Biggest bang for your nutritional buck

Judging by the conversations here, in the Track Your Plaque Forums, and elsewhere, it's clear that many people are searching for the perfect diet.

Should we reconsider the role of saturated fat? Are there fractions of fatty acids in saturated fat that are more or less harmful? How about the role of fats on cancer risk? How about the role of proteins like casein on cancer risk? Are there flavonoid sources, or combinations of flavonoids, that yield outsized health benefits? Is there a ceiling for omega-3 fatty acid supplementation? Is there a role for linolenic acid sources in cardiovascular disease prevention? And on and on.

All important issues, to be sure, ones that we've all zig-zagged through over the past 30 years.

I also see patients every day, however, who are not interested in micro-managing their diet. Their goals are less ambitious: lose 20 lbs, feel good, raise HDL, reduce triglycerides and small LDL, all while meeting all the other responsibilities in their lives, like children, spouses, maintaining a household and jobs.

So, if your interest is not to consider whether we should distinguish myristic acid sources from palmitic, or if epigallocatechin is better when combined with quercetin, then the biggest bang from your nutritional buck can come from one single strategy:

Eliminate wheat flour products

Secondarily, avoiding corn starch products and "goodies" (candy, fruit juices, fruit drinks, cookies, potato chips, etc.--you know what they are) is important, as well.

It means weighing your diet more heavily in favor of vegetables and fruits; lean meats; healthy oils; and raw nuts and seeds, all in unlimited quantities. Dairy products should be limited, however, because of sugar effects.

Of course, this advice clearly contradicts the pronouncements of the USDA Food Pyramid (6-8 servings of grains per day), the American Heart Association, and the diabetes-causing American Diabetes Association diabetic diets.

But, follow this approach, a diet strategy that appears too simple to be effective, and the majority of people lose dramatic amounts of weight, raise HDL, reduce triglycerides, reduce small LDL, reduce C-reactive protein and other inflammatory measures, reduce blood pressure, and raise self-esteem.

It's also a lot easier than it sounds (after habits are broken) because the appetite stimulating effect of wheat is removed. Many, if not most, people also experience increased energy, including elimination of the afternoon "slump," improved sleep, less mood swings, less intestinal problems.

It may not be perfect, but if your interest is to get the most with a modest amount of effort, it works like a charm for the majority of people.

Copyright 2008 William Davis, MD

Comments (13) -

  • shreela

    4/29/2008 11:59:00 PM |

    My first time to click through from the reader, so I love the new banner! Your first couple of paragraphs had me giggling, mostly at myself. But I'm not quite that bad, yet.

    In addition to stopping sugar and high-glycemics because I had that borderline A1C a few months back (had to reschedule follow up appt because of jury duty), your harping wheat got me to at least slow it down enough to figure out it was causing my 'gut episodes'. So after an elimination diet, I've been feeling far less pain/bloating (exception peas, a new seemingly unconnected sensitivity). I didn't get a celiac blood test when I went back to GI since I'd been completely off wheat quite a while by that time.

    And I've dropped 20 lbs since stopping the wheat!!  Yay, and THANKS for harping on wheat!!

    But I still don't know if meat fat still needs to be trimmed as much since it seems it doesn't directly contribute to bad cholesterol. I could stand to lose more weight though LOL


  • Zbigniew

    4/30/2008 4:18:00 AM |

    great post for newbies, but you still  dodged:
    I know about the flour and starch, now:
    is there a ceiling for omega-3 fatty acid supplementation?
    you can read how the fish oil was used to suppress the immune system after transplants or something, so should we treat fish oil just like sunflower oil?

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    4/30/2008 5:51:00 AM |

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  • Anonymous

    4/30/2008 6:41:00 AM |

    Same here. I lost about 55 pounds and my CRP, blood pressure, cholesterol, etc., dropped to optimal levels. Fruits, vegetables, occasional salmon, carefully chosen vitamins and supplements, and a daily brisk walk of at least 30 min. While this programs may seem like a considerable sacrifice, it beats the alternative: 100% sacrifice.

  • Anonymous

    4/30/2008 12:06:00 PM |

    My father has been doing the TYP program with out following the low carb. diet.  He just got his test results yesterday and the #s differ little from the last test done.  It has him scratching his head.  After this he might finally follow the diet.  He is asking me lots of questions this morning.  The supplements and drugs were helpful, in particular his triglycerides and HDL have significantly changed for the better, but lots of work to be done still, specifically on lowering LDL, and it's fractions.

  • Michael

    4/30/2008 5:32:00 PM |

    Regarding an upper limit for fish oil, I believe the cut-off (for most people) is considered around 3 grams/daily of Omega 3. Higher doses could theoretically lead to thinning of the blood (eskimos were prone to bleeding-brain type strokes) and immune suppression is another possibility. Even at 3 grams/daily, some immune suppression might be going on. And for some people with auto-immune disorders, that could be a good thing. Although for the general population... not so sure.

    Maybe one day Dr. Davis could devote an article delving into fish oil a bit more? There is the ethyl ester vs. triglyceride form issue, which I don't recall seeing ever mentioned here. And although heavy metal toxicity isn't really an issue with most fish oils (in my opinion), oxidation is. Fish oil doesn't have to be rancid to have some oxidation, which could be unhealthy. And there is also immune suppression... and also the question of which omega 3 is of greater benefit, EPA or DHA. Lots of fishy stuff to look into.

  • Anonymous

    4/30/2008 7:52:00 PM |

    OK - I need a lesson in Wheat & Cholesterol/Weight Gain/Health 101.

      What exactly is the problem with wheat, and why does it have a bad effect on cholesterol/weight?  Can someone point me to this basic information?  I assume it has nothing to do with the gluten in wheat (unless you have Celiac disease).


  • Anonymous

    5/2/2008 4:22:00 AM |

    I find it very difficult to eliminate wheat.  It seems to be in so many things.  Can anyone tell me about breads without wheat, cereal without it and wheatless pasta.  I am Italian and it seems like missing pasta and breads in particular are really hard in our family.

    I do know of spelt bread and we buy it.

  • Ross

    5/4/2008 12:21:00 AM |

    I think that Dr. Davis does himself a disservice in this posting by claiming that it's wheat that is the big problem.  While wheat may well have antinutrients that sabotage our digestion, the big risk for everyone in eating wheat and wheat products is the starch (carbs).

    Your body converts starches to simple sugars before being absorbed across your intestinal wall, which means that for the sake of your insulin levels (and your LDL particle sizes), wheat is as bad as a big glass of glucose syrup.  Not quite as bad as a glass of high fructose corn syrup since the fructose is converted directly to triglycerides by your liver, but bad enough.

    In answer to the anonymous italian looking for wheat-free bread, cereal, and pasta alternatives: the real answer is to realize that these food categories are compromised because they come from grains.  

    If you moderate your intake of these kinds of foods, they won't do very much harm to your metabolism.  But if you can bring yourself to completely eliminate them from your diet, you'll be even better off.

    As for seeking lean meat: I do the exact opposite.  I've been buying suet (beef fat) and rendering tallow to make pemmican and other foods that are very rich and compact, calorie-wise.  These high-fat foods have been helping me lose and then maintain my weight very effectively (and they're tasty too!)  High fat foods make me full, not fat.

    After a rather thorough reading of the science on saturated fat, I've personally concluded that saturated fat is harmless or beneficial.  Most of the older research that doesn't determine the precise composition of solid fats also doesn't discriminate between trans fats and naturally occurring saturated fats.  The balance of the research shows clear benefits to the various fatty acids found from fat sources as varied as coconut oil, palm oil, tallow (beef fat), lard (pork fat), butter, milk, etc.

    Oh, and I'd only stay away from lowfat milk and lowfat milk products.  Whole milk causes a moderate increase in insulin (30GI) along with a parallel increase in glucagon (an antagonist of insulin) leading to nearly perfect digestion and allocation of sugars, fats, and proteins within our bodies.  Yes there are some sugars (mostly lactose), but the fats and proteins seem to be more than enough to balance things out.  Assuming you can tolerate the lactose and don't have serious damage to your intestines (celiac disease and crohn's disease would both qualify), milk is very nearly a perfect food (along with eggs).  IMHO, of course.

  • Dr. William Davis

    5/4/2008 12:44:00 PM |

    I pick on wheat specifically because, after obvious poor sugar-rich choices like candy and soft drinks, wheat constitutes 90% of the problem in the modern diet.

    I am also not so ready to embrace unlimited saturated fats. I do not think we can dismiss the mounds of observations that have tied saturated fat consumption to heightened cancer risk, even in populations not exposed to trans fats nor to processed carbohydrates. Whether it is saturated fat specifically, or something that travels with saturated fat is not entirely clear, but unlimited saturated fat is, in my view, an invitation to adverse effects. This has also been well-documented in in vitro observations.

  • Ross

    5/5/2008 6:58:00 PM |

    In any study I've read that comes out strongly against saturated fats as a category, there are significant problems, from failure to eliminate trans fats as a confounder to inaccurate data gathering (diet questionnaires, etc.) to completely inadequate sample size (17 samples with one worse outcome = conclusive?).  I misstated when I said that this was a problem of older studies.  This is a problem of modern studies as well, especially those most interested in finding problems with unprocessed foods and unprocessed fats.

    The giant EPIC study currently going on is a perfect example of this.  They have no ability to discriminate between trans fats and saturated fats in their data, and yet various analyses based on early data have been quite willing to conclude that saturated fats are bad for you.  Science this shoddy should not only embarass the authors but the journals that let it slip by without effective criticism.

    As for in-vitro studies, I've only seen one recent study that focused on this area, where it was claimed that safflower oil inhibited the anti-inflammatory effects of HDL less than coconut oil.  Except that the scientists forgot to isolate out one gigantic difference between the two oils: Vitamin E.  Which is present in safflower oil, and is not in coconut oil, and is already known to have multiple, significant anti-inflammatory effects.  The authors also failed to note that their flow-mediated dilation data strongly indicated regression to mean.  Despite these issues (and others), the authors were willing to suggest that oils from 15 different food types should be minimized in our diet solely based on the presence of saturated fatty acids in those oils.  These types of scientific failures would be funny if they weren't so common.

    Dr. Davis, there's a lot of bad science on fats out there.  I know your time is precious and reading between the lines on studies is quite time consuming, but you already know to be careful what you accept at face value.  Please be willing to apply the same critical razor to dietary information that you already apply to cardiac information.  I think you'll come away with a much more charitable view towards saturated fats from whole food sources.

  • jpatti

    6/4/2008 10:54:00 PM |

    On the question of how to replace bread and pasta...

    I'm Italian too and grew up on pasta.  The big secret to low-carbing is discovering the flavor is in the sauce, not the pasta!

    I stirfry shredded cabbage as a base for cream-type sauces and stirfry shredded zucchini as a base for tomato-type sauces.  Both are yummy.

    I make lasagna-in-a-bowl sometimes.  Mix some ricotta with chives, top with sauce and mozzarella and nuke.

    Another option is soba noodles.  Many brands are made of both buckwheat and wheat, but some are all buckwheat.

    I make an Italian sausage soup, heavy on the peppers, onions and garlic with loads of other veggies added too.  It's REALLY good stuff, you don't at all "miss" the pasta.

    My primary anti-bread strategy is eating too much other food to miss it!  

    Basically... think of how Subway serves the same stuff on top of a salad instead of a sub.  If you have a big plate of mixed greens,  tomatoes, cucumbers, onions, peppers and olives to go with your ham and cheese, you won't miss the bread much.

    There's also the notion of doing lettuce as "bread" for a sandwich.  Roll-up the ham and cheese in a lettuce leaf (romaine holds up best).  

    If you're trying to avoid *carbs* as opposed to wheat, there are low-carb tortillas, wraps and crispbreads that are mostly fiber that work as bread replacements too.  I'm a whole foods advocate so try to use these rarely myself.  

    But when I really, really want a pizza, a low-carb tortilla topped with sauce, mozzarella, garlic and pepperoni bakes up like a thin crust pizza and satisfies the craving with minimal carbs.

    You didn't ask, but the typical low-carb replacement for potatoes is cauliflower.  You cook it and mash it up with some sour cream or cream cheese or butter and maybe some chives or roasted garlic.  

    Or grind raw cauliflower and "fry" patties of it into "hash browns".  

    Add some whole florets and some mashed cauliflower to soups and stews to "thicken" like potatoes do.  I make an awesome clam chowder with cauliflower!

    After over a decade of low-carbing, I am convinced the *real* secret to doing it in a satisfying manner is to get VERY creative with non-starchy vegetables.

  • Razwell

    11/22/2009 10:40:48 PM |

    Dr. Davis

    How does one teaspoon a day opf Carlson's cod liver oil sound to you for good health?