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Do 'heart healthy' Diets Cause Diabetes?

Some doctors claim recommended diets are doing harm

By David Mendosa

Last Modified On: July 28, 2001

The so-called "heart healthy" diets contribute to diabetes, Dr. Diana Schwarzbein contends. "That is an absolute yes. If you take out fat, you are going to be left with too many carbohydrates. That will increase insulin, and anything that increases insulin over a long period of time is going to give you a higher risk for diabetes."

The diet is a bad joke.

Schwarzbein, an endocrinologist in Santa Barbara, Calif., is the author of The Schwarzbein Principle: The Truth about Losing Weight, Being Healthy and Feeling Younger (Health Communications, 1999). In it, she explains how she prescribes low-carb diets to treat her patients.

"But the so-called heart healthy diets are also a joke on the heart," Schwarzbein said, "because they are not heart healthy. If I start taking away cholesterol and fat, then all I'm doing is getting more carbohydrates. But the liver takes the excess carbohydrates and turns them right into fat and cholesterol. So I am not lowering them at all."

The diets that have been touted as heart healthy during the past two decades have tended to be very low in fat. And since they don't have a lot of protein, that makes these diets high in carbohydrates.

The most important of these diets is Dr. Dean Ornish's Program for Reversing Heart Disease (Ballantine Books, 1990). His Reversal Diet is 10 percent fat, 15 to 20 protein, and 70 to 75 percent carbohydrate. Ornish, a specialist in internal medicine, practices in Sausalito, Calif.

Among many studies of his diet, Ornish reports on a comparison between people with moderate to severe coronary heart disease who adhered to his program and those assigned to conventional, less rigorous lifestyle modification. After five years on the plan, the Ornish group had clearer arteries, while those in the conventional group saw their disease worsen. The study, by Dean Ornish, et al., " Intensive Lifestyle Changes for Reversal of Coronary Heart Disease ," appeared in the December 16, 1998, issue of The Journal of the American Medical Association.

Before Ornish's Reversal Diet, Nathan Pritikin developed a similar diet and exercise lifestyle modification program. Pritikin was the first to advocate a 10 percent fat diet. The Pritikin Longevity Centers in Santa Monica, California, and Aventura, Florida, have a Web site at http://www.pritikin.com.

Originally promoted to treat high blood pressure, the "DASH" diet—Dietary Approaches to Stop Hypertension—may also offer protection against heart disease, according to a recent study. The DASH diet is 55 percent carbohydrates and 27 percent fat. It reduces artery-damaging homocysteine, which is associated with an increased risk of heart attack and stroke when present in high levels. The study by Lawrence J. Appel et al., " Effect of Dietary Patterns on Serum Homocysteine" appeared in the August 22, 2000, issue of Circulation.

These three diets may prevent and even reverse heart disease. But is that at the cost of contributing to diabetes? Dr. Schwarzbein is not the only one to think so.

Dr. Richard K. Bernstein, a Mamaroneck, N.Y., endocrinologist, who uses a very low carbohydrate diet in his practice, agrees with her.

"When I cut the carbohydrates and ignore fat," he said, "the result is that blood lipids—which cause heart disease, diabetes, and obesity—all improve."

The Pritikin diet, for example, provides temporary improvement in a lot of things, Bernstein said. "But he also has people exercising strenuously, and that can make a big difference."

On the other hand, Marion Franz, does not agree that low-fat diets cause diabetes or are bad for people with the disease. She is a registered dietitian and a Certified Diabetes Educator who currently chairs the American Diabetes Association's task force revising the organization's nutrition recommendations.

"The research shows that you seem to lose weight better on a low-fat diet," she said. "People also maintain weight loss better when they have a low-fat diet."

Franz helped draft the ADA's current " Nutrition Recommendations and Principles for People With Diabetes Mellitus," which has moved away from its earlier emphasis on a high-carbohydrate diet while still not embracing a high-fat diet.

From 1986 to 1994, the ADA's nutrition recommendations were for as much as 60 percent carbohydrates, 12 to 20 protein, and less than 30 percent fat. Today, there is no one "diabetic" or "ADA" diet. Instead, the organization recommends one based on "assessment and treatment goals and outcomes."

The debate between those promoting low-fat and low-carb diets doesn't have definitive answers yet. But some are emerging.

A study in the June 2000 issue of the American Journal of Clinical Nutrition showed that a high dietary glycemic load from refined carbohydrates increases the risk of coronary heart disease. The analysis of the 75,521 nurses who participated in the long-term Nurses' Health Study is "A Prospective Study of Dietary Glycemic Load, Carbohydrate Intake, and Risk of Coronary Heart Disease in U.S. Women" by Simin Liu et al.

Ornish recently proposed that Medicare test whether it could replicate his results. The agency agreed, and over the next three years, Medicare will fund a study tracking about 1,800 elderly heart patients in at least 15 centers where Ornish has trained the staffs.

Patients with chronic conditions like high blood pressure and diabetes will get outpatient nutrition counseling. Will they be able to stay on a diet that is no more than 10 percent fat? Will they get better or worse? Nobody knows yet, but the answers to come could go a long way toward resolving one of the most contentious issues in human nutrition. 


This article originally appeared on NutriNews.com on November 10, 2000.


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