The Man Who Ate Everything (26 page)

What are the facts? The medical literature, available on Med-line or in the
Index Medicus
to anybody with a modem or, for that matter, a library card, is quite at odds with the 1988 recommendations of the surgeon general, where most media nutritionists and writers of low-fat cookbooks begin—and then make more extreme. One good place to start is Dr. Walter Willett’s thorough review of the literature in the April 22, 1994, issue of the journal
Science;
then track down the research studies on both sides of each issue in his footnotes. But for now, here are a few specifics:

· Heart disease is not linked to the total amount of fat an individual eats. It is associated only with saturated fat, the kind derived from animals and perhaps from some tropical plants, like the coconut and the palm. This has been known for forty years.

· The heart disease rates of various countries are not linked to their total fat intake. In the famous Seven Countries study, the island of Crete showed the lowest rate of heart disease in the
world, even though its diet was very high in fat, most of it olive oil. Today the countries with the lowest rates of heart disease are
Japan
and France. Japan has historically had a very low-fat diet, France a high-fat diet.

· National rates of heart disease are most closely linked to consumption of nonfermented dairy products and red meat. There is no link with cheese, regardless of its fat content.

· Though your blood cholesterol tends to increase as you eat more saturated fat, it actually tends to go down as you eat more unsaturated fat, the kind found in most vegetable oils.

· Not all fats classified as “saturated” will raise your cholesterol. Cocoa butter, the fat in chocolate, hardly increases your bad LDL cholesterol at all. God’s in his heaven; all’s right with the world.

· A low-fat diet can be dangerous for patients with adult-onset diabetes. A study published last May in the
Journal of the American Medical Association
showed that, contrary to the low-fat, high-carbohydrate diet then recommended by the American Diabetes Association, diabetics can better lower their level of blood sugar, triglycerides, insulin, and LDL cholesterol on a diet very high (45 percent of calories) in monounsaturated fats—olive oil, canola oil, and so on. Why anybody ever thought that non-insulin-dependent diabetics could get control of their blood sugar on a high-carbohydrate diet is a mystery to me.

· As much as 25 percent of the population is “insulin resistant,” which means that they may gain weight more readily from eating carbohydrates than from eating fats.

· Consuming lots of omega-3 fatty acids (the oil in marine fish and some plants, like purslane) has been shown in some (not all) studies to reduce your risk of coronary disease. But low-fat diets restrict you to lean fish that lack omega-3.

· Countries with a low fat intake do show lower cancer rates, but the link is with animal fat and meat consumption rather than with total fat or vegetable fat.

· National rates of breast cancer increase with a higher consumption of total calories, not fat intake. (The early studies confounded the two, and then mistakenly blamed the correlation on
fat.) In a recent Greek study, women who consumed olive oil more than once a day had a 25 percent lower incidence of breast cancer than women who consumed none.

· Colon cancer rates are associated in some studies with animal fat consumption, in other studies with red meat; there is no link with vegetable fat. Similar results have been found with prostate cancer. Alpha-linoleic acid—found in the fat surrounding red meat—appears to be a major culprit.

· Obesity does not seem to be related to fat intake. In a comparison of sixty-five counties in China, no link was found between the fat intake of each population and its tendency to become overweight—even though the people in some counties consumed less than 5 percent of their calories in fat. Southern European countries have a lower fat consumption than northern European countries but show higher rates of obesity.

· In a recent clinical trial at the University of Minnesota involving moderately obese women, a low-fat diet showed no significant advantage over a low-calorie diet. Though some studies claim an initial advantage to a low-fat diet, the difference typically disappears after a few weeks. Research at Rockefeller University has found no difference in the amount of weight experimental subjects gain or lose on liquid diets that are high or low in fat.

· To summarize: Saturated fat is bad for your health; the fat in red meat and unfermented dairy products is the worst. Unsatu-rated fats are perfectly OK. Olive oil is probably beneficial. Your body weight is unlikely to be affected by the percentage of total calories you consume in the form of fat.

If all this is true, then how did the mass frenzy of antifat paranoia begin? What keeps it going?

There is enough blame to go around. The National Research Council’s compendious and influential 1989 report,
Diet and Health,
correctly targeted saturated fat in some chapters but grossly misread the medical literature in others, warning, without foundation, against total fat consumption above 30 percent of
calories. The FDA’s new food labels list total fat calories on line 1 and grams of fat on line 2; saturated fat and cholesterol come later. Nutritionists tell me that too much information confuses the public, and that if people lower their total fat consumption, they will automatically lower their saturated-fat intake. This may or may not be true. But asking people to restrict their diet more severely than they need to lowers the chances that they will heed your advice, reinforces the notion that deprivation and anhedonia are critical to the happy life, increases the ambient level of societal paranoia regarding both the natural and the man-made world, and propagates misinformation, which was once thought to be in itself a bad thing.

And then there are cult figures like Dr. Dean Ornish and Susan Powter. Dean Ornish made his mark in the late 1980s by demonstrating, over the skepticism of many in the medical profession, that a program of smoking cessation, moderate exercise, stress reduction (including meditation), social support, and a very low-fat diet could reverse the progress of atherosclerosis and lessen the risk of coronary heart disease—without surgery or drugs. His credentials as a diet doctor are much less impressive. Ornish’s very lucrative
Eat More, Weigh Less
(HarperCollins) is a low-fat, vegetarian cookbook preceded by eighty-one pages of half-truths. Since in his earlier research with heart patients he never bothered to isolate the relative benefits of diet, exercise, smoking cessation, and so forth, Ornish’s own work is irrelevant to the draconian diet (10 percent fat) he prescribes. His footnotes abound with references to newspaper accounts of other people’s research.

Ornish’s Life Choice program “takes a new approach, one scientifically based on the type of food rather than the amount of food.” This is, of course, the same “new” approach about which every one of the hundreds of low-fat cookbooks that clog the market boasts. The difference is in the fanaticism of the Ornish diet: you must avoid meats of all kinds (including fish), all oils (saturated, monounsaturated, and polyunsaturated—it doesn’t
matter to Ornish), avocados, olives, nuts and seeds, even low-fat dairy, alcohol, and all other products with more than two grams of fat per serving. “No matter what you may have heard,” he writes, “olive oil is not good for you.” I remember attending a nutrition conference with Ornish in Boston a few years ago. An expert panel was struggling with the serious and difficult question of whether olive oil really confers benefits that other vegetable oils do not. As though he had been unwilling or unable to absorb the complexities of the argument, Ornish could contribute nothing more than to sputter that olive oil
must
be harmful because it is a fat. He seems to be fixated and obsessed.

Dean Ornish’s apparent unfamiliarity with the medical literature has not diminished his influence. One casualty is Sarah Schlesinger and her 500
Fat-Free Recipes
(Villard Books), a solid seller last year. Referring to Ornish and more vaguely to studies from “societies around the world,” Schlesinger has become irrationally convinced that cancer and heart disease (plus acne, rashes, vertigo, and “hormonal imbalances”) automatically spring from consuming “excess” fat, which she takes to mean any fat at all. She offers us this urgent advice so that we can follow her diet even on trips abroad:

Learn the necessary phrases to express your needs. For instance, you can say “All my food must be fat-free” around the world in one of the following languages:

Spanish:
Es necessario que mi comida no tenga grasa.

German:
Mem Essen darfkein Fett enthalten.

French:
Tout doit etre prepare sans gras.

Italian:
Niente douvebbe essere fritto.

Ms. Schlesinger surely deserves a refund for her Italian lessons.

If, contrary to Ornish and his polyglot epigones, there is not much to be gained from cooking the low-fat way, the corresponding pain had better be extremely minor. Absence of pain is the chief criterion I used while cooking for a month from a half-dozen low-fat cookbooks. I chose
Butter Busters
because of its popularity. But the pain one suffers from using—even just reading—this book was so excruciating that no gain, perhaps not even immortality, would make it worth cooking from. Two of the six merited serious analysis and experimentation. Martha Rose Shulman’s
Provencal Light
(Bantam) struck me as one of the most attractive and authentic low-fat cookbooks available. And Alice Medrich’s
Chocolate and the Art of Low-Fat Desserts
(Warner Books) is the most methodical approach to the subject of low-fat cooking, for reasons I’ll explain.

What do these authors mean by low-fat cooking? The American Heart Association and the 1988 surgeon general’s report both call for us to take no more than 30 percent of our calories from fat. So this seems a good cutoff. Most low-fat cookbooks aim
for it.

As the average American takes in about 37 percent of his or her calories from fat, cutting down to 30 percent does not seem like a drastic step—certainly not enough to have spawned an entire new industry. Seven percent of a 2,500-calorie day works out to 175 fat calories, less than two tablespoons of olive oil or butter. Why does the world need a flood of painfully self-righteous and badly written cookbooks to teach us how to avoid two tablespoons of butter a day? One reason is that nearly all low-fat cookbooks want every dish—every appetizer, every main course, every salad, every dessert, every bite that you put into your mouth—to contain fewer than 30 percent fat calories. This is, of course, unnecessary. The objective of a low-fat diet should be to
average out
your consumption to 30 percent, or whatever your fat goal is, not to force every single dish into the same low-fat straitjacket. But that is what most low-fat cookbooks do, taking a very modest goal and making it extremely difficult and
distasteful to attain.

Alice Medrich is in a much more difficult fix. Saturated fat is extremely prominent in chocolate desserts, and so is Medrich. Pounder and the owner of the late Cocolat, the dessert and
chocolate shop in Berkeley, California, and author of the
prize
winning cookbook
Cocolat
(Warner Books), Medrich has take the job of creating low-fat chocolate desserts extremely seriously and in
Chocolate and the Art of Low-Fat Desserts
she has succeeded at least half the time by my count, an incredibly good score Her goal, after all, is to create “truly indulgent,” “sensational” desserts, not just desserts that are judged “not bad for low fat” Most of her creations are new, not low-fat versions of her earlier recipes. Medrich cannot help making the kind of apocalyptic and self-congratulatory comments that other low-fat authors do. “These are the new desserts of the future,” she writes proudly, and refers to the research for her book as a “journey of discovery.” But unlike the author of
Butter Busters,
Medrich uses only high-quality, natural ingredients and no food substitutes. She wants her desserts to taste rich, not light, and she uses fat strategically rather than replacing it.

Grease is good. Grease works. As all low-fat cooks discover, fat serves a remarkable number of purposes: it blends and softens flavors, carries them about the mouth and allows them to linger; in cooking, it conducts heat more effectively than water and allows temperatures high enough for the delicious browning reaction to occur; and it contributes to texture in obvious and less obvious ways. At first Medrich discovered that her mousses did not stiffen, frostings did not hold their peaks, pastry became soggy, and fillings would not retain moisture without “bleeding” or draining. And some flavors became oddly aggressive. Sugar grew sweeter, but eliminating sugar made for drier textures because sugar retains water. Fat holds and stabilizes flavors; low-fat desserts can become tasteless after brief storage, and any inferior ingredients in them will be exposed.