Is it exercise or diet?

Wayne, a 61-year old retired school superintendent, had been an exercise fanatic all his adult life. If not running long distances and occasional marathons, he'd bike up to 70 miles a day. He did this year-round. In cold weather, he set his bicycle up on an indoor device and also ran on a treadmill and added weight training.

That's why it was kind of surprising that he sported a large belly. At 5 ft 8 inch and 190 lbs, that put his Body Mass Index (BMI) also high at 28.8 (desirable <25). You'd think that vigorous, almost extreme, exercise like this would guarantee a slender build.

Wayne also had lipoproteins to match: triglycerides 205 mg/dl, LDL 176 mg/dl but LDL particle number much higher at 2403 nmol/l (an effective LDL of 240 mg/dl); 75% of LDL particles were small.

I asked Wayne about his diet. "I eat healthy. Cheerios for breakfast usually. Some days I'll skip breakfast. Lunch is almost always a sandwich: tuna, turkey, something like that on whole wheat bread or a whole wheat bagel. Chips, too, but I guess that's not too healthy. Dinners vary and we eat pretty healthy. Almost never pizza or junk like that."

"Pasta?" I asked.

"Oh. sure. Two or three tiems a week. Always whole wheat. With a salad."

Wayne was well aware of the conventional advice for whole grains and, indeed, had been trying to increase his intake, particularly since his basic cholesterol numbers had been high in past. To his surprise, the more he tried at diet, the more LDL seemed to go up, as did triglycerides.

I see this situation every day: The obsession with processed carbohydrate foods, worsened by the message perpetuated by the American Heart Association, the USDA Food Pyramid, Kraft, Kelloggs, Post, etc. Eat more fiber, eat whole grains.

NY Times columnist, Jane Brody, chronicles her (embarassing) mis-adventure following the same mis-guided advice in Cutting Cholesterol, an Uphill Battle.

According to the USDA Food Pyramid, Wayne is not getting enough grains and whole grains, particularly since he is highly physically active. Consistent with the message given by the food industry: "Eat more!"

The food industry-supported Whole Grain Council advises:

Whole Grains at Every Meal
The US Dietary Guidelines recommend meeting the daily requirement by eating three "ounce-equivalents" of breads, rolls, cereals or other grain foods made with 100% whole grains. A slice of bread or a serving of breakfast cereal usually weighs about an ounce.

Want an easier way to think about it? Just look at your plate at each meal, and make sure you've included some source of whole grains. That's why our slogan is "Whole Grains at Every Meal."

By this scheme, if you are overweight, it's because you lack fiber and you're too inactive. "Get up and go!" It's not the diet, they say, it's you!

See through this for what it is: Nonsense. Wayne was overweight, packing 20 extra pounds in his abdomen from his over-dependence on processsed carbohydrates--"whole grains"--not from inactivity.

Comments (7) -

  • Anonymous

    10/18/2007 11:45:00 PM |

    I'm also an 'exercise fanatic'.  I've run well over 50 marathons.  I lived the high-carb lifestyle because  the literature was saying carbs are necessary for athletics. And in consequence my cholesteral was always above 290.  Now I'm following a lower carb diet and have seen the cholesterol level drop to 210.  And since reading Colpo and Traubes' new book I'm less worried about cholesterol.

  • Jason

    10/19/2007 12:55:00 AM |

    When we eliminate grains and the filling feeling that comes from eating grains,it's difficult to know what the replacement should be.
    Protein? Fat? Low glycemic vegs?
    Some combination of the three?
    If the answer is a combination,  the amount to feel full eating the low glycemic vegs is often large and we wonder whether the insulin response is similar to the grains we eliminated.

  • Dr. Davis

    10/19/2007 2:35:00 PM |

    Good questions. That's why we often base details of diet on lipoprotein patterns. Someone with severe small LDL, for instance, may do best to reduce grains as much as possible, increase healthy oils and proteins accordingly.

    We are still working on the new Track Your Plaque diet that will incorporate some of the more recent experiences in diet manipulations.

  • wccaguy

    10/19/2007 2:58:00 PM |

    Hey Jason,

    I discovered this blog and Dr. Davis' TYP program at the beginning of September.  I have relatively successfully cut carbs and grains from my diet thus far.

    Because I've got some weight to lose, I have tried to keep the carb count low and I've lost 15 pounds since then.

    I have also been very surprised at the significant reduction in my appetite.  I've read about the experience of others with regard to appetite reduction and couldn't really imagine that it could happen for me too.  But it has.

    A few weeks ago, I attended a party catered by one of my favorite italian restaurants and got myself offtrack for two days.  Then it took me a couple of days to get back on track because my appetite returned.

    Check out Jimmy Moore's website for lots of ideas about variations of foods to try.  The latest thing I picked up from Jimmy is the good old-fashioned hard boiled egg.  Two or three eggs with some spicy hot sauce for breakfast and a handful of almonds mid-morning plus a couple glasses of water and I'm good for the morning no problem.

    I find myself thinking about lunch not because I'm really hungry but out of habit.

    The cool thing too now is that the more I do this, the more I'm just not tempted much to do anything but this diet.

  • Dr. Davis

    10/19/2007 9:44:00 PM |

    I am also repeatedly impressed with the dramatic loss of appetite that carbohydrate restriction brings. It is a real effect though one, I regret, that is probably difficult or impossible to precisely and scientificaly quantify.

  • Anonymous

    10/19/2007 10:04:00 PM |

    I thought Taubes explained it well:  Control insulin and you automatically control appetite.

  • larry

    10/20/2007 4:30:00 AM |

    I am 56 years old. I have survived a major stroke in May 2004, most recently I experienced V-Tach and triple bypass and a stint in 2006. I quit smoking in 1992.

    Since mid-August I have ridden my bike close to 500 miles. I often ride 100 miles at a time. I have extremely low chorestoral, (below 100). I have lost close to 30 pounds since surgery and weigh in at 204, medium frame, 6-2.(Sounds like a this corner!)

    I often see healthy bikers that ride with me that are overweight. I try to balance all my meals, I don't live with the Cardiac Diet, but I respect it. I eat fresh meals, hardly ever prepared, and I eat in smaller dozes and at many times of the day...I think that I am on the right track! I am new to this blog and I really appreciate it!