Hydrogenated fats, ‘cholesterol-lowering’ products and sugar-laden alternatives that we promoted are terrible options for the vulnerable cohort of patients we were trying to help.132–135 The recommendations for extreme restriction of saturated fat, cholesterol and total fat are now becoming obsolete and further analysis is proving fat not to be as detrimental to health as we once thought.136,137 The morbid result of our fixation with replacing fats with refined carbohydrates and sugar is exemplified by our current lifestyle-related disease epidemic.138
However, the restricted fat message still exists, particularly among supporters of plant-based lifestyles. To their credit, some small studies demonstrate remarkable cardiovascular disease reversal and cancer improvement using fat restriction and lifestyle change.139,73 On the other hand, the Mediterranean diet, one of the largest and longest studied of eating habits, comprises three times more fat than ‘fat-restricted’ diets with – again – impressive cardiovascular, cancer and diabetes protective effects.50,48
My honest opinion is that we shouldn’t fear fat. We don’t exactly know why some people thrive on low fat intake while others suffer, but I’m certain it comes down to the individual.140 Your environment, gut microbes and ancestry play a major role in predicting the success of any given diet and lowering your risk of disease, but I believe a good proportion of good-quality fats are essential to health.
+ RETHINKING FATS
Fats, including cholesterol, are vital to the functioning of our brains, the composition of cell structures and essential for hormone synthesis. Reducing them to ‘good’ and ‘bad’ fats completely negates the science and lacks an appreciation for how complicated our bodies are. My belief is that a high-sugar, refined-carbohydrate diet in combination with poor-quality fats is the cause of ill health.141 This toxic blend causes inflammation and a cascade of medical problems thereafter, but like a lot of topics in nutrition, the explanation is fraught with complexity. Our thinking about how dietary cholesterol affects heart disease is also changing.142,143,144 Consuming cholesterol, which is only found in animal products, does not necessarily increase the level of cholesterol found in your blood nor increase your risk of heart disease. I know this is quite hard for a lot of people to accept, given the dietary dogma most of us have been subjected to over the last 40 years, but it is based on evidence. Equally, I don’t recommend people actively try to consume more cholesterol. We need to learn from our past mistakes of damning an entire macronutrient to the extent that people are scared into radically removing it, but what I am witnessing now is a swing of the metaphorical pendulum in the opposite direction! Even though butter has been exonerated to some degree, you won’t find me spooning it into my coffee – I like my Americano freshly brewed without lipid-rich particles floating in it, thank you very much. For simplicity’s sake, I stick to the types of fats found in the Mediterranean diet which is packed with nuts, seeds and, of course, extra-virgin olive oil. My simple mantra to patients is: eat whole food and stay away from anything that’s marketed as ‘low fat’ or ‘a healthier alternative to …’ Your body is worth more than those cheap, tasteless alternatives. Some quality fats to enjoy in the context of a whole-foods diet include those found in flaxseeds, nuts, seeds, avocado, extra-virgin olive oil, butter from grass-fed cows, full-fat yoghurt and delicious dark chocolate.
Veganism
In recent times plant-based eating has become exceptionally popular. A number of documentaries have convinced many people of the supposed health benefits of veganism and the health risks of red meat. They do have a lot of successes to feel smug about, that are well documented in the literature. Lower rates of cancer,145 diabetes,146 cardiovascular disease147… the list goes on. It’s compelling stuff and, obviously, I’m a huge supporter of a diet largely made up of fruits and vegetables, but pure veganism doesn’t come without its caveats. B vitamins are noticeably lacking in vegans, as well as zinc, essential fatty acids and vitamin D.148 Careful supplementation with extra nutrients is something I would advise all 100-per-cent plant-based eaters to discuss with their health practitioner.
Also, it’s important to remember that just because you go vegan doesn’t automatically turn you into a dementia-proof, cancer-kicking superhuman with spotless arteries. If I lived on chips and pasta with tomato sauce I could feel pretty ethically minded about not having killed an animal for my dinner, but I probably wouldn’t live for very long to tell people about it.
Ultimately, I have a deep respect for those who choose to live a life on plants alone, whatever their reasons, but my priority would be to make sure everyone is doing it safely.
Wrapping up
What a lot of these diets have in common is a focus on weight loss as a positive outcome, but is this what we should be striving for? Is weight management a reliable biomarker of general health and should this be the common denominator against which we judge the success of a diet? BMI is such a poor predictor of outcomes yet many studies continue to use this as a standard.149
Everyone has the ability to lose weight, tone up and feel lighter, but sometimes it’s at the expense of health rather than in pursuit of it. I want you to feel ‘well’. I’m convinced that good health, contrary to popular belief, is independent of size and especially weight.150 I think we could all do with a little less emphasis on weight as an outcome and more of a focus on wellbeing. Health and wellness conjure images of slim, vivacious, young 20-somethings, but a focus on this as the ultimate goal detracts from why we are trying to achieve a healthier life. I believe it is for the sum of our daily interactions to be positive in mind and physicality. It is to live a fulfilling and happy life. This doesn’t necessarily correspond to a certain number on a machine, even though an industry, and perhaps even your doctor, is trying to convince you it does. Your focus should be on health goals and habits rather than a physical endpoint.
There are endless ways in which you can add nutrient-dense foods to your diet on a daily basis and I want to encourage people to think along these lines. We have an opportunity to be truly nourished, rather than skip from diet to diet in the hope that we hit the ‘carb-protein-fat ratio jackpot’ and achieve that dazzling ‘perfect weight’.
I’m convinced that good health, contrary to popular belief, is independent of size and especially weight.
Medicinal spices
Growing up in an Indian household, I was constantly surrounded by spices, herbs and folk medicines. Everything from sore throats to constipation seemed treatable with the contents of our kitchen cupboards!
Most second-generation kids will concur: Indian families seem to have an encyclopaedic knowledge for complementary health cures. I have vivid memories of being fed a spoonful of toasted spices and salt whenever I had tummy ache. My father would always make a mixture of almonds, clarified butter and sugar during my exams, claiming it was ‘brain food’. And, of course, my mother was years ahead of the ‘Spiced Turmeric Latte’ trend.
You can imagine the number of ‘I told you so’s’ I got when I started researching the clinical validity of traditional treatments. My Indian heritage is steeped in Ayurvedic tradition and what fascinates me is the premise of ‘alternative therapies’ having the potential to become recognised treatment in the battle against chronic disease. Learning about the marriage of flavour and medicinal property was revolutionary for me.
The positive clinical effects of food are unlikely to be caused by a single ingredient, like a spice or herb, so it’s important to maintain a holistic perspective. Remember that any benefit from the inclusion of an ingredient has to be taken in the context of a ‘good diet’. Reiterating what I stated at the start of this book: do not treat food like a pill. Concoctions from herbalists or ‘natural’ food supplements are not panaceas or cure-alls, in exactly the same way that