Fat

So what does this mean? Ten percent calories from fat? How do I translate that into practical terms?

Each gram of fat has 9 calories. If you eat, let's say, 2,000 calories each day, then you want 200 calories from fat Divide 9 into 200 and you go 22 grams of fat per day. Twenty-two grams of fat is equivalent to about 5 teaspoons of oil (or butter, margarine, fat from meat, etc.). Note that we are talking about all the fat in your diet, not just the added fats, such as oils. In fact, to achieve this level, you will want very little or no added fats.

That's great. How many fat grams did you say were in an apple?

There is about half a gram of fat in an average apple.

So I can have forty four apples per day.

Well, that would comply with the fat guideline, all right, but you would not be getting the balance of nutrients that you need. Eating forty-four apples is also not the most interesting diet one could have. If you substituted some potatoes for some of the apples, you would be better off nutritionally, although that would be only slightly more appetizing.

So besides apples and potatoes, just what does 22 grams of fat a day mean, in terms of what I can eat?

To give you a brief overview, let's start with breakfast. You can eat many varieties of cereals, both hot (e.g., oatmeal, Cream of Wheat, Wheatena, other hot grain cereals) and cold (e.g., shredded wheat, Grape Nuts, puffed wheat natural grain cereals), with skim milk, fruit, and fruit juice. You can have various breads, bagels, and English muffins, but avoid cakey muffins and croissant-type pastries, which are full of butter. You can have jams, although avoid the high-sugar ones. Ideal are fruit spreads without added sugar. You can have omelettes made with egg whites or low-fat (and non-fat) egg substitutes. You can have cheeses and spreads that are made with skim milk, but not your usual high-fat cheeses. Of course, avoid butter and margarine, which are all fat.

That sounds like a pretty big breakfast. What about lunch and dinner?

You can eat any fruit. Virtually all vegetables are good, except avocados and olives, which are 90 percent fat, although the type of fat in them is monounsaturated, which is not the worst type. Grains, most breads, beans, and legumes are ideal. But don't drown these foods in fat-no butter or cream sauces or oil-based dressings. So you can have vegetable and grain casseroles of various kinds, pastas with tomato-based sauces, and salads. Try balsamic vinegar as an easy no fat salad dressing. Also, many non-fat and very low fat salad dressings are in the supermarket today.

What about meats and fish?

Many types of fish, such as sole and swordfish, are low to moderate in fat content Some varieties, such as salmon, are fairly high in fat, but the fat in fish is of a special type called omega-3 fat or fish oil, which is beneficial to some extent

A good fat?

Yes, for many people, it appears to be beneficial in moderate quantities. With meats, you have to be very careful. The type of fat in meat is high in saturated fat which is the most damaging type of It. Meat is also high in cholesterol.

So I have to become a vegetarian?

No, that's not necessary But you do have to limit both the type and quantity of meat. You need to change the idea of a big slab of meat as the centerpiece of each meal. Limited quantities of white meat of chicken or turkey cooked without the skin or very lean grades of beef or pork are acceptable. I generally recommend limiting meat or poultry to about 4 ounces per day. But if eating meat is important to you, then it is possible to go as high as 8 ounces per day, as long as the meat is lean, and you otherwise eat very little fat. For example, 8 ounces of the fight meat of chicken roasted without the skin has about 10 grams of fat. So it is possible to eat 8 ounces of meat and still stay within 22 grams of fat per day (which is the right level for 2,000 calories). Note that 8 ounces of fight meat of chicken roasted with the skin has 25 grams of fat and is clearly not acceptable. Another option is to eat no meat on one day and a larger portion of lean meat on the next day.

The limitation of 22 grams of fat-is that it? Is there anything else I have to worry about?

That is by far the most crucial guideline. If you can eat a level of fat that low over a sustained period of time you have a very high likelihood of stopping and even reversing atherosclerosis. And atherosclerosis is the cause of almost all heart disease.

There are a few individuals-less than 5 percent of the population-that have a cholesterol-handling problem not caused by diet who will continue to have high cholesterol levels despite a very low fat low cholesterol diet. This may be due to genetic factors or may have been self-induced, through alcohol abuse or use of other substances and medications. In these cases, diet plus an appropriate cholesterol-lowering medication may be recommended by that person's physician. But what often happens, unfortunately, is that the principle of "try diet firs" means trying the 30-percent-calories-from-fat diet and then going to medication when that fails. Individuals have not really tried an effective dietary approach unless they try levels closer to 10 percent calories from fat 5o fat is by far the most important factor.

What about cholesterol in food?

Cholesterol

Limiting cholesterol to around 100 milligrams per day is also very important This guideline is also stricter than the 300 milligrams recommended by the American Heart Association. Ten percent calories from fat and 100 milligrams of cholesterol have been shown to reduce both cholesterol levels and atherosclerosis far more dramatically than 30 percent and 300 milligrams. Following the l00-milligram-cholesterol guideline does not add a lot of restrictions. By avoiding fat. you are also avoiding most sources of cholesterol. There are a few exceptions. Lobster and shrimp are low in fat, but contain moderate amounts of cholesterol, so should be eaten in limited amounts. Egg yolks (as opposed to egg whites) are also low in fat, but very high in cholesterol-more than 200 milligrams in a single yolk-and so should be avoided altogether. Organ meats and brain in particular are spectacularly high in cholesterol and should never be eaten.

I've heard that it's important to eat fiber.

Fiber

The best way to avoid fat and cholesterol is to eat a diet high in complex carbohydrates. That automatically means a lot of fiber, which itself has many health benefits. Fiber is filling, aids in weight loss, improves digestion, elimination, and blood sugar regulation, and lowers cholesterol. The soluble fibers found in legumes such as peas and beans may be effective in lowering the LDL, or "bad" cholesterol, levels. The insoluble fibers found in most fruits and vegetables are effective in improving elimination and lowering the risk of cancer.'

I've also heard that iron may cause heart disease.

Iron

There are studies that suggest that an average or higher blood iron level is a risk factor for heart disease. A recent study of 1,931 Finnish men, reported by Dr. Jukka Salonen and his associates at the University of Kuopio, showed elevated risk of heart disease with elevated ferritin (a protein that carries iron in the blood) levels.

It should be noted that blood levels of cholesterol and iron are highly correlated. Also, these results in no way alter the role of cholesterol, particularly LDL (the "bad" cholesterol), as a major independent risk factor for heart disease.

The two substances may work together to promote atherosclerosis. It is known that iron promotes oxidation (combining with oxygen). The process of artery plaque formation appears to start with the oxidation of LDL,a process that may be accelerated in the presence of iron. This is consistent with the studs finding that the most dramatic increase in risk was noted for those men with elevated levels of both LDL cholesterol and ferritin.

If iron is a risk, what would that mean?

The dietary implications of avoiding fat and cholesterol and of avoiding iron are similar. Avoiding foods that are high in fat and cholesterol, particularly red meat and other foods of animal origin, will automatically avoid foods that are high in iron. So following the guidelines of the 10% solution for dramatically reducing the level of fat and cholesterol in the diet will automatically avoid concentrated sources of iron. Liver, which in any event is high in fat and cholesterol, is particularly high in iron. It would also be a good idea to avoid iron supplements (unless you have a significant deficiency of iron), vitamin and mineral supplements that include iron, and so-called "fortified" foods which have added iron.

Is there anything else one can do to lower ones level of iron in the blood?

Exercise appears to cause changes in metabolism that interfere with the ability of iron to accelerate damaging oxidation. Also, menstruating significantly lowers the level of iron. This has been proposed as an additional reason that women are protected from heart disease prior to menopause.

Not all of us have that opportunity.

For men and post-menopausal and other nonmenstruating women, donating about three units of blood each year would have a similar effect on iron levels. You should check with your physician to make sure that you are not prone to anemia or other medical conditions that would prevent your donating blood.

So menstruating or giving blood can protect one from heart disease.

Additional studies are needed to clarify the independent role of iron. Donating blood will lower one's iron level and may help to protect you from heart disease. We do know, however, that it can help save me lives of others.

Following the nutritional guidelines of the 10% solution will lower blood and bodily stores of both LDL cholesterol and iron and is by far the most effective way to reduce heart disease risk. In the Finnish study, those with the lowest levels of ferritin had half of the heart disease risk compared to those with the highest levels (above 200 micrograms per liter). Following the guidelines of the 10% solution for a sustained period substantially reduces both LDL and iron levels and can reduce the risk of heart disease by 90 percent or more.

The evidence for a direct link between dietary fat and the development of both heartsease and most cancers is very extensive. Avoiding fat and cholesterol in the diet (which automatically avoids concentrated sources of iron) will provide a very high level of protection from all of these diseases.

Sodium

Another important dietary guideline is to restrict the intake of sodium, which can contribute to hypertension and other conditions. An excessive level of sodium can cause your blood volume to increase. This increases blood pressure, promotes atherosclerosis, and can increase the risk of a stroke or a heart attack. Staying below 2,000 milligrams per day is safe. Since salt is half sodium, that means less than 4,000 milligrams (4 grams) of salt

Persons with normal blood pressure and no history of hypertension or coronary heart disease can probably stay healthy at a level of 3,000 milligrams of sodium (or 6 grams of salt) per day.

Without any known exceptions, in societies that have diets very low in fat and sodium, individuals have lifelong low blood pressure.²

It is advisable to add no salt to your food at all. Many packaged foods contain a large amount of added salt Tomato juice, for example, typically has about 600 milligrams of sodium in a 6-ounce serving. You will, of course, be avoiding such salty snacks as potato chips for their fat content if nothing else. A 2-ounce bag of potato chips can have 20 or more grams of fat, which is your whole day's allotment They are also very high in sodium. In general, pretzels are usually not that high in fat, but you should brush off most or all of the salt

But that's what makes them taste so good.

Sugar

Well, you will change your ideas about that before long. Salt is actually a taste killer. And the more you use it the more you need it for taste. Sugar is also worth avoiding. Unlike the more complex carbohydrates, sugar is digested very quickly and results in a sudden increase in blood insulin levels to process the extra sugar. The insulin processes the sugar and, ironically, often leads within a few hours to rapidly falling and low levels of blood sugar. This leads to further cravings for sugar. When combined with high-fat diets, this pattern can lead to chronic sugar imbalances, either hypoglycemia (low blood sugar) or type II diabetes(sustained high blood sugar). Even if these extremes in sugar metabolism are avoided, concentrated ingestions of sugar and fat can lead to a recurrent cycle of low blood sugar causing sugar cravings leading to further large ingestions of sweets. Usually these sweets are also high in fat, which is the most damaging aspect of indulging in them. If you eat sweets that are low in fat, such as non-fat frozen yogurt (low-fat frozen yogurt may be okay depending on the fat content, but remember to keep track of the fat grams it contains), frozen fruit desserts, and the like, in moderate quantities, then the health problems associated with sugar are limited. It is sugar combined with fat that causes the most significant problems. In fact, serious, chronic problems with sugar metabolism, such as type II diabetes, are caused primarily by fat (and calories) in the diet, not sugar.³

The sugar and salt guidelines sound fairly moderate. The cholesterol guideline seems to affect mostly the same foods as the fat guideline. So the 10 percent-calories from fat guideline seems to be the heart of the matter

Indeed that is well put.

It may be the heart of the matter, but it also seems a bit extreme. It sounds quite different from the way I am now eating. I mean, no ice cream? None of the desserts I am used to eating? No steaks? No french fries? No potato chips? What happened to moderation? Moderation in all things-isn't that also a reasonable guideline?

It is true that there are a lot of things you cannot eat following the 10% solution. But there is an equally long list of things that you can eat. And society is beginning to respond. Our Yankee ingenuity is being applied and there is an increasingly large array of prepared foods from entrees to desserts that are very low in fat (or even non-fat) that are quite appealing. The chairman of Con Agra, one of the nation's largest manufacturers of food, after suffering a heart attack, directed his firm to develop a low-fat line of frozen dinners, which resulted in the successful Healthy Choice series. You can now find very low fat and nonfat varieties of many foods, including frozen desserts, puddings, mayonnaise, even hamburgers. It does take time to discover the foods that appeal to you and that comply with these guidelines, but you would be surprised how much variety you have.

As for moderation, I tend to be a moderate person. But the more I have studied this issue, the more it has become apparent that it is our society that is not moderate. Somewhere along the line, our dietary habits diverged from what is healthy for the human species. We may have evolved intellectually from animals, but our digestive system is not that different from many other mammals, particularly other primates. You have only to examine what chimpanzees and other primates choose to eat when left to their own devices in the wild to obtain one example of a healthy diet.

The divergence of the (primarily Western) "civilized" diet from the diet on which we evolved and thrived began to pick up steam with the advent of the Industrial Revolution. Prior to the Industrial Revolution, such luxuries as rich cakes and large slabs of meat were simply not available to the masses. Even refined sugar was a delicacy available only to nobility and the wealthy. As the Industrial Revolution made the mass production of these items possible, the rich food of the upper class became available to the common man.⁴ This divergence accelerated after World War II when modern production methods led to such innovations as fast food and other manufactured foodstuffs that are typically extremely high in fat, and often salt and sugar as well. The typical fast-food hamburger is more than 50 percent fat, much of which is saturated, with a very high sugar content in the bun.

It is our society that is radical, unfortunately in a very negative direction. We have thousands of people having heart attacks, with nearly three thousand losing their fives from heart and cardiovascular disease each day. Almost all of this destruction is preventable. We know what to do and how.

With the American diet so drastically off the mark, moderate changes won't make much of a difference. It is similar to saying "be moderate" to a smoker. "Don't cut out cigarettes, just cut down a bit, maybe switch to a lower tar and nicotine brand." That, in fact was exactly the approach to smoking that was taken by the medical community after World War II. But as the evidence mounted, it eventually became irresistible and the recommendations today are to avoid cigarette smoke altogether, even in the air around you. But it took more than forty years for that position to be accepted.

So the 10% solution is extreme only in comparison to the extreme devastating diet that people now follow.

Wasn't primitive man a carnivore? You know, the hunter and all that.

Primitive Man

Yes, primitive man ate meat and so can you. But our hunting forebears did not buy one-pound slabs of meat in the grocery store. The amount of work and expenditure of energy involved to hunt a small animal was usually enormous. And this animal was then shared by several families or a whole community. So the amount of meat eaten was generally limited. The meat was also much leaner. Wild animals are usually no more than l0 to 15 percent fat, whereas our genetically altered, hormone-induced livestock are closer to 30 percent fat (by weight). A survey of fifteen different species of African animals in the wild found an average carcass fat content of about 4 percent While it is hard to generalize about many scattered primitive communities over thousands of years, meat was usually not the primary constituent of the diet. The small amounts of lean meat that were shared by a community were generally supplemented by larger amounts of roots, beans, nuts, tubers, and fruits, which were gathered. Recent studies of primitive man have estimated his fat consumption at no more than 20 percent of his calories, and often less. Also, his physical activity level went way beyond that of even our more avid fitness fans, and everyone was involved.⁶

Degenerative diseases that are still unknown to primates in the wild include heart disease; stroke; type II diabetes; breast, colon, and other cancers; arthritis; gallstones; hypertension; glaucoma; and cataracts. The available evidence appears to suggest that primitive man was also free of heart disease. Interestingly, if we subject the primates in captivity to our civilized diet, they do develop heart disease and these other degenerative diseases.⁷

Okay, so dramatically lower the level of fat in the diet, watch those high cholesterol foods that are not otherwise eliminated by way of their fat content, control salt, and watch sugar to some extent. Iron is largely avoided by avoiding fat and cholesterol, but avoid iron supplements and "fortified" foods. Is that it?

Exercise

The other crucial issue is exercise. Numerous studies have shown the effectiveness of exercise in reducing heartdisease,cancer,hypertension,diabetes,obesity,osteoporosis,and other ailments, particularly when combined with a healthy, that is, low-fat, diet. We do not understand all of the mechanisms for this, but several are apparent. Exercise is one of the few ways to increase the level of "good" cholesterol, or HDL, in the blood.⁸ HDL mitigates some of the damage done by LDL. One of the primary findings of the Framingham Study showed that a primary risk predictor for heart disease was the ratio of total serum cholesterol to HDL So increasing HDL reduces heart disease.

There is also evidence that exercise thins the blood, thus reducing the likelihood of clotting.9 Once your atherosclerosis has gotten to the point that your arteries are blocked in that 70 percent-plus danger zone, the factor that actually causes the heart attack or stroke or other catastrophic event is a blood clot developing on or getting stuck in the plaque-clogged artery Reducing spontaneous clotting thus at least reduces the likelihood of this final coup de grace.

Exercise also improves bowel function. The more rapid transportation of food through the digestive tract reduces the likelihood of colon cancer, one of the most prevalent and deadly cancers in American society.¹⁰

Exercise improves body composition and shape. It also greatly assists with weight loss. If you exercise properly, you tend to burn fat rather than sugar and glycogen stores. Exercise suppresses appetite and increases your metabolism, even after you finish exercising. It also strengthens your bones and support tissues and can slow or prevent the development of osteoporosis, which is a loss of bone calcium.¹¹ Eating a sufficient amount of calcium is important, but by itself is not sufficient to prevent this condition.

Regular aerobic exercise also strengthens the heart and enlarges the diameter of the arteries to handle the increased blood flow. This means that atherosclerosis will take longer to clog up the artery.¹²

There is also literature indicating that exercise may increase the development of collateral circulation.¹³ Collateral circulation is the development of additional arteries to supplement the crucial coronary arteries. Collateral arteries tend to develop later in life in the presence of artery disease and often enable an older person to survive a heart attack. But at any age, exercise will promote the collateral circulation process. The development of collateral circulation is a primary hope for people whose arteries are approaching complete blockage. If there is still blood flow through a partially occluded artery, then it is possible through the 10% solution to begin a reversal of the atherosclerotic process and start reducing the occlusion. If an artery is completely blocked, however, then collateral circulation would be the mechanism for maintaining a healthy flow of blood. It is possible over time to develop sufficient collateral circulation to restore blood flow to near the level provided by the original coronary artery.

Exercise increases blood flow to the brain, providing better mental functioning and alertness.¹⁴ Perhaps most interesting is the contribution of exercise to mood. An evolutionary adaptation is the release of natural tranquilizers called endorphins during aerobic exertion.¹⁵ These tranquilizers permit sustained physical activity and thus block the level of stress and even pain that might otherwise accompany such activity. It allowed our ancestors a sustained flight from a hungry predator. These endorphins, chemically related to morphine, result in a natural high that elevates mood for a sustained period of time. It is actually a wonderful treatment for mild depression. It is a chemically induced high that is legal, healthy, and always available.

One thing that exercise will not do is lower the level of LDL, the "bad" cholesterol, in the blood. For that you need a diet low in both fat and cholesterol.

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