The People's Perspective on Medicine

Show 958: Flipping the Food Pyramid Upside-Down

The old-style food pyramid with lots of starches and sugars at the base and fats at the tip may not be the healthiest way to eat.
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Flipping the Food Pyramid Upside-Down

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People often hold fast to their favorite dietary dogma and get annoyed if it is challenged. But lately there has been a great deal of controversy about the best diet for good health, especially for people with diabetes or heart disease.

One sign of a possible paradigm shift is the publication of three different articles in The New England Journal of Medicine this week. Although all were focused on the health implications of sodium intake, they came to rather different conclusions.

The Low-Down on Low-Fat Diets

The usual recommendation for people with diabetes is to follow a low-fat diet and avoid saturated fat in particular like the plague. The natural consequence of following these rules is a diet for diabetes that is high in carbs, sometimes highly processed carbs, though it may be low in fat. Is this truly the healthiest way a person with diabetes can eat? Or should the food pyramid be turned upside-down so that grains are the smallest proportion of the diet and fats provide the most calories?

We talk with Dr. Eric Westman about the benefits of a ketogenic diet for a variety of health problems. He’ll tell us why he often recommends such a diet for his patients, and he will answer your questions.

This Week’s Guest:

Eric Westman, MD, MHS, is an associate professor of medicine and director of the Duke Lifestyle Medicine Clinic. He is medical director of the Duke Center for Smoking Cessation and co-author of the books, The New Atkins for a New You and KetoClarity: Your Definitive Guide to the Benefits of a Low-Carb, High-Fat Diet. The website is His scientific article on “Dietary carbohydrate restriction as thefirst approach in diabetes management” has just been published online in Nutrition.

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The podcast of this program will be available the Monday after the broadcast date. The show can be streamed online from this site and podcasts can be downloaded for free for four weeks after the date of broadcast. After that time has passed, digital downloads are available for $2.99. CDs may be purchased at any time after broadcast for $9.99.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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Love that oil is healthy, includes a high smoking stage and most of all that it’s Canadian:)

Lots of “Food for Thought” by Dr. Westman. There seems to be a fair amount of confusion about the opinions being offered. Being a dyed in the wool contrarian, I was pleased to hear the opposite side of BigPharma’s and the farm lobby’s position, as usual, presented as government policy. Considering that BigPharma is the gatekeeper in controlling what is narrowly allowed to become “evidence” in evidence based medicine, we are left to using our common sense.
I found exploring the links in the summary particularly worthwhile, and recommend them to those who have a thirst for knowledge.

He recommends low carbs, but doesn’t mention high fiber veggies which don’t raise blood sugar. I’m a vegan, eat no sugars, starches or grains that make my blood acid. My fat comes from nuts, mostly almonds and coconut oil. I am not overweight; my glucose and cholesterol are low.
You don’t have to eat bacon and sausage to be healthy and he doesn’t give any evidence for that. Animal fat and protein will acidify your blood and pull calcium out of your bones. In my opinion his diet is not a healthy one.

I do not think Dr. W was condoning any pork product. Only organic, minimally processed meats of any kind. Find these at your local farmers’ market and get to know the folks who grow your food. ASK questions, as an educated consumer controls their food destiny.

I’m really confused now about what’s good for me to eat. Unrefined carbohydrates like whole grains, beans, lentils, peas, cereals, now seem to be out, as are fruit.
So we now have animal protein, fats and vegetables left.
I understand that foods with high glycemic indices cause a rise in blood sugar levels which then require insulin, either produced by the pancreas, or if unavailable from our own body, externally administered, to control blood sugar levels.
One author, Daniel P. Reid, “The Tao of Health, Sex and Longevity”, in whom I have a lot of trust, suggests never eating cooked eggs, much less bacon and sausages but according to Dr. Westman, they constitute a good breakfast. Nutrition has become such a ‘puzzlement’. Help !!

After hearing the radio show (which I found fascinating), I searched for and re-read the article from 2002, “What If It’s All Been A Big Fat Lie”. The author talks about the “small but growing minority of establishment researchers” whose research was leading them to conclude that high carbs were the cause of obesity and diabetes (and other chronic health problems). This article was in the New York Times Magazine of July 7, 2002. All that’s happened since then is an avalanche of research that supports this position, and still almost no change in public policy. It seems health policy, both in medicine and government, is controlled more by political clout than science. What happened to the goal of “evidence-based” medicine?

Great show. Regarding diabetes and dairy, a recent commentary in The Lancet calls for re-thinking dietary guidelines that emphasize low-fat dairy for diabetics:
Current National School Lunch Program guidelines ban whole milk dairy products but allow Cheetos. If so inclined, please sign the petition to remove the ban on full-fat dairy products in our nation’s schools:

I believe they can be complements. The other co-author is a guest on this podcast that I listen to every week. I’d highly recommend it.

I am really disappointed in your not challenging Dr. Westman on eating sausage and bacon. They ARE heavily processed foods and ARE linked to heart disease and cancer. The rate of stomach cancer dropped after salt curing from the 1940s and 1950s were replaced with freezing and better refrigeration.
Harvard has recently come out with studies that show direct linkage of heart disease to all processed meats (including lunch meat). I agree that carbs cause a LOT of problems but so does processed meat.

I am one of the “success stories” featured in Dr. Westman’s book “Keto Clarity.” I recommend it highly and hope you will read it and see how it has effected the lives of real people like me.

Who do we believe? Is the last speaker giving us 100% of truth? Or are we getting a political answer, half truth and the rest half-truths bent to his personal beliefs. The defense is “its written” but whose writing, even the devil writes. What are we the listener (the consumer) to do? listen, mediate, start with a middle road, do everything in moderation. Thanks.

The Wahl’s Protocol has three levels, I believe, based on your needs. She herself is folowing a ketogenic Paleo diet. So, yes, they can easily be combined. You would limit fruits, molasses, honey (and Paleo “treats” made with almond/coconut flour, if consuming them),and starchy vegetables, and increase meat fat, egg yolks, olives, avocados, coconut oil, and olive oil. I eat grass-fed ghee, which is not Paleo, but I tolerate it and enjoy it.

I’m a Type One Diabetic. I came back from the doctor recently with an extremely high LDL-C & LDL-P number. I’ve been doing a very low carb ketogenic diet for ~5 months now. What is the talk (or latest research) on why this happens to some people? Is it harmful, helpful, or what?

The upside down pyramid certainly gains attention. The failure of blanket, one statement fits all suggestions is
almost predictable; of course we are all different, in so many ways. If you need such a guide I suggest: “If man
made it, don’t eat it!” Thanks Jack.

What about all the research on the benefits of starches??

I wonder how this diet compares to Dr. Wahl’s Paleo Diet. Is Dr. Westman familiar with this diet? Can the two be combined or does one need to strictly comply to one or the other.
I have put on 15 pounds since menopause and no MD cares to address this, since my BMI meets standards for my height. I admit I do not consume much meat or fat, although following organic foods. Having been on the Paleo Diet (I am not an MS patient) for the past month, I feel better and have lost three pounds. Could the Ketogenic compliment the Paleo?
Very interesting program today. Thank you.

I was just talking to my own physician about diabetes and diet.
He sounded so frustrated that his patients WILL NOT give up things like diet sodas saying there is no sugar in the drink. I cannot help but wonder if the body detects sweet and responds with insulin in spite of ads to the contrary.
Dr. Richard Bernstein must maintain a very rigid low (almost no in his case) carb diet to even survive. Most of us might be unwilling to be so persistent in maintaining dietary standards to keep blood sugars down.
He is NOT on dialysis and at 80 years of age, his methods have been successful for him and numerous others. He still has an active medical practice and does a monthly Q&A.
This man is amazing.

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