What Should I Eat: Part 3

What should I eat? This is the third edition of this ongoing discussion we've been having and I want to focus a little bit on the question of dietary fat and how that fits a role into healthy living. As you probably recognize, there has been controversy for now many years about fat or no fat in the diet. What type of fat, how does it play a role? I'd like to go back with you to a series of experiences I've had the fortune of having as part of my learning around that question. And it starts with a meeting that I had the privilege of having now 30 years ago with a cardiovascular researcher and practicing cardiologist on the faculty formerly at the University of California, Los Angeles school of medicine, Dr. Lester Morrison. Dr. Morrison, in the early 1950s, actually the late 1940s, came up with a remarkable concept at the time for a cardiologist, and that is that eating a diet that was lower in fat and higher in unrefined or minimally processed products, particularly vegetable based products, could have a dramatic positive effect upon the cardiovascular health of his patients. This was not a generally accepted concept at the time whatsoever. And he published a number of papers, did many clinical trials, and eventually then into his offices and his clinic wanders a fairly young man in his early 40s who is significantly disabled from cardiovascular disease, a very brilliant, capable guy, but has very serious artery blockage and is seeking remediation. This person's name you're probably familiar with, it's Nathan Pritikin. Nathan Pritikin then chose to comply with the Lester Morrison approach and lo and behold, did he have a positive response. And over a course of the next year or two regained his health, his cardiovascular disease went into remission and he become the great guru and devotee of the high complex carbohydrate, minimally processed, unrefined diet that is rich in fiber, rich in phytochemicals and low in animal products. And this became the Pritikin revolution, from which the Pritikin Longevity center were formed, first in Santa Monica and then later in Florida. He affiliated with research projects at the University of California, Los Angeles with Steve Inkelis and his group, and was able then to demonstrate with Dr. Bernard at UCLA in a number of papers published in high tier journals, that the approach that he was advocating could really lead to significant improvement in cardiovascular function in diseased patients. This, by the way, was the precursor obviously of what later Dr. Dean Ornish picked up and became part of the Ornish program. Now, in the course of this discussion and this development of this, as you probably recall Dr. Pritikin, excuse me, Mr. Nathan Pritikin then later developed cardiovascular advocacy that was so popular that literally medical schools and institutions around the globe were starting to introduce this concept. And then he died, unfortunately not by cardiovascular disease, by other causes. And in 1985 in the New England Journal of Medicine, his colleagues then published, published the report of his autopsy. And it was entitled, I think it's a classic paper in the New England Journal of Medicine, Nathan Pritikin's Heart. Pretty simple title. In which they showed that his heart and coronary arteries were free of plaque. There had been complete regression through the implementation over the previous 20 years of this program, the Morrison Pritikin program, and that a reversal of cardiovascular disease in him did occur. As you probably know, this is very comparable then to what Dr. Ornish later proved in his studies in a randomized trial. Now from that then we take away the concept that diet plays a very important role and that maybe certain forms of dietary fat in excess, like saturated animal fats, may have a deleterious effect and a beneficial effect of unrefined vegetable based products, the fiber, the minerals, the vitamins and all the other benefits, even plant protein. Now we take that into the next step. And that is another fortunate meeting I had. After having the pleasure and privilege to meet Dr. Morrison and Mr. Pritikin, I then in the 1970s had the privilege of meeting Dr. Robert Elliott. Dr. Elliott, a cardiologist then at the University of Colorado, previously at the University of Nebraska, was a highly published cardiologist with over 145 papers in the peer reviewed literature, who himself had had a Cardiovascular accident at 44 years of age and had completely turned his work and research, both clinical and basic science research, in trying to understand early stage cardiovascular accidents or heart attack. Through that he came to recognize that there were a variety of variables that played roles. Not just diet itself, but also stress patterns. And in fact, his book Is It Worth Dying For? Question Mark talks about stress and its relationship to cardiovascular disease. And what he pointed out in his publications was that there are certain types of individuals who respond to stress in very different ways. He actually noted this early on in the development of video games back in the 1970s, in which some people, when playing things like Pong under competitive conditions, had their blood pressures go up dramatically, whereas other people under the similar states of stress, there was no vascular response that could be noted. He called these individuals then the hypertensive response, vasoconstrictive response to stress. This beta adrenergic response, hot reactors and and he went on to say that this is really what Meyer Friedman was talking about with type A behaviors, where these hot reactors, the people that are not just urgent in time and vigilant, but people whose bodies genetically respond to these stimuli by vasoconstriction and cardiovascular changes in electrical stimulation of the heart, which leads to early stage and kind of unexpected heart attacks. Now, what went on from Elliot's work then was the recognition that basically the combination of diet and lifestyle, such as smoking and this genetic tendency towards being a hot reactor was like the deadly triad. So if you are an individual who responds to stress stimuli by your blood pressure going up very dramatically, then you're in the class of hot reactors. And for you, then you're at higher risk to these cardiovascular concerns and need to really watch your diet and lifestyle and exercise patterns more vigorously. This is the first step towards a personalized lifestyle intervention, is to understand these things about the person. So there may be something about diet and the saturated fat relationship to hemorrhagic problems and platelet clumping and all the things that we talk about as it relates to cardiovascular disease risk and also to that of having a genotype towards this hot reactor personality. You put them together and now these are the individuals who really need to be very cautious about how they approach diet and lifestyle as it pertains to protection of cardiovascular function. So I think this is a very interesting story about the evolution of how we ask the right questions about ourselves, how we personalize our own response to our diet and lifestyle, and why there may be some people who are really, at best, when they are on this kind of more Pritikin or Ornish or Morrison approach of the minimally processed, unrefined type of diet that is rich in plant carbohydrate, rich in plant protein, fiber, minerals and vitamins, and who are also doing the proper things with stress management, stress reduction and exercise.