means the first to get rich pushing a high-fat diet that restricted carbohydrates, but he popularized it to an extent that the American Medical Association considered it a potential threat to our health.

The AMA attacked Atkins' diet as a "bizarre regimen" that advocated "an unlimited intake of saturated fats and cholesterol-rich foods," and Atkins even had to defend his diet in congressional hearings.

Thirty years later, America has become weirdly polarized on the subject of weight. On the one hand, we've been told with almost religious certainty by everyone from the surgeon general on down, and we have come to believe with almost religious certainty, that obesity is caused by the excessive consumption of fat, and that if we eat less fat we will lose weight and live longer.

On the other, we have the ever-resilient message of Atkins and decades' worth of best-selling diet books, including "The Zone," "Sugar Busters" and "Protein Power" to name a few.

All push some variation of what scientists would call the alternative hypothesis: It's not the fat that makes us fat but the carbohydrates, and if we eat less carbohydrates we will lose weight and live longer.

A subtle shift

The perversity of this alternative hypothesis is that it identifies the cause of obesity as precisely those refined carbohydrates at the base of the famous Food Guide Pyramid — the pasta, rice and bread — that we are told should be the staple of our healthy low-fat diet, and then on the sugar or corn syrup in the soft drinks, fruit juices and sports drinks that we have taken to consuming in quantity if for no other reason than that they are fat free and so appear intrinsically healthy.

Over the past five years, however, there has been a subtle shift in the scientific consensus. It used to be that even considering the possibility of the alternative hypothesis, let alone researching it, was tantamount to quackery by association.

Now a small but growing minority of establishment researchers have come to take seriously what the low-carb-diet doctors have been saying all along.

Walter Willett, chairman of the department of nutrition at the Harvard School of Public Health, may be the most visible proponent of testing this heretic hypothesis.

Willett is the de facto spokesman of the longest-running, most comprehensive diet and health studies ever performed, which have already cost upward of $100 million and include data on nearly 300,000 individuals.

Those data, says Willett, clearly contradict the low-fat-is-good-health message "and the idea that all fat is bad for you; the exclusive focus on adverse effects of fat may have contributed to the obesity epidemic."

The paradox

These researchers point out that there are plenty of reasons to suggest that the low-fat-is-good-health hypothesis has now effectively failed the test of time.

In particular, that we are in the midst of an obesity epidemic that started around the early 1980s, and that this was coincident with the rise of the low-fat dogma. (Type 2 diabetes, the most common form of the disease, also rose significantly through this period.)

They say that low-fat weight-loss diets have proved in clinical trials and real life to be dismal failures, and that on top of it all, the percentage of fat in the American diet has been decreasing for two decades.

Our cholesterol levels have been declining, and we have been smoking less, and yet the incidence of heart disease has not declined as would be expected.

Put simply, if the alternative hypothesis is right, then a low-fat diet is not by definition a healthy diet. In practice, such a diet cannot help being high in carbohydrates, and that can lead to obesity, and perhaps even heart disease.

"For a large percentage of the population, perhaps 30 to 40 percent, low-fat diets are counterproductive," says Eleftheria Maratos-Flier, director of obesity research at Harvard's prestigious Joslin Diabetes Center. "They have the paradoxical effect of making people gain weight."

What's forgotten in the current controversy is that the low-fat dogma itself is only about 25 years old. Until the late '70s, the accepted wisdom was that fat and protein protected against overeating by making you sated, and that carbohydrates made you fat.

It was Ancel Keys, paradoxically, who introduced the low-fat-is-good-health dogma in the '50s with his theory that dietary fat raises cholesterol levels and gives you heart disease. Over the next two decades, however, the scientific evidence supporting this theory remained stubbornly ambiguous.

'This greasy killer'

The case was eventually settled not by new science but by politics. It began in January 1977, when a Senate committee led by George McGovern published its "Dietary Goals for the United States," advising that Americans significantly curb their fat intake to abate an epidemic of "killer diseases" supposedly sweeping the country.

It peaked in late 1984, when the National Institutes of Health officially recommended that all Americans over the age of 2 eat less fat.

By that time, fat had become "this greasy killer," in the memorable words of the Center for Science in the Public Interest, and the model American breakfast of eggs and bacon was well on its way to becoming a bowl of Special K with low-fat milk, a glass of orange juice and toast, hold the butter — a dubious feast of refined carbohydrates.

In the intervening years, the NIH spent several hundred million dollars trying to demonstrate a connection between eating fat and getting heart disease and, despite what we might think, it failed.

Few experts now deny that the low-fat message is radically oversimplified. If nothing else, it effectively ignores the fact that unsaturated fats, like olive oil, are relatively good for you: They tend to elevate your good cholesterol, high-density lipoprotein (HDL), and lower your bad cholesterol, low-density lipoprotein (LDL), at least in comparison to the effect of carbohydrates. While higher LDL raises your heart-disease risk, higher HDL reduces it.

What this means is that even saturated fats — a k a, the bad fats — are not nearly as deleterious as you would think. True, they will elevate your bad cholesterol, but they will also elevate your good cholesterol.

In other words, it's a virtual wash. As Willett explains, you will gain little to no health benefit by giving up milk, butter and cheese and eating bagels instead.

Eating more

But it gets even weirder than that. Foods considered more or less deadly under the low-fat dogma turn out to be comparatively benign if you actually look at their fat content.

More than two-thirds of the fat in a porterhouse steak, for instance, will definitively improve your cholesterol profile (at least in comparison with the baked potato next to it); it's true that the remainder will raise your LDL, the bad stuff, but it will also boost your HDL.

The same is true for lard. If you work out the numbers, you come to the surreal conclusion that you can eat lard straight from the can and conceivably reduce your risk of heart disease.

The major trends in American diets since the late '70s, according to the USDA agricultural economist Judith Putnam, have been a decrease in the percentage of fat calories and a "greatly increased consumption of carbohydrates."

To be precise, annual grain consumption has increased almost 60 pounds per person, and caloric sweeteners (primarily high-fructose corn syrup) by 30 pounds. At the same time, we suddenly began consuming more total calories: now up to 400 more each day since the government started recommending low-fat diets.

If these trends are correct, then the obesity epidemic can certainly be explained by Americans' eating more calories than ever — excess calories, after all, are what causes us to gain weight — and, specifically, more carbohydrates.

Diet wars

Atkins' diet is the battleground on which the fat-vs.-carbohydrates controversy is likely to be fought scientifically over the next few years. After insisting Atkins was a quack for three decades, obesity experts are now finding it difficult to ignore the copious anecdotal evidence that his diet does just what he has claimed.

In fact, when the American Medical Association released its scathing critique of Atkins' diet in March 1973, it acknowledged that the diet probably worked but expressed little interest in why.

Through the '60s, this had been a subject of considerable research, with the conclusion that Atkins-like diets were low-calorie diets in disguise; that when you cut out pasta, bread and potatoes, you'll have a hard time eating enough meat, vegetables and cheese to replace the calories.

Now researchers have finally decided that Atkins' diet and other low-carb diets have to be tested, and are doing so against traditional low-calorie, low-fat diets as recommended by the American Heart Association.

None of these studies have been financed by the NIH, and none have yet been published. But the results have been reported at conferences. The results of all five of these studies done thus far are remarkably consistent. Subjects on some form of the Atkins diet lost twice the weight as the subjects on the low-fat, low-calorie diets.

In all five studies, cholesterol levels improved similarly with both diets, but triglyceride levels were considerably lower with the Atkins diet.

Fat is back?

Though researchers are hesitant to agree with this, it does suggest that heart-disease risk could actually be reduced when fat is added back into the diet and starches and refined carbohydrates are removed.

All of this could be settled sooner rather than later, and with it, perhaps, we might have some long-awaited answers as to why we grow fat and whether it is indeed preordained by societal forces or by our choice of foods. For the first time, the NIH is now actually financing comparative studies of popular diets.

In the course of my research, I have spent my mornings at my local diner, staring down at a plate of scrambled eggs and sausage, convinced that somehow, some way, they must be working to clog my arteries and do me in.

After 20 years steeped in a low-fat paradigm, I find it hard to see the nutritional world any other way.

I have learned that low-fat diets fail in clinical trials and in real life, and they certainly have failed in my life. I have even lost considerable weight with relative ease by giving up carbohydrates on my test diet, and yet I can look down at my eggs and sausage and still imagine the imminent onset of heart disease and obesity.

This is the state of mind I imagine that mainstream nutritionists, researchers and physicians must inevitably take to the fat-vs.-carbohydrate controversy. They may come around, but the evidence will have to be exceptionally compelling.

-- Anonymous, July 28, 2002

Answers

I can't wait to see the progress of those lawsuits against fast-food joints.

-- Anonymous, July 28, 2002

For me, Atkins Diet = ketosis, and for me ketosis = bad, bad idea. I don't understand why someone would intentionally screw up their blood gases.

This assumes, of course, an otherwise healthy situation. A Type II diabetic seems to be doing quite well on it, or at least has reduced his peta bread belly and his cholesterol. But I can't think of any reason it could be right for me.

In the letters Dad wrote Mother during WWII (when censoring meant he couldn't write anything about the war), he wrote a number of times what he concerned to be accepted opinion about the pudgy overweightness that comes from a diet of too many potatoes. (He was a battalion surgeon who got to worry about things like this.) That was for both the inactive servicemen when he was stationed in Iceland at the beginning of the war, and then later in France and Germany when food was rather scarce for the natives. It kind of surprised me.

I have been making an effort to increase the good fats, eliminate the trans fats, and reduce the saturated fats. I have also eliminated my main sources of dietary cholesterol (came with knocking back the fats). I don't exactly worry about calories where the good fats are concerned, but I think I'm probably still not getting enough, so they should all be used up. I was pretty annoyed when my doctor didn't order blood work prior to my last physical, but I hope to find out next year if it has made a difference.

-- Anonymous, July 28, 2002

My mother is 76 years old. She has had cardiac problems for close to 20 years. VERY elevated cholesterol and high triglycerides, even when following the most strict of low-fat diets and exercising religiously every day. She's taken just about every cholesterol reducing drug there is, in addition to trying most of the "alternative" treatments (niacin, etc.). NOTHING ever worked. SHe also gained 20+ pounds following the low fat diet, even with regular and fairly strenuous exercise.

She is a nurse practitioner and has always been very careful about her health.

After her last angioplasty (her 4th), her new cardiologist recommended she follow a low carbohydrate diet, as he does 90% of his patients. Within a month, her cholesterol levels plummeted, as did her triglyceride levels. She felt better, looked better...had more energy...her overall state of health and well being was significantly improved.

She has followed a low carb diet for almost 2 years now, and is in better shape than she's been in years. Doesn't need the cholesterol reducing meds, and her meds for hypertension have significantly been decreased. Made a believer out of her...and a lot of her peers.

I don't have seriously high blood pressure, nor have my cholesterol levels ever been seriously high, but I can tell you that whenever I've followed a low-fat diet, I've gained and my blood work is higher than when I follow my natural tendency to avoid carbs. I've never had a real 'hankering' for cereals, fruits, etc...my built-in inclination is mostly for meats (of all kinds), cheese, eggs, and vegetables...fruit and bread was something that "tastes good", but I rarely craved.

Once I quit trying to "eat right" and just followed my body's natural inclination to eat what it was telling me it NEEDED, I dropped a significant amount of weight, and haven't had a problem with it creeping back up.

Not every "diet" is appropriate for everyone, but eating low carb has certainly helped my mother.

-- Anonymous, July 28, 2002

Brooks and Brooke -- geez! one letter difference! (:

The Atkins diet scares me. Low fat diets scare me, too. Why don't we just eat a little bit of everything?

-- Anonymous, July 28, 2002

Meemur. . .

That's what sounds so good "on paper" - eating a little bit of everything. Not everyone's body works the same, and therein lies the problem.

Whenever I've "eaten right", ie., a "balanced diet", I invariably am never satisfied, and feel sluggish and tired all of the time, gain weight and my cholesterol goes up. This is because my body doesn't respond well to carbohydrates. I end up craving junk.

Once I learned that I FELT so much better overall, and my lab work documented that I *was* healthier by NOT eating a "well balanced" diet, I've stuck with what works for me.

When I tried to eat right, it was a constant struggle to not gain weight, or to lose. When I decided to go with what works for me, I don't have that problem. When I have put on a few pounds, it's because I've gone well over my limit with carbs...and that's usually because I've been out of town (eating out a lot) or relying too much on "convenience" stuff and not fixing real meals. I'll be 48 on my next birthday, am 5'8" and usually weigh around 140 lbs. That's a big improvement over my 'stats' when I "ate right". And I feel good, that's the most important thing! :-)

-- Anonymous, July 28, 2002

Hey, that's cool, Brooke! And you may find that when you're 56 or so, you may have to modify your diet again to meet the needs of your changing metabolism.

My rant was more against having to spend time figuring out what one can and can't eat, which is why I have a lot fewer guests over for non-holiday meals -- people are just getting too hard to cook for! On Thanksgiving, I roast a turkey, and peel about ten pounds of potatoes, and the guests bring whatever else they want to eat or drink. If they can't deal with the turkey or the potatoes, they bring their own dish. It works.

Now, I'm off to eat some oatmeal. (:

-- Anonymous, July 29, 2002

My grandmother lived a full life until she died suddenly at 96. She exercised regularly until she died, and she ate a normal balanced diet of meat, veggies, and dessert. But here's the odd part ...

Her third husband died thirty years ago or so. He was a doctor, and the info he gave her was years ahead of its time.

He said to avoid caffeine. He thought it stressed the circulatory system, and he said good sleep was better than trying to force the body/mind awake with a 'drug'.

He said to avoid carbonated beverages. He said they were exceptionally bad for the body and teeth. Recently there are reports in medical journals about how the body mistakes calcium carbonate for real calcium and stores it in the bones. Young athletes, particulary girls, who drink sodas are far more prone to stress fractures than they should be.

He said to eat veggies of all kinds, but limit starches and try to include a protein with every meal. The report at the beginning of this thread seems to point that direction too.

His take on dessert was that a small one after dinner only was enough.

He said to exercise, exercise, exercise. Walk where possible, take the stairs, and then do some calisthenics anyway. The bottom line on weight is burning excess calories, then and now.

Grandmother followed his advice faithfully every day. She enjoyed exceptionally good health until about two years before she died, which is unusual. She died of the same circulatory failure that killed several of her younger siblings and her siblings children -- it is probably genetic, but she managed to stave it off for a very long time.

-- Anonymous, July 29, 2002

The observation that a certain diet isn't a one-size-fits-all is the most pertinent here, I think. The diet recommended by the American Diabetic Association hasn't helped me at all. I keep reading that it's far more difficult for diabetics to lose weight than it is for non-diabetics--I wonder if that's because the ADA diet is at the root of the problem???

I'm eating a modified Atkins diet, that is, increasing the proteins and decreasing (not eliminating) the carbs. And I'm trying to make sure the carbs I eat are of the complex kind, i.e., no spuds or noodles. I seem to have lost two pounds in the last two weeks. Not much, I grant you, but I'll take a small loss over none.

I got some super strong joint med from the doc today. If it works, then I'll lose a little more weight through activity. As for the left knee, he says, yep, I've done some damage to it, he doesn't think it's a torn meniscus but I need to keep doing what I'm doing with it (babying it). And what I thought might be a wart was a benign growth so I now have a blister on my leg where the cryo- whatsit burned it off.

-- Anonymous, July 29, 2002