The 2015 American Society For Nutrition ConferenceDecember 2015
By Ben Best
A good diet is essential for anyone wishing to achieve healthy longevity.
With conflicting stories appearing in the mass media, ascertaining what the best food choices are can be a daunting task.
There is disagreement among nutrition scientists, and there are often new studies or opinions that substantially alter dietary recommendations.
For example, saturated fats have been claimed to cause cardiovascular disease,1 but this claim is debatable among nutrition scientists.2-5 Interestingly, on a low-carbohydrate diet, high dietary saturated fats do not increase saturated fats in the bloodstream.6
Discussion of the effects of dietary saturated fat rarely acknowledge the fact that there are about a dozen different saturated fats, each of which has unique properties.7,8 Palmitate is the most abundant saturated fat found in foods.9,10 Palmitate constitutes nearly a third of butterfat and beef fat. Palmitate is more likely to cause inflammation than the other saturated fats11 (particularly in obese people).9,12 But palmitate is not inflammatory if consumed with olive oil or fish oil.13-15 A saturated fat called myristate strongly raises blood cholesterol,16 but the saturated fat stearate does not.17 The saturated fat butyrate improves insulin sensitivity.18
The human body derives energy either from glucose (from carbohydrate) or from fat (or from ketones from fat).19 Carbohydrates only became a primary source of energy with the advent of agriculture. As a source of energy, glucose is much more damaging to blood vessels than fat (saturated fat usually can’t be oxidized). Glucose is the preferred energy source for cancer cells.20 With the exception of dietary fiber, the fewer carbohydrates in the diet the better, unless there are compensating benefits, such as eating them with blueberries.
Protein is much more complicated. Protein contains essential amino acids, which are important for growth, maintenance, and metabolism of the human body. These functions are especially important for growing children, but are also important for the elderly and to prevent muscle loss in those who exercise. Adequate protein is also important for good immune system function.21
Population studies indicate that consumption of red meat and processed meat increases cancer and cardiovascular disease.22 Subjects randomly assigned to a vegetarian diet or an omnivorous diet had lower blood pressure when on the vegetarian diet.23 Moderately low protein intake seems advisable for most adults (plant protein preferred), although the amount is hard to specify and is dependent on circumstances.
In seeking a healthy diet, I frequently make substantial changes to my eating patterns. In my search for greater clarity, I attended the American Society for Nutrition conference in Boston, March 28 to April 1, 2015.
My reports of scientific conferences normally only describe the presentations made by the scientists. But because everyone eats, because diet and dieting have such substantial influence on health, and because the discoveries of nutrition scientists so often seem contradictory or confusing, for this report I am following each presentation description with my interpretations and recommendations. These comments will be my opinions, which are not necessarily those of the Life Extension® Foundation.
My dietary opinions have been substantially influenced by scientists advocating a ketogenic diet, that is, a diet low in carbohydrates, and moderately low in protein. I have been on a vegetarian ketogenic diet for over a year. Insofar as food can only consist of carbohydrate, protein, and fat, my diet is high in fat and fiber. When dietary carbohydrate is low, the liver converts fat into ketones to provide energy for the brain. Although fiber is classified as a carbohydrate, when digested, fiber is converted to beneficial fats in the large intestine.
What do I eat? My “main course” is a vegetable salad (broccoli, green leafy vegetables, shredded cabbage) laden with healthy oil (like olive oil), to which I add walnuts, shredded coconut, and a scoop of whey protein. Among other things I eat are cream cheese with cauliflower, as well as avocado mixed with healthful flavorings such as cocoa powder and wheat grass powder.
Although this is a report on a scientific conference, because diet is such a personal matter, and because I am making recommendations, I need to disclose the basis for my opinions. I believe there is good science behind these opinions, and for that reason I am beginning by reporting the views of Dr. Eric Westman, one of the leading scientific advocates of a ketogenic diet.
Health Benefits Of A Ketogenic Diet
Eric Westman, MD, (Duke University Outpatient Clinic, Durham, North Carolina) is one of the pioneers in challenging the benefits of low-fat diets. He has conducted a number of studies showing that low-carbohydrate, high-fat diets (ketogenic diets) result in less hunger, better compliance, and greater weight loss than low-fat diets.24-26
Dr. Westman conducted a clinical trial in which type II diabetics were randomized to low-calorie diets or to ketogenic diets that did not restrict calories. The diabetics on the ketogenic diet showed greater weight loss, greater reduction in glycated hemoglobin (HbA1C), and greater reduction or elimination of required diabetic medications (95.2 versus 62%).27 Subsequent studies by others have confirmed the benefit of a ketogenic diet for treatment of type II diabetes.28,29 Dr. Westman is opening a clinic entirely devoted to weight loss and diabetes treatment using a ketogenic diet (For more information, go to www.healclinics.com).
When carbohydrates are low, the liver converts fats into ketones, which can serve as a fuel source for many tissues, including the brain.30 Dietary ketosis should not be confused with the ketoacidosis of diabetes, which involves acidity as well as much higher blood ketone concentrations.31,32 Unlike sugar, which stimulates appetite,33 ketones reduce appetite.34,35 As a source of energy for the brain, ketones make mitochondria more efficient, reduce free radical production, and protect against a variety of brain diseases, including epilepsy, stroke, and Alzheimer’s disease.36,37
A ketogenic diet has been shown to increase cognitive performance in aged rats.38 Cancer cells thrive on the glucose resulting from dietary carbohydrates, but are generally unable to use ketones as an energy source.39 Ketones have been shown to suppress tumors and prolong survival in mice that have metastatic cancer.40,41
Saturated fats have been claimed to cause cardiovascular disease,1 but this claim is debatable among nutrition scientists.2-5 A lot probably depends on the type of saturated fat and what other foods it is consumed with.
Insulin resistance results when excess fat accumulates in muscle, liver, and pancreas rather than in fat cells.42 But on a carbohydrate-restricted diet, fats are used for energy rather than stored.6 On a low-carbohydrate diet, high dietary saturated fats do not increase saturated fats in the bloodstream.6 Cardiovascular risk factors may be reduced on a high-fat, low-carbohydrate (ketogenic) diet,43,44 and a low-carbohydrate diet has been shown to increase insulin sensitivity.45,46
My interpretation/recommendation: A diet low in carbohydrates, moderately low in protein, and high in proper fats is recommended for persons trying to lose weight as well as for prevention and treatment of diabetes (and other age-related afflictions, notably cancer and cardiovascular disease).
Deborah Sloboda, PhD, (Associate Professor, Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada) does research on the damaging effects of dietary sugar, particularly fructose.
Simple sugar constituted only about 2% of the prehistoric Paleolithic diet, but currently accounts for about 18 to 25% of total calories of the average modern Western diet.47 Modern man is thus consuming about 10 times more simple sugar than our early ancestors.
High fructose corn syrup, introduced in 1967, accounted for 42% of caloric sweeteners being used by the year 2000.48 Fructose consumption increases visceral (abdominal) fat while reducing insulin sensitivity.49 Dr. Sloboda is particularly concerned with fructose consumption during pregnancy, which can lead to gestational diabetes (temporary diabetes due to pregnancy), causing inflammatory metabolic disturbance for both the mother and the fetus.50,51 The amino acid taurine can partially reduce the damaging effects of fructose.51,52
My interpretation/recommendation: Fructose consumption should be limited because fructose can elevate blood triglycerides while causing insulin resistance and the diseases of inflammation and diabetes. The soft drinks accounting for about 90% of the soda market (Coca-Cola®, Pepsi®, Dr. Pepper®, Mountain Dew®, and Sprite®) all contain 60 to 65% fructose.53 Apple juice has more than twice the fructose as orange juice, yet apple juice is the most common sweetener in fruit drinks. Dried apples, dates, apricots, figs, and raisins are one-quarter to one-third fructose by weight, and should be eaten sparingly. Fructose can cause harm to both the mother and fetus during pregnancy and pregnant women should limit consumption of fructose-containing beverages, and perhaps even supplement with taurine.
Diane Birt, PhD, (Distinguished Professor Emeritus, Iowa State University) is interested in using digestion-resistant starch to improve human health. Starch, like sugar, is a form of carbohydrate, but starches that resist digestion in the stomach and small intestine, yet are digested in the large intestine, are called resistant starch or fiber.
Dr. Birt has described most foods in the typical Western diet as being highly digestible starches having a high glycemic index (which raise blood glucose).54 Such foods result in cycles of high and low blood glucose and blood insulin, often causing insulin resistance and type II diabetes.54 All starchy foods are composed of chains of sugar molecules, but not all starchy foods are as easily digested. Digestion-resistant starch eaten for breakfast reduces the surges of glucose and insulin at lunch.55
Legumes (beans) contain more resistant starch than potatoes, rice, pasta, bread, or breakfast cereals. But Dr. Birt wishes to develop foods with higher resistant starch content than legumes.54 Resistant starches have been shown to reduce obesity.56 Starches (dietary fibers) that are more viscous reduce appetite more than those that are less viscous,57 so the starches she is developing would be more viscous. Starches made of long unbranched chains of sugars are more digestion-resistant than starches having branched chains, a fact Dr. Birt also exploits when designing improved foods for health.54
My interpretation/recommendation: Rapidly digested carbohydrate starches such as potatoes, pastry, white bread, and breakfast cereals should be avoided, but beans and waxy corn starch are good sources of dietary fiber that can satisfy appetite while reducing insulin surges after eating.54,58
David Mutch, PhD, (Associate Professor, University of Guelph, Canada) is interested in how fats and inflammatory substances in the bloodstream relate to obesity. Although obesity is often associated with insulin resistance and metabolic syndrome, he estimates that 13 to 29% of obese persons (BMI greater than 30) are metabolically healthy, whereas 10 to 37% of lean persons (BMI less than 25) are metabolically unhealthy, having insulin resistance.59
Metabolically healthy obese people are less likely to have fat in heart cells or in the insulin-producing cells of the pancreas.59 Metabolically unhealthy people have higher blood levels of the saturated fat palmitate.60,61 Foods high in palminate include cocoa butter oil, palm oil, shortening, butter, lard, milk chocolate, fatty meats, pork and beef products, game meats, cashews, and eggs.61
Palmitate can induce inflammation and insulin resistance.62-64 Elevated blood palmitate and glucose cause insulin-producing cells in the pancreas to die, but the monounsaturated fat oleic acid (high in olive oil and avocado) protects cells against glucose and palmitate toxicity.13,14 Omega-3 fatty acid supplementation of a mouse diet high in saturated fat also prevents inflammation from palmitate.15
My interpretation/recommendation: Olive oil, fish oil, and avocado can protect against inflammation due to the saturated fat palmitate.
Kevin Fritsche, PhD, (Professor of Nutritional Immunology, University of Missouri) studies the effects of dietary fats on inflammation and the risk of cardiovascular disease. He believes that the inflammatory blood component C-reactive protein is more strongly associated with cardiovascular disease than LDL cholesterol.65 Release of the inflammatory protein IL-18 from fat cells of obese people is triple of that seen in those who are not obese.66 Although he affirms that trans-fatty acids promote inflammation and reduce function of the endothelial cells lining blood vessels,67 he finds not much support for the claim that omega-6 fatty acids are pro-inflammatory.68,69
The gut microbe Bifidobacteria has been shown to prevent the highly pro-inflammatory endotoxin lipopolysaccharide (or LPS, which constitutes 80% of the cell wall of gram-negative bacteria) from leaking into the bloodstream from the intestine.70-74 A high-fat, high-carbohydrate diet promotes inflammation by reducing the quantity of Bifidobacteria,73-75 although some foods (including walnuts, olive oil, and wheat bran) can lessen this effect.76
The magnitude of inflammation resulting from a high-fat, high-carbohydrate meal is markedly greater in obese than in non-obese subjects.77,78 Inflammation from a high-fat, high-carbohydrate meal may be independent of LPS concentration in the bloodstream.79
My interpretation/recommendation: LDL cholesterol is less of a cardiovascular disease concern than inflammation and insulin resistance. A high-fat diet should be avoided only if it is combined with a diet high in carbohydrates. Dietary carbohydrates cause insulin secretion, and insulin prevents fat from being used as an energy source, resulting in fat being stored in places other than fat cells, namely in muscle and pancreas, resulting in insulin resistance. Because this effect is largest in obesity, obese people should make a particular effort to reduce carbohydrates.
Catherine Hankey, PhD (Senior Lecturer in Human Nutrition, University of Glasgow, United Kingdom) reviewed studies on intermittent fasting as a weight-loss strategy. At any given time, about 40% of women and 20% of men will be fasting for weight loss.80
Dr. Hankey began by acknowledging the bestselling book The Fast Diet by Dr. Michael Mosley and Mimi Spencer, which advocates reducing calories to 25% the usual daily intake on two days each week (Monday and Thursday being the best choice for most people).
A high-protein diet can assist fasting because protein has been shown to reduce appetite.81 High-protein diets (25% or more of calories) are associated with the greatest weight loss (and not much hunger) for a few months. By two years, however, there is little lasting weight loss.81 A three-month comparison of subjects restricting calories 25% either on a daily basis with high protein, or only on two days per week with carbohydrate restriction, showed greater body fat reduction along with improved insulin sensitivity for the intermittent-fasting, carbohydrate-restricting group.82
My interpretation/recommendation: Complete fasting for more than a day is intolerable for most people, but Dr. Mosley’s book became a bestseller because so many people have succeeded in losing weight by eating only 25% of their usual calories twice weekly. I recommend this book to readers who have not succeeded with other weight-loss methods. The book contains recipes and strategies. Despite initial weight loss and reduction of hunger on a high-protein diet, high-protein diets are not recommended. Weight loss with a high-protein diet is only a temporary effect. Moreover, high dietary protein can result in chronic inflammation with subsequent increase in cancer and cardiovascular disease.83,84
Cynthia Kroeger and John Trepanowski, (PhD students, Department of Kinesiology and Nutrition, University of Illinois, Chicago) have conducted a number of studies together on the effects of alternate-day fasting (with 25% of usual calories consumed on the fast day).85-87 In one such study, the weight loss from endurance exercise and fasting in combination was compared with exercise and fasting alone. The combination resulted in a 13.2 pound weight loss, fasting alone resulted in a 6.6 pound weight loss, and exercise alone resulted in a 2.2 pound weight loss.88
Exercise alone is usually not very effective for weight loss,89,90 at least partially because of increased appetite. The most important role of exercise in dieting is to prevent loss of lean mass (and to boost AMPK enzyme activity).91 In another study, Kroeger and Trepanowski found that adding liquid meal replacement to intermittent fasting and calorie restriction resulted in an even greater reduction in weight, visceral fat, and LDL cholesterol. The liquid meals ensured greater portion control. Only the subjects receiving the liquid meal replacement showed a reduction in blood glucose, insulin, and homocysteine, as well as reduced LDL particle size.86
My interpretation/recommendation: Although exercise alone is not very effective for weight loss, exercise doubles the weight loss associated with a reduced-calorie diet, while preventing loss of muscle tissue. Combining exercise with calorie restriction is highly recommended for dieters.
Diana Thomas, PhD, (Professor of Mathematical Sciences, Montclair State University, Montclair, New Jersey) has created mathematical models to explain weight-loss effects associated with dieting.92,93 Weight lost in the initial phases of dieting is typically the result of greater water loss associated with protein and carbohydrate loss.94 Unlike fat, proteins (like muscle) and carbohydrates (like glycogen) are stored with much water in the body, so loss of lean mass or carbohydrate results in loss of considerable amounts of water.95,96 Calories required for weight loss increases with the duration of dieting because as dieting proceeds, weight loss increasingly means fat loss. According to Dr. Thomas, after four weeks of dieting, a reduction of about 2,000 dietary calories results in a loss of one pound. But by 24 weeks of dieting, a reduction of about 3,000 dietary calories is required to lose one pound.94
For an average person, resting metabolic rate accounts for 70% of calories consumed, physical activity accounts for 20%, and energy required to digest and metabolize food (the thermic effect of food) accounts for 10%.97
The thermic effect of protein is more than double the thermic effect of fat or carbohydrate.98 The thermic effect of glucose is reduced with insulin resistance because insulin facilitates glucose storage (which consumes more energy than glucose used as an energy source).99
Resting metabolic rate typically declines 2 to 3% every decade after age 20, mostly due to loss of lean, fat-free mass.97 Physical activity also tends to decline with age. These factors make weight loss increasingly difficult with age. On average, body weight is highest for those in the 50-59 age group, but much of the reason for this may be due to higher death rates among the obese.97
My interpretation/recommendation: Weight loss becomes more difficult with age largely because of the muscle loss associated with reduced activity. The more muscle (lean body mass) that a person has, the higher their resting metabolic rate will be. Resistance exercise is particularly important for building and maintaining muscle, as well as preventing the frailty too often associated with aging. Exercise should become a lifetime practice, not simply something done while dieting.
Muscle Loss In The Elderly
Ronenn Roubenoff, MD, (Internist, Tufts Medical Center, Boston) studies muscle loss in the elderly. He cited a three-year study of over 3,000 people in their 70s, which showed that loss of muscle quality was even greater than loss of muscle mass.100 Deterioration of muscle in the elderly not only leads to functional impairment and falls, but to chronic heart failure and chronic obstructive pulmonary disease.101-103 Endurance as well as resistance exercise, along with increased protein intake is recommended to prevent muscular atrophy in the elderly,104 although those with kidney problems due to diabetes may need to limit their protein intake.105
My interpretation/recommendation: As stated above, endurance exercise, resistance exercise, and adequate protein can prevent muscle wasting and can reduce frailty in the elderly (for whom muscle-wasting can be life threatening).
Circadian Rhythm And Diet
Frank Scheer, PhD, (Assistant Professor of Sleep Medicine, Harvard Medical School) is an expert on the effects of circadian (day-night cycle) rhythm on dietary metabolism. The brain has a clock that normally causes melatonin secretion to increase in the evening (facilitating sleep), which causes secretion of growth hormone and prolactin at sleep onset, and which causes secretion of the stress hormone cortisol before awakening.106 The risk of a heart attack in the morning is elevated 40% above the 24-hour average,106 at least partially because cortisol raises blood pressure.107 Dr. Scheer’s research has established that disruption of the circadian rhythm by jet lag or shift work leads to insulin resistance.108 Melatonin supplementation can lessen these circadian stresses.109
Dr. Scheer has also established that for those with a normal circadian rhythm, hunger is lowest at 8 a.m. and highest at 8 p.m.110 There is also a circadian effect on appetite for certain foods. The 8 p.m. appetite for sweets, starches, and meat is increased, but there is no circadian effect for vegetables or dairy products.110
Dr. Scheer conducted two studies showing that breakfast skippers and late eaters gain more weight (and have more trouble losing weight) than early eaters, despite consuming the same total number of calories.111,112 But a randomized study focused only on those who skip breakfast showed no effect on weight gain or loss.113 A review by other authors, while acknowledging that late-night eating contributes to metabolic syndrome, denied a similar effect for breakfast skipping, suggesting that breakfast skipping might be more successful than other strategies for calorie restriction.114
My interpretation/recommendation: Eating in the evening before bedtime can lead to greater weight gain than calorie counting would predict. Skipping breakfast is probably not a health hazard. Melatonin should be used to reduce the effects of jet lag or shift work.
There may be a revolution happening in the perception of the effects of dietary fat, especially in the context of a ketogenic diet. It would be hard to prove that the US Department of Agriculture dietary recommendations of high grain (carbohydrate, the “food pyramid”) and low fat115,116 contributed significantly to the current obesity epidemic, but if true, the government will not readily admit blame.117
If you have any questions on the scientific content of this article, please call a Life Extension® Health Advisor at 1-866-864-3027.
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