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Carbohydrates, Fat and Heart Disease, the Pot Thickens

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About 35 years ago my wife then an ICU nurse and I a surgical resident were overjoyed to bring our 9-month old home from the hospital.  He had just survived life threatening dehydration, otitis and bronchitis. With newly placed tubes in his ears he avidly drank milk and began to gain weight.  At a check-up the doctor asked what we were feeding him.  “Whole milk” my wife beamed.  The doctor replied, “I can’t believe that you a nurse and your husband a physician do not know where heart disease comes from.”

 Autopsies of war casualties in the 1970’s were beginning to show that young soldiers had fatty steaks and even some complete blockages within their coronary arteries. Atherosclerosis was thus discovered to begin very early in life and to be associated with elevated lipids in the blood stream.  These lipids had to come from somewhere and it was only logical to assume that eating fat led to coronary artery disease.  

To the extent that fat was vilified, carbohydrates were extolled.  The food pyramid was invented.  It favored multiple servings of simple starches as the basis of a healthy diet. The food industry was quick to offer a wide assortment of processed carbs in boxes, jars, wrappers and cans.  In addition to containing massive amounts of simple sugars and later fructose these processed foods lacked the natural fiber of fruit and vegetables and were laced with saturated fats and salt.

Beyond its simplicity and naiveté, the food pyramid was based on a suppression contradictory data.  In September of 2016 the Journal of the American Medical Association on the basis of newly discovered archives reported that researchers were paid $49,000 in today’s currency to bias nutritional research. The advisory council for the sugar industry paid for, supervised and edited their research.  Though these researchers are all now deceased, one of the scientists so went on to head the Department of Nutrition at Harvard while another became head of the USDA (JAMA Internal Medicine, Sept. 13, 2016). Carbohydrates were king for decades.

Sadly while Americans followed the proscription of avoiding fat while loading up on carbohydrates, they became substantially fatter thus paradoxically increasing their risk of heart disease and stroke. These processed foods tasted so good and were so heavily promoted as healthy. We choose bread, pasta, rice, pizza, potatoes, snacks, candy and soft drinks (whether colas or fruit juice) over raw fruits and vegetables. Astonishingly, in 2016 coke or coke products were served 1.8 billion times daily worldwide (Warren Buffett, annual meeting of Berkshire Hathaway, Omaha).

And we have taught our children to eat processed carbs as well. The USDA estimates that American kids between the ages of 4 and 8 eat but 5% of the recommended daily amounts of vegetables (Scientific Report of the 2015 Dietary Guidelines Advisory Committee, USDA, 2015).  Only recently have pediatricians battled a new childhood illness—Type II diabetes.

 If diabetes were not enough, one in nine kids now has hypertension. Last month the CDC revealed that 90% of children in the US are consuming too much salt.  Over consumption of salt is the principle cause of high blood pressure.  About 75% of this overconsumption is attributable to processed foods.   Food preferences established early in life are known to continue into adulthood culminating in preventable heart attacks and stroke.

In Eat Fat, Get Thin, Dr. Mark Hymen after years of treating hypertension, diabetes, heart disease, and obesity, argues that we should eat substantially less carbohydrates and more ‘smart fat’.   This means largely avoiding most of the 40, 000 offerings of the average super market neatly packaged in boxes, cans, jars and wrappers.  While these highly processed foods are irresistibly tasty, potable, cheap, and never spoil, they contain inordinate amounts of sugar, saturated fat and salt.  ‘Bet you can’t eat one’ is the mantra that made us the fattest nation on earth.

In The Case Against Sugar, Gary Taube makes the case that all calories are not created equal.  Sugar is handled differently from protein or fat. It was never meant to be consumed in processed foods. Sugar is principally to blame for the increase in the rate of diabetes of 655% over the last 6 decades according to the CDC.

What should we eat? We could do worse than to cover half of our plate with raw vegetables and fruit and the other half in lean meats, vegan protein and mono saturated and polyunsaturated fats.  We can take solace in the fact that obesity, diabetes, stroke and heart attack will actually decline and that eggs, nuts, avocadoes, salmon and even butter (especially from grass fed cows, e.g., Kellygold), are all legitimately put back on the table.  Eating this way will cost a little more, be less convenient and actually require food preparation but hypertension, diabetes, heart disease and stroke will decline.

Dr. Al Graeve, a resident of University Place, is a member of the Board at PULSE Heart Institute and a staff cardiothoracic surgeon at Tacoma General Hospital, Multicare Health Systems.

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