Disease Proof

Ten Reasons to Keep Eating Healthy Foods Despite Today's Headlines

Today's newspapers are blaring with crazy headlines. The New York Times, for instance, says that a "Low-Fat Diet Does Not Cut Health Risks, Study Finds."

Dr. Fuhrman draws no such conclusions. "This study compared two groups that both ate unhealthy diets," he says. "Look closely and you will see that the researchers compared a typical, disease-causing American diet, with one that was just marginally better, but still terribly unhealthy."

According to the study's authors, the "low fat diet" they told the women in the study to eat is as follows:

...postmenopausal women in the intervention group were advised to reduce total fat intake to 20% of energy and to consume at least 5 servings of fruits and vegetables and 6 servings of grains daily; women in the control group continued their usual eating pattern.
As it turned out, the women in the low fat group actually ate just about one more serving of fruit or vegetable per day, fell far short of the even the modest 20%-of-energy-from-fat goal, and consumed the same number of calories as the women who did not modify their diets. As Gina Kolata reports in The New York Times:
In the first year, the women on the low-fat diets reduced the percentage of fat in their diet to 24 percent of daily calories, and by the end of the study their diets had 29 percent of their calories as fat. In the first year, the women in the control group were eating 35 percent of their calories as fat, and by the end of the study their dietary fat content was 37 percent. The two groups consumed about the same number of calories.
Preventing tough diseases like heart disease and cancer with diet requires an approach that is aggressive, multi-faceted, and nuanced. Dr. Fuhrman says research has already shown that simple interventions like those studied here are not effective:
The studies published this week in JAMA are nothing new. Those who conducted those studies should already be aware of hundreds of others studies that demonstrate "low fat" is not the key factor in disease causation. High phytochemical intake, including critical antioxidants in (high-fat) nuts, seeds and avocados contain heart disease and cancer fighting compounds. Eating more low-fat foods such as egg whites, chicken, and pasta does not expose us to the disease-fighting compounds in berries, seeds, nuts, cruciferous vegetables, tomatoes and carrots.
Here are ten reasons why it still makes sense to eat a diet rich in vegetables, fruits, beans, legumes, nuts, and seeds:
1. Fruits and vegetables are the right things to eat, and among the best things they could have studied. But an increase of roughly one serving of vegetables and fruits per day--which is what was found in the study--does little to ward off cancer or heart disease. As described on DiseaseProof yesterday, I advocate a diet in which vegetables are 30-70% of calories, and fruit is 20-50% of calories.

2. A fixation on fat content is misleading. I do advocate little to no animal fats or oils (including olive oil). The fat from nuts and avocados is healthy and necessary, and for most of my patients I do not restrict it.

3. In this study, participants were encouraged to eat more grains, when in my diet--largely to achieve the potent anti-cancer and anti-heart disease benefits--I advocate replacing grains with vegetables as the basis of the diet.

4. Children were not included in this study. As we have discussed in greater detail previously, the best way to see the effects of diet on cancer is to examine the diets of children.

5. Even with this non-optimal diet, this study did find a correlation between diet and breast cancer. As The New York Times reports: "The women on low-fat diets had a 9 percent lower rate of breast cancer; the incidence was 42 per thousand per year in women in the low-fat diet group, compared with 45 per thousand per year in women consuming their regular diet."

6. The most important factor in preventing heart disease is LDL cholesterol. In this study, minor dietary changes were studied--and were found to make minor reductions in this all-important statistic. Imagine if they had studied serious dietary improvements.

7. Eating a diet heavy in bread, pasta, white meat, and processed foods can be low in fat, but is a very poor source of the micronutrition, especially phytonutrients, that contribute mightily to overall health. Many of the most important dietary interventions that we recommend were simply not studied.

8. The study was of post-menopausal women. The later in life they are started, the smaller effects dietary interventions can have.

9. Every time very healthy diets have been studied, they yield tremendous results. Consider the references below, as well as this evidence about diet and cancer, and diet and heart disease. In addition, the anecdotal evidence of my 15-year medical practice shows that not one of my active patients has had a heart attack.

10. For you hardened skeptics: there is no downside whatsoever to eating healthy food like fruits, vegetables, beans, legumes, nuts, and seeds. Try it for six weeks. (The details are in Eat to Live.) You'll feel great.

Dr. Fuhrman has day-to-day experience helping people prevent cancer and heart disease with diet. He sees it working every day in his practice, and says this study fails to focus on some of the most important findings in nutrition research.

To win the war on cancer; these positive diet change must occur when we are young.

When our cells are growing they expose their DNA to the damaging effects of low nutrient and low phytochemical intake. The low consumption of fruits, vegetables, beans, and nuts (only 5 percent of calories consumed by children) results in our unstoppable and growing cancer epidemic. Research scientists have been forced to accept the idea that the causes of cancer are usually set into motion more than 50 years before diagnosis. Our big artillery in the war on cancer is truly our in our kitchen; but we must start feeding our kids right to unleash the big guns.

Even though the factors initiating cancer causation cannot be eliminated with late-life dietary changes, nutritional excellence even later in life can have dramatic effects at lowering cholesterol and preventing heart disease. But a much more aggressive change in diet is required to achieve that degree of protection than what was looked at in these recent studies. It has already been established that a diet-style which contains a much larger percent of calories from unrefined plant foods (ninety percent) has dramatic effects on the occurrence of heart disease.

My vegetable-based diet was studied in the medical journal Metabolism in 2001 and was found to lower LDL cholesterol 33 percent and have dramatic effects on cardiac disease markers. Similar plant-based dietary approaches, either vegetarian or near-vegetarian containing mostly vegetables, bean, fruits, and nuts, have also been shown to offer dramatic protection against heart disease, even when adopted later in life.

And finally, some relevant studies to consider:

Jenkins DJ, Kendall CW, Popovich DG, et al. Effect of a very-high-fiber vegetable, fruit, and nut diet on serum lipids and colonic function. Metabolism 2001 Apr;50(4):494-503.

Hu FB, Willett WC. Optimal diets for prevention of coronary heart disease. JAMA 2002 Nov 27;288(20):2569-2578.

Campbell TC, Parpia B, Chen J. Diet, lifestyle, and the etiology of coronary artery disease: the Cornell China study. Am J Cardiol 1998 Nov 26;82(10B):18T-21T

Esselstyn CB. Resolving the Coronary Artery Disease Epidemic Through Plant-Based Nutrition. 2001 Autumn;4(4):171-177

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Comments (12) Read through and enter the discussion with the form at the end
Douglas Mercer - February 8, 2006 4:24 PM

Dear Dr. Fuhrman,
Thank you for shedding light on todays headlines in the New York Times. Those of us who eat mostly the whole natural plant foods that you recommend know from our own personal health gains that this study's findings are misleading at best. Congratulations to you for all your patients you are helping and all your effort to inform the American public on the major health benefits available through the consumption of whole natural plant foods. God speed with your good work! Most sincerely, Doug Mercer President Nutrition for Wellness Foundation

Don Smith - February 8, 2006 10:17 PM

Dear Dr. Fuhrman
This study is very poorly concieved and without any real controlls. Participants even admitted to going outside the set parameters for fat and vegetable consumption.The worst part is that the good news they present on peoples bad habits is going to appeal to many misguided souls.
Don Smith

tony - February 9, 2006 1:18 AM

Linked you, sir.

Ken Hobbs - February 9, 2006 10:22 AM

Thank you Dr. Fuhrman. I looked through a number of websites for a response to this new JAMA article. You are the first to provide some context to the study.

You cited Dr. T. Colin Campbell's research on diet in rural China. His book, The China Study, goes into significant detail explaining the problems with many attempts to study diet and disease, including this one.

Every organization that promotes healthy lifestyles should follow your example and discuss what this study really means. Many in this country desperately want validation that there are no consequences for the lifestyle choices they make. The press coverage this study prompted gives them permission to continue making themselves sicker every day.

Bob - February 10, 2006 8:08 AM

Headlines. They suck people in but most don't read the entire article.

Many have big bold declarations but if one reads the enitre story - they are based on studies that are not set up well. The study did not distinguish between good fats. The woman did not go as low in fat as most propose. And, they only looked at fat content. I guarantee you if you switch from French Fries and pizza to carrots, blended salads and oatmeal - you will do better.

Also, the women in the study itself were lazy - they were told to reduce fat content to 20%. Guess what? They made it to 29%! They did not increase fruits and veges very much at all.

But the most interesting point in my mind is the control group reduced their fat intake almost as much as the study participants! How could you compare? You can't. Its like taking two groups - asking one to wear seatbelts more often and telling group two to just to keep driving normally. Then, after you find out that pretty much both groups started wearing seatbelts more often that group a's increase in seatbelt wearing didn't save lives!

dan - February 11, 2006 9:12 AM
Russ - February 13, 2006 12:35 AM

Today I read an editorial column in my local paper which sited the recent published findings of the Women's Health Initiative (WHI) study. It's commentary? I quote; " We gullible Americans bought the concept of low-fat diets..." Now I understand that the issue here may very well be a flawed study which may have been "moderately" low in fat but was still very high in animal proteins as well as lower in fruits, vegetables and whole grains. My suspicion is that this is the reason the study "failed" to prove a low fat diet works. A "low fat," junk food, animal based diet would not be expected to work but does the general public know this? Apparently not. The author goes on to use his impression of the study to say "I'll buy whole milk from now on if they are out of 2%" and "basically, the low-fat, high-starch diet completely struck out." Unless my understanding of the science is flawed, this leaves the impression that fat, source of carbohydrates, fiber and animal product consumption make no difference on a persons health. But of course a healthy diet makes a difference. In the battle for proper dissemination of nutrition information, it seems the release of this study is a train wreck. Thanks for publishing your thoughts in an effort to gain some balance in the market. The public deserves to know there is a strong body of evidence that suggests a largely whole foods, plant based, low to no animal product diet IS correlated to lower blood pressure, lower heart disease, lower cancer and stroke.

Theresa Anderson - February 26, 2006 7:10 PM

There's a 300 lb lead weight on your big toe and they lessen the load to a 200 lbs..no difference...of course not!
Now...take the toe out from under the lead weight and wow! What a terrific feeling and a huge difference. So much money wasted on such tepid study.
The WHI Study proved one thing for sure...what they consider low fat is not low fat at all...a little reduction does not bring big results.
We cannot allow ourselves to be taken in by such headlines.
We have to keep on doing the right thing..

Glenda Miles - March 17, 2006 7:10 PM

Your comments are all encouraging me to keep working towards a healthier diet. I've been a vegetarian for a dozen years but I know that is not enough. T. Collin Campbells "China Study" finally got through to me and I am working to eliminate dairy and eggs from my diet - but this is again widening the gulf between what I eat and what they people around me eat. Friends I treasure eat so poorly and I know I can't say anything. I have quote from Ghandi on my cupboard and it gives me courage "You have to live the change you wish to see in the world".

Carol - March 18, 2006 10:13 AM

I beg to differ with Dr. Furhman's comparison of his recommendations with the Jenkins et al. 2001 Metabolism very high fiber study.

In this study, subjects were instructed to consume 11 lbs of fruits and vegetables per day.

Fuhrman recommends 1 lb fruits and 1 lb vegetables per day.

This is different by a factor of 5.

One cannot reasonably expect to receive anywhere near the same beneficial effect on plasma lipids and colon function (to say nothing of certain types of cancers) on 2 lbs of f+v per day as one could get from 10+ lbs.

So eat more fruits and vegetables!

Elizabeth Archerd - April 14, 2006 3:00 PM

Dr. Furhman,

Re: your point #6. "The most important factor in preventing heart disease is LDL cholesterol."

How do you justify this claim in the face of the InterHeart study which evaluated the risk factors of heart disease, worldwide? LDL Cholesterol was not even on the risk factor list. I'm curious that in the face of repeated studies that have failed to show a benefit from aggressivly lowering LDL, and with the results of the InterHeart report, you still list that as a factor. Can you explain? Laypersons are having trouble with dueling experts out here!

Joel Fuhrman, M.D. - April 14, 2006 9:00 PM

The InterHeart Study showed that Apoprotein B, especially the Apo B/Apo A1 ratio was a better predictor of cardiac events than LDL cholesterol. So they used that as their lipid measurement instead of LDL. Over 90% of low density lipoprotein (LDL) particle is composed of Apo B. It serves to solubalize cholesterol within the LDL complex, which in turn increases the transport capacity of LDL for subsequent deposit on the arterial wall. Apo B is therefore a convenient marker for assessing the cholesterol depositing capacity of the blood, and studies have supported that it is a better discriminator of coronary artery disease than LDL cholesterol. So think of Apoprotein B as a new and more accurate LDL measurement. The same risk factors that raise LDL affect Apo B the same way. There should be no dueling experts. There is an overwhelming amount of studies documenting dramatic reduction in cardiac risk from lowering LDL cholesterol. The trouble you are having is that you are considering the wrong people experts. There is lots of health information on the internet, and most of it is junk.

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