Saturday, November 2, 2013

The Nutrition Debate #157: The ADA’s Problematic Position on Dietary Fat

Having just sung the praises of the American Diabetes Association’s new Position Paper on nutrition therapy guidelines, it’s painful for me to have to criticize their unbending adherence to the “conventional wisdom” with respect to saturated fatty acids (SFAs), aka saturated fats. They dodge the issue. Instead of saying “the evidence is inconclusive…so goals should be individualized” (as they did with macronutrient distribution), they say: “Due to a lack of research in this area (?!!), people with diabetes should follow the guidelines for the general population,” from the Dietary Guidelines for Americans. What a cop-out.

The ADA deserves to be cut a little slack, though, for not taking on too many giants at once. For the ADA to have officially said, “It is the position of the American Diabetes Association (ADA) that there is not a ‘one-size-fits-all’ eating pattern for individuals with diabetes,” that’s enough for me, for now. All who have suffered the angst of having the n=1 experience of losing weight easily, without hunger or cravings, and having their Metabolic Syndrome disappear on a Very Low Carb (VLC) dietary, have been frustrated. And we did it all without approbation (and occasional outright hostility) from the “dietary authorities,” We can applaud the ADA now as it is the first major organization in the U.S.A. to break with that outdated idea.

For this diabetic, as my weight dropped, so did my blood pressure, from 130/90 to 110/70 (on the same meds). And while my LDL cholesterol particle number didn’t go down, the particles changed from small-dense (“Pattern B”) to large-buoyant (“Pattern A”), making it less likely that they could get stuck in any erosion in the endothelial layer of my arteries. Such erosion, by the way, is caused by inflammation, but on this VLC Way of Eating, my C-Reactive Protein test, a blood marker for systematic inflammation, is often below 1.0, the level generally considered “ideal” for cardiovascular risk.

Serum cholesterol attempts to repair the small-dense LDL trapped in the eroded arteries, by creating plaque. That’s why cholesterol is blamed for plaque, but it’s like blaming the fireman for putting out the fire. Statins are thought to work by stabilizing plaque. Low systemic inflammation, large-buoyant LDL particles, and high HDL to carry excess LDL particles away from the heart and back to the liver, prevents plaque formation. It is a much better way to mediate CVD risk.

The ADA now recognizes that Low Carb eating is “healthful,” but they still tow the line of the AHA, AMA, HHS and the USDA with respect to which fats are healthful. (If you reduce carbs in your diet, those calories will be replaced primarily with fats, so it is important that you choose healthy fats.) The dietary authorities all suggest that MUFAs (monounsaturated fats like olive oil) are healthful, and all now admit trans fats (artificially saturated vegetable oils) are deadly; but that naturally saturated animal fats, and the dietary cholesterol that accompanies them, are unhealthful. And that PUFAs (highly processed polyunsaturated fats found in vegetable oils like corn and soy bean oil) are healthful!!!

They unfortunately still lump naturally saturated fats found in animal products with the artificially saturated trans fats manufactured from highly processed vegetable oils. This conflation is an egregious and malevolent perfidy perpetrated and perpetuated by industry influence, specifically the Agribusiness lobby which is so thoroughly insinuated in the interstitial tissue of our nation’s advisory and regulatory bodies. It is a bogus association. They are totally dissimilar in their structure and effect on the body’s cells. 

The “authorities” also fail to recognize the dangers from the disproportionate amount of inflammatory Omega 6s we are eating (relative to Omega 3s) since vegetable oil has become so prominent in our diet. Vegetable oils are everywhere, particularly if you eat restaurant meals, processed foods or commercial mayonnaise and salad dressings. It is very difficult to
correct the balance of Omega 6s to Omega 3s without avoiding as completely as you can all vegetable oils (high in Omega 6s). 

The ADA’s position on SFAs leads them inexorably to advocating one “eating pattern” in particular, the Mediterranean style. That’s fine if you’re not diabetic or pre-diabetic. If you can keep a healthy metabolism eating “abundant plant food (fruits, vegetables, breads, other forms of cereals, beans, nuts and seeds)”, good for you. I’m jealous. (Note to the ADA: Diabetics can’t.) But for those who can, by all means eat “fruit as the typical daily dessert and concentrated sugars and honey consumed only for special occasions,” and “olive oil as the principal source of daily lipids, dairy products (mainly cheese and yoghurt) consumed in low to moderate amounts,” etc. Of course, it allows only very limited amounts of red meat and eggs and thus is definitely skewed away from dietary cholesterol and saturated fats – all misguided, unnecessary, and in fact, unwise IMHO – especially for the metabolically compromised, as we diabetics all are.
I do not blame this ADA committee, though. Rather, I praise the courageous stand of this committee comprised of PhDs and MPHs, all of them RDs and CDEs. They prepared this groundbreaking report, and the ADA Executive Committee commissioned and approved the final document. They deserve our acclamation for having made the turn in accepting – no, verily promoting and supporting any and all “healthful eating patterns, emphasizing a variety of nutrient dense foods in appropriate portion sizes, in order to improve overall health…” And even though they incline towards the “Mediterranean style” for reasons relating to what I regard as a vestigial bow to orthodoxy, they now explicitly and unambiguously include the low-carb diet as a healthful Way of Eating. Wunderbar! What will be the next canon of orthodoxy to fall? Will it be saturated fat? See the next column.