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From:	Claudia (conpx05.cms.hhs.gov)
Subject:	Question #3
Date:	September 6, 2007 at 11:56 am PST

In Reply to: Re: Need to keep fat low and calories high posted by Andy on September 6, 2007 at 2:21 am:

Andy,

Here is a quote from Dr. Fuhrman, where he describes some of the problems people can run into when following an ultra lowfat vegetarian diet:

"they can develop dry skin, painful fingers, thinning hair, poor sleep, lethargy, muscle aches, higher triglycerides, and higher lipids and glucose and even failure to lose weight because of the lack of fat in their diet."

Some doctors, who had not anticipated that there could be a downside to a lowfat vegetarian diet, have found a need to change their advice some over the years. Dr. Fuhrman gives the example of Dr. Ornish as follows:

"what happened was that so many started developing cardiac arrhythmias and other medical problems that Ornish had to change his recommendations and start telling his patients to take flax seed oil and fish oil"

As far as the studies go, Dr. Fuhrman points out that the preponderance of the evidence shows that having nuts and seeds in the diet plays a very important role in heart health:

"First of all there is a whole body of literature showing that nuts/seeds offer dramatic reduction in heart attack deaths and the data is more substantial compared to any other research on any other food with regard heart disease. No food shows as much power to reduce heart disease deaths as do raw seeds and nuts. Most of the studies were excellent and funded by the National Institure of Health and other countries and not by the nut companies.... This idea that all fat and nuts/seeds are heart disease or cholesterol unfavorable has been thoroughly disproved over and over again....Eating raw nut/seed save lives,

Kris-Etherton PM, Zhao G, Binkoski AE, et al.The effects of nuts on coronary heart disease risk. Nutr Rev. 2001 Apr;59(4):103-11.

Epidemiologic studies have consistently demonstrated beneficial effects of nut consumption on coronary heart disease (CHD) morbidity and mortality in different population groups. Clinical studies have reported total and low-density lipoprotein cholesterol-lowering effects of heart-healthy diets that contain various nuts or legume peanuts. It is evident that the favorable fatty acid profile of nuts (high in unsaturated fatty acids and low in saturated fatty acids) contributes to cholesterol lowering and, hence, CHD risk reduction. Dietary fiber and other bioactive constituents in nuts may confer additional cardioprotective effects.

Hu FB, Stampfer MJ, Manson JE, et al. Frequent nut consumption and risk of coronary heart disease in women: prospective cohort study. BMJ 1998;317:1341-1345 ( 14 November )

Objective: To examine the relation between nut consumption and risk of coronary heart disease in a cohort of women from the Nurses' Health Study. Subjects: 86 016 women from 34 to 59 years of age without previously diagnosed coronary heart disease, stroke, or cancer at baseline in 1980. Main outcome measures: Major coronary heart disease including non-fatal myocardial infarction and fatal coronary heart disease. Results: 1255 major coronary disease events (861 cases of non-fatal myocardial infarction and 394 cases of fatal coronary heart disease) occurred during 14 years of follow up. After adjusting for age, smoking, and other known risk factors for coronary heart disease, women who ate more than five units of nuts (one unit equivalent to 1 oz of nuts) a week (frequent consumption) had a significantly lower risk of total coronary heart disease (relative risk 0.65, 95% confidence interval 0.47 to 0.89, P for trend=0.0009) than women who never ate nuts or who ate less than one unit a month (rare consumption). The magnitude of risk reduction was similar for both fatal coronary heart disease (0.61, 0.35 to 1.05, P for trend=0.007) and non-fatal myocardial infarction (0.68, 0.47 to 1.00, P for trend=0.04). Further adjustment for intakes of dietary fats, fibre, vegetables, and fruits did not alter these results. The inverse association persisted in subgroups stratified by levels of smoking, use of alcohol, use of multivitamin and vitamin E supplements, body mass index, exercise, and intake of vegetables or fruits. Conclusions: Frequent nut consumption was associated with a reduced risk of both fatal coronary heart disease and non-fatal myocardial infarction. These data, and those from other epidemiological and clinical studies, support a role for nuts in reducing the risk of coronary heart disease. "

Esselstyn did show great success in reversing heart disease when working with a small group of patients who already had advanced heart disease. This does not mean that adding a few raw nuts to their diet would have sabotaged their success, and in fact it may have helped them to recover more rapidly. The culprit that is associated with heart disease is the saturated fat obtained from animal products, not the fat obtained from nuts and seeds. It is by removing the cause of the problem that the disease begins to resolve itself. In a sense, correcting heart disease through diet isn't rocket science. It isn't nearly as complex as something like cancer. There are many doctors who have had great success in using diet to reverse heart disease. On Dr. Fuhrman's blog, I read that in the 15 years he has been practicing, he has never had a patient under his care, and following his dietary advice, who suffered a heart attack. Not even one, and thats really the way it should be, don't you think?

As for the relative percentages of protein, carbs, and fat, some doctors try to specify specific ranges, as in the Barry Sears "Zone" diet. Dr. Fuhrman does not feel that there are specific magical percentages that are optimal for each of these 3 macro-nutrients. Rather, there is a wide range of percentages that could be healthy, and we have differing individual needs in this area. A person who is trying to lose weight might have a somewhat lower fat diet than a world class athlete who may need the additional fat and protein.

Another thing to take into consideration is that the number of total grams of these macro-nutrients can be more significant than the relative percentages. That is, given that most americans are eating an excess of calories, and calories only come from protein, carbs, and fat, the chances are that the average american is eating too many grams of all 3 macro-nutrients, regardless of what the relative percentages might be. That is, most people are just eating too much food.

Consider 2 people of the same age, height, and gender, and level of activity, and assume that they both only really need 1500 calories a day. One eats 1500 calories per day, with 300 calories from fat, while the other eats 3000 calories per day with 300 calories from fat. Both are eating the same number of calories from fat, but for the 2nd person it is only 10% of their total calories, and for the first person it is 20%. Is the 10% fat person doing better than the 20% fat person? I think not, because they are stuffing themselves to the gills in the process of getting their fat percentage down to 10%! Interesting, isn't it?

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