Wednesday, November 22, 2006

Fatally Flawed Health & Risk Paradigms: Part 2

On Friday I wrapped up the first of two posts with:

The fatal flaw in the dietary recommendations is that it's not the fat - it's the excessive carbohydrate and sugar in our diets that is causing our chronic, degenerative diseases.

The fatal flaw is that we're specifically recommended a dietary pattern that increases the risk of higher than optimal blood sugars - advising the population that such a diet is going to reduce their risk, when it is increasing their risk!

I've written many times that the dietary recommendations to the population at large are flawed; I honestly cannot believe that it's intentional, but they're flawed nonetheless, and until we go back to the drawing board and tackle the flaws we're not going to see much change in the rates of obesity or alarming prevalance of diabetes.

How did we get so entrenched in the notion that dietary fat is the critically important macronutrient to modify in our diet to reduce risks?

For that history, an article by Gary Taubes, The Soft Science of Dietary Fat, is a good place to start.

Since its publication in 2003, two large, long-term studies have been published that found no increased risk in those who consumed more total fat and/or more saturated fat than recommended. The first was the Women's Health Initiative study, published earlier this year; the second was just published and examined the data from the Nurses' Health Study.The response to the findings in both were eye-opening. In various articles reporting the WHI findings, the mainstream experts contended the null findings were because dietary fat intake was not lowered enough to make a difference; the response to the Nurses' Health Study data contended that neither dietary pattern (low-carb or low-fat) was healthy.

For whatever reason, those deeply committed to the diet-heart theory cannot accept the idea the foundation of the theory is flawed, that perhaps it isn't dietary fat per se, but the total context of diet that really matters most.

In the last few years we have witnessed some very subtle massaging of the message about what we should eat though, although it is often stated as if this were what we've been told all along! The most obvious changes in the message are two things: dietary fat isn't all bad, in fact you can consume up to 35% of total calories from fat as long as you limit intake of saturated fat to less than 7% of calories and keep intake of trans-fat as low as possible (1% of total calories or less) and concentrate on vegetable sources of fat instead of animal sources; and we're now told about "good carbs" and "bad carbs" and told we should eat complex, low glycemic index carbohydrates and limit refined carbohydrates.

Evidence for these changes to the message? Scant, but that didn't stop anyone in the past from perpetuating the idea a low-fat, predominantly plant-based diet is optimal, so why would it now?How do we keep getting it wrong?

Let me say this - changing the message about quality of carbohydrate isn't an all bad thing, it's just incomplete.

That's because it really doesn't matter if you eat complex carbohydrate or refined carbohydrate when it comes to rising blood sugars and release of insulin. Oh, to be sure, complex carbohydrate works in the metabolism slower, but 100g of carbohydrate - complex or refined - is still 100g of carbohydrate to convert to blood glucose. As noted in previous posts, blood glucose, HbA1c, high insulin, high triglycerides and such are all correlated with poor health outcomes over the long-term.

Yet we continue to preach dietary advice that raises blood sugars, triglycerides and insulin, and over time increases percentage of HbA1c when an individual has become insulin resistant.

The flaw is our focus on dietary fat and the belief we require the majority of our energy from carbohydrates.

What to we keep dismissing as critical in the equation of good health and diet?

Protein, specifically complete protein that provides for our essential amino acid requirements.

Now many counter that protein stimulates insulin too, thus protein is a moot arguement in the dietary debate; besides we eat too much protein anyway!

But do we?

Data published from the NHANES surveys tell us something really interesting - over the last few decades our intake of protein has remained stable, level, not increased; and deficiency in critical nutrients is increasing amongst the population, with too many Americans failing to meet requirements for Vitamin E, C, A and D, selenium, magnesium and potassium.

A study published in May 2006 analyzed the newly updated food pyramids and found they were nutritionally deficient.

How does that happen? Everything these days is fortified or enriched to protect against nutrient deficiency!

It happens because the guidelines are not adequately designed to meet nutrient requirements, they're not focused on essential nutrients, but macronutrients as a percentage of calories; designed to promote reducing fat intake, choosing plant-based proteins over animal foods and convincing you to consume carbohydrates as the major source of your calories.

Did you know protein requirements are based on your weight, not a fixed gram intake that meets everyone's needs like other nutrients?

How often have you heard or read you only need 54g of protein each day? That's what it works out to if you do the math based on the Nutrition Facts panel on every packaged food and are targeting a 2,000-calorie per day diet. (2,000-calories, total fat 65g or 585-calories, total carbohydrate 300g or 1200-calories - leaves 215-calories from protein, or just 53.75g).

If we actually look at the recommendations from the Institutes of Medicine, we find protein intake is not based on a percentage of calories, but on an individuals body weight. So, 53.75g is adequate when you weigh 148-pounds. If you weigh more, you need more each day. The RDA is set at 0.8g/kg of body weight; the IOM acknowledges "much less than most people are typically consume," yet government agencies claim "Americans eat too much protein" in educational documents, including ones that target children.

What gives?

It comes back to the deeply entrenched fear of dietary fats - if you want to reduce fat intake, specifically saturated fat, you have to promote the idea to consume less meat, whole dairy, eggs and other animal foods. What happens, at the same time though, is that both the quality of protein intake and the absolute grams of intake is impacted - both are reduced.

But hey, you did reduce fat intake!

Even with the recent concession that it isn't necessarily total fat intake in the diet, the concurrent reduction in limits on satutated fat means an absolute need to reduce animal foods which come neatly packaged with saturated fats, monounsaturated fats and polyunsaturated fats. Oh, yeah, few highlight the fact that meat, like beef, has a majority of its fat calories from monounsaturated fat, not saturated fat.

Plant-based foods can be complete when consumed together to get over the limiting protein in one or the other, but they're simply not as rich with nutrients as animal-based proteins. Meats, eggs, liver, fish, whole dairy - excellent sources of not only complete protein (essential amino acids), but also zinc, selenium, vitamin B-12, potassium, magnesium and other B-vitamins.

When you choose plant-based proteins you're also eating more calories to consume the same amount of protein - that's because plant-based foods are not rich with protein, they're rich with carbohydrate.

So, what happens when you miss your daily requirement for essential amino acids (EAA)?

Well, if it's a day here or a day there, it probably won't have much impact on your health in the long-term. But, if it's the norm, not an occasional miss, it will have an effect since amino acids are the building blocks to repair and build throughout your body. As the Biology Project at University of Arizona highlights, "Failure to obtain enough of even 1 of the 10 essential amino acids, those that we cannot make, results in degradation of the body's proteins—muscle and so forth—to obtain the one amino acid that is needed. Unlike fat and starch, the human body does not store excess amino acids for later use—the amino acids must be in the food every day."

Our dietary guidelines specifically encourage a diet that is deficient in adequate protein and complete amino acids. Each time a study is released finding protein is critical in satiety, hunger regulation, ease of calorie restriction, and weight management - it is pooh-poohed and we're cautioned too much protein is bad for us and to stick with the recommendation to choose plant-based protein!

This leads us to consume excess carbohydrates, even when we think we're eating healthy. Excess is any level of intake above and beyond what we actually need each day.

Now answer this honestly - do you really think we need to consume 500g of carbohydrate each day for energy?

That's what we're currently averaging in the United States; who is consuming the 400g+ that I'm not?

The fatal flaw is in our fear of fat, we are not meeting our protein requirements, thus we keep eating in an attempt to do so, and the foods we're choosing are poor sources of complete protein and often littered with unnecessary calories from fats and oils.

The beauty of a carbohydrate restricted diet is this - isuch a diet forces you to make protein your focus each day and strictly limits the carbohydrate foods you do it to non-starchy vegetables, low sugar fruits, nuts, seeds - all rich sources of vitamins, minerals and trace elements; and when tolerated, whole grains and legumes as desired and within calories consumed.

A carbohydrate restricted diet is not making you eat more fat or more protein; in fact, odds are better than good that you'll be eating exactly the same amount of protein and fat as you did before you limited carbohydrate! What you're eliminating isn't vegetables, fruits, nuts or seeds - in fact, you'll most likely increase your intake of non-starchy vegetables; what you are eliminating is the nutrient-poor higher carbohydrate foods that provide too much carbohydrate and too little nutrition for those calories.

Many wring their hands trying to figure out what you replace carbohydrate calories with when you're on a carbohydrate restricted diet.

The answer is - you don't replace them with anything, you simply swap out the nutrient-poor carbohydrates for the nutrient-rich ones; and encourage non-starchy vegetables, nuts, seeds and low-sugar fruits as the foods to replace the potatoes, rice, beans, pasta and other high-carbohydrate foods.

A simple example is, the typical American lunch might include a cheeseburger on a bun, french fries with ketchup and a soda. A carbohydrate restricted lunch would instead be a cheeseburger sans the bun, a salad with ranch dressing and water or iced tea with a slice of lemon, no sugar.

Both will satisfy the appetite; both are providing identical complete protein; one is significantly less calories and less carbohydrate - all because a salad is swapped for the french fries and water/iced tea replaces the soda.

Now to be fair, we're told the standard American diet (burger, fries and a soda) is unhealthy; but we're also told the carbohydrate restricted meal is just as bad, if not worse for us.

If Americans aren't going to stop eating burgers, why are we not encouraging them to at least eat them in a way that provides a better nutritional profile with less calories?

It all comes back to the fatal flaw - the dietary fat.

Until we get past the fear of dietary fat, not much is going to change. :::sigh:::