Curing the Diseases of Western Civilization

The diseases of Western civilization are diabetes, high blood pressure, heart attacks and cancer. Two out of three Americans are overweight. These diseases were relatively uncommon in the third world until they adopted a more Western diet.

The basic reason that the Western diet is so unhealthy is that it contains a high level of refined carbohydrates: sugars, white flour and white rice.

The basic problem is that refined carbohydrates are absorbed very quickly by the gut and result in large blood sugar spikes that require large insulin surges to keep blood sugar in a healthy range. Over time, many people develop metabolic problems and are not able to cope with these repeated glucose surges and keep their blood sugar under control. As average blood sugar and insulin levels go up, they cause a cascade of increasing metabolic problems, leading to higher weight or obesity, diabetes, high blood pressure, inflammation and increased risk of heart attack, stroke, cancer and dementia.

Cholesterol and saturated fat. This theory was championed by Dr Keys, who succeeded in turning it into dogma. The idea was that people with extremely high cholesterol (265 and up) had higher risks of heart attacks, so lower cholesterol must be good for everyone, even though only a very small percentage of people have total cholesterol over 265. Eating saturated fat increases total cholesterol, so it must be bad. Eating polyunsaturated fat reduces total cholesterol so it must be good. Eating less saturated fat means that you need to make up the calories that were coming from it, so you needed to eat more polyunsaturated fat or reduce fat and eat more carbohydrate (e.g. a "low fat" diet).

The problem with Keys' theory is that further research did not support it: the epidemiological studies showed a modest risk of increased heart attack for men with total cholesterol over 240 and no increased risk for women. LOW LEVELS OF CHOLESTEROL, UNDER 160, ARE ASSOCIATED WITH INCREASED RISK OF CANCER, so you don't want to get too low. High levels of polyunsaturated fat (think vegetable oils) are associated with an increased risk of cancer, so you don't want to eat too much polyunsaturated fat. Polyunsaturated fats (vegetable oils) increase inflammation which can lead to an increase of cancer.

Cholesterol is carried around in your blood in small globules of fat and cholesterol with a protein backbone, know as "lipoproteins". These globules range in size of very large VLDL for low-density lipoprotein) to medium sized (LDL for low-density lipoprotein) to small (HDL for high-density liproprotein). When you get a blood test for total cholesterol, what is really measured is the cholesterol carried in all of these different sized globules.

IT TURNS OUT THAT LIPOPROTEIN GLOBULE SIZE IS CORRELATED WITH HEART ATTACK RISK. Having more HDL is good (so your total cholesterol can go up and you have a lower risk of hear attack, if the increase comes form HDL). For LDL, there is a wide range of sizes, and the large ones are innocuous (e.g. "pillows floating around in your blood'. The smaller LDL particles are indeed correlated with an increased risk of heart attack. This is because the small LDL particles can squeeze in between the cells of the blood vessels and this causes plaque to build up. Larger LDL particles are unable to do this. So if your total cholesterol goes up but it is because you have more large LDL globules, that is fine. IF it goes up because you have more small LDL globules, that is bad. So it is very important when you get a cholesterol test to get the total cholesterol broken down into its various parts.

EATING SATURATED FAT DOES INCREASE TOTAL CHOLESTEROL, BUT IT INCREASES THE LARGE LDL PARTICLES, WHICH APPEAR TO BE HARMLESS. EATING MORE CARBOHYDRATES INCREASES THE SMALL LDL PARTICLES, WHICH IS DANGEROUS. SO SATURATED FAT DOESN'T APPEAR TO INCREASE THE RISK OF HEART ATTACK, BUT EATING HIGH CARB DIETS DOES.

Weight problems are due to metabolic dysfunction and not a lack of will power. The obvious case are people with diabetes type 1, whose pancreas doesn't make insulin at all. These people cannot put on weight without insulin injections. On the other side of the spectrum, heavier people have higher than average insulin levels. PEOPLE WHO EAT DIETS THAT LOWER THEIR AVERAGE INSULIN LEVELS LOSE WITHOUT WITHOUT BEING HUNGRY (e.g. low-glycemic index diets or extremely-low carb ketogenic diets such as Dr Atkins).