Diet and Health

WHAT IS THE BEST DIET???

We are early into the new year. Among the most common New Year resolutions are those to lose weight and/or follow a healthier diet.
Indeed, it is my belief that the two most important factors that influence
our health are stress and diet. Hippocrates, the father of modern
medicine, famously said “Let food be your medicine, and medicine be your
food.”
It is of great interest and concern that even though Americans are among the most affluent societies and we spend more on health care than any other nation, the health of the American people is rather poor compared to other developed countries. A recent report by the Institute of Medicine and National Research Council titled “U.S. Health in International Perspective: Shorter Lives, Poorer Health” concluded “Although life expectancy and survival rates in the United States have improved dramatically over the past century, Americans live shorter lives and experience more injuries and illnesses than people in other high-income countries. The U.S. health disadvantage cannot be attributed solely to the adverse health status of racial or ethnic minorities or poor people: even highly advantaged
Americans are in worse health than their counterparts in other, “peer” countries.”
(see
http://www.nytimes.com/2013/01/10/health/americans-under-50-fare-poorly-on-health-measures-new-report-says.html?_r=3
and
http://sites.nationalacademies.org/DBASSE/CPOP/DBASSE_080393#deaths-from-all-causes )

This report examines many of the factors that contribute to this imbalance and concludes that high caloric intake and “high intake of saturated fats and inadequate intake of fresh produce and other healthy foods could explain a variety of diet-related non-communicable diseases that are more prevalent in the United States than in comparable countries.”
(http://www.nap.edu/openbook.php?record_id=13497&page=146)

There is a great deal of debate about which diet is the healthiest, but there should be no debate that the Standard American Diet (appropriately abbreviated SAD) is one of the main causes of our epidemics of obesity, cardiovascular disease, cancer, autoimmune disease and other chronic degenerative diseases. Some frightening facts about the Standard American Diet: Only 7% of calories consumed by Americans are from fruits and vegetables. Half of the vegetables are potatoes and half of those are chips and fries. 23% of the calories consumed by Americans are from white sugar and about 20% from white flour. (see http://alaskaveg.org/SpookyFacts/SpookyFacts.pdf ).

So one of the most important questions we can ask is “What is the best diet?”

I don’t think there is one single answer to this extremely important question. There is great variety in the human genome and the old saying “one man’s meat is another man’s poison” is quite true. But there are general principles that are reasonable for almost everyone to follow, which I will arrive at as this essay progresses.

PRINCIPLE #1:
There is no single “best diet” for everyone! Treat any claim that everyone should follow a specific diet with skepticism.

Obviously I am not the only person who has asked this question. There are
a huge number of diets out there and experts who advocate them. One of the biggest divides in recent decades has been the split between Low-Fat diet advocates (including Nathanial Pritikin, Dean Ornish and John McDougall) and the Low-Carb diet advocates (like Robert Atkins and more recently Gary Taubes). Other popular diets in recent times are the Paleo Diet, Vegetarian and Vegan Diets, Raw Food Diets, the Fat Flush Diet, the Body Ecology Diet, Alkalinizing Diets etc.
There are many people who have thrived on each of these diets. So how does someone looking to improve his or her health determine which diet is best for them? I will now examine the pros and cons of some of the main divides in the world of dietary debate:

LOW FAT VS. LOW CARB

In his book Good Calories, Bad Calories
(http://www.amazon.com/Good-Calories-Bad-Controversial-Science/dp/1400033462/ref=sr_1_1?s=books&ie=UTF8&qid=1357207041&sr=1-1&keywords=good+calories+bad+calories),
science writer Gary Taubes reviews the research on low-carb vs. low-fat
diets and makes an excellent case for the low carb school. His main point
is that carbohydrates induce the production of insulin and excess insulin
alters metabolism to cause obesity. A column by Mr. Taubes titled “What
Really Makes Us Fat” from the 7/1/12 New York Times is here:
http://www.nytimes.com/2012/07/01/opinion/sunday/what-really-makes-us-fat.html?_r=0
It is hard to dispute the evidence he cites that simple carbohydrates are
a primary cause of the epidemic of obesity. The average American gets
about 23% of calories from white flour and 20% of calories from refined
sugars and drinks over 600 12 oz. servings of soda each year! Undoubtedly this is a recipe for disaster, one that is evidenced by the epidemics of obesity and diabetes.
Another Low Carb crusader is Dr. Robert Lustig, author of the recent book
“Fat Chance”- see
http://www.sfgate.com/default/article/Dr-Robert-Lustig-crusades-against-sugar-4160268.php.
Dr. Lustig’s lecture on the hazards of sugar on youtube has been (at least
partially) viewed over 3 million times- it can be found at

But does this mean that the Low Fat diets (which tend to be relatively
high in carbs) are dangerous? A recent meta-analysis of 33 studies found
that low-fat diets help people to lose modest amounts of weight and lowers cholesterol and high blood pressure:
http://www.huffingtonpost.com/2012/12/07/low-fat-lose-weight-foods-diet-cholesterol_n_2253725.html
Dr. Dean Ornish found that an extremely low-fat diet, combined with
exercise and stress reduction, can dramatically reverse cardiovascular
disease. Here is Dr. John McDougall’s youtube presentation titled The Diet
Wars: http://www.youtube.com/watch?v=srkd-irmrC0

talking about this clash between low-fat & low-carb diet advocates. Here is an interesting and passionate article in which Dr. McDougall criticizes the “low-carb”
school, particularly the Paleo Diet (more about that later):
http://www.drmcdougall.com/misc/2012nl/jun/paleo2.htm
A very important consideration in this debate is that not all fats and
carbs are created equal. It is now widely understood that there are not
only bad fats (trans fatty acids, large chain saturated fats) but “good
fats” (essential omega 3 and 6 fatty acids). Likewise, there are good
carbs (complex carbohydrates, glyconutrients) and bad carbs (simple
sugars). The carbs found in white flour are very different than the carbs
found in dark leafy greens.
Another useful concept in this debate is that of the glycemic index- how
much a given food raises one’s blood sugar:
http://www.mendosa.com/gilists.htm. Thus, avoiding high glycemic foods is especially wise. However, if you eat a food with a glycemic index of 80
but at the same time have an equal amount of a food with a glycemic index of 10, the average for the meal is 45; it is advised to eat foods with a
glycemic index below 50. Thus, if one eats some simple starches with a
high glycemic index but at the same time has a high protein food with low
glycemic index it will be balanced and our body will not be affected
nearly as badly.
A new concept that looks to be even more valuable than the glycemic index is Carbohydrate Density. A concise discussion of this by Dr. Andrew Weil is at
http://www.huffingtonpost.com/andrew-weil-md/carbohydrates-weight-loss_b_1937312.html
and
http://www.drweil.com/drw/u/ART03415/Using-The-Carbohydrate-Density-Index.html
Bottom line: There is good evidence for health benefits of both a low-carb diet and a low-fat diet. What does not work is the high-carb/high-fat diet that is currently all-too-common. If someone is significantly overweight and/or diabetic a low-carb diet may be wise for weight loss, but one can also lose weight on a plant-based low-fat diet. If one has heart disease a low-fat diet may be the best choice. While a low-carb diet may be useful for weight loss, it may not be best for our overall health due to lack of phytonutrients from fruits and vegetables. Trying to sum this up:

PRINCIPLE #2:
Minimize simple sugars and starches, especially those with high
carbohydrate density/glycemic index.
When you do have these, have them in moderation with or after a balanced meal, never by themselves.
When eating fats emphasize “healthy fats.” Avoid hydrogenated oils/fried
foods and long-chain saturated fats.

WHAT ABOUT THE BLOOD TYPE DIET OR METABOLIC TYPING?
It is likely that some people will do better on low carb while others will
do better on low fat, based on their genetics. One popular subset of
dietary advice involves metabolic typing to help one determine which diet
is best. This concept was introduced by William Kelley DDS, a dentist who
pioneered proteolytic enzyme therapy for cancer. William Wolcott and
Harold Kristal DDS developed these concepts further, dividing people into
metabolic types based on whether their Autonomic Nervous System is
Sympathetic Type, Parasympathetic Type or Balanced and whether they are a Fast Oxidixer, Slow Oxidizer or Mixed Oxidizer, leading to 9 different
metabolic types (see https://www.metabolictypingonline.com/WhatItIs.aspx).
The concept is that each of these types needs an individualized diet and
supplement program. Popular health guru Joseph Mercola DO promotes a
simplified version of metabolic typing
( http://articles.mercola.com/sites/articles/archive/2003/02/26/metabolic-typing-part-three.aspx )
Another concept that has been popular in recent years is the Blood Type
Diet advocated by Peter D’Adamo ND in his book Eat Right For Your Type
(see http://www.dadamo.com/program_welcome2.htm )
Dr. D’Adamo feels that your blood type determines what diet is best for
you. Many practitioners recommend these diets and many people who have tried them feel they help. But what does the science say?
I have always been skeptical of the Blood Type diet- our bodies have
thousands of genes that can affect our metabolism and determine which diet is best for us; to base our entire diet on just one gene (the one that
determines our blood type) seems far too simplistic. Dr. D’Adamo claims
that 71-78% of those who followed his diet for a month or more and
responded to a questionnaire reported benefits. This is impressive, but
many of these people avoided specific foods like gluten and dairy that are
common allergens. Their improvement may have more to do with them avoiding common allergens that have nothing to do with their blood type. There is surprisingly little science to support the Blood Type diet. The best of several critiques I have read was written by a doctor I have tremendous
respect for, Michael Klaper MD:
http://www.earthsave.org/health/bloodtyp.htm
After reading his critique it is hard to put much stock in the Blood Type
diet.
Likewise, there is little science to support the validity of Dr. Wolcott’s
and Mercola’s Metabolic Typing. For a critique by Joel Fuhrman MD see
http://www.diseaseproof.com/archives/diet-myths-the-fallacy-of-the-metabolic-type-questionnaire.html
(and the interesting and passionate discussion that follows below his
article). Another critique is at
http://davekaiser.ca/the-metabolic-typing-diet-book-review/
The metabolic typing advocated by Wolcott does make more sense to me than the blood type diet but I am not aware of any research that validates it, which make it hard to advocate for.
Bottom line: There are significant genetic differences that mean that one
single type of diet is not appropriate for everyone, but we don’t yet have
proven methods to readily determine which diet is best for you.

PRINCIPLE #3: While no single diet is best for everyone, be wary of
schemes that claim to tell you which diet is best for you. Diet needs to
be individualized and is based somewhat on trial and error.

VEGETARIAN/VEGAN DIETS VS. OMNIVOROUS

This is one of the largest divides in the diet debate and the one people
are most passionate about- at least the Vegans and Vegetarians who feel it
is cruel to eat animals and/or animal products. While there are sound
moral, spiritual, environmental and sociopolitical arguments in favor of
vegetarianism, I will focus here on the health aspects of this diet.
A large body of research shows that there are many impressive health
benefits of a vegetarian diet. Vegetarians live longer. Seventh-Day
Adventist men who were vegetarian live 7.28 years longer than average and women live 4.42 years longer. Vegetarians have a 24% lower mortality from heart disease. Vegetarian diets also prevent hypertension, lower blood pressure and decrease risk of stroke. Vegetarians have up to a 40% lower risk of cancer. Vegetarians tend to weigh less than meat-eaters, who have an average Body Mass Index 8.3% higher than vegetarians. Vegetarians also have a lower risk of diabetes.
A nice summary of arguments for and against a Vegetarian diet is at
http://vegetarian.procon.org/
However, there are many who argue that an entirely vegetarian diet is unnatural. Later in this essay I will discuss the invaluable research of Weston Price, who found that the aboriginal diets of the 14 healthiest populations on Earth he investigated all included animal foods.

It is not clear to what degree the proven benefits of a vegetarian diet are due to the inclusion of large amounts of vegetables and fruits versus the absence of meats. The (likely conservative) recommendations of the USDA are that Americans have 5-13 servings of fruit and vegetables a day depending on age/gender/activity level, but the average American eats about 3 servings per day.  Only 7% of the calories consumed by the average American come from fruits and vegetables. Half of all vegetables consumed are potatoes and half of all potatoes consumed are deep-fried as French fries or chips!

Bottom line: there is room for debate as to whether it is wise to include meat/animal-based foods in one’s diet, but whether one is vegetarian or not there is overwhelming evidence that it is beneficial to include large quantities of fruit and vegetables in our diets.

PRINCIPLE #4
A vegetarian diet has many impressive proven health benefits including
lower weight, increased longevity and lower incidence of heart disease,
cancer and diabetes. Even if one is not a vegetarian, it is wise to include a large percentage of plant-based food in one’s diet.

VEGAN VS. VEGETARIAN
While omnivores tend to class vegans and vegetarians together (like I just
did in the previous segment), many vegans feel it is unhealthy to eat
dairy and eggs. One of the biggest proponents of this view is T. Colin
Campbell PhD., a biochemist who wrote the best-selling books The China
Study and Forks Over Knives. The China Study book discusses The
China-Cornell-Oxford Project, a 20 year study that Campbell helped to
direct, though only a small portion of the book directly discusses the
study. An often-repeated quote from the book is “People who ate the most
animal-based foods got the most chronic disease. Even relatively small
intakes of animal-based food were associated with adverse effects. People
who ate the most plant-based foods were the healthiest and tended to avoid chronic disease.” Much of the book is devoted to discussing the hazards of milk, especially the milk protein casein.
The China Study is a very popular book among vegetarians and especially
vegans. Many who have read it, including Bill Clinton, have changed their
diet after reading it. However, it has received a great deal of criticism.
The most detailed and impressive critique I have found is by a writer
named Denise Minger at http://rawfoodsos.com/the-china-study/

Another thorough critique is by Chris Masterjohn, who is pursuing a PhD in
Nutritional Science, at
http://www.cholesterol-and-health.com/China-Study.html
In a nutshell, the critics state that Dr. Campbell’s analysis of the data
of the China Study is incorrect and the data does not actually support a
link between consumption of animal foods and increased risk of heart
disease, cancer, diabetes etc. While some of the research cited by
Campbell may support a link between casein and cancer (but also may not), he ignores the evidence that whey protein from dairy may be highly protective against cancer and unjustifiably generalizes that since casein is hazardous, therefore all animal protein is hazardous. While focusing on the role cow’s milk may play in triggering autoimmune disease and heart disease, he ignores compelling evidence that wheat protein/gluten triggers autoimmune disease and is associated with heart disease even more strongly than dairy. This is one of many examples of Campbell “cherry-picking” data, emphasizing the data that supports his conclusions while ignoring data that negates it. Dr. Campbell did write a response to his critics, but the response largely criticizes the credentials and motives of his critics and does very little to actually address the criticism.  One can literally spend hours reading the information on this, but for a quick taste I
recommend scrolling down towards the end of “The China Study: Fact or
Fallacy?” by Denise Minger at
http://rawfoodsos.com/2010/07/07/the-china-study-fact-or-fallac/ and
reading the section titled “In summary and conclusion…”
Having read much of the point-counterpoint on this (particularly the
shrewd and extremely thorough analysis by Denise Minger) I do not put much stock in “The China Study.”

Dr. Campbell’s fame has spread through being featured it the documentary “Forks Over Knives” along with another hero of proponents of Vegan Diets, Dr. Caldwell B. Esselstyn Jr. MD, a retired surgeon and author of Prevent and Reverse Heart Disease. Dr. Esselstyn advises a radical diet in that it is not only Vegan but fat-free- he believes one should only eat non-fat plant foods- not only no dairy or eggs but no nuts, avocados or oils of any kind, including oils most nutritionists consider healthy, such as olive oil and flax oil. The only grains he allows are 100% whole grains. Dr. Esselstyn has had some very impressive results in reversing heart disease in the few patients who adhered to this diet. However, this does not mean that they would not have had similarly good results if their diets had included nuts, avocados, olive oil or even some fish, eggs or dairy! Again, the most thorough rebuttal to Dr. Esselstyn’s work is my favorite nutrition blogger Denise Minger’s painstakingly detailed critique of “Forks Over Knives” as found here: http://rawfoodsos.com/2011/09/22/forks-over-knives-is-the-science-legit-a-review-and-critique/#more-1487
This is a lengthy yet very well-documented and reasoned critique, made quite readable by the author’s sense of humor. In this debate I tend to side with Ms. Minger; there is too much data that clearly contradicts the conclusions of Dr. Campbell and Dr. Esselstyn to endorse their views. This does not mean that a largely plant-based diet is not healthy; but it does mean that I do not believe that all fats and animal-derived foods are toxic.
Bottom Line(s):
While there is some evidence that a low-fat vegan diet can help to reverse cardiovascular disease, sound science has not yet objectively demonstrated advantages of a vegan diet over a vegetarian diet.
Many people thrive on a vegan diet, yet many do not. As we will see later
in this essay when I explore the ideas of Weston Price, there is good evidence of the health benefits of including at least some animal-derived food in our diets.

GLUTEN-FREE DIET
This has become its own category. 10 years ago very few people avoided
gluten but in recent years this has become positively trendy. Gluten is a
protein that is found in wheat, rye and barley. Oats don’t contain gluten but are often contaminated with gluten so should be avoided unless labeled gluten-free. Gluten-free grains are millet, quiona, amarinth and buckwheat.
Doctors have long known about celiac disease, a hereditary autoimmune
condition that causes allergy to gluten. Celiac disease affects about 0.8%
of Americans, primarily those of Celtic descent. Common symptoms include chronic diarrhea, abdominal pain, gas and bloating, difficulty gaining weight, fatigue, anemia, skin rashes, headaches, infertility and
depression. While celiac disease is more common than it used to be
(research indicates only 0.2% of Americans had it in the 1950’s), it is
still relatively rare. But besides celiac disease, many people suffer from
Gluten Sensitivity that is unrelated to celiac disease, often called
Non-Celiac Gluten Sensitivity. While about 3 million Americans have celiac
disease, it is estimated that about 18 million Americans have Non-Celiac
Gluten Sensitivity, making it far more common. But even those without such sensitivities might have far better health by minimizing wheat consumption.
Symptoms of Gluten Sensitivity are similar to those of celiac disease, but celiac tends to cause more gastrointestinal symptoms (though gluten sensitivity can cause GI symptoms). Non-Celiac Gluten Sensitivity often primarily causes symptoms outside the GI tract such as headache, brain fog, muscle and joint pains, fatigue and numbness (though celiac can cause these too).
Whereas there are blood tests that reliably diagnose celiac disease, there
are no blood tests that reliably diagnose gluten sensitivity. The best way
to determine if one is gluten sensitive is a trial of strictly avoiding
gluten for 2-4 weeks to see how you feel, and then reintroducing it to see if it causes symptoms.
One main difference between Celiac and Non-Celiac Gluten Sensitivity is
that if one has Celiac they will never be able to tolerate Gluten.
Non-Celiac Gluten Sensitivity is a reversible condition that is caused by inflammation of the intestinal lining. With avoidance of gluten and measures to heal the intestines it will disappear over time.
Why has celiac disease and gluten sensitivity become much more common in recent years? The answer is almost certainly related to changes in the wheat plant. While Monsanto is attempting to introduce GMO wheat, the modern wheat we all eat is not officially a GMO product, yet it has been genetically modified by crossing wheat with non-wheat grasses to introduce new genes and by using techniques like exposing wheat seeds and embryos to chemicals and radiation to induce mutations. Modern wheat has a much higher gluten content than the wheat of our grandparent’s time. There have also been significant changes in the chemical makeup and structure of the gluten and gliaden proteins in modern wheat, as well as a chemical called wheat germ agglutinin that may create a variety of health problems. According to William Davis MD, author of the fascinating book Wheat Belly, modern wheat is a powerful appetite stimulant. He feels that modern wheat is highly addicting, with polypeptides from gluten binding to opiate receptors in the brain, and feels that over-consumption of wheat is the main cause of the obesity and diabetes epidemics in the United States. An excellent summary of Wheat Belly can be found at http://thehealingproject.us/2012/09/22/book-summary-wheat-belly-by-william-davis-md/
However, if you’ve read this far you realize there are (at least) 2 sides to every story, so I feel it is only fair to link to this detailed critique of Wheat Belly written by Julie Jones, who is a paid consultant for the wheat industry: http://www.aaccnet.org/publications/plexus/cfw/pastissues/2012/OpenDocuments/CFW-57-4-0177.pdf
I don’t agree with all her critiques but she does make some good points. I would love to see Dr. Davis’s response, but have not found a response by him yet.
A more balanced critique of Wheat Belly is at http://blog.cholesterol-and-health.com/2011/10/wheat-belly-toll-of-hubris-on-human.html
Both of the above critiques are rather lengthy. One that is briefer but points out some significant flaws is http://noglutennoproblem.blogspot.com/2012/03/wheat-belly-busted.html

Many people who try a gluten-free diet do feel noticeably better and thus conclude that they are sensitive to gluten. However, they may only be sensitive to the structurally-altered form of gluten found in the modern wheat plant. Many of these people may tolerate gluten in oats, rye and ancient grains like spelt, teff and kamut. Just as many people once thought that all fat was bad and then learned there are good fats and bad fats, just as many people thought all carbs are bad and have now learned there are good carbs and bad carbs, I think we will learn that, except for the small percentage of people with true celiac disease, that there are good glutens and bad gluten!

While gluten sensitivity has gotten a lot of publicity, other food
sensitivities are also extremely common. Other common foods that create
multiple symptoms include dairy, eggs, corn, soy and almonds. While there are blood tests that will often show evidence of food sensitivities, these tests have significant false positives and false negatives. The ultimate way to check for food sensitivities is to eliminate commonly allergenic foods for a week or more and then reintroduce individually.

PRINCIPLE #5
Sensitivity to gluten and other common foods is surprisingly common.  Modern wheat is a very different plant than the wheat of our ancestors and may be unhealthy even for those without gluten sensitivity. Many people feel much better when avoiding offending foods.

WHY EAT ORGANIC FOOD?

This is one of the most important parts of this series of essays, so I have given it its own section. See https://drrandybaker.com/2013/04/22/organic-food-diet/

Summarizing some of the main principles, while there is no single best diet for everyone, I advise that people eat whole unprocessed foods as much as possible, with an emphasis on organic vegetables as well as organic less-sweet fruits. Include raw foods in your diet. Animal foods that have been raised organically or are wild are reasonable in moderation but not everyone needs meat. Minimize fried foods, sugars and simple starches. Eat slowly, chew your food well and enjoy what you eat. Avoid overeating. If you do have sweets enjoy them in moderation after a well-balanced meal. Pay attention to how you feel after various foods to determine how they agree with you.

I have more controversies and concepts to explore. What about Raw Food Diets? Alkalinizing Diets? The Specific Carbohydrate/GAPS Diet? This and more will be discussed here in the future so stay tuned!

But I do have a couple of great articles about general dietary advice that I endorse as generally wise diets for most people. Dr. Joel Fuhrman’s Nutritarian Diet is an excellent diet. I do disagree with certain aspects- for example, Dr. Fuhrman advises against coconut oil, whereas I believe it is extremely healthy. Also, I think that it is acceptable to have more beef and cheese than he recommends, as long as the source is grass-fed cow and the cheese is raw. But it is one of the better diets I have seen:
http://www.drfuhrman.com/library/what-is-a-nutritarian-diet.aspx

But maybe my favorite article on a healthy diet is Mark Hyman’s Pegan or Paleo-Vegan Diet. His article includes a good discussion of the pros and cons of a wide variety of foods. See
http://drhyman.com/blog/2014/11/07/pegan-paleo-vegan/

In the meantime, this is a genuinely hilarious essay on the dilemmas faced by those striving to eat healthily while treading lightly on our planet:

http://www.nwedible.com/2012/08/tragedy-healthy-eater.html

And if you enjoy this please check out my posts on Vitamins/Supplements for the Prevention of Heart Disease. the Vaccination Debate and how Hemp can Help Save our Environment…

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