Now what do we eat?

As experts bicker, we get fatter.

By JANET K. KEELER, Times Staff Writer
© St. Petersburg Times
published August 7, 2002

[Times photo: Patty Yablonski]

For more than 20 years, we've been told that dietary fat is bad for our hearts and our waistlines.

We read it in books, learned it from doctors and the federal government, and heard it loud and clear from one woman with spiky platinum hair who screamed at us to "Stop the insanity."

"It's fat that's making you fat," hollered Susan Powter, whose late-night, infomercial mantra we gobbled up along with millions of dollars of fat-free cheese, crackers, sour cream, yogurt, cookies and ice cream.

Now there are rumblings in the medical community that maybe fat isn't the sole culprit in the obesity epidemic that began in the 1980s and continues unabated today. Perhaps Dr. Robert Atkins, who has been pushing a high-protein, low-carbohydrate diet for 30 years, isn't the evil charlatan the medical community painted him. Some will never be convinced of that, especially after Atkins' heart problems last spring.

It's enough to make a professional dieter throw up her hands and shove her face into a banana cream pie. How are we supposed to eat to maintain weight and health? And if we decide on a course of action today, will another study come along tomorrow and prove that wrong?

"Research sort of makes you crazy," says Barbara S. Correll, a registered dietitian in private practice in Clearwater and Tampa. "Eat this, don't eat that and then it always comes back to the midpoint."

The midpoint that Correll refers to is the good news in nutrition, and it's something that hasn't wavered much as we've eaten our way through one fad diet after another.

The best diet, Correll and other dietitians say, is one that includes a variety of foods, including meat, dairy products and fat as well as fruits, vegetables and grains, in moderation. Oh yes, and don't forget regular exercise. Exercise helps relieve the stress that causes many of us to overeat.

It's not very exciting, and it's certainly not the magic pill we want.

The bad news is that science is evolutionary, and new research points in different directions seemingly every day. And despite all the studies we read about, there isn't enough research on nutrition and popular diets to prove anyone right or wrong, says Dr. Robert Bonow, president of the American Heart Association and a professor at Northwestern University in Illinois.

Consider recent reports on Hormone Replacement Therapy and arthroscopic knee surgery, for instance. Nearly 70-million women in America taking HRT drugs were rocked last month when the federal government said they were at increased risk for breast cancer, heart disease and blood clots. Within days another government study said that arthroscopic knee surgery for osteoarthritis, performed on 300,000 Americans each year, might not be beneficial at all.

Then a July 7 article in the New York Times Magazine, "What If It's All Been a Big Fat Lie?" rekindled the national nutrition debate. A week later, Time magazine asked "Should You be a Vegetarian?" A recall of 19-million pounds of contaminated ground beef from ConAgra -- none of it in Florida -- made many wonder if they shouldn't be saying "yes" to an all-veggie diet.

Not so fast. Last week, the government warned consumers to avoid Romaine lettuce from Spokane Produce. It was blamed for an E. coli outbreak at a Washington state cheerleading camp.

Bonow says that conflicting nutrition research, along with news reports about tainted food, confuses and confounds people trying to determine the best eating plan for them.

"But we are glad the debate is reaching public awareness again," he says. "We do agree that more research is needed. The kind of research that is required is nutritional and behavioral. Why can't some people exercise? Why do people want the easy way out?"

And if moderation is the key, why doesn't it unlock the thin door for the millions of American struggling with weight?

"It's not hard to grasp, but it's hard to do," Correll says. "We are drawn to fatty foods. We love the smell, taste and the feel of fat in our mouths. It's comfort in our time of need. But I try to tell my patients that food is not our friends."

To eat right, you need to know something about food or else you're just adding more stress to your life. For instance, bananas are better for you than banana pudding. A glass of orange juice, while still less nutritious than an orange, is more healthful than a glass of soda pop at breakfast.

"Food should be far down on your list of things to worry about if you know what you are doing," Correll says.

But what are we doing?

We are eating a lot of high-sugar, high-fat convenience food. In all the discussions about what has made the obesity rate rise 60 percent in the last 10 years, no one has ever said that potato chips are good nutrition.

There is plenty of reliable research that tells us saturated fat is bad for the heart, Bonow says, which is why the American Heart Association does not endorse the Atkins diet.

In the 1980s, the research about saturated fat was translated into an indictment of all dietary fat which, in part, led to the low-fat, high-carb craze. In fact, low-fat, high-carb regimens were not considered fad diets at all, but were accepted health wisdom. The duel between low-fat adherents and Atkins zealots could be seen as conflicting world views.

(Subsequent studies showed that monounsaturated fat, such as olive oil, was good for your cholesterol count, elevating the good HDL (high-density lipoproteins), and lowering the bad LDL (low-density lipoproteins.)

The food industry jumped on the low-fat bandwagon and before we knew it there wasn't a product in the grocery store that didn't come in a no-fat or low-fat version. And we got fatter.

The low-fat concept made sense to us, especially when considering calories. A gram of protein or carbohydrate is 4 calories; a gram of fat is 9. Fewer calories are better, right? Of course they are, but we weren't watching calories, we were watching fat grams and ignoring the total consumption altogether.

Many low-fat processed foods were loaded with calories. Something had to be added to replace the fat; otherwise, fat-free chocolate cookies would taste like sawdust.

The replacements were usually salt and sugar, says registered dietitian Anne Schreiner, an educator at the Joslin Center for Diabetes in Clearwater. Sugar, however, doesn't keep us satisfied for long. We experience a spike in blood sugar and then a ravenous crash. Fat and protein keep us sated longer.

"We've been seduced into thinking low-fat is healthy," Bonow says. "Some low-fat (highly processed) foods have their own health risks."

Balanced diets, such as those espoused by the American Diabetes Association, Heart Association and Weight Watchers, all include moderate amounts of fat, coming mostly from animal protein, and added fats such as oil and butter. Plus, these diets suggest that dieters eat something nutritious every four hours or so to keep blood sugar levels constant.

"People have forgotten about calories," Schreiner says. "And servings have become helpings."

The federal government has been criticized for anchoring the food pyramid with six to 11 servings of bread, cereal, rice and pasta. Proponents of high-protein, low-carb diets say that all those carbohydrates are killing us.

But how can the government help us when our idea of one serving of bread is a monster bagel? Those popular, fist-size bagels are about 500 calories and five starch servings, Schreiner says.

Dr. Dean Ornish, who outlined his nearly no-fat, high-fiber diet in Eat More, Weigh Less (HarperCollins, 1993), challenged the New York Times article in a letter to the newspaper. He wrote that high-protein diets are based on "half truths" and that the solution to obesity is not to go from simple carbohydrates like potato chips and french fries to pork rinds. The answer, he says, is to eat complex carbohydrates such as fruits, vegetables, beans and other legumes and whole-grain breads and pastas which are absorbed into the system slowly and thus stave off hunger.

(Just because bread is brown, doesn't mean it is whole-grain. Molasses is added to many breads to darken them. Look at the nutrition label. If it lists whole-grain oats or whole-grain rice, for instance, among the first ingredients, you've got what you need.)

Ornish, president of the Preventive Medicine Research Institute at the University of San Francisco, has published a widely respected peer-reviewed study of his diet that shows its ability to reverse the ravages of heart disease.

Now there are independent tests under way on both the Ornish and Atkins diets. The National Institutes of Health has just funded a $2.5-million five-year trial of the Atkins diet on 360 obese people. Several previous proposals to test the Atkins diet were rejected by the federally funded NIH, reports the New York Times.

In 2000, Medicare began paying about $7,200 each for 1,800 elderly heart patients to follow the Ornish program. Results of that study have not yet been released.

"Until we have that kind of definite information, we really need to make recommendations based on available evidence," Bonow says.

Those recommendations include the dreaded M-word. Moderation.

"It's boring," Bonow says. "It doesn't grab the imagination."

Something that does grab our imagination, however, is advertising. That is another factor that may have gotten us into this pickle.

Millions of dollars are spent annually to get us to eat what can be described only as junk food. That would be high-carb, sugar-laden snack foods and drinks. Much of that advertising is aimed at children.

"I've got kids coming in here who are 270 percent over their ideal body weight," Correll says. "They are 40 inches tall and 40 inches wide. How do I help them?"

Correll and Bonow both agree that we have to use our heads rather than our stomachs and hearts when we feed ourselves and our families. Resist the kiddie toys designed to pull our children and us into fast-food joints and the claims that 32-ounce bottles of sugary sports and juice drinks can energize us.

"We have to change behavior to effectively change nutrition," Correll says. "We have deep-set problems and deep-set behavior."

What to do, though, while the scientists decide whether we should be eating Ornish's low-fat, high-fiber diet or Atkins' high-protein, low-carb regime?

"Look at calories and where you are getting them from," Schreiner says. "If you can get all your vitamins from food, that's fine."

Most women will lose weight on a 1,400-calorie-a-day diet; men on 1,700. Don't kid yourself though. If the 1,400 calories come from fast food, you won't be able to stick to the plan because you won't get enough nourishment. Eat food as close to its natural source as possible, say nutrition experts. That means eating apples rather than drinking apple juice and snacking on cherries rather than cherries jubilee.

"If you want vitamins and antioxidants, Mother Nature packages those much better than people do," Bonow says.

-- Information from Times files and wire reports was used in this story.

Help online

For information on nutrition and finding a dietitian in your area, log on to the American Diabetes Association Web site at www.diabetes.org. Other helpful nutrition sites include:

American Heart Association, www.americanheart.org

Tufts University Nutrition Navigator, www.navigator.tufts.edu/

American Dietetic Association, www.eatright.org

National Institutes of Health, www.nih.gov/

We do enjoy diet books

Need proof of just how polarized we are about nutrition and how interested we are in finding the best way to eat?

Here are last week's best-selling food books compiled by the Los Angeles Times.

The rankings are based on a Times poll of national cookbook and independent booksellers.

1. Dr. Atkins' New Diet Revolution by Robert C. Atkins. High-protein, low-carb dieting regime.

2. The Healthy Kitchen by Andrew Weil and Rosie Daley. Cookbook for Weil's low-fat, organic whole-foods eating plan.

3. Fast Food Nation by Eric Schlosser. Indictment of the "unhealthy" fast-food industry.

4. I'm Just Here for the Food by Alton Brown. A scientific explanation of cooking by host of Food Network's Good Eats.

5. Cooking Thin With Chef Kathleen by Kathleen Daelemans. Cookbook for low-fat, high-flavor diet.

Personal stories from formerly overweight host of Food Network's Cooking Thin.

6. 30-Minute Meals by Rachael Ray. Companion book to Ray's Food Network show of the same name. Quick homemade meals.

7. Weight Watchers New Complete Cookbook. Latest general cookbook by venerable weight-loss organization which promotes a moderate, balanced diet.

8. How to Be a Domestic Goddess by Nigella Lawson. British diva shares her entertaining secrets.

9. The Schwarzbein Principle Cookbook by Diana Schwarzbein, Nancy Deville and Evelyn Jacob Jaffe. Cookbook for Schwarzbein's high-protein, low-carb diet. She's an Atkins proponent.

10. How to Eat by Nigella Lawson. Lawson describes herself as an eater, not a cook in this tribute to eating well.

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