Who knew that when I woke up this morning it was going to be such a big day for health and wellness. It’s always a good sign when there’s a health article in the mainstream newspaper, but to have two very prominent articles on the same day is extremely unique and a rare treat for a wellness junkie like myself. There was an article in the San Diego Union Tribune today about the debate over the health risks of dietary saturated fat. There was also an article in the Wall Street Journal about the benefits of exercise beyond simple weight-loss. Neither of these are brand-new concepts, but anytime these debates spillover into the mainstream media, I see it as a win for everyone. It starts the conversation out in public, and forces us as a medical community to defend our practices with good science and convincing evidence.
The Union Tribune article focused on the recent study published in Open Heart (part of the British Medical Journal’s publications) that called into question the “shaky evidence” supposedly proving a direct connection between the increase in dietary saturated fat and an increased risk of developing coronary artery disease. The United States government adopted an official recommendation that everyone should follow a low-saturated fat diet to reduce the risk of heart disease back in 1977. However the article in Open Heart reviewed the evidence prior to that time and showed that there was not any solid scientific evidence to support this recommendation. In fact, there was not a single randomized controlled trial to test the hypothesis. Of the studies that were done, they authors pointed to six studies that found reducing saturated fat did not decrease the risk of heart disease.
How could this be? Well, if you are outraged, you have good reason. In retrospect, it is always amazing how something without any good scientific evidence can take on a life of its own and be regarded as absolute truth. By this argument coming to light in the mainstream media, the medical community and the public as a whole should come together to be more vigilant about what we develop as dogma. We need to demand good science and randomized controlled trials prior to adopting widespread recommendations and labeling something as scientific truth (see the supposed “link” between vaccines and autism for another example).
However, I also see a potential negative impact from this story coming to light. There may be a resulting backlash against the low saturated fat movement with some people using this as an excuse to increase their intake of trans fats and saturated fats. This in turn leads to eating more processed foods, sweets, and other calorie dense foods that have multiple proven potential harmful effects ranging from obesity to diabetes to inflammation. Our society as a whole does not need any more excuses to not pay attention to what we eat. On the contrary, I hope that this article forces us to become even more aware of what we eat, how we eat and why we eat. Therefore, even though this article calls into question the data supporting a low saturated fat diet, it provides a great opportunity for us to explore the excellent evidence that does exist for dietary interventions that can reduce the risk of heart disease and cardiovascular complications.
A 2013 article published in the New England Journal of Medicine showed that a Mediterranean diet was successful in reducing cardiovascular complications such as heart attacks, strokes or cardiovascular deaths over a five-year period. This diet focused on whole grains, olive oil, tree nuts, fresh fruit, fresh vegetables, fish, legumes, beans, white meat and moderate wine consumption. The Mediterranean diet discouraged soda, bakery goods, sweets, spread fats, red meats, processed meats and processed food in general. Notice there was no specific mention of saturated fat or cholesterol avoidance. However, by focusing on real foods and fresh foods in those specific categories, there was a natural modest reduction in saturated fat, and the dietary intervention was successful at reducing heart attacks, strokes and death.
The Mediterranean diet had very powerful results considering there was no change in medications, exercise, or other lifestyle interventions. However, was it the reduction in saturated fat that led to the beneficial effects? Or was it the positive effects of the components of the diet such as omega-3 fatty acids? That question remains unanswered. However we do know for certain that the diet works.
Another study that proved the beneficial impact of diet was published in 1990 in the Lancet, and again in 1998 in JAMA. Dean Ornish studied the impact of a very low fat vegetarian diet combined with lifestyle changes such as moderate cardiovascular exercise, stress reduction, smoking cessation, and psychosocial support. He showed that his program could not only prevent the progression of heart disease, it could even reverse pre-existing coronary artery disease.
Whereas the data leading up to the U.S. government’s recommendation on avoiding saturated fat was clearly faulty, it is important to note that there is plenty of good scientific data that demonstrates the benefits of food we should be focusing on. This includes a Mediterranean-style diet or a vegetarian diet. Both of these diets focus on real, whole foods and avoid processed foods. So whether or not you choose to liberalize your intake of saturated fat, as long as you adhere to the tenants of one of these diets, you are following a proven method to improving your health and reducing your risk cardiovascular disease.
It is important to point out that the focus of this (rather long) blog post so far has been on health outcomes. Not weight loss. I will say that again. The studies did not care about weight loss. They looked instead at health, cardiovascular disease and its complications. Any diet that is commercially available can aid in weight loss over a short period of time. However the outcome that is most pertinent to me and the clients that I see relates more to health, longevity, and reducing disease rather than weight-loss as the primary focus.
That brings up the article that was in the Wall Street Journal, which discussed the benefits of exercise without weight loss. The article focused on a recent study in the American Journal of Clinical Nutrition that showed how exercise, as little as 20 minutes of walking daily, improves health, reduces the risk of death and reduces medical complications irrespective of weight loss.
As with the nutrition article, this is not a new concept. However we should all welcome the discussion into our public forum. The study correlates well with a study in 2012 in the Journal of American College of Cardiology (JACC) that showed there was a significant health risk to being overweight, but that this risk could be attenuated by increasing one’s fitness level even in the absence of weight loss. In 2014, also in JACC, an article addressed the health risks of normal weight people with poor fitness levels, and showed how their risks were actually higher than people who were overweight but had a good fitness levels. The conclusion of these studies? Fitness can temper the negative effects of being overweight.
So how do we sum all this up? We have to focus on living well, feeling good, and making good positive health choices, and not being as concerned about any metric of weight or any one component of our diet. We have to focus on what we know are good, whole and beneficial foods, and limit the processed items that barely qualify as “real food.” We have to commit to a healthy, purposeful and physically active lifestyle. Being healthy needs to become who we are and not a job that we have to do.
At Boundless health we work with clients every day to achieve exactly this outlook on life to help you live a healthier, more energetic, disease-free life. Please contact us today to see how we can start this journey together.
Bret Scher, MD, FACC
Titleist Level 1 Certified
NASM Certified Personal Trainer
|Mediterranean Diet:1-Base every meal on fruits, vegetables, whole grains, nuts, beans and legumes. Olive oil is the main source of dietary fat.2- Fish and seafood are additional main sources of protein|
3- Yogurt, cheese, poultry and eggs are eaten in moderate portions a few times per week
4- Meats are a “sometimes” food in small portions
5- Sweets, baked goods and processed foods are avoided
6- Wine is allowed in moderation with meals
|Exercise and Weight1-Being overweight has significant health risks2-Improving one’s fitness level can dramatically reduce the risks of being overweight even in the absence of weight loss|
3- Being “normal” weight with a poor fitness level is a greater health risk than being overweight with a good fitness level
4- As little as 20minutes of brisk walking daily can reduce the risk of death and medical complications