| When I read the front page headline in the | | | | follow-up--from the Nurses' Health Study of |
| February 7 edition of the New York Times, | | | | dietary fat intake and risk of coronary heart |
| LOW-FAT DIET DOES NOT CUT HEALTH RISKS, | | | | disease. It showed clearly favorable results. In |
| my 35 years as a cardiologist-researcher told me | | | | January of this year, a report in The Lancet |
| something was probably amiss. The article that | | | | analyzed the effect of fruit and vegetable |
| followed seemed to faithfully report the | | | | consumption in eight studies that included a total |
| conclusions of an 8 year, $4.15 million study of | | | | of 257,551 men and women with a 13 year |
| nearly 49,000 postmenopausal women from the | | | | average follow-up period. The investigators |
| Women's Health Initiative (WHI) Trial. But after | | | | concluded: "Our results provide strong support for |
| carefully reviewing the original reports in the | | | | the recommendations to consume more than five |
| Journal of the American Medical Association, I | | | | servings of fruit and vegetables per day, which is |
| discovered the problem. Fundamental flaws in the | | | | likely to cause a major reduction in strokes." |
| research invalidated the dangerously misleading | | | | Since the WHI study was undertaken, a revolution |
| headline. | | | | has taken place in our understanding of specific |
| The government sponsored study followed | | | | types of dietary fat. Intakes of specific fats are |
| women, ages 50 to 79, to determine whether a | | | | related far more strongly to heart disease risk |
| group assigned to a low-fat diet lowered their risk | | | | than total fat. Collectively, these analyses |
| of breast and colon cancer, heart attacks and | | | | demonstrate that a diet lower in saturated fat |
| strokes when compared to those allowed to eat | | | | (fatty meats and butter) and trans fat |
| whatever they pleased. The researchers found no | | | | (processed foods, and stick margarines), and |
| difference for any of the diseases between the | | | | higher in monounsaturated (olive, canola and |
| two groups. | | | | peanut oils) and polyunsaturated fat (safflower, |
| Authorities hailed the report. Newspaper quotes | | | | sesame and corn oils), as well as amounts of fruit |
| read: "revolutionary," "the Rolls-Royce of studies," | | | | and vegetables not approached in the WHI Trial, |
| "overturning three decades of wisdom," "largely | | | | help prevent heart disease. In fact, a trend was |
| closes the book on a highly publicized chapter of | | | | observed toward reduction of cardiovascular |
| dietary history." Does it? If the women who ate | | | | disease risk in the quartile of women who ate the |
| whatever they pleased did as well as those | | | | lowest amounts of saturated and trans fat, and |
| struggling to cut fat intake, doesn't that mean | | | | highest monounsaturated and polyunsaturated |
| that we are finally and forever free to pursue a | | | | varieties. If the study had been carried out longer, |
| diet of bacon cheeseburgers, and chocolate | | | | this observation might well have become |
| cheesecake? Unfortunately, the answer is no. The | | | | statistically significant. |
| reason? The problems with the WHI study make | | | | The WHI investigators noted this, stating that |
| it impossible to draw valid conclusions. | | | | "Trends toward greater reductions in CHD |
| The women assigned to the low-fat group were | | | | (Coronary Heart Disease) risk was observed in |
| instructed to reduce their total fat to 20% of | | | | those with lower intakes of saturated fat or trans |
| total energy intake. They fell far short of that | | | | fat or higher intakes of vegetables/fruits." They |
| goal, decreasing the fat to 29%. Additionally, the | | | | concluded by suggesting that "more focused diet |
| comparison group (after receiving a copy of the | | | | and lifestyle interventions may be needed to |
| Dietary Guidelines for America, and other | | | | improve risk factors and reduce CVD |
| health-related materials) also decreased their | | | | (cardiovascular) risks." |
| dietary fat to approximately 35%. | | | | So, what to do? My advice may surprise you. |
| Given the minor dietary differences between the | | | | The primary goal of healthy eating is to reach and |
| two groups, the resulting minor differences in their | | | | maintain a normal body weight in order to lower |
| "bad" (LDL) cholesterol levels was predictable. In | | | | the risks of diabetes, high blood pressure or the |
| the "low-fat" group, average LDL-cholesterol fell | | | | metabolic syndrome (the combination of diabetes, |
| from 133 to 123 mg/Dl, while the "eat anything" | | | | hypertension and a particularly malignant form of |
| group also fell, from 134 to 127! Both levels are | | | | high LDL-cholesterol). This is best achieved, not by |
| well within the recently revised Federal guidelines | | | | "going on a diet," but by learning to develop |
| that recommend LDL-cholesterol be kept below | | | | sensible eating habits. Heart-healthy eating is easier |
| 130 in individuals without additional cardiovascular | | | | and more satisfying than one might think. There is |
| risk factors. | | | | no need to deprive yourself of an occasional |
| In addition to the low "bad" cholesterol levels, both | | | | steak or delectable dessert, while nibbling |
| groups had high amounts of "good" (HDL) | | | | miserably on raw carrots for the rest of your |
| cholesterol, ranging from 58 to 60 mg/Dl. Normal | | | | days. Healthy eating is a long-term commitment. It |
| "good" cholesterol levels are 30 to 60, and those | | | | is about choosing nutritious foods that are |
| in the higher ranges are at a significantly lower | | | | satisfying by making sensible substitutes, |
| risk for cardiovascular disease. Thus, both groups | | | | modifying favorite recipes, adopting an |
| had highly desirable cholesterol profiles. | | | | experimental attitude, and discovering over time |
| It should come as no surprise that the "eat | | | | what works best for you. |
| anything group" had a 30% lower incidence of | | | | To round out a heart-healthy lifestyle, become |
| developing cardiovascular diseases than the | | | | physically active. Exercise is the great health |
| researcher-statisticians originally anticipated. The | | | | facilitator because it increases HDL ("good") |
| higher prediction of disease occurrence was the | | | | cholesterol, lowers blood pressure, helps prevent |
| main reason why the study was designed to be | | | | diabetes, and improves heart function. In addition, |
| only eight years in duration. | | | | physical activity is a natural antidepressant, and a |
| How does this study apply to men? According to | | | | great way to rediscover the wonders of your |
| the Los Angeles Times, "it probably applied to | | | | body. Research has shown that you can reap |
| men as well because the disease mechanisms are | | | | major health benefits with a minimum amount of |
| the same." Even if the study was valid, that | | | | effort and time. Begin by taking brisk walks for |
| conclusion would not be, because the assumption | | | | 30 minutes or more, several times a week. |
| about similar disease mechanisms omits a crucial | | | | Decrease sodium intake if you have a tendency |
| fact. Since men typically have much lower "good" | | | | towards high blood pressure, and of course, avoid |
| (HDL) cholesterol levels than women, decreasing | | | | tobacco exposure. |
| their "bad" (LDL) cholesterol is considerably more | | | | Despite the findings from the WHI Trial, it is vital |
| important. | | | | for women, and men, to understand that simple |
| Confused? Don't be. A solid body of evidence | | | | lifestyle changes do provide invaluable health |
| supports the notion that lifestyle changes do | | | | benefits. They also provide a wonderful bonus. In |
| decrease the risk of cardiovascular disease. Last | | | | addition to being healthier, you will look and feel |
| year, the American Journal of Epidemiology | | | | healthier too! |
| published a large report-with a 20 year | | | | |