The Fat and The Furious

A recent study last month by the Centers for Disease Control (CDC)[i] highlighted the ongoing epidemic rise in the incidence and prevalence of diabetes. In 1995, age-adjusted prevalence was ≥6% in only three states, DC and Puerto Rico. However, just fifteen years later in 2010 it was ≥6% in every state, DC and Puerto Rico. In six states and Puerto Rico more than 1 in 10 persons is diabetic. In 2010 there were estimated to be over 25 million people in the United States with diabetes; almost 19 million diagnosed and an additional 7 million undiagnosed. The increase was across every age group, every ethnicity and racial group and both sexes. It increased in every region across the United States. The largest increase was in the South followed by the West, the Midwest and the Northeast.

Although some of the increase is due to increased survival and decreasing mortality in those persons with diabetes, the major driver is the fact that there are simply more people with the disease. There are many factors which contribute to the development of diabetes. However, there is no denying that the increase in diabetes parallels the increasing American waistline. Just as exercise confers a diverse set of benefits, physical inactivity confers a number of risks including extra poundage. Combine physical inactivity with the typical Western diet and you have the recipe for diabetes.

As a cardiologist I am often asked for advice and recommendations regarding exercise and diet. A reasonable and regular exercise program has innumerable benefits, no major downsides and is clearly something most of us don’t get enough of. However, when it comes to food it seems the majority of the advice from so-called ‘health experts’ involves deprivation, elimination or just plain denunciation. And the easiest guy in the room to pick on is the fat guy. Literally.

As a chef and a food person, that just makes me furious. Since an aggressive campaign was started in the 1970s to reduce the percentage of fat in the typical American diet, Americans have in fact continued to reduce not only the percentage of fats, but saturated fats in particular. This trending decrease in fat consumption clearly does not correlate with the increase in obesity and diabetes. Dr. Walter Willett, chairman of the department of nutrition at the Harvard School of Public Health, notes simply that “(f)at is not the problem.”[ii]

Fat is essential for good health providing the substrate for a number of important compounds and hormones. In fact, there are specific essential fatty acids that are called essential because they are necessary for life. Across all forms of media we are barraged with the message to consume heart healthy omega-3s for their purported cardiovascular and general health benefits. Omega-3s are fats. Fats also act as important transport vehicles for compounds like the fat dependent vitamins A, D, E, and K. In addition, fats transport an innumerable number of flavor molecules. They provide foods with that certain mouth feel, umami, often described as the fifth taste. The current recommendations for a heart healthy diet include 25% – 35% of total calories from fat[iii]. That’s more than one third of our daily calories from fat.

The common and misguided method to direct people to healthful eating is often to simply remove the fat in an attempt to reduce the overall caloric intake. This thoughtless and flavorless approach to ‘healthy eating’ becomes neither. Simply removing the natural fats found in wholesome and delicious foods and replacing them with highly processed, adulterated and shadowy substitutions is not a thoughtful solution. Sacrificing flavor on the altar of caloric reduction by removing the fats robs us of important balance in our diet, flavor in our food and joy in our lives.

Better to spend our daily allotment of caloric currency on items of value. Fresh, balanced and foods as nature intended them prepared with craft and care are the choices for healthful living. These items provide nutrition for our bodies and food for our soul. These are always the better choice, the better value; no matter how many weapons of mass consumption they cram into a sack for a dollar or how many calories have been reduced by transforming a delectable bastion of yumminess into a zombified shadow of its former self.