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Dr. Andrew Weil

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Fat or Carbs: Which Is Worse?

Posted: 07/02/10 09:00 AM ET

In my home state of Arizona, a restaurant named "Heart Attack Grill" does brisk business in Chandler, a Phoenix suburb. Waitresses in nurse-themed uniforms with miniskirts deliver single, double, triple and quadruple "bypass burgers" (featuring one, two, three and four hefty patties, respectively) dripping with cheese, to patrons who wear hospital gowns that double as bibs. The motto: "Taste Worth Dying For!"

Now, there is much for a medical doctor (as opposed to "Dr. Jon," the stethoscope-wearing, burger-flipping owner) to dislike in this establishment. If you visit, I implore you to steer clear of the white-flour buns, the sugary sodas and the piles of "flatliner fries" that accompany the burgers in the restaurant's signature bedpan plates. This is precisely the sort of processed-carbohydrate-intensive meal that, via this and other fast-food establishments, is propelling the epidemic of obesity and diabetes in America.

But the Grill's essential, in-your-face concept is that the saturated fat in beef clogs arteries, and hamburger meat is consequently among the most heart-damaging foods a human being can consume. As the Grill literature puts it, "The menu names imply coronary bypass surgery, and refer to the danger of developing atherosclerosis from the food's high proportion of saturated fat..." Aimed at a certain crowd, this is clever, edgy marketing. Some people enjoy flirting with death.

The problem? It's not true. The saturated fat lauded in this menu won't kill you. It may even be the safest element of the meal.

Saturated fat is made of fatty acid chains that cannot incorporate additional hydrogen atoms. It is often of animal origin, and is typically solid at room temperature. Its relative safety has been a theme in nutrition science for at least the last decade, but in my view, a significant exoneration took place in March of this year. An analysis that combined the results of 21 studies, published in The American Journal of Clinical Nutrition found that "saturated fat was not associated with an increased risk" of coronary heart disease, stroke or coronary vascular disease.

Although this was not a true study, it was a big analysis. It aggregated information from nearly 348,000 participants, most of whom were healthy at the start of the studies. They were surveyed about their dietary habits and followed for five to 23 years. In that time, 11,000 developed heart disease or had a stroke. Researcher Ronald M. Krauss of the Children's Hospital Oakland Research Center in California found that there was no difference in the risk of heart disease or stroke between people with the lowest and highest intakes of saturated fat.

This contradicts nutritional dogma we've heard repeated since 1970, when a physiologist named Ancel Keys published his "Seven Countries" study that showed animal fat consumption strongly predicted heart attack risk. His conclusions influenced US dietary guidelines for decades to come, but other researchers pointed out that if 21 other countries had been included in that study, the association that Keys observed would have been seen as extremely weak.

Meanwhile, in the years since, there has been increasing evidence that added sweeteners in foods may contribute to heart disease. Sweeteners appear to lower levels of HDL cholesterol (the higher your HDL, the better) and raise triglycerides (the lower the better). That's according to a study of more than 6,000 adults by Emory University and the Centers for Disease Control and Prevention, and published in April in The Journal of the American Medical Association.

People who received at least 25 percent of their daily calories from any type of sweetener had more than triple the normal risk of having low HDL levels than those who consumed less than five percent of their calories from sweeteners. Beyond that, those whose sugar intake made up 17.5 percent or more of daily calories were 20 to 30 percent more likely to have high triglycerides.

Science writer Gary Taubes has done more than anyone else to deconstruct the Keys mythos and replace it with a more sensible view, informed by better science. I recommend his book, Good Calories, Bad Calories: Challenging the Conventional Wisdom on Diet, Weight Control and Disease. It presents more than 600 pages of evidence that lead to these conclusions:

  1. Dietary fat, whether saturated or not, is not a cause of obesity, heart disease or any other chronic disease of civilization.
  2. The problem is the carbohydrates in the diet, their effect on insulin secretion, and thus the hormonal regulation of homeostasis -- the entire harmonic ensemble of the human body. The more easily digestible and refined the carbohydrates, the greater the effect on our health, weight and well-being.
  3. Sugars -- sucrose and high-fructose corn syrup specifically -- are particularly harmful, probably because the combination of fructose and glucose simultaneously elevates insulin levels while overloading the liver with carbohydrates.
  4. Through their direct effects on insulin and blood sugar, refined carbohydrates, starches and sugars are the dietary cause of coronary heart disease and diabetes. They are the most likely dietary causes of cancer, Alzheimer's disease and other chronic diseases of modern civilization.

My point here is not to promote meat consumption. I've written here previously about humanitarian and ecological reasons to avoid a meat-centric diet, especially if the meat comes from factory-farmed animals. Instead, my purpose is to emphasize that we would be much healthier as a nation if we stopped worrying so much about fats, and instead made a concerted effort to avoid processed, quick-digesting carbohydrates -- especially added sugars. The average American consumes almost 22 teaspoons of sugars that are added to foods each day. This obscene amount is the principal driver of the "diabesity" epidemic, sharply increases coronary risks and promises to make this generation of children the first in American history that will die sooner than their parents.

My Anti-Inflammatory Food Pyramid emphasizes whole or minimally processed foods -- especially vegetables -- with low glycemic loads. That means consuming these foods keeps blood sugar levels relatively stable, which in turn lowers both fat deposition and heart-disease risk. If you make a concerted effort to eat such foods and avoid sugar, you'll soon lose your taste for it. The natural sugars in fruits and vegetables will provide all the sweetness you desire.

While saturated fat appears to have no effect on heart health, eating too much can crowd out vitamins, minerals and fiber needed for optimal health. So I recommend sticking to a "saturated fat budget" which can be "spent" on an occasional steak (from organic, grass-fed, grass-finished cattle, see LocalHarvest for sources), some butter, or, as I do, high quality, natural cheese a few times a week.

Andrew Weil, M.D., invites you to join the conversation: become a fan on Facebook, follow him on Twitter, and check out his Daily Health Tips Blog. Dr. Weil is the founder and director of the Arizona Center for Integrative Medicine and the editorial director of www.DrWeil.com.

 
 
 

Follow Dr. Andrew Weil on Twitter: www.twitter.com/DrWeil

In my home state of Arizona, a restaurant named "Heart Attack Grill" does brisk business in Chandler, a Phoenix suburb. Waitresses in nurse-themed uniforms with miniskirts deliver single, double, trip...
In my home state of Arizona, a restaurant named "Heart Attack Grill" does brisk business in Chandler, a Phoenix suburb. Waitresses in nurse-themed uniforms with miniskirts deliver single, double, trip...
 
 
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HUFFPOST SUPER USER
drxcreatures
09:02 PM on 07/20/2010
I'd say the major influence, of that place is the tiny, nurse uniforms. Also, it amuses the guys to dress in costume. If the dangerous food, was an important factor, then why the sex appeal and costumes? I still understand, what you're saying.
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demockracy
The Library:Like taking your brain to the gym
03:33 PM on 07/14/2010
One more comment: It'd be fine with me if carnivores ate meat, used heroin, etc. as long as they paid their own way. Agricultural subsidies make the unhealthy feedlot meat possible because it such meat would vanish (along with a lot of fast food outlets) if feedlots couldn't feed subsidized corn to the animals.

According to Michael Pollan, about 40% of agricultural income now is subsidy ("Like laundering money for Cargill and ADM"... he quotes one farmer saying), and the bulk of that subsidy goes to insuring a calorie of high-fructose corn syrup is cheaper than a calorie of carrot.

So meat subsidies make our meat consumption artificially cheap. ... and I haven't even mentioned the subsidy we provide by letting feedlots consume 60% of the antibiotics Americans use. Could we possibly be doing more antibiotic research than necessary because feedlots continue to breed super drug-resistant germs?

Gosh, I wonder....
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demockracy
The Library:Like taking your brain to the gym
11:52 AM on 07/14/2010
Weill's citation of a dairy-sponsored study is debunked here:http://www.drmcdougall.com/misc/2010other/news/weil.htm

Also worth considering is Marcia Angell's conclusion (from:http://www.nybooks.com/articles/archives/2009/jan/15/drug-companies-doctorsa-story-of-corruption/?pagination=false). A relevant excerpt:

The problems I’ve discussed are not limited to psychiatry, although they reach their most florid form there. Similar conflicts of interest and biases exist in virtually every field of medicine, particularly those that rely heavily on drugs or devices. It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.

Yow!
08:40 PM on 08/24/2010
Please, read book that Weil recommends. Dr McDougall cant debunk more than 1 century of clinical research. Saturated fats are healthy. Low Fat paradigm is a myth. Dr McDougall article is ridiculous and full of lies, please!
06:03 PM on 07/13/2010
You still have an interesting and cautious conclusion to eating saturated fats. How can saturated fats crowd out vitamins and nutrients? They don't take the same pathways. Also, what about fat soluble vitamins like B12? If B12 can only be metabolized with fat how can eating too much saturated fats crowd it out. The science is starting to seep into our unfortunate and dogmatic training, but you aren't will to take the plunge.
01:07 PM on 07/12/2010
You've pretty much completely argued for the new Atkins diet except for taking the plunge. Maybe an in-depth look at the flawed Friedwald will finally convince you!
10:23 PM on 07/08/2010
Another topic that is addressed in Gary Taubes's book that has relevance to this discussion is the phenomonon exhibited by those who can't believe that saturated is not the dietary evil they have been lead to believe it is for oh so many years. This is explained by "cognitive dissonance" which is on display here in full force.
10:20 PM on 07/08/2010
Another feature of Gary Taubes's book that is relevance to the fascinating discussion this article has inspired: Taubes discusses the phenomonon that explains the passionate disbelief of those who just can't believe that saturated fat isn't the root of all health evils. It is called "cognitive dissonance." Very much on display here.
05:25 PM on 07/08/2010
Really the most important thing to understand is that research funded by the Dairy and Cattle industires always shows that their products are no problem while all the other research shows that dairy and beef are indeed very problematic.

Dr Krauss who did the research referred to here has spent his entire life aligned with the beef and dairy industries and he is an expert at designing studies to confuse and obsfucate reality. He is professional grade.

Likewise Weston Price which is nothing but a beef and dairy lobby group posing as nutrition experts.

So sad. Americans have little chance of ever figuring it out.

Please people do not believe the assertions of the beef and dairy industries. They are manipulative and deceptive and they know it.

You can read The China Study or The Engine 2 Diet for a look into what a healthy diet can actually do for you, and if you want to be disease free, please read these excellent books for starters.
12:42 AM on 07/09/2010
Your unfounded comments on the Weston A Price Foundation are uncalled for. I doubt that you have actually read Dr. Price's research. When I read his book after I retired as a dietitian, it changed my outlook entirely, and made much more sense. It is unfortunate that nutrition gets to be so controversial. Perhaps that is because people vary so in their response to fat and carb levels. Some of you may do well on a low fat diet, but others simply do not do well on that type of diet.

I'm glad that Dr. Weil has recognized that saturated fat does not deserve it's bad reputation, though I'm wondering if he's really read Taubes 'Good Calorie, Bad Calories', since he's still pushing lots of carbs in his 'Anti-inflammatory Pyramid.' And 'No thank you' on the soy!
07:25 PM on 07/10/2010
This is laughable. The China Study has proven to be a fraud: http://rawfoodsos.com/2010/07/07/the-china-study-fact-or-fallac/ . Also, check out The Vegetarian Myth by a former vegan (Lierre Keith).
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demockracy
The Library:Like taking your brain to the gym
11:27 AM on 07/14/2010
Laughable? The link you cite casts some doubt on some, but not all of Campbell's conclusions. It agrees with a few too.

Now all that author has to answer is http://www.drmcdougall.com‘s anecdotal evidence that moving from meat eating to vegan diet helps many people get off diabetes and heart medication. Watch the testimonial videos…

She’s also got to deal with all the global warming problems stemming from the way we raise livestock now (according to a recent U.N. report, raising livestock accounts for more global warming than all human transportation combined…see: http://www.newsreview.com/sacramento/content?oid=775299 for one footnote).

But if you want some bitter controversy, just try to talk about diet with people. Sure, my Dad had a stroke (and macular degeneration) when he went on the (high-meat) Adkins diet, and the macular degeneration halted as soon as he ended the diet. And sure, my arthritis went away when I stopped eating animal protein (I'm not a purist, but the results were pretty dramatic)... But those are just anecdotes.

I just read a group of string theory physicists suggests Einstein's conclusions about gravity (experimentally tested to be correct within 1 part in 2 billion) are flawed, so the debate that is science continues unabated.

Try cutting back on the meat yourself, and see what happens is what I say...
01:16 PM on 07/08/2010
I have posted a number of comments on this article, and I may just be missing them, but I find the posts that mention the book "The New Atkins for a New You" are not published. Any reason why?
10:43 AM on 07/07/2010
Weston A Price discovered in the early 1900's what humans need for optimal health. It hasn't changed.

It can be found in his book, Nutrition and Physical Degeneration, free online at http://journeytoforever.org/farm_library/price/pricetoc.html
08:35 AM on 07/07/2010
Okinawans eat more saturated fat than mainland Japanese. It is a myth that their longevity has anything to do with a low-fat, or vegetarian diet.

In this study, increased fat (probably from natural sources such as lard, pork, goat, and goat milk) correlated with increased longevity.

http://www.ncbi.nlm.nih.gov/pubmed/1407826

"Nutrient intakes in 94 Japanese centenarians investigated between 1972 and 1973 showed a higher proportion of animal protein to total proteins than in contemporary average Japanese. 2. High intakes of milk and fats and oils had favorable effects on 10-year (1976-1986) survivorship in 422 urban residents aged 69-71. The survivors revealed a longitudinal increase in intakes of animal foods such as eggs, milk, fish and meat over the 10 years. 3. Nutrient intakes were compared, based on 24-hour dietary records, between a sample from Okinawa Prefecture where life expectancies at birth and 65 were the longest in Japan, and a sample from Akita Prefecture where the life expectancies were much shorter. Intakes of Ca, Fe, vitamins A, B1, B2, C, and the proportion of energy from proteins and fats were significantly higher in the former than in the latter. Intakes of carbohydrates and NaCl were lower."
08:54 AM on 07/08/2010
Sorry, but that study does not look at the Okinawan diet. The traditional Okinawan diet is in fact about 72% veggies, fiber, and other carbs, and only 3% animal protein. There are countless studies detailing this. Okinawans also have, or had before western food started eroding their arteries, avg total cholesterol in the 120's, and hdl in the 20's.

"The Okinawan diet might well amaze Americans. The average citizen consumes at least seven servings of vegetables daily, and an equal number of grains (in the form of noodles, bread, and rice—many of them whole grains). Add to this two to four servings of fruit, plus tofu and other forms of soy, green tea, seaweed, and fish rich in omega-3s (three times weekly). Sweet potatoes, bean sprouts, onions, and green peppers are prominent in the diet. Vegetables, grains, and fruits make up 72% of the diet by weight. Soy and seaweed provide another 14%. Meat, poultry, and eggs account for just 3% of the diet, fish about 11%. The emphasis is on dark green vegetables rich in calcium (Okinawans, like other Japanese, don't eat much dairy). Okinawans do drink alcohol, but women usually stick to one drink a day, while men average twice that. Moderation is the key.
In short, the average Okinawan's diet is far richer in complex carbohydrates and plant-based foods, and lower in fat, than the average American's. (It's completely different from low-carbohydrate plans like the Atkins and Zone diets.) "
03:23 PM on 07/09/2010
Please do me the favor of providing citations to your statistics. Thank you.
03:29 PM on 07/09/2010
You said, "Sorry, but that study does not look at the Okinawan diet."

The study says, "a sample from Okinawa Prefecture."

Okinawa Prefecture is Okinawa.

The "proportion of energy from proteins and fats were significantly higher" in Okinawa.
04:05 PM on 07/06/2010
The problem with the study Dr. Weill quotes is that it looks only at a population that consumes relatively high amounts of fat. Differences between the high and low fat intake cohorts were relatively small. If you look at populations in the world, such as the one in this study of the long lived Tarahumara in Mexico http://www.ncbi.nlm.nih.gov/pubmed/1944471 and countless other studies there are strong indications that even small amounts of added fats cause lipid levels to rise along with associated diseases. The Tarahumara, as do the Okinawans, and other long-lived populations eat a diet of around 10% fat, small amounts of protein, and the rest unrefined carbs. They eat virtually no added fats such as oils of any kind. Despite having what our Doctors would call low hdl, they also have very low ldl, and live much longer healthier lives than the average Westerner from more developed countries. If you only look at people who eat western diets where even the low fat groups consume 30% fat, you will still see significant disease, as we do in the US, and the correlations with disease will not be apparent. It is sad that we ignore these healthy populations and instead choose to base our studies on populations that on the whole are quite sick.
05:57 PM on 07/06/2010
I'm 67 and have lost 85 pounds in the first 4.5 months on Atkins. My personal experience is that a low fat diet is hard if not impossible to maintain. The only part of my meal that keeps me full is the fat. Most people just can't stay on a low fat diet for any length of time for that reason. You're always hungry or in my case starving. Even though I was able to reduce my weight for a short period, going low fat, I was never able to keep it off. I was always very hungry. On Atkins I'm never even a little hungry. Anyone with a major weight problem will probably never succeed, long term, by either reducing calories or fat.
07:50 PM on 07/06/2010
I'm happy for you, but weight loss does not automatically equate with good health. As far as ease of sticking with a diet, I've found the exact opposite. I tried the zone and then atkins and was always starving. I agree with you that the typical American low fat diet of around 30% fat, and lots of refined carbs is a recipe for disaster. You'll never lose weight on it, and the need to control portions is unsustainable. When you fully remove all added fats in the form of oils, and stick with low calorie density food, you can eat huge quantities and still lose weight. A true low fat diet of around 10% fat all from intact sources, and an emphasis on low density foods like greens, allows you to never worry about quantities, and there is no reason you would ever be hungry on this diet as you simply eat whenever the urge hits. 4 years and counting and it's the easiest diet I've ever been on by far.
06:38 AM on 07/07/2010
FYI. Ten years ago I lost over 150 pounds following the Mcdougall Program for Maximum Weight Loss. This program is based on an extreme low-fat diet of WHOLE grains, potatoes and squashes (no flour products), fruits, vegetables and beans. I found the program very easy to stick with as I could eat HUGE volumes of food (including all the potatoes I wanted) and still lose weight. I have kept the weight off for 10 years and as a bonus, my chronic asthma cleared up the moment I removed all dairy from my diet. Today my diet remains 10% fat, 15% protein and 75% complex carbs. I actually weight a few pounds less than I did 10 years ago. My blood work is great (low cholesterol, good HDL:LDL ratio, low blood sugar, low blood pressure) and I can run 5Ks every weekend at age 54 without so much as a muscle twinge. All you really need to do is look at photos of John and Mary McDougall, Joel Fuhrman, Dean Ornish, Neal Barnard, etc. and compare them to Dr. Weil to see what diet really works.
HUFFPOST SUPER USER
Skepacabra
01:41 PM on 07/06/2010
"Dr. Weil is the founder and director of the Arizona Center for Integrative Medicine and the editorial director of www.DrWeil.com."

English translation: He's got no real medical expertise at all and is a voodoo practitioner.
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HUFFPOST SUPER USER
EAPrince
My other car is an Al'kesh
11:34 AM on 07/06/2010
What I find so frustrating about medical & nutritional articles is that a disturbing percentage of them will be dis-proven a year or so down the road. Therefore it's difficult to feel enough confidence in any of them to use the theories as any sort of guide. I feel like I can't really trust anything until it's withstood challenge for a century or so. How many times have reputable experts proclaimed something only to be proven completely wrong a few years or decades later. Makes it tough to make major life changes based on them.

Erik
http://eaprince.blogspot.com
01:43 PM on 07/06/2010
I think if you don't want to get bogged down in shifting rules about what to eat or not eat, a good guide is Michael Pollan's seven-word rule: "Eat food. Not too much. Mostly plants."

"Food" here meaning real, whole, unprocessed foods (whole grains, vegetables, but also fish and meat if that's your thing).

What's depressing about the nutrition debate is that people throw up their hands and just go on eating like crap, as if there's no middle ground between perfection and no rules at all. If everyone just followed the very basic guideline Pollan presents, we'd be many times more healthy than we are now, even if we weren't eating according to the nutrition study of the week.
02:12 PM on 07/06/2010
I'm also a fan of much that Michael Pollen has to say. And I think you've hit the nail on the head when you say that many people, and certainly many practitioners and diet gurus, think there's no middle ground between perfection and no rules at all. I couldn't agree more. Which is why my personal obesity treatment has been all about imperfection. Once you embrace that maybe you can achieve anything.

http://winningtheobesitybattle.wordpress.com/
11:06 AM on 07/06/2010
That actually makes a lot of sense when you think about it.

total-anonymity.es.tc