Understanding Fat and Nutrition for Human Performance from the Cellular Level with Jim Goetz8/25/2019 Understanding Fat and Nutrition for Human Performance from the Cellular Level
By: Jim Goetz Board Certified Chiropractic Board Certified Physiotherapy From the beginning of known human life on earth, we as a species have wrestled with the notion of paradigms. At one point in time, we believed the earth was flat. Before this concept was changed, there was violent resistance and alas, from our current perspective, the world is now spherical. The purpose of this article is not to vilify any person or group. Research on animals will not be referenced as the anatomy and physiology is different than that of humans. My goal is to discover what foods our bodies function optimally from and why. It is imperative this knowledge become effical. In the 1940's, based on the epidemiological research by Dr. Ancel Keys, the American Heart Association recommended a low fat diet to eliminate heart disease. (Keys, 1957) This diet was built on the belief that fat, especially saturated fat, caused increased cholesterol levels and high levels of cholesterol caused heart disease and obesity. This belief came as Dr. Keys observed when saturated fat is poured into the drain of a kitchen sink, it would solidify and clog the drain. He believed this was comparable to atherosclerotic plaque in our blood vessels. While this is not what actually happens in reality, this was his belief at the time and the foundation of our current foundation of nutrition in our country. In order to prove his hypothesis, bias appeared more paramount than did truth. In 1980, based on the infamous Seven Countries Study (Keys, 1980), the United States Department of Agriculture (USDA) created the food pyramid, further vilifying fat. Since that time, the United States government reported Americans have reduced their consumption of saturated fat by 11% and reduced total fat by 5%. (Dietary Guidelines Committee, 2010) Americans have even followed the government's official advice and lowered consumption of dietary cholesterol, such as the type found in eggs and shellfish, even though cholesterol in food has been proven to have very little impact on serum cholesterol levels. (Eckel, et al., 2013) In 1952, when Dr. Keys began his argument for the low fat diet, he predicted, "If mankind stopped eating eggs, dairy products, meats and all visible fats, heart disease would become very rare". (Allen, 1952) Instead of heart disease being very rare, at this point in our present time, the Center for Disease Control and Prevention (CDC) estimated 75 million Americans are affected by metabolic syndrome-x, a disorder characterized by central obesity, high blood pressure, elevated triglycerides, low HDL cholesterol (the good kind) and high levels of fasting plasma glucose. A combination of these symptoms increases rick for coronary artery disease, stroke and diabetes mellitus type 2. (This is also referred to as cardio metabolic syndrome and insulin resistance syndrome). Since the USDA first recommended a low fat diet and introduced the food pyramid in 1980, the obesity epidemic has steadily increased each year. In baby boomers alone, obesity rates have risen over 20% from 1980-2006. (CDC/NCHS, 2008) Instead of rates of heart disease decreasing, it has instead quintupled, rising from 1.2 million to 5.4 million. (McDougall, 2015) The more and more nutritional studies are completed; we appear to be getting sicker as opposed to healthier. With what certainly appears to be an early death sentence and life filled with ailments and diseases, it is a curious dilemma on what is being done to bring back true health to humans. In order to understand what must be done, it is important to understand the basics of what is truly healthy for us and why. It is believed early man traveled in packs. These packs (tribes) roamed the region in which they inhabited in pursuit of wild game. When a region's wild game became depleted, they would move to a different region. As doing health studies on peoples long deceased and unfortunately not possible; what we can do is epidemiological studies on the descendants of these ancient people around the world today and follow up with controlled trials. Let us further explore this! What Really Makes Humans Fat There is a hilarious episode of the once popular hit television show, Seinfeld. It appeared that everyone from the main cast of characters to New York City Mayor Giuliani, was eating non- fat frozen yogurt. They believed they could eat as much as they wanted and not gain body fat weight. In theory this made sense. Eat fat=get fat. As most people have realized though (as did everyone in that episode), even while eating foods that do not contain fat, they get fat. (For accuracy- in that episode, Mayor Giuliani announced to the public that the yogurt did contain fat, which has nothing to do with the remainder of this article). While protein and carbohydrates contain 4 kcal/gram, fat contains 9 kcal/ gram. Fat is much more calorie (energy) dense than are it's macronutrient counter parts. (Macronutrient= carbohydrates, protein, and fat). For generations, doctors have advised us that in order to slim down, we must avoid fat. Yet efficably speaking, it appears the opposite is true. If fat made people fat, everyone eating the "Atkins Diet" would have to be rolled out their front door as they would be ginormous! Instead, those that live the "Atkins Way", lose countless body fat weight, retain and even increase muscle mass. This will be discussed in depth in a bit. Keeping things basic- our bodies utilize either glucose or ketone bodies for energy. When glucose is not readily available, our bodies are in a constant state of releasing fat to be converted into energy (ketones). When we eat a meal high in carbohydrates, insulin levels spike, driving glucose into cells. Glucose not used is then stored as...body fat. Thus by constantly introducing carbohydrates into our body, body fat is unable to be released to be used as energy and we get fat. (We do not get fat by frozen yogurt alone). The higher the carbohydrate ranks on the glycemic index scale, the more insulin is released and the more energy we potentially store as body fat. Fat is the only macronutrient that does not stimulate insulin. Think of your body as a machine. You can use a hot, slow burning fuel that lasts a very long time or use a short burning fuel that needs to constantly be replenished. For performance, maintaining a lasting energy makes much more sense than having to continuously consume sugar, spike insulin- lather, rinse and repeat. Our cells were not designed to operate in this manner. Our bodies deserve better. When given better, they perform better. A group of experts in the field of nutrition made a consensus, publishing a high level paper confirming, "no benefit could be demonstrated for eating carbohydrates rather than saturated fats". (Astrup, et al., 2011) This is rather a bold statement to come forth with during the time when the opposite is held to the gold standard of nutritional belief. While many experts still squabble today on this topic, let them. Our bodies gain fat by consuming carbohydrates, especially sugar. Our bodies lose fat by consuming fat. It's basic nutrition based on our human cellular physiology. We can argue all we want about how our bodies were designed to work. They work how they work and there is little we can do to change this. It's our choice to allow them to function at an optimal level or sub-optimal level. In 2010, an LA times Headline declared, "Fat Was Once the Devil, Now More Nutritionists Are Pointing at Sugar and Refined Grains". (Jameson, 2010) It appears the paradigm has began to shift. Polyunsaturated Fats- A False Hope The propaganda vilifying saturated fats informs us we are to avoid them at all costs. The fats to eat, supposedly the healthy fats to consume in moderation, are though to be polyunsaturated fats. In order to fully grasp the information about to be dispensed, it would be prudent to go back to the basics of biochemistry. Bear with the science here for a moment as this will eventually (hopefully) make sense. A fatty acid (fats) is a long carbon chain surrounded by hydrogen atoms with a carboxylic acid group at one end. These chains can vary in length. It is the type of bond between carbon atoms that dictate whether the fatty acid is saturated or unsaturated. A saturated fat contains only single bonds, linking carbon atoms together with a fatty acid chain. These molecules cannot bond with any new atoms, as they are already saturated with hydrogen atoms. Due to the structure- these fats are only straight chains that pack tightly together. This causes saturated fats such as butter, lard, suet, and tallow, to be solid at room temperature. In contrast, a polyunsaturated fat gets it's name as it contains multiple (poly-) double bonds. These added bonds are like trying to hug two people at once. If hugging only one person, you can give a big, warm bear hug. The other individual being hugged is not going anywhere once in this embrace. By introducing person number two, the hug becomes less stable. The other hugging arm can be freed up at any moment to take on more people (carbon atoms). The bonds then kink and loses it's neat and rigid structure so the carbon chain no longer lies nice and neat against it's neighbors. These fatty acid molecules lie loosely arranged together forming oils. Examples of this are vegetable oils such as canola, rapeseed, safflower, sunflower, peanut, corn, cottonseed and soybean oil. Monounsaturated fats contain but only one single double bond in it's carbon chain, making it far more stable than polyunsaturated fats. Examples of this are palm, olive and coconut oil. Due to the double bond structure of vegetable oils, they oxidize easily. The type of fatty acid in these oils (linoleic acid) oxidized into 130 volatile compounds such as (in addition to free radicals and aldehydes) sterol derivatives and products from degraded triglycerides plus other unnatural chemical compounds created by hydrolysis, isomerization and polymerization. (Zhong, et al., 2012) In 1976, researchers studied the population of Israel, who at the time consumed, "the highest quantity of vegetable oils in the world". Their rates of heart disease was quite significant. This directly contradicted the belief of the protective qualities of vegetable oil. (Blondheim, et al., 1976) If vegetable oil does lower total serum cholesterol levels, this should mean rates of heart disease should be reduced. If this is true, then total serum cholesterol levels should be directly proportional to heart disease. As we already know, this is not the case. Vegetable oils consist mostly of omega-6 fatty acids, which are pro-inflammatory, as they go down the prostaglandin 2 pathway. Omega-3 fatty acids on the other hand (most bioavailable forms come from fish and grass fed free range meat) follow the prostaglandin 1 or 3 pathways. As we know, diffuse inflammation is characteristic of internal disorders, such as heart disease. Heart disease in America continues to rise. By questioning what is told to us, we may find answers. Question we must. Saturated Fat- Unchanged Over Time If polyunsaturated fats are obviously not what we thought they are, then what is wrong with saturated fats? Why is it vilified as it appears in mainstream media? At this point in our time period, saturated fat is understood as unhealthy by most. Saturated fats are not considered as part of "eating clean". In the 1950's, when a few men clutched their chests and dropped dead from a heart attack, Ancel Keys wanted to know why. From the very beginning of this research, cholesterol has been at the forefront of discussion. Based on the previously mentioned clogged kitchen sink drain analogy, cholesterol was the hypothesis of Keys as being the cause of heart disease and therefore fit the bill of the solution. Cholesterol is a vital component of the structure of cell membranes, the metabolism of sex hormones and necessary for neural function. It has also been found to be in atherosclerotic plaque. The understanding became that eventually enough cholesterol builds up in arteries, preventing blood flow and causes a heart attack. Therefore, researchers began to ignore cholesterol's vital functions and focused on the misconception that it caused heart attacks. (In reality, it is only when LDL cholesterol oxidizes does it develop into atherosclerotic plaque). A famous study known as the Boeing Study (yes, it was done using the airline employees) used 444 male Boeing employees with high cholesterol as the subjects. Half of the employees consumed 18% of their total calories as fat and the other half consumed 30%. At the completion of one year, significant changes were realized. Robert Knapp, a lipid specialist and chief researcher noted a decrease in LDL cholesterol (the bad one). Initially, this would appear as positive. But Knapp also observed the men with the lowest fat diets also saw a decline in HDL cholesterol levels (the good kind) as well as a significantly unhealthy rise in triglyceride levels (fats circulating in the blood). (Knapp, 1997) These results have been independently confirmed. (Katan, 1997) LDL cholesterol has been associated with obesity, high blood pressure and a plethora of inflammatory conditions. On the other hand, HDL cholesterol has the opposite effect. HDL brings free cholesterol from the periphery (arterial walls) and transports it to the liver for use in the body. HDL is not only good for us but necessary for a healthy functioning body. In a follow up to the famous and often referenced Framingham Study; the investigators reported that in both men and women (ages 40-90), HDL had the largest impact on risk of heart disease. Those with low HDL levels (under 35 mg/dL) had eight times greater risk of heart attacks than those with higher HDL levels (65 mg/dL or above). (Gordon, et al., 1977). The studies authors wrote, "this finding was the most important finding of all cholesterol data". It would appear the evidence shows that while polyunsaturated fat reduces total serum cholesterol levels, it increases risk of heart disease not because of lower derum or LDL levels but partially from low HDL levels. HDL is necessary to function without incidence of disease. If saturated fats raise cholesterol levels, then what effect would a diet primarily consisting of this be on heart disease? It appeared that in numerous trials, a high fat/ low carbohydrate diet lowers risk for heart disease and diabetes. In over fifteen controlled trials, a diet high in fat and low in carbohydrates raises HDL levels, lowers triglyceride levels, lowers blood pressure and reduces inflammation. (Volek, et al., 2004) This type of diet also improves endothelial function (ability of blood vessels to properly function and release nitrous oxide), another marker related to heart health. (Volek, et al., 2009) When endothelial cells stretch (as occurs during exercise), nitrous oxide is released. This causes atherosclerotic plaque to be absorbed back into the body and thus creating greater blood flow and greater oxygenation of body tissues. This undoubtedly is a good thing. Experiments where subjects consumed 60% or greater calories from fat appear to show the most beneficial results to overcome obesity, diabetes and heart disease. The kicker comes from the idea that sometimes answers we seek are right in front of our eyes. They can even be intertwined amongst other information. We simply need to know where to look. To prove my thought that if not fat- carbohydrates (more specifically sugar) is far greater correlated with heart disease than saturated fat, we merely need to look at the study that shaped our present paradigm in American nutrition culture, The Seven Countries Study. In 1999, lead researcher Alesandro Menatti, decided to go back and take a look at the data from the 12,770 study subjects. He found the category most related to coronary mortality was not saturated fat, as the study proposes. Instead he found it was sweets (sugar products). Sugar products had a correlation coefficient to coronary mortality of 0.821. In comparison, animal food (saturated fat) had a correlation coefficient of 0.798. (A perfect correlation is 1.0) (Menotti, et al., 1999) This number may have been lower if margarine, a vegetable fat, had not been included in the same category. The study that shaped our nations nutritional culture was looking at the incorrect statistics!!! As central obesity leads to heart disease and the famous Seven Countries Study appears debunked by it's chief researcher twenty five years after the study was published; it appears saturated fat does not lead to heart disease. Instead the chief culprit is and always has been sugar. Vegan, High Carb, Low Carb and in Between The idea of diets is infuriating. One month diet "X" is all the rave. The following month it is diet "y". Book publishers make money. Authors get their fifteen minutes of fame and we find that instead of losing bodyweight, it is the weight of our wallets that are lost. Let me spend a few moments to give a brief overview of some of the most popular diet trends of today. Between vegetarian and low carbohydrate- most diets are a variation of these. Dr. Ornish, the founder of the Ornish Diet, made the vegetarian lifestyle famous. On the other end of the spectrum, it was Dr. Atkins who made eating low carb all the rage. A plethora of diets mimic these two and everywhere in between rests comfortably on the book store shelves. Low Fat/ High Carb Red meat, liver, butter, cream, and egg yolks- gone. These foods are "group five" forbidden foods according to Dr. Dean Ornish, founder of the Ornish Diet. Dr. Ornish advocates that in order to reverse heart disease, individuals must eat primarily vegetables, fruits and grains. "Three quarters of all calories must come from carbohydrates", according to Dr. Ornish. This principle allows people to be alert, whereas high fat diets make people "tired, depressed, lethargic, and impotent". (Ornish, 2014) Dr. Ornish's program involves aerobic exercise, yoga and meditation. Physical activity as a part of daily life is definitely something positive. As mentioned previously, physical exercise causes a positive endothelial function, resulting in increased nitrous oxide release and decrease in atherosclerotic plaque. It's a wonderful habit for all. Dr. Ornish's phenomenal claims of his diet are based on a study from 1990, involving just 22 subjects. In this study, the subjects completed one year on this diet (including exercise). At this time an angiography was completed, where a widening of arteries was visualized in the subjects. The controls showed a narrowing of their arteries. (Ornish, et al., 1990) These findings appear to be remarkable and received high acclaim. But it is a very small study size. More concerning is these results were unable to be replicated. (Aldana, et al., 2007) Nutrition research journalist, Nina Teicholz, conducted an interview with Dr. Kay Gould, the co-author of Dr. Ornish's research papers. Dr. Gould contests the reliability of angiographic evidence of artery widening. (Teicholz, 2009) Dr. Ornish also claims an amazing 300% improvement in blood flow in those who followed his regime. Unfortunately his co-author Dr. Gould, contested that number, stating it was closer to 10%-15%. Dr. Ornish was contacted in regards to Dr. Gould's contradiction and responded stating, "Well, I'm not going to quibble about that". (Teicholz, 2009) 10%-15% is still something positive to notice but must be questioned due to matters of honesty and ethics. A 1998 scientific examination of the Ornish Diet was completed with researchers looking at markers effected by a low fat diet, where fat consisted of only 10% or less of total daily caloric intake. Both LDL and HDL were reduced. Triglyceride levels were observed as rising as high as 70% from baseline. There was also concern that study subjects became fat soluble vitamin deficient (A,E,D,K). The studies' authors recommended this diet might be harmful for high risk populations such as the elderly, pregnant, children, type 2 diabetes mellitus, those with high triglycerides and those with carbohydrate intolerance. (Lichtenstein and Van Horn, 1998) Research goes as far as linking low cholesterol levels to high rates of stroke, (Tanaka, et al., 2012) cerebral hemorrhage and suicide, (Tanaka, H., 1982) increased rates of cancer, (Friedorowicz, 2010) and gallstones. (Feinleib, 1981) Cholesterol is also essential for both cerebral and sexual function. If a vegetarian diet reduces levels of cholesterol, then the risk for these terrible conditions and ones thus associated with is thereby believed to be elevated. It is also well known that vegetarians are often anemic ass they are unable to eat enough B-vitamins, specifically B-12, in their diet. A lack of B-12 causes lack of intrinsic factor in the duodenum and the inability for iron to be absorbed. A variety of conditions can occur because of this. I want to believe in this diet. I truly do. Eating raw foods and exercising daily feels like it should be the answer to have the ripped look I desire, a positive outlook on life, a sharp mind, lifelong avoidance of disease and unrelenting extreme virility. Yet these disturbing findings lead me to question if eating mostly fruits, vegetables, and grains is the answer to optimal human functioning. I question whether the idea of heart disease reversal comes from the nutrition aspect of the Ornish program or the exercise aspect. Would these results, whatever the true results were, be the same if instead the subjects ate a diet high in fat? In regards to disease, a report in 2007 by the World Cancer Research Fund and the American Institute for Cancer Research went on to say, "in no case was the evidence for the consumption of fruits and vegetables in the prevention of cancer to be judged to be convincing". (Washington DC: American Institute for Cancer Research, 2007). Obtaining water soluble vitamins and minerals in fruits and vegetables, yes. This seems prudent, though the fat soluble vitamins will still need to be eaten with fat for maximal absorption. Preventing heart disease and cancer from fruits and vegetables. The research speaks for itself- no. "Doing Atkins" Low Carb/ High Fat "Then they cut slices from the things, wrapped them in layers of fat and laid row meat on top...while the young men stood by, fire pronged forks in their hands". -Homer, the Iliad Those who opt to eat a diet consisting of low carbohydrate intake are often heard stating, "I'm doing Atkins" or "I'm on Atkins". This fad began not by the company known today as, Atkins, but by it's founder, Dr. Robert Atkins. Dr. Atkins was a cardiologist until he met his unfortunate demise. While leaving his New York City office, he slipped on the ice and struck his head on the concrete. Previous to his, he published Dr. Atkins' Diet Revolution, causing an uproar to common nutritional thought. While the idea of a low carb/ high fat diet was seen as egregious, truth be told that in terms of body fat loss, it worked(s). In addition to weight loss, Dr. Atkins believed eating meat, eggs, cream, and cheese would fight heart disease, diabetes and a plethora of other chronic diseases afflicting people across the globe. By the time Dr. Atkins gained popularity, the low fat paradigm was firmly engrained into society. Dr. Atkins was accused by his peers as being "guilty of malpractice" and "a nutritionist's nightmare", for his idea that consumption of high amounts of fat was healthy. Unfortunately for Dr. Atkins' theory, he counted on case studies to back him up as opposed to clinical trials. Simply because Dr. Atkins did not create an evidence basis for a low carb/ high fat diet, does not mean one does not exist. A long history of diet lifestyle in eating low carbohydrates dates back thousands of years. A bit more recently, it was documented in the memoir, Strong Medicine (1961) by Dr. Blake Donaldson. He was introduced to the high fat diet by experts at the American Museum of Natural History in New York City. They educated him on the Inuit culture, who sustained life mostly disease free, by living almost entirely on the "fattest meat they could kill". Dr. Donaldson attempted to replicate this diet for his patients by removing all flour and sugar while eating fatty meat three times per day. He claimed that his seventeen thousand patients lost an average of two to three pounds per week without experiencing hunger pangs (this may be due tot he fact that fat leads to greater feelings of satiety than do carbohydrates, avoiding the risks of overeating). Learning from Dr. Donaldson, Dr. Alfred Pennington, an in house physician for DuPont, applied this diet within the organization in an attempt to lower risk of heart disease in it's middle aged executives. These executives consumed over three thousand calories per day with a maximum of eighty carbohydrate calories at each meal, three times per day. Pennington described the executives on this diet as experiencing, "a lack of hunger between meals increased physical energy and sense of well-being". (Pennington, 1953) These executives, despite eating a diet so high in calories, lost seven to ten pounds per month. Again though, these are case studies and not controlled trials. It is through true high quality research we can fine tune our understanding of a hypothesis. The case studies by physicians such as Dr. Atkins, Dr. Donaldson, and Dr. Pennington are all very promising and pioneered the way for future research. It was Dr. Eric Westman at Duke University who went though and was impressed with Dr. Atkins' patient files, that did a randomized controlled trial evolve. Dr. Westman and colleagues were among the first to provide solid scientific backing to the treatment of type two diabetes mellitus. They found that when carbohydrates are replaced instead by fat; blood glucose and insulin levels normalize, patients must cease use of their medication and the disease (in essence) goes into remission. (Vernon, et al., 2003) In more than fifteen controlled trials since the year 2000, researcher Jeff Volek and colleagues determined a diet consisting of high fat/ low carbohydrates: increased HDL levels, decreased triglycerides, decreased blood pressure, decreased inflammatory markers, and increased endothelial function. (Volek, et al., 2009) Heart disease, arthridities, and metabolic syndromes all share common traits such as low HDL, high triglycerides, high blood pressure, high levels of systemic inflammation and low endothelial function. The controlled trials by Volek and company appear to have merit in the realization of healthy human body functioning. When considering human performance, we often have an image of athletic performance in mind. Especially for endurance athletes; the idea of carb-loading has been tested and so called perfected. But even today, the idea of carb loading and performance peaking has not come to fruition. It is believed during training, a lower carb, higher fat diet can help train the body to use fat during exercise and recovery. (Spriet, 2011) We have known this as far back as 1983; Volek and (doctor and nutritional biochemist) Stephen Phinney observed athletes performed optimally on zero carbohydrates. (Phinney, et al., 1983) By operating on ketone bodies (derived free floating fatty acids), carbohydrate loading becomes non- existent and our bodies may perform at a sustained higher level. Closing Thoughts It is estimated Inuit's live off of 70%-80% fat calories. They have an extremely low rate of disease. (1946 reprint NY:Macmillan, 1956) The Masai tribe in Africa exist on a diet of meat (fatty), blood and milk. They believe fruits and vegetables are to be eaten only by the cows. Over 60% of their calories come from animal sources. Their blood pressure and weight were 50% lower than their low fat eating American counterparts. (Mann, et al., 1964) A diet high in fat has been understood for decades now to be the optimal source of nutrition as our body was intended to live. Yet modern Americans appear ignorant of this fact and continue on a downward spiral of health. Charles Darwin discussed survival of the fittest. Perhaps survival of the sickest, as is the state of present day Americans, should consider the findings of eating a diet high in fat. It appears from a psychological level of cellular function, we need fat. Replacing it with inadequate fuel leads to disease. A motor vehicle that requires 93 octane will not only function poorly if instead you fill it with 87 octane but it will break down. The same goes for your body. Great innovator Steve Jobs, once said, "Don't be trapped by dogma- which is living with the results of other peoples thinking. Don't let the noise of other's opinions drown out your own inner voice. And most important, have the courage to follow your heart and intuition". Your body was designed to work in a particular manner. I have dispensed the information to which this manner works. Optimal human function is now in your hands. What will you do with it? With the information presented, it's your choice now. Can you shift your mental paradigm in which you live or will you be stuck in a paradigm where disease is omnipresent? Albert Einstein once defined insanity as doing the same thing over and over again while expecting a different result. What is the result you desire? What is your goal? I would hope for all that peak human performance is at the top of everyone's list of goals. This spills over in a positive manner to all other aspects in life. The decision of what you do now is up to you. References: Keys, A., (1957) Diet and Epidemiology of Coronary Heart Disease. Journal of the American Medical Association. 164:17 Keys, A., (1970) Coronary Heart Disease in Seven Countries. American Heart Association Monograph. 61(1):29 Dietary Guidelines Advisory Committee, Prepared for the Agricultural Research Service, United States Department of Agriculture and United States Department of Health and Human Services. Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010. To the Secretary of Agriculture and the Secretary of Health and Human Services. Washington, DC: US Government Printing Office, June 15, 2010 Eckel, R., Jakicic, J.M., Hubbard, V.S., et al., (2013) AHA/ACC Guideline of Lifestyle Management to Reduce Cardiovascular Risk: A Report of the American College of Cardiology/ American Heart Association Task Force on Practical Guidelines Allen, E., Clinical PRogress: Atherosclerosis. (1952) A Symposium. 5(1):99 CDC/NCHS, (2008) National Health and Nutrition Examination Survey; Adapted for Health, United States McDougall, C., Natural Born Heroes. Alfred A. Knopf: New York (2015) Jameson, M., A Reversal on Carbs: Fat Was Once the Devil. Now More Nutritionists Are Pointing Accusingly at Sugar and Refined Grains. Los Angeles Times. December 20, 2010 Astrup, A., Dyeburg, J., Elwood, P., et al., (2011) The Role of Reducing Intakes of Saturated Fat in the Prevention of Cardiovascular Disease: Where Does the Evidence Stand in 2010? American Journal of Clinical Nutrition. 93(4):684-688 Zhong, Q., Saleh, A., et al., (2012) Chemical Alterations Taken Place During Deep Fat Frying Based on Certain Reaction Products: A Review. Chemistry and Physics of Lipids. 165(6):662-681 Blondheim, S., et al., (1976) Unsaturated Fatty Acids in Adipose Tissue of Israeli Jews. Israel Journal of Medicinal Sciences. 12(7):658 Knopp R., (1977) The Dietary Alternatives Study. Journal of the American Medical Association. 278(18):1509-1515 Katan, M., (1977) High-Oil Compared with Low Fat, High Carbohydrate Diets in the Prevention of Ischemis Heart Disease. American Journal of Clinical Nutrition. 66(4):974S-979S Gordon, T., et al., (1977) High Density Lipoprotein as a Protective Factor Against Coronary Heart Disease: The Framingham Study. American Journal of Medicine. 66(5):707 Volek et al., (2004) Comparison of Energy-Restricted Very Low Carbohydrate and Low-Fat Diets on Weight Loss and Body Composition in Overweight Men and Women. Nutrition and Metabolism. 1(13):1-32 Volek et al., (2009) Effects of Dietary Carbohydrate Restriction versus Low-Fat Diet on Flow Mediated Dilation. Metabolism. 58(12):1769-1777 Menotti et al., (1999) Food Intake Patterns and 25 Year Mortality from Coronary Heart Disease: Cross Cultural Correlations in the Seven Countries Study. European Journal of Epidemiology. 15(6):507-515 Ornish, D., Healing Through Diet. TED Talks, Monterey, CA. October 2008. Accessed July 10, 2016. http://www.ted.com/talks/dean_ornish_on_healing.html Ornish, D., Brown, S., Billings, J.H., et al,. (1990) Can Lifestyle Changes Reverse Coronary Heart Disease? The Lifestyle Heart Trial. Lancet. 336(8708):129-133 Aldana, S., et al., (2007) The Effects of an Intensive Lifestyle Modification Program on Carotid Artery Intima-Media Thickness. A Randomized Trial. The American Journal of Health Promotion. 21(6):510-516 Teicholz, N., The Big Fat Surprise. Simon and Schuster, New York, NY (2014) World Cancer Research Fund and the American Institute for Cancer Research, Food Nutrition, Physical Activity and the Prevention of Cancer: A Global Perspective. Washington, DC: American Institute for Cancer Research (2007) 116-128 Lichtenstein, A., Van Horn, L., (1998) Very Low Fat Diets. American Heart Association Publication Circulation. (9):935-939 Tanaka, T., Oramura, T., (2012) Blood Cholesterol Level and Risk of Stroke in Community Baded or Worksite Cohort Studies: A Review of Japanese Cohort Studies in the Past 20 Years. Keio Journal of Medicine. 61(3):79-88 Tanaka, H., Ueda, Y., (1982) Hayashi, M., et al., Risk Factors for Cerebral Hemorrhage and Cerebral Infarction in Japanese Rural Community. Stroke. 13(1):62-73 Fiedorowicz, J., Haynes, W., (2010) Cholesterol, Mood and Vascular Health- Untangling the Relationship. Does Low Cholesterol Predispose to Depression and Suicide or Vice Versa? Current Psychiatry. 9-7 Feinleib, M., (1981) On a Possible Inverse Relationship Between Serum Cholesterol and Cancer Mortality. American Journal of Epidemiology. 114(1):5-10 Pennington, A., (1953) Symposium on Obesity: A Reorientation on Obesity: New England Journal of Medicine. 248(23):963 Vernon, M., et al., (2003) Clinical Experience of a Carbohydrate Restricted Diet: Effect on Diabetes Mellitus. Metabolic Syndrome and Related Disorders. 1(3):234 Spriet, L.L., (2011) Metabolic Regulation of Fat Use During Exercise in Recovery. Department of Human Health and Nutrition Science, University of Guleph. Guleph, ON, Canada. Nestle Nutrition Institute Workshop Series. (69):39-53; discussion 53-8. Epub Jan 8, 2012 Volek, J., et al., (2009) Effects of Dietary Carbohydrate Restriction Versus Low-Fat Diet on Flow-Mediated Dilation. Metabolism. 58(12):1769-1777 Phinney, S., et al., (1983) The Human Metabolic Response to Chronic Ketosis Without Caloric Restriction: Prevention of Submaximal Exercise Capability Without Reduced Carbohydrate Oxidation. Metabolism. 32(8):769-776 Stefansson, V., The Fat of the Land, enlg ed of Not by Bread Alone (1956) reprint. New York: Macmillan Mann, G., et al., (1964) Cardiovascular Disease in the Masai. Journal of Atherosclerosis Research. 4(4):289-312 |
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