Maligned but Benign: Readjusting Perspective on Dietary Fat September 5, 2014 Guest Blog, San Francisco Medicine, SFMS Member Dietary Fat, JumpstartMD, San Francisco Medicine, Sean Bourke 0 By: Sean Bourke, MD Note: This article was originally published in the July/August 2014 issue of San Francisco Medicine. When Dr. Conrad Lai and I started JumpstartMD in 2007, we approached the venture from the standpoint of two Stanford-trained emergency medicine physicians passionate about creating a medically supervised weight-loss and wellness program designed to provide a practical, sustainable, and preemptive response to the chronic and preventable medical conditions that account for 75 percent of our nation’s health care spending. At the time, our thinking echoed the conventional wisdom that we learned in medical school—namely, that a low-fat diet pays the most dividends for health. It’s advice that’s aligned for the last fifty years with that of the American Diabetes Association (ADA), American Heart Association (AHA), and the U.S. Department of Agriculture’s (USDA) Dietary Guidelines for Americans and Food Guide Pyramid. But the years of patient interactions; engaging with thought leaders, many from the Bay Area (Gary Taubes and Drs. Robert Lustig, Steve Phinney, Peter Attia, and Ronald Krauss); and my own reading, including Bay Area native Nina Teicholz’s recent book, The Big Fat Surprise, which informed many of the arguments in this article, have brought me to the conclusion that the vast majority of contemporary dietary recommendations that we’ve assumed to be correct are simply wrong, the product of weak data overinterpreted by well-intentioned experts eager to end the rising tide of diseases of modernity. A “Great Experiment” This “great experiment” in low-fat living begat an era unprecedented in human history. We now consume, and export, what can arguably be described as the world’s deadliest diet, the nutritional equivalent of cigarettes. The spark? Amid an ambient fat phobia and obsession—first with total cholesterol and later with low-density lipoproteins (LDL) as primary risk factors for cardiovascular disease—experts made low-fat dietary recommendations that, despite being premature and unfounded, became institutionalized and entrenched. These events triggered a reciprocal—and unanticipated—creep in the consumption of refined carbohydrates, which now make up the bulk of our modern diet in the face of increasing evidence that they are (1) precursors to the most atherogenic small LDL particles (particles that can predict a proclivity to develop diabetes even prior to a rise in insulin), (2) promoters of fat formation through the insulin response, (3) proinflammatory, and (4) associated with advanced glycation end (AGE)-products that may accelerate aging. I see the consequences of this misguided thinking in my practice regularly. Recently, a patient, expressing frustration at her poor weight loss during a diet recall, was surprised to learn that the 38 grams of carbohydrates in her daily Frappuccino—32 of which came from added sugar, which is 7 grams higher than the daily added sugar limits now recommended for women by AHA—were not “completely innocuous” from a weight-loss and health standpoint. And why wouldn’t our fellow Americans assume as much when every trip to the grocery store bombards them with messaging that this or that product is “low fat” or “low in cholesterol.” (Dietary cholesterol, meanwhile, was definitively shown as far back as the 1950s to have minimal—that is, a “trivial”—effect on serum cholesterol, yet you’d never know it given our low-fat, low-cholesterol emphasis.) Shouldn’t we own up to our contribution to the disastrous public health debacle that is our country today? The Food Guide Pyramid has had it all wrong since its formation, and yet it’s been propelled upward by misguided politics posing as science. The path forward? It starts with education and awareness. And that education and awareness begins with an understanding of the flimsy science behind the dietary recommendations that our friends, families, and patients accepted in good faith long before they’d been definitively proven. Unfortunately, support for that science still exists. Where It All Started In the second half of the twentieth century, no man and no study had a greater influence on our arguably misguided direction than Ancel Keys, the scientist who secured a seat in 1961 on the AHA’s Nutrition Committee and who led the famous “Seven Countries Study,” the first multicountry epidemiologic study ever undertaken. Further review of this pivotally influential study has shown that, aside from the fact that epidemiologic studies can identify associations but not causality, the scientific rigor and methodologies on which Keys based his conclusions were deeply flawed for a host of reasons: selection bias and lack of randomization, incomplete data, postwar dietary aberrations from the norm, flawed sampling 9such as one-third of the diet recall surveys for the population of Crete occurring during the Lenten period, when saturated fat intake was halved), and more. These flaws were buried while Keys's recommendations were pushed forward through his great force of will, savvy leveraging of media and other influencers, and marginalization of dissenting viewpoints. Click here to read Part 2 -- Maligned but Benign: Readjusting Perspective on Dietary Fat (Part 2) Sean Bourke, MD, is CEO of JumpstartMD, Northern California’s largest medical weight loss and wellness practice. A member of the SFMS and the American Society of Bariatric Physicians, Dr. Bourke is a graduate of Yale College and the University of Southern California School of Medicine. He recede his postgraduate training in emergency medicine at Stanford University. JumpstartMD has two offices in San Francisco and nine others encircling the greater Bay Area. Comments are closed.
