The American Heart Association has been issuing dietary advice to reduce the chances for cardiovascular disease, which also involves normal weight, bloody pressure, blood glucose levels, blood fats/ cholesterol levels (Lichtenstein et al. 2021).
I have been given the same advice by the doctor and nutritionist after a high blood pressure diagnosis but I am not convinced that the AHA guidelines are effective guidelines for heart/ metabolic health. I find that less carbs (not elimination)/ sugar and low stress are the most conducive to this outcome, while the AHA recommendations focus on low-fat, low-salt diets rich in fruits, vegetables, whole grains, legumes, nuts, fish and poultry.
My objection to the fat/ salt blood pressure hypothesis (DiNicolantanio and Lucan 2014; Unwin et al. 2019) is as follows: assuming a constant protein share, low fat diet automatically means high carb/ sugar diet (if you want to avoid starvation, which would be low fat, low carb). High sugar causes hyperinsulinaemia as the pancreas secretes more insulin and this insulin results in salt and fluid retention, which each raise blood pressure (it’s like adding water to a balloon, which stretches out and has more internal pressure). Thus, in a high carb diet even low consumption of sodium can elevate blood pressure because the insulin will make the kidney retain whatever salt you consume (including those in the natural, unsalted foods like meat). In the keto diet, there is the opposite problem of salt deficiency due to the kidneys excreting sodium and water from the body. I would say don’t overconsume salt, but don’t make this the main cause for high blood pressure.
In the meantime, I don’t agree that fat in the appropriate quantity is a problem: it does not cause a glucose spike, it gives consistent long-term energy, it reduces hunger cravings (Roekenes and Martins 2021) and therefore snacking that leads to weight gain. The problem is that the sugar companies are blaming fat for disease (Kearns et al. 2016) and, unfortunately, even AHA has adopted this nonsense advice that makes people overload on carbs. There is a reason that sugar companies are more profitable than fat companies (e.g. those selling oil or meat): sugar gives you a brief glucose spike, followed by a crash, which makes you hungry for more food, while fat gives you satiety so you stop eating too much. Yes, too much fat can be damaging but that’s not an issue because of satiety, while too much sugar means elevated triglycerides (blood fat), insulin production and blood pressure which can easily happen as you have sugar cravings and overeat on sugar (Parks 2001).
Here are my sources of agreement:
Sedentary lifestyle is bad/ exercise is important
Portion size control is important/ don’t eat too much
Eat a lot of vegetables
Eat whole fruits instead of juice
Don’t eat refined grains
Eat a lot of fish
Eat poultry
Don’t eat ultra-processed food/ eat minimally processed food [I think this is a big one and could reduce a lot of disease, obesity/ diabetes by itself!]
Don’t drink added sugar beverages like soda
Don’t drink alcohol
Don’t consume trans fat
We need precision nutrition because every individual has different metabolism/ food sensitivity
Here are my sources of disagreement:
Eat a lot of fruits
Depending on the fruit, they contain a lot of sugar, but the fiber and pectin in the whole fruit slows down the absorption of the sugar (Dreher 2018; Giuntini et al. 2022), so I think it’s ok to consume in moderation (not the fruit juices devoid of any fiber!) and I do eat fruit regularly but not in huge amounts. Berries are low-sugar fruits (Eenfeldt and Tamber).
Eat plenty of whole grains
Whole grains contain almost as much carbs/ sugar as the refined grain, so I consume those in small quantity. I spoke to another friend recently who said that Europeans and Asians can eat as much carb as they like and don’t get as fat, so maybe there is something going on in the US food system that is unfavorable to health. Sugar molecules are monosaccharides and disaccharides (single or two sugar molecules). Disaccharides are called lactose, sucrose and maltose. Starch found in whole and refined grains and also starchy vegetables like tubers are polysaccharides (multiple sugar molecules) (Panawala 2017). Starch gradually raises blood sugar level, and the impact of fiber reduces the pace of the spike compared to consuming pure sugar, but what matters for overall health is how much sugar enters your body not at what pace. Whole wheat consumption means more insulin production which can result in more visceral fat (fat around organs), hypertension, heart disease and Type 2 diabetes (Davis 2023). Type 2 diabetics suffer from carbohydrate poisoning, i.e. ingesting too much carbohydrate causing hyperinsulinaemia and insulin resistance, and should not be consuming any significant amount of carbohydrates, including whole grains (low carb diet effect on diabetes and obesity: Pavlidou 2023).
Dr. William Davis (2023) writes
Years ago, I used the ADA [American Diabetes Association] diet in diabetic patients. Following the carbohydrate intake advice of the ADA, I watched patients gain weight, experience deteriorating blood glucose control and increased need for medication, and develop diabetic complications such as kidney disease and neuropathy. Ignoring ADA diet advice and cutting carbohydrate intake leads to improved blood sugar control, reduced HbA1c, dramatic weight loss, and improvement in all the metabolic messiness of diabetes such as high blood pressure and triglycerides.
Get most proteins from legumes/ beans and nuts
AHA fails to point out that meat is more protein and nutrient-dense and is less likely to cause bloating (Dahl and Alvarez 2019). I consume some nuts that go down easily but most of my proteins come from meat which has a lot of bioavailable nutrients. My take is that many doctors who write these guidelines are vegans and vegetarians (Teicholz 2019), and that is often driven by animal welfare concerns and health is used as a justification to push plant-based preference. All of the anti-meat studies are observational/ correlational. Of course, average vegans/ vegetarians live healthier than average omnivores, because the former are more health conscious. Vegans make a conscious choice to avoid meat and they consciously choose the other foods they eat, while the omnivore might eat whatever feels good. As for meat being bad based on an omnivore diet, we don’t know that meat causes the disease. Why was it not the French fries/ cheesecake/ chips/ soda? Better comparison value would be to measure the health effect of carnivore diets, and that’s all good, except LDL cholesterol, although I am not sure whether cardiovascular issues arise if all the other blood vitals are fine (Bathum et al. 2013).
I quote the carnivore study finding: “Participants reported high levels of satisfaction and improvements in overall health (95%), well-being (66%–91%), various medical conditions (48%–98%), and median [IQR] BMI (in kg/m2) (from 27.2 [23.5–31.9] to 24.3 [22.1–27.0]). Among a subset reporting current lipids, LDL-cholesterol was markedly elevated (172 mg/dL), whereas HDL-cholesterol (68 mg/dL) and triglycerides (68 mg/dL) were optimal. Participants with diabetes reported benefits including reductions in median [IQR] BMI (4.3 [1.4–7.2]), glycated hemoglobin (0.4% [0%–1.7%]), and diabetes medication use (84%–100%).” (Lennerz et al. 2021)
Vegans who are not aware of micronutrients will suffer from anemia and nutritional deficiencies (O’Keefe et al. 2022; Mason 2023). It also increases the risk of hunger cravings (which is low in meat-inclusive diets), which could result in unhealthy snacking (cereals, sweets etc.)
Eat low-fat diary products/ low-fat diet
That’s clearly false. I think doctors are afraid that people overeat on high-fat diet because small amount of fat contains a lot of calories, but it’s exactly the opposite: it’s the high fat that increases satiety and reduces hunger cravings and excess caloric intake, while carbs increase your glucose level, then crash and make you hungry again, so you start snacking more leading to excess caloric intake.
Don’t eat red meat
That’s definitely false, as the carnivore study above shows (which I do not recommend or follow). Many doctors dislike saturated fat causing high cholesterol apparently causing CVD, which is based on Ancel Keys’ and AHA’s mistaken hypothesis (Taubes 2001; Teicholz 2023). One red meat study notes that only triglyceride increases but not the other cholesterol markers (Sun et al. 2022). In the keto/ low carb diet that is meat-heavy triglyceride decreases along with other CVD factors, so that might not be an issue either (Dong et al. 2020).
I largely agree with the keto premise, but for those who exercise a lot some carbs are ok. It’s also fine to eat more grains before a marathon.
Consume soybean, corn, safflower and sunflower oils, walnuts, and flax seeds
I consume walnuts and flaxseeds. I am skeptical about vegetable oils that need a lot of processing to make them into consumable oils. I stick to olive oil and butter. Coconut oil is fine too. There are studies that make opposite prediction/ finding about health impacts of vegetable oils (vegetable oil not inflammatory: Fritsche 2014; vegetable oil inflammatory: Shanahan 2017; DiNicolantanio and O’Keefe 2018), but the critics point to the higher linoleic acid content which is inflammatory. Interestingly, red meat is not linked to more inflammation assuming normal BMI (Wood et al. 2023).
Don’t eat coconut oil and animal fats (butter, lard)/ saturated fat
False. Butter looks fine to me (neutral on cardiovascular disease: Pimpin et al. 2016). Coconut oil is clearly opposed by AHA, but the studies do not show a clear health effect of coconut oil (Da Silva Lima and Block 2019). Lard is also fine and lowers blood fat (Koontanatechanon et al. 2022). Beef tallow is also fine, though not too many studies on it: a mouse study shows less fatty liver with tallow consumption (Tajima et al. 1995). Duck fat stimulates lipid metabolism (Shin et al. 2023). So, if the animal made the fat, it looks fine to me and helps with satiety.
Don’t add salt to the diet
As noted above, I think that salt is a minor factor to blood pressure and the major factor is hyperinsulinaemia, i.e. sugar and carbs. In a low carb diet, salt excretion increases, so salt intake should be increased in that case.
High LDL cholesterol is problematic
I am not sure whether that’s an issue, especially if the other markers (HgA1C, Triglyceride, HDL cholesterol, blood pressure, plaque in arteries) are good. For metabolically healthy individuals with high LDL, statins (LDL-lowering drug) should not be prescribed (Diamond et al. 2022). Furthermore, glycation of LDL (i.e. addition of carbs/sugar to LDL) is associated with atherogenesis (artery plaques), and that is the causal pathway for CVD (Younis et al. 2008). Oxidized LDL that is caused by smoking and high sugar intake is also linked to unhealthy high LDL cholesterol (Rhoads and Major 2018). High LDL cholesterol is less problematic if small LDL particles are reduced and most LDL particles are large or “fluffy” (Ivanova 2017).
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