|Robert L. Blum, MD, PhD|
Are Fats Killers or Saviors?
As a physician scientist, I've been interested in nutrition for decades.
Both my grandfather and my father died around age 70 of heart attacks,
so I've always been keenly aware of the much touted causal relationship between
fats and atherosclerosis. Everything I had read in the medical literature
confirmed that relationship.
So, I never thought I would have to defend NOT eating saturated fat -
or not eating fats in general.
mainstream medicine and cardiology for decades. Why am I even
bothering to address this issue? Has anything changed? Perhaps, so.
(One (idiotic) version of the traditional USDA food pyramid with bread, cereals, and pasta at the base.)
Many of my friends are very bright Silicon Valley engineers
and scientists, and some of them have experimented with "paleo" diets -
eating like our paleolithic hunter-gatherer ancestors did - and my friends have
The central claim of the paleo movement is that we humans were doing fine
for millions of years eating freshly killed fish and meat. (A majority of our paleolithic
ancestors did die by age 18 of infections and other causes.) But, then the agricultural revolution
came along 10,000 years ago and suddenly our diets changed to wheat and barley,
a diet for which we were not evolved. This sudden shift accelerated for the worse
in the twentieth century with the introduction of packaged foods, high-frucose corn
the resulting epidemic of massive obesity, diabetes, and cardiovascular disease.
Many of the teachings of paleo are definitely a part of mainstream
medicine, and hence are non-controversial: staying away from high-glycemic
simple sugars, processed foods, and trans fats, for example.
This interest in "paleo" nutrition was given a huge thrust in 2007 by
science writer Gary Taubes with his best-seller Good Calories, Bad Calories,
which I will discuss below. Taubes leveled his gun squarely at carbs
as the source of all our problems, and (controversially) he gave satfats a big OK..
He, and the paleo crowd, say the main culprit causing the modern world's
Getting nutrition right is critical. The body is comprised of
a tightly knit community of ten trillion cells in dynamic equilibrium with the
There are three (and only three) macronutrient food groups:
carbs, fats, and protein. Let's suppose you eat 2400 calories per day.
Given a fixed amount of protein, let's say 400 calories worth (100 grams),
then the real question is "where should the other 2000 calories come from -
CARBS or FATS???" That's the central issue of this article. (I also deal with
the crucial issue of whether eating 2400 calories a day is good for you or
whether you're better off eating a lot less.
Mainstream medicine has traditionally spoken with one voice on this topic::
most of those remaining 2000 calories should come from complex carbs,
specifically whole grains, fruits, and vegetables.
(That includes the second tier
The paleo authors - here I'm including Gary Taubes and
Loren Cordain (and his many disciples) - correctly dispute the wisdom of the
meat, fish, eggs, nuts, and seeds. (Taubes and some paleos also favor lots of dairy.)
the grim reaper of the modern world.
So, who's right? That's my focus. And, what should you be eating
If you eat 11 servings of bread, white rice, breakfast cereal, and pasta and
four servings of fruit, you'll look like the guy with the supersized drink, even
if you don't eat high-fructose corn syrup. Has HFCS been falsely accused of
causing obesity? You decide after viewing this "ad" from SNL.
As a physician for many decades, the saturated fat claim
made by the paleo advocates initially struck me as being preposterous
and even dangerous. It flies in the face of a half century of medical dogma
But could there be a grain of truth in the claim made by the paleo crowd?
For me finding out the truth is absolutely essential.
I found out serendipitously about seven years ago that I already have
early atherosclerotic calcifications in my coronary and carotid arteries,
In the course of an extended correspondence over several months,
I examined hundreds of online articles, studies, and videos that address
the satfat = saturated fatty acid issue. (Special thanks to my brilliant friends -
scientist/engineers Steve Omohundro and Dan Hunter for their many contributions.)
My purpose in writing is to share with you the many
Here's another reason to watch all the videos - the recommended foods
If you can't stand the suspense, here's the bottom line.
1) What really matters is achieving your optimal weight (read THIN -
2) Calorie Restriction with Optimal Nutrition (CRON) is the way to go.
(But, what do you eat to make it possible? It simply won't happen
if you're trying to do it just by eating lettuce and weak tea -
unless you're in a prison camp. I lasted about 5 hours on the Lemonade Diet.)
3) Protein should range from roughly 1 gram to 2 grams per kg per day .
(no more than say about 60- 160 grams per day (that's the weight
of the protein,
4) Fast carbs (like sugar) promote weight gain and need to be greatly curtailed
(initially, even including fruit!) . Fast carbs = high-glycemic index carbs promote
5) Fats make it a lot easier to eat less: they suppress insulin release
and kill your appetite. Suppressing your appetite is critical;
so is getting
6) Trans fats are horrible. They are more atherogenic than satfats.
They need to be buried with the people they killed. Shop from the outer aisles
7) Satfats need to be limited, but replacing all satfats with simple carbs (possibly even
That is, particular foods of a certain type (eg satfats or PUFAs) differ considerably.
(And this has still NOT been sorted out in the medical literature.)
(That is, eat fish rather than meat, and eat olives or avocados rather than cream.)
The weight of the evidence supports limiting satfats. (I consider the total exoneration of
satfats by some bloggers (who recommend unlimited dairy, eg) to be
Mediterranean fat sources (PUFAs and MUFAs,
eg fish, olives, and avocados) are better for you than satfats.
9) Only those researchers who advocate an extremely low fat,
atherosclerosis can be reversed. (I personally will only believe that the
high satfat advocates are right when they have also done similar trials.)
A vegetarian diet may be the best way to prevent atherosclerosis, and
It's also good for the animals and for the planet. (I myself have tried
vegetarian diets through the years. Somehow, it's always a "no go.") Note: I'm
Wheat, barley, rye (but not rice) and also soy and legumes may need to be
restricted to curtail IBS. Fruit needs to be restricted to avoid obesity.
of everyone's diet. Increasing omega 3 fats (fish or flax seeds) and
decreasing omega 6 fats (vegetable oils) is crucial to brain health and to
You're not gonna lose weight by eating all that fruit. Big, fat error!
That's the summary. Now on to the articles,
the evidence, the videos, and what I eat.
My Dietary Goal: Longevity
My personal dietary goal is longevity - to live as long as possible.
Why? As a lifetime science and technology buff, every day brings
exciting new developments. What incredible biomedical advances
That is not, however, the purpose of everyone's diet.
Some young men, for example, want to increase muscle as fast as possible.
Some people love going to fancy restaurants or eating exotic cuisines.
I won't address their dietary preferences here.
My exclusive interest is in achieving optimal health and longevity.
I'll start with the view of mainstream medicine and focus on just one problem.
Dietary advice from every medical, scientific, and nutritional society
must first and foremost emphasize the prevention of atherosclerosis.
It is the number one killer in developed countries, exceeding cancer and
infectious diseases combined. The definitive American source for info is the CDC,
which publishes the annual statistics every year in Circulation.
Here are the mortality statistics for the USA (source: CDC; year 2009)
Total deaths 2,436,652 (out of about 300 million Americans)
1) heart disease 598,607
2) cancer 568,668
3) respiratory dis. 137,082
4) stroke 128,603
Adding heart disease and stroke (most often caused by atherosclerosis),
we get 727,210 deaths per year in the USA - about a third of all USA deaths.
It kills both men and women, although men get it (and die from it) about ten years earlier
than women. Visit a senior residence (old folks home), then ask yourself,
"where are all the men?" Answer: almost all have died.
Atherosclerosis is the process in which arteries of the heart or brain plug up
over decades, leading to a sudden heart attack or stroke in the brain.
Diet (and fat, in particular) has been implicated as a major contributor to this process.
After the fibrous cap on the fatty plaque has ruptured, a blood clot forms.
How and why does plaque form in the arteries? After decades and
a) if LDL = low density lipoprotein cholesterol (ie, "bad cholesterol")
is persistently high,
b) it becomes oxidized and deposits underneath the endothelium
(the inside lining) of arteries.
c) There it is gobbled up by macrophages (" big eaters"), whose
d) Over the years, these fatty deposits, push the outer wall
of the artery further out.
e) At the same time the foam cells cause the smooth muscle cells
in the endothelium to secrete collagen to form a dense fibrous cap (scar tissue)
that narrows the blood flow channel in the artery.
f) if the process continues, inflammation inside the fibrous cap
may weaken it such that the blood flow suddenly lifts it up.
g) As a result, a blood clot forms that completely closes off the artery,
cutting off blood flow to the heart muscle.
i) Deprived of oxygenated blood, the heart muscle dies (a heart attack).
While this pathway is widely acknowledged to be the principal mechanism
of atherosclerosis, which is the leading cause of death, various researchers
Some authors in the popular press - notably science writer Gary Taubes
and biochemist Mary Enig have questioned the role of dietary fat in causing
atherosclerosis, as I mentioned above.. See, eg, this discussion of the
I'll discuss the viewpoint and evidence cited by the skeptics toward
the close of this article. (However note: they are vastly out-numbered by the
believers . But, how many skeptics does to it take to prevail - only one,
if he or she is right. Every scientific theory can be overturned by sufficient evidence.)
Now, on to the experts, what they recommend, and why.
I'm going to start with Loren Cordain, because of all the videos I've seen,
LOREN CORDAIN: Master of Paleo
(Note: this is our first MUST WATCH video -
My favorite paleo advocate is Professor Loren Cordain of
Colorado State University. This one hour YouTube video of Prof. Cordain
gives the complete rationale for paleo nutrition. Cordain did much of the
paleoanthropologic research that provides the evidence for paleo eating.
Whether or not you believe that paleo eating is nutritious (or harmful),
his presentation on the history of human foods is a must. He, as much
as anyone, knows what our ancestors ate, and also what present day
hunter-gatherer (HG) societies eat. He analyzed data on 229 HG societies:
The Paleo Pyramid has fish and meat at its base. Dairy is not part of it.
So, what did our ancestors (and present day hunter-gatherers (HGs)) eat?
Answer: everything! Whatever they could get their hands on.
They and we are omnivores. Eating by us (and by almost every creature)
is determined by calories obtained versus effort expended.
Grains? Forget it! Ancestral grains were scrimy, indigestible weeds
before agriculture (and horticulture) 10,000 years ago.
Fruit? Fine! But these were also apt to be small, wild varieties, not giant
juicy apples. Vegetables? Same comment.
Fish? Played a large role in our ancestral diet and that of many modern HGs.
Animals? Cordain shows that wild animals and fish form about 2/3's of the diet of modern HGs.
If you lived in Northern Europe during the glaciations, you ate like the
wolves and other predators. But, he shows the difference between
wild venison (pure meat) versus a factory farm steer (loads of fat).
The cavemen were slim, as were the animals they ate.
Dairy? Here, Cordain wisely disagrees with the recommendations of his
young disciples some of whom advocate unlimited saturated fats from cheese,
cream, butter and animal fat. They're on thin ice. Their evidence is preliminary
and controvertible. As Cordain points out, the paleolithics did NOT have access
to dairy before animals were domesticated. He shows an angry wildebeast:
"just try to milk that!"
Sugar: Fructose: Fast Carbs Here Cordain and the medical establishment are
in total agreement. Our ancestors rarely ate simple sugars (simply because they were
not available (other than honey)). Consumption of these sugars has gone
I linked to Loren Cordain's lecture first, because 1) it is essential for you
However, look at all that meat, fish, and fat in the paleo diet he recommends.
Vegetarians and Vegans: The Importance of Vegetables
After reading scores of articles and books, I found it hard to
ignore the evidence presented by the vegetarian advocates. These are
physician researchers who have studied the issue over decades,
heart disease and strokes (and to reduce cancer risk), eat mainly
a vegetarian diet (if you can).
My favorite video,
, a professor of neurosurgery at Emory University,
Atlanta, and best known as CNN's chief medical correspondent.
This free, one hour video is mandatory viewing for all my readers.
(All the videos and articles on my entire website are free and open access.
In this video Dr. Gupta interviews former President Bill Clinton, among others.
Clinton had a 4 vessel coronary bypass in 2004. Then, in 2010 he had
two coronary stents placed.
That second coronary intervention forced Clinton to really
get serious about his diet. Here is Bill Clinton explaining his diet
to comedian David Letterman (who also in 2000 had a 5 vessel bypass).
For dietary advice Clinton turned to physicians Dean Ornish
and Caldwell Esselstyn.
I have been a fan of Dr. Dean Ornish for years.
Both Dr. Ornish and Dr. Esselstyn have worked for decades with patients
(including Bill Clinton) who have had heart attacks. Both physicians have
demonstrated by angiography that their 100% vegetarian, very low fat diets,
can arrest and even partially reverse coronary atherosclerosis. This was
formerly thought to be impossible.
(another of my favorites). And,
Besides eating vegetables, Dr. Ornish also advocates stress reduction and
meditation. It takes huge motivation and self-control to eat a 10% fat diet,
but Ornish has decades of data and publications to show that it works.
Caldwell Esselstyn. Like Ornish he has worked for decades with patients
(including Bill Clinton) who have had heart attacks and has shown that
he can arrest and partially reverse their disease.
President Clinton turned to both Ornish and Esselstyn after
his second heart attack in 2010. Clinton is now a vegan (only vegetables:
not only no meat, no chicken, no fish, but also no dairy, no eggs, no avocado
and no nuts!). Is it hard to adhere to a diet that low in fat? You bet.
But like Yoda in Star Wars, Dr. Esselstyn hates moderation: "do not try - do!"
His article is a must-read "Resolving the Coronary Artery Disease Epidemic
I also read and recommend his carefully documented best seller Eat to Live,
2nd edition 2011. Like Ornish and Esselstyn he has worked with hundreds of
patients with heart disease, obesity, metabolic syndrome, and adult diabetes
and reversed their disease. His book, papers, and website present the argument.
By the way, Dr. Fuhrman was a world champion figure skater in his youth.
which compares provinces and cities in China in which meat is eaten
to those on a vegetarian diet. This study, which has received NIH funding
for three decades, carefully documents the salutory effects of an all vegetarian diet.
Campbell presents abundant evidence that not only shows an atherosclerotic effect
of a diet rich in animal fats but, surprisingly, a strong carcinogenic effect.
His conclusions are even more compelling considering his background:
growing up on a dairy farm in the Midwest. Only the power of his study data
persuaded him that vegetables are the way to go. Here Dr. Campbell presents
the China Study. Both he and Dr. Esselstyn are in their late seventies and look terrific.
My favorite website on vegetarianism is VegSource.com .
I discovered it after noting that several of the videos above
were posted by VegSource on YouTube. (See the video link from VegSource.)
Another crucial part of vegetarianism is how animals are "processed"
on the way to your dinner table. Here is an interview with comedian
Ellen Degeneres about why she is a vegan. In it she recommends
the movie Earthlings, commenting that it made Food Inc
(another similar movie) seem like a Disney production. It does.
inflicted on factory farm animals. My reaction was "how could I live six decades
in America and not be aware of this story." It needs to be seen by every man,
(That's not to say that it's 100% accurate, but it's a sad indictment
of our supposedly free society that the monstrous treatment of factory
farm animals has been so hidden from view.) If you believe that
farm animals are conscious (they are!), then their welfare is crucial.
CRON: Calorie Restriction Optimal Nutrition
Calorie restriction (CR) is spectacularly successful in decreasing
the rate of atherosclerosis, diabetes, and perhaps even cancer.
A 2004 study in the prestigious journal PNAS reported a 6 year study of
18 people on a calorie-restriced diet (bmi 19.6) compared to controls
with normal BMIs (avg bmi of 26). The calorie restricted group ate
only 1,100 to 1,950 calories per day vs 1,975 to 3,550 per day for the controls).
The restricted group had spectacular reductions in their LDL and triglyceride levels
and marked increases in their HDL levels. Notably, they experienced a 40% reduction
in their carotid intima media thickness (IMT) - a direct measure of atheroma.
The many benefits of calorie restriction are touted on the
I became interested in CR perhaps 15 years ago
when I read a book by renowned physician Roy Walford,
a professor of pathology at UCLA and a noted pioneer of CR research.
His research, since replicated in many species, showed that
mice fed a calorie-restricted diet almost doubled their lifespan.
The health-inducing effects of CRON were confirmed in
That study showed a marked decrease in diabetes, cancer, heart,
and brain disease. It appears that the voracious eaters are dying
at a rate three times as fast (total of 14 dead) as the dieters (5 dead).
(The monkey who ate to his heart's content is on your right.)
A new study of calorie restriction in humans was begun in 2007.
The new study, called CALERIE and sponsored by the NIH,
is being conducted at three medical centers and has about 250 participants.
It is a two year study that completed enrollment in February 2010.
A preliminary study reported in 2006 showed reduced levels of insulin resistance,
reduced LDL, and less oxidative damage to DNA. CALERIE is described on wiki.
Okinawan Diet of the World's Longest-Lived People
One journal article on the Okinawan Diet provides key support
for a calorie-restriced, vegetarian diet. Okinawa is one of Japan's islands,
known to Americans because of our military base there. The Okinawans
are among the world's longest-lived and healthiest people. In modern times,
their diet has shifted toward a more western (higher calorie, higher fat) diet,
but the authors of this study looked back several decades
at how much and what they used to eat.
Their diet is listed in Table 1 on page 443 of the study.
It has a total of 1785 calories per day from 1262 grams of food
for a calorie density of 1.4 - that's really low.
85% of their calories are from complex carbs; 9% from vegetable protein;
and only 6% from fat. (Look at a bottle of supposedly healthy olive oil
(or any other oil). It has 9 calories of fat per gram of oil.
(A past version of the USDA's Food Pyramid had "healthy oils" at the base.
Forget it! Fortunately, that's no longer recommended.)
Here's what the Okinawans eat: 69% of their diet was sweet potatoes;
12% from rice; 7% from other grains; and 6% from soy dishes.
There was almost NO meat, no dairy, no eggs, no animal fat,
no sugar, no nuts, no seeds.
Their longevity and diseases were studied in the
Okinawa Centenarian Study . Okinawa has an unusually large
centenarian population , and they are remarkably disease-free.
Their death rate from coronary heart disease is the lowest in the world at
18 per 100,000 (compared to America at 100 per 100,000) and
their rate of cancer is 2/3's of ours.
Saturated Fats: Killers or Saviors
So, let's return to the question that started this article and
initiated my recent exploration of this literature.
Are saturated fats killers or saviors?
The above literature would seem to leave little doubt.
Too many calories of food and of saturated fats, in particular, are killers.
That partially explains the heavy predominance of anti-fat statements
in the wiki article entitled "saturated fat and cardiovascular disease controversy."
The article accurately conveys the views of the medical academic establishment,
the American College of Cardiology, and the American Heart Association: fat is bad.
The so-called 'controversy' has arisen only in the popular press and as a result
of publicity efforts by dairy producers, oil producers, and meat producers.
But, lest we be hasty, it's wise to consider the arguments and evidence
brought forth in favor of saturated (and unsaturated) fat. As you will see, they do
For that let’s return to Gary Taubes whose 2007 book
Good Calories, Bad Calories was a best seller and created a firestorm.
I'll summarize his arguments starting with the least controversial
(most generally accepted) and end with his most controversial positions.
By the way, Gary Taubes provided a springboard
and popular voice for the Paleo movement - those writers and bloggers
who advocate eating more meat and virtually unrestricted saturated fat.
Here I’m lumping together Taubes and the paleo advocates for now.
(Loren Cordain, as we’ll see below, is quite clear - dairy products were NOT
In common with academic medicine, Taubes strongly condemns "fast carbs:"
those easily digestible, refined carbs that are a huge part of the American diet:
cookies, cakes, breakfast cereals, etc. Those high glycemic foods stimulate
insulin release and are converted to fat. He rightfully condemns
high-fructose corn syrup as being a key contributor to our current epidemic of obesity.
Now, on to the controversial positions. Taubes attributes
the high incidence of atherosclerosis in Europe and America
not to a high intake of saturated fat but rather (and exclusively) to our high intake
of carbs including starches. In his view insulin release is the universal culprit,
and it is only provoked by carbs and not by fats or protein.
He believes that America has been grossly misled
by the medical establishment: in his view, carbs are the real culprit, not fats.
And finally, his most controversial positions:
1) Chronic diseases like atherosclerosis are caused exclusively by refined carbs
and starches and not by fats. (The paleo gang blames inflammation and not fats.)
2) The following foods can be eaten without restraint:
meat, fish, fowl, cheese, eggs, butter, and non-starchy vegetables. Really?
3) Consuming excess calories does not cause us to grow fatter.
4) The obesity epidemic is not due to overeating nor to our sedentary lifestyle.
While these positions seem ludicrous (especially considering the
mountains of evidence presented by the vegetarian and CR advocates,
there is a grain of truth in some of them - just a grain.
(taken out of context, they are each grossly inaccurate.)
Is atherosclerosis caused by fats or by carbs?
The answer is probably both, when consumed in excess.
A) Decades of evidence have correlated saturated fat with atherosclerosis.
B) However, the recommendation that was advocated by the USDA in the 1960s
and 70s to replace fats with pasta, bread, and cereal is dead wrong.
(The USDA is so heavily influenced by food industry lobbyists that it must be ignored.)
Being a lifetime athlete, I was intrigued by Taubes' position on
the futility of exercise as a means of weight loss. He argues that
appetite is tightly controlled by the brain. In the course of a year,
we take in literally a million calories and burn the same.
Obviously, calorie expenditure must be about equal to calorie consumption.
When you exercise, you just eat more to make up for it.
It's really hard to lose weight just by exercising. Everybody knows that.
Score one major point for Taubes. You can bust your fanny on the treadmill,
but if you eat tons of fruit and pasta afterward, your weight is going nowhere but(t) up.)
However, the combination of Taubes' positions,
is where his argument breaks down.
You cannot just sit in an easy chair and eat an excess of anything
and expect to lose weight or be healthy.
My lifestyle every August is the closest I come to a paleolithic style:
backpacking for weeks in the Sierras. There are no grocery stores, no refrigerators,
no cars, no pantries, no tv or internet. Every meal is a job; every bottle
of water means finding a lake or creek. Dairy foods, which spoil, are non-existent.
The real paleo lifestyle is hard work; every calorie counts.
One unusual feature of my Sierra hiking trips is that I frequently encounter
By the way, almost no one recommends eating more than
about 2 grams of protein per kg of body weight per day
At four calories per gram, if you eat 100 grams of protein, that's 400 calories..
The real question is this: if your diet is (NOT should be) about 2,400 calories per day,
then what should make up the remaining 2000 calories: complex carbs or fats?
Again, here's an interim summary of what I've read
(coupled with my own experiences).
1) it's very important to achieve your ideal weight (for me, that's a bmi of 22
(weight 150 lbs at a height = 5' 10";). It's hard work.
2) Getting rid of fattening snack food is crucial. It cannot be in your house.
That includes fruit! Modern fruits - grapes, oranges, apples - are just giant sugar bags.
Get rid of 'em. (First dump the cakes, cookies, cereals, bread, and pasta.)
3) Eat whatever kills your appetite. What it is exactly, probably doesn't matter much.
Sardines, a giant salad or plate of vegetables (but not grease-soaked french fries).
4) No mindless eating: sitting is one thing but watching tv or a movie
and mindlessly shoveling calories of any kind is bad.
That's where Dean Ornish's mindfulness comes in. You should be
aware of every biteful. Is it bringing you closer to life (lower weight)
or closer to death (promoting atherosclerosis)?
5) If you're eating a calorie-restricted diet and are at your ideal weight,
does it really matter whether 10% or 30% of your calories are from fat?
Possibly not, according to Taubes; Ornish and Esselstyn would say, it DOES matter
if you want to reverse heart disease. (I take Lipitor and say "bless you, Pfizer."
Where do people trip up with what they eat? Do your own research
But let's return to the issue of fat consumption.
Fish, Fish Oil, and Omega-3 Fatty Acids
This is a crucial part of the story not only for weight loss but also for
reduction of cardiovascular disease and a host of other problems
including depression and cognitive impairment.
The most authoritative source on the topic of omega-3 fatty acids is
Prof. Bill Lands, a renowned NIH researcher, who did the original studies
that showed exactly why omega-3s are beneficial. Why not hear the argument
This is a four-part YouTube video that totals about 40 minutes. Note that
The bottom line is that the Western diet includes far too much omega-6 fat
by a factor of ten. It's in all our salad dressings (including olive oil), in peanuts,
and contribute to heart disease, stroke, and an array of common diseases.
Lands refers to omega-6s as the insurgents (like the Taliban), while lecturing to the cadets.
Omega-3s, in contrast to omega-6s, are benign bystanders (peaceful villagers).
They are anti-inflammatory. Our cell membranes and tissues are directly composed of
what we eat, and we Americans are loaded with omega-6s from our diet.
Take a look at this graph that Prof. Lands uses in his lectures. It shows
I also recommend these brief videos by Dr. Joe Hibbeln, a principal investigator
Look at the white matter in the brain below. It is white because
it is almost entirely made of fat: the phospholipids and sphyingolipids that make up the
myelin sheathes that surround your one million miles of neural axons. That insulation,
Jaminet's Perfect Health Diet
In their book The Perfect Health Diet, Paul Jaminet (a physicist) and
his wife Janet (a PhD biochemist) take the highly controversial position that
saturated fats may be eaten in unlimited amounts without causing harm.
They also present evidence against eating four groups of foods they consider toxic:
a) wheat and other cereal grains, b) legumes - especially soy beans and
particularly the "textured vegetable protein" found in so many imitation meat products,
c) liquid vegetable oils like corn oil, soy oil, and safflower oil, and
finally d) fructose, especially high-fructose corn syrup. Let's first consider
A) Are Saturated Fats Actually OK?
A 2011 study that appeared after the Jaminet's book came out serves
Say, what? No association? After decades of epidemiologic, clinical, and animal feeding
studies showing a consistent atherogenic effect (or at least an elevation
of biomarkers like cholesterol), how is it that a study that combines
21 separate studies including over 348,000 patients shows no association?
My belief, shared by critics of the study and certainly by
the likes of Gary Taubes, is that when you eat less of one food (like saturated fats),
you eat more of something else. Exactly what that something else is
(the replacement food), matters considerably. Replacing saturated fats
with trans fats, for example, is definitely worse. Furthermore, it seems
that replacing saturated fats with simple carbs is not helpful and may even be worse.
But, that lack of association between satfats and atherosclerosis
So, before you start swilling cream, consider another paper from AJCN in 2011
1) the evidence from epidemiologic, clinical and mechanistic studies is consistent in finding
So, there you have it. The conclusion reached by the world's top nutritional
While the medical establishment may have overdid their
It is also instructive to watch Dean Ornish and Gary Taubes debate this issue,
They even agree that eating a high fat diet may lead to weight loss as least as rapidly as eating
a low fat diet. The real issue, as Ornish states, is whether the end result is more
heart disease. Ornish's studies rigorously demonstrate that the patients who are able to follow
his ultralow fat diet, can partially reverse their heart disease. Taubes makes the excellent point
that most ordinary mortals may not be able to follow a diet with almost no fat.
I return now to the other issues raised by the Jaminets that are important and less controversial.
B) "Toxic Foods:" Cereal Grains, Soy Beans,
Liquid Vegetable Oils, and Fructose
When I was in med school around 1970 we were taught
that celiac disease was a very rare disease. The latest estimate is
that it is probably present in about 1% of Americans, and possibly many
more in the form of IBS, irritable bowel syndrome. This 2005 paper from Nature,
Cereal grains like wheat and barley are "new" in our diet,
having only appeared since the agricultural revolution of 10,000 years ago
that transformed us from paleolithic hunter-gatherers to neolithic farmers.
Our genes have not caught up. The result is an epidemic of obesity
and gluten sensitivity due to several wheat-borne antigens
that result in gut inflammation.
What goes for wheat, also goes for soy beans and other legumes.
About a decade ago I was stunned by a revision of the
USDA's Food Pyramid that showed vegetable oils at the
base of the food pyramid with suggestions that the path to
health consisted in drenching ones food in olive oil.
Fortunately, that idiocy has passed.
(I'm not knocking a Mediterranean diet, just this one misconstrual.)
The Jaminets nicely summarize the many problems with vegetable oils:
Similarly misguided in early iterations of the USDA Food Pyramid
are versions showing heaping quantities of fruit at the base of the pyramid.
Anyone who's tried to lose weight knows that that's not right.
How can eating those delicious little bags of sugar make you thin?
They can't and they don't. The advice is wrong. What's even worse, of course,
is the high-fructose corn syrup (HFCS) that pervades the American diet.
(But do see this "ad" from Saturday Night Live: HFCS is good for you!)
What I Eat
Having spent months intensively reading this literature
(and years perusing it), what's my bottom line?
What do I actually eat? Here's my bottom line: the foods that actually
go into my mouth. (Here: I must caution you.
What I eat is in large part determined by my own athletic lifestyle,
writing schedule, and my occasionally finicky gut. So, for example,
If I could, I'd be eating more vegetables and salads, as advocated by
Here's my food list.
1) SARDINES, HERRING, SALMON
Rationale: They're tasty. Those cans of sardines or herring are cheap.
They kill my appetite. Sardines and herring are not top predators like salmon,
so they are far less apt to contain mercury or halogenated hydrocarbons.
I do eat wild-caught salmon, but it's expensive (unless you buy the cans),
and is more apt to contain mercury. I dislike the fact that
eating salmon is not globally sustainable. I'm convinced that fish has been
part of a hominin diet for millions of years.
Fatty fish are high in omega-3 fatty acids.
With all that DHA, fish is pure brain food. Or, as my mother used to say,
"fish is bene-fish-al."
How about legumes like soy beans or soy burgers instead of fish?
Not for me. You may be ok with them. But, in addition to the arguments
against soy made by the Jaminets and others, I simply cannot tolerate soy
and most other beans. Here is a key principle of the foods I eat.
Do not eat any food that causes you problems!
If a food gives you gas, bloating, diarrhea, constipation,
low energy (or whatever), dump it. Forget whatever the literature says.
That's just theory.
Rationale: It's tasty. I eat a fair bit of chicken
It's skinless. If you have access to free-range chicken,
so much the better. (Remember the factory farms in Earthlings.)
BTW, I'm tapering off chicken and onto more fish.
3) EGG WHITES (and occasionally, yolks)
Rationale: High protein, easy to digest.
That's it for overtly "protein foods."
Note: daily protein intake should be no more
than about 1 to 2 grams per kg of body weight per day..
(BTW, Dr. Fuhrman, makes the point
that vegetables are also protein foods -
what do you think horses and elephants are made of?
What? Where's the beef (or lamb or pork)? I do eat
They are just too fatty for me. The immense literature condemning
satfats from animals makes it seem highly unlikely that they are
as safe as the paleo crowd believes. I'd rather get my daily fats
in the form of omega-3s from fish. BTW, I love the taste of meat
and my gut loves it. However, after eating fatty meat like lamb,
I can feel it in my palms. Look again at Loren Cordain slide showing
Note: Why is my list heavy with animal products when most of the links
I displayed in this article condemn them? Answer: I myself cannot tolerate
the legumes and many of the plant food recommended by the laudable
vegetarian advocates I cited above. It would be dishonest of me
Furthermore, this diet has led to my achieving my ideal weight
and improving my LDL and HDL. If you can
tolerate the diet advocated by Dean Ornish or
by Caldwell Esselstyn for Bill Clinton, then go for it, especially
if you have bad coronaries. (I'll let you know when and if the paleo crowd
does a study like Ornish's only showing that unlimited saturated fat
Here's another quote from my mother (a rabbi's daughter and
4) NUTS: Almonds, Walnuts, Cashews, Macademias
Rationale: tasty, compact for hiking and biking, nongreasy (unlike animal fats),
source of PUFAs and MUFAs. But need to be carefully rationed. Easy to overdo and
loaded with fat. The MUFA wiki contains a handy table of fat content in various foods.
Among the nuts, walnuts contain the most PUFAs. But, if you're not worried about
satfats, then also eat the others. As Bill Lands pointed out in his lecture above,
peanuts are loaded with omega-6 fatty acids (the pro-inflammatory "insurgents"),
so no peanuts or peanut butter (the staple of my youth). I also recommend
5) AVOCADOS and OLIVES
Rationale: tasty, good source of MUFAs, staple of Meditteranean diets,
nongreasy. Need to be carefully rationed. Loaded with fat - not for everyday consumption.
6) FRUIT: APPLES and oranges, lemons, blueberries, raspberries, etc.
Rationale: tasty, good source of carbs but need to be carefully rationed.
These little bags of sugar are seductive. I almost never buy grapes, for example.
wild varieties that our paleolithic ancestors ate. Compare a giant, sweet
modern apple to a scrawny, crab apple, and you get the idea.
My guess is that the medical establishment's recommendation to
eat lots of fruits and vegetables, gets translated to "eat lots of fruit."
(What do you think? Are people eating kale and broccoli or apples and oranges?)
If you're trying to lose weight, fruit is a huge mistake. As an experiment,
cut the fruit out entirely for awhile.
7) SALADS: Romaine, Spinach
Rationale: After listening to Joel Furman's lectures, I thought
"yes, three big heaping plates of salad per day."
I tried it and just could not do it.
My gut won't tolerate it. Note, Dr. Furman makes
the point that there is absolutely no point in putting
500 calories worth of dressing on a 5 calorie salad.
As he says, "why not just skip the salad, and
just drink the dressing straight out of the bottle."
I use marinara sauce on my salads instead of
any oil or mayonnaise-based dressings.
Dr. Furman loves beans. Sorry, I just can't do it.
8) VEGETABLES: Sweet Potatoes, Carrots, String Beans, Peas
Rationale: Sweet potatoes are an idea from the
traditional Okinawan diet. They are great.
I slice them thin and microwave them for about 3 minutes.
I eat them with some seasoning salt.
My vegetables are typically frozen (a convenience thing).
I pour them into bowls in the regular section of the fridge
and then defrost for 24 hours. I then eat them raw. I also steam
bok choy and spinach.
I'd love to be able to eat crucifers (broccoli, brussel sprouts,
cabbage, etc.) with all those wonderful anticarcinogens. If you can, go for
it. I just can't do it, despite having tried all the tricks. Apparently, this is
a problem also shared by Big Bang’s uber-nerd Sheldon Cooper, as he
tries to go on an all-crucifer diet, desiring to live long enough to do a
9) RICE and rice crackers and cakes
Rationale: I and most people on the planet have no digestive problems with rice.
It lacks the antigens present in the other grains like wheat and barley.
Rice is a staple in Asian diets, especially the Okinawan diet described above.
But watch it! Rice, even brown rice, is high-glycemic.
I never cook rice. I don't want to eat that much. It's easier to titrate
as rice cakes or rice crackers. I eat a gluten-free diet.
I drink distilled water. Our municipal water,
which comes from Sierra snowmelt, is pretty good.
But, by the time it gets to me, it tastes like iron from the pipes.
The snowmelt I drink in the Sierras every August
tastes much more like my distilled water. At home
I usually add a splash of low-cal cranberry juice. Yum.
(Also see my article on supplements I take.
A note about chewing gum. I occasionally chew
And a note on DAIRY FOODS. Most people on the planet have
As I Iook at what I actually eat, it looks far more
like a Loren Cordain paleo diet than a complex carb,
ultra-low fat vegetarian diet a la Dean Ornish. Yes, indeed.
But please note - this is heavily influenced by
what happens to work best for me .
But perhaps this is also a part of the truth that has been exposed by
the paleo advocates like Gary Taubes and Loren Cordain.
That is part of what motivated this article (the difference between
It must be carefully tailored by each of us
to our own circumstances, tastes, and tolerances.
To your health. Live long and prosper!
With Ray Kurzweil at the SETI Institute. We're holding the Drake Equation.
On January 15, 2012 I sent the following letter to Stephen Guyenet, PhD.
I wanted to sort out the statin/ saturated fat/ LDLc issues for myself to see
Similarly, with LDLc, I note that Chris Kresser poo poos it, and possibly you do, too .
And here, on January 17, 2012 Dr. Guyenet responds.Hi Dr. Blum,
Thanks for your message. My position is that LDL (most likely oxLDL (oxidized LDL),
but I can't be 100% confident that native LDL does not play a role) contributes to
atherosclerosis and thus the likelihood of having a heart attack. Statins are effective
preventative agents against heart attacks in high-risk groups (particularly secondary
prevention in men), probably via a mechanism involving LDL reduction and
suppression of inflammation (statins are anti-inflammatory and have shown efficacy
against rheumatoid arthritis for example). Statins also have negative side effects
including increased risk of myopathy, cognitive problems and diabetes.
Atherosclerosis, as far as I can tell, is primarily an inflammatory disorder, and
the primary inflammatory agent is excessive oxidized lipoproteins with insufficient
reverse cholesterol transport via HDL. But there are probably many other
inflammatory factors that can contribute to the process.
Regarding the effect of SFA (satfat) on atherosclerosis and CHD risk, I continue
to maintain that a significant role in humans has not been established.
A recent meta-analysis by Ronald Krauss's group concluded "there is
no significant evidence for concluding that dietary saturated fat is associated
with an increased risk of CHD or CVD". SFA increases LDL cholesterol content
(not necessarily particle number) in the short term, but apparently not oxLDL and
they also increase HDL. Therefore, the effect of SFA on LDL cholesterol content
cannot be used in isolation to predict its effect on CHD risk.
What we need to consider are studies that examine the effect of SFA
on CHD risk directly. These have been conducted, and they largely indicate that
SFA reduction is ineffective for CHD prevention,
particularly when it is replaced by n-6 rich refined seed oils.
I have no doubt that a simple, unprocessed, high-fiber, low-fat plant-based diet would
lower CHD risk relative to what most people eat today. Therefore I am not at all surprised
by the apparent results of Ornish, Esselstyn etc, although I think that scientifically,
they really have not rigorously established that their interventions work. My position is that
this kind of diet would be better for overall health if it included more animal foods and focused
on starchy root vegetables to a greater extent than grains, and this would still be consistent
with excellent cardiovascular health. But I have nothing against a low-ish fat diet that
contains only a small amount of meat/fish/dairy/eggs as long as it is well composed
(no white flour, seed oils, refined sugar, processed food, grains and legumes
prepared according to traditional methods). And I certainly have nothing at all against
Stephan J. Guyenet, Ph.D.
University of Washington
Division of Metabolism, Endocrinology and Nutrition
Laboratory of Dr. Michael W. Schwartz