Different merits of a Mediterranean diet – Ethics & Data

This is a debate of two Cardiologists, Dr. Aseem Malhotra and Dr. Joel Kahn, who both believe in the merits of a Mediterranean diet, but for two different reasons.

Dr. Aseem Malhotra believes in getting back to the root of the Mediterranean diet, but avoiding the carbs, and incorporating saturated fats, where as Dr. Joel Kahn believes in the traditional Mediterranean diet, which includes carbohydrates and plant-based oils only.

Dr. Aseem Malhotra is strongly driven by science to reverse the obesity and diabetes epidemics.

Dr. Joel Kahn is a vegan and is strongly driven by ethics to try and save the planet.

Both causes are hugely admirable, but sometimes science gets overlooked when one has such a strong attachment to a belief, as Dr. Aseem Malhotra tries to point out to Dr. Joel Kahn.

“The environmental impact of your food choices is the single biggest decision you can make for a green earth or a barren earth. And only plant-based diets are going to make that impact. I live a life that is enriched knowing I don’t harm animals. This is the unsaid in the Paleo/low-carb movement. That’s huge.” Dr. Joel Kahn.

“I’m not going to stand here and say you have to eat meat to reduce your cardiovascular risk, you don’t need to. The question is, how is that data and interpretation of the evidence and science around meat consumption, being used by people with fundamental beliefs, which I respect as my mom’s a vegetarian. But, let’s just get the science right.” Dr. Aseem Malhotra

At the Real Meal Revolution, we see the skewing of data to boost arguments all the time, with more and more evidence popping up especially where Big Pharma, Big Business and Big Sugar are concerned.

It is no secret that we agree with Dr. Aseem Malhotra on this statement, “we now have a complete healthcare system failure routed in a number of factors: biased funding of research (profitable and not beneficial to patients), biased reporting in medical journals, biased reporting in the media and commercial conflicts of interest.”

Greed for the most part has caused this, but sometimes even doctors with the intention to do good may inadvertently skew the data to fit into what they believe.

Dr. Aseem Malhotra, “the third most common cause of death after heart disease and cancer is prescribed medications,” which is no surprise if you consider the amount of medication that has been pushed to cover up lifestyle diseases, simply to make a profit, instead of trying to heal the underlying cause.

Both of these cardiologists have a lot in common. They both believe that 80% of heart disease is preventable, through lifestyle, that a diet high in sugar causes inflammation, that exercise is necessary, and that a plant-strong diet is best, but their points of view differ when it comes to fat and carbohydrates.

According to Lancet Global Burden of Disease, “Poor diet contributes to more disease and death than physical inactivity, smoking and alcohol combined.” This is where both cardiologists agree – but their definitions of a poor diet are very different.

Both men agree that the American scientist Ancel Keys had a point when most of his nutritional research was done in the tiny Italian village of Pioppi, with just 200 inhabitants and an average life expectancy of 90 years of age.

What we know of Ancel Keys is that he believed that heart disease was caused by a diet high in saturated fat, which lead to the recommendations to eat more carbohydrates and fewer fats, especially those of animal origin, and this formed the basis of the US dietary guidelines in 1977. The problem with Ancel Keys’ findings is that he only took data from seven countries instead of 22.

Dr. Aseem wanted to find out how to apply the Pioppi lifestyle to modern scientific literature. What he found is that their diet is very low in sugar, and they have a big sense of community. He believes that the root cause of chronic disease is driven by excess sugar and industrial vegetable oils. “Coronary heart disease is an inflammatory disease, and not caused by dietary fat.” A huge contradiction to Ancel Keys’ theory. Dr. Aseem believes that a high-fat Mediterranean diet, movement and mobility, stress reduction and stopping smoking is more powerful than any drug in preventing and treating heart disease.

Dr. Joel Kahn believes in the original Mediterranean diet, a high oil diet, just not high in saturated fat, and that cereal, pasta, and bread is the foundation of a Mediterranean diet. “You have to bring the bread bowl back,” says Dr. Joel. Dr. Aseem says no to bread and other processed carbs.

Dr. Joel advocates the low-fat diets of Nathan Pritikin and Dean Ornish, who both believed that lifestyle played a huge impact on health, wellbeing and heart disease. Their peer-reviewed published data states that coronary heart disease melts away with a low-fat plant-based diet (“for the verysick and very few, but it’s uncontested.” According to Dr. Joel.)

It’s time to point out that Senator George McGovern, head of the Senate Committee for Nutrition and Human Needs in 1977 (when the new dietary guidelines were drawn up) was very fond of the very low-fat Pritikin diet, and what further helped his cause was that the individual who drew up the guidelines, Nick Mottern, was a vegetarian with no training in the nutritional sciences, and voila the world now has a new food pyramid to follow, strongly avoiding saturated fats.

Dr. Joel says, “The only two diets that government reimburses patients for to reverse heart disease are the Pritikin and Ornish diets.” Co-incidence? “I’m obligated as a Cardiologist to teach patients with coronary heart disease that this is science, this is an option for coronary heart disease.”

Dr. Joel asks, “If you’re giving up saturated fat what are you replacing it with? We all agree that if you eat simple carbs, you’re doomed. [Is this not a contradiction to what he said above?] Although they don’t make you worse than saturated fat, there’s just no advantage.”

Dr. Joel says that according to the Harvard School of Public Health, replacing saturated fat with whole grains and vegetable oils drops your risk of dying, and your risk of heart attack goes down 25%. He embraces this data, which was published in the last six weeks because it fits in nicely to what he believes. Dr. Aseem reminds him that a few days ago the New York Times published an article stating that Harvard scientists were paid by the Sugar Industry to shift blame to fat. Dr. Aseem questions, “How do you cut through a lot of the bull?”

Dr. Aseem says that “it’s about the quality of the research – Cambridge Medical Research Council did a very big study, with over 600 thousand participants, which concluded that saturated fat could be part of a healthy diet as long as you’re getting the rest of it right. Cut out refined carbs and sugar, have the vegetables, the olive oil, the nuts, the oily fish and some meat. Fat is very satiating and has the least impact on insulin responses.”

“Yes, the Mediterranean diet did feature pasta, but in very small amounts. The modern wheat we consume now is very different to the wheat they were consuming in the time of Ancel Keys. What should be at the base of the pyramid – lots of non-starchy veg, olive oil, nuts (lots of studies of anti-inflammatory properties) and oily fish,” says Dr. Aseem.

“Type 2 diabetes is a disease of carbohydrate intolerance. Refined carbohydrates have the biggest response on glucose and insulin, which makes it more likely to develop type 2 diabetes,” says Dr. Aseem

A patient of Dr. Aseem’s is a woman in her early 60s who has had type 2 diabetes for 25 years, and for the last 17 years has been on 80 units of insulin a day. She came off her insulin within three months by cutting out rice, sugar, and bread and started eating butter and cheese again.

Dr. Joel says that research has been done to prove low-fat plant-based diet is best for heart disease, prostate cancer, and longevity and that cheese actually increases insulin resistance and metabolic syndrome according to the PREDIMED diet.

“Low-carb high-fat diet increases coronary heart disease and death that’s incontrovertible data,” saysDr. Joel.

Dr. Aseem disagrees, “in a critical reviewin nutrition, apart from fasting/starvation, a low-carb diet had the most beneficial results for type 2 diabetes, not just for reducing medication and improving glucose markers, but for reversing all markers for metabolic syndrome.”

Dr. Aseem comments on the Dean Ornish studies which were done on a very small scale but did have very good outcomes for people at risk for heart disease. One of the factors was a low-fat diet, but the other factors that were focused on were stress reduction, exercise and a reduction in smoking. “The biggest decline in cardiovascular death in the last several decades has happened because of a decline in smoking. It took 50 years for the first link between smoking and lung cancer to be published in the British Medical Journal because the tobacco industry played dirty.”

Dr. Aseem says, “The solutions are relatively simple – through lifestyle mechanisms: diet, movement, and exercise, stress reduction, sleep. The future of healthcare is going to come through lifestyle. Good health rarely comes out of a medicine bottle.”

The takeaway message is that you cannot look at only one factor when it comes to health, diet alone will not make you healthy if the rest of your life is out of balance. Each individual is unique and should be treated as such. Yes, beliefs can sway how you treat your patients, but science as a whole cannot be ignored.

Underneath what drives both of these individuals is a common goal to be healthy and happy in a world that is free from corruption and selfishness. And the only way we are going to get there is if we all work together to beat those who are only in it for themselves and their greed.

We have always said that Banting is not a diet, it’s a lifestyle. We believe in this statement so much that we have created a new phased approach to Banting, which will be released on 1 December 2016 and incorporates all of the aspects that Dr. Aseem has mentioned – diet, movement, and exercise, stress reduction and getting enough sleep.

If you would like some guidance on how to take back control of your health by starting with the food you eat, our Online Program is the best place to start.