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Chapter One

"We have a fifty-five-year-old man in full arrest, CPR in progress. We are three minutes out. Do you copy?" When the emergency medical technicians (EMTs) arrived we were waiting, fully gloved, in our appointed positions around the bed in the code bay. I was at the head of the bed, where I could take control of the airway and orchestrate the activity of the three nurses, two technicians, and the physician's assistant. Compressing the chest as the patient was rolled in, an EMT gave me the essentials:

"Fifty-five-year-old male, no previous medical history, was at work and complained of feeling light-headed. He went down, and coworkers administered CPR. When we arrived he was in V-Fib so we shocked him. Got no pulse, so we shocked him again. Then he went flatline. Gave a total of seven milligrams of epinephrine but got nothing."

They counted to three, lifted together, and loaded his obese body on the emergency room gurney. I looked at his purple, plethoric face.

"How long before you guys got to him?" I asked.

"About ten minutes."

I passed a laryngoscope into his mouth, suctioned out the fluid and the vomit, and passed a tube into his trachea so we could deliver 100 percent oxygen directly to his lungs. I stood up from my stooped position. His large belly protruded each time they compressed his chest.

"And how long was his transport time?"

"About twenty minutes," the EMT responded.

Thirty minutes without a pulse. I knew then he wasn't going to make it. As soon as you go beyond eight to ten minutes, chances of survival plummet to near zero. But, you never know. So we continued to work on him. CPR, more epi (epinephrine), a flicker of chaotic heart activity, another shock, then flatline again.

His wife was already in the family room when I entered. She knew what I was going to say, but still she looked at me with fearful, expectant eyes that said, "Don't tell me that. I don't want to hear that. Tell me something different."

I sat down, and as I took her hand she knew the inevitable was coming and started to cry.

"I'm very sorry."

The sobs grew louder.

"He passed on."

She wailed. "No, no, he didn't. Don't tell me that. It's not true."

"I'm sorry, ma'am. We did everything we could."

"What happened?"

"It looks like he had a massive heart attack," I said. "He went very quickly, even before the rescue squad got there. I can assure you that he didn't suffer."

"But he was fine," she said. "He had no problems. He just saw the doctor two months ago. He was going to retire and we were going to...." She couldn't finish the sentence.

"I know, I know," I said, although I knew he couldn't have been fine. This problem had been brewing silently for years.

"I guess it was his time," she said.

"I guess it was." But I didn't really believe that. It's a great comfort to the grieving to believe the hour of death is beyond our control. I suppose sometimes it is. But after seeing too many premature deaths from gunshot wounds, drug abuse, drunk driving, smoking, overeating, and sedentary living, I long ago stopped believing that we are passive victims of fate. Many people who end up in the emergency room make choices that land them there.

The patient's wife composed herself, picked up the phone, and dialed. But when she made the connection she barely got the words out. "Daddy's gone. He's dead." She started crying again. Saying the words to someone else always seems to make it more real, more final. "I'm with the doctor now. Yes, yes, I'm fine." Then she hung up, put her head down, and sobbed the deep, quiet cry of someone who had lost her best friend and was facing the rest of her life alone.

You remember some resuscitations better than others. I don't know why this one from years ago sticks in my mind, but it does. Maybe it's because his wife was so sweet. I must confess that I don't remember their names. I do know that I have had such conversations too many times in nearly twenty years in medicine.

Most of the premature deaths I see are preventable. This man was fifty to seventy-five pounds overweight. He could have dramatically lowered his risk by making relatively simple changes in his lifestyle. Instead, because of his central obesity (obesity concentrated around the midsection), he had been set up for what is called the metabolic syndrome. This syndrome, which is epidemic in our society, consists of obesity, abnormal levels of cholesterol and triglycerides (blood fats), high blood pressure, elevated fasting insulin, and a predisposition to blood clotting. Often these abnormalities are subtle and, taken individually, might be overlooked. But combined they can do tremendous damage over the years and eventually choke off the blood vessels feeding the heart.

What could he have done to put off that day and enjoy another twenty or thirty years with his family? You know the answer. Diet and exercise. Now you'll turn off, tune out, and give up, because you've heard it too many times before and tried too many times before, and you are tired of failing.
But don't give up yet. Yes, diet and exercise are the key. That much of what you've heard is true. But if you are the typical American listening to the typical advice that you get from doctors, dietitians, the media, and food manufacturers, you have been set up for failure.

In fact, you've been lied to. Maybe not on purpose, and sometimes with good intentions, but the bottom line is that you haven't been told the truth. And the truth is that the diet regimen embraced by most physicians, the National Cholesterol Education Program, and low-fat gurus such as Dr. Dean Ornish largely haven't worked for most people.

If you are one of tens of millions of Americans who have tried and failed to lower your weight, maintain an exercise program, or control your cholesterol, the reason may be that you have been programmed to fail. In all likelihood the dietary advice you have been given is fundamentally flawed, is impractical for most people, requires radical and unpalatable changes, and is simply impossible for most people to stick with.

If you are like the majority of Americans who have been programmed to fail in this way, you have been the victim of low-fat lies.

For most of you the core of your dietary program is a radical reduction in fat intake. For almost thirty years Americans have been cutting back on fat, or trying to. The percentage of fat in the American diet has dropped by almost 15 percent, and low-fat prepared foods litter the grocery shelves. And all this time Americans have continued to get fatterover 30 percent fatter.--

If that's your story, you've been victimized by the low-fat lie. Tens of millions probably have been victimized in this way over the past thirty years. The truth is, not only do low-fat diets often not work, for many people who fail to lose weight they may actually be dangerous, worsening HDL cholesterol and triglycerides. Very low-fat diets may even deprive the body of important nutrients that defend against heart disease and cancer.

The low-fat diet craze has been with us for two decades, yet Americans continue to gain weight. Why? The reason is simple: Much of the time, low-fat diets don't work.

Low-fat diets are unsatisfying, unpalatable, and for most people impossible to stick to. And there is compelling new evidence that they can be positively unhealthy.

If a low-fat diet is good, a very-low-fat diet must be better, and a no-fat diet must be best of all, right? After years of low-fat propaganda, many seem to think so. The no-fat/low-fat message has become so pervasive that in a poll of schoolchildren, 81 percent thought that the healthiest diet possible is one that eliminated all dietary fat--a nutritional disaster.

Americans have been convinced that "low fat" is synonymous with "healthy." They treat fat like poison, and they are obsessed with banishing it from their lives. They will eat a cupboard full of rice cakes for lunch and pasta by the pound for dinner and wonder why they don't lose weight. Even if they do lose weight on the very-low-fat diets recommended by low-fat gurus, they have a hard time sticking to the diet and keeping off the weight. Worse yet, and unknown to them, if they fail to lose weight, as many do, their low-fat diets may be causing dangerous biochemical side effects that may increase the health risks low-fat diets are intended to reduce--a danger they will seldom hear about from Nathan Pritikin, Dr. Dean Ornish, and other fat phobes.

These days there is a new lie out there, just as dangerous as the old one, that a lot of people are falling for because of their frustration with the failure of low-fat diets.

Maybe you are one of them. Maybe in frustration you have turned to the super-high-fat Atkins diet or its cousins, the Zone and Sugar Busters diets. But these unproven fad diets are just as flawed as the low-fat advice that drove you to try them. In fact, the Atkins diet is potentially so dangerous that the surgeon general should probably put a warning on every book Dr. Robert Atkins sells. The diet's only salvation is that people can't tolerate it for very long--not long enough for the increase in the risk of heart disease or cancer that long-term use of such a diet could bring.

Low-fat lies. High-fat frauds. Both are perpetuated by misinformation propagated by government, doctors, the media, and various health organizations. Are they out to get you? Do they mean you harm? No, but most of the nutritional advice Americans get is distorted by one disastrous assumption made by well-intentioned experts: Most people are not smart enough to really understand everything they need to know to take control of their own nutrition and health. So the experts feed us half-truths like "avoid fat," because they think we can't understand the real, somewhat more complex message.

And all the time Americans keep getting fatter. The production of diet foods, books, and advice--almost all based on gross oversimplifications--has become an industry bigger than the gross domestic product of a small country. And so Americans continue to gain weight, eat badly, and suffer from the chronic diseases associated with obesity and poor nutrition.

The most egregious violations of truth can be found in the legions of diet books that peddle distorted information to an unsuspecting and vulnerable public. These modern-day snake-oil salesmen should be condemned to the first circle of dieters' inferno. Right next to them are the food manufacturers that exploit our cultural obsession with fat to convince folks that their highly unhealthy, calorie-dense, processed foods are good for you because they are low in fat. In the next circle go those who present shaky theory as fact.

There is nothing wrong with having hunches and opinions, but if that's what they are, they should be identified as such. In matters of health it is irresponsible to present unproven theory as fact, no matter how good it sounds on paper. That's how people get hurt. In dieters' purgatory go the well-intentioned medical professionals and health agencies who want very much to do the right thing but who, for a variety of reasons, have fallen victim to lies, myths, or misinformation.

So, is there no hope? Actually, there is hope. You can dramatically improve your prospects. You can lose weight; improve your blood pressure and blood lipids; lower your risk of stroke, heart disease, and cancer; and increase your chances of living a long, healthy life without ever eating another rice cake, going on a dangerous fad diet, eating cottage cheese with lettuce every day, or becoming a lifelong gym rat.

For the most part you can do it without "dieting" in the conventional American sense. This book will show you how. "Knowledge is power," a wise man once said, and we are going to give you the power to use food in a healthy, happy way.

By the time you're finished, you will know enough so that you will no longer be trapped by mindless rituals of fad diets that make you a slave to food--or some diet doctor's bizarre, unappetizing notion of what food is. You will learn how to love and respect food, eat healthier, enjoy food more than you ever have before, and take control of food and make it the core of your own way of healthy living. You will learn about one of the healthiest diets in the world--not a diet in the conventional sense but a way of life (which is what the word "diet" originally meant).

This diet has worked for thousands of years, producing some of the lowest rates of cancer, heart disease, stroke, and other chronic diseases of aging in the world. But only in recent years has a number of scientists unearthed the true reasons for the power unleashed by adopting this way of life. What these scientists have learned is very different from most of the dietary advice most Americans have been getting for many years.

Obesity is epidemic in America and around the world. Even in far-off places more often associated with privation and hunger, obesity is spreading along with the proliferation of modern technology and lifestyles. It is a life-threatening epidemic spreading the diseases of modern life--cancer, diabetes, kidney failure, hypertension, heart disease, arthritis, and others. By the time patients arrive in the emergency room blue and without a pulse, it is too late. The time to prevent these needless premature deaths is now. And the best way to do that is to stop smoking, eat right, exercise, and lose weight.

But you can't eat right or lose weight if you hate food. Food is a central pleasure in life. No dogmatic directive from any doctor or diet guru is going to change that by telling you everything will be okay if you just switch to the latest bizarre, unpalatable diet.

Let's face it: A life of fat-free muffins, fat-free salad dressing, fat-free chocolate chip "un"cookies, tofu, and raw broccoli is, well, not worth living. The proof: Nobody lives that way. Our diets don't last because we hate them. They are not a permanent part of a good life but rather our temporary penance for "too much of a good thing." Any prescription for attacking the epidemic of obesity has to respect our universal human propensity to celebrate and enjoy food. People will not adhere to diets that require a lifetime of privation.

There are certain cultures that are particularly renowned for their love affair with food and have very low rates of heart disease, cancer, stroke, and the other diseases of modern life. The Mediterranean cultures, in particular, celebrate food with intense passion--and they have some of the lowest rates of these diseases in the world. The truth is, the more we know food, love food, and respect food, and all the celebrations and rituals that go with food, the thinner and healthier we will be.

Dr. Dean Ornish and Dr. Robert Atkins can't help you, because no matter what they say, they hate food. Ornish practically bans half of all the possible foods you could eat (foods with fat), and Atkins bans the other half (foods with carbohydrates).

We truly love food. True love implies not just passion and affection but respect and reverence as well. Rekindling reverence for food isn't hard, and it isn't time consuming, but it does require awareness, thought, and some reflection. In this book we will present a good deal of scientific information about diet, weight loss, health, and nutrition. We also provide practical guidelines to help you achieve your health and weight-loss goals, including some quick, simple recipes for healthy and delicious eating. But we hope that we also impart a sense of reverence for the food that, in a very real and miraculous way, becomes you. Such reverence for food is vitally important to achieving health and weight loss.

Although we have passion and reverence for food, we do not have similar feelings about protein, carbohydrates, or fat. These are not foods. As food reformer Dun Gifford is fond of pointing out, "You don't say, ÔHoney, let's go out tonight and have some carbohydrates.' When you go to the store, you don't walk down the fat aisle or protein aisle."

But that's what the diet gurus want you to do. That's even what the National Cancer Institute and the National Cholesterol Education Program want you to do. And that's one reason why their advice fails.

When we talk about what we want to eat, we talk about real foods: grilled trout, pasta puttanesca, arugula salad, risotto with sun-dried tomatoes, tomatoes with mozzarella and olive oil, mussels in white wine sauce, spinach and bean soup, baked potatoes, grilled vegetables, a smooth merlot, a succulent peach. These are foods. They feed our bodies and souls. They are shared with family and friends. They mark the great moments in our lives--birthdays, graduations, and weddings. But they are also part of our daily routine. By passionately and reverently making the right foods part of our daily routine, we will be much healthier and happier. Any strategy for a lifetime of health and weight control must be based on the simple recognition that people by their nature are drawn to food.

Unfortunately our national strategy for health and weight control is not based on food but on nutrients. Actually, today, it is based on only one nutrient--fat. Aristotle said, "Small mistakes in the beginning can lead to enormous errors in the end." This has certainly proven to be the case in America. The narrow-minded focus on fat has been a failure that seems to have exacerbated the problem of obesity. The people who have profited are food manufacturers and certain diet-book authors who have exploited the well-intended but poorly conceived government guidelines. They have used the no-fat/low-fat label as a governmental imprimatur meant to be synonymous with health and weight loss.

This corruption of the government's seemingly simple message to consume less than 30 percent of your diet as fat has spawned decades of lies, myths, and misconceptions about what and how much people should eat. And now, with the obvious failure of the narrow focus on fat, there has been a recent pendulum swing among popular diet books. The new best-selling message is that the problem isn't fat at all but sugar and other carbohydrates. Although the success of this latest round of books seems to be in direct proportion to the failure of the low-fat strategy, this new message is equally flawed because, once again, it fails to focus on real food and relies instead on bizarre, unpalatable diets no one will stick to.

To make matters worse, the government can't even get its story straight. While government health agencies keep mouthing the low-fat mantra, the U.S. Department of Agriculture pushes meat consumption through its famous food pyramid created under the careful watch of the powerful cattle and beef lobby.

I don't know the personal habits of the unfortunate man who died in the emergency room that day. But I do know that he was obese and that his obesity put him at high risk for disease and death. If he was like most Americans, his doctor probably told him to lose weight and go on a low-fat diet. But despite the low-fat ice cream, yogurt, chips, cheese, salad dressing, pretzels, and cookies, he just got fatter and fatter.

As he did, his levels of good cholesterol fell, his triglyceride levels climbed, and his fasting insulin levels rose. Without exercise and adequate doses of antioxidants provided by fruits and vegetables, the process progressed unchecked. As it did the deposits inside his blood vessels got thicker and thicker until they choked off the blood supply to his heart. That's when he collapsed, his heart stopped beating, he turned purple, and he died. Even though his wife indulged herself in the self-deception that it was his preordained time, and even though I was a silent accomplice to her deception, this tragically premature death could have been prevented. Although it is too late for him, it is not too late for you and millions of other Americans. It is for you and for them that this book is written.

Americans are constantly confronted with lies, misconceptions, and myths about diet. Today, confusion reigns because juxtaposed to the low-fat fanatics is an equally fanatic faction urging dieters to eat as much fat--any fat--as they can get their hands on. No wonder Americans are confused. In the course of this book, we go beyond the lie of the low-fat diet to expose high-fat frauds, clear up carbohydrate conundrums, and present you with a time-tested way to achieve health by eating truly delicious and satisfying food. We will show you the following:

• Why low-fat diets so often fail when it comes to permanent weight loss.
• How the latest in medical research--including research by coauthor Dr. Mary Flynn--exposes the false promises and potential risks of low-fat diets.
• How low-fat diets can worsen the levels of dangerous blood fats you never hear about (triglycerides).
• How the diet recommended by the National Cholesterol Education Program can worsen your cholesterol and triglyceride levels if you fail to lose weight.
• How extremely low-fat diets might deprive you of valuable nutrients that may help prevent heart disease, stroke, and cancer.\ How pizza may help prevent prostate cancer.
• What nutritional benefits the foods that make up the Mediterranean diet provide.
• How to tell good fats from bad fats, and how the right kinds of fat are essential to good nutrition and health, and can help reduce levels of bad cholesterol (LDL) and dangerous triglycerides.
• How eating the right kind of fat may help lower your risk of breast cancer.
• Why a popular no-fat diet food may be one of the most unhealthy items in your fridge. (Hint: It comes in a bottle and you shake before pouring.)
• How olive oil can raise levels of good cholesterol without increasing bad cholesterol; can reduce dangerous triglyceride levels; and may help to lower the risk of cancer.
• How another fat--this one from the sea--can prevent the arterial blockages and blood clots that cause strokes and heart disease.
• How in one of the healthiest nations on earth the average person's diet is almost 40 percent fat--but the right kind of fat.
• What your doctor probably doesn't know about the true effects--and dangers--of low-fat diets, blood lipids, and the low-fat craze.
• What fats really are risky--including those the government, under the influence of food lobbies, are encouraging Americans to consume.
• Why the government's food pyramid, which you see displayed on the walls of doctors' offices, in schools, and even on cereal boxes, is hazardous to your health.
• How the most potentially deadly fat of all is being pushed into your diet--especially your children's--and how to get it out of your home and your life.
• Why the very high-fat fad diets may often be dangerous.
• How to get the exercise you need without becoming a gym rat. How you can embrace one of the healthiest diets in the world, eat better than ever before, start a love affair with food--and still lose weight.
• How you can fuse the wisdom of ancient cultures with modern science to embrace a diet and way of life that will help you reach your potential for health and longevity.

Much of what we say will be controversial because we criticize many of the mandarins of medicine and nutrition. It's not that they are all wrong, and they certainly are not liars in the literal sense, but many have become personally or institutionally invested in certain points of view that are proving with new research to be erroneous. Rather than admit error or entertain alternatives, they often go through intellectual contortions to defend those positions.

We propose a different approach. We will endeavor to provide information that addresses the nuances and subtleties of food, nutrition, fat, and obesity. At times learning this information requires some science and some effort. But we think that your time and effort will be well spent, and we are confident that people will invest the effort because they are hungry for the truth. But we also recognize that food is not reducible to chemical equations. Food is about nourishment on many levels, both physical and psychological. It is about pleasure, art, taste, and aesthetics. It is about family, friends, and love.

Though Mary Flynn has a Ph.D. in nutrition and I am a physician, we are food lovers in the fullest sense of the term. Not only has Flynn made a career out of studying food, she also grows it, cooks it, celebrates it, and thoroughly enjoys eating it. I love food so much my brother and I opened our own restaurant, Christopher Martins, in New Haven, Connecticut. Our objective is to provide food lovers with the scientific tools to better understand the foods they love and to prove to them that they don't have to surrender these foods to be healthy.

Low-Fat Lies not only exposes the diet myths and clears up the confusion, it also offers an alternative: a delicious, satisfying, and healthy way of eating and living. It shows you how to use the right fats well, adjust your diet in other pleasant and positive ways, and alter your thinking and lifestyle in ways that will reduce stress and increase fitness without arduous and impractical exercise regimens. You can be healthy, lose weight, and enjoy food--and life--again.

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