My colleague Caldwell Esselstyn MD eats a plant-based, vegan diet that is virtually fat-free (10% or less) and completely devoid of all fish and animal products of any kind.  He has eaten that way himself for years now, and he has documented the reversal of severe coronary artery disease in a number of patients whom he has taught to eat the same way.

Then there is Dr. Robert Atkins, of the renowned Atkins Diet, and Dr. Richard Feinman, a biochemist from SUNY Downstate Medical Center who conducted the first serious scientific research on the Atkins Diet.  Feinman observes that “the deleterious effects of fat have been measured in the presence of high carbohydrate.  A high fat diet in the presence of high carbohydrate [doughnuts] is different than a high fat diet in the presence of low carbohydrate [steak with buttered broccoli].”

Last week someone showed me a copy of the Mayo Clinic diet their doc had handed them a few weeks earlier. Low-fat chicken.  Grapefruit and tomato juice (They have a lower glycemic index than apple, grape and orange juices.).  Lots of produce.  Anyone can lose weight eating like that.  The question is whether you can eat like that for the next 50 years.  And when you get sick of this restrictive diet, what is the dieter supposed to add back next?  Anyway, that’s not what struck me most.  What I noticed first was — no manufactured calories.  That’s key to any successful eating plan.

Michael Pollan says we should “eat food, not too much, mostly plants.”  What does Michael Pollan mean when he says to eat “food”?  Well, he’s written a whole book about it, and I won’t reproduce it here, only to say that he means items that human beings have eaten throughout evolution.  He does NOT mean items that are an invention of the 20th century.  So we’re not talking about Crisco, or granola bars, or ho-ho-ding-dongs, or shakin’ bakin’, or crisps or chips of any kind. These things aren’t food; they’re manufactured calories.  Food is things our great-great-great-grandparents ate, and things that we ourselves can prepare in the kitchen with ingredients that are easy
enough to grow ourselves or find at the market.

So which diet is the right one?  I believe they all are.  Esselstyn, Atkins, Feinman and Pollan are like the proverbial blind men all touching and describing a different part of the great big elephant in the living room.

I love mixing metaphors.

Dr. Esselstyn has observed that if he can get people to eat ONLY vegetables, legumes (beans) and whole grains, their cholesterol improves, their blood sugar improves, their blood pressure improves, and they lose weight, especially around their midsection.  He even has data to show that coronary artery disease can be reversed, partial blockages be resorbed, and blood once again flow freely through open vessels.  Dr. Esselstyn reports that the only patients who “fail” the diet are the ones who “cheat” by going back to eating small amounts of processed foods containing very small amounts of processed fats (containing very small amounts of trans fats).

Back in the 1970’s, Dr. Atkins observed that if he could get people to stop eating carbohydrate, their cholesterol improved, their blood sugars improved, their blood pressure improved, and they lost weight, especially around their midsection.  At first, Atkins didn’t realize that there was a difference between stripped carbs (mainly white flour and sugar) and other carbs, such as produce, dairy, whole grains and legumes.  So he said not to eat any carbohydrate at all.  Later on, he did come to understand that we pay a huge metabolic price for eating stripped carbohydrates, and then he created guidelines for incorporating only nourishing carbs.

Michael Pollan’s approach?  I’ve been using my own version of it, and guess what?  Patients’ cholesterol improves, their blood sugar improves, their blood pressure improves, and they lose weight, especially around their midsection.  The way I see it, Esselstyn, Feinman, Mayo and Pollan are each touching a different part of an elephant called FOOD.

My take-home message this week is that the ultimate effect of adopting any of these diets is to decrease immediately the amount of manufactured calories you eat, and to replace them with real food.  That real food might be sweet potato, sprinkled with cinnamon, wrapped in kale, and served with brown rice.  It might be lemon-butter sauce on roasted chicken.  It might be fried eggs and carrot soup.  It might be as simple as a spoonful of peanut butter.  What it isn’t is deep-fried tater tots and chicken nuggets.

I’m not saying that all of us can eat any of these diets interchangeably.  We have to experiment and figure out what is right for us.  What I am saying is that, because these approaches are all based on real food, the answer will lie somewhere in and among them.

And the elephant in the living room?  The fact that the standard American diet is causing the obesity and diabetes epidemic.  We are doing this to ourselves, and it will end when we stop eating manufactured calories.  We hold the solution in our own hands.  Now…go make a pot of soup!

Thank you, KevinMD.com, for picking up my post on a Virtual Visit to the Supermarket !  Check it out at KevinMD.com !
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Have you ever had a problem that turned out to be a blessing in disguise?     

A long time ago I used to know a family that had a daughter with a corn allergy.  The way they found out about it was that she used to get these terrible headaches, and then get sick to her stomach.  When it started, she was little, like 6 or 7 years old.  It got so bad that she practically couldn’t leave the house.  Often, she would get sick on the bus in the morning, so at first they thought it was all about school.  I don’t need to tell you that they tried EVERYTHING.  

Now this happened about 20 years ago.  Nowadays everybody talks about food, but it wasn’t like that 20 years ago.  So you can imagine how desperate they all must have been if the pediatrician recommended an “elimination diet.”  If you don’t know what that is, it’s a structured, programmed method for determining what foods are causing symptoms.  Basically, you completely stop eating a select food group for three weeks (dairy, for instance), and then you eat a ton of it (like pizza, ice cream, etc.) over one weekend.  If your symptoms slowly disappear for a few weeks, and then come back with a vengeance when you reintroduce the food, you’ve got your answer.  

In this kid’s case, the problem was so bad that they decided to do the elimination diet in a more drastic way — backwards.  They were going to give her just one food to start, and then reintroduce other things one at a time.  They used an interval of one week instead of three weeks because it made more sense under the circumstances.  I don’t remember what she ate the first week, maybe chicken.  Just chicken.  It was a long week.  

But I do remember what they gave her on week 2 — Cola.  I really have no clue why the pediatrician picked that.  Maybe she thought it was easy to digest.  Maybe she wanted to make it easier for the little girl to cooperate, and thought the soda would be a nice reward. 

As a doc, I am an inveterate people-watcher.  I watch people walk, move, and think.  I notice the angle of their shoulders, their hands, the looks on their faces, their skin.  When people start trading processed, food-like stuff for real food, the skin on their faces becomes smoother, less puffy, younger looking.  Its yellowish cast is replaced by a pink shine.  As the levels of insulin responsible for the deposition of central, visceral fat begin to plummet, even children lose the soft double chin hanging from their jaw bones.  I see these changes as readily as I see a week without sleep, or a new coat.  

The little girl’s case was even more dramatic.  Within minutes, she was sobbing and puking.  Her mom picked up the can, and turned it over to read the ingredients.  Then she picked up the phone to call the pediatrician.  It was the corn syrup.   

The story ends well.  With just a few mishaps over the years, the young girl grew up without symptoms, and without corn.  In the way that many families do to accommodate one member with a serious food allergy, her entire family stopped eating all products containing corn.  That means all processed food.  They stopped eating most breakfast cereals, candy, soda, store-bought baked goods.  No more cheap restaurants, cheap ice cream, corn starch, food starch, high-fructose corn syrup.  In a nutshell, they stopped buying things with an ingredient list.  It wasn’t something they chose.  They had to do it.  The health and wellbeing of their daughter was at stake.

Then something unexpected happened. 

Over the next few months the entire family became slender, more relaxed and more active.  At the time, no one could explain it.  But the mom said it was certainly the best thing that could ever have happened to them. 

Next week:  More on getting off the American food grid: what the vegan and Atkins diets have in common!
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If you think of good health as an investment in three different kinds of activities — eating, moving and relaxing — then I would say that many, if not most, of the human endeavors that best exemplify these activities actually occur at their intersections.  

As the school bus pulled away almost every afternoon when I was growing up in New Jersey, I would drop my bag and head off to spend time in the 600 acres of woods directly across the street from my house.  Those walks that I took in the woods every day after school cleared my mind, calmed my brain, focused my thoughts, and piqued my appetite.  I came inside ready for food, homework, and whatever else was about to come my way.

Last summer there were many days when I started dinner by collecting arms full of Swiss chard and tomatoes, knowing that my daughter and I had nailed together the boards to make a raised bed, had filled that bed with yards of compost and topsoil, and had watered and weeded and weeded some more.  It’s not everyone’s cup of tea, but it certainly is mine.  Watching vegetables grow — I can’t think of a more pleasant way to enjoy a late summer afternoon!  

This morning I was invited to share in a most generous meal.  Plans to spend time with my new friend, Judith, turned into an invitation to eat poached salmon with mint pesto, strained yogurt cheese with za’atar [hyssop] and crusty bread, caramelized Brussels sprouts, carrot and blueberry salad, olives, homemade baked goods and dark chocolate truffles.  The mint for the pesto came from the local supermarket, but it usually comes from her mother’s mint patch, lovingly tended not far from here.  The Brussels sprouts tasted as if they had been sprayed with a light coating of honey.  They had not; patience was the secret ingredient, she said.  We laughed together when I shared my own discovery that nothing cannot be made delicious in 8 hours at 250 degrees.  

Also for brunch we enjoyed an embroidered beribboned table runner, matching milky white serving dishes on pedestals, thoughtful conversation, dreams for the future, sincere admiration for all kinds of work well done and stories well told, and friends, silver and gold.   

Yes, you can purchase food for a few coins through a small window while you remain seated in your car.  You can put that stuff into your mouth, and use it to make hunger pangs disappear for a little while.  But it is not an investment in good health.  It is just calories without history, calories to which you have no connection.  And because it consists of eating without movement or relaxation, you receive only a little bit of sustenance.  At the end of the day, it’s a question of how we nourish ourselves, in the broadest sense possible.