Tuesday, July 23, 2019

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

Having just sung the praises of the American Diabetes Association’s Position Paper on nutrition therapy, it is unfortunately still necessary to have to criticize their unbending adherence to the Establishment’s 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.” That would be the Dietary Guidelines for Americans. What a cop-out!
But the ADA did say in this Position Paper on “recommended eating patterns for adults with Type 2 diabetes”:
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 was enough for me, then. We have all suffered from the ADA’s intransigence. Many, like myself, have had the n=1 experience of losing weight easily, without hunger or cravings, and having their Metabolic Syndrome disappear on a Very Low Carb (VLC) diet. And we did it all without the approval, and occasionally with outright hostility, from our doctors, from our family, and from the “dietary authorities.”
For this Type 2 diabetic, as my weight dropped, so did my blood pressure, from 130/90 to 110/70 (on fewer 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 chronic systematic inflammation, is often below 1.0, the level generally considered “ideal” for cardiovascular risk.
Cholesterol in the blood attempts to repair the eroded, “small-dense” LDL particle-filled 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, but what prevents plaque formation? Answer: Low systemic inflammation, large-buoyant LDL particles, and high HDL to carry excess LDL particles away from the heart and back to the liver. This is a much better way to mediate CVD risk, and it is attainable by eating Very Low Carb.
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. Everyone says that MUFAs (monounsaturated fats like olive oil) are healthful, and the dietary authorities now admit that trans fats (artificially saturated vegetable oils) are deadly; but they still insist that naturally saturated animal fats, are unhealthful. And that PUFAs (highly processed, inflammatory polyunsaturated fats (e.g. soybean oil. Corn oil, etc.) are healthful!!!
Naturally occurring saturated fats found in animal products and artificially saturated manufactured TRANS fats are totally dissimilar in structure and effect on the body’s cells. Conflating them is an egregious misrepresentation.  
The ADA’s position on SFAs leads them inexorably to advocating one “eating pattern” in particular, the Mediterranean diet. That’s okay IF YOU’RE NOT A TYPE 2 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. You’re very lucky, and I’m jealous. Note however to the ADA and to my readers: TYPE 2 DIABETICS AND PRE-DIABETICS CAN’T EAT A MEDITERRANEAN STYLE DIET AND BE HEALTHY. 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 – especially for the metabolically compromised, AS TYPE 2 DIABETICS (AND PRE-DIABETICS) ALL ARE.
So, what will be the next canon of “healthy nutrition” orthodoxy to fall? Will it be saturated fat? Let’s hope so.

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