10-15% Factor: Diet
When people consider what they can do for their health, the mind goes quickly to diet — usually low-fat, vegetarian, organic with plenty of fresh fruits and vegetables. Sometimes supplements are included, but only after considerable reading of literature on all bookshelves these days.
There actually has been a lot of research on nutrition for many decades, but most of it nowadays is sponsored by food and drug industry resources — including their clones in the health food industry. Moreover, most modern books have a particular axe to grind and are selective in their descriptions of research. It can be a fulltime job just mastering valid information.
I began my practice 32 years ago primarily as a nutritionist, and I have tried to keep abreast reasonably well. Overall, my impression is that diet in America has little or no effect on chronic disease. I have never seen it be curative.
Malnutrition in the US is virtually nonexistent in urban, non-fanatic settings. I mean this even in terms of specific nutrient deficiencies. These are claimed all the time by people trying to sell products, but I do not see in practice specific diagnoses curable by specific supplements.
However, overconsumption and consequent toxicity are clearly huge issues. The most recent National Nutrition Survey of the NIH shows a rise in obesity from 48% in 1991 to 63% in 2001. A similar survey published a few months ago documented a rise in childhood obesity from 11% to 23% of the child population in just 20 years! These trends are alarming!
Over 50% of the middle-aged population of North America have Type II Diabetes, which is correlated with higher rates of heart disease, strokes, kidney failure, blindness, and peripheral neuropathy. This disease does have a hereditary component but is almost exclusively a lifestyle problem. Exercise and low carbohydrate diet are the solutions to Type II Diabetes.
The same National Nutrition Survey tracked fat and carbohydrate consumption as well. Between 1991 and 2001, Americans consumed half as much fat but twice the carbohydrates! Since fat holds down appetite, more calories were consumed, and the obesity rate went from 48% of the population to 63%!
Given all these facts, what are we to do? My recommendation is to first attend to sleep, then exercise, and lastly diet.
Sleep is necessary as a foundation because sleep deprivation interferes with energy, motivation, functioning, and exercising. Exercising is necessary to reduce insulin so that carbohydrates consumed are used for energy and not for fat production. Lastly, diet is important to reduce carbohydrates (especially refined sugar and flour).
The best book I have seen to explain diet is The Schwarzbein Principle, by Diana K. Schwarzbein. To my knowledge it is not found in bookstores. It is self-published and can be ordered through Amazon.com, BarnesandNoble.com, and others.
Dr. Schwarzbein is an endocrinologist, so she views patients from a very holistic perspective. She is an excellent clinician as I can see by her approach to actual cases. And her grasp of the scientific literature is solid.
Basically, she documents that fat is not the enemy once thought. As a matter of fact, avoiding fat in the diet can lead to relative collapse of adrenal hormones, which are primary governors of stress-response. Meanwhile, she recommends a low carbohydrate (not zero, just low) diet to hold down insulin. Her explanations of the physiciology of carbohydrates, insulin, Type II Diabetes, and obesity and heart disease are excellent.
For those who like formulae, Dr. Schwarzbein presents tables of 15 Gm portions of common carbohydrates. These then are taken in moderation throughout the day.
I will be writing another paper on cholesterol myths soon, but let me address this subject here briefly. Basically, cholesterol never was proven to be a cardiac risk. The evidence is convincing that it has no causal relationship at all. Moreover, the naive assumption that fats in the diet raise cholesterol has been repeatedly proven to be incorrect.
For this reason, Dr. Schwarzbein’s advocacy of fat in the diet should not be bothersome. Fat is necessary for stress hormones, and low fat diets cause higher death rates from coma (not heart disease) because of this fact.
In addition, I have proven over and over in practice that the most effective diet to lower cholesterol is by low carbohydrate diet. This is true because carbohydrates induce higher (and more resistant) insulin, which in turn converts carbohydrates to cholesterol and also directly deposits cholesterol into arteries and fat cells.
In summary, diet is a relatively minor factor in overall health. For those who remain focused on diet, The Schwarzbein Principle is the most complete answer. Eating fat as desired and holding down carbohydrates are the best strategies.