By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.
I should start a section on my website called “Old News.” I’d fill it with all of the “breaking” stories about things I was telling my patients more than two decades ago—like this piece from the New York Times: “New Study Favors Fat Over Carbs.”
The gist of the article is that people who eat a lot of carbohydrates have a higher risk of dying early than people who eat a lot of fat.
That’s right, fat can actually be good for you.
I’ll pause for a few seconds so you can let that sink in, since it’s the exact opposite of the message that mainstream doctors—not to mention food marketers—have been promoting for thirty-some years!
From my perspective, though, none of this is really news. I’ve been bullish on fats for a long time, and this study is one more proof point that they’re a critical part of a good diet.
Carbs vs. Fat: Then and Now
A lot of the momentum behind the changing attitude toward fats has to do with our evolving understanding of both cholesterol and inflammation.
In the old days, when it came to carbs vs. fat, the thinking was that fat raised cholesterol levels, which then raised the risk of cardiovascular disease, heart attack, and stroke. So, doctors steered patients toward low-fat diets. That generally meant more carbohydrates.
The problem was that this thinking was all backward.
Now, I’m not one to go around saying “I told you so”—but I started to see this years ago, when I began researching why people eating a Mediterranean Diet lived so much longer than people who eat a Western Diet, and when I started questioning why half the patients coming into my emergency room with heart attacks had normal cholesterol levels.
It’s not cholesterol that causes heart disease, it’s inflammation. So to prevent heart disease (as well as many other progressive diseases), it’s inflammation that you have to go after.
That brings us back to fats and carbs…
Healthy Fats Reduce Inflammation
This would probably be a good time for me to clarify that this isn’t a “Get Out of Jail Free” card for all fats. Some fats—like trans fats—are still incredibly dangerous because they stoke inflammation, and you should avoid them like the plague.
But others, like the omega-3 fats in fatty fish, nuts, and seeds, and especially the monounsaturated fat in olive oil and avocados, are quite healthy. Not only are they good sources of energy and vital nutrients for maintaining our cell membranes, but they can also help reduce and prevent inflammation.
One way they do this is by not causing inflammation in the first place (like trans fats do). But another is through the antioxidant polyphenols they contain, which help neutralize free radical activity and shut down inflammation before it starts. In the case of olive oil, these nutrients may even “down-regulate” the genes that predispose you toward having high levels of inflammation.
A lot of the evidence supporting this comes from a large Spanish study called PREDIMED, which took a long-term look at the Mediterranean-style diet.
Researchers divided 7,500 adults with risk factors for cardiovascular disease into three groups:
- One that ate a Mediterranean diet supplemented with four tablespoons of extra-virgin olive oil every day
- One that ate a Mediterranean diet supplemented with 30 grams of walnuts, hazelnuts, and almonds every day
- One that ate a low-fat diet recommended by the American Heart Association
After almost five years, the group that supplemented with olive oil had 30 percent less risk for a heart attack, stroke, or sudden death than the low-fat group. In fact, the difference was so significant that the study was stopped early because the risk for the low-fat group was so great.
Since then, even more research has followed about the benefits of olive oil, which has led me to believe that it’s really the “secret sauce” that makes the whole of the Mediterranean Diet work.
Why Are Carbs Bad, Anyway?
Now let’s look at the other side of the coin—carbs, and why they’ve gone from hero to villain.
We’ve known for quite a while that long-term high blood sugar levels cause inflammation—that’s one of the main reasons why having diabetes increases your risk for developing so many other health problems. But now we’re learning that chronically high insulin levels can also cause inflammation.
What do these two things have in common? Yep, carbohydrate foods.
Whenever you eat something that contains carbohydrates, your body breaks down the carbs into glucose. This causes a rise in your blood sugar, which triggers the pancreas to secrete insulin. Insulin goes to work clearing the glucose out of your blood, either by moving it into your cells, for energy, or storing it as fat. Then, as your glucose level drops, your insulin level drops along with it.
This is what I call the “insulin response.” It’s perfectly normal—but like many things about the body, it can be dangerous when it’s “on” too often or at too high of levels. It’s also why added sugar and processed foods are so damaging, and why eliminating them from your diet is one of the best things you can do to promote long-term health.
When you add this insight to the anti-inflammatory properties of healthy fats, it’s no surprise that the latest study results came out the way they did!
PAMM: The Best Diet for Balancing Healthy Fats and Carbs
So, how can you make sure you’re getting the right balance of healthy fats and carbs?
Hands down, the best way is to follow the Pan Asian Modified Mediterranean (PAMM) diet.
PAMM combines the eating habits of people in the Mediterranean and Pacific Rim regions of the world. The Mediterranean way of eating, in particular, includes generous amounts of olive oil, fresh seafood, poultry and other lean protein, and “good” carbs.
“Good” carbs in my book are low-glycemic fruits, nuts, vegetables, and legumes. Whole grains are okay, too, as long as they haven’t undergone too much processing. “Bad” carbs, on the other hand, are high-glycemic foods often loaded with sugar and artificial sweeteners—things like white bread, white flour, sodas, fruit and energy drinks, pastries, and virtually any kind of processed or packaged food.
High-glycemic carbs hit your bloodstream almost immediately after you eat them and spike both glucose and insulin levels. Worse, when your glucose level falls after eating those kinds of foods, you often crave more of them. This sets up a cycle of bingeing that makes you more prone not just to inflammation and disease, but also weight gain.
Here’s how to plan individual meals to get the ideal amount of both carbs and fats:
- 20 to 25 percent lean protein
- 40 to 45 percent low-glycemic carbohydrates
- 35 to 40 percent healthy fats
The best (and my favorite) way to increase the amount of fat in your diet by including more extra-virgin olive oil, adding it to salads, sauces, and steamed vegetables. Make sure you choose extra virgin, though, because it’s the least processed and includes the most nutrients.
Another great option is to add more nuts and seeds to your diet—almonds, walnuts, and hazelnuts, especially. (These were the nuts used in the PREDIMED study.) Nuts bring omega-3 fats to the table, which makes them a nice complement to the monounsaturated fat in olive oil. Plus, nuts are plant foods, which means they also have antioxidant properties.
I also recommend cooking with coconut oil (it holds up better when heated and is really good for the brain). Even fats from fish, poultry, and marbled meats are good—although if you eat meat, choose the free-range, organic products. That will help minimize your intake of toxins such as pesticides, herbicides, hormones, and antibiotics.
Last but not least, add some avocado to your meals. This superfood is loaded with healthy fat, not to mention fiber.
The Bottom Line
It’s time to “flip the script” on carbs vs. fats, because it’s not the fats that will get you—it’s the carbs! Start making the switch in your diet today, and you’ll enjoy a healthier tomorrow.
- Bakalar N. New study favors fat over carbs. New York Times. 8 Sep 2017.
- Carmargo A, et al. Gene expression changes in mononuclear cells in patients with metabolic syndrome after acute intake of phenol-rich virgin olive oil. BMC Genomics. 2010;11:253.
- Estruch R. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013 Apr 4;368(14):1279-90. Retracted and republished June 2018 at https://pubmed.ncbi.nlm.nih.gov/29897866/.
- Estruch R and Salas-Salvadó J. “Towards an even healthier Mediterranean diet”. Nutr Metab Cardiovasc Dis. 2013 Dec;23(12):1163-6.
- Guasch-Ferré M, et al. Olive oil intake and risk of cardiovascular disease and mortality in the PREDIMED Study. BMC Med. 2014 May 13;12:78.
- Ros E, et al. Mediterranean diet and cardiovascular health: Teachings of the PREDIMED study. Adv Nutr. 2014 May 14;5(3):330S-6S.
- Sinatra ST and Bowden J. The Great Cholesterol Myth (Fair Winds Press, 2012).
- Sinatra ST and Bowden J. The Great Cholesterol Myth Cookbook (Fair Winds Press, 2014).
- Sinatra ST and Healthy J. The Healing Kitchen (Bottom Line Books, 2010).
- Tresserra-Rimbau A, et al. Polyphenol intake and mortality risk: a re-analysis of the PREDIMED trial. BMC Med. 2014 May 13;12:77.
© Stephen Sinatra, MD. All rights reserved.