The 4 Pillars of Health

What constitutes a RIGHT Diet?

A Right Diet is a diet that can keep a person in optimal health. I define optimal health as having all the biomarkers in your medical check-up within normal ranges; recovering quickly from common infections without the need to see a doctor for medications; not having any physical pains; no problems falling asleep at night; rarely snore during sleep; no sudden tiredness during the day for no apparent reasons; and mentally sound.

Some people thrive on being vegans while some thrive on being carnivores. I believe they belong to the minority (maybe less than 20%). Most people (more than 80%) thrive on real foods and eating most things from both the plant and animal based foods. Most people don’t do well on eating too much carbohydrates (>50% of total calories) or having too much processed foods. If you are not in the best of health, most probably it is due to too much processed foods, added sugar, refined carbs or vegetable oils. If you are healthy currently as evidenced by your medical results, it means the diet you are taking is working for you. There is no need to change unless you start falling sick.

There are people who reversed their diabetes with a low-carb diet; some fixed their bipolar disorder with a carnivore diet; some don’t do well on a vegan diet unless they supplement well; some do not tolerate certain kinds of food well (such as dairy or wheat) and they end up with many health issues. The bottom line is, if you are not in good health, you should find out which kinds of food might be causing the issues.

Many people who switched to a particular diet found that their health improved greatly. This is most likely due to the elimination of processed foods, added sugar, refined carbs or vegetable oils from their diet and not so much due to whatever diet they are on. As such, if you are not keen to stick to any diet plan, you should do rather well just by eliminating such foods.

One thing I learned about diet and nutrition is that when we eat, we are consuming nutrients that our body needs in order to maintain our health. When we avoid a particular macro-nutrient, we need to replace it with a higher portion of the other macro-nutrients. So when many guidelines are recommending a limit on saturated fats, people will eat more carbohydrates or unsaturated fats most of the time in order to feel satiated. In my opinion, this is the cause of the rise in modern chronic illnesses.

Proteins and fats from animal based foods are more nutrient dense compared to plant based foods. As such, you won’t need to consume much to feel satiated. Our hunger hormone won’t be activated so easily. But when we eat carbohydrate rich foods which are not nutrient dense at all, once the glucose is burned up for energy, we will start to feel hungry, resulting in frequent eating and over-eating in some cases.

We are not meant to eat MOST of the time. We are meant to FAST most of the time. Fasting prolongs the lifespan of our cells and hence increases our longevity. When we are eating the right kind of foods which are nutrient dense, we won’t need to eat so frequently. This is the basis of a Right Diet.

My shocking discovery about Cholesterol and Saturated Fats

Since the mid 1950s, we have been told that a diet rich in saturated fats will cause a rise in blood cholesterol and lead to an increased risk of heart disease. This was based on the Diet-Heart-Hypothesis by Ancel Keys, which was based on faulty science. He manipulated his data by including only 6 out of 22 countries in his hypothesis to show the direct association between Dietary Fats and Coronary Heart Disease (CHD). Recent research studies have shown that although saturated fats increase the so-called ‘bad’ LDL cholesterol (LDL-C), they do not increase the risk of death from CHD or all causes. (Ref A) LDL-C does not cause cardiovascular disease. (Ref B)

You will see this constant tug-of-war between the two camps, one side pushing for LDL-C lowering drugs called statins, and the other side promoting lifestyle and diet changes as more effective in improving cholesterol levels in the blood. The important thing is that the consumer must be informed about both options and the risks and side effects involved.

Cholesterol is so important in our body that the liver produces any shortfall (about 80%) from our diet (about 20%). Our brain produces its own cholesterol, making up 25% of the total cholesterol in our body even though our brain is only 2-3% of our body weight. Every single cell in our body contains cholesterol. Cholesterol is also needed to make vitamin D, hormones (including testosterone and estrogen), and fat-dissolving bile acids.

The fact is, dietary cholesterol contributes very little effect on blood cholesterol levels, only around 20%. As such, we have been avoiding the wrong foods such as egg yolks and animal fats, missing out on important vitamins and minerals in fear of cholesterol. Even the recommendation to replace saturated fats with unsaturated fats is unwarranted. As such, we should eat saturated fats from real foods (animal and plant based) because they are healthy and safe. Find out more about Saturated Fats from my detailed write-up (click on words in bold).

If you have high cholesterol from your recent blood test, should you be worried about it then? Well, it is not so straightforward. You have to understand what each of the numbers in your lipid profile mean in order to find out your risk of CVD and whether you need to do anything to your diet. Refer to my detailed write-up on Cholesterol to find out more. (click on words in bold)

Are Poly-Unsaturated Fatty Acids (PUFA) really heart healthy? How about monounsaturated fats?

Almost all the national health organisations around the world recommend replacing saturated fats with unsaturated fats to reduce the risk of CVD, specifically Poly-Unsaturated Vegetable Oils and margarine. They call these unsaturated fats ‘heart healthy’ options. The support for this recommendation comes from rather weak observational studies actually. (Ref C) Even when randomized clinical trials (RCT) are used in the study, the beneficial effects are very little. (Ref D)

However, a study published in 2013 using data recovered from the Sydney Diet Heart Study conducted in 1966 to 73, showed that there is no evidence to support the clinical benefits of poly-unsaturated fats. In fact, substituting PUFA for SFA increased the rates of death from all-cause mortality, CHD and CVD! (Ref E) Another meta-analysis of RCT also indicated a possible increase in risk of CHD and death. (Ref F)

Omega-3 FA is classified under unsaturated fats. There is no controversy regarding the benefits of Omega-3 FA. It exists in oily fish such as mackerel, sardines and salmon, and in walnuts, soybeans, chia seeds and flaxseeds.

One study observed that the omega-6:omega-3 PUFA ratio in modern western diets has increased to more than 15:1 over the past decades from 1:1. Along with this increase, there has been a corresponding increase in chronic inflammatory diseases such as NAFLD, CVD, obesity, rheumatoid arthritis, inflammatory bowel disease and Alzheimer’s disease. This is due to the pro-inflammatory eicosanoids derived from omega-6 PUFA. (Ref G)

However, a review of RCT of the effect of omega-6 FA, in particular linoleic acid (LA), found no evidence of increased concentration of inflammatory markers among healthy people. (Ref H)

Confused? Let me summarise. There is very little evidence to support that PUFA is heart healthy. When the omega-6:omega-3 PUFA ratio is above 5:1, the body will be prone to inflammation. As such, the best option to consume enough dietary fats is to consume either saturated fats or monounsaturated fats. If you are not cutting down on vegetable oil consumption because you seldom eat home-cooked meals, the least you could do is to take Omega-3 Fish Oil supplements to try and balance out the O-6:O-3 ratio. And if you really have to buy vegetable oil for whatever reason, choose one with the lowest Omega-6 content and as much Omega-3 or Omega-9 content as possible.

Why Sugar is harmful and addictive

There is no controversy on this topic. Sugar is the cause of all modern chronic illnesses, not saturated fats. Proteins and fats are essential in our diet because our body needs the essential amino acids and fatty acids to function whereas our liver can produce glucose via gluconeogenesis from fatty acids.

Experts agree that sugar is as addictive as smoking. While you can choose not to smoke, it is nearly impossible not to eat foods with sugar. The best way to reduce sugar intake is to reduce consumption of processed foods and switch to real foods.

Consuming sugary foods causes our body to release dopamine, which gives us the ‘pleasure’ feeling. It activates the opiate receptors in our brain and leads to compulsive behaviour. Sugar does not activate the satiety signal and leads to over eating. Many people can eat a pint of ice cream even though they already feel full from their main meal.

Sugar has been added to almost all processed foods. If we don’t take note of the percentage of sugar in our foods, we will end up eating much more than the recommended limit. Increased sugar intake has been linked to the increase in prevalence of obesity, Type 2 diabetes and metabolic syndrome.

The Good and Bad Carbohydrates​

In case you are not aware, fruits and vegetables are classified under carbohydrates. Fortunately, they are the good carbs. Vegetables need to be prepared and cooked properly to remove the toxins in them, even if it means destroying some of the vitamins and minerals in them. Fruits should be eaten whole and not as juices because the fibre helps to slow down the digestion of the whole fruits. Fruit juices contain only fructose and goes directly to your liver and may cause Non-Alcoholic Fatty Liver Disease (NAFLD) and unintended weight gain. Never drink fruit juices in packets from the supermarket chilled section. Bottled/packet fruit juices for breakfast is a bad idea.

The ‘bad’ carbohydrates are non-other than refined carbs. Anything that is made of refined grains are bad carbs. Due to the refining process, much of the nutrients are gone and you end up eating ‘empty calories’. The worse is, they are digested quickly and have a high glycemic index. They spike your insulin levels and blood sugar. You feel hungry quickly and end up eating more. Some examples are white rice and bread, breakfast cereals, bagels, pastries and waffles, pizza, pasta, noodles, cakes and so on. Go for whole-grain versions if you really need to have them but it is best to avoid refined carbs as much as you can.

Why Eating in Moderation doesn’t work for Everyone​

Do you know the breakdown (in percentages) of the 3 macronutrients from the food you eat daily? Weekly? If you don’t, how do you know you are eating in moderation? Chances are, the majority of your food intake is from carbohydrates (50% or more) and you are slowly becoming insulin resistant if you continue to eat like this. If you consume processed foods frequently, it’s even more difficult to determine the percentages. If you don’t believe what I am saying, try using an app to keep track of what you eat in a week. You can easily find out the percentage of the macronutrients you consumed.

It’s not your fault. It’s the constant advertisements from food industries that have skewed our views on the kinds of food we should be eating. We can’t have a balanced diet by eating healthy foods 50% of the time because the other 50% of unhealthy foods cause much damage to our body. To make things worse, some unhealthy foods have been promoted to be healthy, even by well-meaning government organisations. So when you eat in moderation by eating all kinds of foods, you will only achieve moderate health. Unless this is what you want, you might want to be more mindful of the food that you put into your mouth.

References

Ref A     Ramsden, C. E., Zamora, D., Majchrzak-Hong, S., Faurot, K. R., Broste, S. K., Frantz, R. P., … & Hibbeln, J. R. (2016). Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73)bmj353, i1246. https://www.ncbi.nlm.nih.gov/pubmed/27071971

Ref B     Ravnskov, U., de Lorgeril, M., Diamond, D. M., Hama, R., Hamazaki, T., Hammarskjöld, B., … & McCully, K. S. (2018). LDL-C does not cause cardiovascular disease: a comprehensive review of the current literatureExpert review of clinical pharmacology11(10), 959-970. https://doi.org/10.1080/17512433.2018.1519391

Ref C     Farvid, M. S., Ding, M., Pan, A., Sun, Q., Chiuve, S. E., Steffen, L. M., … & Hu, F. B. (2014). Dietary linoleic acid and risk of coronary heart disease: a systematic review and meta-analysis of prospective cohort studiesCirculation130(18), 1568-1578. https://www.ahajournals.org/doi/full/10.1161/circulationaha.114.010236

Ref D     Mozaffarian, D., Micha, R., & Wallace, S. (2010). Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: a systematic review and meta-analysis of randomized controlled trialsPLoS medicine7(3). https://pubmed.ncbi.nlm.nih.gov/20351774/?dopt=Abstract

Ref E      Ramsden, C. E., Zamora, D., Leelarthaepin, B., Majchrzak-Hong, S. F., Faurot, K. R., Suchindran, C. M., … & Hibbeln, J. R. (2013). Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysisBmj346, e8707. https://www.bmj.com/content/bmj/346/bmj.e8707.full.pdf

Ref F      Ramsden, C. E., Hibbeln, J. R., Majchrzak, S. F., & Davis, J. M. (2010). n-6 fatty acid-specific and mixed polyunsaturate dietary interventions have different effects on CHD risk: a meta-analysis of randomised controlled trialsBritish Journal of Nutrition104(11), 1586-1600. https://pubmed.ncbi.nlm.nih.gov/21118617/

Ref G     Patterson, E., Wall, R., Fitzgerald, G. F., Ross, R. P., & Stanton, C. (2012). Health implications of high dietary omega-6 polyunsaturated fatty acidsJournal of nutrition and metabolism2012. https://www.hindawi.com/journals/jnme/2012/539426/

Ref H     Johnson, G. H., & Fritsche, K. (2012). Effect of dietary linoleic acid on markers of inflammation in healthy persons: a systematic review of randomized controlled trialsJournal of the Academy of Nutrition and Dietetics112(7), 1029-1041. https://pubmed.ncbi.nlm.nih.gov/22889633/