The current Western diet, now unfortunately enjoyed worldwide, has produced many unintended consequences in its consumers. Most readers of "low-carb" literature can probably recite, line and verse, most descriptions of how we got into the current "healthy, low-fat lifestyle" that seems to be killing us. Nevertheless, and at the risk of being bombarded with e-mail, as someone who wrote his Honors Thesis at Yale on "Human Biological and Social Evolution," allow me to offer a few insights into our past and current eating behaviors.

We share from 98 to 99% of our genes with chimps and gorillas, who have been forest dwelling apes for the past 5 million years or more. The bulk of the food consumed by these apes, then as now, are leaves and occasional fruit. While gorillas solely eat leaves, chimpanzees supplement their diet with animal protein, including insects, grubs, and even higher animals such as monkeys. Although the gorilla is classified as an herbivore (plant eating only), most herbivores consume a modest amount of animal products (insects, insect eggs, spiders) just in the process of eating leaves. That fact notwithstanding, the vast majority of the interaction between apes' intestines and the genes of each ape's cell are with green plants and the compounds they contain.

It is also abundantly clear from the fossil evidence of early man, both in our facial bone structure, teeth formation, and animal bones associated with our fossils, that early humans supplemented their diets with animals. However, there is no evidence, for most of our evolution, that animals became the dominant food source. What do I mean by this? Simply put, even if we received the majority of our calories from eating animal products, the quantity of plant material entering our bodies far exceeded the amount of animal products on a day to day basis. This concept is a bit difficult to grasp the first time around, so consider an example that illustrates the point. The fat in whole milk only accounts for 4% of its weight; 2% milk is 2% fat by weight; in other words, a very small percentage of that cup of milk you're drinking is fat, yet, because fat has 9 Kcal of energy per gram, whole milk gets approximately 60% of its calories from fat. Even 2% milk gets 35% of its calories from fat. But if we were to look at all the types of nutrients you consumed while drinking that glass of milk, the number one nutrient is water! So, if you went on a 100% whole milk diet, fully 60% of your caloric intake would be from fat, even though in essence you're drinking water with just a tiny bit of fat added. It's the same way with our ancestors' "meat eating" diet. A lot of calories, even the majority, may have been obtained from eating animal prey, but the majority of food by weight entering our ancestors' mouths was probably plant based.

It also goes without saying, but I will anyway, that our ancestors consumed a low fat diet, even if they consumed huge amounts of animal products. Let's make sure we understand this concept: Wild animals are lean. The fat they do contain is remarkably different from our factory farm raised animals of today, as most of the animals our forefathers consumed, even two generations ago, were leaf and grass eating herbivores, whose fat contained high amounts of conjugated linolenic acid and a much greater proportion of the saturated fat, stearic acid, both "heart-healthy" fats. Let's also understand that most good carnivores love fat! Why? Two reasons: Fat contains fat-soluble vitamins that carnivores require; and fat has more than twice the calories as the muscle of an animal, and three times the available energy than protein or carbohydrates (leaves). Those are very good reasons why any animal, when starvation is a real daily possibility, loves fat. Our ancestors were so good at finding the fat in an animal, that they routinely split all the long bones to get to the fatty marrow inside. That's an impressive effort to get to something that's supposedly bad for you!

So, it's easy to understand our innate desire for fat and why we heed the siren call of "eat all the meat and fat" pitchmen of "low carb" diets out there today. Unfortunately, I must beg you: Don't listen! The fat our ancestors ate bears no resemblance to the animal fat we eat today! Proponents of this "eat fat" argument seem to think that "parts is parts" as the old TV commercial stated regarding the composition of one company's chicken "nuggets" over a competitor's. Unfortunately, it simply isn't true. Studies of cows fed either alpine meadow grass, hay, or grains show a direct negative correlation of beneficial fats and nutrients which appear in their milk, fat, or muscles. In other words, as fresh grass intake lessens and grain intake increases, the benefits of consuming dairy products declines. Is "grain fed" fat deadly? Absolutely! Studies at the University of Maryland, where I was once a Professor, have shown that the average blood flow through healthy volunteers' arteries decreases by 40% following a fatty meal! Now that's a "low carb" lifestyle I can live without (excuse the pun).

Despite this depressing information, it is clear from the various habitats that humans occupy that we can survive on a near total animal protein and fat based diet or a total plant based diet. But the fact that humans can survive on a certain diet doesn't suggest that they are thriving on that diet. The gentleman I performed a quadruple coronary artery bypass on today has survived very well on a typical American junk food diet, but I doubt when he wakes up that he would claim that he has thrived on that same diet! The words "survive" and "thrive" are simply not interchangeable, yet many proponents of one or another style of eating constantly confuse the two words, setting the stage for dietary disaster. But, what about cholesterol levels improving on a "high fat/low carb diet"? Yes, it does happen frequently, because your liver is no longer receiving instructions to manufacture cholesterol. Sadly, however, one half of all patients who experience a heart attack have "normal" cholesterol levels.

So much for our ancestors. What about our current mess? And am I saying that the low fat Ornish or Pritikin diet is the way to life-long happiness? Absolutely not! However, the low-fat hysteria of the last twenty years had its basis in good solid data and the evolutionary records of early man, but how that dietary recommendation was implemented spelled disaster for our health and waistlines. We're surviving but we're definitely not thriving. Readers of Low Carb Luxury probably already realize that the substitution of refined carbohydrates for the excessive fats in our diet over the past twenty years was the food industry's and the health care industry's way of implementing the "Low Fat Lifestyle". Prestigious health organizations such as the American Heart Association (of which I am the local chapter's President), championed the low-fat lifestyle, and most of us physicians followed in lock step behind. Why? Because, on the surface, the evidence is extremely convincing that low fat diets produce less heart disease and obesity. What isn't apparent is what kind of "low fat" diet this evidence is based upon. The people with the low incidence of heart disease in Ancel Keys' pioneering Seven Countries Study in the 1950's weren't eating much fat because they were busy eating lots of vegetables, not bagels and rice cakes. And, because most people Keys studied were recovering from the devastation of World War II, meat products were hard to come by, number one, and number two, what meat people did consume was primarily fish or scraggly cows, pigs, or chickens with little fat. And even if people were eating pasta or breads or grains, they immediately were walking or performing heavy labor, using those concentrated carbohydrate calories for immediate fuel, rather than storing it as fat like we inactive Americans.

For many years, we physicians missed these subtle, but telling findings. It wasn't really the low fat; it was the huge amount of unrefined plant material that produced low rates of heart disease! And this finding comes full circle back to our prehistoric forefathers and even our great ape cousins. We evolved eating huge amounts of green "things" (a gorilla eats 16 lbs of leaves a day to maintain its weight). Groups of humans that do that in recent times continue to show very low incidences of heart disease (or any other disease for that matter). Groups of humans, who don't do that, regardless of country of origin or foods indigenous to the region, develop heart disease. This was just confirmed this week at the European Society of Cardiology Congress where the incidence of heart disease was compared in 30,000 individuals from around the globe who were followed for 9 years. Those who ate large amounts of vegetables and fruit, didn't smoke, and engaged in daily exercise had approximately a 90% less chance of developing heart disease!

Having said all that, when I have an overweight or obese patient with heart disease, I start them on an induction phase diet for two weeks that resembles a South Beach diet, that we call the "Restore Eating Plan". I have real problems with the high amount of milk based products in the Atkins or South Beach programs, so our program allows much less. Why a reduction in milk products? Doesn't milk "do a body good"? Unfortunately milk products contain a hormone called insulin-like growth factor (IGF), which is so named for its remarkable chemical similarity to insulin and to its similar actions. While much rhetoric and emotions have been wasted on cows being injected with BGH (bovine growth hormone) and causing IGF secretion in their milk, all cows produce IGF and lots of it in their milk, whether or not they receive BGH.

When excess insulin is a problem in my patients with metabolic syndrome (and it is a major problem), the last thing I want them eating is more of an insulin-like hormone! And unfortunately, IGF levels go up in your blood stream the more milk you drink or milk products you ingest. In general then, we try to limit milk products to ricotta cheese, which is made from the whey in milk. We do encourage whey based protein powder supplements for the same reason.

And like most "low carb" programs, we do get dramatic results. But! And it's a big BUT! We like to think of fat in your belly as a cancer. After all, a cancer is a collection of cells that are growing and are trying to kill you. If your belly fat isn't a cancer, I don't know what is! If I were treating you for a "real" cancer, I might prescribe chemotherapy to kill off your cancer cells. But I probably wouldn't keep you on intensive chemotherapy the rest of your life, because the chemotherapy in itself is toxic to your normal cells if they're exposed for long enough. It is the same with intensive "low carb" therapy. We use it for a short time to help "kill off" your growing fat cells, because it really works. But in the long run it's about as dangerous as what it replaced. That's why in the Restore plan, we transition our patients to become vegephiles. And I don't mean vegetarians. I spent 13 years as Professor and Chief of Cardiothoracic Surgery at Loma Linda University Medical Center which is a Seventh-Day Adventist Medical School and have treated scores of Vegetarians for heart disease. The common factor? Most of these vegetarians were, in fact, pasta-tarians or grain-atarians (my terms), as the majority of their food intake were refined grain based meals heavily supplemented with fat to ensure adequate caloric intake. Sure, they avoided meats, but they also avoided vegetables. And, they too, developed heart disease. So, in the "Restore Eating Plan", we restore our patients' blood vessels by having them become vegetable eaters, not vegetarians.

In doing so, it appears that we have lessened the confusion about simple versus complex carbohydrates, or between processed or refined carbohydrates. Frankly, all these terms befuddle the vast majority of my patients. So we apply the KISS principle whenever possible: Keep It Simple, Stupid. Our patients are taught:

1. Eat green and become lean.
2. If it's brown, slow down.
3. If it's white, keep it out of sight.
4. Eat nuts and food raw, your heart will go "ahhhhh!"
5. Your heart and brain have a wish, please eat more fish.
6. Berries and cherries make your heart and brain merry.

Does this mean no meat? Not at all; but, we place meat in the brown food group, so you merely "slow down".

Does it work? A study we have conducted on the "Restore Eating Plan" has been selected for presentation at the 4th International Conference on Diet and Aging in Toulouse, France in November, due in large part to the careful monitoring of cholesterol reductions, weight reductions, and changes in inflammatory markers in our patients and ourselves. I personally am excited about the "Restore Eating Plan" for selfish reasons: I've lost 55 lbs over the past 15 months and totally restored my previously terrible cholesterol profile to stellar! My body fat dropped from 27% to its current 15%. My administrator has lost 30 lbs in 8 months and dropped her total cholesterol from 250 to under 200, while raising her HDL (good cholesterol) to 97!

So, in conclusion, "low-carb" is a wonderful and effective tool to induce weight loss and to jump start a diet that we use in the initial treatment of our overweight or obese patients with heart disease and/or metabolic syndrome. It is a powerful chemotherapeutic method of "killing" fat cells. However, transitioning from a low carbohydrate into a "greens eating machine" appears critical to achieving a lifetime of health. In such a way, the Restore Eating Plan is not a diet, but a new way of life.

For those interested in more details of the "Restore Eating Plan", contact The Heart and Lung Institute and click on "Health Tips."

                                      Steven R. Gundry, M.D., FACS, FACC
                                      Director, The International Heart and Lung Institute
                                      Center for Restorative Medicine

Copyright © November 2004  Steven R. Gundry, M.D. and Low Carb Luxury