Diet—A Matter of Concern

“GO, EAT your food with rejoicing,” says the Bible at Ecclesiastes 9:7. Eating, indeed, is not only a necessity but also one of the greatest pleasures in life.

Consider 34-year-old Thomas. He enjoys his meat. And he has it every day—often several times a day. His typical breakfast includes milk, several eggs, bread or toast smothered with butter, and sausage or bacon. At fast-food places, he orders cheeseburgers, French fries, and milk shakes. When dining out, he chooses beefsteak as an entrée. His favorite restaurant serves a 24-ounce [680 g] steak and a baked potato heaped with sour cream, just the way he likes it. Chocolate cake topped with chocolate ice cream is his favorite dessert.

Thomas is five feet ten inches [178 cm] tall and weighs 196 pounds [89 kg]; he is 20 pounds [9 kg] overweight, according to the 1995 U.S. government dietary guidelines. “I am not uncomfortable with my weight,” says Thomas. “My health is excellent. I haven’t missed a day of work in the last 12 years. Most of the time, I feel good and energetic—except, of course, after eating a 24-ounce [680 g] steak.”

Could Thomas’s diet, though, be affecting him for the worse, slowly making him a candidate for a heart attack? In his book How We Die, Dr. Sherwin Nuland speaks of ‘patterns of living that are suicidal’ and includes in them a diet of ‘red meat, great slabs of bacon, and butter.’

How do certain foods lead to heart disease in many? What is in them that causes danger? Before discussing these questions, let us take a closer look at the health risks of being overweight.

When Bigger Is Not Better

“I can’t fit into my clothes anymore,” bemoaned Rosa, age 35. “I am up to 190 pounds [86 kg] now, and I never imagined I would become so big!”

ROSA is not alone in worrying about her increasing weight. In the United States, where she resides, nearly a third of the nation is obese.a The proportion of obese adults in Britain doubled in ten years. And in Japan—where overweight used to be rare—obesity is becoming common.

Increasing numbers of children are heavier than they should be. Some 4.7 million American youths between the ages of 6 and 17 are severely overweight, while some 20 percent of Canadian children are obese. In recent years childhood obesity has shown a threefold increase in Singapore.

In some countries, being big from weight gain is viewed as evidence of prosperity and health, a far more desirable condition than poverty and undernourishment. But in Western lands, where food is often readily available, gaining weight is usually not considered desirable. On the contrary, it is generally a cause for serious concern. Why?

“Although most people believe obesity is an appearance problem,” says Dr. C. Everett Koop, former U.S. surgeon general, “it is in fact a serious disease.” Endocrinologist F. Xavier Pi-Sunyer of New York explains: “[The fattening of America is] putting more people at risk of diabetes, high blood pressure, stroke, heart disease, even some forms of cancer.”

More Weight, More Risk

Consider one study of 115,000 female American nurses, who were followed for 16 years. The study found that when adults gain even 11 to 18 pounds, it results in a higher risk of heart disease. This study, published in The New England Journal of Medicine of September 14, 1995, indicated that one third of cancer deaths and one half of cardiovascular deaths were due to overweight. According to a report in The Journal of the American Medical Association (JAMA) of May 22/29, 1996, “78% of hypertension in men and 65% in women can be directly attributable to obesity.” The American Cancer Society says that those who are “significantly overweight” (40 percent or more above ideal weight) “have a higher cancer risk.”

But it’s not just putting on extra weight that is a danger; the distribution of body fat also affects the risk of disease. Those who carry excess fat in the abdomen are actually at higher risk than those who carry more weight in their hips and thighs. Fat in the stomach area is associated with increased risk of diabetes, heart disease, breast cancer, and uterine cancer.

Similarly, overweight youths suffer from high blood pressure, elevated cholesterol levels, and prediabetic conditions. And they often become obese adults. The New York Times, using data published in the British medical journal The Lancet, reported that “people who were fat as children died earlier and suffered far more diseases at far younger ages than the general public.”

New Weight Guidelines

The U.S. government, convinced of a serious weight crisis, toughened its recommended weight guidelines in 1995. (See the box on the next page.) The updated guidelines identify “healthy weight,” “moderate overweight,” and “severe overweight.” The guidelines apply to both adult men and women, irrespective of age.

The 1990 guidelines made allowance for middle-body growth in middle age, often called middle-age spread. The new guidelines do not make this allowance, since indications are that adults should not gain weight over time.b Thus, a person who was formerly considered of normal weight may now find himself in the overweight category. For example, a five-foot-six-inch [168 cm] person between the ages of 35 and 65 who weighed 165 pounds [75 kg] would have been within the healthy weight range under the 1990 guidelines. But under the new guidelines, he or she would be ten pounds [5 kg] overweight!

How Did We Get So Big?

Genetic traits can influence a person’s tendency toward obesity, but they do not account for the weight gain in Western countries. Something else is responsible for the problem.

Health professionals agree that eating fat can make us fat. Much meat and many dairy products, baked goods, fast foods, snack foods, fried foods, sauces, gravies, and oils are loaded with fat, and eating them can lead to obesity. How so?

Well, consuming more calories in the food we eat than our body expends causes us to put on weight. Fat has nine calories per gram, compared to four calories in a gram of protein or a gram of carbohydrate. So we take in more calories when we eat fat. But there is another important factor—the way the human body uses the energy supplied by carbohydrates, protein, and fat. The body burns carbohydrates and protein first, then fat. The unused fat calories are converted into body fat. So cutting down on fatty foods is an important way to reduce weight.

Yet, some who believe that they have decreased their fat intake find that their bodies are still widening. Why? One reason is that they are eating large quantities of food. A nutritionist in the United States says: “We overeat because too much is served. When it’s there, we eat it.” People also tend to overconsume low-fat or fat-free foods. But an expert with a U.S. food-industry consulting firm explains: “Reduced-fat products often make up taste by increasing the [high-in-calories] sugar content.” Thus, The New York Times reported: “Two trends of the 90’s—getting value for money and eating low-fat, or fat-free, foods—have become invitations to gluttony,” hence to gaining weight.

The couch-potato life-style also promotes weight gain. A study in Britain found that more than a third of the adults in that land do less than 20 minutes of moderate exercise each week. Fewer than half ever engage in active sports. Car travel has replaced walking in many Western countries, and increased television viewing encourages both sloth and gluttony. In the United States, children sit and watch an estimated 26 hours of television each week, not to mention time spent with video games. Meanwhile, only some 36 percent of the schools still have physical education.

There are also psychological reasons for being overweight. “We eat out of emotional needs,” says Dr. Lawrence Cheskin, of the Johns Hopkins Weight Management Center. “We eat when we’re happy, we eat when we’re sad. We’ve grown up in a way that food is a substitute for many other things.”

Can We Succeed?

The issues of overweight are complex. Each year an estimated 80 million Americans go on a diet. But nearly all return to their former way of eating soon after losing some weight. Within five years, 95 percent regain the weight they have lost.

What are needed to lose weight and to keep it off are life-style changes. Such changes require effort and commitment, along with assistance from family and friends. In some cases the assistance of health professionals may also be needed.c For your efforts to succeed, however, positive motivation is a must. It is good to ask yourself, ‘Why do I want to lose weight?’ Your efforts to lose weight are more likely to succeed if the desire to avoid health dangers is accompanied by a desire to feel better and look better and to improve the quality of your life.

You can eat plenty of delicious and satisfying food that is both nutritious and low in calories. But before considering the foods that can help you lose weight, let us examine how certain elements of diet can become health risks.

[Footnotes]

[Chart on page 6]

Are you in the “healthy weight,” “moderate overweight,” or “severe overweight” range? The graph shown here will help you answer that question

1995 Weight Guidelines for Both Men and Women

(For fully formatted text, see publication)

Height *

6ʹ 6ʺ

6ʹ 0ʺ

5ʹ 6ʺ HEALTHY WEIGHT MODERATE OVERWEIGHT SEVERE OVERWEIGHT

5ʹ 0ʺ

50 lb 75 100 125 150 175 200 225 250

Weight†

Statistics based on: U.S. Department of Agriculture, U.S. Department of Health and Human Services

* Without shoes.

† Without clothes. The higher weights apply to people with more muscle and bone, such as many men.

Your Diet—Can It Kill You?

“You have a severely blocked coronary artery, about a 95% obstruction . . . At this moment you are a heart attack statistic just waiting to happen.”

THIRTY-TWO-YEAR-OLD Joe could hardly believe these words of a cardiologist who examined him to determine the cause of his chest pain. Almost half of those who will die of heart disease are not even aware that they have it.

But what led up to Joe’s condition? ‘For 32 years I ate the typical American “meat and milk” diet,’ laments Joe. ‘Somehow the fact that the American diet is hazardous to my health fell through the cracks.’

Your Diet and Heart Disease

What was wrong with Joe’s diet? Basically, it contained too much cholesterol and fat, especially saturated fat. From his youth, Joe had been setting himself up for coronary heart disease with nearly every forkful of food. A high-fat diet is, in fact, linked to five of the ten leading causes of death in the United States. At the top of the list is coronary disease.

The connection between diet and heart disease is seen in a study conducted in seven countries on some 12,000 men aged 40 to 49. The extremes are particularly revealing. The study showed that Finnish men—eating 20 percent of their calories as saturated fat—had elevated blood-cholesterol levels, while Japanese men—eating only 5 percent of their calories as saturated fat—had low blood-cholesterol levels. And the Finnish men had a rate of heart attack six times greater than the Japanese men!

Coronary heart disease, however, is no longer rare in Japan. In the past several years, as Western-style fast foods have become popular there, the consumption of animal fats has gone up 800 percent. Now, Japanese boys have even higher blood-cholesterol levels than American boys of the same age! Clearly, dietary fat and cholesterol are implicated in life-threatening conditions, particularly heart disease.

The Role of Cholesterol

Cholesterol is a white, waxy substance that is essential to life. It is found in the cells of all humans and animals. Our liver produces cholesterol, and it is also found in varying amounts in foods we eat. Blood carries cholesterol to the cells in molecules called lipoproteins, which are composed of cholesterol, fats, and proteins. The two types of lipoproteins that carry most of the blood cholesterol are low-density lipoproteins (LDL) and high-density lipoproteins (HDL).

LDLs are rich in cholesterol. As they circulate in the bloodstream, they enter cells through LDL receptors on cell walls and are broken down for use by the cell. Most cells in the body have such receptors, and they take up some LDL. But the liver is designed so that 70 percent of the removal of LDL from the bloodstream by LDL receptors occurs there.

HDLs, on the other hand, are cholesterol-thirsty molecules. When traveling through the bloodstream, they soak up surplus cholesterol and transport it to the liver. The liver breaks down cholesterol and eliminates it from the body. The body is thus marvelously designed to utilize the cholesterol it needs and to discard the rest.

The problem occurs when there is excessive LDL in the blood. This increases the possibility of a buildup of plaque on artery walls. When plaque buildup occurs, the arteries become narrow and the amount of oxygen-carrying blood that can pass through them decreases. This condition is called atherosclerosis. The process continues slowly and silently, taking decades to manifest discernable symptoms. One symptom is angina pectoris, or chest pain, like Joe experienced.

When a coronary artery is completely blocked, often by a blood clot, the part of the heart that receives blood from that artery dies. The result is a sudden, often deadly, myocardial infarction—better known as a heart attack. Even partial blockage of a coronary artery can lead to death of heart tissue, which may not be manifest by pronounced physical discomfort. Blockage of arteries in other parts of the body can cause strokes, gangrene of the legs, and even loss of kidney function.

Not surprisingly, LDL is called bad cholesterol, and HDL good cholesterol. If LDL tests high or HDL low, the risk of heart disease is high.a A simple blood test will often indicate impending danger long before a person experiences noticeable symptoms, such as angina. It is important, then, to keep your blood-cholesterol level in check. Let us now see how your diet can affect this level.

Blood Cholesterol and Diet

Cholesterol is a natural part of foods derived from animals. Meat, eggs, fish, poultry, and dairy products all contain cholesterol. Foods from plants, on the other hand, are free of cholesterol.

The body produces all the cholesterol it needs, so cholesterol consumed in food is extra. Most of our dietary cholesterol ends up in the liver. Ordinarily, as dietary cholesterol enters the liver, the liver processes it and decreases its own production of cholesterol. This keeps the total amount of cholesterol in the blood regulated.

What happens, though, if the diet is so abundant in cholesterol that it cannot be quickly processed by the liver? The likelihood of cholesterol directly entering the cells of the artery wall is increased. When it does, the process of atherosclerosis occurs. The situation is especially dangerous when the body continues to make the same amount of cholesterol regardless of the amount of dietary cholesterol consumed. In the United States, 1 in 5 persons has this problem.

Cutting down on your intake of dietary cholesterol, then, is a course of wisdom. But another component of our diet has an even greater effect on the level of blood cholesterol—saturated fats.

Fats and Cholesterol

Fats fall into two categories: saturated and unsaturated. Unsaturated fats can be either monounsaturated or polyunsaturated. Unsaturated fats are better for you than their saturated counterparts, since consuming saturated fats raises the level of cholesterol in the blood. Saturated fats do this in two ways: They help create more cholesterol in the liver, and they suppress LDL receptors on liver cells, reducing the speed of removal of LDL from the blood.

Saturated fats are primarily found in foods of animal origin, such as butter, egg yolks, lard, milk, ice cream, meat, and poultry. They are also prevalent in chocolate, coconut and its oils, vegetable shortening, and palm oil. Saturated fats are solid at room temperature.

Unsaturated fats, on the other hand, are liquid at room temperature. Foods that contain monounsaturated fats and polyunsaturated fats may help to decrease your blood-cholesterol level if substituted for foods containing saturated fats.b While polyunsaturated fats, common in corn oil and sunflower-seed oil, reduce both good and bad cholesterol, monounsaturated fats, plentiful in olive oil and canola oil, reduce only the bad cholesterol without affecting the good cholesterol.

Fats, of course, are a necessary part of our diet. Without them, for instance, there would be no absorption of vitamins A, D, E, and K. The fat requirements of the body, however, are very small. They are easily met through the consumption of vegetables, beans, grains, and fruits. So minimizing the intake of saturated fats does not deprive the body of needed nutrients.

Why Reduce Fats and Cholesterol

Will a diet rich in fats and cholesterol always increase blood cholesterol? Not necessarily. Thomas, mentioned in the opening article, decided to take a blood test after his interview with Awake! The results revealed that his cholesterol levels were within the desired limits. His liver was evidently able to keep the cholesterol level regulated.

This, however, does not mean that Thomas is risk free. Recent studies indicate that dietary cholesterol may affect the risk of coronary heart disease independently of its effect on blood cholesterol. “Cholesterol-rich foods promote heart disease even in people with low blood cholesterol,” says Dr. Jeremiah Stamler, of Northwestern University. “And that’s why eating less cholesterol must be of concern to all people, irrespective of their blood cholesterol level.”

There is also the matter of fat in the diet. Too much fat in the blood, be it from saturated or unsaturated fat in the food, causes red blood cells to clump together. Such thickened blood does not pass through the narrow capillaries, causing the tissues to be deprived of needed nutrients. Clumped cells moving along the arteries also disrupt the oxygen distribution to artery walls, causing surface damage, where plaque can easily begin to form. But there is another danger in consuming excessive amounts of fat.

Cancer and Diet

“All fats—saturated and unsaturated—are involved in the growth of certain kinds of cancer cells,” says Dr. John A. McDougall. One survey of the international incidence of colorectal cancer and breast cancer showed alarming differences between Western nations, where diets are high in fat, and developing nations. In the United States, for example, colorectal cancer is the second most common cancer for men and women combined, while breast cancer is the most common for women.

According to the American Cancer Society, groups of people who relocate to a country with high incidences of cancer eventually develop the cancer rate of that land, depending on the length of time it takes for them to switch to the new life-style and diet. “Japanese immigrants to Hawaii,” notes the cancer society’s cookbook, “are developing a Western cancer pattern: high for colon and breast cancer, low for stomach cancer—the reverse of the Japanese pattern.” Evidently, cancer is linked to diet.

If your diet is high in total fat, saturated fat, cholesterol, and calories, you need to make some changes. A good diet can lead to good health and can even reverse many ill effects of a bad diet. In view of such options as painful bypass surgery, which often costs $40,000 or more, this is surely desirable.

By sensibly choosing what you eat, you can lose weight, improve how you feel, and help yourself avoid or reverse some diseases. Hints along this line are discussed in the next article.

[Footnotes]