184. DIET DILEMMAS: Part 2 of 3 – by Robert Yoho MD (ret)

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Obesity is a true pandemic and one of the worst health disasters of our lifetime. The best treatment is unknown. Diets that are appropriate for thin people do not help the obese—advice like “eat a moderate diet” and “don’t eat between meals” is useless for them. Intermittent fasting and the Adkin’s-type diets work but require weeks to months of adjustment and need to be continued indefinitely.

Agriculture is a great gift that is saving the world. Farm productivity has exploded in the last 50 years. Worldwide famine deaths have crashed. The chart below is from Steven Pinker’s phenomenal Enlightenment Now (2018):

Hybrid crops and mechanization have driven up corn yields. There were 20 bushels per acre in 1980, but by 2019 this increased to 160. Other crops show similar trends.

Other advances have paralleled and were likely the result of abundant food. Global literacy was 55 percent in 1950 and rose by 5 percent a decade after that. It is now 86 percent. No rational person—outside of an oddball billionaire or two—still worries about the “population bomb.” The number of people in the world is projected to be 9.7 billion by 2064, but this will decline to 8.8 billion by 2100.

These trends debunk the media’s disaster-mongering. But against this optimistic tide, we have obesity. The daily calories food producers supplied to US citizens rose from 2900 per person in 1961 to 3700 today. Adult caloric requirements range from 2000 for sedentary women to about 3000 for a few active men. Big Food must either export the excess or force-fed it to us using marketing. In 1980, 15 percent of us were obese, but this number is now a third. Overweight people are another third (CDC).

Authorities have recommended low-fat diets for forty years. “Saturated” animal fats increase blood levels of “bad” cholesterol (LDL), which was assumed to be evidence that a high-fat diet caused heart disease. So in 1985, the Surgeon General’s Report on Nutrition and Health recommended dietary fat restriction. When the Food Pyramid came out in 1992, these guidelines went mainstream. Later versions were promoted in 2005 and 2011. It all sounded sensible—the government was trying to help. What could go wrong?

Ideas from 1992

Confusing changes in 2005

What does this mean? (2011)

Our obesity began about the same time as the Food Pyramids promoted low-fat and low animal fat diets. The for-profit food companies helped market these ideas, peddling cheap manufactured fats and processed sugar under “low fat and cholesterol” labels. The graph below shows that how this correlated with the development of our obesity.

Although the consensus is not complete, powerful evidence has now developed that we eat too little fat, and that saturated animal fats are safe. Even though meat consumption raises bad LDL cholesterol, it also raises the “good” one, HDL. Dozens of studies have proven that this diet does not cause heart disease. Others showed no association with death or stroke, either. Eating less fat also encourages carbohydrate consumption, which increases heart attack risks.

Cholesterol numbers are related to atherosclerosis, but changing them with drugs or diet is less beneficial than was originally thought. Statin medications, for example, lower the bad LDL cholesterol but do not decrease heart attack deaths enough to justify their side effects. They are only useful in a few narrow circumstances. (Butchered by “Healthcare,” 2020.)

Food manufacturers use high pressure and temperature to synthesize the hazardous “partially hydrogenated” oils and “trans fats” that have infested our foods for a century. The process transforms cheap vegetable oils into tasty solids with seductive textures and “mouth feel.” These are ideal for cooking because they tolerate high temperatures. When baked into cookies and sweets, they can sit for years in colorful packages on store shelves without getting rancid. They are commonly found in:

1) Margarine

2) Vegetable shortening (often used in restaurant deep fryers)

3) Many packaged snacks

4) Many commercial baked foods

5) Ready-to-use dough

6) Many fried foods

7) Coffee creamers, dairy and nondairy

The good news now is that these synthetically altered oils have been partially banned in many countries and some states. The US requires labels and is supposedly phasing them out.

The US Department of Agriculture (USDA) and the Food and Drug Agency (FDA) are our food regulators. They promoted the now obsolete idea that animal fat caused heart disease and recommended replacing butter with cheap, processed vegetable oil. These regulators are captives of big Food’s money and work closely with their puppet masters. For more, see Born With a Junk Food Deficiency (2012) by Martha Rosenberg.

The same author wrote, “Big corporations like Nestle are aggressively making people even fatter across the globe” in Salon (2017). She tells how food companies market soft drinks and other junk foods with complete disregard for health consequences. Duff Wilson’s article (Reuters, 2012) elaborated. Coke and other corporations hijacked the World Health Organization’s policies using donations.

Yearly US sugar intake increased from 120 pounds in 1970 to over 150 pounds currently (note the correlation with obesity on the graph above). This is 2/5th of a pound per day—700 calories, and a third of it came from soft drinks. This total is the highest in the world and a quarter higher than the next biggest users, Germany, Netherlands, Ireland, and Australia.

Dietary sugar is over a fourth of the calories we consume, and this doubles our risk of dying from heart disease. Sugar consumption causes diabetes, fatty liver, increased triglycerides—and obesity. People with type 2 diabetes, which is also caused by obesity, have twice the Alzheimer’s rates as those with normal glucose levels. Our sugar consumption is likely a bigger health hazard than even processed oils.

Corn is used to create most of the sugary additives in our packaged food. The US spends $5 billion a year subsidizing the crop’s production with federal farm supports. These began ninety years ago as a well-meaning attempt to protect farmers from bankruptcy by dampening fluctuations of crop yields and markets. In recent decades, the system mutated into a mandate to overproduce sugar. The land in the US now devoted to corn cultivation is an area 80 percent as large as California. A few monster agricultural producers pay lobbyists tens of millions of dollars a year to keep it all going.

Industry gave us a third damaging “food” class—artificial sugars. The first artificial sweetener, saccharin, was invented in the late 1800s and was in common use for most of the twentieth century. The FDA banned it in 1977 because it caused cancer in lab rats. Indigestible sugars like this, just like real sugar, stimulate the body to produce insulin, which drops blood sugar and makes people hungry. This promotes a vicious cycle of more junk food consumption and more obesity.

WHAT DIET WORKS?

The vegans are vocal, but their evidence is slender. Michael Greger, an influential herbivore, makes convincing, rational arguments favoring vegetable diets and against fat consumption at NutritionFacts.org. These diets make some people feel great, and Greger has a huge following. His latest book, How Not to Diet, includes over 5000 citations. Some are valid, but others back oddball ideas. For example, Greger reports that consuming chili peppers burns a few extra calories a day.

Greger is an “ethical vegan.” This means he believes animal lives matter and that we are murdering them. A plant-eating friend patiently clarified their doctrine for me. She said that meat-eating increases carbon usage and “all the scientists agree” that this will cause planetary apocalypse. If this is true, it renders all other considerations frivolous. My friend adds that she does not care if these eating habits damage her health.

Although I am not an expert on climate change, my study of healthcare corruption taught me that conclusions based on small numbers are suspect. Likewise, divining the future is a game that most experts lose. I also have suspicions that other scientists are as subject to muddy thinking and financial influences as the people in medicine. And after all the falsehoods the media has fed us recently, I have trouble believing anything they claim as fact. So I leave these considerations to the reader. For myself, I chose not to imagine that I am inside a dystopian science fiction novel.

The “China Study” (the China-Oxford-Cornell Study on Dietary, Lifestyle and Disease Mortality Characteristics in 65 Rural Chinese Counties) was a massive epidemiological investigation of nutrition conducted in the 1980s. It concluded that dining on animals was harmful to the heart and caused cancer. The Study advocated consuming carbohydrates and, like the other sources of its day, was critical of cholesterol. Vegetable advocates oft quote it.

But the science supporting the superiority of vegan or vegetarian diets is questionable, and many studies undermine it. A meta-analysis with 37,000 participants showed higher rates of bone fractures and osteoporosis (1) in vegans and vegetarians. They had lower bone density (2). Another study of 42 European countries showed that the populations that ate more fat and meats had lower heart disease and death rates than those with higher carbohydrate consumption (3). An interview study of 1300 Australians found “a vegetarian diet is associated with poorer health (higher incidences of cancer, allergies, and mental health disorders), a higher need for health care, and poorer quality of life” (4). Vegans have a higher overall death rate in both Australia (5) and Britain (6). Harriet Hall’s article in Science Based Medicine (2013), Death as a Foodborne Illness Curable by Veganism, is a skeptical, comprehensive review.

For readers of the print edition: references for this paragraph are at the end of the chapter.

We now eat anything, any time we want. We often consume food from the time we arise until we go to sleep at night—16 hours a day or more. Contrary to the “eat many small meals” myth, this is unhealthy.

Human studies support various types of fasting (Weightlifting is a Waste of Time, 2020, has many references). During the period that people do not eat, their bodies heal. They produce higher levels of testosterone and growth hormone. These have “anabolic” effects that stimulate muscle growth and fat loss.

Mice experiments studying food deprivation have been performed as far back as 1945. One recent study showed extended lifespans and improved health when the animals were fed over eight hours rather than the entire day. And the mice lost weight even though the number of calories they consumed was the same.

Humans with a modicum of restraint can simply eat for 8 hours in a row and then quit. For example, they might consume food only from 11 AM to 7 PM. This has been successful for many if they avoid junk food. Some do well if they simply cut out eating after six PM. The next step in this sort of restricted diet is to limit food to only two to four hours a day. This is popularly called “one meal a day” (OMAD). Some people require longer fasting periods of up to several days to produce significant weight loss.

These are complex issues and there is no consensus. John Ioannidis, the renowned Stanford study design expert, says the trials about the effects of diet on health are flawed. He believes these are too small, not randomized, or otherwise biased. Observational surveys such as the China Study show correlation and not causation. This means that the Chinese likely have less heart disease because of factors other than diet.

To illustrate how little we know, recall the last chapter’s discussion of Atkin’s-type diets. These consist solely of meat, eggs, cheese, and fat. According to mainstream medicine, Atkins was discredited (he died, after all). But patients who can tolerate this method long-term have declining cholesterols and can quit most or all of their diabetes and high blood pressure medications. Some eat hamburger patties from fast-food restaurants—and it works.

Conclusions:

✪ Animal fat consumption has no special damaging effects on the heart. Vegan diets have not been proven to be the healthiest, but they work well for many. Results vary and there are no rules about what is best for everyone.

✪ Eating all day promotes weight gain and is less healthy than only having one or a few meals.

✪ Americans are using huge quantities of sugar, and this a cause, possibly the primary reason, for our heart disease. It is hard to avoid—for example, there is a lot of sugar in dried cranberries and beef jerky. Exactly how much you can safely consume is unknown.

✪ Partially hydrogenated (trans) fats also cause heart disease. Try to avoid these completely. This stuff is leaving the marketplace, but watch out for it anyway. If “hydrogenated oil” is listed, it could contain the partially hydrogenated type.

✪ Monounsaturated fats such as olive, almond, coconut, and avocado oils are traditionally thought to be the healthiest choices for cooking. But they are no better than animal fats such as butter.

✪ Avoiding most restaurants is safest. They want our business more than they care about our health. Many serve the least expensive and most palatable fats along with all the sugar possible. They put salt in everything, which has effects on high blood pressure and stomach cancer.

✪ In grocery stores, you must ignore tens of thousands of alluring, colorful packages. Check the labels but always remain skeptical. Processed foods are unhealthy and hard to evaluate. Frozen, packaged, and canned foods usually contain undesirable ingredients.

✪ Buy the foods you understand and recognize. Meat, fruit, nuts, dairy, whole grains, and vegetables are the best choices.

A few references for the “Vegans are vocal” section:

1) Veganism, vegetarianism, bone mineral density, and fracture risk: a systematic review and meta-analysis. Isabel Iguacel et al. Nutrition Reviews, Volume 77, Issue 1, January 2019, Pages 1–18.

2) Veganism and osteoporosis: A review of the current literature. Annabelle M Smith MS RN OCN. International Journal of Nursing Practice Volume 12, Issue 5 p. 302-306.

3) Food consumption and the actual statistics of cardiovascular diseases: an epidemiological comparison of 42 European countries, Pavel Grasgruber, Martin Sebera, Eduard Hrazdira, Sylva Hrebickova & Jan Cacek (2016) Food & Nutrition Research, 60:1, DOI: 10.3402/fnr.v60.31694

4) Nutrition and Health – The Association between Eating Behavior and Various Health Parameters: A Matched Sample Study. Nathalie T. Burkert et al. Plos One. February 7, 2014 https://doi.org/10.1371/journal.pone.0088278

5) Vegetarian diet and all-cause mortality: Evidence from a large population-based Australian cohort – the 45 and Up Study. Seema Mihrshahi et al. Prev Med. . 2017 Apr;97:1-7. doi: 10.1016/j.ypmed.2016.12.044. Epub 2016 Dec 29.

6) Mortality in British vegetarians: results from the European Prospective Investigation into Cancer and Nutrition (EPIC-Oxford). Timothy J Key et al. The American Journal of Clinical Nutrition, Volume 89, Issue 5, May 2009, Pages 1613S–1619S, https://doi.org/10.3945/ajcn.2009.26736L

For more references about meat diets, the advantages of saturated fats, and other narratives countering the vegans: See Greg Denis’s Fit Rx HERE for many podcasts. I listen to most of his work.

NEW: I am now offering OFFICE HOURS. For the rest of December, they are 1 to 3 PM weekdays. You can call my call (626) 536-2000 to ask questions and share ideas. Since I am retired, I do not give medical advice. There is no charge.

About the comments: I know that I am an acquired taste. The friends I cherish are the ones who tell me when I am wrong so I can sharpen my messages against their critiques. The rule here is that you can be be as pushy as you want, but if I suspect you are insincere, I kick you off (this has happened only a few times). It is free speech–sharp sticks are tolerated. When you test my assumptions, we get a chance to learn from each other. As I was writing Butchered by “Healthcare,” I had a wonderful critic (thanks, M!) who treated me like a retarded stepson. She always got the message across, and after I got used to her, I was never offended.