Sarah-Kate Rems, NP
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IN With the Fat, OUT With the Carbs for a Healthy Heart

1/8/2017

 
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Obesity, diabetes, and heart disease have skyrocketed and continue to increase since the government’s recommendation for low-fat diet for a healthy heart starting in the 1970s. When we take a closer look at the evidence connecting saturated fat and heart disease, the evidence presented is pretty weak, and more and more evidence is mounting and getting recognition against the long term belief that saturated fat intake leads to cardiovascular disease and death.
 
The low-fat mantra all started in the 1950s with a scientist named Ancel Keys. He performed a couple of highly flawed studies where he "cherry-picked" data to show that saturuated fat intake caused heart disease. The government and food industry locked onto this idea, despite data and numerous studies that have flooded in to debunk this theory. I highly recommend the books Eat Fat Get Thin by Mark Hyman, MD, and  Why We Get Fat by Gary Taubes, for more information and citations of this.

Here are 5 reasons that saturated fats are not going to increase your risk for heart disease or death:
 
1. Low-fat diets are NOT effective at preventing heart disease
No study has been able to prove that a low fat diet will decrease risk of cardiovascular mortality. Plenty of studies show that saturated fat can increase total cholesterol, and then make the simplified conclusion that saturated fats lead to heart disease. But this is highly misleading because yes, saturated fat will increase total cholesterol because it increases HDL cholesterol (good cholesterol), as well as the good type of LDL cholesterol (more on this below); however,  no study can show a direct link between saturated fat intake and cardiovascular related death. Again, there are more studies then I could ever reference, but here are a couple good ones:

In 2010, an analysis of 21 quality studies that looked at roughly 350,000 individuals up to a 21 year period found no risk of saturated fat intake with cardiovascular disease or stroke 
 
And lastly, one of the largest and most expensive and long term clinical trials called the Women’s Health Inititiative (WHI) was meant to show the benefit of a low-fat diet for lowering cholesterol and heart disease. After eight years of this study, the women on low-fat diet had lowered their total and LDL cholesterol, however, there was no beneficial effect on heart disease, stroke, or cancer found from eating a low fat diet.
 
2. Fat increases your HDL cholesterol (good cholesterol) 
Low HDL cholesterol has been found to be a far greater risk factor of having a heart attack than a high LDL cholesterol . When you replace fat in your diet (including saturated fat), with carbohydrate, this lowers your HDL cholesterol. A study by The New England Journal of Medicine explains that a low HDL cholesterol is a “biomarker for dietary carbohydrate.” Saturated fats have been shown to increase your HDL cholesterol (good cholesterol), and to have either no effect on your triglyceride cholesterol or to reduce this (another type of bad cholesterol).

In practice, when I get a patient's labs back and I see a low HDL cholesterol level with high triglycerides, this is an indicator to me that this individual is eating a high carb, low fat diet. 
 
3. Fat increases large LDL particles (good type) and decrease small LDL particles (bad type)
Yes, to make things more confusing there are different types of LDL, large "fluffy" type (think cotton balls), small dense type (think rocks), and many other sizes in between. We want more of the large LDL particles to small dense LDL particles because the small dense LDL particles are much easier to lodge themselves into the walls of your arteries causing your arteries to narrow which leads to decreased blood flow (ie oxygen to your heart). These small dense LDL particles also are known to oxidize which leads to rancidity and inflammation in the blood vessels. Saturated fats will increase large LDL and decrease small LDL which in effect will cut your risk of heart disease. 
 
4. Replacing saturated fats with carbohydrates increases bad cholesterol
This is more of a summary of the above, but I want to reiterate that replacing saturated fats for carbohydrates makes your cholesterol profile much worse. Carbohydrates have been shown to decrease your good HDL cholesterol while increasing small particle LDL bad cholesterol, as well as inceasing your triglyceride cholesterol. As mentioned above, heart disease is most associated with a low HDL cholesterol and high triglyceride cholesterol. LDL is a little harder to predict with heart disease because of the varying sizes and conflicting evidence. 
 
5. Prevents "Diabesity"
Cutting back on fat almost enevitably means you are going to add carbohydrates to your diet, and high  carbohydrate intake is what leads to diabetes as well as obesity - this is something that is not disputed. Obesity is a risk factor in itself for heart disease, as is diabetes, put these two major risk factos together and you are talking about a massive increase in your chance of cardiovascular disease (think heart attack).  
 
Just as guidelines have changed in terms of cholesterol containing foods (in case you didn’t know, cholesterol containing foods do not raise bad cholesterol and this has finally been recognized by the American Heart Association (AHA) and the United States Department of Agriculture (USDA)) I have a hunch that there will be new guidelines for saturated fats in the near future.

​Be sure to increase your intake of good saturated fats such as organic eggs, organic grass-fed beef, coconut oil, and dark chocolate.

SK

8 Good Reasons to Limit your Wheat Consumption

1/2/2017

 
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One of the most frequent questions I have in practice is about wheat/gluten-free and my take on how it effects the body and mind. I started doing more research on the topic and I found more than enough reasons to cut out wheat completely from my own diet. Here are the top 8 to get you started:
 
1. Not the original wheat
First of all, wheat is not what it was thousands of years ago, or even fifty years ago. Wheat today is produced by countless hybridiazations making for thousands of different potentially harmfull proteins and other compounds  We now have “wheat” that was grown in synthetic soil, saturated in chemicals, made to survive the worst environmental conditions and cultivated so that no pest would eat it – and we’re wondering if this could make us sick? Currently there is no requirement for crops that have undergone hybridization to be tested on animals or humans. Read more about this here and here.
 
2. Increases blood sugar higher than table sugar
Wheat’s main carbohydrate is Amylopectin A and raises your blood sugar higher and faster than any other carbohydrate including table sugar! When there is a large amount of sugar in your blood all at once, this signals a large amount of insulin to remove this sugar as quickly as possible and deliver this preferentially to your fat cells (why we call insulin the fat storage hormone). This is why you feel hungry an hour or two after eating a wheat product – all the sugar has been removed from your bloodstream by then and your cells are still hungry because your fat cells are hogging all of the energy. 
 
3. Addictive
Wheat contains a unique protein called gliadin which, when broken down in the body into polypeptides, crosses the blood-brain barrier and binds the morphine receptor in the brain (i.e. euphoric center). These particular polypeptides are termed “exorphins” (exogenous morphine like compounds) because of how like other opiates, you feel a mini-high after ingesting and a slump short while after. In short, these exorphins stimulate the addictive, pleasure seeking part of your brain, stimulating your appetite making you want more and more. Just as other drugs that bind the morphin receptor (think heroin, morphin), this repeated exposure distorts the brain causing mental fog, sluggishness, fatigue and makes one more susceptible to depression and other psychological disorders down the road.
 
Interesting note - there are now drugs that contain naloxone to treat obesity. Naloxone is formerly known as a drug used to treat narcotic overdose, most notably heroin. It works for weight loss because it blocks the morphine receptor, exorphins are unable to bind, and thus prevents appetite from being stimulated.

4. Blocks your brain from understanding you are full
Digested wheat proteins have been found to block the leptin receptor. This is bad because leptin functions to tell our brain that we are full - if this is being blocked, you are more likely to be hungrier regardless of how much you may have just eaten.
 
5. Increased risk for diabetes and obesity
This goes along with it’s addictive like quality, stimulating your appetite, increasing blood sugar rapidly, and blocking the mechanism that tells you that you are full. This is a recipe for you to overeat (overeat carbohydrates in particular because of their addictive quality), which leads to obesity and diabetes from too much carbohydrate ingestion aka chronic high blood sugar. I hear all the time from slender patients not understanding how they can be at risk for diabetes with a normal weight and eating healthy “whole grains.” It doesn’t matter if you are thin or overweight, if you are consuming a high carbohydrate diet (which is easiest to do with consuming too many wheat products) your blood sugar will be chronically elevated unless you start making changes.
 
6. Worsening ADHD
This is still a controversial topic and more studies need to be done to look at this, but there have been many studies showing the improvement of ADHD in children and adults when cutting out the wheat products. You can read more about this here.
 
7. Inflammation to your gut
Gluten is the main protein of wheat, and it is made up of two proteins gliadin and glutenins. Gliadin is the primary group that triggers the immune response (i.e. infallmation) in celiac diease. But even beyond gluten and celiac diease, there are a wide range of other proteins present in wheat, more than could ever be accounted for due to the countless transformations via countless cross-breeding of strains as discussed above. These modified proteins as well as gluten have been shown to be associated with irritable bowel syndrome in non-celiac disease individuals, and accounts for digestive issues in individuals without full-blown celiac diease. This is why individuals who cut out wheat tend to have less stomach issues. 

 
8. Joint inflammation
As discussed above, wheat products raise your blood sugar more than nearly all foods. The more your blood sugar rises, the more glycation occurs. Glycation is when a sugar binds to protein causing irrversible changes, and thereby modifies proteins in the blood stream, body tissues, and joints. Glycation is particularly damaging to cartilage, and when cartilage proteins become glycated they become stiff. Overtime, glycation makes the cartilage brittle, stiff, and crumbling resulting in more pain and destruction in your joints.
 
I know it sounds hard to cut back on wheat (because wheat is in virtually all processed foods), but replace with filling full fat foods – avocado, eggs, olive oil, cheese, etc. Healthy non-processed fats should be the bulk of your diet, as the low-fat craze has brought upon the increased obesity, diabetes, and heart diease rate since it was instituted in the 1970s - more on this for another post. If you want to read more about the effects of wheat I highly recommend the book Wheat Belly by cardiologist William Davis, MD. 

SK


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