Heart Disease – Fat or Sugar? by Nicholas Gonzalez, M.D.
Vascular disease remains our number one killer, and I understand full well how confusing the subject can be, with warring doctors attacking each other’s dietary theories and the conventional medical world often indifferent to the benefits of scientific nutrition. One can go into a bookstore and pick off the shelf a book by Dr. Dean Ornish, insisting that extremely low fat, high carb diets are the only way to prevent and reverse heart disease, then on the shelf above you’ll find the Dr. Robert Atkins’ books that claim the high carb approach causes heart disease, and his high fat low carb diet alone solves the problem.
Confusion can seem to reign supreme, but in one way, Atkins and Ornish are both right, and both wrong. The low fat, Ornish, traditional American Heart Association diet does work for some, but not for others; recent studies confirm that some patients on an Atkins’ type high-fat diet will have, overall, improvement, not worsening, in their lipid profile.
The trouble begins because scientists and physicians like to simplify, and we’re not a simple organism. Our ancestors inhabited a variety of ecological niches and adapted over time to vastly different diets. The traditional Eskimo (or Inuet as they are now known) consumed an all meat, high fat diet, up to 80% fat, with no evidence of heart disease, even in the most elderly of Eskimo. Academic research teams studied the Eskimo intensely during the first half of the 20th century, when this group still followed its traditional way of life and found no heart disease. The well studied Masai in Africa traditionally lived on a diet of 70% fat, obtained largely from fresh raw cow’s milk, and were among the healthiest people on earth. Other groups, in equatorial areas, consumed more plant-based diets, our ancestors living in moderate climes a more varied, “balanced diet.” The truth is when one studies the anthropological literature in terms of dietary habits, our predecessors did thrive on a variety of diets, from all meat to largely plant based, and adopted to each well.
So those of us with a vegetarian ancestry will do quite well on a plant-based, high carb diet, as promoted by Pritikin and more recently Dr. Ornish. Those of us with carnivore genes will thrive on Atkins and do best on fatty red meat and few carbs. Those with a mixed ancestry and inbetween metabolism do best on a varied diet, fruits, vegetables, nuts seeds, grains, dairy, fish, poultry and red meat.
Remember, food is fuel, and our bodies are about the most sophisticated engine in the world. To run smoothly, we all require the proper diet for us, not for anyone else, and what works for me most likely won’t work for you. When we eat the wrong diet, often because of the dictatorial claims of some expert extolling the “one size fits all” hypothesis, we can end up in trouble, just the way our cars will end up in trouble if we try to run them on wood or steam instead of gas.
With the wrong fuel, nothing works the way it should, and disease, including heart disease and cancer, make inroads, with devastating results. To avoid degenerative disease, the basic rule, at least in my practice, is always that each of us has unique dietary needs, the product of our genetics, and one size doesn’t fit all, and what works for one may not work for the person standing next to them. In my office, I prescribe diets specifically according to each patient’s metabolic needs, not based on some preconceived notion. That’s a starting place, for good health.
People often ask me, “well that sounds great, but how do I know what diet I need to follow?” I have diagnostics tests that give me that information, and frankly, after nearly 30 years of practice, I can often tell what diet a patient needs within a few minutes of meeting just from experience. But even people who never make their way into my office can to a large extent come to some sensible conclusion – if you find yourself craving fruits, vegetables, carbs, and are repulsed by the thought of fatty red meat, the chances are – in general of course- that you need a plant based diet for optimal health. If you crave bacon, and fat, etc, but have little interest in fruits and carbs, I often find your body needs meat. My tests confirm all this in my practice, but food cravings often tell us a lot (yes, I know we all crave chocolate, but I hope you understand the general idea).
The concept that has long dominated Western medical thinking about heart disease and fat is simplistic, outdated, and based largely on misinterpretation of epidemiological studies from the 1950’s. Dr. Ancel Keys, who recently died at 100 years or so old, was a physiologist who in the early 1950’s became convinced that the rising rates of heart disease apparent in Western nations had to be the result of our high fat intake – ignoring the fact that our ancestors in the early 20th century ate considerable fat but suffered little heart disease. Dr. Keys studies heart disease rates and fat intake in 20 plus countries, then, to prove his hypothesis, concentrated on those six nations with high heart disease death rates and high fat intake. But what he didn’t tell anyone when he published his first papers is that he just ignored those countries with high fat intake and very low heart disease rates. Other researchers later on caught the omission, but by then the fat-heart disease hypothesis had taken hold in the medical community and the pharmaceutical industry.
Considerable new evidence now suggests that our enormous intake of white sugar – estimated to be on average 160 pounds per person per year in the US – may be far more the culprit in heart disease than fat. The late John Yudkin, a brilliant English scientist at the University of London, was one of the first conventional scientists to warn that Keys had misled us, fat wasn’t really a problem but rather our extraordinary intake of white sugar accounted for the rising heart disease rates. Yudkin published several extraordinary books in which he carefully, meticulously laid out his argument that the increase in sugar intake was catastrophic, and the true cause of the epidemic obesity, diabetes and heart disease rampaging through Western nations. With Dr. Yudkin, other scientists, like Dr. Gerald Reaven at Stanford, also proposed that refined carbs and not fat was the real culprit behind these serious health problems. Dr. Reaven has linked heart disease to what he calls “insulin resistance,” basically, our inability to handle sugars efficiently because of our over-indulgence in the white stuff. Many conventional investigators now accept the work of Reaven, and have, largely unknown to the public at large, begun to rethink the associations of dietary components such as fat and sugar, and heart disease. Both Dr. Yudkin and Dr. Reaven have also linked our excessive intake of white sugar to diabetes, now epidemic in the US, as well as heart disease.
Though it may not make intuitive sense that sugar, not fat, correlates with atherosclerosis and heart disease, high sugar intakes provoke high secretion of insulin, the hormone that drives blood sugar into the cells where it can be used for energy. Over time, however, with excess insulin circulating in the blood, the cells become resistant to the hormone, and the pancreas responds by secreting still more. Insulin is a powerful hormone that in excess can damage the arterial wall and then set the stage for inflammation and atherosclerosis. Furthermore, excess insulin seems to be associated with the conversion of sugar into storage fat, hence obesity, so common among “mature onset’ diabetics.” This sequence of events has become widely known in recent years as “Syndrome X,” or the metabolic syndrome – a constellation of high triglycerides, low HDL (good) cholesterol, high levels of “bad” LDL cholesterol, abdominal obesity, high blood sugar, insulin resistance and hypertension.
Therefore, whatever our metabolic inheritance and inherent dietary needs, none of us should be eating white sugar. That’s a general rule I believe holds true for everyone. Cut out the white sugar, and you lessen the chances for obesity, diabetes, atherosclerosis, hypertension and heart disease.
Try to determine which diet seems to suit you best – a high carb or low carb, or somewhere in between. Use the cleanest food available, use “good” fats from oils like olive oil, take fish oils – which lower triglycerides, increase HDL, lower blood pressure and help normalize insulin function. Avoid refined, processed foods as much as possible and instead eat natural, local and wholesome foods. This is how I advise my patients and how I have lived my own life for the past 40 years.
By Nicholas Gonzalez, MD