Smoking good for your health? Making sense of the new fat and heart disease study.

It was like waking up in Sleeper, the Woody Allen movie, when the main character, asleep for umpteen years, wakes to find that cigarette smoking is good for your health. That’s how I felt some weeks ago after reading the half page article in the NY Times entitled “Study Questions Fat and Heart Disease Link”, based on the recent study by Dr. Chowdhury et al which reviewed more than 70 scientific studies and appears to turn our cholesterol lowering guidelines on its head.

No one is concluding you should be eating more of this.

You, my readers, may have little concern about your heart disease risk. Yet I urge you to keep reading—because unless this news splash is explained, you’ll be left feeling like health professionals just can’t get it right. I mean, one day they say saturated fats are bad, and next day they tell you they don’t impact your risk. Carbs are good, and then they’re bad. Hormone replacement therapy is recommended, and then it’s dangerous. Confronted with so much conflicting information, you, like me, might decide to trust none of it. And health professionals end up looking like a bunch of clowns.

After a deep breath, I poked through the research and sorted through the recommendations. And here’s how I’ve made sense of it so far:

• Saturated fat increases blood cholesterol levels, including LDL, the so-called ‘bad’ cholesterol. Yes, that’s still true.
• LDL does increase heart disease risk. Yup, still the case.
• But reducing saturated fat doesn’t appear to lower heart disease.

So why doesn’t reducing saturated (sat) fat appear to improve risk? There are a few explanations:

Cornbread from Food to Eat and Drop the Diet, 
fits in a balanced diet!

• Because most studies reducing sat fat reduced all fat. And when you reduce all fat something has to fill the void. Our food supply has three main building blocks—protein, carbohydrate and fats. Dramatically reduce one, something else fills the void, as a percentage of total calories. Generally, carbohydrate-rich foods replaced saturated fats in our diets. And the increased carbs tend to come from convenient, more processed, low fiber choices. Now let me clarify—those foods, themselves, as part of a balanced diet, don’t cause disease! But substituting saturated fat with a large intake of these items—rather than, let’s say foods rich in non-saturated fats (think nuts, avocado/guacamole, olive oil) raises another blood fat called triglycerides. And triglycerides increase heart disease risk. So in an effort to do something positive, namely reduce saturated fat to lower LDL/bad cholesterol, we’ve been increasing triglyceride levels. It’s like thinking that eating fat free Snackwell cookies instead of Oreos will make you healthier.

• Harvard professors Willett, Sacks and Stampfer highlight several problems with Chodhury’s study. It fails to point out that substituting polyunsaturated fat for sat fat was associated with lower risk of heart disease. And the monounsaturated fats we usually think about as the healthy ones-those from avocado, nuts and olive oil, for instance—were not the sources referred to when concluding no health benefit from monounsaturated fats. 
• When we combine lots of studies, the summary of the data may block out the small but critical findings. For instance, the authors conclude that  "Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats." And that is surely what the media jumped on. But the truth is that certain unsaturated fats did result in benefits. Specifically, the active components in fatty fish, the omega 3s EPA and DHA were clearly shown to be protective. It's well established that these fatty acids lower triglyceride levels, decrease clot formation, decrease inflammation and act as a blood thinner, among other functions. 

Don't let fatty fish scare you!
Check out our curry salmon recipe in Food to Eat.

• Supplementing with omega 3 fats had no benefit in Chodhury’s study. But here’s what I’d wonder: how consistent were supplementers with taking their supplements? Were doses at levels that really make a difference (most people mistake total omega 3s for the active EPA and DHA we’re looking to boost), and were those supplement takers already at higher risk—like maybe people who had already had heart attacks? Perhaps increasing food sources of omega 3 fatty acids (think salmon, tuna, bluefish, sardines, for instance), displaced saturated fat from other common protein sources, such as beef, pork and poultry, showing that food sources have more impact than simply supplements. Just a thought.

• Lumping saturated fats as a single category misses the differences of various types of saturated fats. Saturated fat from dairy fat, for instance, was not viewed as a bad fat; it was associated with lower cardiovascular risk (perhaps it’s time to skip the low fat cheese and enjoy the good stuff!). So if you combine a bunch of studies with different sources of saturated fats with varying benefits and risks for heart disease, it waters down the results. As this study concludes, saturated fats (AS A WHOLE GROUP) may not be the issue, but certain types remain a concern.

Where do we go from here?

Can't go wrong with my favorite wheatberry salad, made with 
whole grains,a bit of sweetness and heart healthy oil and nuts.

First, let's focus on foods, not just nutrients. To me what’s most practical is to learn from the diets of populations which have lower(ed their) risk of heart disease. This Circulation article demonstrates the benefits of a Mediterranean style diet on not just lowering cholesterol values, but significantly reducing heart disease risk—so much so, that the study had to be stopped early, given the 50-70% lower risk of recurrence. “These study subjects adopted a Mediterranean-type diet that contained more bread, more root vegetables and green vegetables, more fish, fruit at least once daily, less red meat (replaced with poultry), and margarine supplied by the study to replace butter and cream.”  Use of various oils were recommended, but not limited to olive oil, and moderate alcohol was also included.

And then there was the diet in Crete which is quite similar—full of fresh and dried fruits, grains and cereals, daily dairy, poultry and fish only weekly and red meat rarely. Oil was the predominant fat and oh, the Cretans ate desserts—and not just fruit, but pastry made with honey, too--a few times weekly!

Yes, balance.

Nope, the healthiest people were not eating low carb, nor gluten free. There was no almond milk nor fear of dairy. And fats and desserts still had a role in this most healthy way of life.

My conclusion? We should focus more on eating a balanced diet rich in a range of nutrients. Yes, back to the basics you may now fear—grains and cereals (whole grains are best), nuts and oils, fruits and vegetables and fish, including fatty types and lean meats and poultry to fill the void. Include dairy, not limited to the lowest fat ones you can stomach.

And remember there’s a place for wine and desserts, in moderation.

You? An eating disorder? Breaking the silence on binge eating disorder and OSFED.

I'm not posting this to brag nor, I'll add, to solicit more emails. 

We can't tell just looking at you who's living with an eating disorder.

And I certainly don't want those of you who are not in such a great place to feel worse about your apparent lack of recovery; I'm aware that's how some of you may think. Perhaps you, too, have come a long way on your journey toward recovery, in ways you rarely stop to acknowledge. (SHOUT OUT: identify what you have done well with today!)

Rather, I write because of what could have happened to Leah. And about what usually happens, to those with Binge Eating Disorder and other eating disorders. So please read on!

"I hope you are doing well and a Happy Belated Birthday!  I just read your latest blog post and it made me quite happy and blessed for our time together.I am happy and proud to say that I am doing great and haven't used food to deal with my emotions.  I am still in therapy and it is a big help but I have really come to the other side with my eating disorder.  I have my moments here and there but ultimately I consider my self in recovery.  I completely think a different way about food and to me that is huge.  I have an amazing relationship with food again and for that I thank you and all of your help.  It was just a year ago - March 18, 2013 that we had our first Skype session and I was in a pretty dark place and didn't know how I was going to get through it all....and then you came into my life.

To build on what Dana wrote....thank you thank you thank you for having the confidence in me when I didn't and for being there as a guide to help me get to this amazing place in my life that I can now say I am truly thankful and happy to live. Thank you!!"

I'm driven to post after an ICED (International Conference on Eating Disorders) session about the lack of treatment for eating disorders, particularly binge eating disorder and EDNOS—Eating Disorders Not Otherwise Specified (now renamed OSFED for Other Specific Feeding or Eating Disorder)—that catch all disorders not meeting the criteria for bulimia, anorexia, and binge eating disorder.

Anorexia and to a lesser extent, bulimia, are more likely to be treated—although admittedly so many more aren't in treatment and need to be. And truly, treatment is typically not long enough or intense enough or multi-faceted enough—my thoughts, not the presenter’s.

But I write about these other conditions, these seemingly lessor eating disorders because their impact is so great; of those with eating disorders, approximately 60% of women and 83% of men have BED/EDNOS combined. And while the need for hospitalization or risk of sudden death might be lower, the impact on quality of life, mood, self-esteem, body image, control over eating is tremendous. And let's not forget GI distress, heartburn, constipation, fatigue, high cholesterol, blood sugar management issues—I could go on.

You? Living with an eating disorder?

No, it's not about size!

Sufferers are rarely identified nor have their eating behaviors addressed, contributing to minimizing their own struggle. I mean, if your doctor doesn't ask the questions why would you volunteer about your struggle? More likely, attention is paid to your BMI or 'weight issue' instead. If your loved ones don't sense your struggle with food, but rather just see your weight as a concern, maybe you're the one with the distortion. If you look good and your weight is more or less fine, what's the big deal? They have no idea how you struggle. And if everyone around you is focused in how fat their thighs are or how much weight they're gaining, then you’re certainly not the one needing treatment, right?

Wrong.

Back to Leah. I received her note coincidently while at the ICED conference, and invited her to stop by, as we had never met in person. She would have surely agreed to meet for lunch—as she had come a long way from relying on froyo as lunch/dinner—but time was tight for me, so chai lattes would have to do. And our meeting got me thinking about her history. She long struggled with dieting and food rules, consuming way too much of her mental energy.  That was the norm in both her family and in her peer group.

But Leah knew that this was no way to live.

As she recalls it, it took a tweet of mine that she came across, which lead her to my blog, and then my website and then my book, food to eat, to move her from knowing to doing, to taking action on making her life around food better. We skyped, and I encouraged therapy as well. And as you can see by her note, she did it.

But what if she didn't stumble upon that tweet? Would she, or you, or your friends take the step and initiate change, to move from being ruled by food? Apparently not. The stigma and shame around binge eating and EDNOS is great,as described by Stephanie Bauer, PhD, a researcher in Heidelberg, Germany, making the barrier to change hard to get over. And I learned in a session by Federico Girosi, PhD, from the University of Western Sydney, Australia, that it's hard for those with eating disorders to consider the long term consequences of their disorder, when the short term risk of seeking treatment seems great.

I'm doing my small part. You can do yours too!

Let me tell you, you are not alone. More of you struggle with binge eating disorder and other eating disorders that don't meet the criteria for anorexia or bulimia but which need to be treated!!! You are no less deserving of being freed from the burden of your disease as the person living with cancer.

Please speak up. Halt the fat talk that you hear in your home and with your friends. Start living now, regardless of your size. Ask yourself if the cost of treatment--your fear of what you might hear and how you might feel--is really greater than the cost of not seeking treatment. Do you want to live your whole life concerned about food labels and the calories you consume? Do you want to spend time at meals preoccupied with food and it's nutritional value, rather than enjoying the company of your loved ones? And do you want to carry this sentiment to your children as well? For Leah, that might've been just the tipping point she need, as she was approaching age 30. It felt like enough was enough.

Yet there was no action until perhaps she felt like somebody got it, that she'd be understood, that the risk of shame and stigma might be lower seeking help from someone whose messages she was already comfortable with.

Or in a blog?

Please share this with your friends, whether they have an eating disorder or not. If they start a conversation about dieting or body image, turn it on it's head. share the messages you're reading here and challenge them to have a better life. Check out our new book drop the diet: guided recipes for overcoming your food rules, a modified version of food to eat, rewritten with chronic dieters and binge eaters in mind—coming VERY soon!

Work on giving yourself permission to eat, and enjoying food, all foods, regardless of their fat or carb content. And seek out the services of providers who specialize in eating disorders to help guide you along the way.

Really it's not too late.

Please share on FB, Twitter, Pinterest, email or in conversation with your community! Thanks for reading. More to come from the ICED conference soon!