Health for life

The overall pattern of food that a person eats is more important to a healthy diet than focusing on single foods or individual nutrients, according to the Academy of Nutrition and Dietetics in its newly updated position paper "Total Diet Approach to Healthy Eating."

According to the position paper: "In contrast to the total diet approach, classification of specific foods as good or bad is overly simplistic and may foster unhealthy eating behaviors." The Academys position paper stresses that moderation, portion size and exercise are the key concepts for balancing food and beverage intakes.

The position paper has been published in the February Journal of the Academy of Nutrition and Dietetics and can be found on the Academys website. It states:

It is the position of the Academy of Nutrition and Dietetics that the total diet or overall pattern of food eaten is the most important focus of healthy eating. All foods can fit within this pattern, if consumed in moderation with appropriate portion size and combined with physical activity. The Academy strives to communicate healthy eating messages that emphasize a balance of food and beverages within energy needs, rather than any one food or meal.

The Academys position paper has been updated to lect the most current nutrition guidance, such as the 2010 Dietary Guidelines for Americans and the USDAs MyPlate food guidance system; the White Houses Lets Move! campaign to reduce childhood obesity and Healthy People 2020. Each of these public policies and dietary patterns supports the total diet approach.

According to the position paper, while studies including the Academys "Nutrition and You" national consumer survey show Americans are "conscious of the importance of healthy diets and physical activity," most people do not meet the recommendations of the Dietary Guidelines. For example, large majorities do not eat fruit (68 percent) or vegetables (74 percent) more than twice a day, and a substantial number (36 percent) engage in no leisure-time physical activity.

In that environment, according to the Academy: "Labeling specific foods in an overly simplistic manner as good foods and bad foods is not only inconsistent with the total diet approach, but it may cause many people to abandon efforts to make dietary improvements."

The position paper adds: "In 2011, 82 percent of U.S. adults cited not wanting to give up foods they like as a reason for not eating healthier. For these reasons, the concepts of moderation and proportionality are necessary components of a practical, action-oriented understanding of the total diet approach."

The Academys position paper notes that the most recent Dietary Reference Intakes use a total diet approach because it allows for a broad range of foods to meet a persons nutrition needs over time. Theore, a person can make diet choices based on individual perences, genetic background, personal health status and food availability.

The position paper was written by registered dietitians Jeanne Freeland-Graves, Bess Heflin Centennial Professor in the department of nutritional sciences at the University of Texas -- Austin; and Susan Nitzke, professor emerita and extension specialist in nutritional sciences at the University of Wisconsin -- Madison.

The Academys position paper contains advice and recommendations for health professionals as well as consumers. It explains how food and nutrition practitioners can use behavioral theories and models to develop effective nutrition communications; and how food and beverage choices are affected by multiple factors that influence peoples ability to make use of expert advice on healthy eating.

Updated sections of the position paper look at new indicators of nutrient quality, such as the Nutrient Rich Food Index, the European Union Nutrient Profiling System and the Overall Nutrient Quality Index. In addition, the Social Ecological model, used in the Dietary Guidelines, is incorporated into the Academys position as "a guide for understanding why we eat what we do."

According to the Academys position paper: "Food and nutrition practitioners have a responsibility to communicate unbiased food and nutrition information that is culturally sensitive, scientifically accurate, medically appropriate and tailored to the needs and perences of the target audience. Some health and nutrition professionals and many pseudo-experts promote specific types of foods to choose or avoid. A more responsible and effective approach is to help consumers understand and apply the principles of healthy diet and lifestyle choices. Unless there are extenuating circumstances (severe cognitive or physical limitations), the total diet approach is perred because it is more consistent with research on effective communication and inclusive of cultural/personal differences."

Its been too long since Ive spoken about cholesterol, too long I tell you. For those of you who dont know, I would sum up my view on cholesterol like this: its the most overhyped risk factor for heart disease there is. All you hear in the media is "Watch your cholesterol!" or "Cheerios lower cholesterol!" or "This food is cholesterol-free, so its good for you!". Bollocks. Bollocks I say.

First of all, the cholesterol in the food you eat barely has any effect on the cholesterol in your blood, if it has any effect at all. And second, lets set the record straight on "high cholesterol"... please for the love of God, quit worrying about it. Your total cholesterol is just about meaningless unless its taken in context with your triglycerides, HDL, and LDL... even better, your LDL particle number. Despite having no real, accurate clinical implications though, "high cholesterol" has taken on this sort-of boogey man role, scaring every health-conscious person into Lipitor land.

Anyway, I came across something today that was just too good not to write about; this stuff needs to be shared. This study was designed to analyze lipid-lowering therapy, but thats not the part I want to talk about here; its the cholesterol levels of the patients that piqued my interest. The researchers examined 65,396 patients hospitalized for heart disease (heart attack or angina) across the United States. Below youll find a screenshot of the baseline blood lipid data, taken within the first 24 hours of admission. You would expect, based on what you think you know, that heart disease patients must have had high cholesterol, right?

Average blood lipid values upon admission among all study participants.

Nope. On average, their cholesterol was 170.1 mg/dl, well below the high limit of 200. If any of these people had visited the doctor for a check-up a week before their hospitalization, the doc would have looked at these numbers and said "Steve, your cholesterol is great! Keep up the great work!" Assuming his name is Steve.

But things werent great. Each of these people experienced an acute coronary event that required hospitalization and very well could have ended their lives. Its irresponsible that were putting so much stock into cholesterol values when they clearly are NOT a good indicator of heart disease risk.

Sometimes it only takes one little piece of data, like this one, to completely change your beliefs on cholesterol and heart disease. I hope this provided the baseball to your brand new home window.

But what does this mean??
Now, theres an excellent chance that many of these people were already taking a cholesterol-lowering drug. Theres no data in the study to show whether this is true, but since so many people are on them, its very likely. So lets say for a moment that they were on statins. Say their normal cholesterol levels are around 220 mg/dl, and the statins bring it down to a more friendly-looking 170. Well, this only destroys the cholesterol and heart disease connection even more doesnt it? First off, it doesnt say much about the efficacy of the drugs. But also, it shows that reducing cholesterol from "high" back into "normal", at least via these mechanisms, is useless.

Okay, let me say it another way... if high cholesterol is the cause of our problems, lowering it should reduce our risk, regardless of the manner by which we do so. If it is not the cause, and it is just an indicator of a problem, then pharmacologically lowering it will NOT reduce our risk. It will, in fact, just make things appear to be fine when they are not.

Its sort of like when we get sick and we get a fever. We may take over-the-counter meds to reduce the fever; it makes us feel better and it takes away one of the symptoms of our illness. But we forget that the fever is an important part of our bodys defense mechanism to fight a bacterial infection... bacteria dont like the heat. We may feel a little better, but we remain just as sick as we were before, and weve now likely prolonged our sickness by messing with our bodys natural defense mechanisms.

The fever is like cholesterol, the symptom. The bacterial infection is the root cause. Got it? Okay its not a perfect analogy, but you get the point.


What is the root cause of heart disease then? If not total cholesterol, what should we focus on? Well thats a big can of worms... there are many factors that go into it. Stay tuned next week for a comprehensive guide on how to prevent heart disease!