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Forget calorie-counting and low-fat diets; focus on eating healthful foods, say experts

The Open Heart commentary’s authors are as harsh on the weight-loss industry as they are on the food industry for misleading the public about food, calories, weight and health.

Fruits and vegetables are an integral part of the recommended Mediterranean diet.
REUTERS/Jason Reed

We need to stop counting calories and focus instead on the nutritional value of the foods we eat if we want to protect ourselves from heart disease, according to a provocative commentary published this week in Open Heart, the official journal of the British Cardiovascular Society.

Making more healthful dietary choices would “substantially and rapidly” reduce obesity, related diseases (such as type 2 diabetes) and the risk of heart disease — for individuals as well as for entire populations, the commentary argues.

And what is a healthful diet? A high-fat Mediterranean-style one, say the commentary’s three authors.

Those authors are Dr. Assem Malhotra, a British cardiologist who has been a prominent critic of the idea that saturated fat must be avoided to reduce the risk of heart disease, James Di Nicolantonio, a pharmacologist and cardiovascular researcher at Saint Luke’s Mid-America Heart Institute and an associate editor of Open Heart, and Dr. Simon Capewell, a professor of public health and policy at the University of Liverpool.

Not all calories are equal

As the three experts point out in their commentary, “focusing on total energy consumed [calories], as opposed to nutritional value, has been exploited by the food industry, which has added sugar to over 80% of all processed foods.”

These added-sugar calories should not be considered equal to calories from other food sources, they stress.

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For example: Drinking a can of cola, which contains about 150 calories of added sugar, each day has been associated with a significant increased risk of type 2 diabetes. By comparison, the daily consumption of a handful (one ounce) of nuts, which contains about 200 calories, or four tablespoons of extra virgin olive oil, which contains about 500 calories, has been associated with a reduced risk of heart attack and stroke.

(FYI: These findings all come from observational studies, which can demonstrate only a correlation between two things,  in these cases, a particular food and better — or worse — health. Observational studies can’t prove cause and effect.)

The commentary’s authors also cite a few clinical trials to back up their points, including a 2013 trial that switched some people to a Mediterranean diet rich in olive oil, nuts, beans, fish, fruits and vegetables but did not instruct them to lose weight or to increase their exercise. That study found a 30 percent reduction in heart attacks, strokes and deaths from heart disease among the people who switched their diet — regardless of any changes in their weight.

The researchers ended that study early because they believed it would be unethical to continue without offering the diet to all the participants.

The failure of fad diets

The Open Heart commentary’s authors are as harsh on the weight-loss industry as they are on the food industry for misleading the public about food, calories, weight and health.

“The weight loss industry, which emphasises calorie restriction over good nutrition, generates $58 billion in revenue annually in the USA, even though long-term follow-up studies reveal that the majority of individuals regain virtually all of the weight that was lost during treatment irrespective of whether they maintain their diet or exercise programme,” they write (with British spellings).

“Rapid weight loss and regain that can occur from fad dieting is actually detrimental to health,” they add. “Such ‘weight cycling’ contributes to hypertension, insulin resistance and [high cholesterol] resulting in increased mortality risk and worse cardiovascular outcomes.”

Needed: new policies

Medications are also not going to be a sustainable answer to the growing global burden of disease caused by poor diets, the commentary’s authors conclude.

Instead, lowering that burden is going to require “policy interventions that make healthier diet choices easier (the ‘default option’),” they write. “The most powerful and effective policies include taxation on sugary drinks, and subsidies to increase the affordability and availability of healthier foods including nuts vegetables and fruit, in addition to controls on the marketing of junk foods and clear package labeling.”

“It is time to stop counting calories, and time to instead promote good nutrition and dietary changes that can rapidly and substantially reduce cardiovascular mortality,” they conclude. “The evidence indeed supports the mantra that ‘food can be the most powerful form of medicine or the slowest form of poison.” Recommending a high fat Mediterranean-type diet and lifestyle to our patients, friends and families, might be a good place to start.”

You can download and read the commentary in full through the Open Heart website.