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Low Fats, or Low Carbs?

Is there common ground between these two warring camps?


Updated June 10, 2014

Q: Which rival groups display the most intolerance toward one other?
  • Democrats vs. Republicans
  • Sunis vs. Shi'ites
  • Ohio State vs. Michigan
  • Low fat cardiologists vs. low carb cardiologists
A: Yep, it's the docs.

While politics, religion and sports each create their fair share of bloody rivalries, nothing beats the level of animus generated by differing dietary philosophies.

A case in point would be physicians espousing low fat diets vs. those advocating low carbohydrate diets. The low fat diets, promoted most publicly by Dean Ornish and Nathan Pritikin, stress fat-avoidance and the ingestion of high carbohydrate meals. The low carbohydrate diets, pushed most prominently by the recently deceased Robert Atkins (who died, we are assured, of non-cardiac causes,) stress a radical avoidance of carbohydrates in favor of fat and protein. Members of each group think they are absolutely and demonstrably right about the best dietary pathway to weight loss and good health, and that their opponents are intractably, thickheadedly, and disastrously wrong. Each group publishes scores of articles and books supporting their respective positions, backed up by scientific studies, and all of these tracts sound quite convincing. What we're left with is two groups of eminent physicians passionately supporting opposite points of view on something as fundamental to health as the optimal diet. So given this state of affairs, what are regular folks - those who just want to know what they should be doing to maintain their health, without sorting through food politics - supposed to do?

This question takes on even more urgency with the appearance of 3 papers from the Women's Health Initiative Dietary Modification Trial, published in the February 8, 2006 issue of the Journal of the American Medical Association, showing that women treated for 8 years with a classic low-fat diet achieved no measurable cardiovascular benefits. This study has embarassed the low-fat diet community, and has left them scrambling to explain these results. No matter how they cut it, however, it appears that the "classic" low-fat diet doesn't do the job it's supposed to do. On the other hand, just the thought of the classic Atkins diet - in which dipping your pork rinds in lard would constitute a perfectly healthful appetizer (prior to the main course of a Porterhouse wrapped in bacon) - is enough to initiate squeezing chest pain.

The purpose of this article is to review - as objectively as possible - information supporting these seemingly opposite approaches to a heart healthy diet, and to try to point out that the low fat and low carb folks aren't quite as far apart as they appear to be. In fact, it is possible to describe several dietary rules that promote both heart health and weight loss, that both groups would, though perhaps reluctantly, agree to.

The low fat case

The folks promoting low fat diets are clearly in the mainstream, inasmuch as they are fully supported by the American Heart Association, the AMA, and the USDA among other prominent health-related institutions. Their position also has the benefit of being eminently logical, and thus intuitively appealing.

Abnormally high levels of cholesterol and triglycerides are clearly associated with cardiovascular risk. Dietary fats - especially saturated fats and trans fatty acids - increase the blood levels of these bad lipids. Further, fatty foods are loaded with far more calories than the same amount of non-fatty foods, and thus lead to obesity - another major risk factor for cardiovascular disease.

It simply stands to reason, then, that strictly limiting the amount of fat (and calories) in the diet should help individuals control both their weight and their blood lipid levels, and there are plenty of clinical studies demonstrating that this is the case. There is some evidence that patients following an extremely strict low-fat diet can experience some degree of reversal of their coronary artery disease. Indeed, proponents of low fat diets simply don't understand all the fuss about the bizarre low carbohydrate diets - low fat is both logical and demonstrably effective. People who think otherwise are simply beyond help.

Page 2 - The Low Carb Case

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