How to define a “healthy” diet. Period.

Whether you’re strictly adhering to a diet or just doing your own thing, if year after year your GP is prescribing more and more medications to stave off morbidity and keep you intact, then the diet you’re following is most likely Fail.  The same is true if your body weight is creeping upward or your quality of life is creeping downward.lunchables

The glaring Fail of all 3 diets in the recent Mediterranean Diet Study for the medications criteria threw up a huge red flag.  As a brief refresher, at baseline and 5 years later, prescription medication usage was as follows:

Med 1

and at follow-up:Med 2

In other words:

med 4

This study included two Mediterranean diets and a low fat control diet, none of which markedly differed from a normal diet in terms of macronutrient ratios -Med 3

So, changing foods while keeping macronutrients the same didn’t work.  This is like switching from white bread to whole wheat bread.  Or switching from pork to chicken.  It didn’t work, because medication use increased (that’s how I’m defining what “works”).

What else could Estruch and colleagues have tried?


With regard to the rise in insulin and antidiabetic drug use.

From the notorious Samaha study, which produced this stunning visual:Samaha weight loss

But that’s not the point of this post.  It’s This:Samaha meds

So the low carb stopped taking their antidiabetic medication.  Their glucose metabolism must’ve down the toilet.  Or not:Samaha metabolism data

because of This:Samaha diet

Switching from white bread to organic whole wheat bread didn’t do the trick for Estruch, but switching from white bread to low carb did (for Samaha).  They went off glucose-lowering medications but blood glucose levels went down.  Go figure.

Is this an isolated finding?  Unfortunately [for some], not.  In the soon-to-be-notorious weight loss by Hussain, obese participants in the low carb group:Hussain meds

Yet their glucose levels still declined, while body weight plummeted:Hussain data

It’s difficult to find studies which assess medication usage patterns AND diet at both baseline and follow-up.  But given what we’ve got so far, switching from white bread to organic multi-grain bread doesn’t do a whole lot.  When it comes to the rise in use of insulin and antidiabetic medications in Estruch’s Mediterranean dieters, data from Samaha and Hussain suggest a lower carbohydrate higher fat diet would’ve prevented this.


With regard to antihypertensive medications.

Teunissen-Beekman compared the effects of dietary protein on blood pressure in moderately hypertensive subjects for 4 weeks and found the following (A, systolic; B, diastolic):protein BP

Because of this:protein diet

And from the very well-designed OmniHeart study, subjects assigned to either high protein or high fat both fared better than those assigned to a high carb diet.

This.OmniHeart data

Because of This.

Appel data2

Collectively, data from Teunissen-Beekman & Appel suggest a higher protein, higher fat, and lower carb diet might’ve prevented the rise in antihypertensive medication use seen in Estruch’s Mediterranean and low fat dieters.

With regard to anti-platelet therapy.

EPA/DHA, fatty fish (eg, salmon), and red wine? (Allman-Farinelli et al., 2005)

Low GI diet*? (Brand-Miller et al., 2009)  (*the easiest and most effective way to low GI is low carb high fat)

High protein? (Rizkalla et al., 2012)

in other words: anything other than what Estruch did.

Confounding variables.

Is it possible that the generally poor overall health of the subjects in Estruch’s study led to their increased requirement for prescription medications – regardless of diet?  Of course [I say begrudgingly].  But the diets they were assigned to were very similar, in terms of macronutrients, to the diets that contributed to their generally poor overall health to begin with.  And the diets used by Samaha, Hussain, Teunissen-Beekman, Appel, etc., etc., were very, very different (in terms of macronutrient composition.)

A Mediterranean diet is probably “healthy” for healthy people.  The same can be said for a low fat diet – healthy women in the WHI didn’t fare any worse when they reduced their fat intake.  But those with pre-existing heart conditions at baseline went downhill when they actively tried to lower their consumption of dietary fat.  IOW the insult incurred by a low fat diet may be too small to affect healthy people; but it does no favors for and may actually harm susceptible people and those with pre-existing heart conditions.

IMHO, it just seems like tweaking the types of foods while keeping macronutrients the same is like whacking a big block of ice with a wiffle-ball bat, whereas drastically altering macro’s is like smashing it with a sledge hammer.

just sayin’

calories proper

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  • http://www.facebook.com/people/Doc-Jayh/100001759793744 Doc Jayh

    If I have to recommend a diet to most people with little knowledge of how to do it for themselves, I choose the old style Mediterranean diet.

    Personally, I eat IF vegan with seafood, but most people can’t do that.

    I am also a fan or the Ornish protocol for heart disease as I’ve seen it do wonders. I am not defensive about it all like Dean is as I have no agenda in any of this.

    I think there are many healthy ways to eat. Bottom line with me, maintaining a healthy weight and genetics are the ruling factors.

    • http://www.caloriesproper.com/ William Lagakos

      Hi Doc Jayh,
      Thanks for the comment and I tend to agree – there are many healthy diets out there. Exclusion of processed junk empty calories seems to be a major commonality among them.
      best,
      Bill

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  • Alicia

    Hi Bill,

    In your last table of macronutrient intakes for the 6-week study comparing blood pressure among High Carb, High Protein, and High Fat groups, are the numbers correct for the final column (High Fat)? It looks like fat intake for the High-Fat group is only 15% of calories–the same as the carbohydrate group…

    Thanks! Keep up the great posts!

    Alicia

    • http://www.caloriesproper.com/ William Lagakos

      Hi Alicia,
      Good eye!!! Thank you. I’ve corrected it.
      Best regards,
      Bill

      • Alicia

        And now that I look at it again… Were carbs really at 48% for both the high protein and high fat diets? I couldn’t download the paper to see for myself (my university doesn’t have access to Diabetes Care). Those values seem a bit high if they wanted to test for the differences. Particularly because percentage of dietary calories from carbs are STILL higher than either the fat in the high fat group, or the protein in the high protein group…

        • http://www.caloriesproper.com/ William Lagakos

          Yup, none of the diets were low carb proper. What’s your email address? I’ll send you the paper.