by Lee Kurisko, MD
Paleo (caveman) and ketogenic (super low carb) diets are all the rage right now. I used to believe the Paleo diet was a good way to go and that ketosis is a desirable state and also believed that cholesterol was not relevant to cardiovascular risk. Currently, I no longer hold these views and could write at length about why I don’t. I used to have a cholesterol of 330, and I was not concerned as I should have been. A number like that puts me at about 15 times baseline risk for a heart attack compared to a baseline risk in the population that is very high with one in four of us destined to die of CV disease. Fortunately, I stumbled across Michael Gregor, MD and his book “How Not to Die,” which is a completely evidence based book reviewing the top 15 causes of death and the connection to nutrition. The majority of these diseases are entirely or partially connected to nutrition, and the risk can be mitigated or even eliminated with a whole food plant based diet. The longest lived populations have lived this way; the Okinawans only consumed about one half an ounce of animal products daily (prior to McDonald’s moving in) and ate an almost entirely plant based diet with ideal health profiles a few decades ago. Presently, the longest lived population on earth are the vegan Seventh Day Adventists in Loma Linda, CA.
Where are these healthy populations of meat-gorging people? They don’t exist. The Paleo advocates love to cite the Canadian Innuit (Eskimos) and the Masai tribe in Africa, but neglect to mention that the life expectancies in both cases are only about 45 at best while eating their traditional diets. Since switching to a whole food plant-based diet, I have experienced a number of amazing health improvements – and I thought my health was good. I went from about 10.5% body fat (DEXA measurement which measures the highest of all methods) to about seven or eight with no hunger. I sleep deeper. My urinary stream has markedly improved (who would have thought). I used to have the occasional fasting glucose measurement of over 100 qualifying me as a pre-diabetic. This morning, my glucose was 66 and I felt fine. By eating a whole food plant-based diet, my cholesterol (sorry, it is an important risk factor) dropped by 181 points. This is all with no meds!
Two large meta-analyses have shown no connection between saturated fat and heart disease, but they have been debunked. Firstly, they were funded by the meat and dairy industries, and secondly, used statistical methods to minimize any apparent effect. High fat diets in the short run can seem to improve diabetic control. With less carbohydrate available, yes, glucose measurements will drop in the short run. In the long run, a latent state of Type 2 DM is produced because the mechanism for insulin resistance is the presence of intracytoplasmic lipid (fat within the cells) interfering with function of insulin. Challenge a ketogenic dieter with glucose, and yes, serum glucose will go up because they have created a state of insulin resistance from all the fat that they are eating messing up insulin signaling. The mistake is to think the carbs are the problem when they are not. It is the fat! Put people on a whole food low fat HI CARB diet (beans, peas, lentils, potatoes, veggies etc.) and within a few weeks, fasting glucose will plummet!
Drs. Ornish and Esselstyn have done peer reviewed scientific studies that prove that cardiovascular disease can be reversed with a whole food plant-based diet, which is the complete opposite of a ketogenic diet. Cardiovascular disease is the number one killer in Western societies and is destined to kill one in four of us. It is the only type of diet with objective radiographic evidence to do this. It has never been shown with any other type of diet. Therefore, a whole food plant-based diet should be the default diet until anyone can come up with evidence that there is an approach that is more healthy.
I just did some blood work. My Hgb A1C was only 4.7 while eating hundreds and hundreds of grams of carbs every day! Be careful with high fat diets. Three large longitudinal studies have shown that low carb eaters die sooner. People love to hear good news about their bad habits, but sorry, bacon and eggs are not good for us!
Lee Kurisko MD is Chief Medical Officer with MediBid and radiologist with Consulting Radiologists Ltd. based in the Twin Cities. He is Medical Director of Diagnostic Imaging at St. Francis Regional Medical Center in Shakopee, Minnesota. He is trained in Family Medicine, Radiology, Neuroradiology and Nutritional and Metabolic Medicine.
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