Big fat buttery silence: Irving T. Gilson

The June 23 cover of Time magazine displays an artistic swirl of butter captioned, “Scientists labeled fat the enemy. Why they were wrong.”

In the accompanying article, Bryan Walsh lends support to the arguments contained in the recent best-seller “Big Fat Surprise” by Nina Teicholz. In her carefully researched and highly readable book, she details major flaws in the evidence presented by those who have been advocating a low-fat diet to reduce heart disease and obesity for the past 30 years.

She also reports that as Americans jumped on the low-fat bandwagon, they increased their intake of carbohydrates — an unintended consequence resulting in our present epidemics of obesity and diabetes. In addition, it should be noted that going “low-fat” during the past three decades has had no effect on the incidence of cardiovascular disease.

Supported by overwhelming research, but to the chagrin of the pharmaceutical and food manufacturers, we are now in the midst of a low-carbohydrate revolution. Analogous to Thomas Paine’s “Common Sense,” which helped inspire the American Revolution, its manifesto was a New York Times Magazine article by Gary Taubes in 2002 headlined, “What If It’s All Been a Big Fat Lie?”

Since then, a continuing flow of clinical research studies have consistently confirmed the benefits of low-carbohydrate diets with respect to weight loss and cardiac risk factors, while negating the demonization of saturated fat. If you are obese, a low-carb diet can help you lose. If you’re diabetic, it may reduce your reliance on expensive medication. If you’re hypertensive, it can lower your blood pressure. If you are at risk for a coronary, it can raise your good cholesterol (HDL) and significantly lower your triglycerides. In short, it can reduce one’s risk of a heart attack or stroke. Bottom line: the demon is the sugar — not the fat!

To describe the reaction of the nutrition and medical communities to the low carbohydrate paradigm as cool would be a gross understatement. Where there should be at least meaningful dialogue, there is silence. This is not without significance or implication, since patients being discharged from hospitals following a heart attack may still be instructed to follow a “cardiac diet.” This might be the same low fat diet that may well have contributed to their hospitalization to begin with.

While deafening, the silence is understandable. Low-cholesterol, low-saturated fat recommendations by dietitians invariably conform to nutritional guidelines prepared by expert panels of respected organizations such as the American Heart, Diabetes, and Dietetic Associations. In our litigious society and possibly enmeshed in the intellectually stifling atmosphere of some organizations, staying within the guidelines — their appropriateness notwithstanding — is comfortable and safe. There is an old medical school adage: Be neither the first to initiate a new treatment, nor the last.

Physicians may be less constrained by dietary guidelines. But having been under constant siege by drug companies promoting their products (e.g., statin drugs), many doctors — and, indeed, many patients — have become pharmaceutically oriented and nutritionally apathetic. After all, it’s only food ... .

Then there’s just plain human nature and its inherent tendency to seek permanence and consistency in our beliefs and perceptions. For example, if one has been teaching that high-fat diets can lead to heart attacks for 30 years but then finds that this may not be true, or that, indeed, more fat and less carbohydrate in the diet may be beneficial to one’s health and longevity, feelings of discomfort can result. Subconscious mechanisms may then keep enduring convictions firmly in place for extended periods of time, despite evidence to the contrary.

In Rhode Island, we have an opportunity to play a leadership role in establishing evidence-based guidelines that encompass a new dietary paradigm, one that can bring major benefits to those afflicted with obesity, diabetes or cardiovascular disease. In the Rhode Island branches of the Heart, Diabetes and Dietetic Associations, and within our hospitals and the Warren Alpert School of Medicine at Brown University, let there be honest debate and careful review of the evidence in order to accomplish this goal.

Worth noting: In 2013, Sweden became the first Western nation to recommend a lower-carbohydrate, higher-fat diet as part of an effort to reduce the national prevalence of obesity and diabetes and to improve markers of heart health. This bold move was based on a literature review of 16,000 studies on diet and obesity in a report published by the Swedish Council on Health Technology Assessment.

Let’s break the silence.

http://www.providencejournal.com/

Graham