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I added a little fat to my diet for a good reason, and discovered a far better reason for doing so: my total cholesterol/HDL ratio improved from "very good" to "excellent". Even better, my triglycerides dropped 50 percent. What's more, the added fat may have helped me become leaner.
Triglycerides and Heart Disease
Triglycerides are the fats that circulate in the blood. They are formed in the liver from the fats you eat or from the body's own synthesis of fat. They're essential for good health; your tissues rely on triglycerides for energy. Like high cholesterol, however, elevated triglycerides are implicated in arterial disease.
The importance of triglycerides has been a subject of some debate, but recent evidence strengthens the connection between high triglycerides and heart disease. The New England Journal of Medicine HealthNews, in its latest issue (May 11. 1998), highlighted a Danish study involving 3000 healthy men. This study, called the Copenhagen Male Study, found that the risk of having a first heart attack was twice as high in those with the highest triglyceride levels, compared to those with the lowest levels.
Triglyceride levels can range over 1000 (over 5000 in very extreme cases), but the Danish study found that the risk of heart attack substantially rose at levels above 140. Most doctors consider 100 or less ideal.
My medical and fitness exams at the Cooper Clinic over the last ten years have consistently shown my cholesterol profile to be very good. On the first visit, in 1988, my cholesterol was normal at 216 and my total cholesterol/HDL risk ratio was 3.7 (normal is 5.0 and below 4.0 is considered very good). My triglycerides, however, have always been slightly elevated. In 1988, they were 153, slightly above the normal range of 40-150. The pattern was the same in subsequent visits: my cholesterol ranged up to 228 (1992) and my triglycerides were 157 and 155 in 1989 and 1992, respectively.
Something happened in 1998, however.
My cholesterol dropped to 197 - most doctors like to see cholesterol below 200 - moving my cholesterol/HDL ratio into the excellent category, at 3.3; my HDL cholesterol, the good kind, remained in the excellent category, at 60. That means my risk of having a heart attack is now less than one-half the average. The really good news, however, was that my triglycerides plummeted to 95; and on a retest eight weeks later dropped another 20 percent, to 76.
Why the Big Improvement?
The reason my triglycerides dropped from borderline risk to ideal, I believe, was a seemingly minor change in my diet about six months before my latest exam. For more than 20 years I've eaten a low fat, medium protein, high complex-carbohydrate diet. I've also exercised regularly, both weight training and aerobics. That was no different. I made only one change.
To make my meals stay with me a little longer, I added 1/2 teaspoon of vegetable oil (first olive and then flax seed) to each of my meals and snacks. I wanted to take advantage of the fact that fat leaves the stomach slowly, which delays the return of hunger. It worked pretty well; I did feel satisfied longer. More importantly, however, my research suggests that the addition of only a little over one tablespoon of oil (total) caused the small, but significant improvement in my cholesterol - and the profound reduction in my blood triglycerides.
How Much Dietary Fat?
Everyone agrees that some dietary fat is necessary for good health. In The Lean Advantage (Ripped Enterprises, 1984), I pointed out the need for the essential fatty acids found in nuts, seeds, grains and other foods. I cautioned bodybuilders against trying to completely eliminate fat from their diet. Agreement breaks down, however, on how much dietary fat is ideal.
Low-fat advocate and strict vegetarian John A. McDougall, M.D., author of many books and director of the McDougall Program at St. Helena Hospital in the Napa Valley of California, wrote in The McDougall Program For a Healthy Heart (Plume, 1996): "Since all foods contain fat, you cannot create a diet composed of whole foods that's inadequate in fat. It can't be done."
Dean Ornish, M.D., whose well-publicized Lifestyle Heart Trial reversed coronary artery blockage through a program of exercise, stress reduction and a low-fat vegetarian diet, is also in the very-low fat camp.
On the other hand, Artemis P. Simopoulos, M.D., president of The Center for Genetics, Nutrition and Health in Washington, D.C. and for nine consecutive years chairperson of the Nutrition Coordinating Committee of the National Institutes of Health, says a diet high in "good fats" (monounsaturated and polyunsaturated) is the key to optimum health. In The Omega Plan (Harper Collins, 1998), she recommends eating 30-35 percent of your calories as fat (mostly "good fats").
A Fat-Making Machine!
Dr. Simopoulos says new research shows that eating a very low-fat diet "turns your body into a fat-making machine!" According to Simopoulos, it's one of our built-in survival mechanisms. Sensing that a fat famine is under way, the body converts carbohydrates into fat that circulate in your blood as triglycerides. On a high-fat diet, however, the body says, "Okay, I'm getting an adequate supply of fats in my diet, so I don't need to make any of my own."
Actually, it's well known that a low-fat, high-carbohydrate diet can drive up a person's triglycerides. This mainly occurs when calorie consumption is excessive, however. A study conducted by Ernst J. Schaefer, M.D., and his colleagues at the Lipid Metabolism Laboratory at Tufts University School of Medicine and report in the Journal of the American Medical Association (1995; 274: 1450-5) demonstrates that eating bulky, high-fiber foods usually solves the problem.
The study compared the effect of eating the average US diet, which contains 35% fat, with a high-bulk, high-fiber diet containing 15 percent fat. In addition to fat content, the critical difference was that the high-fiber diet took up more room in the stomach; it weighed 30% more than the diet most Americans eat. In fact, when required to eat enough of the bulky diet to maintain bodyweight the "subjects frequently complained ... of abdominal fullness and satiety before the end of the meals." In the final phase of the study, where they were allowed to eat as much - or little - as they wanted, Dr. Schaefer reported that the "patients all adjusted downward." Importantly, when given a choice, they automatically ate less - and lost weight.
The fear that a low-fat, high-carbohydrate diet can increase triglycerides proved well founded. Triglycerides increased 47.3%. This only happened when the subjects were forced to eat enough calories to maintain their body weight, however.
Happily, when the participants adjusted their intake of the bulky, low-fat diet to suit themselves, the outcome was much more positive. Not only did they lose weight, their LDL cholesterol (the bad kind) declined 24.3%. Significantly, when the subjects ate only as much as they wanted, their triglycerides did not increase; they were unchanged.
The message from Dr. Schaefer's study is clear: Stick to a bulky, whole-foods, low-fat diet. You'll be leaner - because you'll be satisfied eating fewer calories. And your triglycerides will be fine.
Okay, but I eat a bulky, high-fiber, low-fat diet. What happened to me?
Heredity plays a large role in these matters. Dr. Jensen believes that may be my problem. As David Prokop explained in his "Fit At 50" article about my first visit to the Cooper Clinic (the article is on this site), my father had diabetes and heart trouble, and I probably have a genetic predisposition in the direction of high cholesterol and triglycerides. "With your family history," Jensen said to me, "it would be my guess that you'd probably develop adult-onset diabetes if you weren't lean, fit and on an excellent diet."
Now, it seems I've stumbled onto something to make my diet even better. Both Dr. McDougall and Dr. Simopoulos say that omega 3 polyunsaturated fat, the kind found in flax seed oil and fatty fish, has been shown to lower blood triglyceride levels.
As you'll recall, I added a little over one tablespoon of flax seed oil to my diet before my last visit to the Cooper Clinic, and that's when my triglycerides were found to have dropped below 100 for the first time.
In the eight weeks following that exam, I doubled my flax seed oil intake and added sardines or salmon (both fatty fish) to my evening meal several times a week. That's when my triglycerides dropped another 20%, to 76.
I believe I'm onto something good. I've made an excellent diet even better - by simply adding a little "good fat."
Don't misunderstand, however. This is not to be interpreted as a license to add fat helter-skelter. My total fat intake is still a low 18%, and the saturated fat in my diet remains a very low 3%
The Leanness Factor
Something else seems to be happening. Even though I added about 200 calories of "good fat" to my daily diet nine weeks ago, my body weight has not changed. My body fat may even be trending down.
The Saturday morning after I got home from the Copper Clinic, my Tanita Body Fat Monitor/Scale registered my fat level at 6%. Since then my Saturday morning readings have varied between 6.5% and 5.5%, and have been as low as 4.5% in the evening when I'm fully hydrated.
This is not supposed to happen - calories do count - but there is at least one mouse study that could explain it. (Metabolism, Vol. 45, No. 12 (December), 1996: pp 1539-1546)
In this study, mice prone to diabetes and obesity were raised on a variety of high-fat (60%) diets, all containing the same number of calories. Interestingly, body weight gains varied widely depending on the type of fat consumed. For example, mice fed soybean oil (high in omega 6 fat) or lard (high in saturated fat) gained far more than those fed fish oil (high in omega 3).
The discrepancies were startling. According to Dr. Simopoulos, the difference in weight between the mice fed a soybean-oil diet and those fed a fish-oil diet is comparable to the difference in weight between a 225- and a 150-pound man. The lard/fish oil comparison produced a lesser disparity, but the mice on the lard diet still gained significantly more weight. Remember, all three diets contained the same number of calories and percentage of fat.
The researchers warn that humans may respond differently, but there sure seems to be something magic in fish oil.
One more thing: This study also found some magic in a high-carb diet. Mice fed a diet with 63-percent carbohydrates and only 11% fat were just as lean as those fed the fish-oil diet. Again, that's compared to mice fed a high-fat diet composed largely of lard or other oils.
Hmmm. Sounds like a low-fat, high-complex-carb diet, with a little fish oil (or flax seed oil) added to keep triglycerides in check, might be the perfect combination for leanness and health.
Chef Jeff (Novick) called my attention to an excellent seven page article by the McDougall Wellness Center on essential fatty acids (EFAs). As you know from the above, John A. McDougall, M.D., is an outspoken advocate of the low-fat diet. Dr. McDougall's basic position is that you can't create a diet of whole foods that's inadequate in fat. "It can't be done," he says.
The article suggests that McDougall may have softened his position somewhat on optimum fat intake. He still turns thumbs down on oils of all kinds, saying "The safest and healthiest way to get your EFAs is in their natural package of starches, vegetables, and fruits." He's on the fence on fatty fish; he believes the possible benefits and the adverse effects may be roughly equivalent. But he acknowledges that nuts, seeds and soybean products in moderation may be beneficial. What's more, he says without serious reservation that flaxseed -- the whole seed or ground, not the oil -- has positive effects. Among other benefits, he says flax seeds lower cholesterol and LDL "bad" cholesterol, stabilize blood sugar, provide phytoestrogens and are a good source of soluble fiber.
McDougall's bottom line recommendation is still the same: Get your "good fats" mainly from whole plant foods. As those who have read my books know, I'm a strong believer of whole foods. So, I think that's generally good advice.
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