I’m loathe to become involved in a food fight, having watched John Belushi in the movie Animal House. However, a recent challenge to dietary “group-think” in a British newspaper caused me to question the experts. The current standard is the “Dietary Guidelines for Americans” published in 2015 by our Department of Health and Human Services (DHHS) and the Department of Agriculture (USDA). Though I am not a dietary expert or a contrarian by nature, the Brits have again raised my skepticism of government and experts.
I listen when experts tell us that dietary fat and sugar additives are bad. You can read their latest admonitions at www.health.gov/DietaryGuidelines. The experts say we should limit saturated fats and sugar additives to less than 10% of daily calories. Additionally, Americans should reduce their average salt ingestion by a third. The group-think is that saturated fats, especially the trans-fat portion, contribute to cholesterol deposition in arteries which causes strokes, heart attacks and peripheral artery disease. It is interesting that the current guideline omit the previous limits on dietary cholesterol. I realize these are “guidelines,” but too often people take these position statements as absolute truth and quit thinking. And the “herd” proscription to reduce “excessive” salt to combat hypertension is understandable, even though humans must have salt to live. My favorite Gospeler, Luke, quoted Jesus as saying, “Salt is good…” (Luke 14:34).
I am not a skeptic of “prudent” dietary prescriptions. It is obvious Americans eat too much and perhaps too many of the wrong things. If someone has hypertension or congestive heart failure I believe salt restriction is sensible. I’ve told many patients their indiscretions negate my therapeutic attempts to control their elevated blood pressure or to treat their failing heart muscle. On the other hand prescribing the same salt restrictions for an obese black man with hypertension and to an eighty-year -old slender white woman is absurd – no, wait, that was the topic of last week’s Focus essay! Common sense and science must work together to tailor the best treatment for each person and condition.
These days, much is ballyhooed about unsaturated trans-fats, and we hear little about its cousin cis-fats. These are biochemical descriptors of fat molecules or fatty-acids. Perhaps New York City’s former mayor, Michael Bloomberg, is an expert on saturated fats and additive sugars without “essential nutrients.” His prohibitions of large sodas and trans-fat cooking in NYC are well known and perhaps well intended, though I believe primarily politically driven.
Humans require dietary protein, carbohydrates and fats for health. Trans-fats are thought to raise levels of the cholesterol carrier protein, LDL, and lower levels of HDL, the so-called “good cholesterol” carrying protein. As a result experts recommend eating fewer saturated fats. Saturated fats have the “maximum number of hydrogen [atoms] bonded” to the fat molecule’s carbon chain. Vegetable oils have less saturation than animal fats/oil, and olive oil, for example, has the least saturation. In nature the cis configuration of unsaturated fatty acids is most common. However, “In food preparation cis-unsaturated fats such as vegetable oils are hydrogenated to trans-fats” thus raising their melting temperature, increasing the shelf life and making them solid at room temperature.
I no longer read traditional newspapers, except The Knoxville Focus, of course! However, I read local, national and international papers and news services daily online. I especially like the perspectives of the BBC and an English news blog called MailOnLine. The British press is far less docile than our politically correct and largely “progressive” American press. A recent contrarian article appearing in a British newspaper has apparently angered the health establishment in England. The chairman of the National Obesity Forum said, “Guidelines from on high suggesting high-carb, low-fat diets [as a] panacea are deeply flawed.” The proof is that obesity and type two diabetes in England and America continue to spiral upwards since experts recommended a diet low in fats with higher carbohydrate substitution.
This argument is challenging, but may be too simplistic. I suspect the answer is more related to the fact that westerners live in abundance and inactivity. Some years ago I wrote an essay describing the “thrifty gene hypothesis” first posited by James V. Neel in 1962. Neel wondered why diabetes is so common in humans yet so detrimental. He conjured that hunter-gatherers who possessed genes to maximize calorie absorption and storage after a kill would have an evolutionary survival advantage. Some have posited that insulin evolved to allow maximum absorption of calories and storage as fats during times of plenty, and parsimoniously release this stored energy during lean periods.
Today, we know that obesity often leads to type two diabetes. The basic mechanism is due to insulin resistance at the cellular and subcellular level. Interestingly, the Romans made a similar observation two thousand years ago. They treated obese diabetes with diet. You realize that we get the name diabetes mellitus from the Romans, and is translated as “sweet urine.” They didn’t have blood sugar testing technology! Suffice it to say, if you put people with ancient hunter-gatherer genes in a bus and transport them to a smorgasbord feed-trough, you get obesity and diabetes.
Years ago when giving medical lectures, I often quipped that “An expert is someone fifty miles from home who has projection slides or a powerpoint presentation.” While hubris (arrogant pride) is dangerous, where “Pride goeth before the fall,” so is slavish devotion to expert opinions who demand we surrender our observations, our reason and common sense. Need I mention AlGorian global warming…ah, climate change? I remember being told we should eat three meals a day. This might be true if we were plowing the lower forty acres this afternoon, but would be absurd if our job entailed staring at a computer monitor. Eat sensibly when you’re hungry rather than when the lunch bells rings.
The ancient Greek playwright, Aeschylus once advised that we “Learn to practice moderation.” Many similar aphorisms appear in the Bible and in other diverse wisdom writings. The answer to obesity and associated type two diabetes is not to label them a disability. The answer is to eat less, exercise more and don’t get hung up on arcane dietary details. It ain’t rocket science!